D56 #100WorkingDays Family time

As many in healthcare will know families are never alike and rarely predictable especially when meeting them for the first time. The nature of family varies across cultures and the often seen model in the west of a two parent and child/children is not as common as it once was. Nor was it a global tradition.

As we began to think about starting family life there were considerations such as our health and resources to take into account. Becoming parents was something we desired. So began the journey to parenthood. We had a home and were fortunate to have the resources and capacity to give it a go.

That a longed for pregnancy didn’t materialise immediately was not a cause for anxiety. As time went on we needed to explore our concerns and ask for help to find out what was, or was not happening. More time passed and facing possible hard choices about investigations were required. It was a time of sensitive feelings that our wider family watched progress. In that, as currently the support of them and close friends was/ is much appreciated.

D37 #100WorkingDays Nursing as a profession

 So now I’m immersed in Nursing, and working towards becoming registered. There are lots of things to learn and practical skills to acquire. I found it useful to know something of the current news, and important sports results each morning. These gave me an opening to conversations with those in my care. Sharing a little of my self too could be helpful. And being visibly confident even when inside I was wasn’t was a trick to acquire.

Nursing quickly became a comfortable place to be, even during my training. Even now the precise reason for that is unclear. If following this blog series you’ll know I didn’t plan on Nursing as a career from a young age. I’ve known some nurses for which that early drive and passion never left them. 

Here I was almost accidentally. Since then I’ve enjoyed (mostly) a fascinating time, with travel and meeting all sorts of folk along the way.I still enjoy thinking of the nursing family and how that has developed. Specialisms, advancing practice, and changes in regulation have all come along. Now we can communicate through Twitter and share via chats through @WeNurses for example. And then there’s the friendships, connections that have endured.

Too painful to laugh

It’s International Nurses Day 2020 and a motivation to digitally pen this piece. I find this COVID-19 time tough; it is tiring and has been something of an emotional experience. 

And that’s just the last week.

Whilst our team have worked hard with courage and resourcefulness, we’ve seen the impact on those dying and witnessed over the phone or via digital media the separation and sorrow on the part of loved ones.

I’ve wondered if I should scream at the sky, let the tears flow (wondering if they’d ever stop), simply wallow on the sofa (plus or minus alcohol) or find the words for a blog.

Apart from the poem below, tweeted about a week ago this will have to do.

Supporting each other has been critical; one of us is at home and able to work though stuck inside except the daily walk. I’m busy having daily interactions with others though each of those conversations has overtones of concern and uncertainty.

Then, personal loss struck through the death of a schooldays contemporary due to COVID. His family are bereft; and so many of us would like to be on hand to support and celebrate the life of Barry. 

And despite the jollity of VE Day and today being International Nurses Day it’s difficult to laugh and feel joyful.

And yet I am sustained today by the kindness of my team who staged an intervention today over their concern for me. Through social media there have been lots of messages broad and personal that have helped. Family members have been fabulous too. 

It’s good to celebrate the positives of nursing, where I’ve been home since 1978. 

I’m glad we can do this; and yet….

It is a painful time, and despite the rhetoric I’m not a hero. I’m simply doing a job I love. I suspect many of us will be reflecting on what it means to nurse, and to be bereaved at this time. 

I guess I could be accused of pouring cold water on this special day; it’s not what I intend. 2020 will remain a topic of discussion (for some); for others it may be just good to survive.

Thank you if you’ve got to here; I hope I’ve not been too negative. 

And I do look forward to laughing again soon.

Today, Was not just another day; A time when COVID anger and angst Brought so close pain and disbelief. And more pain, for those we’ve lost And those we’ve left alone. Tears don’t seem enough, For now they’ll have to do, Until we hold again. #COVID19. Written 5.5.20.

Feelings of an ad hoc carer and frustrated professional

Just now I'm aware my mum is undergoing a endoscopy and I'm at home after spending a few days with her. In my earlier post about the NHS in November 2017 I laid out my views of what we were experiencing.  
Now it's time for an update and perhaps less positive reading.
After discharge from a 3 week stay in a rehabilitation bed the Friday before Christmas mum was experiencing trouble with reflux from what we eventually discovered (in a post Christmas telephone call with a GP) was a sliding hiatus hernia. This was known about in hospital yet no mention of it was ever made.
Mum has gradually regained her mobility and with support from the family and neighbours was managing just about at home. 
The big problem has been to get anyone to take her painful regurgitation and reflux seriously, along with her weight loss. For a serious cook like mum, who enjoyed a varied diet and particularly going out to eat the reduction in appetite and feelings of hunger have been a depressing downward spiral with no sign of improvement. 
The oral medicines prescribed to improve the situation were having no chance to work.
We've tried all sorts of things; bed head end elevated, mum using the internet to make sure she was using NHS advice for her diet and the variety of medication that was promised to make a difference.
Only this week have we got a GP to call round; the vomiting of almost every fluid and food mum has tried to take was largely ignored because its all 'infection'. Mum has lost half a stone in recent weeks and we believed we were approaching a crisis point that could surely have been anticipated with better community support. The community nurses who visited shortly after discharge told mum they'd keep an eye on her; though hearing impaired mum got the (correct) impression she'd not see them again. 
The senior GP who mum got through to thought she was calling her rehab place; we'd made it clear to the surgery that mum was home...
So between family members and her marvelous neighbours we've tried to find attractive foods and fluids; my catering experience helped here though only marginally.
This week, having been forced to take a frail and low energy mum to the local hospital for a blood test we reached crisis point. The 111 doctor called to say her bloods deranged and needs to go to hospital. So mum is now back in hospital and having her endoscopy. We'd considered getting a private consultation to see if we could get someone to take notice. 
For us, and my experience in the last week this seems unnecessary; felt like trying to keep mum out of hospital (understandable in some way given recent news) though at the expense of ambulance crews and long (overnight) waits in A & E. And we had more than one nurse advocate trying to get help for her. 
Where is the multi professional review and support for older people in the community?
Were mum without family and her support network I dread to think what would have happened. 
It's frustrating and we have some inside knowledge that you would expect to help get us further; it's frightening too.
Right now I have to trust my hospital colleagues and keep faith in the system overall; for Mum and as so many other carers have to do day after day.
As I finishing writing this mum's GP surgery have called me - they're trying to get hold of mum and wondered where she was - her blood results need rechecking... they are surprised (and relieved) she's already in hospital... where's the communication? 

Life.Death.Whatever ... next?

I've wanted to write something about the Life.Death.Whatever. event for over a week now, since making my visit to the National Trust's Sutton House in Hackney where the October long event is being held. There was much to take in so I needed to start before too long goes by.

As I write this remarkable experience is in its last week; the creators and curators Louise Winter  and  Anna Lyons deserve praise and awards for the rich content that has gone into the exhibition. 
Use the website to see the ideas and contents of the exhibition; I'd like to reflect a little on my visit. I was able to attend the Good Funeral weekender where a variety of funeral providers and celebrants interacted with visitors set amongst the installations. I've included some pictures below.
I was able to reflect on the death of my father and who he was to me. This was really helpful as I come to understand who I am, and be at peace with what our relationship had as well as what was missed. Dad died 12 years ago and I'm conscious too that I am possibly - as has been mentioned recently - turning into my father. Given his health deteriorated with dementia progressing to dying aged 77 I'd prefer a different ending. Whatever ending that will be, Life Death Whatever helped me rethink how ones life can be celebrated as it ends and in terms of what happens when death happens. I realised we did a good thing in celebrating dad and his life; more recent family funerals have also been uplifting in terms of celebration rather than extreme somber-ness.
It's time to consider how I'd like to be remembered at the time of farewell; this requires thought and discussion with my loved ones. It will need financial planning and careful consideration; I have lots of music I'd like to include as well as some words to say, that is to have said. The great thing I learned on my visit was that there are many creative people who are willing to help with the farewell planning of an individualised event. 
From the coffin ball pit, the paintings, sculptures, digital recordings, talks and creative cocktails plus NT type tea coffee and cakes LifeDeathWhatever was thought provoking, challenging of traditional 
funeral rites, and a beautiful way to consider what we might like to do when death comes. After life there's death, and to save an awkward Whatever for those who are left behind, I suggest you get planning.
Thanks and congratulations go to all involved with LifeDeathWhatever; it will have affected people in many ways and I'm just describing one of the areas that it's had impact on me. I hope the team will be able to take LifeDeathWhatever forward; the openness of the conversations should however be all the responsibility of all of us. 

Louise Winter

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.

A man of letters, all about E's and the 7th C

Enthusiasm - our younger cat has a way of launching herself at the world each day as the dawn chorus starts without hesitation and a tangible sense of purpose. How many days do we start like that?
Engagement - on the 12th May #IND2014 I was able to join my Twitter friend Pam Nelmes and the lovely team at Plymouth University School of Nursing and Midwifery to witness the finals of the 4th annual Nursing and Midwifery Challenge. This was a great day seeing how nurses and midwives of the future can engage through their learning and experiences on placements to create innovations. It was motivating to see; a positive sign for the future, and I strongly advise you to to keep a look out for the winning idea. 
Enterprising - All this is of course very enterprising; I know our hospice team enjoy the challenge of finding person-centred ways to deliver care to those in our hospice. The team thrive on discovering ways to raise and save money to support our work. Their enterprising nature is taking our service forward.
Employment - this is more personal; as I write the organisational  announcement is expected regarding the outcome of the reorganisation process going on at my level that began in late March 2014. I and my peers have had our current posts 'deleted' (technological language providing cover for harsher words - a whole other subject?) and an interview process for the new posts has taken place.
I have been unsuccessful. 
I know now, for the first time in my experience,  that redundancy is a realistic proposition. 
I readily acknowledge that I am not unique in this; I am not complaining, merely letting you know. I would like to make plain my thanks to all those who have offered words of support and commiseration. My peers in the same situation as me and the hospice leaders I met at the end of last week have been very kind; my family have stepped up too with their messages.
The Challenge is to keep going; there's no immediate threat to my income as there is plenty to get done. I suggest though that for me Challenge is the 7th C (see the 6Cs here). It is almost unnecessary to say its a time of opportunity too.
As so often happens though timing is all. I have joined the discussion on compassion and resilience stimulated through the blog by Maxine Craig. Then along came a blog by Laura Green, about the nature of resilience, and in particular its dynamic state, within the setting of end of life and palliative care. All in all very helpful and enabling me to keep my head. 
So now I face new opportunities; I'll need my enthusiasm; I must find ways of sustaining my engagement and use enterprise to identify what next in terms of employment.  I think that's enough challenges for this Monday morning.

The funeral of a friend who was a nurse

Working in palliative care, the end of life is a daily event, but today it touched me personally. I, and many others, attended a gathering and well attended reunion at the local Crematorium. We were there to remember our friend, boss, peer and co-worker. Of course there many family there too. Her husband had also worked with us. Jenni took the development of Willen Hospice, and its clinical services to a point where a 20 bed inpatient unit was complimented by all the community services with back up from incredible fund raising and retail support.
I know too that Jenni would play down her part, understandably pointing to the team effort involved.

Jenni had trained as a nurse, and went on later to manage a variety of services after leaving the hospice. Whilst care of the patients was at the forefront of her mind Jenni also had the care and development of her staff alongside this too. I think this is why so many turned up today, from all sections of the hospice, current staff and those who have moved on or been wise enough to retire. Many of the people there today came from Willen. I was lucky enough to have two bites of the cherry working there, both times Jenni took me on under her wing. In many ways these two appointments were critical to me in the development of my career, particularly in palliative and end of life care, and in taking me forward as a service manager. 

Whatever the role, Jenni had touched all these lives as well as all the lives of all those whom the Hospice has cared for. As such then the turnout today was a reflection of the esteem and affection we had for her. That a malignant disease should be the cause of her death at so young an age is another part of the story. 

Alongside that is her reputation for enjoying a night out. In the company of friends and co-workers the loudest laugh was hers. A love of gin, as well as other drinks if required, fueled many an evening. Of course Jenni loved her job and her family; she will be much missed.
Jenni leaves a significant legacy; people who continue to clean, cook and care for those who are frail and nearing the ends of their lives; those who have been encouraged to take chances, develop as people and as servants of those who need the care.
At a time when healthcare and nursing particularly are being frowned upon, and the NHS seems to be falling apart, I am proud to say Jenni was someone who taught us all how to do it right; how to enjoy work; and how to make a difference.  I am very happy to have known Jenni, though very sad now that she has left our presence. She was a light in our lives, and I look forward to carrying her legacy into the future.

My Family, the CQC and other animals

With apologies to Gerald Durrell for the title; it's been a long week and a blog feels well overdue.
First the Care Quality Commission (CQC); they regulate most of health and social care in England so I approached them in a professional capacity regarding a question about a possible new building. The Inspector didn't have any advice to give me - it's out of their experience so I'm told I should speak to the Registration team - there's no-one to talk to directly when I tried via the call centre; when the operator finally got through themselves to the Registration department they came back to tell me I should speak to my Inspector - a Kafka-esque situation - I'm not sure what the operator told the Regsitration department. We'll have to write to them and see how far we get - though I'm sure other people must have built new in recent times?

The family - we're all in one piece despite the car crash this afternoon when no. 2 son wrote off my old Honda; fortunately no-one seriously hurt though we now face all the disruption and expense that is involved. The emergency teams were brilliant; the police team very calm and helpful. We now wait to see how well the Insurance company does.

The theme I have in mind is that of organisations' responsibilities and responses; we do emergency care so well here and the response of the teams on the ground were efficient and willing to go a bit further than they could have done.
The CQC is a behemoth with little presonality and little abilitty to help on the ground; it leaves me wondering abut how much help they could be to a lay person looking to them for help. In addition the CQC would appear to have Inspectors who do not have a sufficient range of expertise - so how can we trust the processes of inspection and consideration of services? Rigour and expertise are required for professionals to value the CQC judgement; it would help us and their political masters to have confidence in them.