Learning through writing 2: Fitting in?

Following my last blog on Bourdieu, this posting focuses on another article that has Bourdieu at the heart of it (still waiting for Distinction to arrive......).  This one was recommended to me by my colleague who knows Reay's work well, and I plan to provide a simple overview of the key points (as part of the learning process!).

Reference for the article:
Reay, D., Crozier, G. and Clayton, J. (2009). 'Fitting in' or 'standing out': working-class students in higher education. British Educational Research Journal, iFirst Article, 1-18.

• Students who enter higher education (HE) come from a range of socio-economic groups. 'Widening participation' has been on the government's agenda for some time now.
• Retention and success of students is important for a number of reasons (social, economic, cultural, personal, etc), and with widening participation has come an increase in attrition rates.
• There are differences between universities in their ability to attract students from working-class and minority ethnic backgrounds. Prior attainment is not the only reason for lower numbers accessing HE from these backgrounds in certain universities (Russell Group). Still, even the post-1992 universities are not as successful overall as they might like to be in recruiting the numbers of students from these backgrounds.
• Race, social class and gender impact on the way in which students access and experience HE. This article focuses on class whilst acknowledging that race and gender are important mediating factors. The research uses the concept of 'institutional habitus' to explore these experiences.
• Habitus:
• dynamic concept
• 'a rich interlacing of past and present, individual and collective'
• adaptation to external influences leading sometimes to change
• social context key to behaviours and characteristics
• institutional habitus reflects these points but are less likely to change than individuals due to the size of the organisation
• 'Expressive order' of the HE is important to the case studies under investigation in this research and this relates to expectations, conduct, character and manners - 'embodied cultural capital' (we can see it in the way that students dress, how they behave, how they view their learning and their level of confidence in the world of HE).
• The research: undergraduate students, aged 18 or over, working class backgrounds (defined through the ONSSEC); mixed methods; 4 different kinds of HEIs; different degrees; questionnaire, interviews; habitus and field were used as sensitising concepts in the data analysis phase.
• Findings:
• institutional habitus impacts on the ways in which class has an effect on student experiences including how the students see themselves within the different kinds of HEIs.
• Staying close to home geographically and academically had its benefits (safety, reassurance) but means that the process of transformation through the educational experience is not as stark as in those students who went further afield for their education (both in geographical and academic terms). 
• When students attended HEIs within their 'comfort zones', they may have felt accepted, but may have taken a more instrumental approach to their education.
• Living in halls (rather than at home) appears to impact on the ability of students to integrate into the social and academic aspects of university life that are on offer - relating to the institutional habituses.
• Those in paid work and with family commitments were less likely to take on the strong learner identify that others who could commit more time to the whole student experience. These factors impacted on the students' identities as academic learners.
• The students who managed to 'fit in' socially whilst also 'standing out' as different were the ones who, unsurprisingly, were most successful.
• Working class students who enter into elite HEIs may face both academic challenge (like their counterparts) as well as 'identity work' - where their habitus comes into contact with a very different field to the one(s) they had been used to.
• The most important message is that inequalities persist, with working class students being less likely to make it into elite institutions.

An interesting article - an area where there is still much to be done. As before, the work of Reay et al resonates with the findings from my PhD (although I didn't investigate social class as such but knew from my data that the overwhelming majority of the students were first generation university goers). Further thoughts on Bourdieu will follow once my book arrives.

To carry on my theme of including a photo - this is another taken in France and I imagine this (somewhat tentatively) as a hard slog to get the top - reflecting what it may feel like for some working class students who enter into HE. 

Learning through writing 1: Easing into Bourdieu

Here goes. In my last blog I promised myself that I would write about areas of theory (or practice) that I feel that I need to know more about (that will be everything then!), and through that process both learn and engage with others who hopefully will help me think about the things that I write about. I also plan to consider the relevance of my reading to nursing education.

I am starting with Bourdieu. The reason for this is that I 'used' some of his theory in my PhD - I used it quite well but as I have read more, I realise that I didn't get to the depth of his work. I have ordered Distinction: A Social Critique of the Judgement of Taste today but am easing into my reading with a critique of this work (possibly the wrong way round to do this). The article's reference is:
Murdock, G. (2010). Pierre Bourdieu, Distinction: a social critique of the judgement of taste. International Journal of Cultural Policy, 16:1, 63-65.

What does the article tell us?

• Bourdieu was born in 1930 in rural south-west France.
• He was the son of a postmaster.
• He was successful in gaining a place in an elite higher education institution in Paris.
• Coming from provincial France, he was thrust into this cosmopolitan lifestyle in an era of importance for Paris - as the cultural and intellectual centre of the west at the time.
• These differences - between what he had grown up with and what he was coming to know in his academic city life - led to his lifelong fascination with culture, class and power.
• He approached this fascination through a body of empirical work that investigated cultural practices and institutions.
• His military service was in Algeria after which he stayed on to train as an anthropologist - he investigated the Berber culture (apologies for the wikipedia link); the ways in which the organising principles of their culture were perpetuated through the rituals in their lives. He recognised that the 'modernisation' that was taking place was impacting negatively on the cultural lives of the Berbers.
• As the Director of Sociological Studies in a university in Paris, he went on to focus his research on continuity and change in modern France. His time here coincided with the shift from industrial production as the valuable asset, to education and intellectualism as assets.
• What he recognised was that education favoured those from the middle and upper classes, rather than those from working classes (social privilege).
• He then went on to identify that those from the working classes did not feel 'comfortable' in environments such as museums. 
• In 1979, Distinction was published and confirmed him as the leading social analyst of his time.
• Cultural preferences are derived from the experiences and input one has in families, education and other social situations.
• These are habituses and are not fixed (as we can gain capital in different ways as we progress through life) but impact on how we behave and feel in different circumstances.
• "Class positions are defined by holdings of social and cultural capital as well as economic assets." These relate to the distribution of power, and generate views of what constitutes 'low' and 'high' culture - resulting in inequalities in what are perceived as personal qualities, and is an act of symbolic violence.
• There are inherent barriers to cultural participation arising from these class positions and the 'amount' and 'types' of capital - thus excluding (often self-exclusion) people from particular situations.

So, how is this information relevant to nursing education? My own PhD seemed to indicate that there were problems with the way that some student nurses were able to engage with university education because of the differences in cultural preferences - many of the students in my study were first generation university goers and were therefore coming into a situation about which they may have had little or no experience or preparation. The power in the relationship described here is likely to have sat with the academics and others in the university rather than with the student - in these particular circumstances. I will leave it here as I want to explore the concepts further before I go on to consider the implications in more depth.

A bit of a tentative connection - but here is a picture of a beautiful village in France which I visited with my family a couple of years ago.

Learning through writing

I haven't written on my blog for quite some time. I haven't been able to find a focus that I could consistently follow through. This weekend I had a conversation with my husband who happens to be a sociologist. I was telling him about a conversation that I had had with a colleague who knows that I write about social capital and who then asked me from what perspective I write. I was able to answer him (Putnam's Bowling Alone). But I also refer to Bourdieu's habitus (a non-academic link provided here). It made me think about how we refer to and use the work of others. In hindsight I am not sure that I know enough about Bourdieu to be talking in-depth about his work. And my hermeneutic phenomenology in my PhD (based on Heidegger's and Gadamer's work) is based on a detailed and committed approach to understanding, but does not scale the heights of true understanding of their philosophical perspectives.

I am therefore going to use this blog as a learning tool for myself. I plan to read and engage with the thinking so that I can make more sense of the difficult concepts - ones that I sometimes avoid on the basis that they are so challenging (not a great thing to admit as an academic!). I really hope that anyone who is still linked into this blog will help me in this learning journey. I am sure that by engaging in discussion, as an active learner I will benefit. If you wish to participate in anyway - by commenting or by writing a guest blog on an area of mutual interest - I would be delighted!!

I choose also to share some pictures that encapsulate some of the important messages in the learning. For me, this picture of my daughters and two of their cousins illustrates the importance of the connections we create in our lives (and I simply love the picture as it makes me smile).

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.

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.

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.

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!

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,

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!

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.

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.

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.

Compassion
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.

Back from Malawi.....

I have been remiss in keeping up my blog over the past few weeks - partly due to the lack of internet connection for some of the time that we were in Malawi. I thought that some readers may be interested in what we achieved, and some reflections on the overall experience. Our Scottish Government International Development Fund project focuses on the provision and retention of midwives in rural areas of Malawi. The achievement of the MDG-5 is an ongoing priority for the Government of Malawi and there continues to be real concerns about the maternal and infant mortality rates as described in this in-depth country analysis. The Government has introduced a new cadre of midwifery workers - the Community Midwifery Technician (CMT) - whose role focuses on midwifery care in rural areas. It is an 18-month programme and the first cohort of students has already completed.

The purpose of this most recent visit to Malawi was to undertake a syllabus review of the CMT programme as there had been some recognition of potential 'gaps' in the learning. In addition, we had been asked to work with the Colleges and the NMC, Malawi to develop a learning package for mentorship as there is an urgent requirement for these CMTs to receive mentoring as students and as newly qualified CMTs. We achieved what we set out to do, and the documents are with the Ministry of Health in Malawi as we speak. From a  personal learning perspective it was an amazing trip that taught me as much about myself as it did about the context that we were working in. We facilitated the sessions with colleagues from the Colleges and from the NMC and worked hard to ensure that the outcomes and outputs were what the people in the room were looking for and what they thought would work. The cultural learning for me was immense having never worked outside of Europe, the States and Australasia.

It is a three-year collaborative project with our Malawian collaborators taking a leading role in its monitoring and evaluation. I look forward to what comes next and hope that together we can make a difference in a small way, but with potential for learning more widely.

Midwifery in Malawi

I am on my way to Malawi (currently delayed in Ethiopia) for my first trip for a project which we are doing in partnership with University of Aberdeen and Ministry of Health Malawi. For this trip we are undertaking a curriculum review of the Community Midwives Training in collaboration with the Nurses and Midwives Council of Malawi (and other stakeholders). In addition, we are working with colleagues to develop a mentorship programme - both for those supporting the CMTs currently, and for integration into existing educational programmes with the aim of building capacity and capability. Maternal and infant mortality is still a real problem in Malawi - particularly in rural areas where the focus of this project lies. Ideally the Ministry of Health and the NMC are hoping to recruit and retain qualified midwives in rural areas so as to improve the mortality and morbidity.

It is going to be a fascinating week - one where I will personally experience many different things, not least my first experience of Africa. If anyone is reading this who has experience of similar work, I would be delighted to hear from you.

Patient-satisfaction or person-centred leadership?

We are all engaged with policy that emphasises person-centred care (for example, The Health Care Quality Strategy for NHSScotland). Reflecting on some of my previous posts, and the national focus on care, I am interested in unpicking what we mean by person-centredness when we work with students. Clinical leadership aims to create the conditions where person-centred care can thrive and the Institute for Healthcare Improvement discusses leadership within this context in its bulletin this week (for those who are not signed up to it, I recommend it as a forum where useful discussion and debate takes place). Morag Bisognano is the President and CEO of the Institute (and someone that I have seen present a couple of times - a good example of leadership impacting in practice) and writes in an article, "Perhaps the central questions for leaders are: What really matters to patients and families? Is our organization engaged in patient-centred leadership or patient-satisfaction leadership?" The general thrust of the argument is that when we are focused on achieving 'good' patient satisfaction, we may miss out on the issues that really matter to patients and families and may impact on improvements (where patient-centredness is not also a key driver). Some may feel that this is a matter of semantics, but I believe that the use of words reflects complimentary but differing philosophical perspectives. The measures of satisfaction are usually determined by professionals whereas person-centredness puts the patient (rather obviously) at the centre of any conversation about care. If we help our students to appreciate the need to genuinely listen to patients and families, and enable them to develop the skills to do this, we will push forward person-centredness as the way of being as a health professional.

Start of semester - and enthusiasm for learning

It's the start of semester - my second favourite time of the year (the first being graduation as I love seeing the students walk proudly across the podium to celebrate their achievements). I met with three of my dissertation students to get to know them a bit, discuss expectations (theirs and mine) and to work out how we can work together (and individually) to achieve their ambitions (they all want to achieve first class Honours degrees, and more importantly they are very clear that they want to make a difference to patient care). I always come away from these kinds of sessions feeling enthused and motivated - firstly, the women that I met are all seriously focused on achieving all they can and to enhancing care. Secondly, as a teacher I learn something from my students whenever I come into contact with them. The three of them are all going to be exploring very different subjects and I know that the learning journey for us all will be fulfilling and rewarding.

As a consequence of this meeting, I reflected (again!) on the issues surrounding poor care and the 'blame' that is sometimes laid at the door of pre-registration nursing education. Without going into the latter issue again (although I am sure that I will touch on it again as I am about to be getting involved in some interesting work around values-based selection of students), I am very interested in what sometimes happens when nurses have been in particular practice situations for a period of time. Do they really change their outlook and their approach to care? Do they move on from areas where poorer care is experienced thus leaving gaps where their knowledge, enthusiasm and commitment once were? Is poor care really related to their education, and have we simply not prepared them for what's ahead (not what I have experienced and the feedback that I regularly get about the students I know does not reflect this latter point). I know there are multiple arguments, theories, views on why poor care happens (and I have highlighted some of these in previous posting), but I remain baffled by the reports and the evidence that seems to demonstrate that sometimes nurses do not give the care that they should.

One of my goals as an educator is to provide a level of inspiration that students can hold onto and improve as they make their way into nursing practice as qualified practitioners. I know that my colleagues do the same. The photo is one of mine - a beautiful sunset over the Basin in Montrose - an image to reflect inspiration and what I believe is a need to continually work towards improving role modelling behaviours as educators and leaders in practice.

Reflections on caring - learning for education

My daughter has just been discharged after a short emergency stay in hospital. As always, it is absolutely fascinating to experience care from the other side and I always learn so much - both from what I have seen done very well and from those aspects of the experience that I think could have been done better. This experience led me to reflect (in the car on the way home) about the place of experience in student learning. There is much out there where patient stories provide meaningful accounts that enable learning (for example Patient Voices which I think I have mentioned here before) and I have used these kinds of resources effectively with students. But what about our own experiences - is there a place for us to use these experiences in some way to facilitate learning? I don't advocate that we should stand in front of a group of students and tell them about particular personal situations, but the learning that I have gained should be of some use, shouldn't it?

What I learnt over the past few days (things that I already knew but which were illuminated during this time):

• the way in which nurses speak to relatives on the phone (I was on holiday in Greece at the time of my daughter's admission) is so important. Letting the relative know that they are welcome to contact the ward at any time is so reassuring.
• providing information to the patient (and repeating that information if needed) with patience is crucial to the feeling of security in an alien environment.
• appearing to have time to answer questions etc at the point of discharge empowers both the patient and the relative.

All of these are small things but indicate the care and compassion that I have spoken about before on my blog. Being present in a ward (as a visitor) exposed me to the day-to-day interactions and actions of the nurses and others in a way that is so powerful. In England the Department of Health has developed a consultation/discussion document which aims to embed a culture of compassion (amongst other things) within nursing and other healthcare. I don't think there will be many things in the document that we could disagree with particularly - but what I want to do is really think about the proposals for the enactment of the intentions/vision. How can we make sure that the nurse provides a close interaction with the patient and the relative at point of discharge for example? And how can we ensure that the education that we offer enables students to work with patients and others so that they are empowered partners in the care experience?

Late winter sunshine - an academic's break

I am just preparing for my last-gasp 'summer' break - Kefalonia to set me up for the winter. I love  late summer sun and sea leaving me energised. I've got a few things to think about while I am away:
- my birthday resolution which is to read all the Booker prize winners (Margaret Atwood and AS Byatt are packed);
- the article I am writing with an Australian colleague - developing a theoretical stance on partnership working which we are going to test out collaboratively with my local Director of Nursing;
- the final part of my Florence Nightingale Foundation/Burdett Trust scholarship - bringing the learning together. If anyone out there is looking for any leadership development, you might want to consider FNF - an amazing experience for me personally and for the good friends that I have made over the year.
- my imminent (November) Malawi trip - anyone out there with experience of Malawi or of developing/evaluating educational and mentorship initiatives in developing countries..... please get in touch!
- the final report for my NHS Education for Scotland funded project on the selection of students.

I am looking forward to the clear blue skies, the sea and the mountains, and the time for thinking and relaxing. I know that I will come back ready for the new academic session. Exciting times! (Mind you, I'm not sure that even the Greek Islands can get much more beautiful than a sunset in Stonehaven with friends).

Missing NET2012.... And Tweeting

It's that time of year again - NET 2012 in Cambridge (and incidentally my birthday! - reminds me of when I went to school in England and I always went back after the summer holidays on or around my birthday...). I have a paper for presentation at the conference on the work of the NES Recruitment and Retention Delivery Group which Mike Sabin is presenting on our behalf. We think it will be of interest nationally (and more widely), particularly in relation to the work we have done on data enhancement and ongoing work on selection of students. There seems to be an appetite nationally to invest our energies in understanding values-based selection, and the Delivery Group is collaborating nationally on this area.

I am sorry to be missing NET for a number of reasons - it's always good to present one's ideas/research in a supportively challenging environment, along with the genuine opportunities to make meaningful connections with like-minded colleagues. As well as those important reasons, I love Cambridge where I did my own training.

On to Tweeting - As well as being quite new to blogging, I have taken to Twitter (@ruthft1). As an introvert (see previous postings), I am getting into Twitter in the same way that I do with relationships - slowly but surely. I have found it to be a fantastic resource for policy developments and wider debate as well as the creation of connections with people that I might not otherwise have been in contact with. If you're interested in 140 character discussion, I'd be delighted to see you following me so that we can 'talk' on subjects of interest. In the meantime, I will be keeping my eye on Twitter for the chat that will be coming from NET2012, and will look forward to catching up with my colleagues when they get back.

Other people's views - working with patients who are 'different' from ourselves

George Galloway finally seems to have lost the plot in his recent statements regarding rape. This blog post is not really about what he has to say, except to say that I am personally outraged by what he (and similar others) have been saying. It is hurtful and offensive. These feelings set me thinking about what happens when we work with patients who hold different views from ourselves - on issues that are fundamental to the way we see the world. How do we work with our student nurses to enable them to deal with the tension that can sometimes exist when we have to hear and experience the views of others that sit uncomfortably with our own world views? For me this issue relates to the focus on caring and compassion that I have had running through many of my postings. My perspective is that it is possible to offer compassionate care even in circumstances that are personally challenging. The education of nurses involves the development of self-awareness, interpersonal skills, awareness of others and their needs, and a real focus on person-centredness. Delivering compassionate care can be learned in my opinion - I think that as long as the nurse has the fundamental characteristics required for compassionate care, the skills required for the enactment of that compassion can be learned. We need to help our students understand that patients have many views, characteristics and values - and each person is a complex mix. So, even though I cannot bear the thought of George Galloway today, I know that I could deliver compassionate care to him if I needed to.