Dumfries and Galloway White Ribbon by Kerry Herriott

November 25^th is the international day for the elimination of violence against women. It marks the start of 16 Days of Action for the Elimination of Violence Against Women which ends on the 10^th December on Human Rights day. This movement started in 1991 and was coordinated by the Center for Women’s Global Leadership. It now has thousands of followers and all over the world work takes place to raise the profile of gender based violence and the need to challenge such abuse.

Men, boys, women, and girls can all be affected by most forms of gender based violence (domestic abuse, rape and sexual assault, childhood sexual abuse, forced marriage, so-called honour crimes, sex trafficking and other forms of commercial sexual exploitation including prostitution; with the exception of FGM which only affects women and girls). However, since the majority of the victims of these forms of violence are women and girls, when we talk about gender based violence we usually talk about Violence Against Women and Girls.

The best known and most prevalent form of gender based violence in Scotland is domestic abuse and this is the one that most people are aware of. Domestic abuse is so common that all of us probably know someone who has been affected by it. It is estimated that 1 in 5 Scottish Women will experience it during their lifetime. Our understanding has developed over the last couple of decades and we have progressed from an acceptance that some men are violent/abusive and that the women who live with them should either fight back or leave, to having a much more sophisticated understanding.

This new understanding reveals that for many women fighting back or leaving is not an option and trying to do so may put them at increased risk. We now recognise that fear has a big part to play in abusive relationships and that the absence of physical violence does not lessen a victim’s risk. She may be subjected to coercive control which is in reality removal of a person’s choices and freedoms. For many women rape and sexual abuse form part of the domestic abuse as does emotional abuse such as putting someone down; not allowing them access to money; and a range of other behaviours. We understand that even when a woman leaves an abusive relationship, this is rarely a singular event but may be a process that takes around 7 attempts. We also know that the woman is likely to have the best understanding of her risk and how to promote her safety. Leaving an abusive relationship does not necessarily mean an abuser will stop the abuse, in fact, he might increase or start abuse at this time; and we know that this is one of the most dangerous stages in an abusive relationship.

Every year during 16 days of action people ask “What about men?” there is an international men’s day on 19^th November but most people would agree that when we discuss issues such as domestic abuse, rape, trafficking, etc. it is women who are mainly subjected to such abuse. Worldwide, men still hold more positions of power, more wealth and privilege than women this of course changes when we take into account issues of health, sexuality and race.

Here in Dumfries and Galloway, we have a Domestic Abuse and Violence Against Women Partnership who meet to plan the ways in which we can work together to eliminate violence against women in all its forms. You may be aware of some of our campaigns including leaflets and posters with the tag line “domestic abuse – there’s no excuse”. We have met since 1999 and have been responsible for the development of 3 domestic abuse/violence against women Strategies and Action Plans.

Every year during 16 days of action we organise a variety of ways to raise awareness of violence against women. These include our annual youth Song Writing Competition which is now in year 5. We have been very encouraged at the ways young people in Dumfries and Galloway find to include issues of violence against women into their songs. We regularly have community film shows, send messages via tweets/facebook and have training events.

We are very pleased that this year we will continue to work with White Ribbon Scotland to promote their message of men working to challenge violence against women. The White Ribbon campaign started in Canada as a response by men who recognise that violence against women is unacceptable, that the majority of men aren’t violent towards women and want to do something to challenge such abuse. White Ribbon Scotland as the name suggests works across Scotland to promote positive messages against violence against women.

There is recognition that gender based violence is harmful to men as well as women, that most men think it’s wrong and that many men want to do something about this. Violence against women has many costs to individuals, families, communities and services. Many of our agencies spend time and effort supporting women, men and children who have been harmed by abuse and who often face challenges as a result of the abuse.

Some rigid gender stereotypes along with negative messages of masculinity, can be restrictive to both men and women and can contribute to the perpetuation of domestic abuse and some other forms of gender based violence including sex trafficking.

The White Ribbon campaign asks men to pledge “to never commit, condone or remain silent about violence against women”. Women are able to sign up too but the main objective is to involve men and provide a platform for them to speak against these issues. Some of you in Dumfries might be aware of Queen of the South’s support of White Ribbon and have seen the cards with messages about positive relationships or the white ribbons on their practice strips. We will continue to work with Queens this year with a White Ribbon game in early 2016.

In D&G we have agreed to work towards becoming a White Ribbon Area. This means that we need men to help! We want men who are prepared to speak out against such abuse to train as speakers, we want 1000 local people to sign the pledge, we want sports groups/organisations to become White Ribbon Groups and we hope that some of you reading this will have some other ideas.

Do you want to help? Please contact us at domesticabuse@dumgal.gov.uk or phone 01387 245190. You can find more information at www.dumgal.gov.uk/davawp

Kerry Herriott, Development Officer (Domestic Abuse and Violence Against Women Partnership)

 

Under Pressure…… by @fionacgreen

In November 2013 “Dave” was admitted to hospital following a hip fracture. Dave didn’t always like the food choices and at times found it difficult to drink enough. Several days into his admission his wife noticed a blister on his heel- she mentioned it to the ward team but felt she was dismissed.

By the time of his discharge from hospital Dave had an established ulcer that required regular input from the community nursing team and podiatry.

In June 2014 Dave was admitted to hospital again. The fact that he had already one pressure sore, combined with diabetes meant that he was at high risk of developing further pressure sores and this time he left with a further two pressure sores.

Further prolonged admissions followed to treat deep-seated infection of bone resulting from the presence of pressure sores and ultimately surgical debridement and vascular intervention was required to aid the healing process. With each further admission Dave and his wife became increasingly terrified of what might happen and worried that he may leave with further pressure sores. Last year Dave spent his wife’s birthday, Christmas and New Year in hospital and throughout was visited daily by his wife -it is clear from his story the human impact of developing pressure ulcers

Dave and his wife have given their permission to share their story in the hope that we can begin to learn how important it is that we work together to prevent

pressure ulcers

Lesson one -Prevention is better than cure.

Each year 700,000 people in the UK develop pressure ulcers. Each pressure ulcer adds approximately £ 4000 to the cost of care. It has been suggested that 80-95% of pressure ulcers may be avoidable. Sometimes in healthcare as we concentrate our efforts on the complicated and exciting new developments that come our way we can lose sight of the simple things that can make a huge difference to the outcomes for our patients. By paying attention to early detection of risk, encouraging patients to keep as mobile as possible, addressing incontinence appropriately and by improving hydration and nutrition we can make steps to reduce the risk of pressure ulcers developing.

Preventing Pressure Ulcers- the CPR approach

1 Check and identify problems early– this means that socks, TED stockings, and dressings must be removed to allow the pressure areas to be properly visualised

2 Protect – if pressure areas are at risk encourage regular changes in position, consider a pressure relieving mattress and apply REPOSE heel splints or Sundance Z-flex boots to relieve pressure. These are available locally by ordering through the PECOS system.

3 Refer – it is never too early to refer to the podiatry team if you have concerns

Repose Heel protectors and Sundance Z-Flex protectors

If you want make sure you are skilled in the CPR approach to pressure ulcer prevention you can like me complete a short and practical e-learning module available on the NHS Learnpro site ( you’ll be pleased to see that I passed!)

 

Lesson 2- Improving Patient Experience/reducing harm/ improving financial efficiency

Sadly Dave’s story is one of many but so clearly illustrates that developing a pressure ulcer is an important physical harm that also impacts significantly on the healthcare experience of the patient and their family. Pressure ulcers are not just a huge burden to the patient and their family but also to the NHS and its staff as a consequence of prolonged hospital admissions and ongoing intense community treatment that may be required to heal the pressure ulcer. In Dave’s case listening to his wife’s concerns and making sure that he was eating and drinking well may have helped to prevent the prolonged and costly treatment that followed

Lesson 3 Changing Practice

Over the last few years we have all found ourselves under increasing pressure in the NHS. Some of these pressures relate to our desire to reduce harm, improve our patient’s experience of care, and finally to make financial efficiency savings.

People who come into hospital are also under pressure- they are in a frightening and alien environment and their illness may make it difficult to eat, difficult to maintain hydration and difficult to keep mobile. These factors are all important in the development of pressure ulcers. In Dumfries and Galloway we have begun work to accurately record the numbers of pressure ulcers acquired and we implemented a risk assessment pathway incorporating the elements of the ACTIVE PATIENT CARE bundle, Waterlow score and NATVNS pressure ulcer recording tool on pilot wards. Work is currently ongoing to spread these practices throughout the acute sites and the community

21^st November 2015 marks worldwide STOP PRESSURE ULCER day- Following on from Dr Bell’s blog last week this is one aspiration that we cannot afford to give up on

Dr Fiona Green is a Consultant Physician and Diabetologist and Clinical Lead for Pressure Ulcer workstream

 

 

Prioritisation in NHS Scotland by Ewan Bell

I have to make it clear from the outset that the views expressed here are my own – these are my personal views.  They are nothing to do with being Associate Medical Director in NHS Dumfries and Galloway and do not reflect any local management or Board view! I’m writing this as an avid armchair follower of politics, current affairs and economics! I should also stress that I am a member of no political party.

To put my views in context, I should state that I believe that there are 2 fundamental and essential pillars of a fair society;

• Equality of opportunity; in real terms this means free access to education and zero tolerance of discrimination
• Free healthcare; people should not suffer or die because they can’t afford to pay for health-care

I am a passionate believer in the concept of the NHS and free health-care for all. My mum and dad tell me stories about how their grand-parents couldn’t afford to go to see the Doctor. In my view this is unacceptable, incompatible with a fair society and must remain in the past. 

On one hand we have increasing costs due to advances in health-care technology, changing demographics, increased expectation and the costs of prescribing. And on the other hand we have limited resources. Demand will always outstrip capacity. Just about every health-care system in the world is wrestling with this challenge, no matter whether they are publicly or privately funded. There will never be unlimited resources, or indeed adequate resources, to provide all health-care, free of charge, for all people. So how should we, as a society, respond to this challenge?

Let’s consider an analogy.  All households have a defined income. We might moan about it and complain, but there’s not much we can do about it. So how do we respond to this? Most organised households will budget and align expenditure with income. There are fixed essentials, such as tax, national insurance, council tax and rental (or mortgage) payments, over which we have little control. But there are other outgoing costs which can be varied and influenced by the household (maybe not enthusiastically), such as, for example, food, clothes, heating, alcohol, etc. If times are hard, then a household will pull back to the fixed essentials and moderate spending in other areas, or to put it another way, the household will prioritise its spending.

If we apply this approach to health-care, then we need to start debating and defining the essentials of health-care and what can we pull back from. In other words, we really are going to have to start discussing what we should be focusing our limited resources on and what we should stop doing, as not all interventions are equal.

I suppose this goes back to my initial views on the pillars of a fair society. To maintain free health-care for critical, core services in the NHS, we are going to have to start redefining what health-care means and acknowledge that we can’t continue to provide the current range of interventions and services, if we want a sustainable NHS for the future.

So, what are the essentials and what should we stop doing?

Dr Ewan Bell is a Consultant Biochemist and Associate Medical Director for NHS Dumfries and Galloway

 

 

 

 

 

 

Time to do the right thing? by Barbara Tamburrini

During my current secondment to the Emergency Department in DGRI, I recently had the pleasure of reviewing a patient who I will call Jane and who required admission for an acute health issue. Jane was very apprehensive and reluctant to be admitted which is quite understandable. However, on exploring this further to reassure her, I discovered that much of Jane’s apprehension surrounded her experiences during a previous admission to hospital. Jane had been a patient in a very busy general ward and she had required frequent assistance but English was not her first language. Jane was very conscious that her communication and understanding had caused her some challenges and she stated she felt “slow” because of this language barrier.

Jane described in some detail, that she had felt very uncomfortable pressing her buzzer when she required assistance and she explained that she thought the staff on the ward were wonderful and caring but they appeared, in Jane’s words:

“too much, too busy busy, too small time.”

 

Jane’s perception was that by requiring assistance, she was contributing to what she considered to be an already unachievable workload for busy staff. Jane was clear that staff had been efficient and had never expressed displeasure when she requested help but the speed at which staff interacted with her and assisted her, coupled with her self-awareness regarding her language had all made Jane feel “a nuisance”.

 

After spending some time reassuring Jane, I came away from this consultation having been touched considerably by it.

Why?

Because, all too often, I have been one of those nurses on a busy ward, rushing around to get my work done and trying to juggle many different ‘plates’ in the air. It’s so easy to get into this mind set in a healthcare environment which demands so much from staff to deliver optimal services with the limited resources we currently have and a potentially depleted morale.

BUT, and this point is crucial…

Who do we forget about when this work culture is put under the spotlight?

Where does our most important element, our patient, feature in this busy work schedule?

Of course, looking after our patient’s effectively is the reason we are all so busy but is that thinking doing our patients’ an injustice? If we had the chance to ask those who utilise our services and who we interact with during our hectic shift, how they view the busy environmental culture within our wards and departments and what they think and feel about our workload, what would they say? Ask yourself honestly how many of your patients’ or clients have said to you they “don’t want to bother you”? When I think of this, I am certainly left wondering whether I have given my patients the perception that I was too busy for them. Have the patient’s I’ve interacted with during a busy shift been left feeling as though they didn’t want to ‘bother me’ or worse, they didn’t want to be a bother to me? Like most people in the NHS, I came into this profession to care for people in the best way I can but are we achieving this if this is how our patients could be feeling?

A significant quote comes to mind when I consider this…

How have you made someone feel today?

Its certainly a juggling act between making our patients feel listened to and valued and managing the hectic workload. Arguably, that juggling act has been no more challenging than it is in our clinical areas and departments today in the face of financial pressures, tight staffing numbers and a seemingly increasing need for our services.

SO, how on earth do we begin to address this? Ask yourself some very simple questions…

1. The problem is we are too busy but we need to make time for our patient.
2. The solution is to free up time from our current schedule – what do we do consistently and regularly which we could look at?
3. We perform many handovers during a busy shift, what would happen if we made these more efficient?
4. How do we give this a try?

How do we give this a try? When we come up against a question like this but our heads are full of everything else going on in our busy working day, we need a strategy to give us some direction. Think of this strategy as being our ‘work-place problem-solving’ SatNav!

The destination in our ‘SatNav’ is symbolised by the question mark in this diagram and it brings us back to the question in our problem-solving steps – How do we achieve more efficient Handovers?

This diagram leads us to the outcome by asking key questions:

• WHY do we want to achieve more efficient handovers? – To release time to care for our patients.
• WHERE do our handovers occur? – In our care area and in other departments.
• WHEN do these handovers occur? – When we transfer patients and when we change shifts.
• HOW do these handovers occur? – Are they structured, formal enough and does everyone use the same approach?
• WHAT is handed over? – Do we communicate accurate clinical details in the right way to ensure the receivers clearly understand what we want them to?
• WHO are essential participants for our handover to occur? – Which staff groups do we need at which handovers?

The key questions asked in our problem-solving approach provide the foundation for NHSDG’s current Handover Strategy;

WHO?, WHAT?, WHEN?, WHERE? & HOW?

By choosing just one handover process, which occurs at any point in your departmental working day, and answering these simple but crucial questions, you can begin to develop the structure for your departmental handover protocol. A simple protocol document is available either in electronic or paper form, which you can adapt to suit your specific area and handover needs. What’s more, you don’t need to do this alone, assistance is available from myself or Jean Robson as NHSDG handover leads or from members of the Patient Safety & Improvement Team or the NHSDG Handover Group to support and guide you through every stage.

Some tips which will help you to achieve success are:

• Start small and plan well
• Engage all your colleagues in the process
• Build up gradually & extend what you learn
• Expect challenges & address these as they arise
• Use continual evaluation to continually develop & improve
• Never think you’ve finished – its always evolving!

By making this frequently occurring element of our workload much more efficient, we will release considerable time in our day to give back to our patients, relatives and colleagues.

The added ‘Brucey Bonus!’ (and here’s a blast from the past!!) is that a more structured handover will improve the accuracy and safety of clinical communication, which will enhance cohesive, collaborative and consistent multi-disciplinary team working.

The handover group are planning information sessions on 24^th November 2015 to share existing developments from departments working on their handover processes, to learn new ideas relating to improving your handovers and give support in promoting optimal handover practice which is essential, valuable and time-saving.

So, to return to our original thought, look once again at the title of this blog:

‘Time to do the right thing?’

Do you see the question “Is it time to do the right thing?

Or do you see the question “Do we have time to do the right thing?”

The focus of this blog has been the latter. Are we giving time? Are we allowing time in our day to ensure that we do the right thing by our service users and their relatives as well as our peers and colleagues?

I leave you with one final point:

Think of your last work interaction with a patient, relative, colleague or client. During this, did you give them time and have you left them with the perception that you had time for them? If not, what do you need to improve?

Did you make time to read this?

Further information is available from Barbara (btamburrini@nhs.net) Jean Robson (jean.robson@nhs.net) or Amy Sellors, Patient Safety & Improvement Team (asellors@nhs.net).

Barbara Tamburrini, ANP & NHSDG Lead Nurse for Handover at NHS D&G

01387 246246 Ext 32983