Doughnuts and the courage to continue…

When did you last have a doughnut?

It’s been a wonderful ‘homework’ task set by ‘Partners in Paediatrics’ to reflect on resilience, and for me it’s been about everyone having the courage to continue in the most challenging of times. Let me tell you more ….

Doughnuts were a bit of a theme here in North East London throughout wave one of the pandemic as we learnt to adapt to the challenges that were presented to us. The sugar boost I’m sure helped to draw on hidden reserves of strength, both physically and mentally seeing us through, although I’m not sure Public Health England would approve!

At the centre of every good doughnut is the jammy bit in the middle, for me it’s what a good doughnut is all about, a bit like the babies, children, young people and families who were and remain our central focus, the jammy bit!

Our absolute priority as champions for child health is to shine the light on issues that matter most to them, keep them safe and wherever appropriate and possible, out, of a hospital environment. Whilst thankfully children were not the face of the pandemic, mostly being spared the direct effects medically of Covid19, they are and will be the biggest victims of this evolving crisis. The crisis is having and continues to have a profound effect on their wellbeing.

Central to addressing child health is the presence of a resourced and cared for workforce, retaining staff, yet also releasing staff to support adult areas, was challenging, the redeployment of staff at the height of the crisis meant the development of additional skills and training. It was our senior ward managers who led the way, taking them out of their sphere of clinical confidence. But what we didn’t predict was the isolation and loneliness felt by many redeployed staff at this time. It was a Clinical Nurse Specialist who led the way in identifying this, she created a peer support group, circulating names and numbers on a Sunday evening for a checkin with staff at the beginning of each week, offering a listening ear, signposting to additional support and practically demonstrating that redeployed staff hadn’t been forgotten. The CNS who led this work was nominated for a ‘Cavell Star’ award, from the Cavell Nurses Trust (@CavellTrust) by a colleague to recognise her contribution. Encouraging individuals to lead the way and celebrating initiative taking, role models to everyone that we all have a part to play in shaping cultures and can take action. Helpfully the peer support programme has now led to further conversations about how the model of clinical supervision works for staff across the organisation, wonderfully its being led by practitioners directly delivering care, rather than it being imposed.

Celebrating contributions, Cavell Star

Bringing the over 50 members of staff from Children’s services who’d been redeployed together in July for a day of reflection (and you’ve guessed it doughnuts) helped to connect people to each other’s experiences and know that they were not alone in how they were feeling. There were other interventions that supported the resilience of the teams, which offered the courage to continue, regular daily briefings, a 10k fun run (on one of the hottest evenings of the year) organised by another one of our clinical nurse specialists, and recently as we’re heading into winter, a Trust wide ‘Winter Wellness’ week where we banked our steps to achieve #BHWalktheWorld. Oh and there was an online virtual biscuit baking session with a follow up soda bread making session too. All of these interventions and many more, reach out and connect people, bringing the NHS People Plan to life, in meaningful ways, building stronger resilient communities, growing a sense of belonging and strengthening our resilience for what’s ahead.

Throughout the pandemic we have worked collaboratively as a system across North East London, our Sustainability and Transformation Partnership (STP), the emerging Integrated Care System (ICS) which includes Community, Mental Health, Primary, Secondary, Tertiary Care, Local Authority and Voluntary Sector colleagues, has brought us all together to collaborate on Child Health issues.

In the height of the pandemic we were concerned about delayed presentations to A&E so information resources were created by local GPs and Paediatricians to reassure families that we were open for them https://www.eastlondonhcp.nhs.uk/ourplans/children-and-young-people.htm

Yet now we’re facing challenges with managing social distancing and the prevention of nosocomial infection. So there’s been a need to reconsider how we build resilience within families. Many years ago I worked on a programme to reduce emergency department attendance (https://www.rcem.ac.uk/RCEM/Quality_Policy/Clinical_Standards_Guidance/External_Guidance/Paediatric_EM_Guidance__NHS_Institute_/RCEM/Quality-Policy/Clinical_Standards_Guidance/Paediatric_EM_guidance__NHS_Institute_.aspx?hkey=d37183bc-4ad0-4649-b6cf-3c659f79ebe4) so we’ve recently been revisiting this, data analysts confirmed the top reasons for A&E attendance in North East London as being for

1. Accident/Injuires

2. Fever

3. Abdominal pain/diarrhoea & vomiting

4. Respiratory issues

5. and Rashes/skin presentations

It made us ask, have we got accessible parent information on accident prevention and management of these childhood illnesses? NHS Choices have them, but we took action to make sure we were promoting them locally in a range of ways. We’re also promoting culturally focused short animations developed by one of our CCGs (https://www.towerhamletstogether.com/care-confident) to supplement written information.

Another opportunity presented to us has been to explore growing resilience with young people through youth social prescribing, building on our youth volunteering and NHS Cadets programme, specifically focusing on our connections with young people who are in need of additional support.

In one of our boroughs a GP is running clinic sessions based in a youth centre alongside youth workers, mental and sexual health professionals and violence reduction programmes, its having great impact and is currently being evaluated by the Association of Young People’s Health (@AYPHCharity).

In another borough over 400 Royal Society of Public Health (RSPH) Youth champions https://www.rsph.org.uk/our-work/programmes-hub/young-health-champions-test.html have been developed by one the Public Health teams, they are now peer health influencers.

Most recently we’ve looked at how we support young people who are care experienced into employment in the NHS bringing to life the model of ‘anchor institutions’ (https://www.health.org.uk/news-and-comment/charts-and-infographics/the-nhs-as-an-anchor-institution) and exploring what the ‘care leavers covenant’ https://mycovenant.org.uk/about/ means for us in the NHS.

A key ingredient in all of these STP meetings has been the children, young people and families. Young people with mental health needs, reminded us of the importance of professionals building trusting relationships with them and the impact continuity of care has on them. A mum whose son has asthma challenged us on our lack of accessible information and how complex navigation of the system is for the population who may not be as familiar with health services. A sister of a 16 year old who had died in Haven House, one of our local Children’s Hospices, shared her sisters bucket list and how they’d laughed as they’d spent time in the hospice garden together plotting their next adventure. These were the highlights of the system wide meetings, giving us all a little bit of headspace and energy to build resilience and to keep working collaboratively on what matters most by hearing directly from users of services.

Helpful national reports have emerged during this time that strengthen our voices, offering affirmation on key issues as we advocate for and with children and families.

Children’s views on well-being and what makes a happy life was published in October by ONS offering important evidence based insights into the things that children say matter for a happy life, vitally including that feeling that their views are being listened to by decision makers matters https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/childrensviewsonwellbeingandwhatmakesahappylifeuk2020/2020-10-02

Best Beginnings and Partners published ‘Babies born in lockdown’ in August (https://babiesinlockdown.files.wordpress.com/2020/08/babies-in-lockdown-main-report-final-version-1.pdf) Alison Baum, Best beginnings CEO asks us to shift from a patchy, fragmented family support landscape, to a nurturing society that supports the caregiving capacity of parents during their transition to parenthood. They ask for support to wrap around the needs of families and communities, rightly saying this will happen if parents are enabled to take a lead in designing better systems, working alongside charities, community groups, and statutory services.

Childhood in the time of Covid19 was published by the office of the children’s commissioner, (https://www.childrenscommissioner.gov.uk/wp-content/uploads/2020/09/cco-childhood-in-the-time-of-covid.pdf.) The reports highlights that before the pandemic 2.2 million children in England were living in households affected by any of the so-called ‘toxic trio’ of family issues:

domestic abuse,

parental drug and/or alcohol dependency,

and severe parental mental health issues,

During the pandemic these numbers will have swelled, fuelled by families locked down in close quarters for weeks and months, and an emerging economic crisis adding pressures on family finances.

The report asks for the full range of services which protect children to be prioritised, including children’s centres and visits from social workers, Viv Bennet and Ruth May’s letter (https://www.local.gov.uk/joint-letter-winter-planning-support-children-and-families-7-october-2020) to the system last week, specifically asked that Health Visitors and School Nurses were not redeployed in the second wave.

Experiences of Parent Carers in Lockdown from the Disabled Children’s Partnership (https://disabledchildrenspartnership.org.uk/wp-content/uploads/2020/06/LeftInLockdown-Parent-carers%E2%80%99-experiences-of-lockdown-June-2020.pdf) highlights the experiences of 400 families in lockdown, parents talk about extreme exhaustion, stress and sleepless nights, which have pushed some families to the limits. They share their overwhelming feeling of ‘being abandoned by society’, to deal with often complex care and medical procedures on their own. Parent carers also talk about siblings, non-disabled children having to take up the slack. A lot of concern about increased behaviour challenges and meltdown, children going backwards or falling behind is also highlighted.

Starlight the Children’s Play Charity, published their review on ‘the impact of play in hospital’ https://www.starlight.org.uk/wp-content/uploads/2020/10/Starlight_ImpactOfPlay_Report_Oct20.pdf and as well as offering a contemporary perspective on the evidence relating to the importance of play highlighted the impact the pandemic is having on increased isolation, lack of access to play facilities and resources, and further pressure on families.

Clearly there’s lots more to do on our journey, so we do indeed need the courage to continue, all segments of our doughnut play a part, so together let’s ….

1. As Children’s Champions, keep speaking up for and with Children, Young People and their families.

2. Keep a focus on staff wellbeing and our workforce in the most complex of circumstances.

3. Use this opportunity to continue to progress integration across all our services, particularly supporting parents with access to health information to support them make informed, empowered choices.

4. Grow Youth Social Prescribing opportunities and youth volunteering, keeping a focus on our most vulnerable young people, such as those who are care experienced.

5. Use evidence collated in national reports to make sure in our local systems #ChildHealth has a place in the spotlight.

It feels like now more than ever, across the community of child health we all need the courage to continue in our collective ambition to ensure every child’s right to healthcare to support them in achieving the very best life outcomes, it requires us to be collectively resilient, it’s a challenge that’s never been more important.

Participation holds magical, transformative qualities, #hellomynameis Kath and I’m a Children’s Champion..

This blog is based on a presentation at a ‘Don’t forget the bubbles’ @DFTBubbles online conference on 26/8/20.

I want to focus on you, just for a moment I’d like to get you to reflect. Who (outside your immediate family) believed in you as you grew, who encouraged you to speak up and be heard? What did they do? How did they do it? How did they make you feel?

There’s a wonderful Ted Talk (https://www.ted.com/talks/rita_pierson_every_kid_needs_a_champion) by an educator of over 40 years, Rita Pierson, it’s well worth a listen! Her message? ‘Every child deserves a champion’. She reminds us that every child needs an adult who will never give up on them, who understands the power of connections and insists that they become the best that they can possibly be’.

Significant learning comes from significant relationships, but let’s be in no doubt this is mutually beneficial to the child and the adult.

May I take you back in history? Let’s go back to 1919, Eglantyne Jebb, was a teacher and social reformer. She had a vision to achieve and protect the rights of the children, they were extended in 1954, and in 1989 the UN Convention on the Rights of the Child, a landmark human treaty was ratified. Article 12 highlights their right to express views, feelings and wishes in all matters affecting them and for them to be taken seriously, article 13 highlights the importance of accessible information.

Eglantyne formed the ‘Save the Children fund’, from the outset they listened and responded to Children’s stories of famine in Europe, and over the years extended their work to Asia and Africa. Over 100 years later stories about children’s rights are at the heart of Save the Children’s @savechildrenuk work, and why they continue to have such impact globally https://www.youtube.com/watch?v=U0RnucW3Wn0

We all have a story within us waiting to be told. The Health Foundation’s overview (https://www.health.org.uk/newsletter-feature/power-of-storytelling) on the importance of narrative in healthcare reminds us that an authentic story connects, it unleashes curiosity, taps into emotions and imagination, it uncovers the art of the possible. Stories help us understand and make sense of the world. The telling of a story can become etched in our memory, motivating us to keep improving, it can change mindsets, bringing into focus to what matters most. When someone tells us their own personal story we catch a glimpse of a world that may be radically different to our own. The experience can inspire empathy, neuroscience suggest through connecting via stories we begin to mirror one another, connecting physically as well as emotionally. We relate to an individual’s story, 1st person narratives focus on the individual, rather than on groups such as ‘Young People’, ‘patients’, ‘refugees’ or ‘the homeless’. When we connect on such a personal level the result can be transformative not only for the person telling but for the receiver of the gift of the story too.

So next let’s head to the boardroom, where either around the physical or virtual table will sit professionals with many years of experience and qualifications, yet none of them likely to be under 25. If we’re lucky in that very corporate environment, when the focus is on the 0-25 population, someone may speak up and ask, ‘so what do children, young people and families want?’. A colleague once said ‘well the engagement work has been done, we can use that and push on’. Yet it made me reflect that if we only use the engagement work of others (as important as that is) we haven’t got the magic of participation.

The personal growth and development participation brings to children and young people must not be underestimated, especially to those with complex medical conditions, young people facing economic hardship, those from Black, Asian and Minority Ethnic backgrounds or our children who are looked after for whom we are corporate parents. These young people are those most in need of enriching opportunities to support their growth in confidence, to find their voice and experience the impact of being heard. We must not miss golden opportunities to encourage children and young people, to open doors for and with them, connecting them with peers and youth workers, as well as mentoring, it’s vital social medicine.

Even as health professionals working with children and young people we still view participation through a corporate lens of providing insight, knowing if we seek information on accessing services and then listen and take action it will lead to improved experience and outcomes for current and future service users, yet we know and must continue to share that the benefits of participation are so much broader.

Children and young people who are actively supported to participate in health care acquire knowledge, develop new skills, increase their self esteem and achieve a growing sense of citizenship. It connects them to potential role models and to a glittering array of future employment opportunities. As a result they go on to convey vital health information to the peer groups, their families and communities.

The boardroom must not be a just a passive recipient of engagement work, they must open up to diverse person centred narratives, to expand thinking beyond command and control structures. Boardrooms must open up to stories from children and young people themselves, offering personal development opportunities. When young people speak directly their narratives sit on our shoulders, focusing us on what matters most, issues at the heart of the matter are articulated.

I want to take you to a conference hall in Birmingham, 2,000 professionals watched the narrative of a young lady’s experience of health care, ‘Behind the curtain’ https://youtu.be/vnUmpFP9XsU

The young lady whose experience is shared in the film was sat in amongst the professionals (they didn’t know she was there) and experienced the silence, you could hear a pin drop in the huge auditorium. We debriefed together afterwards, she reflected ‘that’s what I wanted, I wanted others to see and connect with how I’d been made to feel.’ That sense of connection and impact was more powerful that any formal complaint process. The young lady went on to do her nurse training as her confidence in the system was secured, she’s now qualified and works for our armed forces, the power of transformational listening…

Then there’s Gulwali Passarly (@GulwaliP) at 12, his dad, a Doctor in Afghanistan was killed by US forces, the Taliban wanted him and his brother to avenge their father’s death, yet his mother, scared for their futures paid people traffickers to take them to the UK, saying ‘be safe and never return’. Gulwali was separated from his brother the day after they left, and then for over a year endured hardship and incredibly tough circumstances as he travelled to the UK, spending a month in the Calais jungle, being interrogated by UK boarder forces who thought he was too smart to be someone so young, eventually making into foster care, excelling at GCSEs, Alevels & completed his degree at Manchester University. Gulwali a member of our NHS Youth forum taught so many of about the plight of refugees, his Ted Talk (https://gulwalipassarlay.wordpress.com/2014/06/22/tedxmanchester-talk-about-my-journey/) and book ‘The Lightless Sky’ are worth seeking out. Now his charity ‘my bright kite’ helps other young refugees, through his work he has grown to be the most amazing advocate for refugees, fuelled by being heard. He reflects that the toughest of times he faced was when he wasn’t believed.

So as we work to chip away at corporate structures, the powerhouses that rely on data and indicators, let’s not forget the powerful contribution of participation in social medicine. As leaders in child health we can open doors and support young people to ensure diverse, rich narratives are heard, leading to better outcomes on so many levels.

So let’s bring this all together, as we go forward let’s…

1. Think about what’s made a different to you, use that to shape your actions with others.

2. Use our history to inspire us so we keep standing on the shoulders of giants as we continue to make progress.

3. Unleash the power of narrative directly from young people, it benefits services and young people themselves, helping us address inequalities head on.

4. Never underestimate the power of a story to make transformational change and create powerful ripples in the system, stories keep whispering in our ears and hold us all to account.

5. And my final thought, let’s remember that things do not just happen, they are made to happen, it’s up to us to work in partnership with children and young people, using the teams around us the voluntary sector, youth workers, to ensure together we transform child health outcomes.

PS can I give a huge shout out in recognition to Margo Horsley someone who really believes in #VoiceasValue this is a great blog https://www.margohorsley.co.uk/post/voice-as-value-the-people-are-rising-it-s-time-to-listen

And if you want some practical resources, dip in to the work of the @NHSYouthForum https://www.england.nhs.uk/participation/get-involved/how/forums/nhs-youth-forum/

#YellowSelfie for #IDN2020

The brilliant @wemidwives team last week got us to post a #yellowselfie to celebrate International Day of the Midwife http://www.wecommunities.org/blogs/3562. Well I wonder if we can carry this on as we celebrate International Day of the Nurse? #IDN2020

As a children’s nurse and someone who is a passionate believer in growing and nurturing the future generation of babies, children and young people, along with growing our student nurses too, I do hope you’ll join me in continuing to bring a splash of yellow cheerfulness to twitter as we celebrate the contribution of nurses. Let’s use #YellowSelfie and perhaps add what type of nurse you’re proud to be ie #Proud2baCYPNurse 😉

Nurses are brilliant, intelligent, curious and compassionate professionals who also have an ability to bring cheer to situations too. I was on a lovely #EarlyRisersClub zoom call this weekend with Claire ‪@C_Carmichael83‬ and she had sunflowers 🌻 on her background! Oh they made me smile! It reminded me of beautiful GOWER Sunflowers from last August, I’m so hoping they’ll be there this year thanks to the National Trust ‪@NTWales‬.

Sunflowers on Rhossili at the GOWER 2019

As I look at the picture I took, I can see the variation, some are flourishing, some look a tad weary, some are standing firm in the breeze, I think it’s a poignant reminder of how the nursing community are feeling at the moment. Many have been and are going through some very very tough challenging times. Some have found opportunities to take on new leadership roles and teach others, whilst others are acquiring skills they’d never dreamt of doing. Every nurse everywhere in whatever role has been touched by this pandemic…

So as we celebrate International Nurses Day and say a sincere thank you to nursing colleagues and celebrate their contribution to society on so many levels, let’s add a splash of cheer too.

That #YellowSelfie calls 😉 will you join me?

Day 1 #IND2020
Day 2 #IND2020
Day 3 #IND2020
Day 4 #IND2020 – Mary Seacole
Day 5 #IND2020

Pausing and reflecting

On Facebook this week someone shared that whilst we may feel we’re all in this Covid19 Pandemic storm together we’re certainly not in the same boat. Purely by chance I saw a post capturing an interview with Professor Cynthia Enloe (a feminist writer, best known for work on gender and for her contributions to the field of feminist international relations) she reflected ‘We aren’t all in this together. We’re in the same rough seas, but we’re in very different boats ..some of those boats are very leaky, some of those boats were never given oars, some of those boats have high-powered motors on them’ it’s worth a listen https://www.youtube.com/watch?v=Gaif6mTwFw8

Wonderful ‪@GretaThunberg‬ raises awareness of the wider social impact Cobid19 is having on children internationally, she is supporting @UNICEF’s wonderful work https://twitter.com/unicef/status/1255879798380953600?s=21

Closer to home the @NHSYouthForum celebrated young people’s contribution in the pandemic, this blog is well worth dipping into https://www.iwill.org.uk/young-people-matter I loved their key messages …

‪We’ve also been challenged by the awful loss of life of health professionals which @nursingnotesuk are diligently and compassionately documenting publicly https://nursingnotes.co.uk/covid-19-memorial/ and by concerns about the impact on BAME colleagues, @westm61 blogs for @thekingsfund asking us what we can do as individuals to address this, the blog is well worth a read too https://www.kingsfund.org.uk/blog/2020/04/ethnic-minority-deaths-covid-19

The always encouraging @charliemackesy‬ captured the need for us to hold on, that dawn is coming ….

…what we can’t do is lose sight of those who are most vulnerable in this storm, we must keep sharing concerns, providing life rafts in multiple shapes and sizes so that we all weather this storm in the best way we possibly can …

‘41% of young offenders have experienced family bereavement’ how we support children who are bereaved during this pandemic matters ….

When we realise that 41% of young offenders have experienced a family bereavement in the childhood (Winstons Wish @winstonswish‬ the charity established to support bereaved children) it makes us realise how important it is that we support children who face bereavement, as it really will transform life outcomes. Whilst children may not be the face of this pandemic they risk being among its biggest victims. They have thankfully been largely spared from the direct health effects of COVID-19 – at least to date – yet the crisis is having a profound effect on their wellbeing (Policy Brief, The impact of Covid19 on Children, UN 2020 https://www.un.org/sites/un2.un.org/files/policy_brief_on_covid_impact_on_children_16_april_2020.pdf). The impact of bereavement in childhood is an element we must pay attention to, particularly as the physical face to face support of schools is missing currently.

As adults how we break life changing news to children matters, there’s some valuable information on @RCPCH Covid19 pages on how to do this from the University of Oxford https://www.rcpch.ac.uk/sites/default/files/2020-04/how_to_tell_children_that_someone_has_died_final.pdf that we can signpost people to, its a hugely daunting task that people value support with.

Ongoing conversations and sharing positive memories matter tremendously. I recall us all as a family sitting and crying together as we read ‘Badgers Parting Gifts’ when my husband’s mum died, it was a moment of unity in great sadness. The added complexity of social isolation makes loss even harder than ever and this beautiful animation summarises this powerfully ‘Saying goodbye’ https://vimeo.com/407701292 by ‪@WillisBelfast‬ and the Child Bereavement Network provide a range of resources http://www.childhoodbereavementnetwork.org.uk/

@NHSEngland also bring together contacts that are helpful, including:

How we signpost families to support during this intense period of loss will change children’s lives, we can’t change what has happened, but how we care, talk and act will be remembered forever ….

Putting the spotlight on Patient Experience in #Covid19

I have a passion for improving patient experience, I loved my previous job at NHS England where I got to focus on working with children, young people and their families along with maternity service users, to improve their experiences of care.

Our world has changed hugely in the last 102 days and things are being established, PPE is being delivered, ITU capacity extended, staff are being trained and redeployed, staff wellbeing is being focused on, so my mind has shifted to patient experience, what’s happening to address this?

It was last Saturday morning at about 7am, I was sitting in my living room with the sun streaming through the window and mug of freshly brewed steaming coffee at hand, skimming through twitter, scanning for snippets me of information that may catch my eye. My phone rang ‘Kath, it’s my mum she had chemo on Thursday and now she’s spiked a temperature, dad says she’s having a funny turn’ well as you can imagine after a brief conversation, my friend got in her car, and ensured her mum was safely transported to hospital for antibiotics and admission. That’s where things got a bit challenging.

My friend’s mum had turned up with a mobile and charger, but was feeling pretty rubbish. Staff understandably, focused on caring for patients and contact with relatives was limited to once a day, my friend uncertain about what was happening was awake for 38 hours, she was totally beside herself with worry. Her mum was and is receiving great care, but it got me thinking what can we do about situations like this? Can we do better?

One of the 1st things we did, which was really simple, was remind people to bring in mobile phones/devices and chargers with key numbers with them when they are admitted – we got this on our Trust website. Some Trusts have developed teams of family liaison people to help maintain contact, ‪@MichaelaTait8‬ is tweeting about the great work at Milton Keynes, do give her a follow!

The team at Chelsea and Westminster shared a great poster on communicating with relatives, an amazing resource for staff working in unfamiliar environments.

Talking to relatives
Thanks to the team at Chelsea and Westminster

A conversation got started on twitter this week too about what we’d say to relatives to reassure them at this time – the responses were fabulous, here are some…

And of course sadly there will be difficult conversations ahead, this really helpful guidance from the University of Oxford shared by RCPCH is well worth reading and sharing when talking to children about the death of a loved one.

Over the weeks ahead many more examples will emerge, do follow the Heads of Patient Experience network, who tweet using the hashtag #HOPENetwork ‪@lgoodbu‬ is a great follow for inspiration, as is ‪@clairem7523‬.

So as we work vitally to get all the technical stuff right in the weeks and months ahead, let’s keep sharing the work that people are doing to improve experiences, these memories will stay with people forever.

Happy Easter all x

Who inspires you?

When the year of the nurse blogging challenge started in 2020 we had no idea of what was ahead of us. Goodness how the world has changed. In January if I’m honest I’d never heard of Wuhan and ‘Coronavirus’ was just the small print on the back of a Dettol spray that I’d never taken more than a passing glance at, this summary from the BBC is a helpful overview of recent weeks

Now with everything focused on COVID 19, caring for those who need it most and vitally keeping staff safe who are providing that care, EVERYTHING has been reprioritised, not only personally but globally.

So the challenge at the beginning of the year was to identify who inspired us, well in recent weeks I’ve been blown away by staff who’ve asked ‘what can I do’ ‘how do I learn the skills that are going to be needed’, along with comments including ‘we can do this’. Team NHS with other essential services, those who make sure we have water, electricity, gas supplies, along with food and the provision of other household essentials (loo rolls!), people who continue to ‘do the doing’ that’s required whilst recognising that for the vast majority of people, the action #Stayathome to reduce the spread of the virus 🦠 is mission critical.

Those of us in Children’s Health care, thankfully have not been overwhelmed in the same way as our adult colleagues. Yet there have been significant issues that have evolved during this pandemic including delayed presentations to hospital of sick children, Tessa, Giles and local GPs of East London compiled helpful information for families to help guide them in decision making.

Challenges have also included training staff to care for older patients, working with reduced staffing ratios, moving to virtual clinics across primary, secondary and tertiary care, pausing elective surgery, whilst making sure that the vital stuff in child health continues, immunisations, safeguarding, emergency care and excellent care for those that need inpatient care such as our neonates and those with complex medical conditions.

Many of the things we’re learning as we progress on this ultra marathon journey will stay with us forever, we’ll change how we do things, make processes slicker, more efficient and effective, but it has been and will continue to be at a phenomenal cost to individuals, families, communities and society.

In amongst all of this are the memories we create for and with children, what will they tell their children and their grandchildren about this time? Certainly the rainbows on windows have inspired me each morning from children offering hope through looking to the future and encouraging that ‘we’ll get through this’.

The poster resources @MonkeyWellbeing has created have ensured we’re providing child friendly information in challenging times, they can be downloaded here https://www.monkeywellbeing.com/resources/posters-leaflets/, wonderful @beciward has a range of colouring challenges too http://beciward.com/category/news/ and @DrKathrynHolden of Sheffield Children’s has developed a great children’s wellbeing resource https://www.sheffieldchildrens.nhs.uk/download/766/coronavirus-resources/9747/self-care-kit-covid-19.pdf

So to return to who inspires me, whilst there are amazing leaders who are doing a brilliant job in the most challenging of times. It’s our health care support workers, our students and junior staff nurses, our newly appointed ward leaders who inspire me most. They’ve been the ones who’ve completed the online learning, done shadowing shifts in unfamiliar environments with new colleagues, who’ve wobbled openly and then got on and done the doing….

Thank you all….

Wonky days …. and joy at work

I was listening to Zoe Ball’s cheery voice on BBC Radio 2’s breakfast show this week when she asked what sort of day we’re having, she encouraged that if we’re having a ‘wonky day’, hang on in there.

It got me thinking that we all have ‘wonky days’ those days when things get out of sorts for a host of reasons and things get really challenging.

We focused a bit more on this at our Children’s Clinical Board meeting this week. Our clinical board brings nursing, medical and AHP colleagues along with the management team who provide care to CYP and their families/carers together from across all sites, we share best practices, address inequities and encourage each other as we all work to provide outstanding care to the CYP and families/carers we serve. Dr Susie Minson shared the work that along with a fab multi disciplinary team she’s been leading to create ‘joy at work’. There’s more information about the IHI ‘Joy at Work’ approach here ‘Joy in Work | IHI – Institute for Healthcare Improvement’ Some of the things that have been introduced following coproduction and collaboration with staff, have included a monthly divisional shared lunch, improved break areas, starting handover with a reflection on what’s gone well in a shift, small welcome gifts for new starters, thank you notes on one year of service, and adopting the ‘you’ve been mugged’ approach (a lovely mug is filled up with goodies and left for someone to show how much they are appreciated). All approaches have all made a difference in enhancing the community that we all work in. It’s been significant to staff wellbeing and recognises the contribution of staff in providing great care day in day out.

@PaedPDNSRLH shared their gifts to staff on twitter recently ….

There was certainly joy too as I was travelling on the underground this week, the cheeriness of the @TfL staff on the Victoria line made me smile with their fun (slightly bonkers) reminders to keep safe, as weery soggy commuters headed into work. Their unconventional unscripted announcements certainly made me smile and lifted my spirits! It’s often small moments of joy that can make the difference in a challenging day.

So when ‘wonky days’ happen (as they often will!) hang on, look around, seek out a colleague, a smile, and if we’re able to be the provider of that smile, word of encouragement let’s be the ones that offer it, a bit like team TfL and the fab Children’s team at Barts Health 😉

How can we empower nurses?

How can we empower nurses? That’s the February #YearoftheNurseandMidwife blog challenge, it’s a good question that’s got me pondering this week.

Perhaps importantly empowering others starts with ourselves and the actions we can take. I remember last year when Ruth May started as the Chief Nursing Officer of England in January 2019 tweeting about creating #TeamCNO and encouraged others to join in. She set the tone and foundation of a culture aiming to include others, bringing them into the CNO team in an inclusive manner. Such an approach can be highly empowering, it encourages people to play their part and make a contribution to the agenda. Ruth through using twitter and that simple hashtag offered ‘permission’ to join in, to be part of the journey ahead as she works to amplify and celebrate the contribution of nurses and midwives across the NHS and beyond.

Sharing information is another way we can empower nurses. Often I worry about forwarding too much information when people are so busy, but in reality I know people are incredibly adept at filtering information that’s relevant to them. One of the great things about social media is we can share information freely, people can tap into it when it’s convenient to them, using hashtags can help in organising content too. I’m always grateful to colleagues who know which issues matter most to me and tag me in their tweets ensuring I get sight of something they think I’ll be interested in.

Encouraging people to set goals can be helpful too, the fabulous Jane of ‘Quiet the hive’ asks us each week to set our three intentions for the week ahead, sometimes I manage to achieve them, sometimes not, but it’s the thought process, the creation of some time and space that is really helpful. Nurses are busy people, not only in work but at home and in the community too, so we all need a little nudge sometimes to create some reflection space and to create goals or intentions to keep us focused.

Its important we acknowledge we work in highly complex environments, caring for people who are often at their most vulnerable, requiring not only expertise in compassion but also sophisticated technical skills. Sometimes we don’t possess all the knowledge we’d like and we may make mistakes. What’s vital is we share them openly so we can learn and address the issues. I remember as a junior staff nurse working in an incredibly technical environment surrounded by wonderfully competent staff, I constantly gave myself a really hard time about not being the expert I wanted to be and it contributed to me leaving after two years in the role, applying for a more generic post in a less technical environment. Whilst I loved the new job, I do wonder if I’d been kinder to myself and had the recognition from others that whilst I didn’t have their technical expertise, I could bring other things to the team may have made me remain in post longer to acquire the technical expertise others seemingly possessed? Colleagues and teams can be hugely influential in creating empowering environments in which we can flourish.

This week on twitter a great infographic was shared…

It seems to bring some key actions together, having a spirit of optimism, setting out a vision of what ‘best’ looks like, growing collaborations, being ‘human kind’, and having a belief in people’s potential. If we universally and consistently adopted theses approaches I wonder what impact it would have on empowering nurses and midwives?

Pondering on partnerships, dialogue and engagement …

It’s been a busy few weeks, I’m particularly in awe of clinical colleagues who keep delivering direct patient care with compassion and professionalism in the busiest of times.

Sometimes though the activity can seem quite overwhelming, the talented and insightful artist ‪@charliemackesy‬ posted this message on Instagram, encouraging us to just take the next step forward, a simple but important message especially when things can seem overwhelming.

I’ve also been thinking about how we all communicate with each other in organisations and grow dialogue about important complex issues, exploring and understanding challenges is one of the most important elements of our roles. The ever inspiring ‪@Sonia_Sparkles ‬ posted this fabulous graphic about the essentials of understanding problems rather than simply reaching for solutions.

This communication is often badged as ‘staff engagement’ and it’s clear we can never do enough of it between staff delivering direct patient care and those in managerial roles. Dialogue needs to be vertical and horizontal and we can all play a part in growing a culture that reaches out, explores issues together, so that we can discover shared solutions to move things forward.

Yet the reality it in the business and requirement to ‘get stuff done’ to keep on top of things it can be challenging to keep engaging ….. then Charlie posted this….

Perhaps a reminder that every conversation is a step in the right direction 😉

Supporting staff engagement and wellbeing comes through in this ‘quintuple’ model of Population Health Management, which extends the original triple aim model of focusing on best use of resources, improving population health outcomes along with enhancing experiences, along with highlighting the needs to actively address health inequalities, it’s always helpful to have a map as we journey onwards!