Saturday, November 16, 2013

Stories that need telling


I bought "The Other Side" by Kate Granger (http://theothersidestory.co.uk/)  last week and read it in two gulps. It is a compelling read and it made me reflect on why I found it so gripping.  I think it is such a visceral and honest account of the patient experience that it is like you are there beside Kate. I felt moved to tears on quite a few occasions and also shouted to myself about the issues that resonated in other areas of health care. Cancer is the hook – life limiting and perilous – the treatment debilitating and the trajectory so uncertain. Knowing the ending and Kate’s current dilemma made it even more of an emotional roller coaster. My main thought was whether other life limiting illnesses create equally compelling narratives and whether the public and health care professionals would be as interested in an account of diabetes clinic visits, trips to neurology for a differential diagnosis of vague and diffuse symptoms. I am so grateful (if that sounds patronising then it is not meant to be) for Kate Granger for being so clear minded that she wrote her story during sleepless nights and had the courage to put it out in the public domain. I have been interested in the stories behind people’s experiences of disease and its treatment for over 20 years. That's quite a scary statement - as I realised the other day that it is 20 years since I started my MSc in Health Research - the beginning of my research interests and my resulting love/hate relationship with all things scholarly...

My career as a diabetes specialist nurse (DSN) didn’t last very long but it was, I hope, person-centred. I didn’t last as a DSN because I got frustrated by the profession centred approach and the focus on clinical measurements and the organisation of the clinic rather than a focus on what mattered for the person with diabetes. I used to get very irritated with the powerful decision makers in diabetes care. I started my PhD research in response to my disquiet about what was going on and wanted to find out what people talked about when they were given an opportunity to “tell their story”. Each interview started  like a stopper had been taken off a bottle of fizzy drink – they gushed forth with the beginning of their life with diabetes(diagnosis), the trials and tribulations ( follow up clinics and annual reviews) and then the current experience. I didn’t have to ask much or prompt– the stories just kept on coming – back in 1999 after I had these stories as my data I couldn’t find a way of keeping the experiences whole.

Narrative research in nursing was very new and even service user views were still quite novel and no one seemed able to help me find a way of presenting my findings in a way that  honoured the diversity and complexity of each person’s life with diabetes and their encounters with health care professionals. The frustration of hospital parking, the irritation of inconsistent staffing at clinics, the anxiety of retinal screening, the ongoing exasperation of a total oversight of the emotional and psychological aspects of managing a life changing, demanding and intrusive condition. All the people I interviewed thanked me for letting them tell their story – a fact that still makes me feel guilty that I didn’t get my PhD. Maybe this blog can help with that as more people will read this than would have read any thesis I might have produced.

I guess my thoughts are that many people experiencing ongoing and demanding health care deserve to have their stories heard and that is one of my areas of learning since I joined Twitter. I follow quite a few people with diabetes (mostly type 1) and a lot of what I read makes me very cross as it seems like a lot of what I learned during my research by listening to people with diabetes has yet to filter into diabetes care in any obvious way.

It happens a lot in my writing workshops – patients and practitioners have a different conversation – not disease or symptom focussed but person and life focussed… this has to be the better way of informing care needs. How can we make that happen??

Below is one of the poems I wrote in response to the stories people told me – this was the beginning of my need to write poetry. There are a quite few of these I might put them here for you to read..

 

Beginnings

Rapid onset
Gradual change
Everyone is different
No two are the same

Playing in the woods
Sitting in the car

Unexpected symptoms

A slight change in the view


Going in for something else
Didn’t know I had it

Had an itch that wouldn’t go away
Doctor said it was my age

didn't know that was part of the deal!

Thought I was thirsty, peeing a lot
Thought it was my age

Didn't bargain for this!

 

 

Sunday, November 10, 2013

Friday, November 8, 2013

My Shadow Side - the courage to share


Last week I had the privilege to be part of a retreat around courage, compassion and choice at the Global Retreat Centre, Oxford (more details here) . I was invited to attend by Andy Bradley founder of  Frameworks4change via twitter.

I have been thinking a lot about my learning from the Retreat last week. I found it difficult and returned home feeling uncomfortable about my experience. It wasn’t what I had expected and I guess as a somewhat impatient and restless soul I thought it would be a call to action. I have been looking for that rallying call to be in my vicinity and give me the chance to step forward and answer the call. I have been looking for my heroic leader, the one I can follow and to whom I can align my mission. Looking back this has been a recurrent theme throughout my career and has been dogged by disappointment and disillusionment; people who I have looked up to have not been up to it and have failed to see my potential. I have been over looked and ignored. As a consequence of this I have been quite cross for a very long time. Upset and hurt I have been festering away with resentment.
I took this to Oxford last week and hoped to find that hero within the participants. I realised I was a bit desperate to find people who I could follow (be asked to join their mission) but that wasn’t the focus. The retreat was about stillness and listening. I did a very good job in resisting any learning at the retreat. I wanted to run away the first morning and I felt somewhat disturbed by the proximity of the Retreat to my childhood town, Reading. We were even on the bloody bus route that my dad often uses when he goes on one of his jaunts. I felt quite distracted by this to begin with but sat with the emotions and recognised that the loss of my Mum 7 years ago is still unfinished business and maybe I ought to be a little gentler on myself.

Once I leaned into the stillness and began listening I started to feel calmer and less anguished, I stopped being miffed that there would not be any rallying calls and that action would come later. I also started paying more attention to what I was hearing about myself and taking on board  what wonderful folk were telling me about the skills I might have to offer.

I am still processing a lot of the learning and still inpatient to get on with using listening and support in practice. I want practitioners in healthcare to know that some of us are looking out for them, I continue to be frustrated about the distance HE has from practice but I also have started to spend less time in my head, reduce the drain of thinking. I have started to believe in role modelling compassion and thoughtfulness.
 I still get grumpy and I can still see that my default setting is melancholy and anger but I am also enjoying the times when I am feeling brighter and also hearing the positive in my interactions with other people.
Twitter is a wonderful place for learning and sharing and over the last few days I have a number of conversations that have helped begin to provide a solid foundation for my thoughts and ideas.

Thanks to a session facilitated by Francis Briers I have come to know about U theory ( more details here) and have also begun to see my own blind spots. I have always been fixated about writing things up and getting them published. This has often culminated in nothing, nada, depression and low confidence. I have often bleated on about how much better I am verbally, how I can express myself well and also that I really quite like an audience!! Well how about doing some clips about some of ideas, thoughts and projects? Thanks Andy for the suggestion I will explore this and as my daughter is skilled in the use of information technology I will make sure it will happen. Seems a bit scary because it might be ridiculed and mocked but that is a risk I am happy to take to see if I can share my thoughts around supporting practitioners and the role of values and beliefs in their practice.


When I stop thinking too much and I allow myself to calm I find the poems come..

Switching The Mind


It is in the stillness
that we can listen.


It is only in this time
can we really hear.


Nurture stillness, silence,
connection, clarity.

Declutter.

It is only by stopping
can we start again.

Hope, courage, growth
peace, resistance.
It is only by persistence
 
can we share the way forward

Together stronger –  joy.

 

Sunday, October 13, 2013

Sharing Stories Part II

How many of you out there wanted to write about your nursing journey?
Did you feel excited about the prospect of getting it down on paper and then sharing?
Did you think that sounds like a  good idea? Did you think I'll have a bit of that?

If you did then how far have you got? Have you worried about it being good enough?
Are you certain that you can't write and that no one will want to read your story anyway?
Well all these reactions how expected and predictable. What I would like to happen is to see hose stories arriving in my in box. Stories to read, edit, collate and curate....

Winter is not my most productive time but if I have a project I might find myself optimistic and energised..

Project Ready!!

Changing the Conversation


“There is something very healing about working on the jigsaw of a poem, even though the subject matter maybe upsetting. Understanding and working with the craft of poetry frees us form the emotional glare of a situation and lessens our fears.”
Julia Darling p. 12 The Poetry Cure

I’ve been thinking about how you can celebrate what you do, how you can recognise the value in what you are doing without showing off, without over claiming, without being accused of being a fraud. Writing this make me realise what stops me shouting from the roof tops about how I believe poetry can make a difference. If I make too much of these things then maybe someone might come along and blow my cover, show me up for not knowing a thing about what I am talking about, expose my emptiness. Reading an article in the GuardianOnline this week about poetry in health care made me realise that my frustration about the lack of recognition for the power of poetry is more about me than the poetry. I tend to think I am an imposter wherever I am, as a nurse, as an educator, as a writer, it hinders me and represses me; stops me being what I can be. It has been hanging about for a long time and mining it for its origins is a risky business. However I think if I am to take my message forward about the power of poetry then I have to leave it all behind.
I have been running poetry workshops in health related settings for a number of years now, I discovered the power of creative writing and well being in 2004 and for the last 7 years (since my Mum died) I have sought to offer that possibility in a number of places.
In hospices it has been revelatory, where it is possible to regularly underestimate the power of language and memory, that ordinary people can find extraordinary ways to express themselves in poetry, all they need is permission, a piece of flip chart, a scribe and a safe space to explore words. When I run our writing sessions all people in the room contribute to the making of the poetry, patients, volunteers and staff. If someone happens to walk through the room en route to the photocopier they must participate. It is about generosity and sharing, it is about giving people space to think and have a journey of discovery. It is a time to have the opportunity to rediscover childhood games, childhood spaces, local myths, and local landmarks. The agenda is set by the people present, in early times I went equipped with a plan, this often didn’t work and all my preparation often inhibited the flow of ideas. For the last few years I have simply been part of the conversation at the beginning of the session, listening and responding until I notice an issue or theme that might be worth excavating. It never ceases to surprise me how profound and insightful people can be, changing the conversation, paying attention adds something to the relationships between folk in the room. The academic in me wants to find out more about what is going on but I often find that inhibits my thinking, shrinks the view. Instead I will just carry on just doing what I do and wait for the analysis and evaluation to happen. These workshops have been a life changing experience for me and I increasingly find I want to offer the same type of space to all those I come into contact, a safe exploratory space rather than a formal, prescribed space.
Simply by writing this I find I have more confidence in this approach, poetry is one way of creating this space but I am sure it is not the only one. However I think that offering poetry into the space changes the tone of how we communicate. The compression of language, the attention to expression and evocation of emotion makes a difference. I now carry poetry with me into many spaces and mention poetry when I can, some folk might see me as an eccentric outsider but I hope I can cultivate more places where I can offer this way of learning – it is important and it can save your life!


You will love again the stranger who was your self 
 Derek Walcott from Love after Love

Sunday, October 6, 2013

Writing and art


Yesterday was the first time I facilitated a health linked writing workshop outside the comfort zone of health care education - it was at the Lit and Phil in Newcastle.  I wanted to facilitate a writing workshop that responded to the art exhibited there at the moment by people affected by Parkinson’s disease. I have written about the exhibition before, Brain Box, as I find it deeply moving and feel it deserves a larger audience. That said we had the launch evening at the Lit and Phil and it was wonderfully warm and intimate evening. Some of us read poems and Jan Sopher (the artist behind the work and the curator) read a piece from Waterlogged by Roger Deakin.

Participants at yesterday’s workshop produced some wonderful work and we are hoping to collate the pieces into a little pamphlet that can be read alongside the pieces in the exhibition.

I wrote a poem for Thursday’s event and I felt a little daunted but I gave myself the task of writing about celebrity and illness. I found some information out about a famous photographer from the 1950’s who was diagnosed with Parkinson’s disease and I wrote about her. It took a while to develop but I felt it needed attention before I was OK about it and the response on the evening was positive.

I acknowledge the source of the inspiration and hope that I attribute the source and have changed the tone by writing poetry in response to the prose.

Anyway here it is for others to read....


Embracing Parkinson's

She wanted to tell her story, reveal it

all on the page tell it all to “Life” magazine.
 

A photographer of renown she had captured

Roosevelt, Stalin, Gandhi, to name but a few.
 

Maggie the Indestructible,

seemingly always in the right

place at the right time.
 

 Then she became frozen not shaken.

Her fingers stiffened so she could no longer

press the shutter, focus her lens.

 
Going public with private issues -

a diagnosis and experimental  destruction

of cells in her thalamus by her god like surgeon
 

Her celebrity raised awareness

but unwise choices may have had
 

consequence.
 

She didn't accept the disease

She tried to squeeze it out,

eliminate it.
 

A message that extends

across half a century as another

 
famous name comes out with her lost voice

Telling the world she’s not taking the pills

until she's spinning on the spot.

 
Do we seek a wise role model?

or do we revel in a celebrated warrior?

 

Written in response to an article in The Atlantic by Barron H Lerner about Margaret Bourke-White

 

Sunday, September 8, 2013

Poetry, compassion and nursing; some thoughts


This blog is a follow up to a tweet chat I was involved in a couple of weeks ago with  Wenurses
 
The subject under discussion was whether compassion could be taught. I thought I would just lurk but ended up having say and I included links to some poetry that I find helps “remind” us of our human connections. This then led to some questions about why poetry and compassion. I had an answer in 140 characters but I wanted to explore it a bit more here on the blog. It has taken me a couple of weeks to get round to it because I have been pondering on why it is so important to me.
Poetry came into my life in an unexpected and wonderful way back in 2004. Meeting a local writer (Julia Darling) at a workshop changed how I expressed myself and this was when I began to write poetry and found a whole new way of looking at the world. The best bits of advice on writing poetry is to be reading poetry so that you can find out what others are writing but also it is the best way through mimicry and discovering what you like to find your own voice when writing poetry. If you offer your poetry up to scrutiny of others, either in a workshop, or a course then the feedback might often be about how your poem might remind someone of someone else’s work. This particular adventure has been the most rewarding and surprising as I have discovered a rich seam of poetry from all around the world and from ancient times to the present.

So the question asked is why is poetry so special? What is it about poetry that makes you brave enough to get a classroom of students/practitioners to read a poem in the expectation that they might get to discuss hopes, fears and aspirations in their practice?

To me it became a gesture that I could not ignore. Reading great poems about health care experiences like those written by Julia Darling, UA Fanthorpe and Jo Shapcott provide a crystallisation of an experience, an authentic snapshot that can evoke an emotional response. This response is often spontaneous and unedited, the words used or the sense created in the work can bypass the practitioners usually carefully orchestrated responses to the emotional aspects of delivering care. Poetry can take you by surprise, make you cry, make you angry, just stops you in your tracks. I believe this is a fine way to encourage reflective and thoughtful practice. My belief is that good poetry always comes from a truth, an authentic and genuine event, thought or emotion. Those beginnings often end up in a finely crafted piece of poetry that does something special.
The poetry offered doesn’t have to be about concrete experiences. The poems I shared during the tweet chat were about “being human”. One of my favourite poems is by Rumi, a Persian poet from the 13th Century. Here is a link to The Guest House, a poem that I come to every week and get something new from it, each time. Another poem I shared was by William Stafford that I discovered via the wonderful Roselle Angwin. … here is a link http://roselle-angwin.blogspot.co.uk/

The other poem I shared is by Elizabeth Bishop, a poet I had on the bookshelf but hadn’t really read until 2006. Bishop is one of the finest poets ever and I wish I had known about her before, but it is never too late to discover wonderful things and here is a link to the poem I shared on the tweet chat Sonnet 1928
 
 
I really believe poetry can make a difference in this world and I am becoming more passionate about that project. If you have poems you want to share then please comment or if you want me to come along and run a poetry workshop then I will!! Lets spread the word..

…..

 

 

Sunday, August 11, 2013

Sharing Stories (again)

The idea about a book containing stories about nursing and nurses seems to be taking off. I now realise that it is important for me to explore my own story as well as encouraging others.
I keep putting off writing anything on the page. I am not sure what I am scared of, maybe it is the worry that I haven't actually got anything interesting to say but if I am encouraging others to do the same then I ought to do it myself!!
I admire those who can write prose and get their thesis written, their draft novel. I seem to have little stamina and find I get put off when I start thinking about writing more than 16 lines of poetry!!
I seem to be OK at writing learning outcomes and evaluation reports and maybe I ought to say "No" to those and concentrate on my own writing. It is difficult to do it all on your own and my belief in a project is difficult when you are not sure if anyone is interested. Paradoxically writing this blog seems to be more liberating.... I don't care who reads it but I do find I can just splurge onto the page without worrying about what I am going to write about. 
I am interested in encouraging reflective practice for health care practitioners, enabling them to find time and space to think about their work. I also seem to have a lot of ideas in my head that I find difficult to commit to the page. That stamp of authority, that confidence to say "This is how I see it." seems to be a long way off. I am expecting someone to tell me that it's all rubbish and that's what stops me...

First Ward

Don't let me bore you.
I am sure I have tales
to tell. Stories to share.

Ghosts in the attic,
tears in the sluice,
ward sisters who cared

more about neat cupboards
than the first year student
struggling to make sense

of worn out bodies.
Confused and angry
we all waited for a scrap

of attention. Jessie hit me
with her stick, whack!
I had to ignore it

move away, cry later.
Thirty four years on
it comes alive and I

wonder what made me stay.




Saturday, August 3, 2013

Learning from Tweeting - post Francis

On Wednesday I attended a Department of Health event in Newcastle that invited participants to consider their responses to the Francis Inquiry. A So What Now?

Thanks to the wonderful Maxine Craig, whom I have met through Twitter, I live tweeted from the event. I got quite excited about it and realised it was a great way for me to concentrate. On occasions like this I am prone to mind wandering but this kept me focussed.
After a while I started tweeting haikus as there were some essential messages that were in danger of being lost within PowerPoint slides. It was all very interesting and the event left me more frustrated, in that the need to disrupt old ways of working is becoming crucial and so is working with staff. Please STOP telling them to be more efficient and expect besieged and beleaguered folk to find time and energy to be reflective. It needs to be acknowledged that they need space and attention... I think they need poetry and nurturing. If I hear the word productive once more I'll scream...
 
Here are my haikus - they were read and re-tweeted by others on the day which means the power of poetry has spread!!

LEARN. SHARE, CARE

duty of candour
acknowledge can do better
help share improvement

*****
enthusiasm
passion, drive - all matter
learning through nurture

*****
recruit for values
retain around attitude
care matters for all

*****
putting patients first
everybody's business
culture change needed

*****
accountability
support excellence in care
all responsible

*****

sharing stories
want to make a difference
to staff and patients


Tuesday, July 23, 2013

Muggleswick

Love the name?
Small hamlet on County Durham/Northumberland border

Turning up to write


I love reading other people's blogs and discovering what people are sharing with others.

Two I have discovered recently have been Moira Mcloughlin 's blog and Lynne Stobbart's
 

I have learnt so much by writing and have realised that writing the blog has set me a discipline that I lacked before in relation to turning up at the page. After all you can't expect to write a book if all you do is think about writing.

In my friend Kate's book I shared my experience of not begin able to write my PhD and re-reading it has made me realise how tough I have been on myself. I have just read Moiras blog (see above) and I realise that my PhD journey was strewn with rocks and boulders, some of my doing and some that I could not see my way round. So rather than continue to be highly critical of my failings I have begun to see that maybe there is a reason for it and that instead of regretting not being Dr Sue I can think about whether that title would have ever served its purpose of giving me permission to be me, permission to explore the issues I am interested in - butterfly minded and eclectic!!

The police helicopter has just been over our house and it gave me flash of insight into the way I see the world. I like the helicopter view...up high , looking across and making connections and linking folk. A PhD requires microscopic and forensic analysis of a very narrow topic, not sure I want that and can do it. I know I want to write about lots of subjects and that sharing them is important but I also know that the academic environment is too exclusive, I want to share with ordinary folk, real people who inhabit the real world.

 

Lets see what happens.
 
River Derwent at Muggleswick
 

Sunday, July 14, 2013

Writing Day

I spent yesterday in Scarborough with  four wonderful women at a Lapidus writing event. If you don't know about Lapidus I strongly recommend you look them up and explore the work we are trying to encourage in writing and well-being.
Sue Wilson, a very talented poet and cake maker, facilitated the day and the subject was Food.
I was not enthusiastic about it but I went down because I value the companionship and I wanted to make time to write. Sue began the session with some very well prepared and demanding 5 minute exercises. I am always surprised about just how much can be splurged onto the page in 5 minutes - try it, it is amazing what pours forth, particularly when you stash the critic and editor away.

One of the exercises was about food we loathe. Here is my poem....


Coleslaw


It depends so much

on how we are chopped.

 
How we, the vegetables,

are selected. We do not

 
intend to offend,

our intention sound.

 
We never wish

to repulse, disappoint.

 
We set out, fresh

wholehearted, to do good.

 
It is you that cuts us down,

makes us small, drowns us

 
in a curdle of cheapness.

Mixes us up with sour vinegar,

 
camouflages our true flavour,

attempts to create acceptability.

 
Perish the thought that we

might be seen as too much,

 
that pieces of us might be too large,

too recognisable, too obvious.

 
What does it take to allow

each one of us to be

 
savoured, identifiable,

allow us to just be.

 

 

Learning from Blogging


I have been thinking about the reasons I started a blog. There was a chat about it on twitter the other week with WeNurses  I realised how tricky stepping out into public might be for folk. I started blogging because I wanted to write more and see if I could get into a regular practice that would help me feel more at ease about that part of me. It has been interesting because I thought I could keep the different interests of mine separate. At one point I thought  could run two blogs, one on my usual musings and then one of nurse education and the issues around that, but I found that was difficult to manage and anyway the issues all stem from who I am and that is a complicated mixture of all sorts of things!!

Anyway two people I follow on twitter also blog  Anne Cooper, who has been blogging for a year and  Lynne Stobbart  who has just been brave enough to out herself “out there”.

Both blogs have really made me think about who I am and what contributes to my thinking, feelings and actions.

I realised that I have been fighting with myself for some considerable time and the part of me that trained as a nurse and qualified in 1982 has not had a lot of attention paid to her since she went to work in HE in 1996. I was ignoring the reason why I have stuck with nursing for 34 years – I was trying to devise an exit route and escape but every time I have pushed at that door I have been poorly – knocked down by depression and ground to a halt.

 I have begun to understand the issues I have having had an utterly rotten time as student.  I have realised that being a nurse is important to me and although I am hugely conflicted about the profession of nursing I am still part of the clan, albeit not one who fits neatly into any stereotype. I have not been a conformist and I found hospital nursing really difficult, finding myself at my best out in the community negotiating with GPs and helping people function in their own home. As a Diabetes Specialist Nurse I thrived when setting up a new post and challenging outmoded approaches to delivering care and working with people and their families to live more easily with the condition. However back then I was in a hurry and ambitious (I wanted to be Professor Sue) and I also found I was working with people who didn’t quite get a nurse doing a PhD and wanting to improve practice by developing evidence and patient centred approaches.

That’s why I moved into HE – I didn’t have much choice as the climate of the team was not going to let me spread my wings and thrive.  However my ambition of changing the world from an academic position soon ran into a siding and caused distress. I now know I need to be working closer to the delivery of care. It has taken me years to identify what I value most and what I can recognise in myself as strengths. I have been concentrating on all the things I can’t do and haven’t achieved – not getting my PhD, not getting promoted, not writing academic papers from my PhD research. ALL that negativity. I am reading Brene Brown’s book at the moment “Daring Greatly” and as I turn each page I may shed a tear or raise a cheer BUT boy is it affirming.

I still have lots to learn but I am beginning to enjoy my journey rather than focus on having got off at the wrong stop!!

 

Sunday, June 30, 2013

Books again

Here are some books that have provoked me to think about writing about nursing.
What books would you include?

Saturday, June 29, 2013

Sharing Stories - seeking recognition



This week I am sharing an idea I had whilst spending Sunday tweeting!! Anne Cooper shared a link from a US Website. It was a wonderful account by a nurse about her clinical experiences. It was well written and extremely moving. I started thinking about the stories shared on Twitter and Molly Case’s recent triumph with her poem at  RCN Congress and I wondered whether it was time UK nurses shared their stories.
 
 
Nicola White  a writer in Scotland has been a “writer in residence” at the School of Nursing at Edinburgh University. Her experience has shown what a diverse range of stories nurse have to tell and what rich learning there can be from paying attention to what folk are saying.
 
The link Anne Cooper shared was originally from a book of Nurse’s Stories and when I discovered this I had the idea that maybe UK nurses could do a similar thing. For some time now I have been composting the idea of writing a book (a small one) about my journeys in nursing. This task has often felt daunting and I have not got far with it but collaborating with lots of other wonderful folk feels much more my thing.

I went to Kate Evans’ book launch this week in Scarborough, at the rather wonderful Edith Sitwell library, and that got me even more fired up about this project. I met a long time hero of mine Linda Finlay   and she so understood my PhD failure that I really felt my plight had been heard. I am one of the case studies in Kate’s rather wonderful book and her analysis of my writing block has been both troubling and empowering. See here for a link to Kate's blog

So I have suggested the idea of a book out on Twitter and have had quite a lot of interest from folk offering their story. I found time to write an outline proposal and feel it might be a project that might see the light of day.

If you are reading this and what to share your nursing story then let me know. I don't think folk need to write a lot but we do not want it written well. You might need to practice writing your story and I am happy to help craft it into a meaningful narrative. Don't be scared and don't think you don't have anything worthwhile to say - you will have and others might want to know about it.  
BOOKS!!!
 

Thursday, June 20, 2013

Reflections and self observation


 

“Well, I fought with a stranger and I met myself
I opened my mouth and I heard myself
It can get pretty lonely when you show yourself
Guess I could have made it easier on myself”

 

from The long Way Around by Dixie Chicks

 

My thanks to Maxine Craig who I first met on Twitter and have now met in person (at the Compassion Dialogue) for making the connection between my blog yesterday and the Dixie Chicks’ lyrics. Perfect!!

 I have the album and know the song really well as I used to play the CD quite loudly in the car as “Not Ready to Make Nice” is also on the album and it was a very important song at the time the album came out. I am sure I can mine that observation in the future.

 

 

Walking the dog this morning I decided to think and be rather than take photographs. On the way to school a car overtook us just before the 30 mph sign at Marley Hill.

 

I was angry and outraged by this behaviour having noticed the driver was agitated and restless behind us when driving through our village. It is quite obvious looking at the road markings etc that this is not an overtaking place and she hurtled through Marley Hill at over the speed limit and she disappeared over the crest of the hill. As we got to the traffics lights at Sunniside there she was just in front of us, waiting. We then followed her all the way to Lobley Hill where she impatiently followed the car in front of her. I was really angry. Like Brene Brown ( her talk with Lissa Rankin available from here is wonderful) my default setting is “angry” and I had to simmer away for a while. My daughter is very good at calming me down but I do think that it is 30 for a reason.
I am not sure I got that angry about stupid driving before I was a Mum. Now I think of all the vulnerable pedestrians and passengers on their way to school that might be hurt by someone in a hurry. I also thought about his lady's state of mind. If she was on her way to work she is going to have a horrible day. She was clearly in a hurry, restless, agitated and must be distressed. I hope she isn't in charge of folk as that agitation will leak out and be uncomfortable to work alongside. I am practising compassion and hoping this helps me stop ruminating on the issues that arise.

I bought the book “How to stay sane" by Phillipa Perry yesterday and the ideas and reflections within it are very helpful. It is a simple and accessible book aims to do what it says – a kind book. I discovered the book via the wonderful Brain Pickings website which is a wonderful and rich resource find it here

All this learning and reflection is certainly helping my well-being and have become less defensive and happy to share this with others.

 

 

 

Wednesday, June 19, 2013

Back on Track

Been away for a while - crashed and burned for a little while after my Lit and Phil gig but I am back now...


I went to an unusual and inspiring meeting last night. Invited to attend a “Compassion Dialogue” with Andy Bradley from Frameworks for Change and I was very apprehensive about it. I had no idea what to expect and looking at the list of other participants I didn’t really know what I was letting myself in for.

Well I have avoided challenges and new situations for long enough so when the invite arrived I had no hesitation in accepting it. I have wittered on about care and compassion for long enough. I hope it infuses my teaching and I care very deeply that the world has become damaged and the world of health care has suffered as a consequence of fragmentation and rationalisation. Health care is a complex, complicated and messy business; there are no quick answers and no simple solutions. The time I worked in diabetes taught me that and watching health care from a distance over the last 17 years has cemented my belief that we need to pay far more attention to the well-being and support to those delivering care. I have had burn out, stress and depression; overwhelmed by what was expected of me and hurt by the bitching and sniping around me. I tried to make a difference but I was defeated by power and hierarchy, that experience has left a legacy of a lack of real self-belief and I know  it contributed to me not getting my PhD.
Last night was inspiring and energising but not in a frenetic and fizzy way. It has left me with a calmer purpose (hence me turning up at the blog today) and a solid determination to make things happen with poetry, expressive arts and health. I am not sure what that will be but I know I have an idea of what if looks and feels like when it is being delivered and how participants leave with a new insight.

When walking the dog this morning I wandered off onto a path that led me “the long way round”. I was a little frustrated as it meant I was out for much longer than I planned but then came across a field of rape seed scattered with poppies.


 

I realised then that “the long way round" might lead you somewhere unexpected but beautiful and that might just be where I am right now at 52. Twenty years ago I was in an awful rush – seeking promotion and academic attainment. Along the way I learnt about social theory and met inspiring teachers (transforming perspective).  My hurrying to get somewhere was derailed in 1999 with depression and a new track appeared in 2001 with motherhood but now I think I might have found  the right path and one that might be better for me and my family.

 

Friday, May 24, 2013

Poetry

Having revisited my nursing days on the blog I thought I would share a poem written about those 
days so long ago. Click on link below and scroll down - poem called "Morning Routines"
http://litnphilwriterinresidence.wordpress.com/

Sunday, May 19, 2013

You tube excursion - making a Moral Compass Folded book

Prompted by a request on Twitter Lizzie and I have made a video to help people make their own little folded book like the ones on display and made last night  for the  Moral Compass.
Enjoy!! (third time lucky but Lizzie a good Director)

http://www.youtube.com/watch?v=vhC1aFM9XuM&feature=youtu.be

Saturday, May 18, 2013

Reblogging

My badges and buckle appear here - had to share that!!
http://teresachinn.co.uk/432/

Sneaky Peek - Moral Compass

Artists' Books - Moral Compass 

These books were created in response to the outrage levelled at nurses and the nursing profession following the publication of the Francis report that investigated the delivery of poor care at Stafford Hospital.

Accusations have been thrown at a profession once highly regarded with many commentators taking it upon themselves to suggest that the move into Higher Education in 1995 lies behind the demise in standards and the moral fibre of how nursing care is delivered. As someone who has worked in Higher Education since 1996 and thus my academic career has been alongside these developments I have taken many of these criticisms personally. Very little has been said about Nurse educators/Academics in the discussion but the inference is that we are not doing a very good job of making sure nurses are caring, compassionate and competent. The reason I moved from clinical practice to education was a belief that I could have more influence of the way care was delivered by encouraging reflective practice and learning from the students with whom I came into contact.  

If standards have slipped in nursing in relation to how we respond to vulnerable people in their time of need then it is most likely a reflection of a problem in wider society.

My first response was to wallow in the iniquity of it all and that nurse educators do not seem to have a voice in the debate, are rarely seen in the media and although crucial to the preparation of student nurses are invisible in the debates.

Fortunately with my Art Practice I found a way of expressing myself. The request to participate in The Late Shows at The Lit & Phil in Newcastle provided me with an answer and has given me an opportunity to be more constructive and creative in my response to this issue.

The creation of these small books has provided me with a way of expressing my standards and values in general and states them clearly and unequivocally for others to view.

The impetus for these books originates in a lesson I delivered with students influenced by Theresa Easton's work with folded books. Senior practitioners in health care, when invited to create a small book of values and beliefs about their practice, responded with enthusiasm, skill and commitment. This has led me to believe that this medium is an accessible and powerful way of people expressing and remembering their Moral Compass in practice. This is why I also offer passersby to add to this and create their own Moral Compass on an artists book to take with them as talisman that contains those ideals in and they can hold on to in everyday life. 
 

Dementia Awareness


It’s Dementia Awareness Week, next week, and it has given me pause for thought about the condition. I am very fortunate indeed not have encountered the condition personally, none of my close relatives have been diagnosed with the condition and I have had no close friends living with dementia BUT my next door neighbour’s Dad has it and boy has it impacted on their lives.

My neighbour now lives almost full time with his Dad, leaving his wife all alone most of the week. He had carers in for a while but did not trust them and now feels obliged, as the only child, to take his work and belongings over to his Dad’s and take care of him as best he can. Viewed from an emotional distance this has got be avoidable for all concerned, his Dad is diminishing, each time I see him; never a tall chap he seems to have shrunk considerably over the last few months. I also worry about our neighbour’s relationship – it just cannot be easy dealing with this and no one seems to be offering him the right support and resources. I can’t help feeling that if he had cancer or other life-limiting physical condition I would know exactly what to do and what agencies to get him to bother! The stigma of a mental health condition like dementia does not just sit with the person diagnosed but with the family and all of those around them. Reaching out for help is clearly really difficult and so many hurdles put in your way when no one single point of contact is readily identifiable. His Dad doesn’t live in the same village so the GP link is tricky and moving him to live with him was never an option as they have an old cottage that just would not be safe for his Dad to live in. His Mum is already in a Care Home following a stroke three years ago and that is costing him money. I can’t offer a solution but I can at least raise awareness of what people are putting up with and making do with!!

We have events at work all next week and I have been really heartened by the students’ interest and enthusiasm to sign up for sessions. It was never a condition we were really taught about when I was a student but it was one I encountered early on in my clinical practice, on my first ward. A little lady hitting me with her walking stick as she was agitated and upset; I am not convinced we did anything particularly constructive to help her back then. That memory reminds me of how fragile we all are ( to quote Sting) and how many of us will need help and support from increasingly creaking and brittle health and social care services in the future. Fingers crossed the current Government don’t destroy it.

Tuesday, May 14, 2013

nostalgia


Sunday was our daughter's 12th birthday and also International Nurse's Day (Florence Nightingale was born on 12th May - a bit of info I did not appreciate until I started noticing  the date when Lizzie was born!). Having always been ambivalent about nurses and nursing I entered into a tweet chat with some reluctance. Well I got swept up with the common experiences and dared to share a photo of me when a second year student.

Below you will see a photo of me meeting Prince Charles when he came to the hospital to open the CAT scan - 1981 just before he was getting married. This is not the one on twitter but the one I should have shown - Miss Howard one of our tutors also features. To my shame I cannot remember all the names of those around me, although there were third years there who we had little to do with!!. I do remember the event as I was sent to redo my hair three times as it was permed and very wayward (think I ended up with about 10 kirby grips keeping it in place) - we were in the School of Nursing at the time so we were lined up along the corridor to represent students - to Miss Howard’s alarm he stopped to speak to me and asked me how I liked Cambridge - I believe I gave an appropriate response - memories!!

Here it is enjoy!!

Can you spot me? - grinning under HRH's chin!!

Sunday, May 5, 2013

Reviewing the Past - Out patient clinics

Once, when I had a proper job, I asked a consultant I was working with, why he asked patients to come back to the clinic every 3 months - his answer was “to train the junior docs".  At the time I was a little surprised by his candid answer but when asked whether there might be any evidence to suggest the most appropriate frequency of appointments he did not appear to be interested.

I was a little surprised but that was back in 1992 when the purchaser/provider split first came along and I thought that as the purchaser we might have some leverage in examining what went on in OPDs and what we might do to improve the experiences of the people waiting in clinics and also increase the satisfaction of the professionals working there. Alas nothing came of it and I went off to do another proper job and in 1996 started my PhD research that examined people's experience of diabetes care. I didn't really appreciate it back then but the dominate experience of diabetes care IS outpatients and so my research was quite unique and that context of people's experiences was not fully explored at the time. The findings from my research identified how the experiences were often about uncertainty, disruption and anxiety leading up to an appointment, during the visit and for some weeks after. No one talked about coming away from the clinic feeling better about themselves and/or their diabetes management quite the opposite. The overall experience could be summed up as transitional a neither here nor there experience – betwixt and between.  

My motive for undertaking the research came from my complete and utter dislike of my role in OP clinics. I was a nuisance to the nurses in OPD as I would sit in the waiting area inviting questions and inciting dissatisfaction from the patients. I would not do what I was supposed to which was to stay in my room and be like the doctors, summoning people to the room when it was their turn. I also used to go to great lengths to delay my arrival at the clinic. In the days before mobile phones (i.e. no one could contact me away from the office) I could procrastinate a great deal; often fitting in a few home visits and a trip to a GP’s surgery on my way to the hospital from my office in a Health Centre. this was all just so I could put off the inevitable slog of the diabetes clinics. They ALWAYS ran over. We were there from 1pm until after 6pm most Wednesdays and alternate Fridays were nearly as bad. The diabetes clinic was notorious in the department and the OP nurses hated being assigned to the clinic.

I have been prompted to revisit my PhD beginnings and my “proper jobs” back in the day after reading Anne Cooper's blog about her experiences of outpatients as person with type 1 diabetes (http://anniecoops.com/2013/05/04/have-things-improved-since-1993/ ). I am saddened to think that the way the clinics run and the experiences of folk attending the clinic sounds very much like the experiences in my research over 15 years ago. To satisfy my curious mind I did a quick search to see what has been written about the OP clinic – other than that by sociologists (1) and forward thinking folk like John Launer (2) whose interest in narrative and stories set him apart from the usual medical commentary.

Here I found remarks on teaching in OPD (3) – maybe the clinic is just about professional discourse and that the patient has little to do with it. The patient presents as a medical curiosity a problem to be solved – much better in OPD than on the ward (4) – a lot goes on that I hadn’t appreciated in the medial discourse – much food for thought and insightful. Yet again the patient presents as a site of surveillance and the vagaries of a poorly performing body as a problem to be solved rather than the human being with the appointment, someone to get to know and forge a relationship with..
 
I wonder if my PhD would have made any difference if I had got it. Somehow I think very little and maybe blogging about it in this way might get a bigger readership than that elusive thesis.
 
References and further reading

1. Strong PM . The Ceremonial Order of the Clinic: Parents, Doctors and Medical Bureaucracies. London: Routledge, 1979

2. Launer J (2012) Waiting Rooms and the Unconscious Post Grad Med Journal 88; 361-362 available from  http://pmj.bmj.com/content/88/1040/361.full

3. Williamson J (2012)Teaching & learning in outpatients clinics The Clinical Teacher 9; 304-307

4. Watkins P (2004)  Outpatient departments: a unique opportunity for understanding illness Clinical Medicine 4,2; 97-98