Let’s Listen Part 2 by Karen Robertson

NES AHP Career Fellowship Project by Karen Robertson, Occupational Therapist for Children and Young People     

What does effective family-centred AHP neonatal and developmental follow up really look like? Part 2

Context

In Part 1 of this blog, I shared my perspective on the earlier stages of my NES AHP Career Fellowship experience.  I discussed the opportunity and learning that has come from rich lived experience conversations with our local families who are accessing our AHP neonatal and developmental follow up service. 

National guidelines informing neonatal and follow-up services advise around evaluating infants’ needs and promoting family-centeredness is a key recommendation (NICE 2017).  Locally, our AHP neonatal and developmental follow up service is delivered by an existing pool of CYPF AHP’s and therefore capacity to do so remains limited, not ring-fenced and essentially fragile.  Our AHP team wished to better understand what family-centeredness looks like within deliverable practice locally while recognising the constraints of our service.  We wanted to explore the question;

“If we only have a limited time with this family and their baby, what will make the most positive impact for them now, and for the future?”

Policy informing healthcare in Scotland is underpinned by values such as partnership and integration and participation and engagement advocating continual improvement, creating the opportunity and environment to co-design services and honesty about priorities and constraints around what can be co-produced (Scottish Government 2016; 2022).  This project has involved a response to families lived experience stories of participation to “further upskill AHPs and influence our future decisions about our ways of working and creating environments in which participation and participative relationships are possible.” (Scottish Government 2016)

Immersing in local lived experience

I recall feeling a sense of privilege to hold such rich information, as well as a responsibility to make sure it was handled with sensitivity, respect and managed in a way that would have the greatest impact for local families.  Our next step was to make sure we could truly understand the wealth of information and what it could enable us to think about. 

Key themes with underpinning sub-themes very quickly and consistently emerged from local lived experience stories which we immersed ourselves in as a team:

– Parenting on the Neonatal Unit

– Empowering families to access therapy support and the team around the family

– Supporting parental wellbeing

– Communication and resources

– The focus of developmental follow-up appointments

– Empowering parents to advocate for their child beyond follow-up

Family-Centred & Family Integrated Care

It was important to understand how local lived experience could be considered within wider frameworks informing on family-centred care.  Within healthcare for the neonatal population, the British Association of Perinatal Medicine highlights the augmented nature of family-integrated care beside family-centred care.  With the key being to not only ‘involve’ but to ‘enable families as partners in care’, as AHP’s our core skills within CYPF practice most certainly stood us in good stead for applying this framework to our neonatal and follow up practice.

(BAPM 2021)

BAPM (2021) highlight 5 key principles of family-integrated care when working with this healthcare population within neonatal care. 

https://hubble-live-assets.s3.eu-west-1.amazonaws.com/bapm/file_asset/file/793/BAPM_FICare_Framework_November_2021.pdfre

Co-designing as a team

As an AHP team, we met to explore how we could realistically approach service improvement, within the scope of the project itself, our AHP roles and remit while holding on to the fact that our service is not ring-fenced and fragile.  At this point, it felt enormous as all the data, with every parental quote felt important.  This is when QI tools such as the high/low effort/impact scale became our friend to enable us to set realistic project goals.  Another key asset was to consider what was within our circle of control and influence versus what would be reliant on wider complex systems. 

Throughout December and January, we met as a team to collaboratively embed the local lived experience themes within each stage of our own AHP neonatal and developmental follow up care pathway.

We aimed to approach our service redesign to….

• concentrate resource utilisation on where it is of most value and will have the most impact by responding to local lived experience
• reflect the underpinnings of AHP policy in Scotland & existing models of family-centred care for this healthcare population
• outline delivery of a realistic and sustainable local AHP service

Sense checking with families

In February, we were delighted to host a ‘together session’ with participating families as an opportunity to share our thoughts so far on our service redesign based on their lived experience.  This brought about a further opportunity to sense check with families that we were going in the right direction, and equally to prompt us to do so if we weren’t!  Via a questionnaire following the event, 3 participating families shared with us that they think our service redesign proposal…

Key outcomes from the project

As an AHP team together with local families, we have been able to create

• an AHP service name, role and remit with an ability to be recognised for what we are and can do more of for local babies and families.  We will be able to measure our impact and measure, manage and report on mitigation of risk with any incidence of unmet need.
• an AHP Neonatal Service Leaflet, outlining the roles and remit of the team, and to provide families with agency over when and how to seek support. 
• A value based co-redesign proposal for an AHP Neonatal and Developmental Follow-Up Service based on lived experience of local families
• A journey map of resources for this population including available evidence based resources, and co-produced resources with visual supports across AHP team with family consultation.

If you would like to know more about this project, including the lived experience theme and sub themes, the co-redesign proposal our team are planning to implement and test and our long term vision, you can access a SWAY via this link: https://sway.cloud.microsoft/PoaVloHapya97zaH?ref=Link

So what’ next?

With supportive leadership across our AHP team leads and AHP management, we have permission to proceed with the next phase to test our service redesign proposal.

As well as being able to audit our requests for support quantitatively with this healthcare population, we have now embedded lived experience feedback opportunities for families into our core pathway to understand the impact.

Non ring-fenced AHP capacity means that service fragility is still a very real constraint facing CYPF AHP services.  Our approach moving forward must be fluid, dynamic and responsive to needs of our local families balanced with wider CYPF service constraints.

In line with Ready to Act (Scottish Government 2016) in increasing appropriate access to interventions at universal and targeted levels of service as needed for improved well-being outcomes; we aim to explore how the journey map of resources can be made available for all neonatal families who are not receiving follow up.

Personal reflections – together truly is better!

As I approach the final weeks of the project phase, I am considering the impact that the experience has had on me.  To mention my main learning outcomes would be a blog in itself, and so Ill skip to the headline; my most valuable (and unsurprising to me) learning outcome.  This is that working together to co-redesign and co-produce really is better.  When I review what we have achieved locally, I am full of pride to notice a part of each and every one of our local families and colleagues who participated and I thank each and every one of them.  I would extend this understanding of co-redesign and therefore thanks to everyone locally and further afield who helped in any way to support his project.  Service improvement relies on wider ingredients from supportive leaders to advising teams behind the scenes. Thank you!

If you would like to know more about the AHP Neonatal & Developmental Follow Up role, any aspect of our local practice for this health care population, or about this Career AHP Fellowship project, please get in touch.

Karen Robertson Karen.Robertson8@nhs.scot; @KarenOTRob

Blog part 1- AHPs across health and social care.

NICE 2017 – Overview | Developmental follow-up of children and young people born preterm | Guidance | NICE

Scottish Government 2016 – Ready to Act – A transformational plan for Children and young people, their parents, carers and families who require support from allied health professionals (AHPs)

Scottish Government 2022 – National Workforce Strategy for Health and Social Care in Scotland.

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.

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)

Get up, Get dressed, Get moving by Amy Conley

Think about an older person, someone in their eighties – let’s say it’s your Granma…

Your Granma lives in her own house; she’s not quite so good on her feet anymore, but she gets about OK.  Stairs are difficult but she manages – and she manages to get up and dressed, make her breakfast and her tea, feed her cat, read the paper, get to Tesco in the car with you.

Then your Granma gets ill – she has say, a chest infection.  She is admitted to hospital.  You pack her bag – nightie, toothbrush, comb.  She is admitted to the ward – she is poorly, needs antibiotics and a drip for a few days. So, on goes the nightie and your Granma is in bed; that’s what you do in hospital – you are poorly and tired and you need to rest in bed.

Your Granma is in bed in her single room.  She needs the toilet but doesn’t think she should get up by herself – she is a patient in a nightie so needs help.  But she can’t see very well or hear very well and can’t find her glasses or hearing aids.  She can’t find the buzzer to buzz the nurses and she can’t hear when they are near.   She thinks maybe she could get herself to the toilet, but she can’t see her walking sticks and is scared she will fall. 

Time passes.  Your Granma is incontinent in the bed.  She is embarrassed and frightened – what will the nurses think?

Now she is scared to drink and eat because she doesn’t want to need the toilet and be incontinent again.  And she doesn’t want to bother anyone.  The physio comes to see her, tries to get her up.  But she is still embarrassed and frightened.  She has no clothes to wear.  And she has only those foam slippers she got from the nurse.  So it’s best just to stay in bed.

Your Granma stays in bed for longer and longer.  There is nothing to do.  There is a TV but she can’t see it or hear it without her glasses and hearing aids.   She is getting mixed up now; she can’t remember when she came here or why or what day it is.  She thinks she can see cats in the corner of her room.  She still won’t eat, so she has no strength and feels weak. She doesn’t want to get up.  Her bottom and back hurt.  Her leg has swollen up – they said it is a blood clot.

The physios keep coming back.  They try to get her up; two of them struggle to get her to stand.  She is stuck in bed. 

Your Granma’s chest infection has been treated and she has no acute medical illness, but now she is immobile, confused, dehydrated, incontinent, her muscles are weak and she cannot walk anymore, or get herself washed or dressed. 

Your Granma is not going to manage at home anymore; she has to go to a care home.

 

“GET UP, GET DRESSED, GET MOVING”

At DGRI, we are launching our campaign on Monday 23rd July– the aim is help our patients maintain their function, mobility and independence while in hospital, and for them to return home as soon as possible, as able as possible.

 

WHY HAVE THIS CAMPAIGN?

• Most patients in hospital are over 65
• In hospital, older people spend up to 83% of their time in bed
• 65% of people’s functional ability declines during admission
• 60% immobile older patients in hospital have no medical reason to stay in bed
• If you are over 80, 10 days in hospital ages muscles by 10 years
• 1 week of bed rest equates to 10% muscle loss
• These changes are “deconditioning” –  “reconditioning” takes twice as long

WEARING YOUR PYJAMAS IN HOSPITAL

• Affects your confidence and self-esteem
• Changes how you interact with healthcare staff and other people
• Is usually unnecessary no matter why you are in hospital
• Doesn’t feel very dignified when you are trying to eat your dinner

 

STAYING IN BED IN YOUR PYJAMAS

• Reduces muscle strength
• Reduces confidence
• Reduces function
• Increases blood clots, delirium, pressure sores and infections
• Leads to reduced appetite, low mood and anxiety
• Reduces social interactions
• Lowers pain thresholds
• Can make blood pressure drop
• Causes constipation and incontinence

WHAT CAN HEALTHCARE STAFF DO?

• All of us can and should help patients get moving – nurses, doctors, AHPs, porters, domestic staff, pharmacists…
• Ask the patients how they normally get about and what they normally do
• Make sure patients can access buzzers, water, remote controls
• Encourage patients to get dressed and sit up in the chair

 

WHAT CAN PATIENTS DO?

• Tell us how you normally get about and get things done and what you need to help you
• Try to do things that you do at home – wash and dress, eat and drink on your own if able
• Sit up in your chair and for meals
• Drink lots
• If you can’t get out of bed, do little things – wiggle your toes, do a crossword – every little movement  helps

 

WHAT CAN VISITORS DO?

• Tell us what you do at home
• Bring in glasses, hearing aids and walking aids
• Bring in comfortable day clothes and well fitting shoes
• Encourage you to sit up in the chair and for meals
• Take you for a walk
• Bring in photos, books, puzzles, crosswords

THE BENEFITS

• Speeds recovery
• Reduces time in hospital
• Encourages patient and carer involvement in healthcare and recovery
• Helps to retain patients’ individuality and self-esteem
• Helps patients to quickly return home, mobile and functional

 

If you or your family are worried that it is not safe for you to get up or you might do the wrong thing – ASK US!  We will tell you what is safe and OK for you!

#endpjparalysis

#goinghome

Amy Conley is a Consultant in Geriatric Medicine at Dumfries and Galloway Royal Infirmary

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

Thank you to Ward 18 and DGRI by Kevin Irving

Dear Mr Ace,

I am writing to you to express my sincere gratitude and thanks to the staff in Ward 18 (Elderly Care) of the Dumfries and Galloway Royal Infirmary. Whilst I was visiting the UK my Mother took critically ill and was admitted to the hospital where she received excellent care from the doctors and staff on this particular ward. I spent nearly 4 to 5 hours a day in the hospital for over 15 days attending my mother’s bedside and could observe the highest quality of care. Having worked in health and safety in my career as a mining engineer, at the most senior executive level, for over 35 years I can honestly comment that the leadership and team work on Ward 18 was some of the best I have seen and is a credit to the staff.

The doctors on the ward, from the lead consultant caring for my mother to the rest of the team, showed enormous care and compassion to my mother’s needs and requests. My mother made what I think we all would agree was a remarkable recovery. During the difficult time of when my mother was very ill the doctors ensured that both my sister and I were well informed and we were able to have very open and honest discussions regarding my mother’s care. They also showed compassion towards my sister and my own feelings through what was a very stressful period.

I would like to give special thanks to Snr Charge Nurse Janice Cluckie who demonstrates incredible leadership to her staff and also discussed my mother’s needs with empathy and thoughtfulness. It was clear to see that she took time to see that all patients on her ward were well cared for. Janice is certainly a role model that your organisation should be proud of.

I have nothing but praise for the ward staff who showed consideration and care for all the patients. From a visitors point of view I saw total dedication to their duty for the well-being of their patients with humbleness and sincere kind heartedness.

Whilst spending time in the area I had the opportunity to look around the premises and surf the internet about the hospital. I see from your Board papers and Inspectors reports that you have some areas for improvement. I can only say from my observations that you certainly appear to be on a positive trend. I noted in your most recent Board papers that complaints about the hospital service are on the increase. I would recommend making a KPI of some of the positive comments you may be receiving, such as this letter, as they may show another side of the story or use information from the website www.patientopinion.org.uk or NHS Choices website.

As an aside I used the dining room daily at lunch times and the food served was of good healthy quality, a good price and presented by excellent welcoming staff. I feel the NHS food is sometimes often viewed negatively. I can only say that Dumfries and Galloway seem to be improving this aspect of patient and staff care.

I would be very grateful if you could ensure that the leadership team of Dumfries and Galloway Royal Infirmary give some recognition and positive feedback on my behalf to the doctors and staff on Ward 18.

With many thanks, yours sincerely

Kevin Irving

Kevin, who lives in Australia, added a handwritten post script which read “Wishing you all a Merry Christmas and a Happy New Year from the sunny side of Down Under.”

Sometimes you can’t see the wood for the trees… by Laura White

In September 2015 when my team and I were at the glittering Excellence in Care Awards ceremony at Easterbrook Hall after being nominated for not one, but two awards, I found myself pondering what it took for us to get from our lowest low to our highest high…

In early 2014 the Healthcare Environment Inspectorate walked into ICU unannounced and unearthed a catalogue of issues that turned our world upside down. In an instant our team went from a well-oiled machine to a rusty old tractor not knowing how to function.

The title of the blog sums up what we thought, as an organisation none of us could see what the Healthcare Inspectorate saw, we were in fact too close, too involved. For all our nursing care was never in question, we still doubted our abilities as nurses and wondered whether we were failing at the job we worked so hard at and got so much satisfaction from. The shame and embarrassment of having our place of work discussed in the newspapers and throughout the hospital, whilst trying to ‘keep it together’ still caring for critically ill patients and their families, was an overwhelmingly stressful time for all of us. The whole time we seemed to only have one question for each other…”How did this happen?” We put all our time and effort in to caring for our patients, did it matter that there wasn’t a record of the shelves being wiped down? Yes it did.

We listened to feedback, sought advice and did extensive research around the way we did things. We really dug deep and relearned our roles to include a vast new array of cleaning and infection control measures. It took months of liaising with the Infection Control Team, Domestic Services, Medics, Management, and Estates to name a few. There was clarification sought for EVERYTHING, from everyday things like bed bathing a patient to the fear of the effects of excessive Actichlor on our health.

The transition period between the inspection and the refurbishment of ICU put strain on everyone involved, however during this time it became apparent how well we pulled together, worked as a team and were committed to putting the broken pieces back together in order to be the best we could be. Staff came in to help in their own time, worked extra shifts and there was actually a lot of excitement about working in the newly refurbished unit, it was like a blank canvas. Don’t get me wrong, it wasn’t all plain sailing, the months following the inspection included periods of extremely low staff morale, increased sickness absence and an emotionally fragile workforce who at times found it difficult to talk about what happened to us. We eventually found that discussing the experience with colleagues and other professionals did help to rid us of some of the mixed emotions we were struggling with. Thankfully there did come a time when we realised we had to stop looking back and start looking forward and take the good from a bad situation.

We slowly began to regain confidence in ourselves and became very proud of our ‘new’ unit. During this time it became clear just how many of us had ‘a touch of OCD’! There were times when you could probably have eaten your dinner off the floor in ICU, and we just stopped short of putting Actichlor in our cereal! We now work relentlessly keeping our very extensive cleaning schedule up to date and everyone is involved in adhering to our philosophy of cleanliness, God help anyone who tries to put their gloves and aprons in a domestic stream waste bin! We really are acutely aware of everything now.

We knew that changing habits would be the hardest part but also that these changes had to be sustainable and over time these changes have become the new norm for us. These are the changes which are now the norm to the new staff that have joined us since the inspection and will undoubtedly evolve and develop in the future, as everything does in nursing.  The HEI inspectors have since returned to the unit and saw a drastic improvement in all aspects of cleanliness, which we knew they would.

Winning the Excellence in Care award for Infection Prevention in a way closed the chapter on the hard times we faced in 2014 and reinforced to us how we took the best from it and got to where we are today. We are dedicated, committed and knowledgeable in Infection Prevention and have regained the confidence we lost when our unit was put under the microscope.

As the saying goes “what doesn’t kill you makes you stronger”.

Laura White is the Senior Charge Nurse for ICU and Surgical HDU at DGRI

 

Let’s Get Physical by Amanda Taka

With the festive season looming towards us, the last thing you want to be told is to get physical right? However with 8 weeks to Christmas, we still have plenty of time before we carve the turkey. The Physical Activity Guidelines for adults recommend that we build up to 30 minutes of moderate intensity activity 5 days out of 7. But how do we fit this in to our busy working lives? And is it worth the effort?

We’ve all heard of the benefits of exercising, but here’s a recap:

Regular exercise:

• reduces the risk of many diseases such as type 2 diabetes, coronary heart disease and stroke
• helps us to maintain a healthy weight
• improves our self esteem
• promotes a sense of wellbeing
• reduces symptoms of depression and anxiety

Working in the NHS we can’t fail to be reminded of what we should be doing and why. However, being ready, willing and able to make those lifestyle changes can be another matter.

And before you write me off as one of those typical fitness fanatics, let me tell you a bit of my story. At school I was always the last to be picked for team games, I didn’t learn to swim until I was 16 because I was frightened to put my head under water, I hated PE and used to hide in the Geography block toilets to avoid detection. My Mum and Dad told me to stay as I was because playing squash and golf gave you a heart attack. My Dad’s motto was ‘built for comfort not for speed’. They were both overweight and although I wasn’t, I always knew I would be too because that’s what happened to us in our family. And so it would have gone on if I hadn’t returned to Uni and trained to be a nurse.

Anyone who has trained to be a nurse knows that it changes you. It changes the way you look at people, the way to speak to people and the way you react to people. Furthermore, it challenges hard held beliefs and preconceptions. Studying at UWS under the influence of Julie Orr and her colleagues, I began to see that getting older doesn’t need to mean that we inevitably get bigger and slower. I realised that the ability to change was within me and additionally I had the power to influence my young daughters’ long term health.

This Eureka moment happened to me in the middle of one lecture towards the end of my training. Julie was telling us about when she was doing her Masters and how she fitted it into family life “and I still went to the gym three times a week” was the phrase that hit home for me. Like a bolt of lightning I realised that I needed to make physical activity a priority for me. I started to take up yoga again – something that I hadn’t done regularly since I’d had my children. Slowly I began to build physical activity into my day, feeling very smug about it too thank-you very much.

After qualifying, I got a job on a fast paced 22 bedded respiratory ward. Working full time was enough to achieve my 30 minutes a day. Life doesn’t stay static though, and I moved to a 6 bedded Coronary Care Unit. My daily steps dropped, my waistband started to feel a bit tighter and I put half a stone on. I realised that I had to change tactics. I began to walk into town on my days off, I got myself a Fitbit and tried to do 10,000 steps a day, challenging nurses on other wards inspired my competitive streak. Obviously when you put physical activity first, other things slide. I won’t be winning any Good Housekeeping awards imminently and I don’t have time to watch TV. But as I see it, the benefits outweigh the costs.

Then earlier this year I left Coronary Care and moved to the Keep Well project here in Dumfries and Galloway. Keep Well is an anticipatory person-centred service that aims to reduce health inequalities. Part of this role involves delivering brief interventions for physical activity. I started to see that the guidelines weren’t going to be achievable for everyone – like the 64 year old lady who had to use a wheelchair because of her COPD. In that case, the message is do what you can, keep doing it and try and build on what you can do. Most of my clients with long term conditions are very aware of their limitations and they know better than I do, what is achievable for them.

Changing from a shift based work life to a ‘normal’ 8.30 to 4.30 job required further readjustment to my physical activity routine. Covering the whole of D&G has found me spending large amounts of time in the car. But the advantage is that I now have my weekends free and I make sure I do something active with my children. But I was struggling to do something on week days. So I started a 90 day Yoga challenge – 30 minutes of aerobic yoga for 90 days. The only time of the day I could fit this in was before everyone else got up. I found that I was so used to getting up at 5am to go to Carlisle that doing yoga at 6.30am was achievable for me. In all honesty, I haven’t made it onto my yoga mat every single day because sometimes life gets in the way, but I didn’t beat myself up because I knew that tomorrow was another day.

Now I realise that getting up at 6am to exercise isn’t going to work for everyone. So, I suppose the main message I’m trying to share is

• Find an activity that you enjoy
• Small changes really make the difference if you do them often enough
• Give yourself permission to exercise – no one else can do it for you
• Don’t give up if you miss a few days/weeks/months. Life gets busy and big events sometimes engulf us.
• Set a SMART goal, running the London marathon next April is not appropriate for everyone. Parking the car as far away from the office 3 days a week could be more achievable.

As the largest occupational group in Scotland, we nurses are in an incredible position to reach a huge number of people. If we start with ourselves, this will ripple out to our families, our communities and ultimately to the Scottish population.

Lesley Fightmaster Yoga Fix 90 – 90 day to build a healthy habit https://www.youtube.com/watch?v=ArZDT5zXSR0

Amanda Taka is a Keep Well Nurse based in Public Health, Crichton Royal Hospital and a Coronary Care Nurse with North Cumbria University Hospitals NHS Trust.

“Dear Ward 7” by Jackie Shrimpton

Dear Ward 7,

I would like to take the opportunity, afforded to me by this blog, to thank all of you on ward 7 for the care I received during my 14 day stay in June of this year. I have worked for 40 years in the NHS and all of them spent in DGRI so the thought of being an inpatient was not a terribly nice one. However there was something so special about the way I was cared for, the personal touches, the kindness, that I felt I had to put my gratitude into writing.

I became ill some years ago although at this time I did not know the severity of my illness. I had a painful right shoulder which nothing seemed to help. This got progressively worse and then about a year ago I had a brief stay in hospital with a DVT. Subsequent investigations revealed that I had breast cancer and that it had spread to my lungs and shoulder. I was devastated. Treatment commenced with radiotherapy and medications but I knew this was all ‘Palliative’. Earlier this year I became increasingly dizzy and sick and eventually had a brain scan which revealed the cancer had spread to my brain. It was now that I was admitted to ward 7.

From the moment I was admitted to ward 7 I realised I was somewhere special. The nursing staff seemed to go out of their way to make me feel comfortable, even when they were clearly busy. I have heard it said before but it can’t be said enough: at times like this it is the small things that really matter. Combing my hair to make me look nice for my family, knowing the right thing to say to cheer me up when I was down, a simple wee word here and there made all the difference. To feel that someone genuinely wants to help, to see joy in their faces when they know they have helped, means so much. One nurse said that helping me to the shower and making me feel better in myself helped her because she was not coming to me to inject something or do something to me.

I am particularly indebted to Dr Finlay. She was obviously busy and had many patients to care for but never made me feel this way. I was made to feel important and all decisions that had to be made were made with me, not for me. She went above and beyond and I viewed her as a person rather than a doctor. I didn’t feel silly when I struggled to understand, especially when my head was in a fug due to steroids. This was such a huge thing to me at the time. Thank you Dr Finlay.

It is sometimes easy to forget how being an inpatient with an illness like mine can affect your family. My two children and other family were clearly concerned but all said that seeing me in ward 7, speaking to the nurses looking after me, filled them with confidence and made the situation easier for them. My daughter said that she was overwhelmed with gratitude as she wasn’t spending time at work worrying that I wasn’t being cared for. This meant a lot to them and a lot to me.

To all the nurses, auxiliaries, therapists, domestics, doctors, porters, pharmacists, everyone on ward 7……Thank You. I am very proud to know you and have worked in the same hospital as you.

Yours,

Jackie

Team work – Ward 12 style by @jacalinanicnac

I have been nursing for 33 years this November and over those years I have experienced a variety of good and not so good team working. Those experiences have influenced me greatly to form the nurse and team leader I am today.

My job as Senior Charge Nurse in Ward 12 is to provide a high standard of effective care in an environment that patients feel safe in and by a team that feel confident and supported to do so , and everything else that falls within the patient / relative experience. Working in a team can be challenging but also fulfilling when the job is done well. We couldn’t do what we do every day without good team work .

WHAT IS A TEAM?

A group of people that share a common purpose, are committed and empowered to set goals and problem solve. Without these traits they are not a team but a group of people who work together, a work group.

A patient sent us this thank-you card ,

“Together Everyone Achieves More”

Together = we have a common purpose = giving excellent care.

Everyone = all who work in Ward 12= everyone has a voice.

Achieves = how we deliver our care = evidence based, safe and effective.

My role as team leader is to make clear the team goals, identify the issues that stop the team from achieving their goals and solve those issues with the help of the team .We would do this by doing tests of change , getting feedback and auditing improvement . My job is to create an environment where team members are supported and valued in the work place .By keeping the team motivated, developing and maintaining skills, being aware of individual strengths and weaknesses and attitudes and behaviours I can enhance the staff experience. I was encouraged and guided by work done by Julie Booth, Senior Charge Nurse in Ward 3. Julie and her team developed Values and Standards for the ward. All our staff had input in developing the ward standards and all staff agree to work by them. The basis for the Values and Standards is respect, being non judgemental, and being respectfully open and honest in giving and receiving feedback.

As well as the patient wellbeing, the wellbeing of my staff has equal standing. I believe you can’t enhance or improve the patients experience unless you value and enhance your staff experience. I have encouraged staff to attend the National Person Centred Health and Care Programme, and our local Patient experience events. The staff come back to the ward enthused with ideas for change, they share them with colleagues and then as a team we plan how best to introduce those changes to the benefit of patients and staff.

One such idea was after a local Patient Experience event. Team members returned to the ward and wanted to introduce reflection for staff. The team felt that after a busy shift there was no opportunity for them to say how that shift was for them. Staff felt they took their thoughts home and returned on their next shift with heavy minds and frustrations from the previous shift.

We have a definition of reflection, an aim and a process for reflection. The purpose of the reflection session was to be able to speak freely about their experience of that shift , any challenges and to discuss what could have worked better, or to say what was good about that shift and how that could be embedded. It is time limited to 10 minutes at a convenient time, it involves all nurses on the shift, there is a lead person for the session (not necessarily the Senior Charge Nurse, or person in charge), and ground rules were established = confidential- no notes taken – what was said in the room stayed in the room, discussions are relaxed and non confrontational, open and honest. Any “bigger” issues arising would be discussed with the staff member and myself out with the reflection session. The sessions were greeted with apprehension by some staff who found it difficult to speak about their experiences, but after a few sessions everyone soon got into the swing of it. These sessions were soon generating ideas for improvement and themes of frustrations in the work place. We added 2 boxes , one where staff could write down their good ideas =Golden Nuggets box, and one where they could write what was annoying on their shift = The Bug box.( replacing what you had used and tidying up were the top 2 ). We then discuss what is in the boxes each week and plan how to improve or change our practice. We have a questionnaire for staff for feedback and we use the safety cross check chart per month to record our consistency. We saw very quickly that staff felt they had the chance to reflect on the challenges and the successes of their shift and by giving everyone the chance to talk about it freely the staff felt they no longer left work feeling burdened by “work stuff”. This has improved our communication within the team and improved staff morale .It takes commitment by all staff to maintain these sessions, when we are extremely busy some sessions do not happen and the staff comment that they miss them. It is my job to raise the focus again and encourage the staff to keep it going.

Dale Stewart and Wendy Langan who facilitated the reflection development.

Another idea introduced by the Health Care Support Workers in the ward was to have a welcome and information leaflet for all staff coming to help in the ward. It starts with thank you for coming to help in the ward today, you will be working with….. , the ward routine is…. , your break is… . We have feedback sheets which we review monthly and encourage suggestions to improve staff’s short term experience whilst in ward12. We have had a lot of positive feedback from staff helping in the ward and they look forward to coming again.

By encouraging staff to develop their ideas and improve the team performance they take ownership of change and enthuse others to do the same. This makes my job easier it enhances the patient care and journey which we measure with our patient questionnaires; What did we do well? What could we have done better?

Being part of a good team gives you a sense of pride in achievement and celebrating success, and camaraderie in supporting the team. In Ward 12 a wicked sense of humour and a liking for sarcasm will also enhance your experience!

 

Celebrating success , Susan ,Drew and Mary.

I would like to dedicate this blog to Charge Nurse Heather Renwick who retires this week after an outstanding 37 year nursing career, one of my excellent experiences in my nursing career.

Jackie Nicholson is the Senior Charge Nurse on Ward 12 at Dumfries and Galloway Royal Infirmary

Never, ever too posh to wash! by @AliceWilson771

When I was a student nurse the ward Sister reigned supreme, not just over the nursing staff but with everyone who set foot in her ward. I say “her” because even when I was a student, there were very few males in nursing and the only man I ever knew who had been in charge of a ward was my own dad. In his day, my dad had to train in London with 4 other men because there were very few places that allowed men to train as nurses and certainly not in a group with women – not so much equity of access then; mind you those were also the days when women had to leave nursing and other jobs if they got married.

We have, of course, moved on but the role of the Senior Charge Nurse is fundamentally the same; to ensure the standards of care in their areas and develop and support staff – sounds simple but is done in the context of a very complex and demanding environment

Back in the day student nurses were employed by Health Boards and had a stronger sense of belonging to the organisation. Everyone had a vested interest in you from the very first day you set (a very shaky) foot into your first ward. The ward Sister took a real (and scary!) interest in first year students, working with us and teaching us things we never forgot. Over the years I have adapted much of that teaching as things move on and because there are ways I feel suit me better but there is one thing that never changes and, if I walked into a room now, I would do exactly as I had been taught; here’s why: In my first ward and on my third shift the ward Sister announced that I was going to learn “properly” about bed bathing and that she and I would bed bath “Mary”

Before we even got into the room we had discussed what we would notice immediately and over the course of the process of bathing; I didn’t understand the importance of that at that point. On entering the room, I was expected to introduce myself to Mary and explain I was a student and was learning and that the Sister would involve me in lots of discussion and questions. Mary didn’t look terribly impressed…and then, remembering what Sister had said about noticing, I realised it was cold in the room and that the window was open – that tiny prompt was the start for me about what a bed bath really means. It meant that I asked Mary if she was cold and allowed her to make the decision to close the window and realised that a bed bath wasn’t just about cleanliness and comfort, it is a unique opportunity to make a connection with another human being who is in a vulnerable situation, afraid, maybe in pain or discomfort or worrying, not about their illness but about their family, home, or often, their pets!

It is a fantastic opportunity to assess the physical and emotional state of an individual; by simply coming into a room, talking and listening and laying hands on a person you can assess so many things and offer reassurance and explanation. It is often suggested that nurses have moved in their focus to a more technical role and away from “menial” tasks such as personal hygiene,

I find this an interesting consideration and would offer that in more than 31 years of nursing I have never considered washing another human being as a menial task for the reasons I have just laid out. It is a privileged position we hold and I firmly believe that any nurse who is “too posh to wash” has perhaps lost sight of that unique chance to notice the individual