Health inequalities and the impact of racism on child health, kindness and advocacy

Health inequities is an issue I keep returning to in this blog. Perhaps it’s the complexity and vastness of addressing the economic, political, and social challenges, including racism that impact so heavily on health outcomes that frustrate me on a seemingly daily basis currently at the moment.

The American Academy of Pediatrics @AmerAcadPeds this week published a statement on the impact of racism on child health, I think there’s much we can take note of and challenge ourselves on here in the UK https://pediatrics.aappublications.org/content/144/2/e20191765

The AAP share that racism has a profound impact on the health status of children, adolescents, emerging adults, and their families. Whilst they acknowledge progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships still exists, I’d suggest this certainly isn’t unique to the USA.

Through discussing these issues openly they suggest health professionals can proactively engage in strategies to optimize clinical care, workforce development, professional education, systems engagement, and research in a manner designed to reduce the health effects of structural, personally mediated, and internalized racism and as a result improve the health and well-being of all children, adolescents, emerging adults, and their families. If we fail to address this, health inequalities will remain.

The New York Times also covered this https://www.nytimes.com/2019/08/12/well/family/the-impact-of-racism-on-childrens-health.html and in a interview with a paediatrician they shared that clinical settings need to make everyone feel explicitly welcome, with images of diverse families up on the wall and with the capacity to provide care in different languages. The reception families get at the front desk, who is staffing it, as well as who is seeing patients all play a part. Toys, dolls, books, videos should they encourage all be multicultural.

They go on to state that ‘Our diverse pediatric workforce is critically important to begin untangling the thread of racism sewn through the fabric of society and affecting the health of pediatric populations.’

As Child Health professionals our challenge is to examine and acknowledge our own biases, seek out, embrace and advocate for innovative policies and cross-sector partnerships designed to improve medical, economic, environmental, housing, judicial, and educational equity for optimal child, adolescent, and emerging adult developmental outcomes. It’s an issue I think we can become more activated and engaged with.

As I continue to immerse myself back into being in a provider organisation, seeing the societal challenges faced by children and young people, advocating for and with those in our local communities seems increasingly important.

I met Lillian of @PinPointIncorp, an amazing not for profit organisation based in Walthamstow this week. Lillian shared feedback from a vulnerable young person who completed one of her programmes, on being asked what have you got out of this bike mechanics course, they wrote ‘kindness’, it was the first time they’d experienced such kindness …. it was the kindness rather than the mechanical skills that had had the greatest impact on that young person.

And I’ve just finished listening to the David Nott’s ‘War Doctor’ whose advocacy is inspiring, I’d really recommend listening on @audibleuk and do follow the difference the @NottFoundation is making.

So my reflections this week include acknowledging and tackling racism, the power of kindness and the impact of advocacy….

…. I’ve much to ponder on….

Stop apologising, start thanking… #ForcesforChange

There was a tweet from @kennygibsonnhs that captured my imagination this week it included a visual (NB Tweets with images have far more impact 😉) ... it suggested we should stop apologising and start thanking. It was something that resonated with me, here are some ideas for us to try.

Next time I’m late for a meeting, due to train hassles or trying to fit too much into a day, I’m going to thank those on the receiving end for being so patient!

I wonder if the women profiled in Vogue this month have this issue?

Vogue isn’t my usual magazine of choice but this issue is rather special as it profiles 15 women making a difference in world and it’s been guest edited by Megan, HRH Duchess of Sussex here’s an overview https://twitter.com/jinajaycasting/status/1159856011957723136?s=21 and a summary of those profiled https://www.vogue.co.uk/article/meghan-markle-guest-editor-september-issue-british-vogue-2019

If you haven’t got a copy yet… DO… its AWESOME the photography is beautiful and totally inclusive, HRH The Duchess of Sussex writes in her guest editorial ‘and amongst all of these strong women on the cover, a mirror – a space for you, the reader, to see yourself. Because you too are part of this collective’. Jane @NHS_Jane the awesome woman who co-ordinated the ASCEND Women’s Leadership programme for @NHSLLA with @drgemmamunro and creator of @quiet_the_hive showed us how it’s done…

Hunt down a copy, at £3.99 it’s a bargain, although you may end up feeling like you’ve found a ‘golden ticket 🎫 ‘ as Charlie did in Roald Dahl’s ‘Charlie and the Chocolate Factory’ as copies in newsagents are understandably elusive.

Megan calls out women from across the world who are making a difference, such as Jacinda Arden…

Brene Brown….

Sinéad Burke, diversity advocate and lecturer highlights that ”We need to constantly be asking what voices are not in the world, which perspectives are not being considered, and make sure that change occurs with as much intersectionality as possible.” I’m in awe of her gracefulness and fab outfit!

Michelle O’bama @MichelleObama writes to Megan … dip in to find out more 😉

And there’s poetry too, the ‘Beach’ asks us all to be ourselves, a reminder it’s ok to ‘just be…’

Perhaps one women I’d add to Megan’s list is Edith Edgar, I’ve just finished listening to ‘The Choice’ on @AudibleUk https://www.nytimes.com/2017/10/06/books/review/the-choice-edith-eva-eger-auschwitz-memoir.html Its a powerful narrative that shares the horrors of the Holocaust. She shares how her experiences in Auschwitz, even though it claimed her parents, didn’t break Edith. Her experiences helped her appreciate and live life with strength and remarkable resilience. Edith shares ‘We have the capacity to hate and the capacity to love. Which one we reach for,” she writes, “is up to us.” As she comments throughout the book, it’s our choice. The New York Times shares ‘Eger’s book is a triumph, and should be read by all who care about both their inner freedom and the future of humanity.’ I think it should be a compulsory read on the GCSE English curriculum.

Melinda Gates also launched #Equalitycantwait this week highlighting it will horrifyingly take 208 years for women to be equal to men in the USA https://twitter.com/melindagates/status/1158712902586519553?s=21 are we further ahead in the UK I wonder?

Whilst all of these women are in the public eye, I’m surrounded by amazing women in work, at home and in my community who are making a difference day in day, who often get on with ‘doing the doing’ often quietly and very effectively. So my reflections this week? Let’s stop apologising and start thanking, let’s take our place in the mirror, challenge inequalities, and embrace the fact that we all have choices.

Bring on #NursesActive

I love the summer months, bright light early mornings seem to nudge me out of the door to get an early plod in. I’m always grateful to my dad for his gift of an ‘early riser’ gene, and I’m a regular member of the #earlyrisersclub. It feels good to bank an early morning plod by 6.30am when I need to get my act together, head out to catch a train and embrace the day. The summer seems to make this so much easier than dark winter mornings!

It was a family holiday to Centre Parks back in 2006 when I knew I needed to take action and become a bit more focused with my exercise routine. Beth my daughter was 3 and I wanted to be fit for her and knew if I was a bit fitter I’d feel better in myself. I was also in a job I loved yet it was consuming physically and emotionally, I knew getting some balance by introducing regular activity would be helpful in many ways for me personally, my family and for work. So I treated myself to a new pair of trainers and some running kit and headed out to a local bit of greenery. It was the couch to 5k that got me going https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/

There have been lulls over the years when I haven’t run as much as I’d like, I’ve lost my running mojo and found it again along the way, but it was 2016 when I decided to start doing organised runs. I set my sights on a half marathon and once that was achieved I looked around for a marathon. It was the Cancer Research UK Race for Life Marathon in September 2016 that confirmed that even I could run a marathon. It was the start of my ongoing commitment to trying (not always successfully) to keep my weight in check, keep my resting heart rate at less than 65 (less than 60 would be amazing) and creating a bit of space or ‘headroom’ for my thoughts to wander.

Regular Saturday morning ParkRuns at beautiful Panshanger and friendly Ellenbrook fields are part of my weekend routine. Yet it was my local running club that if I’m honest has made a huge difference to my sustained commitment to exercise. They say that you become most like the people you spend time with and I think this picture sums up the joy of a Saturday morning, normal people with busy full on lives trying to keep active and have fun too (even in the rain). I am forever grateful I was brave enough to join my local club, Garden City Runners.

The club has meant I’ve met people who like me embrace the joy of distance running and over the last 2 years I’ve given ultra running (that’s any distance over 26.2miles) a try. My ultra running buddy Elaine would say we’ve chatted, got lost, eaten lots and had plenty of adventures along the way too. Ultra Running has also provided some cracking multi day challenges along the Cotswold way and Jurassic Coast too https://kathevans.com/2019/03/24/ultra-running-nhs1000miles/.

The challenge of #NHS1000miles http://www.wecommunities.org/blogs/3443 and the #WeActiveChallenge http://www.wecommunities.org/blogs/3483 have provided an online community, again with others who are juggling being active in busy lives. People like Cat Wilson, Marc Harder and Jackie Smith are the best encouragers, true motivators in Chief 😉

We’re all aware of benefits of physical activity @LauraKoehli brilliant blog summarises them here http://www.wecommunities.org/blogs/3491

yet there’s something about ‘taking action’ on this information that we need to take a personal decision to do…

For me being part of a likeminded community both physical and virtual is helpful in refreshing, refocusing habits. The #WeActivechallenge offers us this August a chance to have fun, try something new and create a bit more ‘headspace’ to achieve some balance in our lives.

We’ll no doubt have a real giggle on twitter again in August with the #AHPsActive and it looks like #DoctorsActive may be ‘in it to win it’ this year, but seriously it’s our year isn’t it Nurses?! #NursesActive

#BetheNurse

This week I had the pleasure of speaking to nurses about to qualify from City University @CityUniHealth. It was a day of excitement as they prepared to qualify and enter the profession of nursing. Their anticipation of the journey ahead was palpable, smiling faces and hugs abounded, along with plenty of ‘we made it’ comments.

It was a privilege to share their joy and I reflected on the tools I depend on day in and day out 31 years into my nursing career. Those that are most useful I’ve picked up along the way, these are the top ones in my toolkit:

#Hellomynameis is how we should start all our interactions https://www.hellomynameis.org.uk/

#WhatMatterstoyou rather than ‘what’s the matter with you’ is what we need to be asking https://www.whatmatterstoyou.scot/

#Communication is the top skill that we need to get right and requires ongoing focus, this key report from @mariecurieuk sums up its importance so well https://www.mariecurie.org.uk/media/press-releases/poor-communication-in-the-nhs-wastes-public-funds-and-damages-patient-care/103176

#NMCCode underpins all we do https://www.nmc.org.uk/standards/code/

#NHSConstitution eloquently shares the values and beliefs of the NHS https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england

#AskListenDo isn’t just about seeking out insight from people with Learning Disabilities it should be our approach for everyone https://www.england.nhs.uk/learning-disabilities/about/ask-listen-do/

Just as we care for others we need to be #HereforNurses too and the @CavellTrust helps us do this https://www.cavellnursestrust.org/

#LeadershipSkills are always developing! Have a look online at the @NHSLeadership for courses and resources https://www.leadershipacademy.nhs.uk/

I asked twitter for help in bringing key messages together and as always they delivered, here’s the resulting poem ….

Be the Nurse… 

Be the Nurse who is connected to patients, who says #Hellomynameis and asks #Whatmatterstoyou with a smile and an engaging manner.

Who takes time to find out what makes the person in front of you the person they really are by listening 

Who’s kind and offers thoughtful care, someone you’d chose to care for you, your child, your family or someone you love.

And who, however bad things are, radiates calmness, inspires confidence in patients, families and carers. 

Be the Nurse who practices safely, 

Is brave, bold, curious, asks questions, speaks up, is inquisitive and challenges the status quo,

Who’s in touch with and uses up to date evidence to always improve care, 

Who never stops learning and seeks to play a part in expanding knowledge too.

Who challenges poor practice and does the right thing, even when everyone else seems to be doing it wrong.

Be the Nurse who considers health inequalities and plays a part in calling them out and seeks solutions, 

Who works with patients, families and carers as partners,

Who is an ally and shares stories waiting to be told.  

Be the Nurse who’s connected to the community and looks beyond the workplace. 

Who knows the NMC Code and the NHS Constitution and lives by them too,

Who joins twitter and is a role model in using it.

Remember you’re now part of society’s most Trusted Profession; be proud of the difference we make.

 Be the Nurse who gives a little bit of themselves and reflects your true self,  

Who has fun, perhaps has stickers and a finger puppet in a pocket as magical tools!

Be the Nurse who looks out for colleagues, not just other nurses, but the cleaners, housekeepers, the reception team, the doctors, HCAs, associates, AHPs and the managers too, 

Who encourages and celebrates the achievements of others, 

Offers thanks freely and meaningfully, and sprinkles kindness and joy along the way too.   

Be the Nurse who takes care of  yourself, know your strengths as well as your limitations. 

Nursing is only a part of what defines you, 

Nursing will nourish part of you, yet don’t forget to feed the other passions that make you who you are. 

Remember you’ll experience many emotions in your career, there’ll be highs and lows over your lifetime as a nurse, take the time to breathe, centre yourself, hold your nerve and seek support from others… you are never alone, 

Be the Nurse who loves the job you do, who wears an invisible Nightingale, Seacole and Cavell cloak and remembers the warriors of nursing past and present on whose shoulders we stand, 

Who’s SASSY who ‘Smiles, is Academic, Supportive, and Speaks up’ and inspires others to join the profession too.

I’ll #beTHENurse who…

feel free to take a selfie 🤳 and post on twitter with the hashtag ….

with thanks to @jomwlever @C_Carmichael83 @BeckyPlatt3 @ppi_jane @SueAn1904 @BecksBDaniels @AliceOliviaG1 @SheVC @reboverend_RNc @LisaSaysThis @DrKateOulton @JessLSainsbury @AgencyNurse @RunMoreEatMore @KayeNicoll @janette_v @organiclemon et al!

 

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?