“Going that extra mile” by Sharon Shaw

Patient Centred Care

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

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

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

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

“IT WAS HIS LIFE LINE”.

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

“Hello John, my name is Sharon”

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

As my father always said…

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

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

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

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

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

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

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

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

Thanks for taking time to read this.

Sharon Shaw is Clinical Educator for NHS Dumfries and Galloway

 

 

 

In Memory of Kate by @kendonaldson

Over the years compassion and kindness have been common themes on this blog and nobody encompassed them more than Kate Granger.

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Kate was many things; Consultant geriatrician, campaigner, wife, aunty, MBE and patient. She was born and raised in Yorkshire and after qualifying in medicine from Edinburgh University returned there to complete her training in medicine for the elderly. She married the love of her life, Chris Pointon, in 2005 and then in 2011, at the age of 29, everything changed. After falling ill whilst on holiday in California she was diagnosed with a Sarcoma and given 12 – 18 months to live. Characteristically she decided to defy the odds and do something meaningful with the short time she had left.

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I think it would be fair to say that prior to her illness Kate was a compassionate, caring and person centred clinician who inspired those around her. However her illness gave her a unique insight into how we deliver healthcare, in particular the ‘small things’ which we often forget – like introducing ourselves. It was during a hospital admission in 2013 that Kate noticed that none of the healthcare professionals dealing with her told her their names. The first person to do so, and show real care and compassion, was a porter. She reflected (and raged a little) about this and from that experience the #hellomynameis campaign was born.

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#hellomynameis is a great example of a very simple idea which has the power to make a difference. It started on twitter and progressed to name badges, internet memes and finally circled the globe. During the Ebola outbreak in Western Africa those caring for the afflicted could write their name on a #hellomynameis sticker and attach it to their protective suit and thus patients would at least know the name of those tending them. Many politicians and celebrities have endorsed the project and it has been adopted in many countries around the world. I for one continue to wear my badge with pride.

We were very fortunate that Kate wrote for this blog in 2014 just prior to her visit to NHS D&G. Her blog can be read here.

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Since Kate died I have read many obituaries and blogs which are far more thoughtful, and certainly more eloquent, than anything I can hope to write. I would like to quote a few of them here.

Ali Cracknell, a fellow Geriatrician and friend had this to say on the British Geriatrics Society blog:

“I always thought we would work together long term, and the thing that makes me really smile is Kate is with me more than any other person at work. Every encounter with a patient “hello my name is …”, every MDT, every meeting with a new member of the team and every morning I put on my “hello my name is” badge, she is with me, she is behind every little thing I do every day, that just makes such a difference. How could one person make a difference like that?  “#hello my name is”, is so much more than those 4 words, Kate knew that and felt it, and we all do, it is the person behind the words, the hierarchy that melts away, the patient:professional barrier that is lowered, the compassion and warmth of those words.”

Just Giving, the website through which Kate raised over £250,000, described 5 Lessons they learned from Kate. You can read them in depth here but the 5 lessons are:

1) We need to communicate
2) Always rebel
3) Remember romance
4) Make goals
5) It’s ok to talk about down days

A little more about number 3, Remember romance. Just giving had this to say about that…

“Kate and her husband Chris have set the bar high when it comes to romance. Throughout Kate’s journey, she never forgot to mention how important her partner is to her and how lucky she feels to have met her soulmate. After the diagnosis, the couple recreated their wedding day and renewed their vows. They even did their first ever date in Leeds all over again.
The duo did absolutely everything together, including competing in fundraising events.
Seeing Kate and Chris wine, dine and care for one another teaches us to never take our loved ones for granted, and to remember romance. The couple remained incredibly close and strong for the duration of Kate’s illness, and managed to maintain an amazing sense of humour in the darkest of
times. It reminds us all to reflect on how we treat our partners.”

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The BMJ published a particularly touching obituary which can be read here.

I will end with a quote from Macleans, a Canadian weekly magazine…

“Jeremy, Jackie, Tasha, Lucy, Pam—Kate’s doctors and nurses had names in her blogs and Twitter feeds. Outliving expectations by three and a half years, she met her fundraising goal of £250,000 for Yorkshire Cancer Charity, encouraging doctors worldwide to say hello, as she herself said goodbye.
On July 23, 2016, on her 11th wedding anniversary, three days after meeting her fundraising target, Kate was lying in her hospice room, no longer able to swallow. Christopher opened a bottle of champagne and placed drops on Kate’s lips. Caretakers called in her other family members. At 3:50pm, after Adam and Christopher’s mother had arrived at her bedside, Kate stopped breathing. She was 34.”

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Ken Donaldson is Deputy Medical Director (Acute Services) at NHS Dumfries and Galloway

Inspirational by Eddie Docherty

As the new Nursing, Midwifery and Allied Health Professions Executive Director I’ve now been in post since February 1st. As I write this blog almost exactly 4 months since starting, Id like to use this opportunity to introduce myself to as many staff as possible, and share some of my initial thoughts.

Prior to starting in NHS Dumfries and Galloway I’d worked in a number of health boards. Initially working in NHS Lanarkshire, in critical care and advanced practice, I moved to NHS Ayrshire and Arran in 2007, initially as nurse consultant for the acutely unwell adult, moving on to senior nurse consultant then associate nurse director. During this period I also worked in NHS Orkney as associate nurse director for 8 months, learning about the challenges and rewards of working in a remote and rural setting. For the year prior to commencing in D&G I worked as the lead nurse for East Ayrshire Integrated Joint Board and Associate Nurse Director for Primary care and Community Nursing. I’ve been incredibly lucky in my career, supported and developed by truly inspirational staff throughout the years, and have maintained roles which have allowed for direct patient contact through most of my time in nursing. Working with patients and staff has always been a key priority for me- its why I started nursing.

This link to inspirational staff continues as I’ve moved to NHS Dumfries and Galloway. At the last Twitter conversation held by the Chief Nursing Officer, Professor Fiona McQueen, one of the questions posed was: – What are you most proud of in your current role? I didn’t hesitate in my answer. I spoke of the compassion I see and hear about everyday from the staff in NHS D&G. The value of compassion is clearly embedded throughout our teams, from the Board to the staff directly delivering care to our patients. The key attitude of compassion in our delivery of care is reflected in the shared behaviours and attitudes I’ve seen in the last 4 months and is the springboard for the excellence in care we all strive for. Of course we aren’t perfect, but on the whole, compassion is being displayed. What I would ask everyone is this- are we compassionate to each other? Are you compassionate to yourself? The organisation is in a period of unprecedented change as we join an integrated world and build a new hospital. D&G couldn’t do just one major change at a time! The financial challenge is more acute than ever as we try to do the same, or even more, with less. If we are not compassionate towards ourselves and each other we may find ourselves overwhelmed and begin to lose touch with the reasons we all came into health care? Something to think about.

We often speak of our challenges, but clearly this period brings significant opportunities. I believe that each team hold the answers to most problems within their areas. The ability to adapt and innovate, to find solutions to complex problems, lie within the gift of all of our teams. If empowerment of staff is to truly have meaning then the staff have to feel empowered to enact change. The application of quality improvement methodology and an understanding of the theories of profound knowledge are the survival tools of the 21st century health care team. I have spoken to staff around our areas about the need for innovation and commonly say “The answer is in the room” It usually is. Someone within the area has the exact answer to the problem. If all staff members can see that improvement is something they do rather than have done to them, combined with the skills and understanding of the science of improvement, we can absolutely change the landscape we all work in.

Speaking to senior nursing, midwifery and AHP staff I have been incredibly impressed with the projects and ideas being developed, and in many areas there is great work being done in one key area: patient experience and satisfaction. For many years patient experience and satisfaction have been placed in the ‘nice to do’ category of work. As we move forward it is clear that the patient experiences of our systems are key to understanding how effective we are. There are many great local examples of this, from such areas as mental health, critical care, occupational therapy and medicine, but we haven’t yet shown our ability to do this at scale and share our learning across the entire organisation. I’m confident we will, following the discussions I’ve had with various teams, but it’s not something we can do without anymore. We look at, and report on, complaints as they come in and use them to look at individual areas of improvement, however, working in Scotland, we don’t spend any time looking at compliments and positive feedback. If we can capture the learning points from the good and bad episodes of the patient experience we can gain a better understanding of the impact we have in a balanced way.

I feel honoured to be Executive Director for Nursing, Midwifery and Allied Health Professions within NHS Dumfries and Galloway. Everywhere I look I see staff members that are committed to the care and well being of their patients and who place the person at the heart of everything they do. We have challenges and opportunities ahead of us and I’m absolutely convinced we can shape the future of our services together to meet the needs of our patients and improve the health of our communities.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway

 

Losing Grace by Robyn Langton

“A grandmother is a little bit parent, a little bit teacher, and a little bit best friend.”

Who remembers that mad feeling of excitement when you were told as a child that you were going to stay with Granny and Papa? As a child growing up, I was very fortunate to have wonderful grandparents around me to support my parents, provide me with unconditional love – and lots of sweeties on the sly. Along the way, as is life, I have lost all of my beloved grandparents, my Granny Grace being the last, saying goodbye at the age of 77. Some people are not lucky enough to know their grandparents, however more and more are able to enjoy them for longer as demography changes and people are living longer. My Granny was incredibly independent, never relying on health or social care apart from the odd trip to her GP and was still going swimming twice a week and ‘raking around’ in her 70’s. Grace was one of life’s treasures, incredibly sweet and kind to everyone around her.

In summer 2010, my Granny began to change and not quite seem herself. Living just up the road from us, she regularly popped in to visit (and secretly do some of my chores Mum had left me) and I distinctly remember one day when she left, she lost her balance on the steps and I watched as she slowly made her way back up the street. Another incident happened when she fell backwards over into the bath (thankfully empty!). These incidents seemed to be happening more and more often and Grace consulted her GP several times; without any diagnosis or medication being prescribed.

It got to the point that my Granny’s loss of vision and mobility was so severe that it made it unsafe for her to be at home. When the family took her up to the hospital to get checked over, Grace was almost blind and needed to use walking sticks. My Granny was admitted to the ward in September. Lying in her hospital bed she was no longer the chatty woman that went out of her way to help everyone else, she was in desperate need of support herself to get changed, move around, go to the toilet, and she had to be fed. A very fit and healthy lady had suddenly turned into a frail, dependent ‘patient’ at DGRI in Dumfries and Galloway. It was terrifying watching the person we knew and loved so much slip away so quickly – we were losing our Grace along the way. Eventually we were told that Grace had developed a neurological condition and they thought this could be something called Creutzfeldt-Jakob disease (CJD) but couldn’t be sure. A specialist team from the National CJD Unit in Edinburgh came down to undertake tests, and confirmed that my Granny had sporadic CJD.  My Granny died less than 4 months after first displaying the symptoms, in November 2010.

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CJD is a rare neurodegenerative condition that affects tissues in the brain, nerves and spinal cord. Despite being the most common form of CJD, sporadic CJD is still very rare, causing 1-2 deaths per million worldwide every year. I always said my Granny was always one in a million.

Symptoms of CJD include:

  • loss of intellect and memory
  • change in personality
  • loss of balance and co-ordination
  • slurred speech
  • visual disturbance and blindness
  • abnormal jerking movements
  • progressive loss of brain function and mobility

It was a difficult and distressing time for the family, as is any serious illness. However, this was made more difficult in the agonising time it took for her diagnosis, and the lack of knowledge around how to manage this condition due to it being so uncommon. This was also not helped by the stigma attached to this disease.

There are various strands of CJD. CJD is caused by an abnormal protein, called prion, which contaminates the nervous system. Variant CJD may have been passed to humans through beef products infected with bovine spongiform encephalopathy (BSE). However, there are four different types of CJD and infection is not always the cause of this condition. For example, the cause of sporadic CJD, which accounts for 85% of all CJD cases (and the type my Granny had) still remains unknown.

The world is an amazing and fascinating place, however it can also be filled with lots of unknowns, and some scary illnesses. We need to make more of the unknowns known; and support the fantastic work of all our world researchers out there spending their days doing exactly this.

Last year, the Brain Research Trust funded two PhD studentships researching CJD and related prion diseases. I want to raise as much awareness of this disease as possible. We had no idea for months what was wrong with Granny, her symptoms began with loss of balance and forgetfulness which quickly turned into a nightmare. Whilst there is no cure for the disease just now I am hoping more research will help come up with some solutions or ways of identifying earlier so people and their families are more supported and informed and can have an agreed care plan in place.

Five years after my Granny died, I decided in November 2015 that I was ready to start talking about the disease and raise awareness amongst health professionals and the general public. Having only ever run as far as 5K, I decided to take the plunge and sign up for the Dumfries Half Marathon. I have been training for the past few months in preparation for the run on Sunday 25th September to run 13.1 miles. It has been a bit of a bumpy ride, with several trips to Physiotherapy, Podiatry and Sports Therapy, however I figure if Grace could swim 50 lengths of Dumfries swimming pool twice a week at 75 years old, this run will be a doddle.

Any support would be greatly appreciated. Thank you.

www.justgiving.com/robyn-langton
Click here for more info http://www.brt.org.uk/creutzfeldt-jakob-disease-cjd

http://www.nhs.uk/Conditions/Creutzfeldt-Jakob-disease/Pages/Introduction.aspx

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Robyn Langton is an Integration Support Officer for NHS Dumfries and Galloway

“One Small Step for Dumfries and Galloway, one giant leap for Scotland” by Wendy Chambers

The occupational therapy mental health service is stepping forward this week and sharing their implementation of the Home Based Memory Rehabilitation (HBMR) programme for people with dementia at a National event in Edinburgh.

The event “Connecting People: Connecting Support” is showcasing occupational therapists contribution to dementia post diagnostic support, with the Home Based Memory Rehab programme centre stage, primed for a roll out across 5 other Health Boards in Scotland in the coming months.

Local occupational therapy staff Wendy Chambers and Alison McKean will be presenting during the morning live link session, and also leading along with Lynda Forrest in the afternoon workshop with the 5 Health Boards. The aim is for consistency of delivery for this evidence based occupational therapy intervention across Scotland, contributing to the developing evidence base and promoting best practice in post diagnostic dementia care

The event is being live-streamed and can be watched again at the following link

  • video3uk.com/actionondementia
  • Click on the EventCast Tab and follow the link called “Connecting People: Connecting Support. Home Based Memory Rehabilitation”

Speakers in the morning also include Mary McGrath, Advanced Clinical Specialist Occupational Therapist from Belfast; current work in Scotland with HBMR is firmly based on Mary’s original research (McGrath and Passmore 2009)

A video of servicer user feedback and opinion of the HBMR programme is also being shown on this day and a link to this can be found at

This work is also being showcased on the ‘Let’s Talk About Dementia’ Blog:

Wendy Chambers is an Occupational Therapy Team Lead at NHS Dumfries and Galloway

 

 

 

 

 

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.

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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.”

Under Pressure…… by @fionacgreen

In November 2013 “Dave” was admitted to hospital following a hip fracture. Dave didn’t always like the food choices and at times found it difficult to drink enough. Several days into his admission his wife noticed a blister on his heel- she mentioned it to the ward team but felt she was dismissed.

By the time of his discharge from hospital Dave had an established ulcer that required regular input from the community nursing team and podiatry.

In June 2014 Dave was admitted to hospital again. The fact that he had already one pressure sore, combined with diabetes meant that he was at high risk of developing further pressure sores and this time he left with a further two pressure sores.

Further prolonged admissions followed to treat deep-seated infection of bone resulting from the presence of pressure sores and ultimately surgical debridement and vascular intervention was required to aid the healing process. With each further admission Dave and his wife became increasingly terrified of what might happen and worried that he may leave with further pressure sores. Last year Dave spent his wife’s birthday, Christmas and New Year in hospital and throughout was visited daily by his wife -it is clear from his story the human impact of developing pressure ulcers

Dave and his wife have given their permission to share their story in the hope that we can begin to learn how important it is that we work together to prevent

pressure ulcers

Lesson one -Prevention is better than cure.

Each year 700,000 people in the UK develop pressure ulcers. Each pressure ulcer adds approximately £ 4000 to the cost of care. It has been suggested that 80-95% of pressure ulcers may be avoidable. Sometimes in healthcare as we concentrate our efforts on the complicated and exciting new developments that come our way we can lose sight of the simple things that can make a huge difference to the outcomes for our patients. By paying attention to early detection of risk, encouraging patients to keep as mobile as possible, addressing incontinence appropriately and by improving hydration and nutrition we can make steps to reduce the risk of pressure ulcers developing.

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Preventing Pressure Ulcers- the CPR approach

1 Check and identify problems early– this means that socks, TED stockings, and dressings must be removed to allow the pressure areas to be properly visualised

2 Protect – if pressure areas are at risk encourage regular changes in position, consider a pressure relieving mattress and apply REPOSE heel splints or Sundance Z-flex boots to relieve pressure. These are available locally by ordering through the PECOS system.

3 Refer – it is never too early to refer to the podiatry team if you have concerns

Repose Heel protectors and Sundance Z-Flex protectors

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FG 3FG 4If you want make sure you are skilled in the CPR approach to pressure ulcer prevention you can like me complete a short and practical e-learning module available on the NHS Learnpro site ( you’ll be pleased to see that I passed!)

 

Lesson 2- Improving Patient Experience/reducing harm/ improving financial efficiency

Sadly Dave’s story is one of many but so clearly illustrates that developing a pressure ulcer is an important physical harm that also impacts significantly on the healthcare experience of the patient and their family. Pressure ulcers are not just a huge burden to the patient and their family but also to the NHS and its staff as a consequence of prolonged hospital admissions and ongoing intense community treatment that may be required to heal the pressure ulcer. In Dave’s case listening to his wife’s concerns and making sure that he was eating and drinking well may have helped to prevent the prolonged and costly treatment that followed

Lesson 3 Changing Practice

Over the last few years we have all found ourselves under increasing pressure in the NHS. Some of these pressures relate to our desire to reduce harm, improve our patient’s experience of care, and finally to make financial efficiency savings.

People who come into hospital are also under pressure- they are in a frightening and alien environment and their illness may make it difficult to eat, difficult to maintain hydration and difficult to keep mobile. These factors are all important in the development of pressure ulcers. In Dumfries and Galloway we have begun work to accurately record the numbers of pressure ulcers acquired and we implemented a risk assessment pathway incorporating the elements of the ACTIVE PATIENT CARE bundle, Waterlow score and NATVNS pressure ulcer recording tool on pilot wards. Work is currently ongoing to spread these practices throughout the acute sites and the community

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21st November 2015 marks worldwide STOP PRESSURE ULCER day- Following on from Dr Bell’s blog last week this is one aspiration that we cannot afford to give up on

Dr Fiona Green is a Consultant Physician and Diabetologist and Clinical Lead for Pressure Ulcer workstream

 

 

“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

J Shrimpton

What are you so scared of? by David Christie (@bagheera79)

“Now, what I want you to do is focus on your breathing. Slow big deep breaths, in and out. You’ll think nothing’s happening at first, then you’ll feel the world become a warm, fuzzy place. Maybe imagine yourself somewhere like a hot sunny beach, waves on the shore, warm sun… big deep breaths, in and out…”

I usually say something along these lines as I’m drifting you off to sleep for your operation. The wording and phrasing obviously varies, and to be honest it’s the tone of my voice that’s important. The aim is to create an atmosphere of calm and reassurance. Something to focus on instead of the beeping of the monitor and the plastic smell of the mask, and the thought of what happens next. It sounds daft, but it’s important. People can be terrified, when they come into theatre, truly terrified. 

Some of the reasons for this are obvious – perhaps the reason that you’re having surgery, such as cancer. Or the surgery itself carries risk – such as surgery to major blood vessels, the brain, the heart. But some of the reasons are a little less obvious, I think, and easily forgotten. Imagine you’re coming to theatre. Just getting to that point involves the co-ordinated effort of many, many different teams. Patients need to be referred, seen in clinic and booked for surgery. There’s a need to have pre-operative assessment done for all the medical, nursing, physiotherapy and social needs. A raft of co-ordinated investigations such as blood tests, ECG and more are ordered to make sure that we know enough about you to be able to do it safely. The booking teams need to create lists that need to match with the availability of the surgeon, the waiting time, the urgency of the surgery and the availability of the patient – and possibly that of your carers or relatives. The theatre team needs to know what particular bits of kit are needed and to have it ready for you on the day. Extra members of staff from different departments may also be needed – such as additional surgeons or radiography – the list goes on and on. The whole process is so enormously complicated and intricate that it astonishes me that it works at all. And it needs to have this level of complexity – we humans are not car parts, stamped out in a factory. There are so many different individual problems that need to be overcome, the system needs to be able to cope with them all. And, by and large, we do.

The downside of being able to cope with all of this with a high degree of safety is that the process has become streamlined, smoothed, tick-boxed and protocol-driven. The most widely publicised example of this is the WHO checklist. With a few simple questions this checklist manages two things that seem obvious but used to be done very badly. The first is that it requires all members of the operating team to meet, introduce themselves to each other, and discuss the day’s work ahead before anything happens. In one neat moment, suddenly everyone knows who everyone else is, what the plan for the particular patients that day is, and what problems are anticipated. The second is that, for every patient – before they’re sent off to sleep, is involved in a discussion that is designed to ensure we have the right patient for the right operation, and various safety aspects taken care of – antibiotics, crossmatched blood, prophylaxis against life-threatening blood clots… It’s simple, effective, and has saved many lives all over the world. Unfortunately, all of this can be hugely depersonalising, and worse, unsettling. Having a group of strangers discuss how much blood you’re possibly going to lose just before you fall off to sleep isn’t necessarily reassuring. The whole process of coming in early on the day of surgery – hungry and anxious – to be told to get undressed and meet a sometimes bewildering range of people, including a surgeon that might be different from the one you expected. To be repeatedly asked about yourself, and then to be discussed while you anxiously wait – no wonder people are scared!

So, what can we do? We only have a few minutes with each patient in the morning rush – but that’s enough. To engage with people on a human level, to let them know that we care, to stop them being quite so terrified is not as difficult as it sounds. Simply saying hello and telling people your name goes a long way – it says you care about them enough to let them know who you are! Tell them what’s going to happen and why, what to expect so that they don’t get a fright. Remember that the nonagenarian in front of you may have had an extraordinary life and seen more than you can ever imagine, don’t be patronising.

All of which brings me back to my little spiel at the top, there. Recently I was anaesthetising a man in his eighties for a straightforward urological procedure. He’d been telling us about his life, time in the mountains, his high-flying daughter, an severe accident he’d had racing motorcycles over fifty years ago. I started to inject the medicines to send him off to sleep, and talking about sunshine, warm weather – and he interrupted to say, “Nah, son. I’m gaunnae dream about scoring a penalty fir Liverpool, right in front of the Kop.” I loved that, it made me smile. It made everyone in the room smile, in fact. It reminded me anew, yet again, that our patients are people, with hopes and dreams and complicated lives, and to not lose sight of it. And it reminded me also, that no matter how old we get, boys never grow up.

David Christie is a Consultant Anaesthetist for Dumfries and Galloway Health Board

‘Walk a mile in someone else’s shoes…’ by @Rosgray

Ros G 1

I remember reading a paper a few years ago now that said (something along the lines of) when thinking about the strategic direction of your organisation, you can focus on customer needs and experience, or you can focus on staff needs and experience. It doesn’t matter which, as long as you focus on one, as the quality of the service you deliver will improve. You just need to focus!

As a staff member I get the point, and as someone who works for the public sector it also feels right to put our focus on the needs of our customers.

So there is a lot of conversation in health and social care just now about the concept of asking patients and others “What matters to you?”. It is generally agreed that it can help us understand their needs and maybe understanding of the position they find themselves in under our care. In some cases it has fundamentally redefined the way the service is delivered and often in ways that health care teams might never have dreamed possible.

Ros G 2The newest Scottish hospital has integrated a systematic approach to delivering ‘what matters to me’ for every patient…

 

But all this got me to thinking – if I was a patient today, what would I put on that board?

I have a small family, a daughter’s wedding imminent, I am an only child so no major significant others to accommodate, so I guess they would need to be on there.

But what else would I say?

Reflecting on a fairly recent hospital admission, I had great confidence in the clinicians (a given…) I wasn’t so confident about hand hygiene; I wasn’t eating much so I was really interested in getting hot soup…

Ros G 3So would my WMTM board say – that your hands are clean (and show me how); I like my soup hot; and ask me about my mother of the bride outfit?

Probably…

But the important thing is that it would give us the opportunity to explore what was underneath those words and begin to consider the differences between asking ‘What’s the matter’ and ‘What matters’ and to understand the patients concerns and goals for clinical outcomes and managing life limiting, long term or indeed any conditions.

Ros G 4

Some say you absolutely cannot walk in someone else’s shoes. Our history makes us who we are; our perspectives, our successes and failures, our experiences. We cannot put ourselves in someone else’s position in exactly the same way, at best, we can be open, to listen and truly hear, to get more information and be better placed to understand and be prepared to do things in a different way.

And that can be tough.

It can be tough on us as professionals trying hard to deliver a service in increasingly challenging times.

But I suggest it might also be rewarding, bring back the reason we went into this kind of work in the first place, and make that work more enjoyable, knowing that we are engineering a different approach to care delivery that is focused on what matters to our patients. Delivering the care to them as we would the ones we love.

So let me leave you with time to reflect…

What would be on your ‘What Matters to Me’ board?

How will you develop ways to ask your patients about what matters to them?

And how will you use that information to deliver the service differently for them and others in the future?

Because that could be you and yours…

While I accept we cant walk exactly in someone else’s shoes, some of our healthcare colleagues in the USA have attempted to open our eyes a little with this short video.

‘Could a greater miracle take place than to look through each others eyes for an instant?’ Henry David Thoreau

https://www.youtube.com/watch?v=cDDWvj_q-o8

Ros Gray is Head of the Early Years Collaborative for the Scottish Government