What can Plato and the Allegory of the Cave teach us about the Media? by @ychristley

In 380 BC, the Greek philosopher Plato in his most famous work ‘The Republic’ presented the ‘Allegory of the Cave.’ The ‘Allegory of the Cave’ is one of the most important and vivid metaphorical stories in the history of philosophy and outlines Plato’s assertion that most people are blind to the reality that surrounds them.

To make his point, Plato asks us to imagine an underground cave, in which prisoners are shackled by their legs and necks. The prisoners are unable to move or turn their heads and can only see the wall in front of them. Behind them, on a raised platform is a puppeteer and behind him, is a fire. The fire casts a continuous parade of puppet shadows on to the prisoners’ wall. The prisoners have never lived outside the cave and consider the shadows to be real.

The peculiar imagery in this story and the way in which it conveys the prisoners’ deep, distorted and disconnected perception of reality has always fascinated me. The notion that reality was framed for the prisoners by not only the puppets, but by the shadows of puppets, is very disturbing. To make the story even more interesting, Plato tells us that if the prisoners are suddenly released and shown the truth they become overwhelmed, confused and bewildered and will ultimately disregard the truth as false. Not all prisoners can bear to recognise that the shadows are puppets and only a few make the journey upwards and out of the cave towards the light.

Plato uses the cave to symbolise society and makes clear his view that we all, at some point, will be prisoners within it. In my view, the cave is one of the most optimistic and beautiful depictions of our human ability to cast aside the bonds of conformity, established opinion and ordinary experience, in the pursuit of enlightenment.

Although Plato wrote about the cave more than twenty four centuries ago its powerful imagery resonates intensely with the influence of mass media on our modern world. We are living through one of the most technologically advanced and intellectually stimulating periods in human history. We can access information and images from a bewildering assortment of mass media outlets (i.e. newspapers, television, radio and the internet) in an instant. Despite the growth of social and other online communication technologies, mass media remains the dominant figure with respect to local, national and global news and what that constitutes. These outlets have unparalleled reach as a communication mechanism and have enormous influence in setting the kinds of issues that we should be thinking about, concerned about and taking action on.

The availability of so much news makes it a formidable challenge for individuals to determine whether or not the information and images provided by the media are real and worthy of our belief. To illustrate the point, the veteran news reporter Jon Snow, in an article in the British Medical Journal, provided a powerful insight into the disproportionate media focus on negative news stories in the NHS. The article made visible the preoccupation amongst the media with naming and shaming hospitals and exposing failures. Little attempt was made to look beyond the immediacy of failures, and opportunities for qualification or even praise were eliminated. His critique acts as a cautionary reminder that reality as depicted by the media is not always what it should be. The way in which the NHS is reported matters, because it shapes how the NHS is perceived by patients, staff and the wider public. It is for this reason that the prevailing tendency towards negative reporting puts the NHS at risk of becoming lost in an abyss of media complacency, which puts news corporation profit above other considerations.

 

The power of Plato’s imagery amazes me with its timelessness and urges us all to recognise that everyday belief and opinion are no better than seeing shadows. Thankfully, we are not like prisoners chained with our backs to reality and all we need to do to improve our modern world is turn around, take notice and do what matters. Of course, doing what matters is never easy and I am reminded of the poem by the Greek poet Aeschylus:

“And even in our sleep, pain that cannot forget falls drop by drop upon the heart and in our own despair and against our will, comes wisdom.”

Yvonne Christley is Head of Patient Experience and Communications at NHS Dumfries and Galloway

One year on….by @kendonaldson

Origins

It was in November 2012 that a friend of mine, Ros Gray of the Early Years Collaborative, suggested that I start a blog for NHS D&G. I had become interested in Twitter and the power of linking to research articles, national documents and blogs and Ros knew that Derek Barron, Associate Nurse Director for Mental Health at NHS Ayrshire & Arran, had established his blog, www.ayrshirehealth.wordpress.com, earlier that year. She introduced me to Derek and from then on there was no going back.

Derek sent me a detailed email outlining how to set up and start a blog and tips on maximising readership. I must confess there then followed a few months of inactivity while I toyed with the idea before finally taking the plunge. After setting up the blog itself I had to ensure I would have some interesting blogs to publish. I also had to decide what sort of content NHS D&G desired and what the underlying ‘ethos’ would be.

Passing the buck

I therefore emailed a mixed bag of nurses, doctors, pharmacists, managers, therapists and Chief Execs asking if they wished to contribute. The remit would be “900 or so words, any topic you wish but related to healthcare and pictures if possible”. So basically the content and ethos would be decided by them, not me!

By the time I had 14 willing bloggers I felt I could get started and set the date as March 22^nd 2013. I had decided to emulate Ayrshirehealth and post once a week and as they posted on a Wednesday I decided to go for a Friday. I had booked a session on our Wednesday lunchtime meeting to discuss ‘Social Media in Healthcare’ but also launch the blog. This way I had no choice but to ensure everything was set to go.

Ready for launch

The final step was to obtain permission from senior managers and IT to use the DG2all email address so that I could email the link to all staff members of the health board weekly. @lauralougraham7 stepped up to the mark and agreed to provide me with our first blog, “Never underestimate the importance of safety briefs” and we were off.

Stats

In the past year we have had 50 blogs (2 weeks off for Christmas and New Year). 15 by doctors, 14 managers, 7 nurses and 6 Guest blogs. The rest are made up from IT, carers, AHPs etc. The most popular categories are person centred care, patient experience, communication, common sense and ethics.  We have had a total of 20,731 views and 263 comments.

If you access the blog from the email link then this is recorded as ‘Home page’ so, unsurprisingly, this is the biggest hit at 13,301. However if the blog is accessed via Twitter then that blog itself is recorded and the biggest has had 727 views with 474 second to it. This drops down to a few blogs in the 20s and 30s.

We have had 19,365 views in the UK with 417 in the USA and 104 in Australia. New Zealand, India and Canada follow with 80, 65 and 59 respectively. There is a total of 87 countries worldwide where the blog has been viewed ranging from Tunisia to Trinidad and Tobago to Thailand. I am still impressed that we had a reader in the Philippines at the same time as Hurricane Haiyan was laying waste to the country. I would have imagined they had something better to do!

The year ahead….coffee

I think the list of categories above probably establishes what the ethos of the blog is but I have a slightly different take on things. Here in the Renal Unit in DGRI there is a longstanding tradition of starting the day with a cup of quality coffee. This involves general conversation that is extremely variable; the current headlines in the news, a new drug that’s been announced, the experience of a patient seen the previous day, an update from a meeting attended or just a funny story.

I like to think of the blog as a similar experience for everyone in NHS D&G and beyond – have a cup of coffee (probably not as good as an ‘Isles Special’) and spend 5 minutes hearing the thoughts and opinions of a colleague. It will probably not change the World or indeed Dumfries and Galloway but it may make you think a little differently about your practice or realise what happens in different areas of the Health Board. Or it may just make you smile. Whatever, I intend to keep the blog going for at least another year and hope you will join me.

I would like to thank Derek Barron (@dtbarron) for all his help and support in setting up the blog. I would also like to thank Ros Gray (@rosgray) for the inspiration and encouragement. I am extremely grateful to all the bloggers to date and would be delighted if anyone reading this would be keen to contribute. Please email me on kdonaldson@nhs.net of you wish to have a go. Finally I would like to thank you Dear Reader for continuing to view the blog.

Ken Donaldson is a Nephrologist and Associate Medical Director at NHS Dumfries and Galloway

 

Education and Revalidation by Gordon Hay

I’d like to take the opportunity to use this Blog to discuss the role of the NES (NHS Education for Scotland) Practice Educator and reflect on some of the projects that I have been involved in during my time working within NHS Dumfries and Galloway. I will also consider the fast approaching issue of NMC Revalidation and how nurses and midwives can start preparing for this now.

I came to the post of NES Practice Educator (PE) for NHS Dumfries and Galloway from a varied career as a Mental Health Nurse with NHS Ayrshire & Arran (and a brief detour to the FE Sector). Working principally in Community Mental Health, I enjoyed roles in Adult CMHT, CAMHS and Addictions Nursing.  As a Senior Charge Nurse and Team Leader professional development was always crucially important: both personally and within the culture of teams I worked in. The PE role with NES offered a unique opportunity to focus exclusively on this area and support a wide range of nurses and midwives to access academically robust, evidence based person centred resources which inform their practice in a meaningful way.

As PE for NHS D&G I am part of a National network of 17 hosted in NHS Boards across Scotland. The role enhances the existing practice education network at a local, regional and national level. We support the continuing professional development of nurses and midwives in care giving roles by bringing educational resources closer to practice and act as a conduit between NES and the Boards. The role has a strong strategic remit as well as hands on facilitation of learning sessions.

My post is part-time with core working days of Monday and Tuesday. I work closely with the Practice Education Facilitators, Practice & Development Skills Facilitator Bill Irving and AHP Practice Education Lead Kathy Banford. My Professional Lead with the Board is Alice Wilson AND.  A large part of my focus since coming into post has centred on developing a network of contacts throughout the board and in particular the promotion of Effective Practitioner (EP – a comprehensive online CPD resource) and ePortfolio (eP – the electronic personal professional portfolio) across a wide range of clinical and geographical settings. There has been a significant uptake of this work from Mental Health, Midwifery some of the Community Nursing teams and Cottage Hospitals and within the Acute Sector, Renal Services and Day Surgery.  I particularly enjoyed filming a videocast for inclusion on the Effective Practitioner website with Learning Disability Champion Emma Groves from Day Surgery where she shared the transformational effect participation in the LD Champ course had on her practice. Despite the significant challenges Nurses and Midwives face in balancing clinical demands with accessing CPD my experience working in these areas has demonstrated that there is an important role for time efficient and well designed resources such as EP and eP in supporting and recording professional development activities.

With the details of NMC Revalidation currently being finalised the effective maintenance of a professional portfolio of robust CPD activity has never been more important for Nurses and Midwives. The Revalidation model is expected to be with is in January 2014 with early implementers going live from early 2015.

 

Key principles of the new model include:

• Improve public protection.
• Increase public confidence in nurses and midwives by allowing them to demonstrate that they are always fit to do their work.
• Ensure nurses and midwives on the register continue to meet NMC standards.
• Enable nurses and midwives to be accountable for demonstrating their continuing fitness to practise.
• Promoting a culture of professionalism and accountability through ongoing reflection on the Code and standards.

 

Revalidation will require every nurse and midwife to confirm that they:

• Continue to remain fit to practise by meeting the principles of the revised Code
• Have completed the required hours of practice and learning activity through Continuing Professional Development (CPD).
• Have used feedback to review and improve the way they work.
• Have received confirmation from someone well placed to comment on their continuing fitness to practise.

 

What is clear is that preparation for the increased demands of Revalidation should be considered now.  How robust is your CPD, how effective are you in recording any CPD activity?

I would encourage all interested parties to participate in with online consultation on the proposed revalidation model which runs till 31/3/14 details here: http://www.nmc-uk.org/Get-involved/Consultations/Consultation-on-revalidation-and-the-revised-Code/CPD

In Strategic Aim 1, Setting the Direction, the Scottish Government propose that we should “Work together to promote a learning culture in which development and improvement are inherent in everyday working practices. Working collaboratively with partners to promote educational technology and other methods which improve flexibility and access and suit a range of learning styles and preferences” This strongly advocates the importance of embracing time efficient use of high quality learning resources e.g.

 

Effective Practitioner includes:

Template for CPD – Self Assessment and Action Planning tools, wide-ranging  Learning Activities and Work-based learning materials and links to Knowledge Network and other resources.

ePortfloio includes:

Simple, intuitive, real time recording of CPD, Clinical learning, reflection and supervision.

Feedback requests: line managers, peers, patients and carers.

These resources can contribute significantly in preparing for Revalidation.

I am currently offering a range of hands on sessions introducing ePortfolio in collaboration with the PEF TEAM, these have been heavily oversubscribed and additional dates have been released.

All Sessions – 1-2 PM Seminar Rm 3 Ed Centre DGRI.

22/4, 27/5, 24/6, 22/7, 26/8, 23/9.

Additionally I am happy to deliver in your clinical area or team base. I am also happy to discuss any other aspect of professional development or use of other NES resources.

Gordon Hay is NES Practice Educator for NHS Dumfries and Galloway

 (email  Gordon.hay1@nhs.net)

 

 

Boundaries . . . by @AnneMar43403619

“Freedom brings men rudely and directly face to face with their own personal responsibility for their own free actions. (Frank Meyr, 1962 in Defence of Freedom).

Do you ever get the feeling that the NHS is trying to run a five star service on a one star budget? Quite some time ago a motivation speaker came to talk to many of the senior managers within D&G NHS about the indisputable fact that demands on the NHS would continue to increase and resources would continue to decrease proportionately.  He asked them to think out of the box about how we could start to overcome this increasing discrepancy. So, here’s some thoughts…

 It is almost as though the welfare state (indisputably needed and a mark of a civilised and moral society) has created its own Catch 22 with so many people believing their right to a choice, their choice, is paramount regardless of the impact on anyone else either individually or corporately.

 This fundamental change in people’s expectations comes with an increasingly litigious mentality and is leading not only the NHS but all welfare provision to breaking point. The boundaries of personal and social responsibility seem to be getting dangerously blurred and I believe that it is time to start defining healthy and sustainable boundaries again. To start saying, dare I say it, ‘No’.

 Before you all shoot me down in flames please be aware that I am not decrying the drive to improve patient care or the patient experience – we all want the best treatment and care for our patients, but it has to be within reasonable and sustainable limits.

 It seems to me, and a lot of my colleagues that it should be possible to cut back without affecting front line services – but the cuts would affect at least two forbidden areas: the patient experience and those strategists who think that forty page documents talking about interface working and cross sectional content mean or change anything.

The latter is probably best summed up by a quote from an anonymous but very well known NHS source: “As is well reported the management and administrators within the health service could keep themselves busy in an empty hospital with paper exercises.”

 Maybe we could summarise the government’s strategic direction 2020LDP paper thus: “Continue to work together to provide the best patient care across all services within budget constraints.”  One person, two minutes, cost to the NHS about 20pence.

O.K tongue in cheek but you get my point.

Any measures that negatively affect the patient experience would be controversial but when you look at it in terms of managing your own home and how your budget affects the choices you make and are sometimes forced to make surely it becomes simpler. Running your own home involves setting limits and boundaries, it involves denial, taking second and third best or frequently going without at all and it is not just you, the adults, but your children that are affected by the choices you make. If you teach your children and help them understand why they cannot always have just what they want when they want they learn to value your family resources, understand why sometimes the answer is ‘No’,  maximise family resources and then take on their own responsibilities as they grow up.

 Perhaps it is time for the NHS to set some realistic boundaries of its own and make it clear that it simply cannot meet every demand or expectation, public or otherwise. Can we really expect to be able to continue paying for patients to occupy acute beds simply because they don’t want to go to a community hospital? Or let patient choice costs tens of thousands of unnecessary pounds when there is an alternative that costs so much less? Can we expect to continue to fund hundreds of unnecessary visits to A&E or GPs, to shell out blanket free prescriptions? Or, on the other hand, continue to allow employees to stick to procedures that not only cost more but have a negative impact on a patients physical, mental and social well-being – just because they have always done it that way? Or to recall patients repeatedly for hospital check ups when a telephone call would do? Or to take up an acute bed simply because a patient needs an urgent scan but is otherwise well. Or to …. the list is endless.

 Why is it so difficult for people to set sensible and realistic boundaries and stick to them? Why do we, as staff, so often capitulate to our patients every whim: “Not eating that sandwich I want grated cheese not slices!” and with each capitulation re-establish the boundary even further in the patient’s favour.

 How too is providing for every expressed patient need going to encourage the culture of self management that is being flagged up as an essential part of the NHS future? Granted there are a huge number of things that are crucial to improving the patient experience that should be a fundamental part of the treatment they receive anywhere in the NHS – respect, courtesy, clear information, empathy and openness – but maybe we need to remember that the original ethos of the NHS was treatment free at the point of delivery based on clinical need.

Clinical  need – not desire.

Anne Marshall is a Staff Nurse on the Renal Unit at NHS Dumfries and Galloway