Sunday, 30 April 2017

1001 Nights of Passion: for life, the universe, and everything

I woke up early last Wednesday morning to a totally silent world. It was strange and very disturbing. I couldn’t hear the light switch being turned on, the water running from the tap or my feet treading on the floor boards. I had been having trouble with my ears for a few days before, although this was mainly earache and a painful neck and face. I suspected a middle ear infection with the pain coming from a blocked Eustachian tube. Having a hot steamy shower seemed to bring some relief and my hearing partially returned in one ear with a pop – although this was a peculiar feeling, with ‘echoing’ and ‘buzzing’ interfering with my ability to hear fully.

I wasn’t unduly worried although both ears and my neck were very painful and sore. I knew the condition would either get better itself (with painkillers to help) or it would get worse and require medical attention. I was however, concerned about a few things that were impacted by the loss of hearing. One was the fact I had no way of knowing if I was shouting or mumbling when I spoke. Normally this wouldn’t have mattered either, but I was due at the Trust Board meeting and due to report on the work of the Quality and Safety Committee.

As it turned out, my colleagues patiently assisted me through the report and provided non-verbal cues over whether they could hear or not. The other concern I had was brought into sharp relief through the patient story agenda item. This month instead of having an actual patient’s story to focus on, we were asked to watch a short video commissioned by the Chief Nursing Officer (Jane Cummings) entitled The Last 1000 Days, which was a poem written by a nurse called Molly Case. It draws attention to the importance that time can have to older people.  

Once you have survived childhood life expectancy rises, the longer you live the longer you can expect to live. In the western world, the average life expectancy is 79 years for men and 83 for women. Now imagine you are a 76 years old man or an 80 year old woman. What you have left is 1000 days – and how many of those would you want to spend in hospital. The Molly Case poem and film vividly brings this question home to the viewer. You can find it here.

Time spent in hospital for older people can be time lost from those 1000 days. 10 days in a hospital bed leads to 10 years of muscle wasting for those aged 80 years and over. This can have a detrimental impact on the persons mobility. Nearly 50% of people aged 85 and over will die in the year following their hospital admission. So getting people seen early, treated promptly and correctly and moved out of hospital, if not to their home, somewhere close to home is an imperative. Getting things right and getting things done in a timely way not only values and respects the importance of patient’s time, but brings value to the work of the nurses and other health care professionals. You can find out more about this approach here.

My temporary loss of hearing brought home to me not only the importance of recognising the gift of time and not wasting a single moment. It also made me think about the choices I make in making decisions. Last week I was fortunate in that I could ask a medical colleague to take a quick look at my ears and reassure me my temporary hearing loss was just that. Had I not been able to do so, trying to access such help through my GP or a Walking Centre would have been very difficult. Partly the difficulties arise from the demand pressures on such services and their capacity to respond to these demands. It was also partly through the choices I was making around prioritising my work demands over sorting out my health problems. 

Currently, I have just 390 working days left between posting this blog and starting my retirement. In order to make the most of these and hopefully continue to make a difference I am going to have to remain healthy and able. Waking up last Wednesday and not being able to hear frightened me. I should have taken time to get sorted straightaway and not worry about my work diary commitments. So I am determined to change that approach.

One of the things I love being able to do these days is hearing the stories of discovery, curiosity, happiness, challenge and success from my children and grandchildren. They are my Scheherazade equivalent (not in the traditional mythical sense of course!). And I want to continue hearing their stories for at least another 1001 nights - and absolutely for as many days and nights after that as I can too!

Sunday, 23 April 2017

Like a Virgin? I don’t think so: Nursing a need to develop a more authentic self

Yet again I travelled to London on a Virgin train where it was impossible to connect to the wi fi. Its a situation I find extremely frustrating. When I got to Euston (which did have free wi fi) my in-box was overflowing with the emails and messages I could have responded to earlier. I had begun to feel like Billy No Mates. When I later complained to Virgin Trains, I was fobbed off with absolutely facile excuses, which I found very patronising. It was not a particularly authentic and helpful customer service - but perhaps this was another secret not learnt at the Business School

I was in London to participate in a Nursing Midwifery Council (NMC) Thought Leadership Group. The group has for the last 18 months, been developing new standards for the education and preparation of nurses. It has been an interesting experience. The group is made up of representatives from across the 4 nations of the UK, and is composed of student nurses, clinical practitioners, researchers, services users and educationalists from all fields of practice. We have met on a regular basis in developing, challenging and refining each standard.

The new standards are aimed at ensuring that graduate nurses will be fit to practice and fit for purpose in 2025. Being ‘fit for practice’ and ‘fit for purpose’ has been a long contested concept. Attempts at both understanding what they might mean and how they might be measured have led to many reforms in the way nurses are educated and trained in the UK. Indeed, the work of the Thought Leadership Group is in part a response to public and political perceptions that the current standards underpinning nurse education today do not ‘produce’ nurses fit for either practice or purpose.

The NMC, defines fitness for practice as: being fit to practise requires a nurse or midwife to have the skills, knowledge, good health and good character to do their job safely and effectively’. It is a definition that reinforces their Code, which has been in force since March 2015. It sets out what nurses need to be able to demonstrate in order they can: prioritise people; practice effectively; preserve safety; and promote professionalism and trust. It is a good piece of work and something the group referred to as we developed each educational standard.

One area the group spent a great deal of time over was the notion of the authentic nurse. This was an idea that reflected the notion that the nurse as a person had to be credible, even though they might at times be fallible and human in the choices they made. So could a nurse who smokes really be authentic in promoting healthy life style advice? For me the answer had to be yes. The authentic nurse is someone who is able to draw upon their life experiences, and psychological capacities (such as hope, optimism, resilience and self-efficacy), and has a high degree of emotional intelligence. It is these attributes and insights of self that enable individuals to become truly authentic. 

In this sense the authentic nurse understands that they may have the knowledge (what happens when someone is having a coronary) and the knowing (how such knowledge should be used in providing treatment and care) but its in responding to the not knowing (how an individual is experiencing the heart attack) that is critical. So for me, authenticity arises from harnessing the knowledge and knowing, and that space in between - not knowing - in providing person centered care. 

Unfortunately at last week’s meeting we returned to this debate for rather sad reasons. We had received some early feedback that the term credible nurse (I lost the argument to use my preferred option of authentic) and it was suggested we revisited this element of one of the standards, as a nurse who was obese could never be credible. Now nearly 60% of men and women in the UK are either overweight or obese (as defined by a BMI over 25 and 30 respectively) – and we rank 3rd behind Iceland and Malta for having the highest rates of obesity in western Europe. 

Of course some of these people are going to be nurses, and whilst being obese is perhaps not a health promoting state to be in, it doesn’t follow that they maybe any less credible as a nurse than any other person. It is a rationale and response similar to the reductionist one dimensional view that Virgin Trains provided me regarding there being no wi fi on the train. I hope as the new standards go out for wider consultation in a few weeks time, that the responses we receive from the profession and the public are a little more authentic in their challenge.     

Sunday, 16 April 2017

A virtual reality experience that changed my view – really!

I hold a Non-Executive Director role at a local NHS Trust. I chair the Trust Boards sub-committee on Quality and Safety and I am immensely proud of the achievements of all of those who work so hard to ensure patient’s safety is put first and foremost at the centre of the care that is provided. Over many years I've been associated with the NHS, I have been exhorted on numerous occasions to look at how the airline industry has successfully developed an approach to quality and safety that many organisations could do well to emulate. And there is good reason to. There is only a 1 in 9785 chance you will die from a airplane crash, whereas there is a 1 in 7 chance of dying by heart attack or 1 in 672 chance of death occurring as a consequence of walking.

It’s safe to fly. Pilots spend many hours in a flight simulator so real that moving from the simulator to flying a real plane is relatively easy. The safety checks and routines are an all pervading part of every stage of a flight. The decisions taken by the pilot, and the equipment they use are all monitored and recorded. Quality on the other hand can be a different thing. I have experienced both the quality experience that is Business Class travel as well as flying with no frills airlines. However it was still a shock to read about David Dao, the 69 year old grandfather and doctor from Kentucky who suffered humiliation, distress, concussion and lost 2 teeth when he was dragged off a United Airplanes plane at Chicago airport last weekend. Undoubtedly and rightly so, there will be a court case with punitive damages being made against the airline.

I found quality and safety featuring large in my world last week. On Tuesday afternoon I was on the 8th floor of St James House in Salford. The view across what is a rapidly changing and rejuvenated city-scape of Salford to the Manchester city centre sky line beyond was wonderful. I was there to interview the short-listed candidates in the innovation category of this year’s Salford Business Awards. The University and Salford City Council have a long association with these awards, and this was the second year running I was asked to be part of the judging panel. It is a great privilege and I always find it very interesting to hear about the various innovations submitted for consideration.

Obviously I can’t disclose any details, it’s all confidential until the awards evening in May. However, a number of new ideas fired up my imagination – ‘cuckoo brewing’ was one. This is where a microbrewery use the facilities and equipment of another (and possibly rival microbrewer) to make their own beers, which I thought was fairly innovative; there was an happiness app that enabled a real-time snap shot to be taken of the mood of an organisations workforce; and a virtual reality facility that was being used to train people what it might be like to work in confined spaces like sewers and underground environments.

The later was pretty interesting but I wasn’t completely convinced that virtual reality could replicate real life in a way to make it, well real. That was until last Thursday when I took an hour out of my day’s meeting to visit the University's Octave facility. It was a totally engaging experience. The Octave is a fully configurable, immersive holographic experience which involves sight, sound and touch that can bring together people and objects in a single virtual reality. It is one of the worlds most advanced multi-modal research systems. The facility recreates 3D vision around and beneath the user, who become immersed in virtual realty world with the ability to move and manipulate any of the objects they see. 

It was fantastic. I was able to engage with a number of experiments, including one that tested peoples responses to vertigo – and the test was that impressive I found myself inching around a narrow ledge trying to keep my balance and prevent myself falling off and into the void below. It was heart poundingly realistic. The system can recreate many different environments using any available data such as building plans, street level images, 360 degree films and it can all be put together in a totally unbelievable way. My favourite experience was being able to walk around a virtual reality construction of the University campus whilst it was shrouded in fog. The campus was situated in the surrounding urban and country environment of Salford and Manchester and beyond. It was a totally different experience (and view) to the one I had seen from the 8th floor window earlier in the week, but just as exhilarating.

And whatever it is you are doing this Easter Sunday, I hope the reality lives up to your expectations!

Sunday, 9 April 2017

Embarrassed Zebra’s, Red Lips and Wheelbarrows

Do you remember that old Christmas cracker joke – ‘what’s black and white and red all over?’ Apparently these days the answer is ‘an embarrassed Zebra’, in my day the answer was ‘a newspaper’! And I have to say like the answer, I thought newspapers as we once knew them, were on the way out – killed off by the rise of on-line versions. Indeed, I've not bought a newspaper for many a year. Thankfully, one of my neighbours does and periodically, he very generously donates a pile of old newspapers so I have something to light my log fire with.

However, in a research report published in February this year, Neil Thurman (from City University) revealed that 89% of newspaper reading still uses the real thing, with just 7% on mobile devices and 4% on computers. His research showed that people who read print versions spent on average 40 mins reading the news per day, but for those reading on-line versions, just some 30 seconds a day! On-line versions have sometimes doubled or even tripled the overall readership of newspapers. The Mail remains the most popular newspaper in the UK, with some 30% share of the total market.

One of the papers I read last week was the Sunday Times, the South African version that is. I came across an article written by Mlambo-Ngcuka, who was South Africa's first female deputy president. Since 2013 she has headed the UN body charged with promoting gender equality and women’s empowerment. As well as discussing pay in-equality, she said that violence was the biggest challenge facing many women today. Across the world, 50% of female murder victims are killed by partners of family members. 1 in 3 women suffer physical or sexual violence during their lifetime and around 120 million girls worldwide (which is about 1 in 10) have experienced forced intercourse or other sexual acts.  

The article also reported on the global campaign aimed at stopping violence against women and in particular, sexual violence. The #RedMyLips campaign invites people to wear the brightest red lipstick (or ‘rock your red’) during the month of April (international sexual assault awareness month) both as a sign of solidarity and to raise awareness of the issues. You can find out more about the campaign here – and the campaign welcomes both men and women to take part, joining together in speaking out and making a difference. Whilst the majority of rapes (90-98%) are committed by men, men and boys can also be victims of sexual assault, abuse and rape. 1 in 6 boys experience sexual abuse before the age of 18 and 1 in 33 men will experience rape or attempted rape in their lifetime.  

And last week I took time to read the European Medial Journal – whose March cover was Black, White and Red – this is a journal that both publishes curated material alongside original papers. They would not be afraid to publish hard hitting articles. However last week they were one of the many on-line news sites who picked up on the Marmite story. You either read it or you didn’t – loving Marmite is a black and white issue. Me, I am in the ‘loving it’ contingent and try and have Marmite every day.

It appears that eating Marmite is good for you. In a recent study one group were given Marmite every day the other group peanut butter (I have both together on toast – sometimes with cucumber too). The study showed that the group who ate Marmite had healthier brains than those who only ate peanut butter. The science behind this is that Marmite appears to boost levels of the neurotransmitter gamma-amino-butyric acid. Importantly this acts to reduce anxiety. Marmite has 116 times more vitamin B12 and 3 times vitamin B6 as peanut butter. While Marmite maybe a quintessential British food, it has always been associated with a ‘love it or hate it’ debate.

As I have already said I love Marmite – equally I love the famous 1923 Red wheelbarrow and white chickens poem written by William Carlos Williams, the first line of which seems poignantly important in the context of the #RedMyLips campaign:

So much depends

a red wheel

gazed with rain

beside the white 

Sunday, 2 April 2017

Captain Midnight: An Old and Young Father in Time

This is the 3rd morning a row that I have woken up feeling exhausted. I think I have slept OK, and my Fitbit seems to suggest that is the case too. Having woken up I feel I could just roll over and go back to sleep. However, by then, as my fellow blogger Lynn, might say, my 'whizzy brain' has fired up, and despite being tired my mind has already started the day’s journey. And as most regular readers of this blog will know, my Membership Card for the #earlyrisersclub say's 05.00 start!  There can be many reasons why people have troubled sleep and just as many cures for sleeplessness.

88 years before I was born, a young Frederick Winslow Taylor was inventing a sleeping harness that he felt would keep him on his stomach while he slept. He suffered with nightmares, and believed that the device would help him sleep peacefully throughout the night. Taylor was famous for his work on how to make organisations more efficient. His ideas around mass production and how organisations can do repetitive tasks more effectively are still in use today. For example, McDonalds provide an almost textbook case study of Taylor’s theory in action. He is known as the Father of Scientific Management.

Nathaniel Kleitman on the other hand, is known as the Father of Modern Sleep Research.  28 years after Taylor published his 144 page monograph on the Principle of Scientific Management, Kleitman published his seminal work entitled Sleep and Wakefulness. Kleitman was a phenomenal scholar. He was just 20 (and penniless) when he emigrated to the US. 8 years later he had gained his PhD from the University of Chicago, where he continued to work on improving our understanding of sleep and was responsible for introducing the concept of rapid eye movement (REM). Much of his early work was sponsored by the Wander Company, the original manufacturer of Ovaltine.

Many nurses of my generation will have a special place in their heart for Ovaltine (along with Horlicks), it was a favourite drink of those working on night shift. Allegedly nutritious, it was seen as a healthy drink that could also help you sleep when nothing else worked. Curiously, Ovaltine sponsored a TV show in 1953 called Captain Midnight, which ran for some 40 episodes and disappeared from our screens a year after I was born. Captain Midnight got his name as he was often on a mission to save the US until that time – we don’t know if he suffered with insomnia or that was just how the missions went. Interestingly, for the time (and still today), this TV show about a male superhero, always scripted women as equals and not just as characters waiting to be rescued!  

Someone who did eventually need rescuing was the philosopher Nietzsche. Just like me, 73 years ago he was also struggling with sleep. Unlike me, he was taking opium as a way to help him sleep. He once observed that 'sleeping is no mean art: for its sake one must stay awake all day'. When that day begins and ends also seems to be important to our health and wellbeing. 20% of us are 'Night Owls', 10% are 'Larks' (most people are somewhere in-between). Now it seems that the 'Larks' have the edge when it comes to good mental health and wellbeing. As a group they report more positive feelings of wellbeing, are more conscientiousness and procrastinate less.

I do like the quietness of an early morning, which gives me time to think. 'Night Owls' on the other hand sit up late with their thoughts, reluctant to go to sleep and leave their thoughts alone by themselves. Not good. I don't follow an exercise regime, but I do take Cello, my 'ever eager to walk' dog out for 30 minutes for a walk at east twice a day. A 2014 study by Jacob Rosenberg explored the differences in peoples chronotype. A person's chronotype is the propensity for them to sleep at a particular time during a 24 hour period. He found that 'Night Owls' were more vulnerable to depression, and tend to indulge in health harming behaviours such as smoking, and/or drinking too much alcohol. 

'Night Owls' might also appear to struggle to get enough hours sleep, on average thought to be 7-8 hours a night. Going to bed late and then having to get to work for 09.00 can be difficult to manage with family responsibilities and commutes to factor in. However, it’s not all bad news for ‘night owls’. The evidence suggests that they tend to be smarter and more creative than 'Larks'. And whilst I might be struggling with my sleep patterns at present, I can't help but smile when thinking about my youngest son Joseph. He is now known as the Father of Carys Anita, born at 03.40 last Friday. My advice, for what it is worth, you might have at least 21 years of troubled sleep in front of you. And if that proves to be the case, Tesco have 50p off a jar of Ovaltine right now - enjoy!