Sunday, July 27, 2014

A Word on Bravery Certificates ...

I had another lightbulb moment today - a truly privilidged experience of "walking in my patient and their families shoes" and understanding the very importance of the impact healthcare professionals can have upon those under their care.  For a while now one of my guiding principles has been an inspiring quote by the great writer Maya Angelou.  She said:

With that context in mind, for those who do not mix in paediatric healthcare circles - let me explain the principle of a "bravery certificate".  A Travel Health Nurse specialist describes bravery certificates as "one of the most popular items nurses like to use when seeing children".  It's very true.  In my 13 years qualified as a nurse, I have seen again and again how important they are to the young people and their families.  But largely within the NHS - they are often seen as a "luxury" that a nurse can only personalise for their patients if they have time.  Sadly the comment I often receive if I am taking time to colour in a bravery certificate for my patient is - "well you obviously aren't busy if you have time to do that".  I understand that comment - in an NHS often consummed with bed numbers, targets, waiting times and so on - a "little" thing like a bravery certificate is seen as unnecessary.

But here's what made me re-energised in the important part they play in the overall experience for especially children and young people and their families - twice this week, and from two different families, I have been able to find the time (usually during my break) to colour in bravery certificates for my patients and have given them on discharge.  And both times I got the same comment from the families;

"Oh wow - look at that "Billy" - we will frame that and put it on your wall!".

Let me make it clear - I am no artist.  My colouring is poor and I sometimes step outside the line.  It is no masterpiece worthy of the National Gallery!  So why this response I wondered?

My reflection leads me to believe that it is quite simply that this certificate reinforces to your patient and their family the fact that you - their nurse - have thought of them as a PERSON - not as a bed number.  The very little bit of colouring demonstrates that you have taken a little bit of extra time in your busy day (and your patients know you are busy - they are mostly watching you!) to express your admiration for the bravery they have demonstrated.  And I think that by giving them this little gift along with their discharge paperwork - you are showing that you recognise they and their families have been through a great deal in coming into hospital and going through the procedure they have or the treatment they have.

My call to nurses is - it doesn't have to be bravery certificates.  It's not about "what".  It's about "how you make them feel".  It is the little action of showing your patient and their family that you are recognising they are people, they have their own individual stories and hopes and fears and aspirations.  It shows that you recognise them coming into hospital is a big deal for them (and possibly scares them rigid) and you care about that and their feelings.

So don't think "it's nothing - it's not important" as yes - bravery certificates can't be quantified, and don't meet CQUIN standards for NHS Trusts.  They are important I feel, because they make a difference to the patients and their families at that moment in time, and improves their patient experience ten-fold.  And that is the one opportunity we have.  Chief Nurse of NHS England - the wonderful Jane Cummings - always says "we only have one opportunity".  And back to my opening quote from Maya Angelou;

"They may forget what we said, they may forget what we did - but they will never, ever forget how we made them feel".

And as nurses - our NMC Code of Conduct binds us - we MUST put patients first!


Anonymous said...

Fab blog Dan love it
Mand xx

Anonymous said...

So Dan - a long time since you have commented on Christian things.

What's your thoughts on Mark Driscoll? Delighted? Pleased?

Chris Welch - 07000INTUNE said...

Chris Welch - 07000INTUNE said...
I am finished living a life without the knowledge of the Father filling me full with all of Himself. I must know God in Person inside of me.
How, then, does that happen for us?
Do we come to know this experience of the Father filling us full by some achievement of our own? Or do we know it by faith?
Do we “prove” to God how much we love Him so that, some day, He will deign to live in us? Or does He live in us now, waiting for us to know Him by faith alone?
God has not left us alone. He has given us a map of the journey before us. That map is the journey of Israel, the journey of the Ark of the Covenant and the seven great feasts of Israel’s religious year, culminating in the Feast of Tabernacles.

Chris Welch - 07000INTUNE said...

Dan Bowen in the Nursing Times 2012
After seeing how seriously ill children could become with flu, Dan Bowen has worked tirelessly to ensure his colleagues are immunised.

A passion for numbers first inspired Dan Bowen’s career – the Birmingham Children’s Hospital nurse originally wanted to go into banking.

In his new role as one of the trust’s flu champions, he is still motivated by numbers – working hard to increase the number of healthcare professionals who take up the flu vaccine.

“I always thought I’d be a banker but, after graduating, the only job I could get was as a domestic in a hospital,” Mr Bowen says. “I started to watch nurses and appreciated what they did and I decided to become a healthcare assistant then trained in nursing.”

Mr Bowen says he felt drawn to paediatric nursing, and says it was this concern for children that motivates him in campaigning for staff to take up the flu vaccination.

Click here!
In 2009, Mr Bowen opted to do a placement in the Health Protection Agency. He worked in its call centre, handling calls from parents and giving them advice.

“I’d heard a few rumours about swine flu and, in 2009, one of our directors decided to open a flu office – a central point where all immunisations could be coordinated.

“Back then, we weren’t sure how serious it would be. Up to that point, I thought flu was a bit of a sneeze,” he says.

“I soon began to see how seriously unwell it could make children in the paediatric intensive care unit.

“Our trust had had a sad paediatric death from swine flu, and I realised how vital it was to not unconsciously transmit that virus to patients or their parents.”

So he became one of 50 nurses whom the trust enlisted to take over roles as immunisation champions. He was responsible for teaching his colleagues that there were no side effects that couldn’t be cured by a quick trip to Boots and that immunisation was essential to protect patients.

“I trained immunisation champions to make it personal for the staff, and ask them would they want to infect a pregnant woman, their grandad or their children. It’s not just getting a few days off sick – it can be life and death.”

Over the past three years that Mr Bowen has been involved in the flu immunisation campaign, average uptake has between 92% to nearly 100% of staff, compared to a comparable national average of around 10-15% before 2009. The success rate at the trust is down to the immunisation champions’ enthusiasm for “jabbing” everyone – and that means everyone.

“I decided on day one I had to have it done. I couldn’t be a hypocrite and encourage people to do it if not,” says Mr Bowen.

He says that having flu champions going out to the wards makes it far more successful to embed in the culture than the traditional occupational health model used by many trusts.

The campaign’s slogan is “Any time, any place, any where”, making it easy to access a flu vaccination at any point in a working day.

“We tried to make it fun by giving lollipops. We really benefited from NHS Employers’ flu-fighting national campaign to encourage take-up among staff.”

The support at the top level has dramatically boosted the success. “Our chief executive Sarah Jane Marsh has been immunised every year, as have all senior managers; board members and the director of nursing insisted on being vaccinated.

“A big coup for me was having the opportunity to vaccinate NHS chief executive Sir David Nicholson at a conference.”

Mr Bowen says he has concerns that, because the winter of 2011-12 was mild, people may be lulled into a false sense of security.

“We still need to keep up the momentum,” he says.

“We need to do this to avoid unnecessary flu mortalities and admissions. I am ambitious for our trust and to improve our figures, but also to see our successful model rolled out across the NHS to protect the public and vulnerable children.”