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!

To Strike - Or Not to Strike? That is the Question ...

There was a fascinating discussion on the Nursing Times twitter feed today which I eagerly took part in.  It was centered around the debate as to whether nurses in the United Kingdom should consider strike action over the on-going pay dispute.

For those non-nurses among us - simply put, nursing and midwifery pay in the UK has effectively been frozen for the last 5 years or so, and the small increases when they have come have been so below inflation that they effectively equal a pay cut.  To add to the anger among my colleagues - it doesn't help reading about MP's voting and awarding themselves pay rises of considerably more.  Or (closer to home) perhaps some senior NHS managers receiving also larger pay rises.  A further note of discomfort for many colleagues is that our regulator - the NMC - is consulting to raise our yearly registration fee from £100 to £120 which is mainly use to hold Fitness to Practice panels often resulting in nurses being struck off over doubts over their capability.

Nurses are angry.  That is common knowledge.  But is striking the best way?  I responded a strong "NO"!  I've suffered too.  I had to take out a loan to renew my NMC registration this year.  My hero - Nursing Times Editor Chief Jenni Middleton commented this to me;

It made me take a step back and think.  Am I disgracing my profession and colleagues by such a standpoint?  Should I be marching with placards out in the street?  Are the government really cackling in glee at such a "naive" view as mine?  But here's my issue.

The Code of Professional Conduct - which defines myself and all colleagues as a nurse or midwife says this;

"The people in your care must be able to trust you with their health and well being. To justify that trust, you must make the care of people your first concern".

In it's closing statement to the "Mid-Staffordshire Public Inquiry" chaired by Sir Robert Francis, the Department of Health submitted this key statement:

"The patient should be at the center of all that the NHS does".

So before I personally consider strike action - no matter how angry I or colleagues may be - the patient must be considered!  Now a couple of unions have proposed variations on a complete strike.  What about emergency cover only (such as firemen often do)?  But here's the rub.  What constitutes "emergency" cover for the patients under my care?  Let me walk a few moments in my patient's shoes.

• What about the young person admitted to Surgical Daycare for the insertion of a Hickman line?  He has just been diagnosed with leukemia and needs to commence chemotherapy.  I guess the insertion could be cancelled - but the longer his chemotherapy is delayed, the longer the potential for spread.  I would argue that procedure constitutes an emergency for that family.
• What about the young person who has an outpatient appointment with a cardiologist - she's been having "funny palpitations" but as yet undiagnosed.  Without an OPD nurse, that appointment could be cancelled.  But the fears and worries for that family that their beloved daughter has a heart problem needing heart surgery would constitute an emergency in their case.
• What about the disabled child with learning disabilities who has been waiting months for an appointment to be fitted for a wheelchair?  They have been getting sore and uncomfortable and have outgrown their current chair.  Without that nurse-led appointment they may have to wait months more.  To that child and family - it's an emergency.

I am aware this very personal view may be seen as a "betrayal" in my colleagues eyes.  I will understand if some unions vote - and indeed go on strike to protest the unacceptable pay decisions imposed upon us as a profession.  But at present - I just cannot see myself personally and professionally accepting going out on strike.  The trust of the patients and their families just mean too much to me.  I have read the complete "Francis Report" and I think the actions of a few have brought the nursing profession into disrepute.

This doesn't concern me - it challenges me!  It is up to us - and me - to re-gain that trust and that respect from the public.  Patient by patient.  Family by family.  And I fear that strike action would further damage the profession I so love.

A Review of "Little Stories of Life and Death" by Dr David Drew

I don't often review books on this blog - but this book was and is an exception.  It is very important to me personally for a number of reasons:

• It is about child patient safety - something both Dr David Drew and myself have dedicated our lives to.
• It is about injustice - something that I cannot tolerate personally or professionally.
• It is about endurance - the story doesn't always end with a happy ending.  But has the story ended?

A few words about how I came across Dr David Drew.  I am an unashamed social media advocate.  Yes I do believe it can be used for harm, and can (like any medium) be misused.  I am grateful as a nurse - to my regulator the Nursing and Midwifery Council - for not blanket banning use of it but promoting professional use.  Any nurse, midwife, doctor or Allied Health Professional must bear in mind at all times we can be called to give account for what we say, write or do.  But the massive benefits of social media mean a far wider social and professional network beyond your immediate workplace.  So it was due to Twitter that I became familiar with the account of Dr Drew and his whistleblowing account, and difficult personal and professional experience at the hands of Walsall NHS Trust.

Haven't heard of Dr Drew?  This page is the best summary with links to appropriate news articles.  The most heart breaking link is this news report concerning baby Kyle Keen.  "Little Stories" - Dr Drew's autobiography - is dedicated to the memory of baby Kyle.  It can be objectively argued that his professional difficulties began when he argued that the manner in which baby Kyle died was unacceptable and should not have happened.  But for more detail on that - you will have to read the book.

Here's what struck me about the book:

1.  Dr David (and all HCP's) is first and foremost HUMAN and have stories.

This book is published at a time when our beloved NHS is coming under a lot of criticism (much of it deserved) because NHS professionals are sometimes not giving their human patients the respect, dignity and care that they deserve.  Much of this inexcusable care is often delivered because a basic human fundamental truth is being forgotten - PATIENTS are HUMAN BEINGS (Mid Staffs and Winterborne show an appalling demonstration of this).  But we must not forget that NHS professionals are human beings too - there's a reason why we ended up wanting to care.  And when that duty of care fails - is anyone asking why?

So I urge and encourage and recommend the first few chapters of "Little Stories" because Dr David writes candidly and honestly as to how he "ended up" in medicine.  I very much found an affinity with him because like him, my parents did not actively encourage me into nursing.  I ended up in nursing quite by accident.

Throughout the account of "Little Stories" - I found myself being drawn time and again to the pain and agony that Mrs Janet Drew must have gone through - living Dr David's pain as an observer.  Again it is something I am hugely familiar with.  In a way healthcare professionals families can suffer uniquely because they have to watch (and not understand) the pain their loved one experiences being mistreated at the hands of their employer.  All they can do is watch.  Their healthcare professional loved one must walk it alone!  And for that (as has been said before) Mrs Drew is very much the heroine of "Little Stories" for standing and walking by his side - what a wife!  What a hero!

2.  Dr David cares passionately about his patients.

Any reader of "Little Stories" - whether they be critic or supporter - cannot deny (I feel) that Dr David cares passionately about the patients under his care.  The quite incredible case of extremely low temperatures on the paediatric ward due to facilities failures demonstrates his concern greatest.  I was gripped by his account of getting up during the night and coming in to direct equally concerned night nurses to ensure electric heaters were distributed appropriately and babies were clothed with woolly hats.  

His heartbreaking account of Baby Kyle - and the healthcare failures that led to his premature death - again demonstrate this beyond doubt.  The reader can easily get into Dr David's head and ask; "Could I have done more?".  To any healthcare professional reader - who has gone through the agony of losing one of their patients, this will be familiar territory.  While death is an accepted part of life, something within our very souls rejects it as abnormal and wrong - particularly in the paediatric world.

I noted particularly - in scouring the Employment Tribunal hearing of Dr David, that the Trust did not once claim he did not care about his patients.  Their claims were directed elsewhere.  The Nursing and Midwifery Council is making this statement key in it's review of the Code; "Make the care and safety of those in your care, your primary concern".  Dr David did this - but confusingly he paid an awful price for it.  The reader must ask - is this right?  Is this just?

3.  Dr David won't give up if patient safety is at stake.

This is the issue for all whistle-blowers I feel - and it is an issue that the Department of Health, NHS England and perhaps the Government have yet to grasp.  They are not trouble-makers.  They are not makers of "toxic culture" - ridiculous phrase.  They - we - are simply people who care desperately about the best for the patients and families under our care.  If they - we - see politics or bureaucracy interfering or hindering that care, then they - we - get mad.  And the whistleblowers - Julie Bailey, Deb Hazledine, Dr David Drew, Sharmilla Chowdhury and so many more - are mad people.  They are not mad because of loss of income, indignity, reputation - no, they are mad because of loss of due right to the patients under their care.

I am ashamed to say there was a part of me that was inwardly begging Dr David to accept the gag bribe that Sue James - the CEO of Walsall Manor - was offering him.  It would have provided temporary safety and security to his family and would have ensured a "happy ending" - that he and Walsall Manor parted company.  But THE hero moment of the account of "Little Stories" comes when Dr David comes home and reports the gag offer to Mrs Janet Drew and his sons.  Her response?

"If you accept that money - I will divorce you".

His sons response?

"If you accept that money - we will never speak to you again".

THAT is family!  THAT is support!  I leapt and whooped in my chair while reading it.  I am ashamed to admit that if I were in Dr David's position, I suspect some of my family may urge me to take the gag offer for the simple results of immediate financial security and peace.  But as healthcare professionals we have a duty to constantly ask ourselves - yes, but is our patients at risk because of our actions?  Dr David rightly noted that his patients WERE at risk if he compromised to the offers from Walsall Manor.  So he didn't.  At his personal detriment.  I hope that Walsall Manor have learned from that experience, and I hope desperately that patients are far safer today than ever before.  I don't know.  But I hope.

But I closed the chapters of "Little Stories" absolutely without question - a true NHS Whistle-blower who really cares for their patients will NEVER accept a gag offer - if the safety and security of their patients is left at stake.  And whistleblowers and their supporters hope and pray the day is coming when the government, the Secretary of State for Health and the Department of Health are wakening to the fact that the safety of our patients will ALWAYS be of higher concern than the "reputation" of any NHS organisation.  Let's face it.  Any "reputation" of ANY NHS organisation based on spin and lies and not on true fact of patient safety - really isn't worth the paper it is written on.

So in conclusion:

I cannot commend "Little Stories" highly enough to you.  If you are the Chief Executive of an NHS Organisation then you need read this.  It may save your career.  You may save your organisation and "political face" in the short term.  But you are managing people.  And truth will out.  Stand for truth - and you will be respected.  Hide - and spin - and you will never escape.  If you are a healthcare professional - nurse or doctor - then you need read this.  It will make you ask the question: how much am I willing to sacrifice for my patient's well being?  Am I willing to remain silent to their cost?  Why am I in nursing or medicine?  And if you are a parent, family member or patient - you need read this.  We who are looking after you are human.  We are fallible.  But the most of us really do care.  So let us connect with you.  Tell us your fears, your hopes, your dreams.  We want to help.  We want to care.

How Her Majesty the Queen helped me survive these past 1.5 years.

Dedicated to every brave soul who daily choses to continue living - even if it means facing demons, hardship and heartache.  Dedicated also to the fabulous Rev Dave and CEO Lisa who together gave me the bravery to speak out and put pen to paper.

It is amazing that even in the 21st century, it still isn't very easy to speak openly about mental health issues - particularly on a personal leveMORE empathetic and compassionate rather than building walls and de-personalising our patients!  Somehow anyone within the NHS, there is a ridiculous notion that "we are professionals and shouldn't struggle on this level".  But the unspoken reality is that the NHS is wonderful because it is staffed by human beings who do go through similar problems to the patients and families we see on a daily basis.  That reality should make us

My own personal background was somewhat more complicated by the fact that I came from an extremely fundemental religious background where mental health issues were particularly disapproved of, and usually put down to "sin" on some level.  When I first went on antidepressants some 10 years ago for a time, I didn't dare tell my parents for some years - as it was seen as an admission of "failure".  I have seen my General Practioner and various Occupational Health services through work pretty regularly - and the clinical feeling is that I am not "depressed" per se - I apparently tend to struggle with "chronic anxiety".  In short - I daily seem to imagine up (I have a very vivid imagination) all sorts of fears, worries and panics about what life may bring.

The last year and a half has been particularly rock-bottom in terms of experience, health and work.  Two or three times I did in fact consider suicide and whether it really "was all worth carrying on".  Those low points were often prompted by events I read, such as the tragic account of the nurse involved with the Australian DJ scandal while Prince William and Kate were in hospital expecting Prince George.  Reading that account made me feel an affinity with the nurse - but in a ludicrous way, a rather morbid wondering if I also committed suicide whether the Chairman/Chief Executive of my workplace would make a statement to the press.  I decided they wouldn't bother - and somehow found that enabled me to "keep living" that particular low day.

But the benefit of this year has meant that I have been forced to confront some of my worst fears headon - with no support, help or alternative.  That's a story for another time - but what I found was that actually - my imagined fears were WORSE than the reality!  But what I wanted to focus on in this post was what enabled me day by day to "keep going" this year.  And that was the person and example of Her Majesty the Queen.  Before you snigger - let me explain why.

I am sure there may be psychological reasons why the Queen means so much to me personally.  I lost both my beloved Grandparents at significantly low times in my life to cancer, and both losses affected me deeply.  I guess there may be a degree to which I long for a "Grandmother" figure.  But Her Majesty's example has meant more than that this year.  It is well known and commonly cited that her life motto is;

"Duty first - self second".

When Her Majesty was 21 she made a monumental speech in South Africa where she committed her life to;

"I declare before you all that my whole life whether it be long or short shall be devoted to your service and the service of our great imperial family to which we all belong".

Her committment to duty has ruled her life and service - even if at times it has meant that her family life and personal life has been affected as a result.  Many commentators (and we never know what Her Majesty herself thinks - as she does not give interviews) suggest that call to duty is something that has remained with her, and has driven her throughout her life and reign - to the present date, her amazing 86 years of age and her now-over 60 years of reign.

Let me make it clear - I do not equate myself in ANY way to Her Majesty the Queen in ANY sense (other than to count myself fortunate to be one of Her subjects).  But what remained with me throughout this blackest of years, was initially a thought - does Her Majesty the Queen ever get down or low?  And this wondering grew into an interest that lead me to reading many of the biographies written about the Queen, and the difficulties that have beset her (especially her famous "annus horribilis" year and the year where HM lost both her beloved mother and her sister) - yet continued to perform her duty.

Her Majesty's personal difficulties are made worse by far because they are so often in the sight, criticism and debate of the press and therefore the public of both the United Kingdom and Commonwealth.  At the very least any personal problems I have, were able to be limited by myself to the people I trust and were able to depend on (and to them - a few in number - I owe them a debt of gratitude I will never be able to repay!).

While working through - day by day - the blackness, the lowness and utter desolation of the past year - at times, it was quite simply the fact of seeing Her Majesty the Queen at an official function (I follow several blogs that track and report the Court Circular) that gave me courage and conviction to try and "live the day".  At times, this was as pathetic as leaving the safety of my flat and walking to the corner shop to buy a pint of milk.  It sounds ridiculous to write this - but my mentality was;

"If Her Majesty can go to yet another engagement despite the wealth of possible aches and pains she may have as an over-80 year old, smile constantly even though she may not feel it, and shake umpteen hands even though she has done nothing but for the last over 60 years of her reign ... then surely I can put clothes on, leave the flat and do a simple task?".

That simple role-model and mentality enabled me to gradually build and grow in confidence, activities - and as a result I found my mood and outlook on life improving, my determination to work through my difficulties strengthen, and focus my goals beyond just "surviving the day".

It is for this reason I will never fail to be grateful to the unfailing example of Her Majesty the Queen.  The couple of visits I have been SO fortunate to make to Buckingham Palace only served to enhance that.  It is why I am a Royalist through and through!  I know this example will not work for everyone who suffers with anxiety, depression or any other mental health disorders.  But I do think it underlines the importance when you are struggling so hard to "keep living" - sometimes it can be the most simple or obvious of things that help keep you "living"!  It could be a family pet that needs feeding.  It could be a planned outing in a few weeks time.

The majority of the victims of suicide almost invariably state; "they ran out of hope".  So for us - as NHS professionals - one of the key responsibilities upon us is to help find that hope (and it will be individual to each person).  But we can only do our job well and effectively - if WE are honest about our struggles and experiences.  Small things such as a "thank-you" from a Chief Executive or a line manager can change the complete "mood" of a working week!  More importantly - cared-for staff give better care (it is widely acknowledged - I cite an excellent PICU Intensive Care Consultant as an example) so it is vital that if NHS staff do share mental health struggles and issues, they are supported and not vilified or patronised (as has sometimes been my experience).

Positive thinking (in my opinion and experience) is absolutely vital to "keeping on going".  For many of my 36 years of living - I thought that positivity and happiness was a reaction to the experiences that life forces upon us.  If life was going well - then I was happy!  If it was going very ill - then I was not.  But I have come to realise and understand (thanks to Twitter friends - in particular Kath Evans, Head of Patient Experience for NHS England and her friend 'Engaging Emma') - that in fact positivity and happiness come from "within" and are a state of mind that can be increasingly immune to life's changes and events!

My conclusions?

1.  Life isn't fair or just.
2.  We all have a choice - to continue and fight or opt out.
3.  We can all chose to benefit from our experiences and use them for good.
4.  There is always hope - even if it is the smallest glimmer (such as the Monarch carrying on her duties!).
5.  The night cannot last forever - the dawn does comes, even if it seems forever!

A View of Things That Matter

This blog post is dedicated in particular to Julie Bailey, Deb Hazeldine, James Titcombe, Liza Brady and Dr David Drew - among so many other whistleblowers.  It takes tremendous courage to speak out and "rock the boat" - courage perhaps more than I possess.  These people have suffered unbearably but want - only the best.  We need to hear from them.

It's been on my mind to write about the last year's public opinion of the NHS for some time.  The important whistleblower revelations of Mid-Staffs, Morcombe Bay and others have broken the rose-coloured fallacy that the "NHS is perfect because it gives free care to people who need it".  That is true and it is wonderful.  But the NHS is made up of imperfect human beings from the porters and domestics who enable hospitals to run, to Chief Executive Officers who lay down vision.

As is common in human behaviour, we tend to hold opinions of extremes (I hold up my hands and admit I personify this!).  If we do not love something passionately, we hate it with a vengance - particularly if wronged by it.

It particularly troubled me to see the horrendous backlash against key whistleblowers such as Julie Bailey and Deb Hazeldine, James Titcombe and Liza Brady.  For those unfamiliar, these two ladies lost their beloved parents in the most appalling failures of care and were not giveNOT just treat "the patient".  That "PERSON" comes as part of a family - and care given to them (whether good, bad, excellent or dreadful) will impact upon the closest people to them.  A caveat: I can somewhat understand why a lot of the backlash comes from the people of Stafford who face losing their hospital.  They are looking for a scapegoat, and inevitably (I suppose - however unacceptable) will look to the whistleblowers.
n the answers and reassurances they deserved - and so began to campaign.  The NHS and health professionals owe them a debt!  They are a reminder that we do

But I want to ask - does anyone mildly rationale think these two ladies - Ms Bailey and Ms Hazeldine EVER considered "becoming campaigners" or "whistleblowers" five to ten years ago?!  We must consider why fate led them to this.

1.  A Step Back and Pause for Thought:

Over this past year I have had a lot of time to think, read and consider the NHS as something incredibly important to me.  The availability of the Mid-Staffordshire Inquiry has enabled in depth reading and consideration of the mistakes and errors and lapses in communication.  In particular I wanted to read the accounts of families like Julie Bailey and Deb Hazeldine to learn and ensure that in my experience - this would NEVER happen again in my human power or sphere of capability wherever I work.  I was seized by a comment Deb Hazeldine made in her testimony to the Inquiry that I think it incredibly telling - she made it early in the complaint (point 25);

"If Martin Yeates had been up front and honest in the first place, I would have walked away.  I just wanted justice.  If he had said; "Hands up, it's bad" but could demonstrate in a robust way that it wouldn't happen again - I would have walked away secure in the knowledge that vulnerable people were not at risk".

I would hesitate a guess that virtually all families who have suffered unjustly or through human error would be actually satisfied with a swift, sincere apology and evidence of real lessons learned and proof that identical mistakes would not be made - would be enough.  I wonder if we can allow for the fact that whistleblowers have happened - because one of the human errors of the human NHS is that we collectively haven't been good at admitting error and learning from mistakes?

When I was at school (a private Christian religious school run by my parent's church) we used to have reports on our progress - both academic, but being religious, also character.  One consistent character point I scored very badly on was called; "Responds Well to Correction".  I can only assume at heart at that point I was an intensely proud and/or stubborn character as I consistently would score; "Needs Improvement".

This is an error I have somehow (I am not sure how) been keen throughout my life to remove and hope will continue to do so.

2.  Applaud the Good but Admit the Bad - and Learn and Improve from It!

There was a report in the Independent today that somewhat ignited the difference of opinion about the NHS.  Sir Mike Richards - the Chief Inspector of the NHS - wrote and commented favourably about the NHS.  He said;

“Compassion in the NHS is alive and well.” And then with extra emphasis: “We’ve also seen some really excellent care.”

This surely is good news?  But on Twitter again opinion was divided.  Those desperate to see the tide of public opinion turn on the NHS highlighted the story and applauded it.  The whistleblowers still seeking "something more" were justifiably concerned - all is still NOT well in the NHS and there is a great distance still to go.  The Sir Mike article states it itself;

"It is what I hoped I would see,” he adds. “But seeing is believing.”

There is a reason that I love reading the Birmingham Children's Hospital Foundation Trust Parent and Carer Feedback page on their website that collates feedback from the instant "Feedback Application" (Award winning!).  It demonstrates so clearly that feedback and performance change.  Some days the NHS gets it very right.  Some days the NHS gets it very wrong.  We are human.  We change!  But as long as we are transparent, live, love and learn - surely there is hope?

I for one - as a proud current NHS healthcare professional - promise and pledge here and now to devote the rest of my working life (up to 70 now I believe!?) to ensuring the patients and families under my care NEVER have any cause to have to raise concerns about the standards of my care.

PEOPLE matter.  End of.  FAMILIES matter.  End of.  And it is our (my) everlasting privilidge to be able to care for some of these vulnerable people when they need it most.  That expression of trust must not be ever let down.

Not WHAT we do but the WAY we do it

I am having a lovely relaxed New Years Day (mainly sheltering from the West Midlands grotty rain!) but hav been "seized" again by a comment made by a patient on a programme I am currently watching.  Having been away from critical care nursing for so long - it is frustratingly agonizing to watch the various ER programmes available and long to be involved!

The programme in question this first evening of 2014 is "Kings Cross ER: St Vincents Hospital" in Sydney, Australia.  11 years in nursing doesn't stop me watching with my toes curled as the ER team treated a poor young man who got stabbed in a nightclub in Sydney.  An ultrasound revealed that the knife pierced the left ventricle and he was bleeding out into the pericardial sack.  The cardiovascular surgeon was too far away by car to be present to save his life so the ER team looked as though they were going to have to perform the life-saving procedure by mobile phone.  Fortunately the young man managed to cope until the surgeon arrived and he was taken to theatre.

The next programme showed our young man re-admitted with possible infection and shortness of breath - and it was a thrill to see he survived the trauma!  However I was fascinated to note the one comment he made about his awareness of the life-saving surgery he had.  He said this;

"I remember hearing the voice of a lady doctor.  She kept telling me I would be okay.  She sounded like she had the voice of an angel".

It struck me again as we enter 2014 - healthcare workers have a UNIQUE privilidge in what we do in caring for patients and families often at their lowest point.  And yes - our patients and their families arrive at the point of care needing something - the care they can only get often from us.  But my point is this - the WAY we deliver that needed care is something that will stick with them for ages to come - far more than the care they needed.  We need both!  From Chief Nurse Jane Cummings "6Cs" - care and compassion run hand in hand.

A good New Year's resolution for all of us who may have the privilidge to care for patients in 2014?!

Another Take on "Making Every Contact Count"

To those non-NHS types, forgive me for another "care-orientated" post.  Much of the last two years have been massively dominated by my nursing role and my proud membership of the National Health Service - and hence my blog does tend to represent my current passions.  I do still maintain my theological/spiritual interests and have a few subjects brewing - but this one is a post that could not wait!

"Making Every Contact Count" is a very important initiative in the NHS at the moment - we are realising that as health professionals we have a unique position of serious responsibility and privilidge with the patients under our care and their families.  Mistakes in the NHS have been made in the past where care has been delivered but not in the right way.  One of my NHS heroes - Chief Executive Officer Sarah-Jane Marsh said (in a CEO briefing at her Children's Hospital in Birmingham);

"It is not just what we do that matters, but the WAY we do it".

Consider nervous parents accompanying their young child to have their tonsils removed - a relatively minor procedure in context.  Imagine if the surgeon did his job and removed the necessary tonsils, but their entire hospital experience was negative.  Say the surgeon was brisk, rude and dismissive and the nursing staff pre-and post operatively did their job and monitored the child but gave the parents and child no compassionate care and support.  The objective may be achieved - removal of tonsils - but the family and child could and would be scared by such a negative experience.

THIS is why it is not enough to simply have competent NHS staff treating the patient.  We MUST have compassionate and caring (AND competent!) staff who support and defend the patient and family from admission to discharge ensuring the whole point of contact with the NHS is positive.  "Making Every Contact Count" is a vital initiative used in the Birmingham Children's Hospital at present;



But I did find myself wondering if many nurses, student nurses and allied health professionals like myself struggle to come to terms with what actually; "every contact" means?  Does it mean if we are simply taking our parents a cup of tea we should sit down and commence a sermon on smoking cessation?  Surely not!  So it was while thinking these matters through that a common motto came to my mind;

"When a butterfly flaps it's wings in Texas, it causes a tornado in China".

This is in other words known as "Chaos Theory".  It is technically defined as; "a minor change in circumstances can cause a large change in outcome".

I am not entirely sure if healthcare professionals are entirely aware of the enormous potential of their actions (and contact) with patients and their families - whether positive or negative.  The Mid-Staffs scandal demonstrated the hideous enormity of negative contact - and it is a nightmare the NHS should NEVER forget.  But something the Chief Nurse of NHS England - Jane Cummings - is vitally reminding the negatively-biased media is that POSITIVE experiences also have a crucial impact.  

Many nurses (and I have been guilty of this in the past) have come to work at times bringing "home life" with us.  Aches, pains, heartaches or simple headaches - have meant that we as healthcare professionals have not been "properly" operating in the "6Cs" framework we should to truly impact our patients and families for the good.  It may seem little to us - a more formal sober greeting of our families after handover and perhaps a distinct lack of smiles and easy small-talk during the shift than perhaps we may do.  This may seem like just an "off-day" to us.  But what of the impact on our patients and their families?  That "off-day" may be their ONLY contact with the NHS during their lives - and the impact they take away is our lack of smiles, care and - presumed - lack of motivation to give them the patient experience they need.

When a butterfly flaps it's wings ... a tornado happens.

When a nurse smiles at a patient and family (even though his/her heart may be breaking due to a recent family dispute) a positive tornado of change and impact happens and that family may leave the hospital or care setting with a positive experience of trust and confidence in the NHS.

When a butterfly flaps it's wings ... a tornado happens.

When a nurse sits with a devastated, bereaved family and is seen to visibly shed tears, that family may leave the hospital knowing that they were cared for (even though the outcome was not what they hoped) by a human being who was impacted by their loved one.  The loss - still and always devasting in the extreme - will be tempered by the fact that they did not suffer it alone as though on a factory production line ("when's the bed available?") but as an event that impacted the healthcare professional with them at the time.

When a butterfly flaps it's wings ... a tornado happens.

When the worried and anxious family sitting in the Accident and Emergency Department, so concerned about their loved relative suffering beside them, are brought a cup of tea by the nurse and an apology for the wait and an explanation - suddenly the nightmare fear that "they just don't care" evaporates and the slight reassurance (though the concern for their relative remains) that humans are in charge and that they are not just another number in the queue potentially breaching their "targets".  But the experience they take away is that they are told and explained that the department is horrendously busy and prioritisation of care is taking place, but their relative is not forgotten and is under observation (even though it does not seem it) - ANY deterioration in health will be responded to swiftly.

When a butterfly flaps it's wings ... a tornado happens.

The devastated parent sitting with their terminally ill child on Christmas Day looks up as yet another nurse comes in to deliver the required chemotherapy (even though the parent knows it will make the child sick) the difference cannot be expressed if the chemo nurse comes in smiling and compassionately open to what the child needs and does his/her utmost to deliver the necessary medication but with the right approach.  That effect will last with them forever, just as a rushed, brutally efficient but distracted nurse who charges in, injects the medication and rushes out without comment.

When a butterfly flaps it's wings ... a tornado happens.

A family sits in a busy Outpatients department worried sick about the appointment with the consultant.  The results are in and in a few words they will be told whether they have a positive, rosy future full of hope and promise - or further worry, dread, more appointments, "maybes", "I hope" and other subject phrases spoken by healthcare professionals.  The Outpatients department is running drastically behind schedule and the worried family know they are now 30 minutes behind their appointment time.

To be approached by an Outpatients nurse who sincerely apologises for the delay, explains the reason and asks if they need anything (an English cup of tea never goes amiss!) will create a tornado of effect, even if the news from the consultant is negative - as compared to a stressed, harressed nurse who is charging around (to the family's view - and they DO see everything) accomplishing little - who then snaps that; "Dr So-and-so will now see you.  Quickly!".

There are many, many more examples and scenarios that could be cited and may ring true with healthcare professionals across the NHS.  But I hope the few examples that have come to my mind will prove my point.  I believe fervently as current HCP in the NHS - we must, must, MUST never forget that we are in a position of ultimate privilidge, trust and opportunity.  

Every action (whether it be a smile, a story read, a hug, or a cup of tea) can have a far greater wave of impact upon our precious patients and their families than maybe we will ever know.

It is our responsibility, duty and joy to ensure that we do not just deliver "competent" care (although that is vital) but we deliver such care in a compassionate manner that thinks ahead of the actual care delivered - and anticipates and expects that our patient and their family will leave the NHS and the care with an overwhelmingly positive experience that they can remember for a long time.  Even if, tragically, the care delivered sees that precious and beloved relative not coming home - let our precious families go home knowing that their relatives were treated with the highest dignity, compassion and care possible and that they did indeed die in the "best hands possible" with their families by their side.

When a butterfly flaps it's wings ... a tornado happens.