Imagine by Heather Currie

Some months ago, in what now feels like a different life, a golden oldie on the radio stirred emotions which inspired me to put pen to paper…..

“Imagine all the people, living life in peace.

You may say I’m a dreamer, but I’m not the only one.
I hope some day you’ll join us,  and the world will be as one…”

World peace, wouldn’t that be awesome, but unachievable? What about starting small, what about peace in our own organisation…do we have that? If not, why not?

I am hugely privileged to now be more involved with colleagues across specialties and across professions.  I see many teams who work well together with individuals caring for and supporting each other. Yes, we all have difficulties that crop up but that can usually be talked through and solutions found.
However, I am saddened to see some individuals who are unhappy, feel that they are being bullied, dread being on shift with certain colleagues, become unwell. I also notice others who do not realise what impact a word, a comment, a frown, a gesture can have on those around them.
Why can it sometimes be difficult for us to be nice??

Have you ever snapped at someone,  raised your voice, talked over someone, rushed a conversation that was important to someone, didn’t make the effort to say good morning,  didn’t thank or congratulate someone for doing a great job, made someone feel belittled, unimportant,  less valued?
I have, probably many times, for which I would like to hugely apologise to each and every one.
I ask myself why…pressures, frustration, my own worries and insecurities, being unaware of the impact of my actions.

A quote that I saw recently rings true..

People will forget what I said
People will forget what I did
But people will always remember how I made them feel

We work in a wonderful organisation but there are many pressures and stresses. The last thing that we need is to be fighting with each other. Not only does fighting and unpleasantness make life miserable for ourselves, but ultimately affects patient care..”civility saves lives”. ”

This was written and parked, and the world changed. In the last few months we have coped with our lives being turned upside down. We have worked together with incredible energy, understanding, innovation and support. Now we are reflecting on our experiences and learning and planning the new world ahead with some uncertainty and anxiety. Let’s continue to reflect on our own behaviour, support each other, and be nice. We need each other more than ever before in this strange uncertain world.

Never has this been more true for me personally than in the last few weeks when my world was further rocked by a tragic family loss. The kindness and support shown by colleagues was wonderful and got me through the challenging and deeply sad times. Thank you all so much.
Whatever is ahead of us, I know we will be ok if we are kind to each other, and ourselves.

I don’t need to imagine!

Heather Currie is an Obstetrician and Gynaecologist and Associate Medical Director for Acute and Diagnostics and Women and Childrens at NHS Dumfries and Galloway

 

 

Mrs Potato Head by Wendy Copeland

I am an extrovert always have been and although I display some introverted traits as I age, MS Teams has confirmed that at heart I am an extrovert!

What reinforced this for me was when I started Googling this on Sunday morning…

“How to turn yourself into a potato on MS Teams”

What prompted this was vanity?  I read an article on the perils of WFH (working from home) and discovered that Zoom offers filters, I was slightly aggrieved that we had MS Teams and not Zoom, otherwise I could filter out the facial hair, the large expanse of grey hair that my colourists will need a double appointment to fix, and I could even try and smooth over some of the wrinkles.

However back to reality, and how we can create a sense of normality whilst adapting to new technology.

MS Teams has been brilliant in bringing us together and every time I see Susan Calman and her Bank of Scotland advert I smile and think ‘that’s us’.

As we settle into our new ways, I have been reflecting this week on my reaction and my behaviours whilst using MS Teams.

And I thought it would be good to hear others too, as we will all experience this from our own perspectives.

My reflections:

• Is it ok to eat whilst on teams…. I do, but I hear others switch of their camera to eat empire biscuits, whilst I crack my way though a mound of pistachio nuts … is this rude?
• We are good at following rules in D&G, we put up our hands to speak and use our mute buttons. I was on a national call this morning and frankly it was a rabble, white noise and constantly talking over each other… I became all teachery on the chat and issued instructions.
• I love when kids photo bomb, dogs wander past, or partners provide table service; when people are working remotely, it reminds me we all have lives outside work.
• I miss the pre meeting chit chat… its straight into business and I miss the spontaneous humour, this, I have not found a solution for, by the time I’ve put my hand up my comment feels inappropriate and forced L
• I fidget, constantly, and I now have MS Team influencers, (who I’d follow if it was Instagram) who always look calm, serene and do not seem to move. You are now my role model every call, I want to be like you!
• I also sometimes behave like I am back in Y2 Maths at High School, sitting in the back of the class being the easily distracted pupil passing notes across the desks…..
• I have also became more vocal…. missing the subtle nuances of body language and reading the room from the shoulder up has made me gubby… not always sure this a good thing.
• What I also notice is lots of people have found their voice and this brings me joy!
• And those yet to find your voice – stick your hand up, you will have something meaningful and valuable to add to the conversation, unlike the extreme extroverts, who like to paraphrase what’s already been said five times.
• An unplanned Teams call is like the door belling ringing at home during lockdown… I find myself ducking for cover
• I also notice its exhausting being on camera all day… need to build in off camera time
• And we need to build in pee breaks… am I the only person that finds anything over 60 mins leg crossing long?
• You can very successfully host a Virtual World Cafe type event ….ask ODL they are experts!

Enough of my extroverted reflections, and I leave you with this to think about.

What do you notice about your MS Teams Behaviour?

Wendy Copeland

Nithsdale Locality

 

 

 

Communicating in a mask by Rebecca Cameron

When our multidisciplinary team was set up to create a poster and video helping to highlight the challenges of communicating in a mask, little did we know that this information would be so important as the weeks were to unfold….  As of Monday the 29^th of June it has become mandatory for everyone to wear masks in clinical settings. The challenges that this poses to staff, patients and visitors cannot be underestimated.

We put out a request on twitter for some feedback on what the lived experience was of having to wear masks all day. There was a lot of frustration, but I think that this comes from a good place; staff want to deliver excellent care for their patients. We know that it’s hard to hear, and hard to be heard in a mask. Shouting is bad for the voice and tiring, miscommunication can be catastrophic. You forget to hydrate and eat. You can no longer share a smile down the corridor, it feels isolating, communication becomes perfunctory, you lose the banter. It’s hot, claustrophobic… chafing.

There’s no doubt that this makes our jobs harder and there is no easy fix but we have a slogan in our office which is “improvise, adapt and overcome”. Here are some firsthand hints and tips of ways that other teams are doing this:

1. Get regular breaks “I can manage about 2 hours in one then I start to get a bit headachy and hot and it all gets a bit much” “I feel claustrophobic and the patients say they can’t see what I’m saying even if they don’t have a hearing impairment, we all rely on lip reading a bit.”

“Take your breaks, our manager bought everyone in the care home ice lollies in the heat to help us hydrate” “My hot flushes make it just unbearable in a mask but my manager’s been really good about letting me take a break”

2. Keep drinking – sip water when you can. Wash your hands, take the mask off, wash your hands, go out of the clinical area, take a drink.
3. Royal college of nursing advice – moisturise before and after putting mask on/off, wear moisturiser overnight and hydrate at home (links at the end)
4. Glasses steaming up ? adjust so upper part of mask is tighter and fits flush to cheeks, wash glasses with soapy water before putting it on.
5. Swap in and out with colleagues, can you write your notes up elsewhere, take a break in the wobble room? Think creatively about spaces.

Link to video: https://youtu.be/naJSkHYfW1Q

Communicating effectively can support patients to understand how to comply with specific treatment advice such as medical dosage, stay informed around their treatment plans and advice and to ensure that they can make their own decisions and give valid consent to any treatment.

Something we’ve all been thinking about in speech therapy is how this will affect people who already experience communication difficulties, for example someone who has had a stroke, head injury or head and neck cancer, or someone living with a progressive disease such as motor neuron disease (MND), Parkinson’s or dementia.

When someone has comprehension difficulties, they need to rely on things other than the spoken word to aid their understanding – cues from your tone of voice, facial expressions, gestures, as well as environmental cues. If someone has difficulty expressing themselves, either because of language difficulties (e.g. being able to find the right word) or mechanical speech changes (difficulty making their speech clear or their voice loud enough), they may be relying on your facial expression to know if you have understood them.

A healthcare setting can be difficult for someone with communication support needs at the best of times – a different environment, different routine, lots of unfamiliar faces, background noise – but the measures now in place because of COVID-19 make the challenge greater. Now patients typically can’t see staff’s faces, don’t have face-to-face contacts with family, and sometimes need to communicate using the telecom systems.

So, how can we help? If someone has lived with communication changes for a while they or their family will likely know what works for them and what doesn’t.

Ask if they like having things written down, if they use a communication chart or book with pictures/photos/ symbols, if they find gestures helpful, or if they have a device they use to help them communicate. Make sure someone has any aids they need in place, e.g. glasses, hearing aids. Some people manage to communicate much more effectively with familiar listeners, so being in hospital without the support of friends and family can be really challenging.

Talking on the phone may be particularly difficult, so trying to stay connected to loved ones in this pandemic can be an additional challenge – trying to set up a video call for someone might make all the difference for them. If someone has a new communication difficulty they may well be confused and scared by this change and there may be a bit more trial and error to what helps and what doesn’t, but as a starting point – use short, simple sentences; emphasize, repeat or write down key words; use gestures and relevant objects/pictures to support what you are talking about, even drawing something can give valuable extra information.

You can also try using a communication chart, both to support your speech, and as an option for the person to express themselves – there are some charts available through Beacon (patient & carer information leaflets -> Speech and Language Therapy -> patient communication charts). There are also some speech to text apps which may also be an option but we would have to be sure that the person reading the text is fully able to understand English – it may that British Sign Language (BSL) is indeed their first language and that English is not.  If someone with communication support needs does not understand why you are wearing a mask or is distressed like this, discuss in your team if wearing a clear visor instead a of a mask may be appropriate in some cases. However, there have been mixed reports of these steaming up when the speaker is talking – so this is not a fail-safe solution.

Many people who are deaf or experience hearing loss rely heavily on visual cues to be able to communicate accurately and effectively. For those who use BSL it’s crucial to be able to see lip patterns and facial expressions – it’s all part of the language. The increased use of masks therefore presents a significant barrier around communication. Clear visors may be the only option in these cases. Public bodies have a legal obligation to ensure that they are meeting the needs of people who are deaf or who experience hearing loss.  It is absolutely vital that we make the necessary reasonable adjustments when we are working with people with sensory loss.  This is backed up by several pieces of legislation, including the Equality Act 2010 and the BSL (Scotland) Act 2015 but this should be more than just a legal duty though.   The Board also now has access to online interpreting through Sign Language Interactions. A clinician could be speaking to a patient in a consulting room with and ipad or laptop nearby and on the screen, a BSL interpreter is interpreting what is being said into BSL.

 Hopefully the hints in the poster have given you some tools to help overcome the significant challenges of communicating in a mask. We would like to acknowledge what a monumental task this is, and recognise that delivering excellent patient care while wearing PPE is very difficult. You are all heroes. Remember to take breaks, to keep hydrated and be kind to yourself.

Some advice on heat stress from RCN here:https://www.rcn.org.uk/get-help/rcn-advice/personal-protective-equipment-ppe-and-covid-19

Skin health:https://www.rcn.org.uk/professional-development/publications/rcn-maintaining-skin-health-when-using-ppe-covid-19-pub009250

Their rest, rehydrate, refuel campaign here: https://www.rcn.org.uk/healthy-workplace/healthy-workplaces/health-and-safety/rest-rehydrate-refuel

D&G BSL guidance:http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/default.aspx?pageid=Interpretation_and_Translation_Key_Documents_Folder_Page

Link to poster: https://dghscp.co.uk/c19-masks/elementor-4940/ Link to video: https://youtu.be/naJSkHYfW1Q

Contributors: Rebecca Cameron, Hannah Dent, Helen Moores-Poole (speech and language therapy), Lynsey Fitzpatrick (equality and diversity) Kim Britton (improvement advisor)

Lockdown and ME by Hannah Green

I’ve lied and said that I was busy; but not in a way most people understand.

I was busy taking deeper breaths

I was busy silencing irrational thoughts

I was busy calming a racing heart

I was busy telling myself that I am okay

Sometimes this has been my busy – and I will not apologize for it.

If you told me at the start of the year that I could have over 8 weeks without social anxiety, I would have bitten your hand off at the thought. Little did I know the cause would be due to a national lockdown.

I have generalized anxiety disorder (GAD), which makes some situations fearful for me, however please note that I am a (fairly!) normal person and go about my business as normal as you do.   To know me, you probably wouldn’t think that my thought process isn’t any different from yours (a little talent of mine).  However, just because someone carries a problem well, doesn’t mean it isn’t heavy.

Anxiety is usually the state of being afraid where there is nothing to be afraid of, catastrophizing outcomes and over estimating danger.  Yes ok, until you throw a world health pandemic into the mix!

When lockdown was announced, all of those weeks ago, the negative part of my brain went into overdrive worrying about childcare, money, the extra stress I would be under, the thought of loneliness, but worst of all was my entire strict schedule being interrupted.  I’m a very structural, habitual person, so the thought of my routine being disrupted was nerve-wracking.  I adapted the best way that I could and created a ‘new’ weekly structure, consisting of home workouts as I’ve found exercise increases my self esteem, as it provides a sense of achievement.

I also decided at the start of lockdown to create a diary which would force me to look for the positive memories in this situation, as the aim was to let my children read it when they grow up and discover how we adapted in these circumstances and to be proud of how we as a family managed this unique situation.

I’ve been practising mindfulness for a few years now, to teach me to focus on the present moment, as the alternative is letting my mind wander into a state of panic, and a panic attack is utterly terrifying, with all rational thoughts swept away.  This new thought process has made it a lot easier to adapt ‘during this time’.  I’m grateful that I get to go to work, and I get to have a busy day.

As the weeks have gone on, I have realised that I am not opposed to this ‘new normal’.  I have always lived my life in the fast lane, working, going to the gym, running after children so it’s been enjoyable for a big pause button to be pressed to allow me a chance to recuperate, gather my thoughts and start again.

A defining moment during lockdown for me was entering Tesco for the first time.  Something as simple as going for the shopping was now a regimental procedure.  At the best of times, supermarkets bring out anxiety in so many individuals (hence so many abandoned trolleys) and now that I had to follow a designated route, queue in the store for longer than normal alarmed me.  If I felt panic rising, I couldn’t just skip aisles and rush to the checkout as I have previously done.  I have continued to go to the supermarket (mainly because my family still need to eat), but also because I have learnt that avoidance maintains anxiety.

Facing up to anxieties, insecurities and fears, taking them on and interrogating them is very empowering.  For me, attending meetings and going out in crowded places such as restaurants are my triggers so I make a conscious effort to try to not avoid them, however I’m also very aware that having over 8 weeks in my ‘safe space’ could cause havoc when lockdown is no more.  But for now I’m not letting those thoughts consume my head.  What is important is the here and now.

It’s very easy to feel judged by society, especially with the rise of social media, however I feel that it’s important to not be ashamed if you have any psychological distress.  We are all human, and we all react differently to situations.  There is no right or wrong way to feel when a lockdown is implemented.  There is no handbook for this.  I’m not going to feel guilty that I’m gutted my holiday was cancelled this year.  That mattered to me.  There will always be someone worse off than you are, but comparisons will only serve to make you unhappy.  During lockdown how many times have you heard “it’s the same for everyone just now”?  We are all experiencing change; however everyone’s story is different.  Every single one of us is struggling with something, whether it is being furloughed, being deployed, having no income, missing family, grieving, loss, loneliness, working more hours, the list is extensive.  We can only focus on what matters to us, and providing kindness to others.

Being at home more during lockdown has made many individuals realise that work and other aspects of their life have previously been used as an emotional anaesthetic.  Lockdown has produced a different sense of identity for many asking what truly matters during a pandemic.  While we can be busy digging in the garden, the house is burning down.  Pay attention to the house, which in this case is your mind.  You will never speak to anyone as much as you speak to yourself in your head.

I’ve learned to accept that I am a work in progress, whilst being kind to myself.  It’s been really really hard, but everyone has been so brave and I’m proud of how everyone has dealt with lockdown.  Go and give yourself a hug, when was the last time you did that?

I was going to submit this blog anonymously, and then I thought, no, I’m proud of me and I own this.

Hannah Green is Personal Assistant to Julie White, Chief Operating Officer at NHS D&G