Sunday, 27 September 2009

The Case for Crown Courts, Squirrels and Being a Nurse

Apart from having to pay £8.50 for a glass of an ordinary red wine at a hotel this week, one of the many strange and unusual things to have happened to me was to find myself on the other side of the Bench in Court, giving evidence at a Crown Court Case.

It was a day of much waiting around, where jovial conversations eventually dry up and you can’t remember how you managed to get into the position in the first place. The conduct of the case was interesting. When I was finally called it was to be asked a series of questions that focused on a very narrow aspect of my relationship and involvement with the individual in the dock. Clearly the barrister had a strategy he was following, and the information I gave, limited and sharply focused as it was, was aimed at him realizing this. I felt as if I was simply a means to an end – and this was, for me, an uncomfortable feeling.

I believe that as nurses we are trained and educated to take on board a wide range of information as we work with others in helping them to help themselves. We listen to what is said, and hopefully also consider what is not said. We watch and observe, we comfort and we suggest. We give individuals room to express their feelings and hopes, and find ways to contain anxieties. We provide a shoulder to lean upon – both physically and metaphorically, and in a general sense we are at our best when we are able to be there for our patients. We do all of this because we learn to become good at ‘doing’ nursing as well as ‘being’ a nurse.

I emphasized these thoughts in my welcome address to all our new students when I greeted them last week. Like many Schools in the University, we had a bumper number of students starting their studies with us. Whilst this large number of student’s poses many challenges for us as educators, it was also reassuring to see so many people, of different ages and backgrounds who wanted to become a nurse. Of course, I know that some will quickly change their mind, and do so for a variety of reasons, some of which we will understand easier than others, but I thought such a large number was a good endorsement of how far nurses have come as a profession.

This brings me to a further strange or rather sad thing to have happened to me this week. I and many other colleagues from practice and education, met with the CNO for England to get an up-date report on a range of ongoing issues currently affecting the profession. Meeting with Chris Beasley was not strange, indeed she was in a feisty and confident mood, and very inspirational, no it was a report from a public focus group undertaken as part of the Prime Ministers Consultation that disturbed me.

The outcomes of this data collection and analysis revealed a much distorted view of nurses being shared across a wide and diverse representative group of the general public. People were reported to have been very surprised that nurses were educated to degree level, that they could be autonomous practitioners, prescribe medication and didn’t need to wait for a doctor to tell them what to do before intervening! I found it strange that such stereotypical views still exist yet the opportunity of becoming a nurse was still demonstrably a very attractive choice, if the numbers starting their education and training with us was anything to go by.

Finally, two story’s about hands, one about biting the hand that feeds, and the other about the hand that cares. The first story is about being attacked (twice) by a very angry squirrel. I have many mature trees and bushes surrounding my house. There is a large colony of grey squirrels that live in these trees, and indeed, for much of the time I enjoy watching them scamper and climb around. They get porridge oats and monkey nuts every morning. So I was very surprised to be attacked by one of these little fellows – and it was a determined attack too. He really was tenacious in his attack (of me and my car). I was eventually able to drive him away and can only suppose the poor little thing was ill as they normally steer clear of any contact with humans. So of course having driven him away I immediately felt guilty that I was unable to do more to help.

The second story was the sight of a nurse comforting one of the children involved in the dreadful accident in Suffolk. As the TV commentator’s spoke of the accident an off duty nurse could be seen gently stroking the child’s hand and arm. Perhaps sometimes we forget the power of touch in our work.

Sunday, 20 September 2009

Station Waiting rooms, the PM’s Commission on Nursing and a Chance of Stardom lost.

The past week was a whirlwind of train journeys; frantic emails from often distraught others, frenetic walks back and forth across campus and being witness to surreal and metaphysical musings by a former Secretary of State for Health. Monday started early with meetings with colleagues looking at the changes a foot in Midwifery, Phd’s and Strategic Planning. At 10am I got to meet one of the groups of students who have just completed their studies with us. This was an interesting meeting, which allowed me to hear from the students how they had experienced being with us. Whilst there was much spoken of what we might have done better, it was also great to hear of those areas where the student experience had been good. Then it was on to a meeting to hear some suggestions for a project that looked at different ways of working with those people who were homeless and living on the streets of Manchester and Salford. It was a humbling meeting to be confronted with tales of continued stigma and tales of such unwillingness to accept there was even an issue in a modern city like Manchester. The discussion provided an uncomfortable juxtaposition of certainty and uncertainty over my emotional location with the media city zeitgeist I am also a part of.

An extraordinary meeting of Senate followed, with challenging decisions being taken over future assessment processes for students. After a brief interlude that was the University Research Strategy Implementation meeting, it was off to meet participants in this years Education in a Challenging Environment. The setting was perfect, the Salford Museum and Art Gallery, and the company excellent. By all accounts the conference turned out to be a great success. Well done to all those involved.

Tuesday and Wednesday were spent at the NHS Institute for Innovation and Improvement with a group of other invited senior nurses from education and practice, many of whom were old friends and/or friends who were becoming old. This is not meant to be a flippant remark, but one that raises where such experience will be found once this group move on and retire. I was left wondering whether I was doing enough to mentor others so that they too might have the opportunity and motivation to influence and lead the future development of nursing. This was an underlying theme to the meeting as the two days were spent, amongst other things, looking at the progress to date of the work of the Prime Ministers Commission on Nursing – a feedback report is due out in the next few weeks, so I am unable to say too much here, BUT I was struck by the certain thought that we as individual nurses, as communities of practitioners needed to become a great deal more assertive. If we fail to do this, we will fail nurses everywhere. There are enormous opportunities to get our collective voice heard. If we don’t seize these opportunities then we our voice will be drowned out in the cacophony of sound that results from ill-informed perceptions, selfish and territorial professional attacks aimed at protecting and defending power and autonomy across the health and social care professions. Is it only me that thinks the observations and calls from the medical profession are becoming ever more strident and worried about what it is the nurse of the future might be engaged in, or more particularly how such activities might erode the medical hegemony. I heard a medical colleague lead a debate at a dinner party the other week where one doctor railed against the very concept of Nurse Led Services, and longed for the days where he knew what his nurses did on his Ward. Perhaps we gave ground too easily in our response to the implications of the European Working Time directive.

Part of the time during these two days was also given over to exploring the value of Experience Based Design (of health care services). This was an area very close to my own research interests, and of course is a major part of the Whole School Project approach. What was also interesting for me was the uncomplicated way non-academics described the process they were engaged in. Not for them the debates around the merit or other wise of ethnomethodology, for me, the conceptual rubric in use, but a straightforward and uncomplicated explanation - we go out, talk, observe, and then share with those same people what it is we found in trying to find explanations and possible new ways forward – very refreshing.

Thursday was a great celebration and showcasing of how far colleagues across the University had come in working together to grow our expertise as researchers. The energy and innovation was wonderful, and when the presentations are put on-line, I urge you to have a look at the many examples presented. It is worth considering that for every one example presented on the day there were at least three or four other examples of collaboration that did not get mentioned. It was a stocktaking opportunity that revealed a potentially bright future for research at Salford. When I got home that night and looked at my emails there was one from Jennie my ever present and superbly effective PA, reminding me there was a film crew arriving at 8am to film some footage for a forthcoming University DVD. I was at my desk at 6.30am, hair under control, newly dried cleaned suit on, looking good even if I say so myself (apparently earlier that week, in a poll to judge the best dressed male in the School, I had come third).

You can imagine my surprise when the film crew eventually arrived only to ask where these dolls and dummies were that they had to film? Cruelly, in what had been a long week, my chance of stardom slipped quickly and quietly away as I humbly showed the film crew the skills lab. As it happened, the day turned out OK, and colleagues and I able to appoint two highly respected and gifted colleagues to part time research fellow posts within the School. Perhaps in dosing so we were, in a small way able perhaps reverse the growing trend of losing experience and knowledge from the intellectual crucible of nurse education noted above.

And the Station Waiting room, Ah, well, I was patiently waiting in the business lounge at Coventry Station, reading the paper, sipping pretty good coffee, when the door at the rear of the room burst open, and two completely incognito plain clothes policemen rushed in followed by an entourage of what looked like blond bright young things, male and female, who fussed around a ruddy and somewhat familiar face. It was, I realized, none other than Alan Johnson (MP), the former Secretary of State of Health and now the Secretary of State for the Home Department.

I maybe wrong but I don’t think the current Government has set up a ministry to assist MPs to more carefully spend their expenses at John Lewis’s so the Department must mean something else.

I resisted the temptation to engage in conversation around the current state of the NHS and what might have brought us to where we are today. So I returned to my news paper with just one eye and ear tuned to what was going on. Whilst Alan Johnson’s stay in the lounge was only ever going to be brief there was an opportunity for refreshment, and he did get up to make himself a cup of tea from the grand looking coffee maker. After a few minutes of fussing, much noise, steam and no cup of tea he was heard to ask as if in wonder, ‘what am I doing here’ – to which one of his young aides earnestly asked, ‘if this was a literal or philosophical question’. As astute readers I can leave you to make your own minds up – but for me the question neatly summed up the State of British politics’ right now.

Sunday, 13 September 2009

Clogs, ladders, Witch-hazel and Making it Better.

This week has been a painful one. Last Sunday while up a ladder trimming a tree, I slipped out of my clogs, fell 15 feet to the ground, pulling the ladder down on top of me. The result was that whilst I hadn’t ‘popped my clogs’ I ended up being severely bruised, covered in grazes, and feeling very foolish. My youngest daughter, who had witnessed the accident, was so annoyed that she missed capturing the fall on camera (apparently its possible to sell such mishaps to the TV for a few hundred pounds) that she returned to bed. My dear wife’s best offer was to dab the afflicted areas with Witch-Hazel. Interestingly the areas which did not have the Witch Hazel applied to them, bruised more vividly, but were far less painful than those areas treated. Here the bruises didn’t come out as well but the area remained painful longer.

The incident stayed with all through the week. I endured a week of stiff limbs, multi colored bruising, scabbed over grazes and still have to finish trimming the tree. I was still very sore on Friday, when I attended a very interesting meeting of educationalists, service providers and colleagues from the NHS North West. The meeting was aimed at reviewing achievements to date with the implementation of the Making it Better initiative – this is an initiative aimed at improving Children’s, neo-natal and Maternity services – and much had clearly been achieved. What made the meeting interesting was two interrelated issues: the first was that the initiative was predicated upon the notion of shifting services closer to home and preferably into the home, and the other was the realization that we may not be any longer training and educating nurses to work effectively in these new service provisions. Like the use of Witch-Hazel on my bruises, I wasn’t very sure what the evidence base was for this shift in service provision, although everyone seemed to agree it was a good thing. The question as to how well we were educating and training nurses for these new service models was challenging. Already, parents of children with long term conditions were being trained as to how to make interventions that allegedly nurse fresh out of training would not be able to do – it was the fitness for practice and purpose argument writ large.

I did my training way back in the 1970s and then it was highly competitive. Trying to get to see everything that was contained in our red book (the precursor to today’s Passport), and to get each observation ticked off was what we lived for. Of course we could only see those problems that other people presented with. It took me a long time to shift my thinking from the problem (diagnosis) to the person sitting in front of me. At the meeting last Friday we talked about ‘neo-nates’, ‘trachies’, ‘pau’s’, ‘nicu’s’, ‘paeds’, so maybe nothing much has changed. Hmm, anyway, I was pleased to see a competency (yes its me being pleased to see a competency) that was about communication and understanding the other. Maybe there is hope we will change, and tall trees can look good as well.

Sunday, 6 September 2009

Robot Nurses and the Schizophenics, I don't think so!

What a week. We have management consultants telling us 1 in 10 health care workers will need to lose their jobs if the NHS is to achieve a balanced budget. My old friend and mentor Professor Joel Richman had some choice words to say about the NHS spending enormous sums of money on management consultants. I think he would have turned in his grave this week hearing the debate. Interestingly, The Times, this weekend was absolutely in his camp, claiming such profligacy was on a par with the payment of bankers bonuses. I agree, and I do get depressed about such blatant ‘let’s see what the punters think’ attitude to managing policy.

The other depressing occurrence this week was the BBC, (unfailingly it seems) referring to Peter Bryant as a ‘schizophrenic’. I hate this way of describing anyone. Despite what he may have done, and in no way dismissing the distress his actions have caused to others, he is suffering from a serious mental illness. He is not a label, and affliction, a disease. He is a person, albeit very troubled. I feel someone at the BBC needs to ask the question why, as a major news organization, they continue to persistently see only the illness and not the person.

My Mum has booked her first holiday on-line. This is maybe not a particularly newsworthy item on its own. However, this is a great leap forward in using new technology. Media City it’s not but its interesting how on the edge of becoming dependent upon others my parents have suddenly got a new lease of life that is predicated upon being independent.

Independence and dependence are such interrelated dynamics. Its something I wondered about when I first heard about the new Japanese invention – the Robot Nurse – this weekend. Having been concerned that we are educating out the essential emotionally of nursing the notion of a robot nurse is an anathema. It certainly made me think again about the huge investment we have made in our high fidelity manikins. In any event, if we need robot nurse who was it that thought it would be a good thing to give it the face of a Teddy Bear?