Honest Reflections by Barbara Tamburrini

As this is now the third blog I have written for DGHealth, either there is a shortage of ‘willing volunteers’ or others have found better ways to say “maybe, possibly, perhaps soon” to Ken Donaldson when his charming request drops in the email ‘in-box’. Whatever the reason, I find myself agreeing to contribute and construct another brief moment of interest in our increasingly busy days. Having written previously about handover processes and the importance of good communication, I thought I would flip this on its head for this blog and consider the ‘inward’ communication reaching our ears from eager and sometimes over-active media sources and outlets.

A scan of headlines published over recent times don’t make happy reading for hard-working and dedicated NHS employees trying their best to simply ‘stay afloat and fight the fire’. Over the last 4 days, a number of reports sum up the general gist of current NHS news:

  • 9th Feb 17 – “Worst A&E waits ever, leak suggests” – BBC News
  • 8th Feb 17 – “The NHS and its crisis: Myths and realities” – Sky News
  • 7th Feb 17 – “Scotland’s A&E departments miss key waiting time targets over festive period” – Daily Record
  • 7th Feb 17 – “Maternity services in Scotland ‘beginning to buckle’” – BBC News
  • 7th Feb 17 – “Ageing UK midwife workforce on ‘cliff edge’, warns RCM” – Nursing Times
  • 7th Feb 17 – “NHS [Scotland] cancels 7740 operations due to lack of resources” – STV News
  • 5th Feb 17 – “Scotland patients waited more than a year for hospital discharge” – Sky News
  • 5th Feb 17 – “Revealed: The hidden waiting list scandal for Scotland’s NHS” – Sunday Post
  • 5th Feb 17 – “Growing waiting times threat to NHS” – BBC News

The recent coverage by the BBC assessing the state of the NHS across the UK in their NHS Health Check Week raised issues including a perception of desperate times inside A&E departments, analysis of patient flow reducing to a halt and “clogging up” hospital wards and frontline services being radically changed in attempts to overhaul health provision in the wake of the publication of NHS England’s five-year plan for the NHS in 2014. Indeed, as recently as 15th January 2017, chair of the BMA, Dr Peter Bennie was quoted as stating the Scottish NHS was “stretched to pretty much breaking point” and “heading for a breakdown” unless the government acknowledge the disparity between the current comprehensive service provision and existing funding levels.

So what does all this mean for humble workers ‘at the coal face’ and patients who so desperately rely on the NHS and our contribution within it? Dr Bennie wisely points out that honesty is required when assessing all elements of our much loved but potentially deeply troubled NHS. Honest reflection on our actions and behaviours as NHS staff is required to ensure we are all maintaining a focus firmly centred on our patients and clients. In a profession which is becoming more and more challenging with morale which seems to be ebbing lower and lower, can I really state with certainty that my focus is always upon my patients?

If I am looking at my last shift on duty, as part of the DGRI capacity team, I know that the greatest majority of my time was spent considering patient care but, the complexities of the work involved in capacity management mean a constant ‘juggle struggle’ between complicated discharges, patients keenly attending for their long-awaited surgery and fast and furious emergency admission rates with significant staff shortages thrown in to make life really interesting. This is a really difficult environment to function effectively, positively and proactively.

Its exceptionally difficult to have to say “I’m really sorry but I don’t have anyone who can give you a hand at the moment” to hard-working and struggling colleagues whom you respect and want to help. This inevitably influences work-focus and morale, sometimes away from patients and onto less fruitful, less important areas – we’re only human after all! I’m sure many of you reading this blog can identify with this and acknowledge that there can be times when we recognise that our concentration has slipped away from the real reason we are all here. This honest reflection is being actively encouraged in nursing through the revalidation process which will positively impact the profession in the future with a similar process in place for medical staff.

Honesty is also required from patients and clients using NHS services with individual ownership of health and the impact of lifestyle choices upon this of fundamental importance. The vast majority of NHS patients freely and actively claim this responsibility but this is not always the case in some crucial clinical areas like Emergency Departments. For the headlines to stop, the public also need to do their part. In a recent article in Glasgow’s ‘Evening Times’ (9th January 2017), it was stated that around 1 in 6 Scottish ED attendances may be unnecessary at a potential cost of £33 million and whilst ministers have provided responses aimed at removing any punitive element and reassuring the public that they are right to be concerned about their health, this concern needs to be correctly channelled for current pressures on health services to be eased. Patients with 3-month history of injuries, minor ailments which could be assessed elsewhere and those telling us they didn’t bother trying their GP as “they wouldn’t get an appointment anyway” are all too frequent presentations in busy ED’s. In my ‘other role’ as an ANP in ED, every time a patient told me this, I called the surgery myself and was given an appointment that day for their patient so, as well as accepting ownership of their own health, patients and service-users also need to be well-informed, confident and comfortable about the health services they access and when they utilise these valuable resources.

My feeling is that an organisational honesty also exits within current healthcare with ‘the powers that be’ having a responsibility to consistently and carefully examine the healthcare delivered with rectitude and reliability. We are somewhat fortunate in that we have an organisation who actively engages with staff through measures such as #ontheground, weekly core briefings, active and lively facebook and twitter accounts and the informative and interesting DG Change website (http://www.dg-change.org.uk). Indeed, this weekly blog also serves as a useful interactive communication with reflections and comments on posts actively encouraged. But is this enough? I would argue that even though these proactive measures exist in NHSDG along with many other approaches, staff morale remains low in some clinical areas and sickness absence rates are running well above optimum levels in some departments. So, are the current measures of engagement between the organisation and its employees inaccessible, uninteresting or unimportant to some staff, not effective enough, not addressing the correct issues or simply not delivering the desired impact? Although impossible to answer within this blog, the significance of this question and the consequences associated with it, must remain high on the agenda if staff empowerment, engagement, motivation and morale are to be maximised as we hurtle head-long towards a new hospital and evolving chapter in our healthcare provision.

Every ward I go in to during my capacity shift has AHP’s, nursing and medical staff who look tired, strained and burdened by an ever-increasing workload with constant financial and resource pressures making the job all the more difficult. But, and this is crucial, staff continue to come to work to do the best job they can given these constraints. They continue to change rota’s to cover absences, work through breaks and past finishing times to help their colleagues and patients and they continue to ‘fight the fire’ with dedication, sometimes in the face of adversity. Healthcare staff MUST care about the service they provide, to deliver care which remains meaningful, appropriate, safe, effective and patient-centred.

Whilst we as staff have a responsibility to continually reflect on our own practice, this must be fully supported, actively encouraged and consistently underpinned by honest reflection at a strategic level on the current ‘state-of-affairs’ and how this can be promoted and enhanced within the existing inflexibility of financial austerity.

Therefore, returning to our news headlines, what does the future hold for the NHS locally and nationally? Locally, despite considerable challenges, there are exciting times ahead as we look to fully embed health and social care integration and also move our main hospital services into our new build. Nationally, the picture is less clear with ever-increasing financial pressures being placed on continually growing workloads in a society with greater demands in terms of health due to conditions such as obesity, diabetes, heart and respiratory diseases. This is compounded by an ageing population sometimes presenting with chronic conditions which one simply did not survive from a decade or two ago.

hould we as NHS employees, the general public, healthcare service providers and users be concerned about the growing tide of negative headlines? Perhaps. Maybe these give an insight into the ‘health of our NHS’ – gosh, that’s a worrying thought. Or maybe, we now live in an environment feeding off news negativity and scandal in which we have all become de-sensitised to minor challenges therefore pushing media providers to ‘raise-the-bar’ in their reactionary reporting of our beloved NHS which would have, until relatively recently, been ‘off-limits’ to the eager reporter looking for a scoop however vague, misleading or sensational.

Lets return to our honesty theme. Within this blog, I have suggested that some honesty is required in our NHS and this should also extend to the reporting of challenges and issues to a certain extent. The antonym to sensationalism, where bad, critical or damming NHS news is forbidden with offenders punished by a stint taking minutes for certain western hemisphere parliamentary press conferences, is also not good for contemporary healthcare since this stifles and prevents honest reflection from which, lessons can be learned and development thrives.

There is every likelihood that the headlines wont go away and they may even increase in frequency or adversity. Perhaps though, if we all contribute in our own way, positive, honest and transparent analysis at individual, peer, organisational and national level will drive, develop and sustain an NHS we are all proud of and which we want to protect, however difficult or complex the discussions and decisions.

Barbara Tamburrini is an Advanced Nurse Practitioner at NHS Dumfries and Galloway

 

 

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.

A Taka 1

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!

A Taka 2

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.

A Taka 3

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)

 

 

  • 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

 

 

  • 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