Enough Love by Ken Donaldson

I was out for a run the other morning (yes, despite the physique I do run. I also eat) and was listening to a random music selection. An oldie by Genesis, Land of Confusion, came on. I smiled wryly as I listened to the lyrics. Lines such as ‘Too many problems’ and ‘losing control by the hour’ certainly resonated.

The past few weeks have been simply unbelievable. The initial adrenaline rush brought on by the Covid 19 crisis has started to dissipate and the realisation of what is coming and how this will affect us is sinking in. The purpose of this blog is not to discuss all the plans we are working through and what needs to happen over the next few days and weeks to make us as ready for this as we can be. The purpose of this blog is to talk about us. When I say us I was thinking NHS D&G but in reality I realise I mean everyone working together with the NHS through these difficult times; social workers, carers, police, council, fire and safety, third sector etc etc. Actually what I now realise is that I mean the People of Dumfries and Galloway. All of us.

What I have witnessed over the past few weeks has been a simply astonishing response to this impending crisis. Those in the critical areas; Primary and Community Care, Emergency Dept, Combined Assessment Unit, Critical Care Unit have stepped forward with plans to significantly alter services and ensure they can cope. Those in other areas less critical stepping forward to offer their skills and time to support services in any way they can.

All this is amazing and, I can’t deny, that when I have been feeling particularly stressed, it has made me feel emotional. But its the small things that have brought on the tears; the catering assistant when I was paying for my lunch who gently laid her hand on my arm and asked if I was ok (I know, she shouldn’t have, infection control etc but it was a lovely gesture), the colleague making a point of stopping me to ask if I was all right, another who offered a hug. I mention these for a specific reason.

Whilst I may be feeling a little stressed just now in a few weeks we are all going to be facing simply unprecedented pressures. Quite a few of us will be sick with this virus, we will have friends and family suffering and work will be relentless. We need to cling on to these small gestures. Simple acts of kindness are going to help keep us going through the dark times.

I was at a meeting with Valerie White, Interim Director of Public Health, and she said words to this effect “This is going to be really hard and we all need to work together but I can say without any shadow of a doubt that there is nowhere else I would rather face this than Dumfries and Galloway. The commitment I am seeing from everyone and the willingness to work together is amazing.” I can only echo Valerie.

Returning to that song, Land of Confusion, there was another line that stuck out; “There’s not enough love to go round”. Now this is one I totally disagree with, in Dumfries and Galloway I think there is enough love to go round, and then some.

Take care everyone. We can do this together.

Ken Donaldson is Medical Director at NHS Dumfries and Galloway

*Image taken from “The Boy, the mole, the fox and the horse” by Charlie Mackesy

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

Because 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.

I’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:

By 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

Whistleblowing & Psychological safety by Gill Stanyard

Three years ago, just before, I was appointed by the Cabinet Secretary to be a Non-Executive Director  , I became a whistleblower. I blew the whistle on an organisation I had previously worked at. The whole process felt like a mini earthquake happened inside of me – I felt physically shattered, on edge and at times, paranoid due to the fear of not knowing what was going to happen next. I was not kept informed and this was the most difficult thing to endure -I did not feel psychologically safe. However, this was bearable compared to the distress of keeping everything in, all the wrong doing I had witnessed and not knowing what to do or where to take it -this ate away at me until I took action to an external source. Despite the high reading on my internal Richter scale, I felt I had done the right thing.  Looking back, I know I did the right thing.

We have heard a lot lately about Whistleblowing in the press, from Julian Assange to the more recent Dr Jane Hamilton, who met with NHS Scotland Chief Executive and last week’s author of this D & G blog,  Paul Gray,  this month, about her concerns as a Psychiatrist working at NHS Lothian.

So, what does it mean when we talk about Whistleblowing? Public Concern at Work define Whistleblowing as:

A worker raising a concern about wrongdoing, risk or malpractice with someone in authority either internally and/or externally (i.e. regulators, media, MSPs/MPs)

In his Report on the Freedom to Speak Up review (“the Report”) published on 11 February 2015, Sir Robert Francis QC defines a whistleblower, in the context of the NHS, as: “a person who raises concerns in the public interest. An important distinction is to highlight the difference between grievances and concerns -the law around whistleblowing (Public Interest Disclosure Act)  responds to ‘concerns’.

 

Grievances                                Concerns

risk is to self                                  risk is to others

need to prove case                   tip off or witness

   rigid process                               pragmatic approach

legal determination                    accountability

private redress                           public interest

 

Fast forward to this present day, as Chair of Staff Governance, I was nominated last year to take on the role of Whistleblowing Champion for the Board -an assurance role created by Scottish Government for Non-Executive Members in November 2015. This was part of an on-going intention to raise the profile of Whistleblowing being safe to do and as part of a response to one of the recommendations from the Francis Report ‘Freedom to Speak Out’.

As Whistleblowing Champion I will look for assurance that investigations are being handled fairly and effectively including:

• that reported cases are being investigated
• that regular updates are provided on the progress of the investigations of reported cases
• Ensure that staff members who report concerns are being treated and supported appropriately and not victimised
• members of staff are regularly updated on the progress of the concern they reported and advised of investigation outcomes;
• ensure that any resultant actions are progressed.
• Ensure that relevant Governance Committees; HR; staff representatives and Whistleblowing policy contacts are being updated on the progress and outcomes of cases; and, recommended actions resulting from an investigation.
• Publicise and champion positive outcomes and experiences.

 

Around the same time as this role was developed, also in response to the Freedom to Speak Up Review recommendations, the Cabinet Secretary for Health, Wellbeing and Sport announced the development and establishment of the role of an Independent National Officer. This is to provide an independent and external level of review on the handling of whistleblowing cases. This role is still being implemented and recent word from Scottish Government representatives last week, is that focus is on investigating the statutory powers that would need to sit alongside this role, so, it is hoped that the post will be live by 2018. A lot of learning has taken place from the established Guardian scheme in England.

Shona Robison has talked very recently about her desire for all NHS Staff to ‘have the confidence to speak up without fear about patient safety.’ Dame Janet Smith, back in 2004,  when she helped to develop proposals following the Shipman Enquiry wrote “I believe that the willingness of one healthcare professional to take responsibility for raising concerns about the conduct, performance or health of another could make a greater potential contribution to patient safety than any other single factor.”

The Right Honourable  Sir Anthony Hooper, in his report on the handling by the GMC to cases involving whistleblowing (2015) revealed an issue around bullying.  The GMC has recognised that the bullying of those who raise concerns may make persons reluctant to do so. A GMC survey (published in November 2014) of the 50,000 doctors in training found nearly one in ten reporting that they had been bullied, while nearly one in seven said they had witnessed it in the workplace. At the time of the publication Mr Niall Dickson said: “There is a need to create a culture where bullying of any kind is simply not tolerated. Apart from the damage it can do to individual self-confidence, it is likely to make these doctors much more reluctant to raise concerns. They need to feel able to raise the alarm and know that they will be listened to and action taken.’ What I see Dickson referring to is the creation of psychological safety,  defined as ‘…a belief that it is absolutely ok, expected even, that people will speak up with concerns, with questions, with ideas and mistakes…’  Amy Edmondson, Professor in Leadership , Harvard University

Recently I came across this painting by Gozzolli depicting the story of St Jerome and the Lion.  I had vague recollections of this story from one dusty morning spent at Sunday School, where I thought the golden motes falling in front of the window were a sign from God that it was ok to eat the mini eggs next to the toy donkey on the Easter shrine. Turns out it was just dusty sunshine and the ‘eggs’ were mint imperials in disguise. .   In the story, a lion approaches St Jerome and other monks whilst they were saying prayers in the monastery -whilst the other monks fled with fear out of the window, running for weapons and other ways to attack and scare the lion away, St Jerome sat quietly and looked into the lion’s eyes. He saw pain reflected back at him, and with pricked curiosity, he watched the lion limp up to him and hold out its heavy front paw.  Jerome took the paw and examined it.. He saw the limb was swollen, and with closer inspection saw there was a thorn embedded in the pad. He removed the thorn and bathed the area with healing herbs and water and placed a bandage of linen cloth around the paw.. Expecting the lion to leave, he sat back and waited. The lion looked at him, now with all  trace of pain gone and lay down on the floor and went to sleep. The lion was said to have never left Jerome’s side.

What strikes me about the lion is his courage and self-compassion to remove the source of his own pain and to take action to do so, despite the risks of being attacked by the monks. Whilst of course it was not in the public interest whether the thorn was removed or not from the lion’s paw in whistleblowing cases it is widely recognised that the whistleblower does suffer before, with the burden of needing to speak out and after, with the worry of the consequences of what may happen next. Robert Francis  acknowledged this in his report ‘Freedom to Speak Out’  ‘… that the stresses and strains of wanting to do the right thing can be immense’  Last September I attended a Whistleblowing event at the Royal College of Surgeons in Edinburgh. One of the speakers was  Dr Kim Holt, Consultant Paeditrician and founder of Patients First. She flagged up concerns to senior management in 2006 about understaffing and poor record keeping at St Ann’s clinic, part of Great Ormond Street Hospital. Sadly, her concerns were not acted upon and in 2007, Baby P died just three days after being seen by a locum doctor at the same clinic, who failed to spot that the toddler was the victim of serious physical abuse. Dr Holt, now recognised by the Health Service Journal as one of the most inspirational women in healthcare, spoke with calmness about the impact her experiences had on her well-being, including becoming severely depressed and unable to eat or sleep. She became a whistleblower, she says, because she feared something terrible would happen to a child and was devastated when her warnings were ignored.

I know it takes courage to speak up and share your concerns. I also know for a fact that we have quite a few St Jerome types here in NHS Dumfries and Galloway.

Our Whistleblowing Policy here at NHS D&G -take a look if you are not familiar :

Click to access Whistleblowing_Policy.pdf

The two people named in the policy are Deputy Nurse Director Alice Wilson – Tel. 01387 272789   and Deputy Finance Director Graham Stewart – Tel 01387 244033

These people have been given special responsibility and training in dealing with whistleblowing concerns. If the matter is to be raised in confidence, then the staff member should advise one of the designated officers at the outset so that appropriate arrangements can be made.

If these channels have been followed and the member of staff still has concerns, or if they feel that the matter is so serious that they cannot discuss it with any of the above, they should contact: Caroline Sharp, Workforce Director NHS Dumfries and Galloway (Tel : 01387 246246)

Also, the national helpline run by Public Concern at Work is called the National Confidential National Confidential Alert Line – 0800 008 6112

Gill Stanyard is a Non-executive member of NHS Dumfries and Galloway Health Board

 

 

“This is doing my head in!” by Harriet Oxley

I wonder how often you’ve heard someone say these words. Every day perhaps? Depending on our circumstances the things that provoke each of us are different. As we become more stressed and pressurized it becomes harder to see the way forward clearly. If we go unsupported and problems start to pile up they can start to bring us down.

Staff listening offers one-to-one support that is confidential and non-judgmental. Each person is supported to talk about issues of concern, deepen his or her understanding and rediscover hope. As a result they are enabled to tap into personal strengths and find a way forward if that’s what they need to do. Staff listening is a service offered by the NHS Dumfries and Galloway’s Spiritual Care team.

I recognise that some people are not sure what spiritual care is or what we do. I notice that some people hear the word ‘spiritual’ and imagine everything from ‘religious nut’ to ‘bible basher’. Others wonder why we need spiritual care in the NHS nowadays.

I wonder if it would help to make the distinction between religious and spiritual care. Religious care is given in the context of the shared beliefs, values and rituals of faith communities. Spiritual care, on the other hand, makes no assumption about personal beliefs or lifestyle. In other words, spiritual care is not necessarily religious and many people with no religious beliefs recognise their own need for spiritual care.

Spiritual care recognises that everyone needs to have meaning and purpose in their lives and fostering this promotes resilience and wellbeing. Spiritual care enables people, whether they’re patients, carers, volunteers or staff, to cope with life transitions, such as illness, loss or bereavement, as well as ethical dilemmas and major life decisions.

The Spiritual Care team consists of self-aware and sensitive listeners who have time to be with each individual in their need. Staff listening promotes spiritual wellbeing by offering a safe space for people to explore their concerns and draw strength from their own inner resources and those of supportive people around them. It is available to any member of staff, volunteer or carer within Dumfries and Galloway Health and Social Care. Equality and diversity is important to us and we welcome everyone irrespective of personal beliefs or life circumstances.

So perhaps you’re wondering what happens in staff listening. Firstly I’d like to point out that our role is not to fix problems or give advice. Instead we listen as each person tells his or her story, ask the right questions and offer support and encouragement. For many people telling their story is all they need to do. To have someone listen to the issues they are struggling with is enough to leave them feeling heard and able to carry on.

Sometimes, in talking about the situation, the person hears themselves say what they need to hear and gains insight just from having put their story into words. At other times the person’s story may be very complex, with many different strands. In such situations our role is to help them disentangle some of these strands, to look at them in turn and perhaps identify what some of their options are.

‘I have just realised what I need to do – I have never thought about that before.’

‘I have just heard the answer to my problem in what I have said.’

‘Saying that made me hear and see my own story differently.’

Space to reflect and talk through issues with colleagues has become rare, yet it is often the very thing that makes a difference in how we cope. If something is troubling you or you’re struggling with a particularly difficult situation, maybe it would help to talk in confidence with someone outside your situation. If so, please drop us an email to: dg.stafflistening@nhs.net

Harriet Oxley

Spiritual Care team

Stressed about Stress by Amanda Taka

Stress is one of those words that has become intrinsic in our everyday vocabulary: we’ve all heard ourselves moaning “I’m so stressed!” What is it and how can we manage it?

Stress is defined in different ways by different organisations, but the common thread seems to be that stress is “feeling under pressure”. A small amount of stress is good for us: it keeps us motivated and helps us to do our best. However, when we are living with stress all the time, it can lead to a myriad of unpleasant feelings and physical symptoms can follow.

Often we are quick to identify stress in others, but would we recognise it in ourselves? Symptoms associated with stress are wide ranging and initially we might not associate the physical symptoms as related to our mental wellbeing. There has been a tradition to separate mental and physical health, but evidence shows the link is greater than we previously may have understood. The jury is still out as to whether stress itself causes disease, but there’s lots of evidence to show that the unhealthy habits we rely on when we’re stressed contribute to many conditions.

Physical symptoms can include:

• Sleep problems
• Dizziness
• Chest pain, palpitations
• Dry mouth, lump in the throat, shaky hands
• Lack of appetite, or conversely, comfort eating
• Repetitive tic
• Headaches
• Diarrhoea or constipation
• Loss of libido
• Tearfulness/depression/anxiety
• Worsening symptoms of long term conditions

Additionally:

• Poor concentration
• Difficulty making decisions
• Irritability
• A feeling that things are hanging over you
• Excessive intake of caffeine, cigarettes or alcohol
• Low self esteem/lack of confidence

This list is not exhaustive!

What causes stress?

Here’s the tricky bit. We’re all different, so we all have different triggers. For example, one nurse would struggle to cope with the incessant physical and emotional demands of working in the Emergency Department, whereas that environment is perfect for a different nurse.

Acknowledged triggers of stress are as follows:

• Work pressures, job instability, fear of redundancy
• Parenting, family and relationship difficulties
• Financial pressures
• Bullying and discrimination
• Loneliness and isolation
• Living with a long term condition
• Caring responsibilities

And one more for us workaholics:

• Taking on too much responsibility and feeling you don’t have enough time to do everything!

OK, so it looks like life itself is stressful.

If you’re feeling like stress is starting to impact on the quality of your life then the first thing would be to get it down on paper. Spotting stress in its early stages can help prevent things from getting worse. Things to include in your “stress diary”:

• Date, time and place of the incident
• What you were doing, before, during and after
• Who you were with
• What were your feelings, before, during and after
• Any physical sensations
• Give the event a “stress rating” e.g 0 = no stress, 10 = the most stressed you could possibly feel.

Making a stress diary is helpful because it aids our ability to make connections between the context and the symptoms. Ideally, a stress diary should be continued for at least 2 weeks. This helps us to see things in perspective. Additionally, this is a vital piece of evidence to discuss with your GP if you’re feeling overwhelmed and unable to cope.

Quick Fix

When I searched ‘wellbeing’ in Amazon at the beginning of the year, I was astounded at the number of different products that claim to enhance one’s wellbeing: necklaces, crystals and orthotic sandals sat alongside the list of ‘new age’ literature that was available. I’m not sure it’s something that can be bought. There’s certainly no single ‘cure all’ solution. Therefore it’s worth trying, or combining, a number of different approaches until you succeed. Most research shows the following are a good place to start:

• Physical activity – doesn’t need to be a gym membership, incorporating 30 minutes of activity can help boost mood and clear the mind (remember it can be in blocks of 10 minutes)

 

• Sleep better – ideas for improving your sleep can be found at http://www.nhsinform.co.uk/mentalhealth/wellbeing/stress-management/

 

• Relaxation techniques such as mindfulness and breathing exercises are evidence based ways of reducing stress. Courses are available across the region, check the local press or http://www.uws.ac.uk/wellnessandrecoverycollege for details.

Nursing is acknowledged to be a stressful profession. In our profession, we tend to put everyone before ourselves, but who looks after the caring professions? I passionately believe that we need to give ourselves the time and effort to look after our own mental wellbeing, and being aware of our stress levels is intrinsic to this.

Further self help resources to try:

• Living Life telephone self help service and online programme for people with mild to moderate feelings of anxiety and depression using Cognitive Based Therapy. See http://www.llttf.com/ for more info

 

• Breathing space – confidential helpline that describes itself as a ‘first stop’ service which aims to listen and provide emotional support. http://breathingspace.scot

 

• Moodjuice – a website designed to improve people’s emotional resilience and ability to solve problems. http://www.moodjuice.scot.nhs.uk/

 

• Steps to Deal with Stress – you may have noticed the little square booklets floating around NHS D&G, pick one up, they have great common sense tips to help with stress busting. More info at http://www.stepsforstress.org/

A last word

If you or someone you know is struggling and self help techniques haven’t worked, you may need to seek expert help. For some people a combination of medication, talking therapy alongside some of the techniques outlined above are appropriate. Also, it’s worth remembering that the Samaritans have changed their number to 116 123. Further helplines can be found at http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/mental-health-helplines.aspx

And remember… “taking on too many commitments” may lead to feelings of stress!

Amanda Taka is a Keep Well Nurse at NHS Dumfries and Galloway