Sunday, 31 October 2010

Traffic Jams, Birthday Cake, and Quails Eggs Protests

It feels like I have driven up and down the M6 motorway too many times this week. The M6 is one of the longest motorways in the UK at 232.2 miles long. It took some 50 years to build, and at times if feels like you might have been travelling on it for as long. In my experience the Manchester to Birmingham section often resembles a slow moving car park for long periods of the day. This is precisely what the M6 was like on Thursday this week. Foolishly, I had decided to drive to Stafford University rather than take the train as I was due to attend a meeting later on that same evening at Holmes Chapel, some 25 miles apart and thought this would be the easiest way to get to both venues. In the end it took three hours to make a journey that should normally take at the most just 90mins. I was not impressed.

I was going to Stafford University as an External Examiner on a PhD Viva. I am always happy to be involved in these events, particularly when they involve hearing about the research of nurses or midwives. Less than 10% of nurses in the UK have a PhD, so I was very pleased that on this occasion the candidate defended their thesis well, and we were able to recommend the award was made. It was also great that he was a mental health nurse who had drawn upon my work in constructing his thesis.

Back on the M6 and the journey back to Holmes Chapel was a tortuous affair. The slow moving traffic, that in the morning had been overwhelming going southbound, seemed to have transferred to the northbound carriageways. It was a slow, frustrating and tiring journey back.

So it was with some trepidation that I started my journey yesterday morning down to Cardiff. For much of the journey one has to use the M6. I was on my way to celebrate my Fathers birthday, 30 guests were due to attend and most of the food was in the back of the car. Thankfully, the road was completely clear, the sun shone, and the autumnal colours were magnificent. The party was a success and a good time was had by all. The guests were family and friends. Among the group there was a teacher, midwife, financial regulator, falconer (complete with a miniature Peruvian Owl), a trainee policeman, house wives and house husbands, plumber, and lots of grandchildren. The conversations were often rich with description and difference.

One of my brothers told of how the social unrest in his part of Surrey (Kingston-upon-Thames) had reached new heights of unacceptability. It appears that the local youth make their protest known by throwing quails eggs at people’s property. He was deadly serious. I couldn’t quite imagine however, young people being so disaffected that they took themselves off to the local Waitrose store to purchase a dozen quails eggs to throw at peoples windows. Social protest is slightly different up here in the North.

The journey back from Cardiff along the M6 took just over three hours and was uneventful, and in a strange way calming. Happy Birthday Dad!

Sunday, 24 October 2010

Holidays, Hearing Hopes Dashed, and Emails Ignored

Well last week was great. I was on holiday in Scotland, on the Solway Coast, and the sun shined. The Gulf Stream weather kicked in and it was wall to wall sunshine and clear, clear days. The light was fantastic, the air fresh and I was able to really get away from it all. I notched up six books read (all novels of course!) and when not reading or resting my eyes, I walked. For those of you who have not been to this part of the world, you can walk for miles on rolling hills without seeing another person, stroll on deserted white beaches, with just the waves for company, and trek through forests that are so vast that it defies one’s ability to comprehend the scale of planting.

Cello acted as if he had never had it so good. Last time we were up here he was plagued by ticks and became poorly, was miserable and generally did not enjoy himself. However, this time, thanks to the wonders of veterinary science (which as we know, is akin to the wonders of medical science) he was kept safe and was able to bound up mountains, leap streams, swim in the sea, and generally had a great time!

As the week progressed, I felt strangely quite guilty. There I was relaxing and having a good time, while elsewhere, many others were awaiting the outcomes of the UK Governments Comprehensive Spending Review. Much had been trailed before, and as a School Executive we have spent some time thinking about the possible scenarios arising from a reduction in our income and in the resources of our partner organisations. When the announcement came, I watched it live on TV and my feelings of guilt and depression rose to new levels. It seemed to me that the consequences of what was being proposed would, for all of us, be far reaching, and likely last for many years to come.

That I was almost completely deaf during this time was of little consequence. Having self diagnosed tinnitus a few weeks ago, I finally went to the GP, who, surprisingly swiftly, diagnosed a wax in the ear problem. He said the treatment was simple. All it required was olive oil (virgin) drops applied to both ears twice a day and then having both ears syringed. Getting the olive oil was easy, well once I got past the ‘health and safety’ inquisition from the Tesco pharmacy assistant. Getting someone to syringe my ears was much more problematical.

In Bolton, those requiring such treatment must ring a central telephone number. I rang, spoke to a very helpful person who arranged an appointment for yesterday (Saturday!). Whilst being seen on a Saturday impressed me, the delay in getting an appointment ran to over a week. Getting there at the appointed time I was wheeled in and asked the usual questions and I was then examined. The changes in the nurse’s body behaviour alerted me to a problem. When she excused herself to find another colleague to come and examine me, my pulse rate increased, slightly. The second nurse came in and examined me and immediately her body language changed from relaxed to a somewhat more guarded posture.

Now as a trained anthropologist, one of things I find myself doing all the time is observing the behaviour of others. Some call this people watching, and ever since I started my training as a mental health nurse I have been fascinated by observing the behaviour of others. So I found it an interesting experience sitting in the examination room with two health care practitioners talking about me as if I wasn’t there, presumably because I couldn’t hear, but doing so whilst sending out high anxiety non verbal communications. I am sure Jan-Kåre Breivikwas, the Norwegian anthropologist whose work on the cultural identities of deaf people and populations has contributed to changing attitudes towards minority cultural groups, particularly people who are deaf.

Eventually, the senior of the two nurses said, I wasn’t to worry, but I needed to see my GP as soon as possible that my right ear in particular was infected and very inflamed. I told them I wasn’t worried as getting to see my GP for the referral to the syringe of ears clinic had taken nearly two weeks and I assumed it would take another two weeks to see him again. By which time whatever the problem was would probably have cured itself. I just had to deal with the deafness, or so I thought. However, on returning home I was advised (strongly) that I needed to report to the Walk-in Clinic at 08.30am, and get the nurse on duty to prescribe some antibiotics.

So despite, having hundreds of (holiday) emails to deal with (and apologies if yours is one of these), that is what I shall be doing later on this morning. And there was me thinking that dealing with the CSR outcomes was tough!

Friday, 15 October 2010

Gone walking!

Hello everyone, I am now on holiday in Scotland, for a few days walking. The next blog will be published on the 24th Oct!

Sunday, 10 October 2010

Memories of Singapore, Liberating Durham, and THAT Milk Advert

This time last year I was in Singapore. It was hot, humid and exciting. I was attending the inaugural meeting of the Cochrane Nursing Care Network. Unfortunately, since then it has been difficult to encourage colleagues to participate in exploring the numerous systematic Cochrane reviews, in order to identify what the nursing in-put might be. I think this is an important aspect of developing an evidence base for nursing practice. I also understand that such an approach is not going to be for everyone. Singapore is one of my favourite places to visit. Whenever there I always try have a drink in the Long Bar at Raffles, and that ice cold beer always tastes as good as it did the first time I went there many years ago.

I also recalled that the last time I was in Singapore I was only on my 8th blog! Those were early days and unlike last week (and the numerous comments around nurse uniforms – and there is a Polo connection) way back then, I wasn’t always sure what I wanted to say. However, I do remember that it was World Mental Health Day on the weekend I was away, and today, the 10th October 2010, it is once again World Mental Health Day. Achieving good mental health is a global concern. The World Health Organisation estimate that more than 450 million people suffer from mental illness. Many more have mental problems. In the UK, one third of all people visiting GPs will have a mental health problem. Every day, 1 in 6 of us experiences mental ill health. 1 in 5 consultations in primary care are for physical illnesses, but many of these conditions, (stroke, coronary heart disease, diabetes) will often give rise to related mental health problems (depression, anxiety and so on).

World Mental Health Day is a day aimed at raising awareness about mental health issues. The day aims to promote more open discussion of mental illness, mental health and wellbeing. The World Health Organisation describes mental health is being an integral part of health; indeed, there is no health without mental health. As part of the awareness raising aims of World Mental Health Day, the School of Nursing & Midwifery is displaying posters and papers that present some of the work being carried out by colleagues into different aspects of mental health and well being. This work can be seen in the Allerton Concourse. If you are unable to come along, more information about this work, and other work in this area from across the College of Health and Social Care can be obtained by emailing Use this email address to learn more about what you can do to promote good mental health and well being.

I was in Durham on Thursday, which although less exotic than Singapore, has its own attractions. I was attending a Council of Deans of Health Meeting. One of the opportunities we had was to engage in was some quality analysis of the Liberating the NHS White Paper. We were helped in this work by Karen Middleton, Chief Health Professions Officer at the Department of Health.

I have to say that at the end of the session I was excited by the possibilities the White Paper proposal presented, but I was in awe of the challenges involved in achieving these. Whilst superficially at least, some of the proposals take us back to the Margaret Thatcher dream of a NHS delivered through the use of market principles, structures and processes, the new opportunities take this dream to a new level.

Ambiguity, uncertainty, not knowing and an absence of rules and regulations, at least in the Focauldian governance sense, lie at the heart of the White Paper. Strangely I felt at home with the context and vision looking forward. This was the subject of my PhD all those years ago, and in any event I have long held the belief that as nurse educationalists we need to find ways to better prepare our students for the challenges of the unknown, embracing the ambiguous, and recognising the difficulties involved in becoming and being a person centred practitioner.

I don’t underestimate the difficulties involved in embarking on this journey. In think about these difficulties, I have taken inspiration from that MILK advert. Clearly I cannot mention the company by name, but getting a bunch of rappers to extol what’s involved in milk production, to sell the health message, and to widen the appeal of mild across generations was brilliant. The break dancing tractors were a stroke of genius.

The advert appealed to my creative side, and reinforced my commitment to keep pushing at the boundaries of what we might be able to do as educationalists.

Sunday, 3 October 2010

A Universal Grey Remembered, 37 years On

 One of the interesting things about having an open door policy is that you don’t always know who you might get to meet from one day to the next. This week a number of our new students, all of whom appeared to be in a state of high anxiety, came to see me. The universal reason for their anxiety was not yet receiving their uniform. It seems that currently many of our students are experiencing difficulties getting hold of their Uniform from the supplier. The main supplier of our uniforms, and indeed nurses’ uniforms across the UK, went into administration earlier in the summer. Although the business was eventually rescued, the new business appears still to be struggling to play catch up with all the back log of orders. The consequence is that some of our students may not receive their uniforms before they go out to their first practice placements, hence the high levels of anxiety.

Bear with me for a minute, but until very recently, I had a framed poster hanging outside my office which I think explicitly captured and presented my thoughts about the uncritical pursuit of universality, homogeneity and the perverse nature of coercive specificity that is often the consequence. These are concepts epitomised by the notion of Uniforms.

The poster was moved in order to create a space to hang the gift of a fine carpet from colleagues in Pakistan. My intention is to hang the rug as a tribute to the truly magnificent work these colleagues are doing, not just in relation to the relief efforts following the recent floods, but in recognition of the unstinting work they are engaged in day after day with thousands of ordinary people across Sothern Pakistan who are suffering illness and distress.

However, I created the poster as a consequence of some work I had undertaken with two of the most influential people in my early academic career – Ian Stronach and Sheila Stark.

Together we wanted to change the face of education. It was this work that provided the foundation upon which my long term collaboration with Sue McAndrew was formed.

Sue and I continue to be concerned with the way mental health nurses are prepared for practice. A concept of preparation that’s as much about attitudes, values, and personal beliefs as it is about technical knowledge and skills.

However my preparation for becoming a nurse started off with being measured for a suit. In 1973, this was a crucial first step in my pre-registration training programme. One had to look the part, and grey two piece suits were what every aspiring male student was given to ensure they did. It was a dreadful and cheap piece of clothing that was meant to last the three years of training. When on the ward and doing real nursing male students were required to wear heavy long white coats. Somewhat strangely, female student nurse were given a bright yellow uniform to wear.

Until about 1972 most hospitals in the UK had their own style of uniform. For females this was usually designed around a traditional dress and starched apron. It was in the mid 70s that the Department of Health introduced the national uniform requirement for all NHS nurses. For females, this national uniform was originally intended to be worn as just the dress with no hat or belt, but as a result of protests by nurses, many hospitals continued to allow hats and belts.

However, whilst male nurses were stuck with their grey suits, female nurse uniforms changed. By now they were delicate shades of yellow, brown and blue check depending on your status. Unlike the shapeless grey suit, these new uniforms for women, continued to be distinctively feminine, allegedly promoting an air of comforting maternal authority. Ward Sisters almost universally refused the new check pattern, staying with the dark navy blue dress that can still be found today in many places.

By 1989, plastic disposable aprons replaced the traditional ones, caps were discarded. Dresses became more practical and, so I am told, more comfortable to wear, with ‘Action Pleats’ becoming the norm. It started to become popular to wear tunic and trouser sets. Indeed current BBC dramas such as Holby City and Casualty show nurses in tunics, and nurses in scrub vests and pants are seen in theatre and the wards. Interestingly, whilst on TV the familiar nurses uniform appears unpopular, with polo shirts and trousers often appearing to be the norm, when these were suggested as a temporary stop gap for our students, the idea was firmly rejected by many practice colleagues on the basis it would be unprofessional. I am not sure that wearing my grey suit, all those years ago really helped me understand what becoming and being a professional was really all about. Perhaps there is still a way to go with my preparation for practice project.