Sunday, 29 May 2011

30,000 miles, 15 flights, 4 trains, 2 buses and too many taxi’s!

This week marks the end of a month long series of overseas trips for the University. I have traveled over 30,000 miles, been on 15 different flights, 4 train journeys (each some three hours long) and two bus journeys (also 3 hours long) and taxi’s too many to mention – I am so fed up with doing taxi therapy. And for those wondering about cost - only the Council of Deans meeting was paid for by the University!

In any event, this week I spent three days in Martin, Slovakia at a nurse education conference that I have been supporting for some 18 years. It was held at the Comenius University, a University renowned for its programmes in both Slovak and English, particular those in the field of medicine.

The University is named after Jan Comenius a 17th century Czech teacher and philosopher…

… as a theologian, Comenius was viewed as a mystic, a believer in prophecies, dreams and revelations. His legacy was the influence he had in educational work. Despite the fact that few people since his day have had a greater influence on health care education, there is little recognition of his relationship to the current advances in educational thinking and practice. His contribution was far reaching. He was originally a teacher and a manager of schools, in Slovakia, Sweden and Holland. In his Didactica Magna (Great Didactic), he outlined a system of schools which today is the exact counterpart of the current American system of nursery, primary school, secondary school, college, and university system.

Comenius was influential in formulating a general theory of education. He was the first person to formulate that idea of ‘education according to nature’ so influential during the latter part of the eighteenth and early part of the nineteenth century. The influence of Comenius on educational thought is comparable with that of his contemporaries, Bacon and Descartes.

None of which compares with the friendships I have enjoyed with colleagues involved in the conference over the past 18 years. Alzbeta (who first introduced me to Slovakia in 1993), Darja, who has shared the stage with me since 1995, Martina who has provided the best hospitality ever over the last ten years, and Stephan – the wisest man I have ever come across.

And of course the trip was a good one, great to be part of a new wave of intellectual debate and discussion – and then there were the medical students from UCL. Do they know how to hold a discussion? Interestingly they had decided not to drink the same drink twice while they were in Bratislava – so by the time I met them they were in mellow mood. And they were so much fun. BUT I have decided that I will not go out and have a drink with medical students again. I had to take two aspirin in the morning, and it took me a while to get going.

This is the last Bank Holiday weekend for a while - and today is for my children, grand children and celebration.

Sunday, 22 May 2011

Deer in Horwich, Health Care in Jersey and if it’s Tuesday it must be Slovakia

One of the highlights of what was a very long week was coming across a female fallow deer on my drive early Tuesday morning. There is a small herd of deer who occupy the slopes of Riverton, on the outskirts of Bolton. I live part way down from and Riverton Moor, and deer can sometimes be seen on the fields between my house and the top of Winter Hill, close by. I was taking Cello for his first walk at 05.20 and as we got to the Orchard, there the deer stood. She appeared calm and watched us for a short while before slipping effortlessly between the chestnut paling fencing and back into the surrounding woodland. It was a wonderfully calm interlude in what turned out to be a turbulent week.

Eight hours later I was sitting in Gatwick, en route to Jersey and this year’s Council of Deans of Health Annual General Meeting. The meeting was held at the Hotel de France. Behind its rather grand 19 century facade was a wonderfully modern and very comfortable hotel. For me, being able to stay in touch with the School and colleagues while away is vital, and the hotel had a fantastic WiFi internet system, accessible anywhere in the hotel, that allowed for this. Situated on the outskirts of Saint Helier, it provided a rare glimpse into a former era of splendour, luxury and hedonism!

However, we were there to look at the big issues facing Schools of Nursing and other Health Care Professions in the here and now and the future, of which there were many. The two days started with an introduction to health care provision in Jersey – and possibly what we heard provided a glimpse into the future for the rest of the UK.

There were some interesting facts however, for example, there are 92 GPs for the total 92,000 population of Jersey. In the US there are 247 doctors per 100,000 patients, in India there are 2200 patients to 1 doctor and in England there are 18 GP per every 100,000 patients. GPs in Jersey make their living from selling everyone of their services. So for example, it will cost you anything from £55125 for each consultation.

It is no wonder that Emergency Departments are seeing an ever increasing number of patients turning up seeking treatment – all A+E treatment is free – at the moment. Current reviews of how the Jersey health care system needs to change are seriously considering charging patients for their A+E consultation in the future. Without enormous investment of capital to increase secondary care capacity, by the year 2016 current services will not be able to provide for the islands populations health care needs. The underlying drivers for this situation show high levels of congruence to those to be found in mainland UK – I think it is only a question of time before we will need to engage in similar debates – but one thing is for certain, comprehensive health care services, free at the point of provision are well and truly a thing of the past. It will be a hard road to travel.

And tomorrow, while not being completely straightforward in terms of what I am doing, it is likely to be both a busy and an important day to get through. Then Tuesday sees me yet again travelling (for the last time in a long while!) – I am off to Chair one of my favourite Nurse Education Conferences. 

This conference is held in Slovakia, more of which next week. I have been involved with this conference for some 16 years, and for me it provides an opportunity to give something back to the nursing profession, and it is a conference based upon relationships that are long standing and which are very dear to my heart.

Sunday, 15 May 2011

International Nurses Day, Bob Dylan,Football and Birthday's

May the 12th was International Nurses Day. It is a day when nurses all over the world celebrate nurses, nursing services and nursing accomplishments while commemorating the anniversary of Florence Nightingale’s birth.

The international theme for 2011 was Closing the Gap: Increasing access and equity. Evidence suggests that effective access to health services can contribute to a person’s life expectancy and/or to the quality of life that they experience.

However health is not merely a commodity produced by health services. Health is socially determined, will be influenced by genetics and environment. It has long been recognised that the ability to achieve good health or, conversely, the risk of suffering ill health, is affected by socio-economic status, geography, employment, education, gender, sexual preference and a host of other elements that impact, both directly or indirectly on a person’s ability to achieve and maintain good health.

The International Council of Nurses believes that nurses have an important role in achieving health equity and developing a clear understanding of how the health sector can act to reduce health inequities. As the principal and, in some cases, the only group of health professionals providing primary health care in many of the most challenging settings, nurses are essential to improving equity and access to health care and adding quality to the outcome of care.

It was with these thoughts in mind that the School facilitated a conference to celebrate International Nurses Day this week. Led by Melanie, our ever enthusiastic International Lead, colleagues from across the School ensured that the day was a great success. Nearly 150 nurses from across the North West attended to share in the day, and speakers from around the world talked about both the history of nursing and nursing today as it can be seen in its many forms and focus.

Unfortunately, I could not stay for the whole day as I was also scheduled to participate in our College Executive Retreat. This was a two day retreat aimed at thinking strategically about the recent academic reconfiguration and the decision to move from three Schools to two Schools. The retreat was a productive one, and we were able to agree a way forward for each School and how these plans will be delivered over the next 12 months.

Dinner and bed was at the Radisson Edwardian Hotel in Manchester. This hotel stands on the site of the Free Trade Hall, indeed the original front facade of this building has been kept intact. The Free Trade Hall has a special place in the history of Manchester. The first hall was erected on the site where the infamous 'Peterloo Massacre' of 1819 took place.

The Free Trade Hall was the setting for important political events: the voices of Gladstone, Disraeli, Lloyd George and Churchill have all filled its cavernous spaces. It was also a place of entertainment. Charles Dickens, Oscar Wilde, Ella Fitzgerald the Halle Orchestra and Bob Dylan all played in the hall. For a fleeting moment, as I lay bed on Friday morning watching the surrounding Manchester City wake up and the sun rise, I wondered if Bob Dylan had also seen the city slowly coming to life when he was here.

Yesterday saw Manchester United secure their 19th Premier Championship a great day for all those who support MU – and for those who support Manchester City it was a great day for them too, MC gained the FA Cup - many congratulations to both teams and thier supporters.

And today I celebrate my birthday –  imperceptibly but unremittingly creeping towards 60, Hmm!

Sunday, 8 May 2011

EmpNURS, Seeing beyond the Panopticon, and some Blue Sky

I spent much of yesterday travelling back from the Czech Republic. The journey took over 12 hours. I had been in Bruno, (known as the small Prague) since Wednesday night for what was the second workshop of the EmpNURS project. This is an EU funded project which aims to advance the empowerment of nursing as a profession through the development of high quality mentorship. The project is being carried out by 11 partner organizations from the Czech Republic, Finland, Hungary, Lithuania, Romania, the Netherlands and the UK. The Project Manager for this study is my long time friend and colleague Mikko. We have known each other for some 15 years and share both a common history and background and a desire to find ways of better preparing individuals for nursing practice.

Over the last 15 years Mikko and I have become increasingly interested (and a little concerned) over what appears to be some big variations in the way nurses  are being educated across Europe. And this appears to be the case, despite the Bologna Agreement which sought to harmonise higher educational systems across Europe. We have written about our concerns, both with each other and with colleagues from other parts of Europe. It was from this work we went on to develop the EmpNURS Project.

The EmpNURS project is aimed at benefiting nurse educators, nurse students and qualified nurses across Europe. The project builds on our previous work and is focused around approaches to mentorship. With my colleague (from our School) Karen, I am undertaking an impact evaluation of the EmpNURS project which among other things, will assess the level of cooperation between health care service providers and educational institutions such as University’s in developing and implementing a mentorship programme. Already we are seeing that despite a common desire to achieve such a programme, there are cultural, organisational and political factors that challenge this work. So it will be an interesting couple of years work!

This week’s workshop was facilitated by my very good friend and colleague Andrea – and her hospitality was brilliant and so helpful for all of us. One of the activities Andrea arranged for us was a visit to the local health care services. These were situated on the same campus as the University – which was new, brash, modern and a huge testament to the investment the Czech government is making in its higher education system. However, when we walked into the main entrance of the hospital, we were confronted with a row of archaic trolleys.

What was unknown to us at the time was the fact that on the other side of an adjoining door was a state of the art major trauma centre – and when we were able to visit this centre I found it truly impressive in terms of not only the available equipment, but also the approach of the staff who worked there. Likewise, on visiting the ICU I found the highest possible care being provided to some very ill patients in a way that really demonstrated how important it is to balance the technical with the humanistic in using our skills and knowledge as nurses.

I found the entrance to the School at the University very interesting. It was ‘guarded’ by a modern example of what Jeremy Bentham (the philosopher and social theorist) described as a ‘panopticon’. This observational device was a somewhat a somewhat sinister presence in the entry foyer of the building. However, once one got past this silent sentry, the rest of the building was encouragingly welcome.

And the blue sky. Well my wonderful PA Jennie, who absolutely ensures everything I need is sorted for these trips, included a five day weather forecast for the Czech Republic in my briefing papers – this forecast showed wind, rain and cold temperatures. However, the reality in Bruno was blue skies, wall to wall sunshine and a barmy heat. The great weather contributed wonderfully to what was a productive and informative three day workshop. Back here in the UK writing this blog this morning, the sky is grey and its raining!

Sunday, 1 May 2011

Pledges, Weddings, and Big Boys Toys

This week saw an impassioned email debate in the School on whether we should instigate the practice of asking our students to make a pledge at their Graduation Ceremony. The suggestion originated at a graduation Ceremony two years ago, but was not taken forward because of the ‘Pledge’ contained in the last UK Prime Ministers Review of Nursing and Midwifery (The Front Line). In preparation for this year’s ceremony I was asked to raise within the School the possibility of our graduating students using the Declaration of Geneva as their prledge at the point of graduating.

It was way back in 1948 that the General Assembly of the World Medical Association adopted the Declaration of Geneva. Despite the wording being amended many times since then (the last being in 2006) it remains to many (within and without the medical profession) an anachronism. In its current form it reads as follows:

At the time of being admitted as a member of the medical profession:

• I solemnly pledge to consecrate my life to the service of humanity;
• I will give to my teachers the respect and gratitude that is their due;
• I will practice my profession with conscience and dignity;
• The health of my patient will be my first consideration;
• I will respect the secrets that are confided in me, even after the patient has died;
• I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
• My colleagues will be my sisters and brothers;
• I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
• I will maintain the utmost respect for human life;
• I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
• I make these promises solemnly, freely and upon my honour.

Even for the medical profession, one can argue there are major problems in the terminology used and how the concepts these words reflect are incongruent with modern values and ethics. When I put this version up on the screen at our last School Development Day, I was (quite rightly) verbally shot down in a fusillade of emotionality.

This week’s debate was both on whether we needed to make a pledge at all (graduating students will already be bound in practice by the NMC Code of Conduct, the law and their moral duty not to harm patients), and if so what would it look like. The general consensus from colleagues and students (albeit a small number from those likely to graduate in 2011) was that a pledge was inappropriate and there were other ways to increase the significance of the ceremony for students, colleagues and the families who attend to celebrate the students success.

Last year, our Chancellor, Irene Khan, asked the students to keep their caps off until they had thanked their family and friends for supporting them over the course of their programme. The students also gave the staff a standing ovation. Many colleagues agreed that this approach had an authenticity to it that no pledge could match.

And of course this week also saw the wedding of Prince William and Kate Middleton. Being an unashamed royalist I of course every moment of the day, and could be found for long periods, sipping champagne in front of the television marvelling in the day as it unfolded. It was a fantastic spectacle and people all over the world witnessed the couple making their own special pledge to each other.

Strangely however, I was particularly captured by the trees used to decorate Westminster Abbey. Six field maples and two hornbeams, all of which were nearly 20ft tall were installed at the Abbey. These trees were English, natural, seasonal, ethical. The field maple symbolises humility and reserve, and was used to make loving cups in medieval times, while the hornbeam signifies resilience. I wish the happy couple well.

This long weekend is also remarkably different for me from the one I spent last weekend. Last weekend was spent at 33000 feet in the air travelling back to Manchester. This weekend like many British people I have stayed at home. What some have called ‘staycations’ – last year this meant people who stayed in the UK to holiday rather than travel abroad, this year, it means ‘camping in your own back yard’. So this weekend, I’ve stocked up with refreshing summer drinks and BBQ food, and have stayed at home and played with my big boys toys in the garden. The result is a garden that has its perfectly stark symmetrical lines once again restored against a backcloth of the irregularity and chaos of shape and colour that Mother Nature gives to the world.