Sunday, 25 May 2014

A bit of a Spring Fling, Sleeping with David Beckham, a Loving-Kindness Meditation

It’s that time of the year again, the sap is rising, the sun is shining and it’s time for a bit of a Spring Fling. Of course this Spring Fling is Scotland’s leading visual art and craft event where some 95 artists, designers and craft makers open up their studies to the public. And it’s all on my door step. The event covers the whole of Dumfries and Galloway. I only came across the event last year, but was knocked out with some of the art and crafts seen. This year I chose to support the extension of the Spring Fling to help show case the work of artists in Glasgow, Newcastle and London.

Yesterday,my first stop off was to my favourite artist Urpu Sellar. Urpu originates from Finland and produces brilliant ceramic sculptures. I have been collecting her work for a number of years. Urpu has a great interest in language and in particular the idiosyncrasies of the English language. Often her pieces cleverly capture a play on words and or an expression. We spent some time playing catch up with our news. I selected a piece called ‘Gossip’ to buy and was able to place an order on a piece that was in the process of being created – called ‘who’s chairing this meeting’.

Last week my colleague Ieuan Ellis chaired his last Council of Deans (Health) meeting. Well to be accurate his last CoDH Summit, we have one more Executive meeting in June.  He has done well over the last 3 years in representing nurses, midwives and allied health professions in his role as chair of council. Last weeks meeting had a great deal of ground to cover, from up-dating on the somewhat stalled negotiations over national benchmark price (the amount of money the UK Government pays universities for each health care professional educated at a university) to what integrated health and social care might look like. And of course we spent some time starting the process of choosing our next Chair – well done June and Jessica for putting your heads above the parapet.

The meeting was held at the Burton on Trent Hilton (yes I was surprised as well!). It was the usual Hilton experience: perfect customer service from the staff, £9.60 for a glass of ordinary Pinot Grigio, and dreadful food for vegetarians – I think these days gnocchi has become the new vegetable lasagne – lazy food. However, the setting was stunning. Unbeknown to me, the Hilton at Burton on Trent is also part of the Football Associations National Football Centre – all 24 England teams use this facility for coaching, training and conferencing. The hotel was football themed throughout. My bedroom had 2 large pictures of David Beckham on the walls, so sorry Victoria, but for 2 nights, I slept with David Beckham.

While the CoDH membership was wrestling with the future of health care professions education, others were becoming vexed about the draft of the proposed new Nursing Midwifery Council (NMC) Code of Conduct. It contains 115 items of good conduct guidance in its 25 pages. Number 114 appeared to cause great consternation and Twitter chat. This was the guidance proposed for the nurses use of Social Media – you must ensure that you use social networking sites and other forms of electronic communication responsibly and in line with our guidance, in particular by not referring to employers, colleagues, or pastor current people you have cared for – to me, this is a completely flawed example of guidance. 

I was more concerned with guidance number 42, which states that nurses must maintain clear professional boundaries (including sexual, personal and emotional boundaries) at all times with people in your care, their families and carers. I struggled with this guidance. What do emotional boundaries mean? Emotion is a differentiated construct – for example, feelings are subjective representations of emotions, unique and personal to the individual experiencing them; whereas moods are usually less intense than emotions, but can last longer than the emotional feeling and sense of being.

I have long advocated that nurses need to embrace the emotionality of their practice. They cannot possibly help others until they know something about who they are as an individual. For me understanding self and the emotions that shape our behaviour is critical to good mental well-being. My PhD was concerned with relationships, how these are constructed, maintained, and used, how they flourish and flounder. I have long been an admirer of Barbara Fredrickson’s and her work . into emotions and positive psychology undertaken over a large number of years.

Drawing on loving kindness mediation (LKM) techniques originating from Buddhist mind training practice, she published a paper last year that showed how learning and practicing LKM can produce enduring increases in positive emotions, which in turn result in the acquisition of arrange of personal resources that augment our experience of life satisfaction – additionally positive emotions improve cardiovascular health and more importantly for nurses (and others), help us engage in positive interpersonal relationships. Understanding the dynamic that exists between our intra, inter, and extra personal relationships is the critical to achieving effective nursing care. 

Sunday, 18 May 2014

Stepping Up to Educate Rita and/or Roger, Are We Ready to Change?

Last Monday was International Nurses Day, and this was celebrated in many different ways by nurses across the globe. Twitter was on fire with 1000's of messages and pictures. I was intrigued by the number of nurses who shared photos of the badges they received from their training schools at the point of completing their programme. Most of these pictures were from nurses who qualified in local Schools of Nursing. These were independent schools that were not embedded in the University system as they are today. It was a huge display of affection, pride, and a sense of achievement, all symbolically captured on small enamelled metal badges.

On Tuesday my colleagues and I worked together with Salford Students Union to look at how we might improve the placement experience for our Social Work students. It is often an area of the programmes we run that cause problems for everyone. Unlike our NHS partners, who have a contractual responsibility to provide placements for our nursing and midwifery students, and in that sense are truly partners in facilitating the students learning, social work placement providers have no such responsibility. So every placement has to be negotiated individually. With nearly 200 students starting their social work programme with us each year, this is not an insignificant task!

However, sometimes these partnerships can really work well and, it was great to see Sheffield Council report this week that the Step Up programmes has helped them recruit and keep high quality Social Workers. The Step Up (to Social Work) programmes started in 2010, and our School was one of just two providers of this new and innovative approach to training social workers. At the time many local authorities across the UK were not able to recruit social workers willing to work with children and families. The Step Up programme changed that. 

It is not for everyone, but the programme which originally ran for 18 months (now 14 months) enabled individuals to gain their qualification to practice much quicker than the more traditional programmes. The other aspect of the programme is that it is a genuine partnership between practice and the University. We are now on our Step Up 3 programme and one of our partners is Sheffield (the lead authority for the Yorkshire and Humberside regional partnership). How Social Workers are to be educated and trained in the future is currently a hotly contested debate. We are keeping an open mind. Our belief is that the one size/approach does not fit all potential social work students. Whichever way it goes it’s going to be different from what we do now.

Friday, we had Ian Cumming (Chief Executive, Health Education England), Kate Nealon (Non-Executive Director and Deputy Chair Health Education England) and Jan Sobieraj (Managing Director of the NHS Leadership Academy) come to the College. We were able to show case some of our research around digital health and well-being, use of social media, and the work we are doing across the university on dementia and design. The presentations were great and captured the imagination of our guests. 

What was also clear from the questions during the day was that the education and training of future health care professions is changing, and changing rapidly. The traditional 3 year degree programme for nurses will change, and I think will change very quickly. Our students today are already demanding more. They don’t want lectures that are essentially nothing more than what they can independently find out – many students today want is debate, discussion, and the opportunity to challenge and be challenged. They use social media to communicate, can create interactive presentations that captivate and they still understand that they are working with people. Can we as educators rise to this challenge? I think listening to the presentations on Friday the answer has to be yes. Sometimes it’s good to spend a day with colleagues hearing what it is they do what their ambitions are and share the passion.

Sunday, 11 May 2014

Looking Back into the Mirror, 10 years On, and Hello Harry!

10 years ago I had a paper published in the Journal of Nursing Management. The paper was entitled: Mirror, Mirror on the wall, who is the most improved of all. I re-read it again last week. The paper was a polemical analysis of clinical governance in the NHS. At the time I was a nurse reviewer for what was then called the Commission for Health Improvement (CHI) - a precursor to the current Care Quality Commission, and like them perhaps, an organisation that looked at quality improvement through the wrong end of the telescope.

Just before writing the paper I had just undertaken a CHI review; an event that lasted nearly a week and something that demanded enormous preparation, involved very long hours of interviewing, observation, analysis and discussion and was an exhausting experience. Traveling back on the train, I found myself somewhat challenged and doubting the value and validity of what I had been involved in. A week or two later I was having dinner with my friends and colleagues Karen Holland and Gary Rolfe at a conference. Gary had just found out he was be a guest editor for a special edition of the British Journal of Nursing Management.

So when he asked if I would write a paper on a contemporary health service management issue, I jumped at the chance, but insisted it would have to be written in my style. And it was. I think it was during my ‘metaphor’ period, when my writing partner Sue McAndrew and I were into using metaphors and analogy to explore difficult issues. The analogy I used was pantomimes – here is a taste of the papers subheadings: The Emperor's New Clothes (who says he's naked?); Sleeping Beauty (being aroused from slumber?); Snow White (and her seven assorted helpers?); The Three Little Pigs (nobody lives in glasshouses here!); Cinderella’s Missing Shoe (or slipping into something more comfortable?); and Little Red Riding Hood (and the wolf in Grandma’s clothing).

Whilst I would argue that the academic content of the paper was of high quality, use of metaphor in this way was at the time, challenging. That the paper got through unscathed was I think, down to the courage of the journal’s Editor in Chief, just 2 years into her role, Professor Melanie Jasper. Melanie and I both became Head of Schools at the same time. While I became Head of School of Nursing, Midwifery, Social Work & Social Sciences at the University of Salford, Melanie became Head of the College of Human and Health Sciences at the University of Swansea. Both Schools are the largest providers of health and social care education in England and Wales.

Melanie, (with Gary Rolfe, and Dawn Freshwater), used her considerable skills and energy to challenge all nurse educators to find ways to enable nurses to improve their skills and knowledge through reflecting on their practice. She led the way with high energy, insightful commentary, and creativity and was always willing to give everyone a voice. Melanie was an outstanding researcher and teacher. Sadly Melanie died last weekend. I, and I'm sure many people, will miss her encouragement, challenge and support.

Whilst for me, the week started with the sad news of Melanie’s untimely and premature death, on Wednesday young Harry was born safe and well. Harry is grandchild no.9. Harry was born at home. It was a planned and prepared for home birth. The Bolton midwives were fantastic. If she had known, I think Melanie would have smiled with contentment at how well today's nurse and midwifery education can deliver great practice (and, of course such adorable little boys). 

Sunday, 4 May 2014

Bluebells and Dog Bites, and Simon Says Back to the Future

Yesterday was so different from last Saturday. Last Saturday I was traveling back from the Czech Republic a journey that took over 12 hours from leaving the hotel to putting the key in my front door. Yesterday I spent the day on the beach playing in rock pools (I did have a grandchild with me!), tending my new garden, and best of all, walking through the woods with Cello. The woods were ablaze with colour, the ground carpeted with bluebells, the gorse and broom out in bright yellows and the crab apple trees full of blossom.

The sun shone and Cello and I enjoyed a couple of hours wandering free and far. Dogs and people don’t always have it so good however. The Health and Social Care Information Centre (HSCIC) last week published their figures for bites and strikes by dogs. In the 12 months to January 2014 there were 9,710 people admitted to hospital because of bites by dogs (and other mammals, such as horses, foxes and cats). This was a 7% increase on the year before. 6,740 of these admissions were dog bites.

Cello and I were blissfully unaware of the facts as we walked and ran through the woods. It appears that admissions to hospital for dog bites are highest in the summer, children up to 9 years of age have the highest admissions and more males than females get bitten. The most common reason for admission is an open cut to the hand although young children tend to have more injuries to the head than other age groups. People in Merseyside are more likely to be bitten than other parts of England.

It could be worse mind you. Dogs are the source of the vast majority of deaths in people from rabies. Rabies occurs in more than 150 countries, and more than 55000 people die of rabies every year in Asia and Africa. Death is not inevitable if post bite treatment is available and given very quickly. More than 15 million people received post-exposure vaccination to prevent the disease last year. What Cello and I didn't know either was that David McRae died after he was bitten by a bat in Scotland. He was the first person to die of rabies in the UK for over 100 years. That was in 2002, but a bat with the same strain of rabies was caught in Perthshire in 2009.

There was lots of wild garlic out in the woods, which is supposed to protect one from vampires, but not, I think, rabies. So in part it was good to read that the new NHS Chief Executive Simon Stevens, having some back to the future thoughts. Last week not only did he posit that further centralisation might not be the way to go (at long last someone gets it), but he expressed a desire to involve Care Commissioning Groups more in decision making over primary care services. CCGs are made up mainly of GPs, who currently already spend over 60% of the NHS budget on our behalf, but not on primary care services. Other organisations are responsible for commissioning the services GPs provide (and of course get paid for).

Now my PhD was on relationships, Specifically those that GP Fundholders used in commissioning secondary care service in supporting the primary care services they were providing for their local communities. That was in 1999. Yesterday I drove past the soon to be opened new Primary Care Centre in the town nearest to the House in Scotland. I wondered if they would carry any rabies vaccination, and who was going to be commissioning primary care in Scotland. So please Paul (Paul Gray, Chief Executive NHS Scotland) can you have a conversation with Simon. GPs commissioning their own services didn't work in 1999, and I am not sure it will now.