Author: @kathevans2

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

4/6/19

I’ve been asking myself this week if in healthcare we’re failing our Black, Asian and Minority Ethnic (BAME) Children and Young People (CYP).

Data highlights the variation in infant mortality across ethnic groups https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730917/local_action_on_health_inequalities.pdf

Recently the LeDer report into deaths of people with learning disabilities alerted us to the fact that CYP from BAME backgrounds died 2 years earlier than CYP from white backgrounds, check out chapter 6 https://www.thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf .

The Care Quality Commission in the data from the Children and Young People’s National Inpatient Survey, highlights that CYP from BAME report poorer experiences of care than those from white ethnicity https://www.cqc.org.uk/publications/surveys/children-young-peoples-survey-2016

The National Child Measurement Programme indicates higher levels of obesity at age 10-11 in ethnic minority groups than the white majority.

Racial inequalities are clearly an unjust global challenge that can be avoided, so we must keep challenging ourselves, to do better.

But if I’m honest it’s not an area I feel hugely experienced in. I grew up in South Wales and the diversity in my classroom was provided by a girl whose family came from Wolverhampton, everyone else was born and raised in the town we were being schooled in. Even when I went off to do my general nurse training in Cardiff my closest friends came from Gloucester, Brecon and Abergavenny, my nursing cohort was full of girls who came from across South Wales and the English boarders.

I recall in my 1st staff nurse post caring for more Asian children with renal illness than children of white ethnicity, yet it was really when I came to London to work at Great Ormond Street and then later at the Whittington where I cared for children with Sickle Cell disease and Thalassaemia that I became aware, first hand, of some of the wider challenges faced by BAME children, young people and families.

Now working in East London the challenges are at the forefront of my consciousness, I constantly have a voice whispering in my ear that asks me ‘would this serious case review have had the same outcome if it related to a child of white ethnicity’? These are complex issues playing a huge role in health outcomes.

There are a myriad of reasons why CYP from BAME backgrounds face health challenges, an increased likelihood of experiencing living in poverty, families speaking in different languages (some which aren’t written), along with the complexity of navigating the healthcare system and most concerningly power imbalances.

As a nurse, I’d like to believe myself to egalitarian and unprejudiced BUT the reality is that our lives shape us all, our memories and experiences help our brains to sort stuff, to categorise information so that it’s swiftly analysed, leading us to make automatic conclusions and assumptions. We all have unconscious biases and whilst I can’t and don’t desire to change my family background I am aware of my limited experience regarding race related issues, therefore I need to proactively seek out advice and guidance from colleagues from diverse backgrounds to challenge and inform thinking. A great practical example of doing this is by ensuring we have BAME representation on interview panels, at meetings, along with brave opportunistic conversations with colleagues from different backgrounds to our own. This, in my opinion, will constantly challenge ideas and offer different perspectives which are critical when striving for improvement in BAME healthcare.

In recent years there has rightly been a growing focus on ensuring we’re more aware of these unconscious biases and ensuring the NHS workforce is representative of the community we serve, particularly in ensuring that senior leadership teams are diverse which will help address this. The Workforce Race Equality Standard (WRES) has done so much to prioritise this agenda and it continues to have great impact.

My ‘go to advisors’ and follows on twitter who champion this work include Yvonne Coghill @yvonnecoghill1, Dr Habib Naqvi @DrHNaqvi whose blog for NHS England is worth dipping into https://www.england.nhs.uk/blog/turning-the-dream-into-reality/ Habib shares that he reverse mentors Simon Stevens. And another colleague who has challenged and taught me lots over the years is Scott Durairaj @ScottDurairaj.

It makes sense that if we have a more diverse and representative workforce across all bands of staff, we’ll begin to think differently and become brave enough to challenge some of the unconscious bias that exists in the NHS and across society.

It is a gross injustice that CYP from BAME backgrounds aren’t getting the access they deserve to healthcare whether due to language issues, our lack of ability as healthcare professionals to connect with people from different ethnic cultures or our failure to make services accessible to all.

But in order to ‘change the system’ and ‘mainstream’ these issues we need to be brave enough to speak out, knowing sometimes we might say the wrong thing, not deliberately but naively, yet if we’re authentic in our seeking of understanding people will open up. What is more concerning is us not challenging inequalities and being apathetic in accepting the status quo. This is a slide from @YvonneCoghill1 that challenges us to think and do differently….

So what can we all do about this? There’s possibly no single solution..,

1. We need to recognise that health inequities exist

2. We need to challenge stereotypical thinking, question our assumptions, and constantly seek to be more person centred

3. We need to proactively seek out new perspectives, increase opportunities for others, build trust, champion fairness and constantly raise awareness of these issues.

The Sure start research by @TheIFS @Gabri_EllaConti funded by @NuffieldFound published this week, summarised here https://www.bbc.com/news/education-48498763

https://www.theguardian.com/society/2019/jun/04/sure-start-saved-nhs-millions demonstrates the impact building community capacity can have on improving health outcomes, we need to be doing more of this, not less.

I’d also really recommend this PHE document on local action in health https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730917/local_action_on_health_inequalities.pdf

This has been a difficult blog to write … I know we can and must do better ….

30/5/19

You may know that I’m a Children’s Nurse who initially trained as a Registered General Nurse back in the late 1980’s. My experience of caring for people with mental needs includes caring for a skeletally year thin young lady with anorexia nervosa on a general medical ward who required intravenous fluids. I struggled to understand why she couldn’t and wouldn’t eat and if I’m honest was totally overwhelmed as an 18 year old seeing her emaciation that wasn’t attributed to a physical health issue. Later in my training I spent a summer on a placement at Whitchurch Hospital in Cardiff, my memories of that time include enjoying the beautiful grounds with the patients being cared for, as well as accompanying patients to and from their ECT treatments. Much of my time was spent ‘being with’ people, not always chatting, just ‘being’. I remember a ward sister (who I respected greatly) remarking that that she didn’t think I’d make a mental health nurse, it takes all types to make the world turn I tell myself, as a result I have huge respect for my mental health nursing colleagues for the work they do.

As I moved throughout my career I’ve focused on nursing children and young people with renal, oncology and general paediatric ‘physical’ health related needs. Emotional well-being was an underlying theme throughout my career and whilst the mental health needs of young people have much greater focus than they’ve ever had previously, it’s something I’m still trying and if I’m honest often struggling to understand.

The Mental Health Foundation flags that while most children grow up mentally healthy, data suggests that more children and young people are having challenges with their mental health today than 30 years ago, they suggest its probably because of changes in society and it’s impact on feelings and behaviours. The transition to adulthood may also include experimenting with alcohol, drugs or other substances that can affect mental health too.

1 in 10 children and young people experience mental health issues and these can be a direct response to what is happening in their lives, issues such as:

• having a long-term physical illness
• having a parent who has had mental health problems, problems with alcohol or has been in trouble with the law
• experiencing the death of someone close to them
• having parents who have separated or divorced
• being separated from the family resulting in them becoming ‘looked after’ by their local authority
• having been severely bullied or physically or sexually abused
• living in poverty or being homeless
• experiencing discrimination, perhaps because of their race, sexuality or religion
• acting as a young carer for a relative, taking on adult responsibilities
• having long-standing educational difficulties.

I’m sure there are no doubt things that have been missed from this list. We’re all far more aware of ACEs ‘Adverse Childhood Experiences’ http://www.healthscotland.scot/population-groups/children/adverse-childhood-experiences-aces/overview-of-aces than ever before and the impact they can and do have on mental health and well-being.

Children and Young People don’t always know or are able to articulate what these adverse experiences are, leading to the complexity of management and care. On chatting to my 15 year old daughter, she offered the wisdom only a 15 can ‘see mum it’s not just about one thing, it’s often multiple stuff, the constant layering of difficult hard life things that makes life tough sometimes’. Beautifully put I think!

This infographic from Healthy London Partnership provides an overview of the challenges children and young people face in London.

The types of mental health issues children and young people can present with include:

• Depression, this affects more children and young people today than in the last few decades, but it is still more common in adults. Teenagers are more likely to experience depression than young children.
• Self Harm is a very common problem among young people. Some people find it helps them manage intense emotional pain if they harm themselves, through cutting or burning, for example. They may not wish to take their own life.
• Generalised anxiety disorder (GAD) can cause young people to become extremely worried. Very young children or children starting or moving school may have separation anxiety.
• PTSD or Post traumatic stress disorder can follow physical or sexual abuse, witnessing something extremely frightening of traumatising, being the victim of violence or severe bullying or surviving a disaster.
• Children who are consistently overactive (‘hyperactive’), behave impulsively and have difficulty paying attention may have ADHD Attention Deficit Hyperactivity Disorder.
• Eating Disorders usually start in the teenage years and are more common in girls than boys. The number of young people who develop an eating disorder is small, but eating disorders such as anorexia nervosa and bulimia nervosa can have serious consequences for physical health and development.

Shockingly the leading cause of death in the 5-19 age group is death by suicide according to the Office for National Statistics http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredinenglandandwalesseriesdr/2015#number-of-land-transport-accidents-among-5-to-19-year-olds-decreases-in-2015

Some of the children with mental health needs as we know present in Emergency Departments. The RCPCH in their ‘Facing the future’ Emergency Care Standards https://www.rcpch.ac.uk/sites/default/files/2018-06/FTFEC%20Digital%20updated%20final.pdf sets out what we need to be able to offer.

The emerging crisis intervention and home treatment models of caring are hugely helpful in supporting children and young people in areas other than ED, it’s a far from therapeutic environment for those in mental health distress.

Of course we also need to support and provide support for the mental health of children and young people with complex ongoing health needs too, the RCPCH Facing the Future sets out the standards required https://www.rcpch.ac.uk/sites/default/files/2018-04/facing_the_future_standards_for_children_with_ongoing_health_needs_2018-03.pdf

We also need a workforce that has the skills to engage with children and young people, the @WeCanTalk programme developed by @RobinfromCAMHS in collaboration with young people and staff is a great example of addressing support and education of staff. Our skills as professionals to connect with children and young people to build trust, foster understanding, show value, respect and creation of safe spaces are key.

Our local mental health services NELFT and ELFT have been so welcoming to visits and collaborations, partnership working across STP patches has to be a key element of future working. Thank you @Nicola21762634 for hosting me this week, I learnt so much! Hoping to meet @bewseyr soon too.

Just as we’ve reflected on the opportunity to consider a RN Child/LD pathway to qualification in recent weeks, I wonder if going forward we could offer a RN Child/MH pathway? Perhaps it already exists? It surprises me that we have adult MH trained nurses caring for CYP and I think we encourage more Children’s trained nurses to work in MH settings?

And of course there are clear opportunities to ‘prevent’ and reduce deterioration of mental health illness too. As people who are passionate about children and young people’s well-being we can all promote and role model the importance of

• being in good physical health, eating a balanced diet and getting regular exercise
• having time to play, indoors and outdoors
• support being part of a family that gets along well (most!) of the time

• encourage taking part in local activities such as attending voluntary organisations as well as opening up volunteering opportunities.

• support going to a school that looks after the physical and emotional wellbeing of all its pupils, do we have governors who lead on well-being in all our schools?

I wonder what more we can do to work in partnership with schools too? The Schools Mental Health toolkit developed by the Healthy London Partnership team can be used to promote wellbeing in schools https://www.healthylondon.org/resource/schools-mental-health-toolkit/

These are the ‘asks’ from young people to schools which are powerful calls to action:

I also think we can do more investing and valuing of school nursing https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/forums/children-and-young-people/staying-healthy-forum/school-nurses-toolkit-2017.pdf, ensuring they have the skills and insight to support the mental health needs of pupil and the staff that support them. Why not recruit mental health nurses to be school nurses?

And what opportunities does Social prescribing offer Paul Jarvis-Beesley, Head of Health at StreetGames @PaulWJarvis blogs about what this can offer here https://www.ukyouth.org/2019/03/05/social-prescribing/

This is clearly a conversation that will continue, please do follow…

@CYPMentalHealth http://cypmhc.org.uk/

@YoungMindsUK https://youngminds.org.uk/

There are loads of really helpful resources from the @rcpsych that are worth dipping into too, they’ve got a great short film on anxiety https://www.rcpsych.ac.uk/mental-health/parents-and-young-people

@EmmySelby is a mental health nurse who is really keen to support digital development and be creative, do follow her on twitter.

@lizziebessell is an ED Matron who’s been awarded a Florence Nightingale Fellowship to explore how we can best support young people with mental health needs in acute hospital settings.

I’d really value hearing more about the challenges faced and the solutions that you’ve put in place to address some of the challenges…..

Have you employed Mental Health Nurses in general paediatric areas, what difference has this made?

Have collaborations with Mental Health Teams brought benefits? Are you working with primary care on this agenda?

Love these prompts from young people to parents

26/5/19

Whilst I am not a Learning Disabilities Nurse, I have had the privilege to care for many children and young adults throughout my career who have learning disabilities. One the highlights of my post registration RSCN training at Great Ormond Street was spending an elective placement with an organisation called ‘Kith and Kids’ https://clarahost.clara.net/www.kithandkids.org.uk/ I’d seen an advertisement in the Evening Standard seeking volunteers to support one of their residential holidays. I got in touch and as a result had one of the richest learning experiences I could have ever wished for. Young people with learning disabilities and a number of similarly aged volunteers had a week of fun activities in the fresh air in Kent enjoying campfires and lots of shrieking on zip wires together! The week reminded me of a similar camp I’d done as a Red Cross cadet helping out on a ‘disabled children’s holiday’ in Margam Park way back in 1982. At both of these events the diagnosis of those participating wasn’t the focus, it was all about fun and helping each other out along the way.

Both of these events confirmed how much we all contribute to each other in creating fulfilling happy lives, so I’m sure I’m not alone in feeling sick at the findings of reports published last week relating to the care of children, young people and adults and the care they receive when they have learning disabilities/Autism. Whilst I know there is much outstanding care across the country, frustratingly there is also poor and unacceptable care, calling this out is vital if change is to happen.

The RCPCH and us team launched their ‘Hidden Health’ film at their conference this year, https://youtu.be/F91tA0VXCGM it’s a reminder that so often the health needs of those who are most vulnerable go unrecognised. Listening attentively to hear people’s voices so that every opportunity is given for active participation in life as well as in care, seems an absolute ‘must do’ that we definitely haven’t consistently cracked yet.

So on reading these reports, discussing findings, I’ve been asking myself ‘what next, what can I do?’

Having an increased awareness of the risks faced by people with a learning disability is needed for all health professionals. NHS England flags that the major killer conditions for this client group include: Pneumonia; Respiratory; Constipation; Sepsis and deterioration; and Cancer https://www.england.nhs.uk/2019/05/nhs-invests-5-million-to-improve-care-for-people-with-a-learning-disability. Increasing use of hospital passports can help in addressing some of the challenges of understanding what’s ‘normal’ for individuals who may require support in communication. There was a fantastic piece of work by Young People who created a campaign with Ambitious about Autism on exactly this, encouraging people to be able to provide early warning flags when stuff deviates from the norm for them https://www.ambitiousaboutautism.org.uk/know-your-normal

The LeDer report published last week https://www.hqip.org.uk/resource/the-learning-disabilities-mortality-review-annual-report-2018/ is worth reading and a summary of recommendations can be found here http://www.bristol.ac.uk/media-library/sites/policybristol/PolicyBristol-PolicyBriefing73-May2019%20LeDeR.pdf This short film offers an excellent overview of the LeDer process and the vital input from families
https://www.youtube.com/watch?v=g-lgegZK4Xo

Chapter six specifically discusses on the deaths of children with learning disabilities.

The LeDer report highlights that children & young people from BAME groups were overrepresented in deaths of people with learning disabilities’ and asks us to focus on addressing any unconscious bias that may exist. I think we’ve got much more awareness to raise on the experiences of children from minority ethnic groups.

They were also able to draw out elements of good practice relating to the care of children and young people and areas where we could do better:

The report by @CareQualityComm on care of children & young people with complex behavioural needs, restraint & segregation, https://www.cqc.org.uk/sites/default/files/20190521b_rssinterimreport_full.pdf was also published, they explored..

The review summarises the pathway that leads to segregation, offering insight for action.

The report highlights the importance of a trained compassionate workforce staff who are supported in caring for people with very complex needs. Surely this is why we need to increase and grow the learning disability nursing workforce, as well as expanding all of our knowledge of caring for people with learning disabilities?

One thing that Anne Corbet @AnneCorbett12 a hugely experienced Occupational Therapist champions is that much earlier intervention and support when behaviour challenges emerge at an early age is critical, BUT we don’t have the workforce or adequate systems in place consistently for this to happen currently.

The wonderful Dr Karen Horridge @KarenHorridge has led the implementation of strong effective data collection in community paediatrics and established ‘Disability Matters’ https://www.disabilitymatters.org.uk/ in collaboration with a range of organisations. Karen’s work offers us clear direction on the importance of understanding the issues, training the workforce and commissioning services to meet need.

A key organisation to follow is @BACD_tweets too.

So my go to people on twitter include:

Jim Blair @jimgblair

Mary Busk @marybusk

Kate Oulton @DrKateOulton

Yvonne Newbold @YvonneNewbold

Prof Ruth Nortway @NorthwayRuth

Tricia Handley @Triciahandley

All are accessible and champion effectively and passionately for better care for all who have learning disabilities.

So let’s read the reports, keep raising our voices, asking ‘why’ and support action to improve lives for all, those residentials many years ago brought so many happy memories… everyone deserves a happy fulfilling life… we can do better ….

21/5/19

I’ve been reflecting on productivity this week, how do I get more stuff done? There’s so much I want to achieve and my ‘to do list’ seems to constantly grow. There’s an old saying I recall that says we make time for the stuff we want to, yet there’s so much I want to do!

So are there tips that can help us get stuff done? Here are the ones I’ve come up with …

1. Get up early – as a member of the #earlyrisersclub I get this. Scrolling through twitter and seeing the positive tweets from colleagues as I enjoy a morning coffee sets the tone for the day.

2. Exercise is said to help us be more productive too, apparently a morning jog is linked to a better mood and productivity, as is access to natural light, all good news for the #NHS1000miles club http://www.wecommunities.org/blogs/3443. Another tip is ensuring sleep is prioritised, I’m delighted when I get 6 hours but ideally I function better on 7! Definitely work in progress.

3. I know I’m most productive and focused in the morning, I need to use this time wisely, a tip I picked up on a recent leadership programme was the ‘pomodora technique’ https://francescocirillo.com/pages/pomodoro-technique carving out bite sized 25 minutes at a time to totally focus on one task without interruptions. Often once I get into the mindset of focusing the work then flows. It can help to avoid procrastination too.

4. Having a clear desk and making a to do list are other elements. But take note apparently we can get addicted to the dopamine surge we get as we tick things off on our to do lists so we focus on the small less onerous tasks, rather than the bigger more complicated time intensive stuff!

5. Sometimes the negative stuff can get in the way and be overwhelming too, focusing on compartmentalising this by putting it in a virtual box for addressing at the right time can help, you’re not ignoring it, just managing it (rather than it becoming overwhelming).

6. I think we all need a bit of self belief in ourselves that we can get stuff done, so bring on that ‘WonderWoman’ pose and hold it for 2 minutes (men are welcome to adopt the pose too), it increases testosterone and decreases our cortisol levels. The power to transform our minds so we ‘fake it til we own it’ with this positioning is powerful, do watch Amy Cuddy’s fab TedTalk https://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are for the science bit! We had great mischievous fun at a recent Roald Dahl conference practicing our WonderWoman poses!

and here are Sophie and Helen of the marvellous @roalddahlfund doing their WomanWoman poses on Monday morning!

All of these techniques are great, but the complexity of our working lives means that we work in an interconnected manner, depending on colleagues to work with us to progress agendas.

So what helps, are there tips that can help us work more collaboratively so we become more enabling?

I think we’d all agree that interpersonal relationships with authentic positive attitudes matter. Asking questions and really understanding the issues in hand can help in finding smart solutions leading to better results, this is definitely something I need to work on, pausing, questioning and pondering before diving in.

Of course so often when we’re working at a distance from colleagues we use emails as a significant communication tool. They can be incredibly convenient, allowing us to bank our thoughts to be picked up at the convenience of the receiver. It’s worth thinking about the language and tone of our emails, they can either engender people to help or they can put our heckles up, which can delay responses and cause unnecessary frustration. It’s helpful to consider how it will feel to be the receiver, asking ourselves if it will generate the right kind of response, impact, and result is a useful check prior to hitting send. Thinking about the timing of emails matters too, if it’s complex and needs action/attention I’d much rather receive it in the morning than last thing in a working day, which will result in me pondering or stewing on it that evening.

When we do get stuff done perhaps we need to acknowledge this more? Rewards, either personal or as a team matter, a coffee, a walk, all help to celebrate the achievement of a task before moving on to the next one!

What are the tips that help you get stuff done? I’d love to get some ideas!

Perhaps this is worth considering too…

16/5/19

Have you ever entered a room and thought, what am I doing here, why am I putting myself in this position, what can I offer as a meaningful contribution to these discussions that will add value? 70% of people experience ‘imposter syndrome’ ie the feeling we don’t have a ‘right’ to be there at sometime in their lives, it’s always good to know I’m not alone!

But how do we dump this feeling, as ‘Jenny the M’ @JennytheM would say, do we, ‘spread on some courage butter’ step forward and perhaps speak positively to ourselves too?

Graphic with thanks to @TerryCulkin1 @WendyMinhinnett @RollercoasterPS @JennytheM

I had the privilege of being at Westminster Abbey this week to celebrate Florence Nightingale’s birthday and the fact it was 100 years since Edith Cavell’s funeral occurred, the address reminded us of the words ‘I am strong, I am invincible, I am Woman’ perhaps repeating this mantra may be helpful for women and men when we’re feeling a bit wobbly?

Perhaps it’s also about exposure? The more we put ourselves in situations that are outside our ‘comfort zone’ the less we’ll feel as if we don’t belong….

I remember when I first started a lead nurse post for children in Hertfordshire, I wrote to Judith Ellis, @Ellisjmellis the then chair of the Association of Chief Children’s Nurses (ACCN) asking if I could join them. I wasn’t the ‘typical attendee’, I came from a District General Hospital Children’s Service, I knew I needed a network of support and the ACCN seemed like the right forum. Judith welcomed me and when I looked around and saw Directors of Children’s Nursing from Children’s Hospitals across the UK, we had a shared purpose, but I felt out of my depth, should I be there? What became clear however when I returned to my workplace were the benefits that being part of those conversations offered. I remember the Clinical Director looking over at me as I spoke with a refreshed confidence after attending the ACCN meetings, exposure to more experienced colleagues helped me grow, mature my thinking and think more broadly.

15 years on I still find the ACCN meetings hugely helpful in sharing ideas and it’s helped retain a network of likeminded colleagues who are some of my ‘go to’ people including @lorraine_tinker and @datt_colette. If I hadn’t been prepared to have gone back I’d have never dumped that feeling of imposter syndrome. What’s been particularly helpful is the ACCN has grown its membership in recent years recognising the need to grow and mentor future Children’s Nursing Leaders. Do follow the chair @Sally_Shearer and @CYPNurseLeaders for great insights and connections to others.

Another way to address imposter syndrome is seeking out a potential mentor in a likeminded colleague, there will always we someone to connect with at events or meetings. It’s worth taking a deep breath, being brave and introducing yourself, more often that not, someone will not only share a bit of themselves but also introduce you to some they know too, offering another opportunity to broaden networks.

Many years ago I heard the phrase ‘tall poppies’ describing those people who stood out and had impact. Perhaps we need to consider how we become brave enough to stand tall, weather the challenges, always accept responsibility for our actions, learn, and move forward?

I also wonder how we can support those who are growing to be tall poppies, our future generation of leaders, do we give them opportunities to shine? Perhaps we can all work to be more collaborative, inclusive, at making ourselves approachable and relatable? The leaders who role model these approaches, who encourage, open doors and nurture others I respect hugely.

We grow into the opportunities that we create, as-well as those that are presented to us. We’re all on a journey, always learning, developing and maturing, some days are tougher than others, and some parts of our careers are harder than others, but no matter what there are always colleagues we can call on to banish those feelings of imposter syndrome and help us stand tall, after all using our voice to improve things for and with others, helping them to flourish is what nursing leadership is all about….

PS thanks to @AnnalBray @Kady85 @darby_darren @Nurse_Green for important conversations this week….

More on #CourageButter here thanks Jenny https://jennythem.com/2015/04/04/courage-butter/

thanks Jenny @JennytheM for these thoughts on courage …..

9/5/19

I’ve been reflecting this week on the importance of cheering each other on authentically, and the difference it makes to us all going further. We can be our own worst critics at times so it can be hugely uplifting to have someone point out something positive about our actions in a genuine way that builds our confidence and self belief.

A wonderful practical example of ‘cheering people on’ can be seen in these ‘greatix reports’ that celebrate what staff are doing well, thanks to the Children’s team at the Royal London for sharing these this week.

Sometimes we miss opportunities to recognise the good stuff that people do. A colleague recently did a cracking bit of work asking parents about their experiences of care, wrote it up and is using it to frame their local improvement work. I’d emailed to say ‘thank you’ and to appreciate the time and effort that had gone into doing this, they replied saying how much they valued the recognition. When there’s so much going on, I know I need to become more intentional in my cheering on of others as it pays so many dividends. In our ever demanding lives creating time to notice and acknowledge the actions of staff can create magical results.

I witnessed this personally when Majella, a wonderful senior nurse who sent me a ‘certificate of recognition’ for a few words I’d said at a recent event. I’d given a lot of thought to the words and framing of them due to the complexity of the situation, the email follow up of appreciation from her meant so much. Yet importantly it said so much about Majella, her kindness, thoughtfulness and ‘noticing’ was hugely impactful, as a result I’m much more likely to accept a complex situation like this again. Majella’s recognition and actions had a significant impact.

Recognising positive engagement and reflecting on it can, and does assist in growing and amplifying that behaviour. I was spending time with nursing students last week and commented on the impact they make when they connect with and care for parents. The difference they make in supporting families in distressing situations and in alien healthcare environments is significant. The nods and facial expression in the group as we chatted together supported their huge role in caring for families, reflecting and valuing their contribution is hugely important.

Feeding back our observations of others and being proactive in our encouragement can have a significant ‘ripple effect’, increasing positive behaviours. Receiving recognition can mean that we don’t give up, that we keep trying, as a result our resilience grows and that positive feeling is conveyed to others.

Digital or ‘virtual cheerleadering’ is something I see a lot of on social media. @Hannanecdotal a Clinical Nurse Specialist recently tweeted of her tiredness and frustration due to resource issues, something many will identify with, she reflected in a follow up tweet that after a sleep, a walk and some self care that she’d watched her phone ‘blow up’ with kindness, that’s rooting for each other in tough times.

Building the confidence of colleagues through reflections on their shared content on twitter means we share perspectives and open ourselves up to new ideas. It also encourages engagement beyond purely broadcasting information which brings added depth of connection and understanding. Social media is an exciting tool that can put us in touch with all sorts of interesting people, expanding our professional networks, fostering exciting collaborations as well as offering support.

So thinking about this, it seems that communicating, noticing and feeding back on the actions of others can also grow our own positive critical thinking skills, it can develop and nurture our written and verbal feedback skills, providing opportunities to test out what works, seeing responses and tweaking our language and behaviours accordingly. Caring about and celebrating the accomplishments of others means that paths can be paved for new collaborations too.

We all seek a sense of belonging, of being part of something bigger than ourselves. Recognising the contribution of others, stating how valued someone’s insight or input was in an interaction or at a meeting WILL have an impact on their future contributions, recognition will mean they’ll continue to contribute and that contribution will mature.

I think being a cheerleader of others requires thoughtfulness, insight, energy and a positive mental attitude, these are all skills that grow when we choose to use them daily. Showing up, and being present, creates that opportunity to connect, to note and take action by speaking up about what we see.

So who is your biggest cheerleader? Do they know how valued they are, could you could tell them this? Are you a cheerleader, who can you ‘cheer on’ today? Perhaps we can all take small steps to notice and encourage more so that we invest in maturing this habit in ourselves and in others? As always I’d love your thoughts!

Thank you for your tweets in response…

2/5/19

Last Sunday evening saw a flurry of tweets appear from @EmmaSelby following an article in the Mirror about the numbers of nurses who had died by suicide https://www.mirror.co.uk/news/uk-news/more-300-overworked-nhs-nurses-14822382 The wonderful @AlysColeKing in response shared the ‘Staying Safe’ https://www.stayingsafe.net/intro resources for people at risk of suicide and those supporting them, which is well worth taking a look at.

Sadly during my career I’ve lost two nurse colleagues to suicide, it’s something that makes me feel incredibly uncomfortable. Helen and Mike will never be forgotten and I am grateful for all they have taught me. However I never want to have to go to a funeral again of a colleague who decided to end their life by suicide, seeing the distress of their families, friends and colleagues is heartbreaking.

Day in and day out staff are faced with the emotional challenge of caring in pressurised environments. So how can we create a culture that thinks and takes action on the psychological safety of staff, allowing us all to ask for help when we need it and experience responses that are compassionate? Achieving this consistently could also help retain our most experienced clinical staff in practice.

The emotional burden of working within in the NHS is not a new one, but increasing mental health pressures, demands on health services to do more for less and reduced funding streams to other public sector services all bring added complexity. There are also often many other pressures that NHS staff face outside work that cause additional emotional distress. For example it worries me that staff in caring roles are significantly affected by domestic violence which is often ‘hidden’ in their day to day professional lives. 1 in 7 nurses experience domestic abuse and NHS staff are three times more likely to suffer domestic abuse than the general public https://www.mirror.co.uk/news/uk-news/nurses-three-times-more-likely-9154697 Financial pressures, caring responsibilities and relationship breakdowns at home, along with complexity at work can result in feelings of being totally overwhelmed. We clearly need to strengthen approaches to staff wellbeing.

Organisational commitment and a range of approaches are essential, no one intervention will solve these issues. Having access to independent advice, support and, if appropriate grants to allow choices to be made can be a life line. The Cavell Nurses Trust https://www.cavellnursestrust.org/ who are #HereforNurses is one team we can signpost colleagues to so that they get practical, responsive support when things get tough. I am grateful to John, the CEO and the team at Cavell for their amazing work to support nurses and midwives facing crisis or hardship.

Strategically though I wonder if we can be more proactive and work ‘upstream’? I was reading a blog this week about the 5 ‘life skills’ the World Health Organisation @WHO thinks we should all be equipped with https://bigthink.com/personal-growth/5-critical-life-skills-everyone-should-have

They include:

1. Decision-making and problem-solving

2. Creative thinking and critical thinking

3. Communication and interpersonal skills

4. Self-awareness and empathy

5. Coping with emotions and coping with stress

This seems like a really practical ‘curriculum for life’ that could change the future….

The team around us has a profound role in offering direct support too. I recall a difficult incident very early in my career when a child’s precious Hickman line split, we couldn’t work out why it had happened, previous lines this child had had split too and things just weren’t adding up, things seemed ‘odd’ and even though it all got sorted and the child was kept safe. I went home at the end of the day emotionally drained by the complexity of the situation, I felt hopeless and helpless. I ‘hid’ underneath my duvet and remained there for much of the following day. Of course a hot bath, good sleep, tea & hobnobs, debriefs, supervision with wise colleagues put things into perspective.

Looking back for me this incident highlighted the complexity of healthcare, situations like this can and do lead to staff questioning themselves relentlessly and can result in an emotional downward spiral.

So what can I do personally to stop this spiral, personally and for the team around me? Well I will:

1. ‘Ask for help’ role modelling that this is the norm is so needed by us all I think…

2. Ask questions and be curious, ask how are you, and use ‘tell me more…?’

3. Listen and validate concerns of colleagues

4. Pay attention to my body language and the body language of colleagues when I’m engaging

5. Value the ‘encouragers’ the #EarlyRisersClub on twitter, the tweets of @CreateTheRipple we all need positivity

6. Support and share the work of organisations like Campaign against living Miserably (CALM) https://www.thecalmzone.net/2019/04/call-for-help-make-sure-no-call-goes-unanswered/ and the Samaritans https://www.samaritans.org/

7. Encourage staff to attend their local Schwatz rounds https://www.pointofcarefoundation.org.uk/our-work/schwartz-rounds/ Or similar supervision/debrief sessions

Being there for each other, recognising that little things can make a huge difference, a thank you when things have been tough, a coffee with colleagues, these things matter. I loved this thoughtful message from Ruth May at a recent event, reinforcing that we all need to take time to recharge.

What are the action/s you’ll take to make self care and staff care a priority, I love some of these suggestions shared on Twitter this week….

And a wise play specialist (thanks Marilyn) gave me these words which I often share and will remain on my wall….

I’ve also been listening to ‘Trauma Stewardship’ on ”Audible’ which was recommended by @MrsBosanquet it’s fascinating, thanks for signposting to this Joanne!

I’d love views on how we can strengthen our approach to caring for each other?

26/4/19

I never cease to be inspired by young people, young adults, and it was Hannah a wonderful paediatrician (@HLB27) who kindly emailed me late on Wednesday evening reminding me teenagers ‘are young adults whose brain is developing and are trying to figure stuff out’. When I shared this with my 15 year old daughter she said ‘tell Hannah thanks, that’s exactly it’ impressive feedback! Mike Farquhar (@DrMikeFarquhar) this week encouraged us to ‘be the person you needed when you were young’ to which Arvind Nagra (@arvnagra) highlighted that all young people need someone to connect with, someone to trust, it was Kate Martin (@_Common_Room) who reinforced that often securing that trust takes time, and young people don’t want us to give up on them.

NHS England in collaboration with the ‘I Will Campaign’, the RCPCH and the Youth People’s Health Partnership with amazing organisation from Nagina Javaid (@nagina_j) ran an important youth voice summit with over 100 young people this week, about what mattered most to them in health care, transition and young adult care was a key theme, take a look at #YVS19 for tweets. It was wonderful to have the support of Simon Stevens and Ruth May, both committing to ensure young people’s views inform the work of the Children and Young People’s Healthcare Transformation Programme as the NHS Long term plan is brought to life.

We’ve also been talking about this issue at Barts Health too, the medical board and the children’s board, along with GPs are working collaboratively to improve transition and young adult experiences. Take a look at tweets from our conversations at #BartsHealthYA.

‘Transition’ is defined as the process of moving from children’s to adults’ services, which includes initial planning, the actual transfer between services, and support throughout. But we also need to focus on ‘young adult experience’ #YAExp especially for those who ‘crash land’ into adult services and may not have had the support of Paediatric services.

NICE Guidance on transition asks us to:

1. Involve young people in the design of services, sharing that co-production is key.

2. Ensure we’re considering the developmental level of young people and delivering appropriate care.

3. Identify support beyond the family network, thinking about youth worker roles.

4. Take person centred approaches and involving primary care, so often GPs have been left out of a young person’s care, but this changes when care is then provided by adult services.

5. Foster collaboration between health and social care managers.

6. Think creatively about the value of peer support and the value of technology.

Importantly NICE ask us to pay particular attention to young people with neurodevelopmental disorders; cerebral palsy; challenging behaviour, or who are being supported with palliative care who are most in need of ongoing support, I’d also add young adults from a BAME background need focus too, as they often report poorer experiences of care https://www.nice.org.uk/guidance/ng43/chapter/Recommendations#overarching-principles

We held an event at Barts Health last summer and the wonderful Beci Ward captured what young people wanted from adult services in the graphics below, they asked:

1. For us to be welcoming

2. To involve them in decisions about their care

3. To focus on building trust and keeping them safe

4. To remember how scary it is to be a young person

Another piece of work by teams providing care for young adults identified the following themes as areas that require ongoing focus……

It feels that whilst we’ve been talking about transition for many years, action is taking place. The support from the Roald Dahl Marvellous Children’s Charity supporting transition clinical nurse specialists has been invaluable in building the capacity to focus on this agenda. Follow @nellyfletch71 @angy_wangy1 @SophieDziwinski @RoaldDahlFund for more information.

Perhaps though the most powerful message of the week came from Katie, a young person who spoke to us about her reflections on transition and moving into adult services, her one ask? ‘Please listen to me… I know what works and what doesn’t‘

…. is that really such a big request?

A post blog note: the RCPCH have brought together transition resources that are worth dipping into https://www.rcpch.ac.uk/resources/health-transition-resources

18/4/19

‘I try not to drink too much water when I’m on the ward so I don’t have to leave my child to go to the loo’.

This was a statement shared by Dr Kate Oulton, @DrKateOulton, a Researcher who was sharing her findings from interviews with families who had children with learning disabilities spending time in hospital. Whilst there was positive feedback relating to care in Kate’s NIHR research there was lots to reflect on too, how should we challenge ourselves ‘to do better’ to be kinder and more thoughtful?

Sonja Jacobs @SltSonja has been doing similar work with families who have children with complex needs in Tower Hamlets. Sonja shared the feedback from families about the multiple appointments they face, not knowing who their key worker/consultant is and no access to signposting for peer support. Sonja’s work affirms many of themes in ‘Caring more than most’ https://contact.org.uk/get-involved/campaigns-research/caring-more-than-most/ research done by the University of Leeds, supported by Contact @contactfamilies, that shows a quarter of parents with disabled children provide an unimaginable 100 hours of care each week, I cannot begin to imagine the exhaustion they face.

Carmen Soto @gourmetpenguin a Paediatrician has also been interviewing families who care for Children with invasive devices e.g. gastrotomies, Hickman lines etc. Carmen shared the privilege of entering homes and seeing the reality of caring for children with complex needs. As a doctor she reflected on the impact kindness has with families. A mum, Willow, who tweets as @riverthistle draws powerful images (TY for sharing on social media Willow) conveying the exhaustion of parents, Willow shared having medical staff acknowledge the caring responsibilities she carries on her shoulders means the world.

The consistent theme that emerges from all of these conversations is the value and impact of kindness from professionals when people are facing such complexity.

But what is kindness? Definitions include it’s the quality of being friendly, generous, they are considerate acts, good deeds, good turns, favours, acts of assistance, service, help or aid.

I think it’s worth busting the myth that ‘being kind’ happens automatically, being kind and thoughtful requires effort and energy.

But where do we get that energy ‘top up’ from to help us be kind in the demands of daily practice? If people are kind to me I’m far more likely to pass on kindness by being kind to others, but if I’m worn down by daily hassles then it follows I’m not going to be as kind in my approach as I’d like to be. The circumstances around us (or some may say culture) such as our colleagues and their behaviours play such an important role in our acts of kindness to others.

However when we’re kind, there are significant personal benefits, it increases our wellbeing and our own feelings of happiness, being kind can reduce the hormones in our brains associated with stress. It also ‘infects’ others with kindness too, as we role model positive behaviours.

Whilst we all have the best of intentions to be kind, the reality is that life is busy with many competing demands, yet I don’t think that should prevent us from exploring thoughtfulness, challenging each other and asking how we can we consistently be kinder? Can we become more intentional in our acts of kindness? When we see acts of kindness by colleagues can we acknowledge them to demonstrate how much they are valued?

Another reflection is that kind people are kind to themselves, creating time for kindness to ourselves is important, so can we commit to this?

Perhaps we start small? Small gestures can mean a great deal to a person who’s having a difficult day, we can offer more focus to acting with good intentions, to see things from the other persons perspective, to put ourselves in their shoes. Reassuringly the reality is kindness isn’t about grand gestures, it’s about thinking of others in often small ways and taking action.

I liked Prof Tony Warne’s @warnetony blog last Sunday http://tonywarne.blogspot.com/2019/04/remarkable-people-black-hole-and.html he shared he was interviewing consultants and asked them for an example of when they were kind, the results were lovely to read.

Imagine if we asked ourselves at the end of each day ‘how was I kind today?’