My favourite books of 2019

As a child I loved reading and Colette Datt @datt_colette reminded me of this as she challenged me to post the covers of 7 children’s books this week. As an adult fitting reading into life has become more challenging. Whilst I love an absorbing book of fiction I find if I read at night, within a paragraph I’m asleep!

Bill Gates @BillGates shares that he reads around 50 books per year. Reading is, he said, “the main way that I both learn new things and test my understanding”. I like this infographic too about why reading is so important …

My daily commute to and from London offers the perfect opportunity to expand my focus on reading with a walk to the train station, tube and sometime bus journeys too. This year I’ve really embraced @audibleuk it’s helped me to ‘read’ more by listening on the move! I often tend to have a book & audio version of the same title!

So these are some of the books I’ve enjoyed so far this year… (sadly no where near as many as Bill tho 😉)

Lift by Melinda Gates @melindagates

‘We are the lift’ says Melinda in the introduction as she shares her life and the journey she’s been on growing philanthropy through the ‘Gates Foundation’ @gatesfoundation. The book reflects on her life and what she’s learnt meeting inspiring people whilst working to change things for the better. Gender equity, empathy and the power of connection are golden threads that drew me in with the powerful narratives shared.

Dare to Lead by Brene Brown, @BreneBrown was kindly gifted to me by Lisa Ramsay @Doula_Lisa. I’ve valued Brene’s work for many years, her focus on the power of connection is one that resonates strongly with me, this book focuses on using these principles of connection to lead. Brene offers reassurance that we don’t have to have the right answers; yet we do need to stay curious and ask the right questions. She highlights that we can’t and shouldn’t avoid difficult conversations and situations; that leaning into vulnerability is necessary to ‘do our best work‘. This is a book I repeatedly go back to. I think one of the other draws to Brene is that her husband is a Paediatrician.

How to treat people by Molly Case @mollycasespeaks was published this year. Molly wowed the RCN Congress with ‘Nursing the Nation’ https://youtu.be/XOCda6OiYpg
and this book is a wonderful insight into modern nursing it’s highs and its challenges. Molly shares herself with us all freely and her voice is beautiful on the audible version, please do take a listen and share.

The Language of Kindness by Christie Watson @tinysunbird bringing further insight into modern nursing, Christie again shares herself and reflects on the world of children’s nursing and also on her role as a resuscitation Officer. Again Christie’s voice is beautiful to listen to, and her rebellious adolescent self that desperately wanted independence is something I could identify with with.

Trauma Stewardship by Laura van Danoot was recommended Joanne Bosanquet @MrsBosanquet and I suspect this will be a reference text I’ll return to in the years ahead. The care of staff is something we’re constantly challenged by and Laura shares many narratives about the importance of sharing recognising the importance of caring for ourselves and how we role model this to others. Loads of food for thought and examples of people involved in really traumatic situations.

Becoming by Michelle Obama @MichelleObama was the book I started 2019 and it’s great! Michelle shares her childhood and her passion for education that she uses to encourage and support others, particularly girls. I hadn’t realised she’d worked in healthcare community engagement, as well as having a legal background. Michelle again shares the ups and down of living in public eye, yet her commitment to making a difference shines through.

Also on my to read list is ‘Educated’ by Tara Westover suggested by Mary @MaryNewburn1 and The Choice by Edith Egar. I have to admit they are books I’ve found harder to connect with, so are both still being read!

So I’d love to hear from you? Which are the books I should put on my ‘to read’ list for the rest of 2019?

Cracking genomics 🧬 what’s our role?

Genomics 🧬 and personalised medicine is here, Chief Scientific Officer Sue Hill @CSOSue, @MRadford_DONi and @SigsworthJanice confirmed at a session I attended a session on genomics supported by Health Education England this week.

Judith Ellis when she was Chief Nurse at Great Ormond Street said repeatedly that the future was Genomics, yet I have to admit my knowledge of genomics if I’m honest is limited! Yes I was aware of the coverage when David Cameron launched the 100,000 genomes project back in 2012 and I was astounded to hear during the session that this target had been exceeded.

I’ve been following @GenomicsEngland on twitter for a while, and on the genomics England website https://www.genomicsengland.co.uk/ is a great animation admittedly aimed at children (but I have to admit I loved how well it explained things) talking about ‘glitches’ it’s well worth a watch! https://youtu.be/sn3_FlEbe0U

If you’re not a Children’s Nurse like me you may appreciate a more grown up explanation! https://youtu.be/X8eNFa6fpLs

For me though what’s most exciting are the benefits to patients. We heard of children who’d been diagnosed with with diabetes who’d received insulin injections having their lives transformed when their genomic profiles had clarified the medication that would work best for them, some now on oral medication and their lives had been transformed. It was narratives such as this that brought the potential for improving lives to life.

So what’s my role as a nurse, well the session was enlightening, if you get a chance to go to a session please do! I’d also recommend following Genomics 🧬 England. Health Education run wonderful short online sessions which are accessible for us all, and if you’re really keen there’s also an opportunity to do a Masters, there’s more info here https://www.genomicseducation.hee.nhs.uk/ 😉

Can we #AskListenDo? …making reasonable adjustments to how we seek and use feedback to drive improvement

This week I had the privilege of attending the House of Lords (it’s such a grand building) for a really important celebration of the work that’s been happening across the NHS and beyond, in adopting the principles of #AskListenDo https://www.england.nhs.uk/learning-disabilities/about/ask-listen-do/

So often we don’t receive feedback, hear of concerns or have complaints from people with learning disabilities/Autism or their families, purely because WE don’t make the engagement and feedback process easy. Yet we do have a duty under the equality act to have processes in place to engage, seek out, hear and act on information that service users have.

This short story shares how life can feel for someone with a learning disability and how vital it is we listen and take action on their feedback.

Families who care for, along with people with learning disabilities, have led the #Asklistendo work.

You’d think that surely we would already ask people what matters to them, intuitively pick up on concerns, actively listen and then take action, BUT what’s clear from various reports into health, education and social care, is that we sadly fail at this repeatedly.

This powerful poem explains it and provides a call to action …

https://vimeo.com/297133519

The event in the House of Lords brought people with LD/Autism, families, the voluntary sector, education, social care and health together to hear from those who had already adopted the principles and are working to socialise the #AskListenDo approach.

The wonderful Tricia Handley, our LD Nurse Specialist at Barts Health spoke of the work to be truly person centred across the Trust and specifically, to make blood tests less traumatic and daunting. Kindness, patience and the commitment to make ‘reasonable adjustments’ can make all the difference to creating positive experiences of hospital care that can last a lifetime, as well as impacting on people with LD accessing healthcare confidently in the future.

Adopting the spirit of #AskListenDo can be achieved by asking ourselves:

1. Have we got our active listening right? Do we ensure people have the attention and focus needed in busy frenetic environments? How can we make environments calmer? What connections have we got with our local community and voluntary sector to hear about what matters most to people?

2. Are our basic processes for getting things done right? Are we using flagging systems effectively? Do we have easy read complaint leaflets? When we listen, do we follow up on our commitments and deliver on actions?

3. Are we supporting staff/teams delivering care with the education and skills to meet the needs of those with LD/Autism? Do our reception, call centre as well as healthcare staff have the education and insight they need to enhance their practices?

Someone commented how straightforward the #AskListenDo approach is and whilst I agree I also think we need to be committed universally to nurturing a culture that makes giving feedback easy for everyone. And of course we need to be honest about the changes we can make and get on with, or the stuff that’s really ‘wicked’ and may take a bit longer.

So an ask, will you be a champion for #AskListenDo and spread the approach?

Creating cultures that deliver great care, involve everyone, work to continuously improve, recognise and value staff, and grow connectivity…

4/7/19

I’ve been reflecting on cultures this week, thinking about the depth and feel of a team, or system of care. The cultures we create make such a great difference to patients, staff and the ability to progress agendas.

I went searching online for a great short animation by the Foundation of Nursing Studies @FoNScharity, its a few years old now yet it sums up that culture is ‘how things get done around here’ its worth a watch https://youtu.be/cZyN_UZvYnQ

With ever greater complexity in our day to day lives it’s hardly surprising that cultures are complex, get a great one and its magic, an awful one by comparison means stress levels rise, people are anxious coming to work, keep their heads down when they are there and ultimately don’t stay, walking away.

The ‘Culture of Care Barometer Report’ published in 2015 provides a strong evidence base to reflect on cultures in organisations https://www.england.nhs.uk/wp-content/uploads/2015/03/culture-care-barometer.pdf its a helpful tool that we can use to ‘check the climate’ of our teams. The tool addresses 4 key elements that influence cultures:

Having the resources to do a good job and deliver quality care is challenging when finances are stretched nationally, but there is certainly significant support from senior leaders for us all to do a good job. And of course something that the NHS wins outright with is an opportunity to do a worthwhile job that really makes a difference to people’s lives. Having this ‘shared purpose’ to make a difference in society is a key motivator. The NHS also offers the opportunity to always be learning and developing our knowledge and skills, whether via mandatory training, annual updates, continuous professional development, academic study or research.

What’s essential clearly is our personal drive for improvement, creating the time to step back, reflect on our behaviours and actions and the part they play in the culture we function in. West et al. (2014) indicates that culture is co-created through the interactions, communications, influences and collaborations among members of an organisation or systems.

Bob Klaber this week talked about the power of ‘connectivity’ and the impact that this can have in building trust in the system in progressing a more ‘joined up’ approach to delivering healthcare, shifting us from a traditional medical model of healthcare to a more holistic approach that’s much more person centred, focusing on ‘what matters to you’ ie the person being cared for. Bob @BobKlaber and Mando @mandowatson have led Connecting Care for Children in West London, please do follow their work via @CC4CLondon. They are really shifting cultures, taking care closer to home and into GP Practices, they’re not only thinking but doing differently.

This week also saw our school nursing team employed by the local authority, the community nursing team employed by a local community and mental health trust, along with ward based staff from the paediatric ward and NICU unit supporting Ruth May on a visit to a local primary school. This collaborative and connected approach of health teams working together with schools is something we need to keep growing.

Then there was the Partnership Board led by a Local Authority, together with the Lead Councillor for Children, the Young Mayor, we all discussed the Children and Young People’s plan for the years ahead. The local head teachers discussed how we can secure system wide support for this the pupil survey, ensuring young people who aren’t in school have an opportunity to contribute too, we were able to plug the need for few more health related questions to help young people understand the services around them.

There was also the joy of attending the @Cavelltrust conversation with Teresa Chinn on Wednesday, discussing how nurses could support each other more on social media and the positive culture we can create whilst being true to ourselves. We’re all looking forward to supporting this years 10k for Nurses challenge https://www.cavellnursestrust.org/10kfornurses/

Cultures are clearly the result of our behaviours and actions, we can help others to flourish and thrive or we can make things difficult. I know the type of team, organisation, system, I’d rather work in but I have to take responsibility and know that I have a part to play ….

Growing our Future Nurses, what will it mean for us day to day?

I’ve been watching ‘Years and Years’ by Russell T Davies on catch up recently. As Russell was born in Swansea and educated at Olchfa (a school we regularly pass on our trips home to Swansea) I really enjoy his writing as the Welsh connections always sing through! Years and Years follows a Manchester family, led by ‘Gran’ through the political, economic and technological changes that take place over a 15 year period. Without giving too much of the plot away, the final episode sees Edith a feisty activist, affected by a nuclear fall out in episode one, uploading memories to water molecules with two kind and compassionate nurses listening intently and guiding her through it. So is this what nurses will be doing in the future? Perhaps Russell’s imagination is a tad too creative, but it’s an issue people have been debating for many years, what will we need from our future nurses and how can the current healthcare workforce help them grow their skills? A peer review meeting last week posed the question ‘how are you preparing for the future nurse programme’. It was a good challenge!

I went back to a blog published by Jackie Smith, who was the CEO of the NMC in May 2018 https://www.nmc.org.uk/news/news-and-updates/ambitious-new-education-standards-will-shape-the-future-of-nursing-for-next-generation/ The curriculum changes that are now being embedded follow a significant consultation that many of us inputted into.

Importantly many articulated that whilst fields of practice and in-depth knowledge of mental health, learning disabilities, adult and child were essential due to the complexity of need from each population group, all professionals need insight and experience of caring for people across all fields of practice. As a Children’s Nurse I’m delighted to see an increased focus on mental health and learning disabilities in the Children and Young People’s field of Nursing.

For us locally the new standards and associated curriculum will take affect in September 2019. It’s important our local teams are aware of the changes, so that we can proactively welcome, understand the needs and support our students as they embark on their careers and grow their ‘professional stories’ whilst working to achieve the professional proficiencies which are grouped in 7 platforms outlined here.

It’s helpful that all healthcare professionals, AHPs, Drs, Nurses and social workers can supervise nursing students going forward. Practice Supervisors (PSs) as these professionals are called, can document the student’s progress in their Practice Assessment Document (PAD). This is an important step forward in continuing to grow multi disciplinary and collaborative working cultures as the contribution of all professionals in training and educating nurses is valued and recognised.

Practice Assessors (PAs) are registered nurses who have been prepared for the role (this can now be locally delivered removing the need for attendance at a formal Approved Educational Institute/AEI Mentorship programme) PAs will support students, meeting them at the beginning of their placement, completing a mid point review and documenting progress in their ongoing record of achievement (OAR). They’ll work closely with PSs.

Academic Assessors who are University focused will support PAs to ensure that students are progressing through the programme appropriately, recording their progress in their ongoing record of achievement (OAR) too.

Getting our heads around these roles will of course become easier as the curriculum is embedded.

Our students bring so much to our environments, many are ‘digital natives’ which is incredibly helpful as the NHS continues to mature in its use of technology, no doubt our students will teach us how to use technology to its best advantage in healthcare and also offer IT solutions to our challenges too.

One of the areas that may be challenging is related to the clinical skills that are required of future nurses on which are outlined here https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf We face some particular issues in children’s nursing as not all our nurses do venepuncture or cannulation, and catheterising boys is not something commonly done so we’re going to need consider how we address these challenges. I don’t think we’re alone in considering this and would value ideas from other units on this.

A colleague this week also flagged the importance of staff having a positive attitude to nurses embarking on this new curriculum and acquiring a range of clinical skills that some registered nurses may not have. Encouraging and creating learning opportunities is vitally important, which is why I think we need to be discussing these issues openly out in practice with nurses and healthcare professionals involved in direct care provision. I’d like to avoid student nurses having to justify in practice why they need to learn these clinical skills.

The future is full of opportunities to continue to raise the profile of nursing and grow the diversity of skills, knowledge and experience that we offer as a profession to improve lives and health outcomes across society. The Future Nurse curriculum supports us to do this.

Nursing as we know offers so many wonderful career paths. This week saw an exciting broadcast into schools by Trusts in East London supported by the local STP, East London Health and Care Partnership. It was great to see Nurses some of whom had been qualified for many years and Ahunna a student nurse reaching out and encouraging young people to consider joining us in the NHS https://elhcpcareers.co.uk/ all online, no travel required! I love this #NursingLondon film that Capital Nurse have produced https://www.hee.nhs.uk/our-work/capitalnurse And this #NHS recruitment film https://youtu.be/GVBP1ld0_n0
is special, these were shared with the young people. I still value this Children’s Nursing recruitment film from the RCN https://youtu.be/O81ZY9wHhHw too.

So as we continue to grow our future nursing workforce let’s encourage and nurture our students as the new curriculum is embedded across the country, after all we’re their role models… Gran in Years and Years would say it’s up to us https://www.dailymail.co.uk/femail/article-7157675/Viewers-Muriels-powerful-speech-nights-finale-Years-Years.html

Advocacy in Child Health

This week I’ve been reflecting on children’s advocacy challenges. Advocacy seeks to ensure everyone is able to have their say on issues that are important to them, that their rights are met and importantly, that their wishes and views are genuinely considered when decisions are being taken about their lives.

As a Children’s Nurse you’d expect me to say I’m committed to hearing the voices of children and young people in healthcare and in ensuring their rights, outlined in the United Nations Convention Rights of the Children (UNCRC), are met. The UNCRC celebrates its 30th birthday on the 20th Nov this year https://www.niccy.org/about-us/childrens-rights/uncrc-at-30/ and just as an aside I’m wondering how we can celebrate Children’s Rights across the NHS on this day?….

As health care professionals whether in homes, schools, primary care, youth justice settings, ED, on wards, anywhere, day in, day out, we’re constantly using advocacy skills, which include:

1. Really listening to the issue at hand;

2. Finding out more, identifying what matters most in the situation;

3. Identifying rights in the situation, using the UNCRC, including addressing issues such as consent, this summary from CQC on consent is helpful https://www.cqc.org.uk/sites/default/files/20180228_briefguide-capacity_consent_under_18s_v2.pdf

4. Exploring solutions;

5. Encouraging children and young people to express their views, opinions and thoughts about the issues, ultimately reaching a decision CYP have actively participated in.

Children and young people however still tell us we’re still not involving them in decisions about their healthcare as much as they want to be. Of course most babies, children and young people will, although, not always, have parents who will advocate appropriately for and ideally with them (although of course children, young people and their families can and do have differing views). Our role then as healthcare professionals is to use our skills in ensuring CYP are active, empowered participants in decision making processes whilst supporting parents too.

We need to constantly work on our refining and maturing communication skills if we’re to advocate effectively for and with individuals.The ‘CYP Me first’ model helps us as professionals to do this better, to more effectively engage with young people, there are loads of great resources on their website https://www.mefirst.org.uk/ and you can follow them on twitter @CYPMeFirst

So I wonder how can CYP using the NHS benefit from professional advocacy services? What’s their professional advocacy offer to Children and Young People across the NHS? I’ve had many conversations with respected colleagues over the years about advocacy services in health, there still seems to be an unmet need. Please correct me if you’ve got a model that we need to be sharing!

The use of professional advocacy services for those with learning disabilities or mental health needs is perhaps more commonplace than in general paediatric care. Children and Young People just as adults can benefit from neutrality in exploring issues and in making decisions.

Last week saw the publication of a Report supported by the office of the Children’s Commissioner into Advocacy Services for Children and Young People https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/06/CCO-Advocacy-for-children-June-2019.pdf

The Children’s Commissioner report highlights advocacy services in health are commissioned via a range of routes, some from local authorities and some trusts run these services internally, the report challenges the access to these services. These are the core values they’ve highlighted as important for advocacy services to work to:

The statutory advocacy support in health is focused on supporting young people to make complaints. Processes are often adult centric, increasingly though NHS complaints processes are becoming more CYP friendly. Yet there’s more to health advocacy than making complaints.

Children and young people who have special educational needs and disabilities, who are detained under the mental health act are also named as those specifically entitled to professional advocacy services but let’s not forget those with physical health needs too. Here’s the full list of situations when statutory advocacy is identified as being needed:

So as influencers in child health do we need to ask questions about what’s available locally to the CYP we serve? how are these services advertised and what training have staff had to support CYP with health related decision making issues?

Of course we also have a system advocacy role too. As Professionals we must advocate for improvements in Children and Young People’s Care and services. Even though they are 25% of the population we often end up focusing on adult related issues. Having Children and Young People in the NHS Longterm Plan puts an imperative on local systems to ensure CYP Health issues receive the focus they deserve, but we as healthcare professionals need to take our place at the STP tables and champion children and young people.

Wonderfully Children, Young People and families advocating for improvements in Children and Young People’s Care and services is another element we’re seeing more of and it’s having huge impact. It’s even better if professionals and users collaborate in advocating for improvement. Together we can be a powerful force for change. A great example of this is that NHS England supported the establishment of the NHS Youth Forum back in 2014 and they are having great impact on collectively lobbying the NHS to think more about the needs of children and young people in healthcare. This film from the Young Reporters summarises the Youth Voice Summit held back in April where young people met with senior leaders and spoke about what mattered most to them
https://www.youtube.com/watch?v=vuNfKkfctgw The @NNPCF is another example of parents advocating for improved services, particularly for disabled children so that their needs are met proactively rather than reactively, the impact they are having on the SEND agenda is phenomenal, although I know they’d say there’s much more to do!

Advocacy is going to continue be in the spotlight, especially in the UNCRC 30th year, let’s ensure practitioners supporting CYP and families have these skills and let’s champion the need for professional advocacy for all CYP across health, social care and education.

Reflections post blog

this is great short film for children on consent, thanks for sharing Lisa Ramsey! https://www.youtube.com/watch?v=h3nhM9UlJjc

Joining services up, health, education and local authority social care… and lobbying the next PM

12/6/19

Last week I sat with nurses, commissioners, the local authority team and head teachers at one of the Special Schools in our area. I love getting out to these schools, they are are always bright, welcoming and I’m guaranteed to get a dazzling smile from children who will have received acute health care at some stage but are now in their ‘right place’ in school, at home, in the heart of their community. Together we explored how to best support children and young people who have nursing needs in special schools given the challenges of recruitment and retention. From a health we talked about the importance of continuity of carer, limiting the numbers of contacts a child has with professionals by supporting teaching assistants to undertake care related roles when trained and supported to do so. Yet a different perspective was given from education of the desire to see children engaging with a variety people. It was an example of how we come from different cultures, differing perspectives, ‘we want to increase the social interactions our children have’ they shared. This simple conversation demonstrates that whilst health and education have the best of intentions to meet needs with the resources at hand, we offer different insights, reinforcing the need for collaborative dialogue. The RCN https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/forums/children-and-young-people/staying-healthy-forum/school-nurses-toolkit-2017.pdf and guidance from DfE on Supporting pupils at school with medical conditions (DfE 2015) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/803956/supporting-pupils-at-school-with-medical-conditions.pdf offers helpful direction to those providing services, the reality is it takes us all to want partnerships to work if we’re to care for children with complex needs in the very best way.

As we all work towards better integration and collaboration across health, social care and education we have to be prepared to learn more about each other’s worlds, considering different languages and cultures in these services.

I came across a guide by the Local Government Association @LGAcomms for new lead council members for children and young people, it gives a clear overview of council priorities relating to children https://www.local.gov.uk/sites/default/files/documents/15%2067%20Lead%20Member%20for%20Children%27s%20Services%20-%20First%20Ten%20Days_03.pdf Clearly the demands of this role are significant. One addition I’d make is encouraging Lead Members to spend time with local health partners to see the care commissioned by Clinical Commissioning Groups and NHS England. This will help secure a ‘whole picture’ of the support delivered to children and young people. Understanding the health contribution in meeting needs of Children with Special Educational Needs and Disability (SEND), along with identifying good practice and whilst securing knowledge relating to gaps in services is important.

I also managed to get out to one of the local Children’s centres last week to attend a session with nursery, primary school teachers and SENCOs discussing the local authority ‘Early help’ offer to children, young people and families, here’s a summary of what’s offered locally https://www.towerhamlets.gov.uk/lgnl/health__social_care/children_and_family_care/Early_Help/Early_Help_Hub.aspx Understanding the types of help these hubs can signpost to is important for all staff in EDs, Outpatients and on wards including NICUs/SCBU. We spend a lot of time with families, and raising awareness of early help is something we can do more of. One of our Assessment Unit Sisters immediately grasped the opportunity to display information.

One thing we also explored was that early help wasn’t limited to early years, adolescents can be offered early help too, as can parents of adolescents. The Children’s Society have a research briefing on Adolescent neglect that is insightful https://www.childrenssociety.org.uk/what-we-do/research/understanding-adolescent-neglect

As the political landscape is so chaotic a number of Children’s Charities have grasped the opportunity to seek help from the public to ask the new Prime Minister to set out their ambition and commitment to children, will you ask them to too? here’s the link to speak up for children… https://act.childrenssociety.org.uk/page/43598/action/1?locale=en-GB