The Patchwork Quilt by Valerie Douglas

A doctor once told me that I had a portfolio career.  As my working life as a nurse in the NHS draws to a close it seems to me more like a patchwork quilt, assembled from many knitted squares.  Beginning in a psychiatric rehabilitation ward, I moved to acute admission in the old Crichton.  I dipped in and out of that ward undertaking secondments: to the Clinical Research Department, a Lecturer/Practitioner role, Care of the Elderly, Patient Safety and Improvement.  Then full circle, I moved back to rehabilitation nursing, this time interwoven with forensic threads.  Knit one, purl one.

Recently I’ve been on a partnership working secondment, with seats on the IJB and the RCN Board.  I have needed to insert some elasticated fabric into my knitting, as this has stretched me in directions unlike anything experienced before.  

With retirement imminent it is inevitable that I reflect on the whole quilt, the completed work, and remember the dropped stitches, the unravelling I’ve seen, the piecing together, the mending.  Some squares have faded with time but others remain vivid.

elegant ba blanket knitting patterns squares instant download pdf Patchwork Quilt Knitting Pattern

The Quiet Man.  This inpatient was polite, smart, of late middle age.  He wore his depression like a waistcoat watch, well-hidden in a little pocket.  You could just catch a glint of it if you really looked.  One Friday he went home for the day.  This wasn’t unusual.  He would typically return before 9 pm.  When he didn’t appear, staff phoned him.  No answer.  They phoned his family.  No, he didn’t have plans to come home that day, he had informed them explicitly.  Alarm bells rang and rightly so.  He never returned.  He had chosen a way out of his deep, silent despair.  Our thoughts of course went out to his lovely family for their loss.  But today my thoughts are also for us, the staff who nursed him, the doctors who treated him, the domestics who cleaned his room, the ladies at medical records who received those final ward documents.  I wonder if they still mourn him like I do over twenty years later.

Miss M.  Mute, traumatised, psychotic, she hardly ate or slept.  I was on a spell of night duty and would sit by her bed, talking to her, after giving her medicine.  She would listen intently, not responding.  ‘Looks perplexed’ were the words used most often to describe her in nursing notes.  After about a week she was out of bed when I arrived for night shift.  She glided around the ward, keeping close to the walls, vigilant.  One evening I took chocolate éclair sweets in.  I gave three to the nurse and three to the nursing assistant, saying to Miss M as she passed, ‘I’m leaving these three sweets on the table for you.’  She neither slowed nor acknowledged me.  A short while later the nursing assistant bounded into the office, ‘She’s taken those sweets.’  In mental health nursing it is often not diagnostic tests that expose signs of improvement, but observation and engagement.  Nurses can usually pinpoint turning points – medication has started to work, trust has been gained – and I have never forgotten the night of the sweets.  Each Christmas I’m reminded of Miss M when I hang the tinsel angel she made for me before her discharge.

Nursing has presented me with many patterns to follow, using different weights and colours of wool, some challenging designs.  Although all secondments have been worthwhile, I’ve always chosen to return to hands on nursing, the role I rate the highest, the role I value, the one I will miss the most.  Knit one, purl one.

 Val Douglas RMN, DipN, BSc (Hons), MSc Research (nursing)

Two tins of soup by Libby Johnston

libby 1When asked to submit something for the blog quite some time ago, the suggestion was that the subject be something that readers would find moving in some way. Recent press has been highlighting the degree of loneliness some are experiencing and how it can effect wellbeing physically, mentally and isn’t always visible to others.

In the run up to Christmas festivities I went to one of the so-called Pound shops. It leans towards my frugal nature and there is nothing like a bargain. However many use such shops to survive with a limited budget.

As I wandered down the first aisle a rather frail but spritely elderly woman moved to allow me to pass and I thanked her and we exchanged pleasantries. As I made my way through the aisles and shelves she seemed on the same route and I couldn’t help but overhear her saying ‘Merry Christmas’ to virtually every person she encountered. I made my way to the checkout and there she was again in front of me in the line. As I looked at her clothes, I could see that she had many layers of threadbare jumpers and no coat on what was a cold day.

She seemed to know the person at the checkout and was asking if they were ready for the holidays and he asked her the same to which she answered yes this was her last shopping trip. On the conveyor belt were 2 tins of soup. He commented, ‘No turkey’? She shook her head, saying nothing and placed the tins of soup in her shopping bag, continuing to wish everyone around her a Merry Christmas and the same to us as she trudged out of the shop, bag in hand. My heart was full as she had shared the joy of the season with everyone she encountered in the shop and yet there was a loneliness to her life.

As a nurse and midwife (retired), it’s always been in my nature to reach out and help others in need. I desperately wanted to ask this dear lady if she was having a Christmas meal with anyone and if not invite her to share ours. I feared she might only be facing a tin of soup. However, she had disappeared from sight and I will never know.

It left me feeling a touch of sadness for her. There is much awareness about people being lonely and particularly at this time of year. Many organisations, charities are endeavouring to help those who may be lonely. There will always be those who won’t want help and soldier on like this woman who found some company, even joy in sharing festive greetings in a shop. A lesson perhaps for the less lonely to be bolder in reaching out to others not only at Christmas but in everyday life.

The government is investing in ‘loneliness’ as it is felt it has been shown to impact health and wellbeing. This is highlighted in this article in The Guardian:“UK to tackle loneliness crisis with £11.5m cash injection”

The money will help establish projects that will bring people together and in so doing reduce elements of loneliness, improving health and wellbeing.

 

“Loneliness and the feeling of being unwanted

is the most terrible poverty.”

Mother Teresa

A Yellow Wood by Gill Stanyard

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The 1st June 2018 was my  last day as a  Non-Executive Director for NHS Dumfries and Galloway.  After four years of a potential eight year appointment from Scottish Government, I decided to  leave. I felt I had reached a good and fulfilling end and to stay on for another four year term would have been signing up to endure.  I made a decision I wanted to enjoy. So, I felt happy with my decision to end my time, made when swimming in a shimmering blue sea one early morning, whilst in Greece.

I made a decision. ‘Decision.’ The Latin origin of this word  literally means, “to cut off.” Making a decision is about “cutting off” choices – cutting you off from some other course of action. Now that may sound a little severe and limiting, it’s not. It is liberating. Decisions, they take us onto the next stepping stone, sometimes called  ‘The End’  – two words which tell us a story is over.

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My friend made the final and shocking decision to end his life at the weekend. A fact I am still struggling to comprehend. Our last communication was a fortnight ago, with me texting him about all the different gins (24 to be exact) that were on the menu at my leaving ‘do.’  He texted me back with a  joke about Rhubarb gin. Then nothing. I didn’t think too much of it, life gets in the way. And then I received ‘The News.’  Yet I have forgotten a couple of times since then, and have gone to text him. Then, with a strange physical ‘flipflop’ stomach feeling,  I have remembered ‘The End,’ which is accompanied by much hurt and sorrow and  strangely, lines from one of my favourite poem’s. – ‘ The Road Not Taken.’ by Robert Frost:

 

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;

 

Then took the other, as just as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that the passing there

Had worn them really about the same,

 

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

 

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

Gill St 3

 A single decision can transform a life. I always assumed Frost wrote this poem about himself, yet I recently read Hollis’s  biography of Welsh poet Edward Thomas, and discovered that Frost and Thomas were ‘besties.’  Frost had written the lines as a joke about Thomas’s depression induced indecision, which showed up on their long ‘walk and talk’ days together, with Thomas never being able to decide whether to take the path on the right or the left. When Frost sent the poem to Thomas, Thomas initially failed to realize that the poem was (mockingly) about him. Instead, he believed it was a serious reflection on the need for decisive action. At the age of 36, after much wrestling, Thomas felt compelled to enlist as a soldier in the Great War.

Gill St 4

 

He wrote of his decision to his friend Robert Frost  “Last week I had screwed myself up to the point of believing I should come out to America & lecture if anyone wanted me to. But I have altered my mind. I am going to enlist on Wednesday if the doctor will pass me.”  On the first day of the battle at Arras, Easter Monday, 9 April 1917, Thomas was killed by a shell blast.  His poem ‘Adlestrop’ was published in the New Statesman three weeks after his death and has since become a classical favourite of British poetry.

 

Adlestrop

Yes, I remember Adlestrop —

The name, because one afternoon

Of heat the express-train drew up there

Unwontedly. It was late June.

 

The steam hissed. Someone cleared his throat.

No one left and no one came

On the bare platform. What I saw

Was Adlestrop — only the name

 

And willows, willow-herb, and grass,

And meadowsweet, and haycocks dry,

No whit less still and lonely fair

Than the high cloudlets in the sky.

 

And for that minute a blackbird sang

Close by, and round him, mistier,

Farther and farther, all the birds

Of Oxfordshire and Gloucestershire

Life sometimes makes decisions for us. I don’t mean to get all Dead Poet’s Society here, yet I think T.S Eliot had something when he wrote “What we call the beginning is often the end. And to make an end is to make a beginning. The end is where we start from.” (Four Quarters) We get ill and have to take time to rest and get well, and sometimes we don’t always recover, we have accidents,  we don’t get chosen for that job or by that person and we lose people and animals we love and care for.

Where possible, make a decision and choose your ending and make a new beginning, whether it be the end of an unhappy relationship and the start of a happier one with yourself,  saying No to working for extra hours, when you could be saying Yes to spending more time with your family, or your dog or your garden, standing up to a bully and choosing to start being assertive and courageous, speaking out against something which you see is wrong and thus ending corruption or collusion, stopping trying to do everything by yourself and start asking for help -(getting a mentor through NES really helped me with this)  and putting a stop to being taken for granted and drawing new boundaries that put your needs first.

Gill St 5

I have taken a Non-Executive decision to be more accountable to myself in my life, to spend more time outside, to stop watching tv and read more poetry,  to save up to live in a place where I can have two donkeys, chickens and  another rescue dog and to track down some Rhubarb gin.

Gill St 6

Sorry if I did not see you to say Goodbye. I wish you well in your decision making and hope that your sigh is a happy and fulfilled one.

 

 

 

 

 

 

I

What Matters by Ken Donaldson & Alastair McAlpine

I recognise that it is a bit cheeky of me to put my name to this as I haven’t written any of it. A few months back I was scrolling through Twitter and came upon this thread that really moved me. The messages are simple yet immensely powerful. I have therefore simply taken some screenshots from Twitter and published them here. As you can see this is by a Doctor called Alastair McAlpine who is a Palliative Paediatrician in Cape Town, South Africa. Read on…..

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Cant Thank Everyone Enough

You don’t have to look very far these days to realise that the NHS is under significant pressure; the local bulletins, national news and local papers are all talking about ‘Winter Pressures’ and ‘Flu Outbreaks.’ This, along with staff shortages and capacity issues, would make many of us dread going in to hospital or having a loved one admitted however I recently had to witness my husband spend the festive period in the new DGRI and I was so impressed by his, and my, care that I wanted to write about it.

On the 19th of December my husband was referred up to X-Ray for a CXR. This rapidly became a CT scan and then direct admission to the Combined Assessment Unit. This itself was a massive shock for all of us and a very scary time. However the staff in X-ray were amazing and made a frightening experience a tiny bit more acceptable by their kindness and attention. Thank you to all of them.

When we arrived on CAU it was obvious that it was a very busy place. For the staff to be working under this pressure in a new environment beggars belief but they did so with equanimity and charm. The care my husband got was excellent and I wish to thank Moira and all the other nurses who were fantastic as well as the Health Care Support Workers (many cups of tea which were never too much bother) and also Drs Ali and Oates. Dr Oates your visit on Christmas Day meant a great deal to us.

After CAU we moved up to Ward B2 and the outstanding care continued. I came in at 8.30am and left at 9pm and having a single room and open visiting meant I was able to stay with my Husband at all times which meant so much to us especially during this time of uncertainty. We could cry in private and talk in a way we could never have in a 4 bedded bay. Once again the staff were amazing – all the staff nurses, HCSWs and Domestics got used to seeing me around and, despite being extremely busy over Christmas and New Year, catered to our needs. They brought blankets and cups of tea – the small things which can mean so much – without us having to ask, in fact they were so busy we would not have asked for anything. Dr Gysin listened to our moans with patience and kindness and ensured that my husband got home as soon as possible, just after New Year.

We have just started a journey which will now mean trips to Edinburgh for more tests and possible treatment. This was always going to be a hard time but the caring and compassion we experienced whilst in DGRI over the festive period has made it that little more bearable.

Thank you

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The man With The Tea Trolley by Alison Wren

image1Hello! My name is Alison! I work as a Clinical Psychologist in the Clinical Health Psychology Service; the final member of the team to blog this month as part of our service promotion! Part of my role within this job is to help individuals and their families manage psychological distress caused by or maintained by physical health problems. Of course as a psychologist I do this at a professional level, but do we always need to be a psychologist to provide psychological care to those who need it?

 
This is the story of a man with a tea trolley; an ordinary chap who made a big difference to me at a particular moment in my life when the chips were down. I didn’t know him and he didn’t know me. We only met once and we don’t keep in touch. He probably doesn’t even remember me. He didn’t need to do what he did; it definitely wasn’t in his job remit and he probably bent the hospital rules.

The story starts on a Saturday afternoon several years ago when my husband unfortunately had a heart attack and was admitted to our local coronary care unit. It all came as a bit of a shock as he had none of the typical risk factors. He wasn’t overweight; he didn’t have high cholesterol, and had never smoked. He drank sensibly and walked miles every week. The event itself was fairly low key; just a burning sensation from throat to stomach followed later by an aching jaw. Symptoms so low key that he still image2went off to a football match that afternoon as planned. Twelve hours later after a trip to A&E (“just to be on the safe side”) our worst fears were confirmed. I’m happy to say that after a successful angioplasty he made a great recovery, but at the time we both pretty devastated. I was beside myself with worry. My stomach churned and my thoughts raced out of control “Was he going to die?”, “Would he have another?”

“Would he be able to stay active?”, “Would he still be able to work?”

image3I felt overwhelmed. How would I help my husband to cope if I was struggling myself? I had no one to talk to and could not voice my fears to my husband who needed me to be strong. As a Clinical Psychologist with many years experience working with people who have experienced distressing life events, I knew that my thoughts and feelings were normal but I was at a loss as to how to help myself.

The coronary unit that my husband was admitted to was located in another region in the UK and has now closed. My husband received excellent medical care, but as a worried spouse I felt alone. Nurses and doctors were busy. Visiting hours were limited (I was not permitted to stay longer than an hour). I wanted to be near my husband and to feel that others understood that we were in this together. I wanted reassurance. I wanted information. I wanted someone to ask me if I was alright. I felt that I needed looking after too.

One afternoon with all this weighing heavily on my mind, the man with the tea trolley came into my life. I had seen him before on and off during my visits serving hot drinks and biscuits to the patients. He was always cheerful and took the time to have a chat with people. He bustled passed me as I sat in the visitor’s room. I guess he must have noticed my forlorn expression through the window, because he doubled back and came into the room. What he did next was a small act of kindness that changed my day, and helped me feel a little better.

image4He simply smiled, gave me a cup of tea and said, “It’s hard isn’t it? How are you doing?”

We chatted for a short while about this and that, and he listened to me as I told him what had happened. Of course he couldn’t answer my medical questions, or give me any assurances about the future. He couldn’t really do anything as such, but he was there for me at the right moment and he seemed to understand. He knew I needed a friendly ear. I never saw him again, so I didn’t get chance to thank him. So whoever you are, thank you! That cup of tea made all the difference.

image5Dr Alison Wren is a Clinical Psychologist for the Clinical Health Psychology Team at NHS Dumfries and Galloway

Take Two Bottles Into The Shower? Not me, I’m a Clinical Health Psychologist by Ross Warwick

image1Because you’re worth it

Bang! And the dirt is gone!

Eat fresh

I’ve been thinking a lot about advertising these past few weeks as September is a significant time for my team in Clinical Health Psychology. This month we will be making a concerted effort to promote our service, raise our profile and increase our contact with the people we aim to help.

As part of this, Ken has kindly allowed us to take over the blog for a few weeks. I’m kicking things off with an account of what the service does and I thought I would take inspiration from psychological tricks used in the world of advertising to help draw you in and get the message out there.

image2I’ll start, then, with a summary of the service that follows the advice of a Professor of Experimental Consumer Psychology at the University of Wales, Jane Raymond. Prof Raymond advises that rather than bombard the audience with information I should break it into chunks to allow the brain time to process each component:

  • Chunk 1: The Clinical Health Psychology service helps people who have a psychological problem that is caused and maintained by a physical illness.
  • Chunk 2: These problems usually involve unpleasant feelings and unhelpful thoughts about the illness that keep someone from doing things that matter to them.
  • Chunk 3: This can cause distress, affecting overall well-being, medical treatment, self-management and health outcomes

An article in a social psychology journal showed that a wide range of people respond well and are persuaded by stories (Thompson and Haddock, 2012). So to illustrate chunks 1-3 here’s a fictionalised case based on real events:

Jane is a young teacher who has type 1 diabetes. Her condition and the things she must do to keep on top of it are often accompanied by feelings of shame, anger and loneliness. She has frequent thoughts that her condition means she is abnormal and that it must be hidden from others. Because of these unhelpful thoughts and feelings she avoids testing her blood, guesses her insulin levels, is inconsistent with her diet and keeps problems to herself.

She has been absent from work and in and out of the DGRI several times within the past twelve months. Because of this she believes friends, family and colleagues are annoyed with her for not taking proper care of herself and landing them with more responsibility. As a result, she avoids seeing people and has become more and more isolated.”

The next steps for Jane are chunked below:

  • Chunk 4: In therapy we would work with Jane to live well with her condition by addressing her unhelpful thoughts, feelings and avoidant behaviour
  • Chunk 5: As therapy is all about collaboration, Jane’s most likely to have a good outcome if she’s motivated to participate and make changes to her life
  • Chunk 6: Jane can be referred to Clinical Health Psychology by anyone who is involved in her care, be it her GP, Practice Nurse, Dietician, Diabetes Specialist Nurse or Consultant.

In Jane’s story, she’s in and out of DGRI because thoughts and feelings stop her from acting in a way that would help keep her well. So psychological therapy would add value by reducing her distress and unplanned contact with services (and by highlighting that sentence your attention has been focused on a key message about how psychology makes a difference to both the person and the hospital; Pieters and Wedel, 2004).

But would you believe that individual therapy expertly delivered by members of our experienced, compassionate, and, yes, attractive, team is but one feature of our service? In Clinical Health Psychology we also provide training, teaching, supervision and consultation because you don’t need to be a psychologist to provide psychological care (worth mentioning because (a) it’s completely true and (b) according to Goodman and Irmak, 2013, audiences are likely to prefer multi-featured products).

Already the Diabetes and Cardiac Teams are benefitting from increasing their psychological knowledge and skill through participating in Emotion Matters training, and a group of local GPs have recently completed training to introduce CBT techniques into their routine consultations. Recruitment of a second cohort will be underway soon.

Time for pictures of the product:

headshotsBy now thanks to my evidence-based and scientifically informed techniques of persuasion, you will no doubt want to know how you can benefit from working with our wonderful service.

You can contact us by email or by calling us at the psychology department to talk about matters psychological, be it complex cases, potential referrals, or training your department. Find out more about making referrals by consulting our service leaflets which are available absolutely FREE through Beacon by searching for ‘Clinical Psychology’ or looking under ‘Documents’ after following the link below. And as the Patient Information Leaflet can also be found there, you enjoy a 2 for 1 bonus!

http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/?pageid=Sitesearch&searchCriteria=clinical%20health%20psychology

Keep your eyes open for opportunities to attend training events we’re delivering this month and enjoy the blog posts written by the Clinical Health Psychology team over the next few weeks. Finally, to eke this advertising ruse out just a little further, comment below to be part of a Clinical Health Psychology virtual focus group.

Just do it.

Ross Warwick is a Consultant Clinical Health Psychologist and Lead for Clinical Health Psychology at NHS Dumfries and Galloway