The tea bag, pencil and toffee penny

Having a lead nurse role involves all sorts of activities. The other day I found myself carrying a tea bag, pencil and toffee penny towards my office. I wondered what to make of that handful. No great idea for a blog came to me then. 

In the last few days I’ve learnt more about what can go wrong, and how we can sort things out on wards in hospitals just by listening to people.

My heart felt heavy about what I’d heard; now I have to write a report on what happened and what I’ve heard. 

Being a lead nurse is not always gazing at the bright shiny business development plans that I might have pencilled in.

As a lead nurse I have lots of people in my care. The team I’m in are great fun to work with, who work very hard. Part of each day is dedicated often implicitly to looking after ourselves, by having drinks and making sure we stop for a lunchtime break. One way to support them is to make the drinks; a simple job (if I remember who wants decaf black coffee, who likes their tea dark with a dash of milk, all in the right mugs) that’s one way to show support. Making sure I have a cuppa on occasion means dipping into the tea bag tin.

The lead nurse sets the tone for the team, and those they come into contact with. There are the days when our Palliative and end of life work will seem heavy. Even so there’s often an opportunity to celebrate some small positive piece of news and to share a gift from a thankful manager or service user. This Christmas, as happened to many others, we were given some sweets as a way to acknowledge our efforts. Amongst the treats were a selection that included toffee pennies, for which I have a little weakness.

Life as a lead nurse is certainly varied; always interesting and with things to learn. The tea bag, pencil and toffee penny have all served to remind me of that variety and that even from such a disparate handful there will be lessons to learn and even a theme for my 100th blog piece.

Doing things badly can be a good thing?

I have had an interesting week; work has been busy with the team doing good things for patients and each other. All very supportive and a joy that they can be trusted to get on with things.

I’ve had two task this week that needed delivering. One was a business case and the other an opportunity to deliver a 6 minute talk as part of a conference day on human rights in end of Life Care.

The business case would seem straightforward however getting the style right for the (NHS) organisation can be a challenge. Fortunately my boss has plenty of experience in our place of work and whilst I started it not very well I’ve submitted what’s been agreed is a much better version. Anxiety about how it might look and be received is lessened; taking the first step is the worst bit for me.

And that, I’ve just realised, is why blog writing regularly hasn’t been easy either.

So I was interested in reading the article by Olivia Remes that points to the science behind beating anxiety, and why doing something badly is a good idea.

This struck a chord with me; getting started is an act that I can successfully sabotage by myself. So reaching a finishing point (sending the business case for consultation, or posting a blog piece) becomes a cause for internal celebration.

The second task has been longer in development as I’d been invited to contribute to a quick fire afternoon session at the Sue Ryder hosted “Human Rights in End of Life Care” on 27th June. A 6 minute slot was mine, along with three others who are trainers like me. The slides were easy, the content came pretty easily too. It was the prospect of delivery that became a matter of anxiety. There was some rehearsal and having the slides safely loaded in advance were helpful strategies.

The night before was not good in terms of sleep and all that could have gone wrong in terms of travel added an extra layer of worry.

On the day the trip was fine and the venue was easy to find and had a nice auditorium. Even so there were nerves; I’m conscious that a poor presentation does no one any favours. As it happened my little contribution was kindly recorded on my iPad by another speaker. I can see I “immediately” a lot to begin with, and then had some trouble with the slides. I did get a hoped for laugh or two, as well as some serious points made. I could have done better (I believe) though I was told I’d done well.

Olivia is helpful in that she points out that doing something badly (or at least not very well) is a way to combat anxiety. So I’m reminded to be kind to myself; to trust the praise of others and to ignore the internal doubts that will lead to further anxiety.

And maybe there’ll be an increase in the frequency of my blogging?

The view from behind

A while ago I did one of those Facebook things, something about a motto for life. The answer I was given said essentially I should drop the past, forget it and move on, looking forward. Had I been 20ish, I might not have thought so much about it. 
Of course I shouldn't take that kind of thing literally; it has however given me something to consider that has to be written out loud now.

My concern when that was said was that I was engaged in looking back. First as I begin to consider planning in advance for retirement there's what has work been about and what options are there for the future. Then via a closed group on Facebook (last mention) of friends who went to Southfields School in SW London the idea of a reunion grew into a reality that happened on the 13th May, just gone. If that's not looking back I'm not sure what is. 
Alongside that the fabulous #twitterdisco held once a month has helped me rediscover music and its associated memories. Yes, flared trousers, longish hair and collars and lapels that needed wide load warnings; standing on platform shoes nervously wondering if a girl would like a dance, if only I could attract one away from the lure of the handbag mound mid-floor.

Then there has been my consideration of my performance at work driven partly through the benefit of excellent coaching over the last few months. This led to looking backwards at how I've performed in the past, digging out evidence of 360 degree feedback and repeating the exercise. So there's been lots of ‘rear view mirror’ work.
For me the benefit of ignoring the ‘forget the past, live for now and look forward’ would be to miss out rich sources of information that can help the future.

So when retirement comes I'll have what I've enjoyed doing recreationally to fall back on as well as new things to learn. Friendships that have endured since school will still exist as we plan road trips and travel to see those across the globe. The writing and drawing that sustained me in school are becoming more important now. My love of listening to music will remain strong and be a source of relaxation and inspiration. More immediate is the feedback I've been given in the last week. It shows a lot of reassuring positives as well as identifying things to work on. Even the worst times of early schooling, pre Southfields, have an importance in showing how good the now and future look.
For me then, without looking back I'd have a poorer future, and certainly a very dull present. I therefore recommend looking back on occasion, you may see something afresh just as useful as what's in front of you. 

Thinking about work or not? A connected era conundrum

I'm sitting under this tree in Potchefstroom (or Potch) South Africa.

I'm enjoying a holiday type break whilst my partner works at nearby North West University.
The guesthouse has WiFi; we can post to Facebook and Twitter and monitor emails. In many ways we can conduct life as usual – checking the bank balance, booking a restaurant and ensuring relatives are safe. Much of my social media (SoMe) usage is related to work particularly Twitter. To clarify I mean work in a broad sense encompassing me as a nurse, leader, manager, director, and contributor; these are just part of the whole me and inseparable from who I am. ‘Work me’ is just part of my life and not a completely separable facet.
Through SoMe I have contacts I have never, only once, or infrequently met in person; some I'll see each day at my work place. Nonetheless there's been sharing and an open hearted welcome; I trust I've reflected that to those who've approached me.  Sharing thoughts about aspects of work, favourite foods, what the cat is doing or ideas about music show much about us. Given  technology now available I've been able to consider aspects of work simply by monitoring my SoMe channels. As ever I find much to reflect on and herein lies my dilemma.
Being on holiday – away at least – means social and family related SoMe activity feels ok, a bit like sending postcards. Alongside this are the posts, pictures, diagrams and powerful 140 character pieces that engage the ‘work’ me. Have work and the social become too entwined?
While I've been away recent posts on kindness and curiosity by Sue Spencer @nursingbard and on listening by Tanmay Vora  via Teresa Chinn @agencynurse have positively piqued my interest. 
Perhaps being away is a good time to think about these things? If I'd turned my devices off completely I wonder if I'd reflected in quite the same way? 
Time spent alone is a potent opportunity. Whether using SoMe or just a notebook and pen where this post started, I cannot ignore the influences and opportunities that our connected selves bring. 
Even so  it is good too, to turn devices off completely; enjoy the sun, thunderstorms, breezes and wildlife in places away from home. Even better is meeting the people whose home this town is; in doing so using the kindness, curiosity and listening I've been reminded of makes all the difference to this experience. 

Heart Head Kindness and other influences

Tweeting away a couple of days ago I came across @WeNurses #nursestaketen  which encourages us to do something a little different, even if just for a short time. It made me seek my take ten moment, and as winter approaches I'll return to some creative activities in the darker evenings. The suggestions also included writing a blog from the heart; a prompt if ever I saw one as my heart has been a cause for concern in the last couple of weeks though thankfully the local rapid access cardiac team tell me I'm ok. My emotional heart has been touched by reminders to be kind to ourselves in David Gilbert's blog and being kind to others in Dr Dharmaraj Karthikesan's blog.

All very well beng chilled about kindness;  then I saw references to poor care home standards in the news; in particular what was evidence of an indefensible nursing attitude. The news piece flags up stereotypes of Care homes; whilst there are obviously concerns about the home mentioned it ignores the many excellent and simply good care home there are who can make a difference. 

It was the quoted, secretly filmed words of the nurse that struck home to my nursing heart and head. Immediate  to be "struck off" thoughts were the initial reaction; the attitude that allows uncritical use of medication for care givers convenience is wrong. But head says how did that person get to that place? Are they so isolated, denied training, supervision and support that they have lost that critical internal voice that says - "stop, think a moment" before you speak and act? I understand from the report the nurse has been suspended; I presume some disciplinary action will follow. 

Both heart and head say who was being kind to this nurse and their colleagues? Who was listening if they raised concerns? I suspect no one was. How can we reach out to our colleagues who find themselves in such conditions that they cannot "take ten"; maybe the act of kindness in seeking other professionals working in isolation and offering to share a coffee, tea and cake (nurses know the value of cake) and allowing them to take a break will avoid this kind of headline being repeated.

I realise I'm fortunate in being able to reflect on this from afar; I hope nursing and others will take heed of the calls for kindness not just to others but to ourselves; if we cannot do that our responses to those in distress, in need of kindness, will find no use of head and no gift of heart in those who are expected to care for them. 

Ten years on

Reflections on a learning experience 

I know I tend to hoard what I'd call resources to do with work, be it books, papers, certificates and bits of card. "It'll all be useful one day" is my internal mantra. I've been cutting down on books by allowing them to be more widely available at work; that in itself has been liberating as in recent times I've gone back to more 'hands on' hard copy reading.

Whilst preparing this week for a session on resilience I went to my cupboard and found amongst other things the workbook from the excellent St Christopher's multi professional week I attended in May 2006. I recall thinking the whole experience had been exciting and stimulating. Do they still do it? Yes, see http://www.stchristophers.org.uk/education/diary and one is coming up soon.

The attendees came from across the world and we were truly multi professional, adding further texture to the week.

The opportunity to learn from David Oliviere, Malcolm Payne, Nigel Sykes, Barbara Monroe, Nigel Hartley, Avril Jackson, amongst other talented colleagues was so invigorating.

I still remember much of what was said and done; from giving instructions on making tea, digital pebbles, spirituality, teamwork and with role play thrown in the international participants were challenged to think, act and learn.

So what's brought this all about? I'm still teaching on occasion so a dive into the resources led to me think about the workbook. I was sure there were pearls of wisdom to find and was right (on managing stress and teamwork). So ten years later I can hold the pages and how that itself has changed. Hospice UK can put entire conference abstracts, posters and videos on line - an example of the revolution in the way we communicate and produce materials. I wonder what those who will attend my session will recall of the session next week, and in 10 years time. How will they access our presentation, will a virtual channel have the same physical and intellectual resonance as my purple covered booklet? 

Maybe the physical presence of thoughts, ideas and reflections last longer in the memory? I need an educationalist to confirm that; may be though that the way that week was organised and led has left this influential mark. It's a  been a powerful experience revisiting these materials; reflection and development distilling an enervating week in one afternoon.

70 degrees of separation

Many will be familiar with the idea that there only 6 degrees of separation between ourselves and others; there are only a few connections between us all whether famous or not. I'm talking about two different places I've visited where the temperature has been separated by 70 degrees Celsius.

It was early 1999 when I joined palliative care colleagues in a visit to Kemerovo in Siberia where one day the temperature was a challenging -35 degrees; currently I'm in Potchefstroom South Africa where I've been able to enjoy +35 degrees. The link is once again sharing my experiences in palliative and end of life care, recognizing I've worked in this area of practice for 25 years. 
So why here in Potch? My partner Megan has been invited here to be an Extraordinary Professor at North-West University Potchefstroom campus, in the School of Education. As her term of office begins we came here at the invitation of the Uni team. I was just going to be a hanger-on for the two weeks, reveling in the first two week break from work for some time. The Uni team had other ideas and recognizing I had my own area of expertise, in end of life care put me me in touch with the Education psychology and nursing departments of NWU. The upshot has been an opportunity to visit the local hospital and to deliver a presentation to two groups at NWU about ethics in end of life care as well as having difficult conversations. In between we have been able to share meals and time traveling in the area, visiting schools and a game park. All very interesting, though the game park details will have to wait another day. 
The two visits have taken place in places undergoing significant change, in political, cultural and social senses. In addition the organisation of resources for health and education has changed. For brevities sake I'll focus on our current visit, that's starting about 150km SW of Johannesburg.

We have experienced great generosity - time, food and drink, and travel. I hadn't realised just how big a country South Africa is. Our travels have included 3-4 hour drives and we have covered only a small part of one province. We're flying to Cape Town later; the time it takes would get us to the Mediterranean from southern UK. For many here though travel is a luxury with poor public transport; so travel from rural areas to the nearest healthcare provision is only undertaken when you're very sick. The result means many arrive at the state funded hospitals in towns like Potch (where there is no hospice) with advanced diseases and in need of end of life care. Being HIV+ is very common and so is tuberculosis, often going together. Getting people to understand the importance of maintaining the anti-viral therapies and the long  term TB treatments is an important priority. The message of changing behaviour about sex and HIV transmission is loud and strong yet some feel that the very strength of the message over a long  time is counterproductive.

The opportunities to meet students and colleagues at the university and hospital have been invaluable to help understand the joys and difficulties of life here. That people are trying to improve services is encouraging yet difficult given the differences of resource provision between provinces. This was highlighted in the difference in the number of educational psychologists in the Western Cape area approx 130, and the 4 in the North Western Cape where we are. Seeing the expertise and enterprise of North-West University in making links with Potchefstroom Hospital, to the benefit of patients and psychology students has been great to see. End of life care is a big part of what the hospital does so sharing my expertise and stories has been a pleasure and made this leave from work so much more rewarding. It has also helped me to appreciate the fund of examples and experiences I've had, as well as realise there is lots more for me to learn. I'm immensely grateful for the opportunities my career has thrown up; I never expected these travels. I am very pleased though that there is now far less than 70 degrees of separation between my understanding of what's happening in South Africa and my working life at home.

Making a difference - being creative with the environment and your care

Today was scheduled to be a day off; possibly a lie-in then potter about. The news the night before of a older relative having had a stroke a couple of days before led to a busman's holiday drive across southern England to see them. Before leaving I was able to read the leaflet about the relevant stroke unit, and find details about the car parking charges; a plus mark of the internet.
So we set off  and in good time arrived at the hospital though 20 min early. We were ushered to the Day Room - visiting time had not started. Of course this set me thinking, the @wenurses tweetchat had discussed visiting times the previous evening; follow the link to read more, including the pre-chat information from @wlasinclair .

We complied with the request to wait and so entered a room that looked like this in one corner -

the opposite corner housed a large TV playing to no-one.

Not a great first impression and certainly not  a safe patient friendly space; nor welcoming for visitors. The label inevitably said 'broken'; I wondered how long it had been there.

There was no easily readable information for visitors, i.e. a map to show the location of the toilets, tell us where the cafe was and so on.
This notice board was inaccessible.

Inside the door was this notice - 

all nicely ironic and the poor grammar seems to indicate we're all Sisters now.

Once we were at the appointed kick-off time we ventured to the Reception desk, and it took a few minutes for us to be asked 'are you OK?' This despite a plethora of staff around the central station; none had easily readable badges. I just had to go on who was wearing fob watches or stethoscopes; a staff nurse did help and showed us where our relative was.
Of course we were limited to two visitors at a time; within minutes though this became problematic when their friends arrived; this is after all a very sociable person who enjoys a good party even though they're 90 plus! I suppose I wouldn't mind the limited visiting and two relatives at a time if the rationale was clearly explained in the literature, by diagrams or by someone tasked with ensuring visitors knew the 'house rules'.
Getting to the bedside we were able to begin to chatting and having taken my drawing pad, we made progress with communication. Of course were relieved to see our person dressed and sitting up; there were a selection of leaflets for them to read - left out of reach on the bed. A nurse on duty for the afternoon passed the #hellomynameis... (thanks to @GrangerKate for this idea) test; as did the speech and language therapist.
Here we were shown the three side of A4 that had been left earlier asking questions about our relative; the SALT team wanted to know more about them. 
Oh how I wished I could have shown them a one page profile; we had fun however altogether completing the form, though were left wondering how widely it would be shared. I hope it will be; there has been a lot of life lived by our relative, around the world. The developing #facetoaname idea would help here too.
During the visiting hiatus caused by the physios - (why restrict visiting?) I had a look at a notice board that showed safety data graphs from a year ago; a 'You said ... We did' poster that was blank and some quotes with codes numbers that were meant to be patient and visitor feedback. Opposite at a drunken angle as its Blu Tac was wearing out was a certificate from 2009 given to the ward team from the hospital management team.
l must acknowledge my bias and perhaps more detailed knowledge than the usual visitor; none-the-less what appeared to be a well staffed ward was not looking at the details. At least not always the right ones; whilst we went back to the Day Room during the physio session, a tidy soul put away our visitors chairs: we had to retrieve them. 
I would ask, and I think I will have to pass on this feedback to the ward, that someone looks again at how you present yourselves as a team, your environment, and demonstrating newer ways of working. 
For a lively mind now hopefully only temporarily caged by impaired speech a one page profile would make a difference; give them a relief from the frustrations of their situation as others can share their life. In looking at the ward environment I hope the ward team can demonstrate how their commitment, courage, care, competence, compassion and communication makes a difference to those they are looking after.

Reflections and Echoes

I have been considering writing again for a while; I suppose this is a kind of 'slow-blog' or 'Slog'.  As ever though, strands of life have combined to make sitting down to this task inevitable. I have a notebook that since given it last Christmas I have used to jot down thoughts and ideas. I can see that in mid-MArch 2013 I was thinking about creativity in nursing.

In response to comments by Prof Don Berwick reported on the BBC on 12/3/13 regarding Mid Staffs I was asking do we stifle creativity in healthcare and particularly in Nursing?
Whilst pondering that on 14/3/13 Roy Lilley said this in the first of his blog pieces that day,

"Nursing has been at the forefront of innovation and nurses use some of the most sophisticated kit the NHS has to offer.... Nurses are the mothers and daughters of invention."
So I am not missing a theme here; once we consider nursing history we find the examples of Florence Nightingale, Mary Seacole and many others who have developed kit and service models since then that have led to improvements in care. In my specialist field of palliative care Dame Cicely Saunders qualified as a nurse, as well as in medicine and social work. Her influence remains profound though I wonder if we have lost some of the energy that went with such creative spirits. Is working under the pressures many nurses describe sapping their energy and ability to see problems as they occur?

The other requisite for creativity is risk taking; when dealing with the lives of others we obviously have to minimise the risks, 'do no harm'. Yet whilst discussing service improvements via a Twitter nurse chat last week, care of WeNurses it was evident there were plenty of ideas yet little evidence that things were easy to change. So if creativity is there, what seems to holding things back? Is the appetite for change difficult to identify amongst the bad taste in nursing's mouth delivered by the hands of the detractors of the NHS? 

In all of this I had decided I ought to try something different in terms of learning. I took advantage of an offer from Martin Shovel to join a cartooning for communicators workshop in Brighton. Martin and Martha his partner led four of us through a journey of discovery through drawing and use of language to communicate in simple direct terms. I hadn't drawn for many years; art was something I have always loved yet lacked the confidence to pursue. The workshop enabled me to connect with the idea of simplicity in drawing; finding the key message and developing from there. I found it quite an emotional day, as echoes of past 'you're useless' school days passed by.

On reflection I now know I can use a simple drawing to convey a message; my style is under development and I try to practice in spare moments. Another side to creativity, yet I am sure it has value in terms of increasing my range of communication styles, as well as my confidence in my messages. It has also reshaped my thinking, making me consider the core messages I want to convey.
All this has come about through social media 'SoMe'; using Twitter I have found a new arena for creativity. The aforementioned chats, blogs and vlogs, all make increased links with greater immediacy. This was brought home to me when a nurse contact made via Twitter looked like they could do with some support. I was happy to offer advice and to listen; and now nearly a year has gone by, the echoes of that time are coming around again. On reflection I have to acknowledge that I know there were some days I thought I could have done differently and been a better support. Even so it appears what I did sufficed for that person, at that time.

Reflections and echoes swirl around; often catching us unawares. For me this 'slow-blog' or 'Slog', has enabled to me look at how I have learnt to innovate with modest personal reputational risk taking, using the opportunities social media have offered to be creative.In my work the benefits are that I can see how important it is to allow all the team to reflect and sense the echoes of learning and opportunities that will allow us to grow and develop; from there we can take innovation forward, personally and professionally.