Fork Handles!!! by Helen Moores

“The single biggest problem with communication is the illusion that it has taken place” George Bernard Shaw

What is the reading age of the most popular newspaper in Scotland, The Sun?

If you were to categorise it and place it on a shelf where would you put it? 8-10 yrs? 12-14? 14-16 yrs? The answer is 8 years old.

In terms of language level, vocabulary, grammar etc. The Sun is written at the same level as a school reading book for an eight year old child. According to The Literacy Trust the average reading age in Scotland is only 9 years old. This sort of information has massive implications for the way we communicate with our patients, carers, their friends and family.  If we are producing written material or talking in a way that is too technical, medical or wordy we lose, bewilder and alienate our audience whilst thinking we have been clear. It is referred to as health literacy –  the gap between what we as professionals think we have said and what our patients have actually heard or understood or are able to access. It brings to mind the confusion in the classic Two Ronnie’s sketch where a man walks into a hardware shop and asks for Fork Handles and receives 4 candles!

October is World Health Literacy Month and the aim is to raise awareness of this gap in communication. The Health Literacy Place is a website attached to The Knowledge Network and details the Making It Easy action plan to improve Health Literacy here in Scotland. It contains some frightening statistics:

• 43% of English working age adults will struggle to understand the instructions to calculate a childhood paracetamol dose
• 26% of people in Scotland have occasional difficulties with day to day reading and numeracy
• People with lower health literacy have increased rates of emergency admissions, wait until they are sicker before visiting their GP and are less likely to engage with public health programmes eg breast screening and vaccination
• In general people remember and understand less than half of what we discuss with them

The implications for patient experience, safety and access to services are clear. This is not just a welfare or financial obligation, but a legal one. The Patient Rights (Scotland) Act 2011 states that “people should be communicated with in a way that they can understand and that healthcare staff should make sure that the patient has understood the information given.” Our skill as healthcare professionals is not only to diagnose and treat but to communicate those findings in a culturally appropriate, meaningful and memorable way.

Here in D&G it has never been more timely for us to think about these issues as we plan our own Big Move, thinking about clear signage, systems for patient appointments, e-records etc in our new home. In addition our English neighbours in Cumbria are getting to grips with the Accessible Information Standards. These legal standards were introduced into NHS England on 31^st July this year and go one step further in addressing communication needs. They stipulate that a person with a disability, impairment or sensory loss should be provided with information that they can easily read or understand with support. The Standards also state that these needs should be identified and recorded prior to a patient accessing a service.

The good news is that because of the introduction of these standards in England there are lots of resources to help us look at our practice here in Scotland. So where do we start? As a communication specialist, it’s a subject close to my heart.

If you are looking at a service audit or improvements, some handy hints include:

• to never be without a pen and paper
• to download a profession specific app or animated sequence for your phone or tablet
• sit down or be at eye level for all conversations, where possible
• order a name tag and say..”Hellomynameis…”
• attend one of the specialist workshops in the Education Centre

but also…….

“Tell me your story…”

Asking this initial interview question allows you time to tune in like a radio to the person’s wavelength. By asking this I can assess fluency, coherence, intelligibility, cognitive ability, word finding skills, language level and most importantly adjust mine accordingly .. but also assess the patient’s accuracy as a historian, their interpretation of events, what they believe the doctor said, if there’s an outstanding or unresolved issue or complaint, their mood and motivation for engaging with therapy, what is important to them, their family, goals, hobbies and start to identify any hooks that I can hang my therapy on to make it personal and meaningful and therefore increase its success. Not bad for one simple question!

 

Perform the SMOG!

The simplified measure of gobbledygook – yes it’s a real thing. Created in 1969, take any piece of written material your service routinely supplies and apply the formula to calculate a reading age. If it’s higher than 9, think again. http://prevention.sph.sc.edu/tools/SMOG.pdf

 

Access The Health Literacy Place

This NES website gives some really great tailored resources for GPs and medics, AHPs and nurses including simple techniques like Teachback, but also online courses, training and templates to re-evaluate and improve your communication personally and within your service. http://www.healthliteracyplace.org.uk/media/1360/health-literacy-month-eflyer-2.pdf

Chat to a friendly Speech & Language Therapist

But then I would say that! The Royal College has a new position paper and website to support Health Literacy or Inclusive Communication as it’s sometimes known.

And Finally……

…for a chortle and a lighter look at Health Literacy as seen from the perspective of the doctor we all love to hate, click or paste the link below…. If you can’t see it you may need to upgrade your version of Internet Explorer to 11. http://www.youtube.com/watch?v=zG2DVoRP86g

Happy Friday and happy Health Literacy Month!

#healthlitmonth

Helen Moores is a Specialist Speech and Language Therapist for Adult Service & The IDEAS Team (Interventions for Dementia, Education, Assessment & Support) at NHS D&G

Follow us @SLT_DG

Find us at NHS D&G SLT Adult

 

Health Literacy Month logo and Health Literacy Heroes illustration are reprinted with permission of Helen Osborne, founder of Health Literacy Month

Gender Matters by Lynsey Fitzpatrick

 

 

 

 

 

 

On 6th September 2016 in Lockerbie Town Hall, NHS Dumfries and Galloway and Dumfries and Galloway Council, supported by the national feminist organisation ‘Engender’, jointly hosted ‘Gender Matters’ – an opportunity, in the form of a workshop, to explore the issues surrounding gender equality.

There were over 40 people from a range of organisations including NHS, Council, South West Rape Crisis and Sexual Abuse Centre, LGBT Plus, LGBT Youth Scotland, DG Mental Health Association, Support in Mind and Glasgow University, and also members of the public along with staff from other Health Board areas.
When I started to write this blog post, I was thinking back as to why the steering group behind the event decided to host this event in the first place. There is a plethora of evidence to back up why we need to support events of this nature, for example:

• Women are twice as dependant on social security than men
• In 2015 the gender pay gap in Scotland was 14.8% (comparing men’s full time average hourly earnings with women’s full time average hourly earnings)
• Also gender pay gap in Scotland when comparing men’s full time average hourly earnings with women’s part time hourly earnings was 33.5%
• This means, on average, women in Scotland earn £175.30 per week less than men.
• The objectification and sexualisation of women’s bodies across media platforms is so commonplace and widely accepted that it generally fails to resonate as an equality issue and contributes to the perception that women are somehow inferior to men.
• Femininity is often sexualised and passive whereas masculinity is defined by dominance and sometimes aggression and violence.
• At least 85,000 women are raped each year in the UK.
• 1 billion women in the world will experience physical or sexual violence in their lifetime.
• In 2014/15, there were 59,882 incidents of domestic abuse recorded by the Police in Scotland. 79% of these incidents involved a female ‘victim’ and male perpetrator.

 

So there are plenty of reasons as to why we held this event; to challenge social gender norms, to progress thinking around changing perceptions in our homes, at work and how we confront the media (not least our legal duty under the Equality Act 2010).

But what is it that made us so passionate about being part of this work?
A huge reason for me personally is that I have an (almost) 5 year old daughter. In my current post as Equality Lead for NHS D&G I have become much more aware of some of the research and facts around gender equality and often reflect on how her future is being shaped as we speak; because of the gender norms all around her, expectations from her family, her peers and her school.
I’m horrified to think that she is more likely in later life to be paid less than a male counterpart for doing the same level of work, or that her relationships and self esteem will be impacted by the stereotyping of her gender in the media.

A friend and I had a discussion at one of the film screenings for “16 days of action against Gender Based Violence” which focused on the sexualisation of children from an early age. We talked in particular detail following the film about the impact the internet might have on our daughters as they grow up – the availability of porn, more opportunity to be groomed, shifting expectations of how our bodies should look and what we should be doing with them – and decided that we really wanted to do something about this, to make a difference to our daughter’s lives, and hopefully many more at the same time.
As NHS employee’s we are legally obliged to consider gender issues in everything we do. The often dreaded impact assessment process is designed to help with this. Yet at times it is seems more of a burden than a way of informing services how best to prevent discrimination and advance equality for all.

I came across the following clip at a Close the Gap event which shows how gender mainstreaming is applicable in situations that many of us deal with on a daily basis and how this can impact on efficiency and quality of public services, benefitting not only the people who use our services, but also our key partners:

(Watch from the beginning to 3:18minutes in for a quick demonstration on how indirect gender approaches can change the way people live).
Back to the event in September: the day was split into two halves – the morning session focused on Culture and the afternoon session on Economy. The format for the day was Open Space Workshops, starting with a short presentation on each of the topics. Participants then identified topics that their group wanted to focus their discussions around. Participants were free to move around the room and join in or leave discussions as desired.
Some of the topics covered during the course of the day included:

• Gender in the Media
  Equal pay for equal work
  Rape Culture
  Part time Work
  ‘Hidden Care’ and the economic ‘value’ of care
  Societal Norms
  Women and Sport
  Success
  Cultural Expectations
  Being non-gender specific (e.g. clothes, toys, activities)
  Women’s Only Groups
  Gender Education
  Welfare Reform

Understanding ‘double standards’
There was a real buzz in the room as each of the groups discussed their topics of interest and it was clear that participants appreciated the opportunity to discuss the issues openly, an opportunity we don’t often get.
All of the event feedback was extremely positive, and there was a real interest from participants in taking this work forward, both in the workplace setting, and in their personal lives. Some of the suggestions included the creation of a Gender Equality Network for D&G, avoiding stereotyping, creating safe spaces for women to talk openly, promoting the White Ribbon Campaign, encouraging managers to see the benefits of a work/life balance, challenging the way gender is represented and considered across society, e.g. across social media, within policies and structures. This list is by no means exhaustive of everything that was covered on the day!
I hope that having a quick read of this sh

ort blog (and hopefully a watch of the gender mainstreaming clip) will be enough to convince a few more people that gender equality really does matter.
If you are interested in being part of future discussions on gender inequality and involved in a Women’s Network then please get in touch.

Lynsey Fitzpatrick is Equality and Diversity Lead at NHS Dumfries and Galloway

“Going that extra mile” by Sharon Shaw

Patient Centred Care

Being caring and compassionate is an unique talent and sometimes sadly often gets forgotten about and falls by the wayside. We are all human beings and sometimes we all need to take a step back and grasp how valuable our lives are and that of loved ones.

I want to share my story. This is the first time I have written a blog, so please be “patient” with me.

In November 2015 I started my new job in clinical education. I was excited and yet in a way I wanted to prove to myself and others how valuable education is in this forever changing healthcare environment.

Approximately 3 weeks into my new role, the Respiratory Team contacted me concerning a patient with a complex condition. It was a 59 year old male who had severe emphysema and required an Under Water Sealed Drain (UWSD) to try and reinflate his left lung. The damage was so severe it became evident that the UWSD could not be removed or his lung would continually, spontaneously collapse.

“IT WAS HIS LIFE LINE”.

I walked into the side room in Ward 12 to introduce myself. With hos blue eyes he gazed up at me looking slightly anxious. Giving him a good firm handshake, I smiled and said

“Hello John, my name is Sharon”

I’m a great believer in “non-verbals” as it delivers communication and initially builds upon a trusting relationship. And indeed it did as from then on it had a huge impact.

As my father always said…

“Sharon a good solid handshake goes a long way”.

John was palliative. He had not long retired and to get devastating news about his diagnosis and outcome was so sad. His ultimate wish was to get back home to spend the rest of his short life left with his beloved family.

I made a point of seeing John everyday in Dumfries and Galloway Royal Infirmary. It was essential to build up that relationship. During the 2 weeks I delivered education on how to care for a patient with an UWSD. Approximately 30 nurses received education, Kirkcudbright Hospital Staff, District Nurses and Rapid Response Team. As you can imagine there was a lot of anxiety, fear and uncertainty amongst the nurses. This was actually the first patient to get discharged to Kirkcudbright Hospital with a UWSD. John was fully aware of my role and was updated.

The time had come, John was ready for discharge. Understandably so, he was very anxious. I took the decision to actually go in the back of the ambulance with him to Kirkcudbright Hospital. Holding his hand and bantering away we both arrived to our destination. We were pleasantly greeted by the nursing staff. They knew John as he was a local from the town and had received care from them in the past.

His family were so supportive especially his daughter Michelle, whom I have now made a lifelong friend.

John managed to continue life for 7 months in Kirkcudbright Hospital. Unfortunately he did not get his wish to go home but in all fairness the care he received from the hospital staff made his last few months comfortable and to have that precious time with his family. He managed to celebrate his 60^th birthday with his family. It was an emotional, uplifting day.

I guess what I’m trying to say folks….

“Going that extra mile” was so successful and beneficial. I would certainly do it all again.

Thanks for taking time to read this.

Sharon Shaw is Clinical Educator for NHS Dumfries and Galloway

 

 

 

“Ae Fond Adieu” by Alwayn Leacock

Recently the NHS Trust of Dumfries and Galloway saw the departure of its greatest ambassador ever.

When I first arrived in Dumfries in August 2000 I thought I was going to the end of the earth. I had driven through fields of greenery and seen more sheep, cows and land than my native country.   I was briefed on arrival by Colin Rodin and Fiona Patterson to report to Mrs Mcvittie the residences officer. Having lived in several NHS residences in England I was already in fear of the staunch matriarchal and regimented residences officers who were very territorial   and authoritarian and had very little conversation with anyone.  I shuddered once more at the thought that I was going to be housed in a military barrack and be greeted by yet another person of the same making who gave me the impression that they were merely facilitating my refuge in this country and that I ought to be on my best behavior and conform to UK norms and standards.

The Tobago keys a UN declared Marine Park just south of Mustique in the Archipelago state of St.Vincent and the Grenadines

When I met Mrs Mcvittie for the first time that fear and reservation vanished immediately. Behind the desk sat a lady with a most welcoming smile. She greeted me in a most alluring and delightful way and informed me that she had already met my  country fellow Dr Camille Nicholls  who was another “cold tatty” like myself. Camille had to be provided with extra blankets to survive her winters. Her first concern then was whether I was managing in the cold. I could not be compared with Camille Nicholls, because apart from being an excellent physician, she was a   stunning five foot eight   beauty who made heads turn when she walked into a room.  All the men held their breath to the point of collapse not wishing to exhibit their customary abdominal protuberance.   She enquired about Camille’s’ well being.  From her conversation I could sense that she had a very good rapport with Camille as she appeared well versed about the geography of    Saint Vincent and the Grenadines, its  pristine  volcanic  black sand beaches,  the turquoise  blue Caribbean waters ideal for sailing and the splendid  golden sands   on which  Kiera Knightly was marooned with Johnny Depp on the Tobago keys in that ever so famous scene form  pirates of the Caribbean.

Mrs.  Mcvittie possesses a radiant personality which placed one immediately at ease and made a very cold September very warm. After I moved into the house at C3 Mayfield terrace there were several calls to find out if I was comfortable enough and if the accommodations had fallen short of anything I wished.   I had no complaints the residences despite not being plush and ultramodern were very clean and some of the best kept and habitable ones that I had lived in thus far in the UK.    I had very little need for further embellishments. The psychological and the emotional support and welcoming embrace made one forget about any adversity if there was any.  As a non EU resident as MTAS and the EWTD took effect   I went from being employable to non employable. Locum trainee to non trainee and therefore was set adrift. One day I was working in Dumfries doing a locum replacement for Heather Currie and the next day I had no job and could not be given a job. Over the subsequent years my sojourn took me to many hospitals and regions of the UK looking for work.   Strange but true despite having an excellent command of English and having worked in the system for your years I was no longer required. I almost fell victim to the massive Exodus of trained non European doctors who had to leave the NHS and the UK. I did eventually leave for a brief period and then was given employment in England when the job advertised for on several occasions was not taken up by a European. That short respite allowed me to gain indefinite leave to remain in the UK. My next step was to wind my way back to Dumfries and guess who was there to greet me as a prodigal son or sheep that had been lost?  The delightful Mrs. Mcvittie.

I was welcomed like a long lost friend who had returned home once more and the feeling was reciprocal  amongst the affable Scots. Mrs. Mcvittie is the “hands on” type of boss who looked after everyone and made sure they were well. If you infringed the residency rules you received a little note placed under the door asking you in a rather polite and diplomatic way to conform and be considerate to others. When you looked through the windows in the early morning you could see her approaching and before going to her office she would set about doing little errands around the compound. She was never afraid to muck in and get her hands dirty.  She was an ambassador extra ordinaire I am yet to meet anyone in her capacity that can fit in to her shoes. She it was that gave the trust in Dumfries a face and a persona that foreign doctors like me could hold on to as being welcomed and appreciated. I was delighted to nominate her for the excellence award a few years ago and was rather disappointed that her work and that of her staff were not recognised as being equally important to the function of the NHS as a heart bypass surgeon. I was devastated that she did not get that  award and even more so that someone revealed to her that I had nominated her and so my secret was blown and I embarrassingly and to admit to her rather coyly  that she was doing a herculean job that few could manage equally as well.

So it was that with much sadness and personal grief that I attended her small farewell gathering at the Margaret Barty room. I thought many more would have been there to give her the fond farewell she deserved.  I sincerely hope we can use her as an occasional resource person in teaching hands on human relations for which she has a natural knack.  I wish her well in her retirement and hope that she will be around for many years to come. She is a truly remarkable daughter of the soil of Dumfries.

 

Dr Alwayn Leacock is a Specialty Doctor Obstetrics and Gynaecology at NHS Dumfries and Galloway