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.