Call it what you want, I’ll call it rape. By Wendy Copeland

Rape and sexual assault…. not words we thankfully use or hear every day, however like periods and menopause are finally words that are being talked about more and more openly. We still have a way to go though.

Rape and Sexual assault are finally being debated and discussed, in part thanks to high profile case like Operation Yewtree ,  #metoo  and the anti Trump woman’s marches. These big news stories have helped many survivors of rape and sexual assault come forward. Many of these are historic abuse and more than we care to imagine, are current.  And many more still stay silent.

I am glad to share that I have never experienced what it would feel like, I do however remember with clarity a near miss when I was a child, when my brother barged into the house I was visiting and saved my day…I’ve never told my brother this. I also recall in the summer of 1982 being on a Lothian No 44 bus going to Currie in my favourite Levi mini skirt, when a man felt it was his right to run his hand up my bare thigh…. he did not anticipate the screams of protest and profanities that my small frame at the time could produce . Sadly that mini skirt was binned… I felt violated and dirty and associated what I wore as a trigger. I know better now.

So what’s all this self indulgent disclosure got to do with the NHS Dumfries and Galloway?

The Scottish Government has set out its vision for consistent, person centred, trauma informed healthcare and forensic medical services, and access to recovery for anyone who has experienced rape or sexual assault in Scotland.

Health Improvement Scotland published 5 National Standards that sets out how local NHS boards are responsible for coordinating and delivering health care service for people following rape, sexual assault, or child sexual abuse and for meeting both health and support needs.

The standards cover the following areas:

  • Leadership and governance
  • Person centred trauma informed care
  • Facilities for forensic examinations
  • Education, training and clinical requirements
  • Consistent documentation and data collection

There was some additional asks too, including relocation of forensic examinations out of a police setting, and locate into health.

NHS Dumfries and Galloway Forensic Health Suite will be located within our estates, and will be operational from May 19.  We are being guided by our local FMEs (Forensic Medical Examiners) Police Scotland, Sexual Health team, Public Protection, Scottish Government Taskforce and our local Rape Crisis team.

All our FME’s are trained in trauma informed care and we are working on a solution to ensure that survivors are examined by their gender of choice; this will also include an appropriately trained nurse being present during forensic examinations.

Once we have the physical space operational, we will develop local person centred recovery pathways, enabling survivors to choose at their own their pace, how to access easily, both health and psychological support locally. This will include access to immediate clinical needs and aftercare, and supporting survivors to access specialist provision for one-off advice and information, or support over time.

When this work landed on my desk I was nervous and felt out of my depth… I still do at times. However, I also feel excited and privileged to be involved in an area that impacts many and yet is still spoken in hushed terms or worse, never spoken about…

Wendy Copeland

Project Manager

Nithsdale Locality

 

Local Support

https://www.rape-crisis.org.uk/

https://www.victimsupportsco.org.uk/how-to-find-us/victim-support/victim-support-dumfries-galloway-2/

 

References:

Honouring the Lived Experience

https://www.gov.scot/Publications/2018/10/3324

Healthcare and Forensic Medical Services for People who have experienced Rape, sexual Assault, or Child Sexual Abuse: Children, Young People and Adults

http://www.healthcareimprovementscotland.org/our_work/person-centred_care/resources/sexual_assault_services.aspx

Healthcare and Forensic Medical Services for People who have experienced Rape, sexual Assault, or Child Sexual Abuse: Children, Young People and Adults

http://www.healthcareimprovementscotland.org/our_work/person-centred_care/resources/sexual_assault_indicators.aspx

 

 

 

 

Oh, The PLACEs You’ll Go! By Valerie White

Congratulations!

Today is your day.

You’re off to Great PLACEs!

You’re off and away!

Val 1Since becoming a parent I have been quite amazed by the world of children’s literature and how so many books convey life affirming messages in simple text. Oh, The PLACEs You’ll Go! By Dr Seuss is one such book. For those of you who haven’t read it – and I recommend you do – this is a simple tale about the ups and downs of the journey through life and sows the seeds of the importance of being resilient and keeping going when things get tough. I am sure there are more complex interpretations out there but English was never my strong suit!

You may have noticed that I have highlighted PLACE in the title and that is because PLACE is the crux of this blog.

You would think that working in Public Health, understanding how PLACE affects our health and wellbeing is something I would totally get, and in theory I do, but it is only since we made our recent office move from the Crichton to Mountainhall that I have really and truly reflected on how PLACE and in particular our workPLACE affects our health and wellbeing.

What sparked this reflective mood – well quite frankly it was this – one day I marched (as I tend to do) – up the two flights of stairs in Mountainhall to second floor East and was truly taken aback by the fact that I was totally out of breath!

How could this be?

Well – when I thought about it the answer wasn’t really that complicated – being mum to two young kids, working full time, mostly sitting at a desk or attending meetings and living in a rural area where I use the car most of the time, my physical activity levels were pretty non-existent.

Something had to change!

Val 2So following my wake up call. I have made up my own little goals, that I try to achieve each week – parking a short distance from work and walking in the rest of the way, walking at lunchtime, walking over to someone’s office for a quick chat rather than hitting the send button on nhs.net. I don’t always achieve what I’ve set out to do but it is now becoming more of a routine – and anyone who knows me knows I love routine and tick lists!

So how has Mountainhall the PLACE helped – well it’s much brighter in the office so you can see how nice the day is outside (it really does rain less than you think!). When I go out for a wander I see lots of people from other Directorates, and colleagues often have a nice smile or a few kind words to say or you can catch somebody for that quick word rather than sending another e-mail. The walk to the bathroom and using the stairs also means I do more steps in Mountainhall than I did in the Crichton.

So not only is my increased physical activity at work helping my physical health, it also helps me to connect more with colleagues and quite frankly I am much cheerier at work than I have ever been before.

So you see our PLACEs can affect us in so many ways – often ones we don’t even realise – and that is why it is so important that PLACEs – be that our workPLACEs or our communityPLACEs – are environment that supports people to adopt healthier lifestyles or make healthier choices. I know that myself and fellow colleagues in Public Health are sometimes (maybe more than sometimes) seen as the fun police – “that Public Health lot – they don’t want biscuits at meeting or traybakes at study days, or chocolates given out as tokens of appreciation – why can’t they get a life and live a little”. This isn’t a direct quote from anyone but I know you get my drift.

As I hope this blog is demonstrating myself and colleagues working in Public Health are not all perfect but we do all have a common aspiration that prevention is better than cure and we try to promote and model this. It is not easy – you should see the argy bargy that goes on in my head when faced with a lovely traybake or biscuit at a meeting – but most of time – particularly because my specialist area is dentistry the angel wins – frequent intakes of sugar being a significant risk factor for tooth decay. But, be rest assured that when I go to my book group I enjoy the sweet treats a much as anyone.

The key to most things in life is moderation, but sadly in terms of our diet and physical activity levels we as a society are not doing too well on either count and this is often because our PLACEs and our culture don’t make it easy for us.

But folks – here’s the thing – improving Public Health is not just my business or the business of those working in the specialist public health field it is everybody’s business. If we choose to leave a preventive approach to those working solely in Public Health – we are pretty stuffed, and the levels of chronic conditions, overweight and obesity and Type 2 Diabetes will absolutely overwhelm our services.

It all to difficult and complicated – its our culture to eat sweets and cakes – I hear you cry!

Well it doesn’t need to be – for a start each of us individually can think about actions we could take/conversations we could have to make our workplace healthier, rewards and appreciation can be demonstrated by things other than sweets and cakes, if we get hungry at meetings could fruit rather than biscuits be available – could we do some gentle yoga moves just before the meeting hits the really boring bit – that could actually even be quite amusing, what is available in vending machines when no other catering is available – does this support healthy choices? do I slope off to the vending machine for a chocolate fix mid afternoon when a quick walk might be a better pick me up? Could we actually have a walking meeting rather than sitting in a stuffy meeting room?

There is some really great work going on supporting the Health and Wellbeing of our workforce so lets also make our workPLACEs a Great PLACE that supports us to make healthier choices as we navigate this wonderful journey of life.

So……

be your name Buxbaum or Bixby or Bray

or Mordecai Ali Van Allen O’Shea,

you’re off to Great PLACEs!

Today is your day!

Your mountain is waiting.

So ……..get on your way!

 

For more information on holding healthy meetings, hints and tips on how to increase your physical activity levels at work. Please see the links below.

Healthy Ireland Meeting Guidelines – https://www.hse.ie/eng/about/who/healthwellbeing/healthy-ireland/publications/meeting-guidelines-final.pdf

WHO – Planning healthy and sustainable meetings –  http://www.euro.who.int/__data/assets/pdf_file/0005/373172/healthy-meetings-eng.pdf?ua=1

NHS website – https://www.nhs.uk/live-well/exercise/get-active-your-way/#

And if you have 5 more minutes the link below is a youtube video of the reading of Oh, The PLACEs You’ll Go!

https://www.youtube.com/watch?v=D6ZeZA6wF-k

 

Valerie White is Consultant in Dental Public Health and Public Health in NHS Dumfries and Galloway.

 

Are we aware yet? by Julie Garton

Garton 1

This week is Dementia Awareness Week in Scotland and Monday saw the Alzheimer Scotland Conference rise to the occasion with over 800 delegates descending on the Edinburgh International Conference Centre for a day which never fails to inspire and remind those of us who work in dementia care what a privilege it is to do what we do. With the theme of:

Prevent now, Care today, Cure tomorrow

Garton 2

There was a range of sessions looking at the importance of brain health, research and living well with dementia, delivered positively whilst never taking away the devastating impact that dementia can have on families.

Garton 3On a day where Donald Trump landed and considering the state of the political landscape, it was heartening to see this headline on day one of Dementia Awareness Week and even more heartening to read a balanced and factual article.

The prevalence of dementia is increasing worldwide, with a predicted increase from 35.6 million in 2010 to 115.4 million in 2050 – someone is diagnosed every 3 seconds and led the English Health Department to say that:

among the over 55’s, dementia is feared more than any other illness’

 

But what if we could do something about this? Whilst we can’t do anything about our age or the genes we inherit from our parents, there are factors that can increase or reduce our risk of developing dementia in later life.

Evidence exists that depression, Type 2 Diabetes, smoking, mid life hypertension, mid life obesity, physical inactivity and low educational attainment can increase our risk of developing dementia in later life.

What’s good for your heart is good for your brain

Eating a Mediterranean style diet, keeping socially engaged, learning new things, sleeping well, alcohol in moderation and being physically active can be regarded as good things that we can do to reduce our risk and act as protective factors as we age.

But it’s also recognised that the public need to be more aware about how a health promotion approach can have a significant impact on dementia.

Stigma and discrimination still exists in our communities and care services and although for around ten years, dementia awareness education has been delivered in a variety of ways by a wide range of providers but there is still some way to go.

It was heartening to hear Claire Haughey, Minister for Mental Health and Henry Simmons, Chief Executive recognise the impact and value  of Dementia Champions and Alzheimer Scotland Dementia Nurse Consultants, read our Annual Report here, on the progress thats been made so far. Dementia Champions keep updated by attending a yearly update, accessing the Champions closed Facebook page, and knowing who to contact for advice and support, but it is a challenge for other staff across health and social services to keep abreast of what’s going on.

Helen Moores Poole, Speech and Language Therapist with the IDEAS Team has some tips on keeping up to date with what’s happening in dementia care.

‘You can complete the Dementia Informed level of the Promoting Excellence Framework  http://www.knowledge.scot.nhs.uk/home/portals-and-topics/dementia-promoting-excellence/framework/about-the-framework.aspx and move onto Dementia Skilled level of the Promoting Excellence Framework as a next step, but staying aware can be really difficult when you have a million and one demands on your time and you’re a busy clinician. Staying up to date and current is a continuous process, and you can quickly become out of date, particularly in the field of dementia research, thoughts and campaigning. New discoveries are happening all the time, for example a new form of dementia ‘Late’ was discovered only last month. Find out more here.

Social Media is a great way to stay current and informed with what’s going on, to network and link in with professionals both within and without your specialist field. Building up your digital base means that when you have a couple of minutes to spare you can catch up with new ideas; it’s great to dip in and out of. If you’re a Facebook user we try to curate the best of what’s available on the IDEAS Facebook page, our focus is particularly on managing distress and what’s happening in D&G.

For bite size info and links, nothing beats Twitter and I regularly forward tweets to my work email to forward onto people! Here are some of our top tips for people to follow:

 

Garton 4

Dumfries & Galloway has over 3000 people currently living with dementia and we have the same challenges as the rest of Scotland in encouraging people who are worried to go to their GP, but this Dementia Awareness Week has made me increasingly optimistic that even if a cure is some way away, we are making progress, and thats good for us as individuals, for the people living with dementia who come into our services, our families and colleagues.

So are we aware yet?

Not quite, there is still an awareness gap, a knowledge gap, stigma and fear of this disease doesn’t help us when we are worried about our memory to step forward and seek help.

Please show your support in any of the following ways:

  1. Join Alzheimer Scotland https://www.alzscot.org/
  2. Become a Dementia Friend https://www.dementiafriends.org.uk/register-digital-friend
  3. Sign up to Dementia Research at https://www.joindementiaresearch.nihr.ac.uk/
  4. Do Dementia Informed and/or Skilled through Learnpro

And a final plea from me to do something good for yourself — get a Power of Attorney! https://www.mygov.scot/power-of-attorney/

Julie Garton, Alzheimer Scotland, Dementia Nurse Consultant – jgarton@nhs.net

Follow me on Twitter @gartju27

Helen Moores-Poole, Speech and Language Therapist, IDEAS Team

Garton 5

 

24 hour Dementia Helpline

Freephone 0808 808 3000

Making sure nobody faces dementia alone

Julie Garton is an Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway

 

 

 

 

Hiding in Plain Sight by Laura Shanahan

Have you noticed that your mum’s wedding ring is looser? Has your father started using a tighter notch on his belt? Do your clothes feel baggy? Are your dentures rattling? Why doesn’t your sister have as much energy? Has granddad been sleeping more? Think… could it be malnutrition? It was my granny Eileen, could it be yours?

Laura S 1People develop malnutrition (undernutrition) as a consequence of various physiological, psychological, socioeconomic and institutional factors such as COPD, Dementia, IBD, Depression, substance abuse and poverty. Malnutrition has serious consequences for a person’s quality of life if unidentified and untreated.

As part of Dietitian’s Week 2019 we are hoping to raise awareness of malnutrition, an often hidden or forgotten problem. Remember an overweight patient can be at high risk of malnutrition too.

Surely malnutrition is not a big problem for the developed world?

It may surprise you to know that it is a major clinical, public health and economic problem in the UK which is estimated to cost us £23.5 billion annually in part related to frequent hospital admissions, increased dependency, longer hospital stays, more GP visits and increased prescription costs (BAPEN, 2015). Malnutrition is common in hospitals, care homes and the community. It is estimated there are about 3 million people who are malnourished in the UK at any time with about 1.3 million being over the age of 65.

Laura S 2

Follow the hyperlink to Lyn’s story which shows how malnutrition can affect anyone and can often be missed in those of us who are lonely or socially isolated:

https://www.youtube.com/watch?reload=9&v=f1ERiWm5aBA

Laura S 3

Messages from our dietetic teams across NHS Dumfries and Galloway

Community Nutrition Support Dietetic Team

Laura S 4

Diabetes Dietitians

Laura S 9.2

 

Stephen has type 1 diabetes and Gastroparesis, he describes how he feels living with these conditions using the UWS Image cards. Stephen picked the following cards and explained his reasons for these choices

Laura S 7

Stephen reflected that what makes a difference to him is the information provided in our locally produced leaflet ‘Gastroparesis, Diet and Diabetes’ which outlines the above advice in an easy to follow format as unfortunately there is very little information available online. http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/singlepageview.aspx?pii=264&row=1023231&SPVPrimaryMenu=5&SPVReferrer=Sitesearch

 

Renal Dietitian

Laura S 8The malnourished person with kidney disease is at risk of weight loss, metabolic acidosis, muscle wasting, frailty, increased infections and recurrent hospital admissions. In particular protein energy wasting (PEW), a state of metabolic and nutritional derangement is a major concern in patients with Chronic Kidney Disease (CKD) undergoing dialysis. This results in muscle wasting, with increased morbidity and mortality. It has serious consequences for a patient’s quality of life.

Within NHS Dumfries and Galloway, a specialist Renal Dietitian carries out a nutritional assessment of CKD patients at least 6 monthly. This is critical for the identification and management of PEW and is considered an integral part of care for patients. The purpose being to obtain, verify and interpret data needed to identify nutrition related problems, their causes and significance.

Acute Dietetic Team

Laura S 9

What is on the Catering Dietitian’s menu?

There are simple steps we can take to try and help maintain and improve nutritional status for those at risk in the hospital setting.

  1. Add the ‘Fortified’ Catering flag on Cortix in DGRI or mark the menu Fortified in Community Hospitals.
  2. Offer snacks between meals
  3. Offer milk with meals
  4. Provide the ‘Food First’ leaflet from Beacon.

The ‘little and often’ approach is an old one, but tried and tested and for those experiencing poor appetite and early satiety this can aid recovery.

 

We don’t and we can’t manage this alone! The Dietetic department work alongside Speech and Language Therapy, Occupational Therapy, other Allied Health Care Professionals, Doctors, Nursing staff, Support Services, Catering, Carers and Patients. It takes a team approach to provide gold standard care! There are also some great community initiatives too such as assisted shopping, meals on wheels, lunch clubs, food banks and many more…

 

What can you do to better tackle the issue?

Laura S 9.1Nutritional screening should be an integral, embedded part of assessments in our organisation. A MUST (Malnutrition Universal Screening Tool) for every patient!

For more information and useful resources visit Beacon; Teams; Food, Fluid and Nutritional Care. If you think that you or your staff would benefit from MUST training or further education on managing malnutrition please get in contact.

If you are concerned that you, or someone you are caring for may be malnourished speak with your GP or Healthcare Professional. BAPEN offers a free self screening tool you can use at home – https://www.malnutritionselfscreening.org/self-screening.html

Useful food first approach resources which can assist with the first line management of malnutrition:

https://www.malnutritionpathway.co.uk

https://www.bda.uk.com/foodfacts/MalnutritionFactSheet.pdf

If you’d like to know more, please do get in touch with us: laura.shanahan@nhs.net

Laura Shanahan is an Acute Dietitian at Dumfries and Galloway Royal Infirmary

The Misfits by Murray Glaister

The incomplete unreliable yet occasionally accurate tale of The Misfits

Murray 1Today.   Press ▶

As the sounds of “the liberty bell’ fade into the dark recesses of the mind.Murray 2

At High Noon assorted willing volunteers will be lining up to face glory…

or doom.

Varied we are. Common in one purpose. Under the same banner. Ours is not the fight for freedom. Our team motto is” what the heck are we doing here”

And then it will start. Who knows what the next four hours will entail. What horrors and adversity, what drama and pain.

And I say yea hey what’s going on….

 

 

What’s going on is that an assembly of NHS workers (not officially representing the NHS to be clear), actually assembly is wrong, there is an expectation or order inherent in the term assembly.

What is the collective noun for a group of NHS workers? A swift google took me here

And it emerges there isn’t one, although I liked the flamboyance of flamingos.

So anyway, getting back on track, a flamboyance of friends of the NHS were assembling in a non-organised unstructured manner at Maryfield at the eleventh hour on the eleventh day of May to take part in “It’s a Knockout”

During our comprehensive briefing session, we had…

  • Agreed where Maryfield was – apparently playing fields were behind Gilbrae and the new Baptist Church (but not accessed from there).
  • Agreed on a range of appropriate themes for the team outfit – although left each individual member of the team to pick one of the varied selections offered.
  • Agreed that the availability of alcohol at the event was something that, at a purely hypothetical level, may be considered.
  • Agreed that the day wouldn’t end at the completion of the event.

It’s probably time to name, names, in alphabetical order, Alastair Murgatroyd, Gordon Loughran, Isla English, Jack Wilson-Green, Jemma Bowman, Ken Donaldson, Linda Bunney, Mark Young, Martin Conquer and Murray Glaister.

The first task was getting the gazebo up, this turned out to be the second, as the first was getting Alastair to tone down his enthusiasm and energy levels just a smidge. The gazebo was duly erected with minimal bits of plastic pinging off in random directions, and filled with out assorted “Stuff”.

The next challenge was registering, and coming up with a team name, somehow “The Misfits” seemed suitably appropriate.

Our tasks for the morning completed, at High Noon the event would start properly. We all choose our separate ways to relax and de-stress. You’ve seen the films where a group of people prepare for the off, possibly on a landing craft, or on an aeroplane to somewhere. The camera slowly pans across the various actors faces as they do things to fill the time before the oncoming onslaught. Although this time there was no adjusting parachute straps or sharpening knives. There was some writing letters home to loved ones, but todays’ text message equivalent was somehow less poignant.

The sounds of distant battle, as on stage the sound system is set-up. After the usual “testing, testing, one, one two, one two, routine” it started playing some ‘Motivational’ music. I can’t remember if they played ‘Eye of the Tiger’ but it was that sort of stuff.

Then we were called to the stage and lined up in teams, nerves flashing across everyone’s face, and nervous laughter fought a losing battle with the music.

Alastair was our team captain, by a ten vote to nil election result that shows a lever of confidence and support that few leaders have achieved since the Polit Bureau elections; well, he was Superman.

Introduction, briefing, motivational talk, reminder that we were there to raise money for cash for kids and most importantly to have fun. (We all said a silent prayer, adding survival).

There was a run through the six events, with a practised ease that speaks of trained athletes whose skills have been honed by years of training. And then it was out turn.

I’m sure that each event had a proper name, but they all involved a collection of inflatables, soapy water hula hoops and laughter.

Each team member was a star in their own right, and this is where I run the risk of upsetting everyone, these are my personal thoughts and no one else is to blame.

  • Alastair – his role as captain meant he was first to try everything. He won key points in the boys dancing category. The photo of him celebrating a successful hula hoop throw was the image of the event.
  • Gordon – missed the first few events but when he arrived he brought unique skills and distractional motivation to the team.
  • Isla – falling off the space hopper was a ploy to show just how good a team we were as we finished the race far enough ahead to have another lap and still beat the rest of the field.
  • Jack – belying his preparation being to buy some training shoes (deck shoes), and Murray 3looking like he was just passing on the way to his yacht. Turned out to have some nifty hoop skills.
  • Jemma – she was a star throughout and won points for the best girls dancing, admittedly with a very different dancing style from Alastair.
  • Ken – made a point of losing some key tiebreaks to keep the other teams interested. His oft quoted line “am I really doing this” reflected the team’s motto well.*
  • Linda – double ran in the Bounce jump race to demoralise the opposition.
  • Mark – with previous experience showed he knew what was going on, his Synchronised swimming display at the end was the envy of other teams.
  • Martin – another solid performance, scoring well in most events, bringing on his dig gave Alastair someone to burn his energy off with in the downtime between events.
  • Murray – he was there too

*(I only lost one tiebreak, Ken)

Murray 5And then it was over, the last race was run (or swum). The judges retired to assess the scores and we milled about drying off and thanking our deity of choice that we’d survived……..

They said prizes for top three, and we were confident that we were there or thereabouts, so we had a chance of a certificate at least.

It wasn’t to be third place as it happened, two second places were announced, so we were confident we were one of those (this wasn’t the time to discuss that with two second places, the third place was at least a fourth place). Sadly we were dashed there as well. Every failed hula hoop throw coming back to haunt us.

Being honest here, other team names were announced and if I was paying attention I would have told you who they were, but they hadn’t said Misfits and that was the only name I was waiting to hear.

To much jubilation, some shock and overwhelming hilarity, they mentioned the misfits next, after the words “And the winners are…”

Murray 4I would like to say how calm and graceful we all were in accepting our certificates, winner’s medals, trophy and a dignified half smile betraying the modicum of pleasure we shared at this news. The scenes of dancing about in wild abandoned jubilation had no place at the end of a strange afternoon’s competition.

There’s a video somewhere of Alastair’s doing the basketball thing, he is last to leave the half way point and miles behind as they near the final challenge. In the last seconds, in one graceful movement, he throws, scores, catches, turns, plants the ball and raises arms aloft to claim victory before anyone else realised what had happened.

Nicely echoing Mo Salah’s T-Shirt “Never Give up”, which should have been out team motto.

Final words, we raised money for cash for kids, we survived, and we did kinda have fun.

 

The rest of the celebration, being last to leave the field and what happened next, are best left to another story

Murray Glaister is a Misfit

Murray 6

17 boxes of tea bags by Fionnuala Edgar

My mother died on the 4th July 2014.  She was the matriarch of our family, the one who held us all together and within five short weeks she had been diagnosed with an aggressive, cancerous tumour which had metastasised  in her liver and she was gone.  There then followed the traditional Irish wake and funeral.  Three full days of everyone who had ever met ‘Mammy’ came to the house to pay their respects.  Fionnula 1In Irish tradition, the coffin is returned to the family home and open for the duration of the wake.  My sisters, brother and Dad had a crash course in etiquette, including ensuring all the proper traditions were met –having people stay up all night with the body (a queue formed for this duty); having the ‘right’ candles (thank goodness for aunties in the know) and making all the decisions for the funeral which was held directly after the wake.  Food started to come in from everywhere; sandwiches were being made the length and breadth of the country and cousins and friends were jostling for tea-making duties in the kitchen.  A conveyor belt food preparation area was set up in the utility room and a make shift break out eating space was set up in my aunt’s house next door.

 

A recent episode of Derry Girls gives a good indication of this system with Da Gerry turning into a militant sandwich maker – not at all far from the truth, it has to be said. Fionnula 2 My (Scottish) husband spent most of the three days in utter bemusement and breaking with tradition by entering the female dominated kitchen space and daring to try to help! Alongside the tea making and the sandwich eating was the constant retelling of ‘what happened’ over and over the same story, how and when Mam was diagnosed, her rapid decline overnight and the frantic phonecalls to try to get my sister home from England in time – which she did, thankfully. After the funeral, I counted 17 boxes of tea-bags left over from the wake; an indication of the volume of people coming through the house and the fact that few attended empty handed.

Six months later, a close friend of mine in Dumfries sadly lost her father very suddenly.  In Ireland, I could have started the sandwich making or rolled up my sleeves and been on tea or dishes duty but I was at a loss.  I rang a mutual friend to ask, ‘what do I do?’; her reply ‘do what you normally would do’. So I went to the shop, bought milk and, yes, tea bags and made scones.  When I arrived at my friend’s mother’s house, her mother was there with just two other family members.  I took my bag of provisions into the kitchen, gave her a hug, had a brief chat and left.  The funeral was held two weeks later and I helped by looking after my friend’s baby twins whilst she went to the funeral.

The cultural differences between our experiences were stark but after the funerals one reality remained.  We had both lost a parent and now were left to grieve. On one hand, the Irish experience and the ‘re-telling’ may enable us to process the circumstances of the loss; particularly if sudden or traumatic , much in the same way as therapeutic re-processing; an integral process in Trauma Focused Cognitive Behavioural Therapy to treat PTSD or traumatic grief. On the other hand, the initial over whelming outpouring of support results in a, possible, assumption that people have ‘done their bit’ and subsequently, post the funeral, life goes on.  More than one person said to me after the funeral, ‘That’s the hard bit done’ but for me, I didn’t want everyone to leave because now we as a family had to face the reality of life without Mam.

 

What I thought I knew about bereavement, prior to my personal experience, has changed.  I recognise that our cultural expectation that we, ‘get over’ or, ‘come to terms with’ a loss is, ultimately, unhelpful.  More helpful is to consider that grief is akin to love.  We will grieve for as long as we have loved that person and for many of us that will be a lifetime.  That’s not to say that we will constantly experience those raw states of grief but that it will hit us, unexpectedly and we can be pulled from our normal state of functioning right back into the overwhelming sadness that we most likely experienced on a daily basis in the first days and weeks after a loss.  Fionnula 3We should allow this to happen and as a society we should encourage expressions of grief and loss.  I often say to my patients, we could learn a thing or two from other cultures; the representation of grief with howling and sobbing and throwing hands in the air.  We, on the other hand, often talk about how ‘well’ someone is doing when they are not crying or upset.  ‘You are so strong’, one of my mam’s best friends said to me.  I wasn’t strong.  I was holding it together for the sake of my Dad and my siblings when all I wanted to do was howl and weep.

A recent Twitter post encapsulated grief as like a ball in a box with a pain button.  At the beginning, the ball is as big as the box and hits the pain button constantly.  As time goes by, the ball gets smaller but can still hit the pain button unexpectedly; but with the same ferocity.

Fionnula 4Fionnula 5

 

This is one of the best analogies of grief that I have read and well worth a view:

 

Woman Shares The “Ball In The Box” Analogy Her Doctor Taught Her To Help Deal With Grief

 

So as we come to the end of ‘Good Death Week’ it is important to be reminded that grief is not a mental health problem but a normal, human experience and the more we talk about it the more our society can begin to see it that way.  Let’s talk about death and dying and support one another in being open about our emotional responses to loss and recognising that the suppression of these normal responses is often what leads to the development of a chronic issue that can result in mental health difficulties.

And finally, remember that love and grief are partners, for if we have never loved we would never grieve. As Elisabeth Kubler-Ross so aptly puts it:

 

“The reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.”

 

NES’ Supporting Scottish Grief & Bereavement Care Workstream has launched its first Annual Report which provides a summary of key achievements in 2018–19
Read the report to learn more about:

  • The vision / mission of the workstream
  • NES’ bereavement-related educational resources, produced with input from over 100 subject and clinical experts
  • The number of learners who have accessed these training materials (on or via our website), e.g.
  • Activities planned for 2019-20

Fionnuala Edgar is a Senior Clinical Psychologist for the Older Adults Psychology Service at NHS Dumfries and Galloway

Values Based Reflective Practice – VBRP® by Dawn Allan

Some staff may be familiar with the letters VBRP® and some will have no idea what they mean.  I hope this blog will generate interest in Values Based Reflective Practice a tool owned by NHS National Education for Scotland, developed eight years ago to support health and social care staff to recognise and value their personal and professional value.  The VBRP® national handbook states –

“Models of reflection abound within the caring professions but most value the work and the quality of the work over the worker.  One of the distinctive hallmarks of VBRP® is that it values the worker who does the work and begins not by asking ‘what do you do?’ but rather ‘why do you do what you do?’ In other words, it takes as its starting point not what happened in the care setting in the recent past, but rather what motivates and drives the worker to come to work in the first place.’

Dawn VBRP 1VBRP® is one of many helpful tools but the difference between other ways of reflecting either at work or about work that VBRP® offers is the way it enables people to bridge their reflections back to actual practice.  In group reflection there is equity of learning in the listening and learning in the sharing of experiences of six or more trusted people who don’t have to work with each other to reflect safely and benefit together.

Health and social care staff are human, not-superhuman and we experience similar feelings and experiences during our working lives which may include self doubt, lack of trust, condemnation or harsh judgement from others that can cause us to feel our capabilities, competencies and skills are undermined or questioned.  Some staff may suggest, “if it ain’t broke, why fix it”?  I’d respond with, “ the risk of carrying on regardless without taking time out to reflect safely is not worth the risk when things DO go wrong, not only in the lives of patients and service users but staff lives can be affected, sometimes long term.  Prevention is the wisest approach to staff wellbeing, not waiting until something or someone is so broken they either leave their job or worse…”   VBRP® can help provide a compassionate, safe, person centred, ‘belts and braces’ approach to caring and valuing each other enough to seek out regular moments and times to reflect about work which may help us become more resilient.  We’re human beings first and foremost – what our work identity badges describe is not a description of who we are.  What we do all have in common is our humanity.  What made you want to be whatever your identity badge describes as your job?

Have you ever wondered what makes you tick?  VBRP® motivates staff by asking us to reflect on the ‘nugget of gold’ in the jobs that we do.  At root, these questions are all about the relationship between soul (motivation) and role (what we are required to do).

In a typical half hour VBRP® group session, one person shares an event and the rest of the group listen and then, in an almost, rhetorical style, framed within the NAVVY explore the event with questions and comments to the person including the words, Notice/Needs, Abilities, Values,  Voices, YOU.  This is the chance for the group to explore the event from a values perspective which promotes a person centred approach.  A group need to make sense of how listening to an event may have made them feel as they listened and they gently, respectfully explore it by stating what they see and heard with noticing and wondering questions and comments.  i.e. “I noticed when you spoke, you looked troubled…”, “I’m wondering why you were on your own in the situation…”, “I wonder if another colleague’s voice had been heard how that might have changed things…” etc.  The person usually waits to respond until everyone has commented on the event.  A good facilitator will ensure any questions that need clarifying for the group are responded to by the person who shared the event.  VBRP® is not an attempt ‘to fix’ or counsel a person or the historical event, the group will have all noticed different visible and audible things to comment on.  This works well within a group who may have reflected several times together and who trust each other.

The power of a multi-disciplinary group of people listening, noticing, wondering and responding to an event shared by one person acts as filtering process for the person to reflect on.  Sometimes there is an immediate, ‘light bulb’ moment via a comment or question offered that resonates and helps them through the responses of the group to recognise the ‘nugget of gold’ in their work or they may realise it later on after a VBRP® session.  This ‘light bulb’ moment of realisation enables a person to ‘bridge back to practice’ i.e. take what they discover and learn in or after a VBRP® session back to work, to imbed the present learning in their role/work/team/committee.  It is this outcome that benefits all staff who participates either as the person who shares an event or as one of the reflective, group members.

Some positive benefits and outcomes after a VBRP® session expressed by staff are:

“It was cathartic”, “encouraging”, “enlightening”, “humbling”, “simply powerful”, “I don’t feel so guilty, I thought it was my fault…”, “It helped to hear everyone’s responses”, “I hadn’t thought about it that way,” “I didn’t realise I communicated so negatively…” it can help…

  • as a sifting process for decision making
  • reduce over-thinking
  • reach acceptance nothing more could have been done and move on
  • to start something fresh and new
  • lower excess stress levels
  • build trust in a department/team/ward rounds
  • raise levels of transparency and honesty
  • adapt/improve communication
  • improve clinical practice with patients
  • with general staff wellbeing and raise confidence at work
  • know how best to respond to concerns/complaints and feedback
  • encourage compassionate leadership
  • share best practice in a safe space
  • know how to plan training in education
  • remind you that you are not alone
  • as group clinical supervision for nurses and re-evaluation
  • raise emotional intelligence and self awareness

 

VBRP® is not the ‘holy grail’ but a safe and protected way for health and social care staff to reflect and it reminds us all to attend to our wellbeing more intentionally at work.  Sometimes just taking a few minutes after a meeting or a situation of bereavement, trauma, disappointment or shock to reflect using a pack of Envision cards can create a safe space e.g. each person picks a card to express how they feel about an event/situation and does not tell anyone why they chose their card.  Colleagues reflect in pairs by exploring, commenting and enquiring about what they notice and wonder about each other’s cards, without trying to interpret, work out why, fix or rescue.  These few minutes can encourage a ‘light bulb’ moment to support each other to breathe and bridge reflective learning in the present about an event/situation to effect positive change in future practice and wellbeing.

We don’t need the ‘wisdom of Solomon’ to recognise health and social care staff have a shared responsibility to help create safer working environments for each other, patients and service users.  An increase in the dosage of compassion and psychological safety at work also helps.  VBRP® is a tool that can provide a regular safe space, to reflect on past events that may be about patient safety or our own safety or practice.  As the handbook states, “VBRP® is about the re-humanising of health and social care through the recovery of, and dialogue between, personal and organisational vocation”.

You can learn more about VBRP® here.

Dawn Allan is the Spiritual Care Lead for NHS Dumfries and Galloway