Sunday, 27 October 2013

Catching up.... Lessons for me from 'popular' reading in nursing

I have spent this evening catching up on work-related activities including reading some of my Nursing Standards (NS). Lessons learned (and for my international colleagues, I hope this will give you a flavour of what's current in nursing practice just now):

  • The Safe Staffing Alliance is a group of senior nurses who have come together through NS and is encouraging MPs to back their campaign message. The Alliance believes that care is unsafe in wards where staffing ratios fall below one nurse to eight patients. This 1:8 ratio is based on significant evidence. One UK hospital at least is displaying staffing levels in wards (Salford Royal NHS Foundation).
  • Fitness to practice is an issue that is of relevance to all of us working with nurses in Higher Education (HE). According to a survey conducted by NS, over 800 students had to go through disciplinary processes at their universities in the past 3 years. The problems are varied ranging from allegations of plagiarism, unprofessional behaviour in practice placements, and criminal offences. What is highlighted within the news report is that there is not a consistent approach to dealing with misconduct across the UK - and will also depend on the stage of learning that the student is at (for example, taking a staged approach to plagiarism offences).
  • Draft guidance on lifestyle weight management services has been developed by NICE (National Institute for Clinical Excellence). One of its key messages is that training would give nurses the confidence to tackle concerns about weight with patients, and to manage expectations associated with weight loss. Is this something that we focus on enough in our undergraduate nursing education?
  • An interesting article about the Keogh Review (which reviewed the quality of care and treatment across a number of Trusts in England) demonstrates that, with true leadership, the outcomes can energise and motivate staff. The process/outcomes can validate the concerns that staff had felt (and maybe hadn't been able to express?) and can enable a focused approach to be taken to the concerns that were raised. Steve Hams is the new chief nurse at Medway NHS Foundation Trust and has used the outcomes from Keogh to work with staff in very positive ways.
  • Finally (amongst many other interesting articles), Beverley Braithwaite's and Asanka Daynananda's article on the use of social media for learning in nursing education struck a cord for me. As with most universities, theirs uses online learning for a variety of reasons (PDP, e-workbooks, online drug calculations, discussion forums etc). What seems to be the innovation here is that they actively encourage students to bring their devices into the classroom so that they can engage with online learning insitu. I am not sure that they focused in on the use of SoMe so much as online learning through their virtual learning environment, but I would suggest that we need to trust students more and not see their use of mobile technology in the classroom as a threat to learning.
These were just some of the issues that I found to be of interest and which have provoked some reflection on nursing education and practice. I have found that writing the blog has enabled me to think more deeply about these topics as well (ever an active learner!).

Finally.... a plug. I am childishly happy that my first book has been published! My edited book will, I hope, be of use to students and lecturers alike. It is called 'The Essentials of Nursing and Healthcare Research' :)

And now just a photo that I took as I make myself a bit more at home 'down south' - loving the mix of old and new alongside the hustle and bustle of river life.

Thursday, 12 September 2013

A Monster Calls: Using literature in education

I went to NET2013 (Network for Healthcare Education Conference) last week. There were good keynotes and many excellent presentations from colleagues from across the globe. I want to write about one of the sessions by Kate Powis a lecturer and researcher from St Helena Hospice. She told us about a book that she uses in her teaching of practitioners about bereavement in young people. It's called 'A Monster Calls' by Patrick Ness and is about Conor, a boy whose mother is dying of cancer who meets a monster who wants Conor's 'truth'. It is an amazing book with atmospheric drawings which have been highly acclaimed and I loved the feeling of holding the book in my hands. For me, though, the written story was what made the impact. I wept as I came to the final part of the story and could really see how young people may find strength through its reading.

Some of the messages that came to me through its reading (and I promise not to give the story away as I want you to read it too!) were:

- the difficulties that some young people may have with their peer relationships when their home circumstances are so different to those of their friends.

- the beautiful love of a mother for her son expressed in ways that may not be easy to understand until much later.

- the way a young person might be treated as 'different' by their teachers and how this can make a person more vulnerable than they already were.

- the way in which young people might keep their feelings hidden - feelings that need to be discussed so that misinterpretations are avoided.

- the way that anger is expressed and then perceived by others, but that the anger is about something totally different to what it has been directed to.

- the need for all of us to talk to our children about loss, bereavement, death.....

I am sure that if you read it you will find many other things. I will read it again. Here is Patrick Ness talking about the book on the radio.

Kate has invited me to go along to one of her sessions where she uses the book as an educational tool. I look forward to being inspired again.

Tuesday, 16 July 2013

A blog post-bereavement: Briefly sympathetic

It has been quite some time since I have written for my blog. The gap relates to a bereavement and I have felt that I couldn't put 'pen to paper'. As you read on I will be interested in your reactions. I imagine that you will think that I have lost a close relative given that I have needed some time away from writing publicly. But no, my friend and colleague is the person who died. I met him just over 15 years ago when we both started on our first day on a new job. We connected immediately and regularly met for coffee, at the photocopier and in passing to discuss our work, our studies, our children and our lives. He was very important to me and I was privileged when he did my leaving speech - a personal and direct account of our friendship. What has been interesting to me is that his death has played on my mind every day for the past few weeks - in ways that I have not experienced before. There are lots of reasons for my reaction, but from an intellectual perspective I have been fascinated by the reaction from others. Yes, people have been briefly sympathetic. When I told my other friends or family they expressed concern, checked whether I was ok...... and then mostly never mentioned it again. Strange, because what I wanted to do was to talk about him and about what he meant to me - and about the gap that he has left in my life. But I feel that I don't have the 'right' to feel this, or the 'right' to keep talking about it. I think that this is partly that our friendship was very much located in the workplace rather than in social situations, but I do wonder whether the reactions would have been very much different if we had enjoyed social situations together.

So, what about others in similar situations? In 1996 Walter's article clearly articulates the need for 'conversation' to facilitate the process of bereavement and the embedding of the memory of the person into our ongoing lives. However, I have struggled to find other literature that tells me something more about the process of bereavement in my kind of situation. There is lots about adolescents, siblings, elderly, HIV, grief generally - but (in my brief search) nothing more about the specific situation I have become interested in. I guess that's all I really needed to say or do - the thinking and the writing down of those thoughts. But when I think about nursing education, my one particular situation does raise questions about how we discuss people's reactions to grief and how we ensure that nurses are not afraid to broach the subject with patients, relatives, colleagues and (hopefully) in their own personal lives.

I finish here with a quiet tribute to my friend and know that I have embedded his memory into my ongoing life.

Tuesday, 21 May 2013

International Council of Nurses - conference musings

I am currently attending the International Council of Nurses 25th Quadrennial Congress in Melbourne (yes, I know how lucky I am). I attended the opening ceremony - a time for all countries represented in the ICN to be recognised. The ceremony really brought home to me the fact that the RCN has chosen to leave the ICN. While I appreciate the reasons, I have been reflecting on the need for nursing to engage in the global context for the benefit of the profession, of nursing education and practice, and for the continued development of patient care. There are many ways to engage globally - through international organisations such as the ICN, through networking with professionals - conferencing, study tours, SoMe, etc. 

The opportunity to spend time at this conference is one that I take seriously - like everyone else attending, I am continually thinking about how the learning and the interactions with colleagues have the potential to impact positively on my own practice in nursing education. So far, these are some of the ways that I can relate the learning to my own practice:

* Confirmed my view that education around leadership - applied to the context in which the student operates - can enhance patient care through the further development of teams, personal skills, and self-awareness. I am working with colleagues on the development of a leadership course for practitioners, and I will take home some of the approaches that I have seen here to complement our thinking so far.

* Hearing an inspirational leader such as Leslie Mancuso from Jhpiego passionately convey messages about how nurses are doing amazing work as advocates for women in developing countries leads me to think about how some of that passion can be better conveyed to our students. Providing examples about how nurses can make a difference to (in this case) women's health (and the lives of their families and communities) could be one way to bring to life the extraordinary work that is going on. The key word for me when I heard Leslie speak was 'compassion' - without compassion none of these activities would be taking place.

* There is a need to enhance the international/global perspectives in nursing within our education - helping students to really appreciate the global challenges, how our health context differs (and shares similarities) with other countries. Lots of different ways to do this through sharing of stories, visits to contribute in some way to the 'other' organisation or context, etc.

* Is there a need to help students to be better social activists with greater political awareness? I have been very interested in some of the presentations where nurses have demonstrated commitment to advocating for others - usually in very challenging situations. Are our students politically astute? Do they need to be? I would suggest that with the increasing politicalisation of nursing, it is vital to have skills that enables the profession to have grown-up conversations with policy makers, the public and others with a vested interest in the profession.

* The growing use and impact of SoMe on the nursing profession - through blogging, Tweeting etc - providing more access to resources, creating connections across the globe, enabling debate and the sharing of practice. Are we preparing our students for this virtual world?

These are some early thoughts - lots to digest and form views on. Like many others here I have formed new connections, planned other meetings and gained collaborative writing opportunities - broadened my horizons!

Sunday, 12 May 2013

International Nurses' Day

Celebrating IND is important for the profession and for raising further awareness more widely about the roles that nurses play in healthcare. I have had a perfect couple of weeks - allowing me to reflect positively on all things nursing.

Firstly, I attended the Student Nursing Times Awards where I was privileged to present the award for partnerships and where I watched the inspiring students, practitioners and lecturers celebrate their successes. What was evident was the focus on compassion, the focus on the patient, and the focus on the student as a learner. When we hear the negative publicity surrounding nursing, it is good to take the opportunity to surround oneself with the most positive and most compassionate of people. I really will need to make sure that I am there next year so that I can celebrate others' success again!

My second experience was at Westminster Abbey to celebrate the life of  Florence Nightingale. I was able to attend as a previous leadership scholar with good friends that I have made through that maxing experience. What I saw were nurses from all walks of life proudly walking into Westminster Abbey to celebrate both Nightingale's life, and the work that nurses do on a daily basis - their work and that of others. I was caught off-guard when Jeremy Hunt walked into the Abbey to take part in the service, but encouraged to hear the voice of nursing in the address telling it like it is - look at staff ratios, reduce the paperwork etc....... I sincerely hope that Hunt was listening!

All of these points of contact with the nurses who inspire us all grounds me in the knowledge of the fantastic practice that goes on. What I do know though is that we all need to keep doing better. I believe that we need to persistently ensure that our voice is heard at policy/government level in ways that help the politicians to truly understand what it is we do everyday. I think that we can do this constructively without being defensive - and I think this because I have never heard any of these brilliant nurses that I
was referring to say anything other than that they want to continually improve the experiences of patients. One final event that I attended really made me think about my own experiences of nursing and how these relate to the debates that go on about compassion in nursing - I may write more about my personal thoughts as I am still reflecting! Professor Jill Maben presented her inaugural professorial lecture where she talked about her personal nursing journey and the research that she has done around compassion. What she has clearly demonstrated is that it is the environment, culture and other staffing issues that are most important in a nurse's expression of compassion in practice - those who work in cultures that allow them to enact their ideals are most likely to deliver compassionate care all the time.

So I finish by saying happy International Nurses' Day to all of you who are working in practice, educating students, and engaging in compassionate care in so many different ways. Let's all resolve to get our voices heard in constructive evidence-based ways that allow the discussions on compassion, values etc to evolve in ways that will make long-term differences to patient care and to the environments that nurses work in,

Saturday, 27 April 2013

Inspiring belief: the compassion that exists in practice

Like many people, I was inspired by the wonderful speech and poem thatMolly Case did at the recent RCN Congress - it has gone viral. What she articulated (and I don't think that anyone else has done this so far in such a powerful way) is that nursing students are compassionate; that they care about what they do every day, even when they find the requirements of compassionate nursing practice challenging; and that perhaps some of the people who are making policy decisions about nursing education do not understand the realities of practice, and the amazing work that nursing students do each day. Now, please do not think that I am complacent. As a nurse educator I am passionate about continuing to enhance nursing practice through ever-improving nursing education. There will always be things that we can do to improve the way we (by we I mean educators in universities and in practice) educate students. I also believe that with the changing demands in nursing, there will always be a need to continually evolve how we select students who are going to be the 'right' ones for the evolving context in healthcare. However, what I do believe (and this belief is based in evidence - for example the NHS Education for Scotland annual survey that is completed with students, mentors and charge nurses for HEIs and their practice partners to learn more about perceptions of our students as they enter newly-qualified practice; and based on experience of working with students) is that most of the people who choose to enter the nursing profession do so because they believe that they have the intelligence, the characteristics, and the behaviours that will enable them to make a difference to patients and others that they work with. I am interested in understanding more about the place that previous experience plays in students' subsequent performance on nursing courses. It seems intuitive that experience of some sort in health or social care should help with decision-making about right choice of career. However, my own PhD research did not reflect this. Although the study did not focus specifically on previous care experience, what I found from some of my respondents was that previous care did not necessarily lead to right career choice. We need, of course, to find a balance between ensuring that people are helped to make the right decision in relation to course and career, and that we as selectors of student nurses have the information that we need to make the strongest choices that we can.

As readers of the blog will know, I am not a fan of the one-year HCA pre-nursing idea. I am a fan of continually focusing on building the selection evidence-base so that we can make the best decisions for the students, for the educators and - most importantly - for the patients and others. There is a great deal of work going on across the UK in relation to this important area - let's make sure that we gather the evidence, learn from each other and help students to feel valued in the process. As Molly says in her speech, it is discouraging to hear the negative comments (on an almost daily basis) about nursing and nursing education. It would be great if politicians and the media noticed, reported on, and used the evidence to appreciate that compassion exists in bucket loads in our student nurse population!

Sunday, 7 April 2013

Where did all the compassion go (a question to the government)

Like everyone, I feel senses of anger, shame, sadness and bewilderment at the findings of the Francis Report. As we have seen in the media and elsewhere, this sense if bewilderment prevails. As I was asked when I was interviewed by BBC Radio Essex - why does it need someone to tell a nurse to offer a drink to a patient (and then to make sure they can drink it). The implication is that many 'nurses' are ignoring the needs of patients purposely. Is this the case? I really hope not.

At the same time as we have a government who is bemoaning the lack of compassion within the nursing profession in particular, I have spent the past week wondering where their compassion for our society has gone. Let's take the issue of welfare and look at some of the views expressed:

Osborne's view that the welfare state has somehow funded the 'kind of lifestyle, that Mick Philpott led - as though there is a particular kind of lifestyle that leads to mass murderer. I am loath to promote the Daily Mail, but their headline says it all in relation to a particular view that is held about welfare by some in this country. and don't even get me started in the terminology used in relation to him being a father ('bred' the children). The government seems to see fit to blame the 'system' for Philpott's crimes (in my view because he represents to them what they most dislike in society more broadly) while conversely blames the individual for wealth-related issues such as lack of employment, poor nutrition and other inequality related areas.. A complete lack of compassion for the people in society who need help sometimes.

As a welcome counter-balance to the government's current messages, the following article puts right some of the falsehoods that are fed to us through the media (such as the Daly Mail) -'Separating fact from fiction'.

So - how to relate this to nursing education? Firstly, as people responsible for educating students in practice and/or university settings, we need to be informed and educated ourselves so that we understand our own views in ways that relate to the patients (and others) that students work with. Secondly, a call for compassion within healthcare is absolutely right - the many nurses and other healthcare professionals who care every day demonstrating compassion in challenging circumstances would agree with the current emphasis on ensuring that we are person-centred in our interactions with patients. Role modelling is vital in healthcare - where there is compassionate leadership, there is likely to be compassionate care. So let's hope the government realises this before too long. At the moment, there's not a lot of compassion evident in the voices that we hear in the leadership of our country.

Sunday, 31 March 2013

Re-connected! (On so many levels....)

All I can say is: 'Hurrah!!'. I am now re-connected to the internet at home after a number of weeks without access. Who would have thought that the internet is so important in a life (my life). I have recently moved 'down south' from Scotland as I have started a new job. The biggest challenge has been in getting the internet into my home. Anyway - I now feel connected once again to my friends and colleagues (having said that, my social calendar has been anything but quiet since I got down here).

I am now at the end of week 3 of an exciting new role at Anglia Ruskin University. In those three weeks I have met many of the academic staff, some of the clinical colleagues that I will be connecting with, and the people who work to support the students across the university. I have also had a live radio interview with BBC Radio Essex (my first foray into live radio!) in which I was asked why student nurses are too posh to wash, where the compassion has gone, and the HCA question (i.e. do I think that people who are accepted on to pre-registration nursing courses should undertake a year as an HCA - NO - of course not!). The interview is only available for a couple more days, but it was good to get a perspective across that balances the government's approach (I hope!). It was a day of media as one of our students had been asked to be interviewed on the same subject. I spoke to this student - a most eloquent, informed and sensible woman - proof that compassion is alive and well within our student body.

It is exciting times for me personally as I move into a totally new context (the England health context is very different from that of Scotland's). I feel enthused and excited by the things that I have heard - the commitment to making a positive difference in education and practice. I look forward to understanding the health and social care situation in more depth as I connect with people down here.

Saturday, 2 February 2013

New Year's resolutions?

Blogging should be a regular habit, but it's one habit that I have been remiss in keeping up as I moved into the new year in January 2013. I told my Principal that I planned to blog when I first started out as he is a regular blogger and he emphasised the need to be regular in writing. Well, I haven't managed it recently but a new iPad provides me with easy access to the tool to do it. No more excuses!

In thinking about the blog, and reading others' blogs, I have considered how it should be focused as I progress with it. Should I be using it in the capacity of a nurse educator's diary? Or should I be making pronouncements about nursing education? Or something else altogether? I've concluded that I should just go with the flow and not worry too much about it! So, I start afresh and will learn as I go along. As before, conversation and debate is welcome.

Returning to one of my favourite topics - compassion in nursing and healthcare education remains a talking point amongst practitioners and the media, with pre-registration education remaining at the forefront of the debate. The article in the link focuses on the selection of students for the profession - important but we should not be aiming to recruit fully-formed nurses. We should be selecting for potential. And yes, I do believe that compassion can be taught. Of course each person must have the innate characteristic in some form, but through an educational process the demonstration of compassion can be developed. I know this because I have seen it - debating with students about the place of the so-called 'softer' aspects of practice with a growing understanding and appreciation of the difference that a compassionate approach makes to the patient experience. The honing of compassionate skills is challenging and I personally think it is a lifetime's work to continually grow both personally and professionally in this respect. A place for further research I think - particularly with the changes to nursing education.

I am fortunate to be attending the NES Research and Innovation in Recruitment and Retention conference on 21st February where I will be presenting the findings from a project that investigated selection processes for nursing and midwifery education. I look forward to the debate around a topic that is so important to us an educators - particularly the issue of recruiting for values/compassion.

And so, I have restarted my habit of blogging. I aim to mimic some of the regular bloggers that I read and keep going now. Thank you for reading.