The truth, the whole truth and nothing but the truth.

No students were harmed in the making of this blog – not physically but perhaps a few bruised egos maybe.

             

In my line of business I don’t pander to the late phone call or e-mail of distress… “I’ve left it very late to hand in my essay…can you help me? ”.

I am always happy to help the “ I’m just a bit stuck…can you help?” student,  and use a mental algorithm [more like a professional barometer] before deflecting the more panic stricken soul back to their rightful tutor if that is needed. It's just not professional to offer support otherwise, the work won’t be organic, just rushed.

The problem always stems from a lack of reading or sticking with material that just doesn’t inspire. As academics we guide students to resources and/or people that still inspire us but the term horse to water springs to mind.  There is a formula that works on the whole and it is about not teaching just to assess. It doesn’t always work in reality. Students on the whole will flip through module handbooks and wince at the challenge of the Learning Outcomes and the old chestnut comes up even before the timetable or reading material section has been touched, especially in Higher Education…


“Can you just explain what critical analysis means again please? ”

                

The struggling student always seems to take shortcuts, they READ, to ANSWER… they travel such a small step. You can see the evidence of repetitive strain injury in their swollen index finger from flipping journal pages trying to find a “quote” that goes with an idea.  Their eureka moment never seems to come and the lack of a sense of purpose or connection with their subject remains lost. It becomes a chore, a hurdle rather than an opportunity to test themselves and gather skills or knowledge for their professional toolbox.

I start by asking a student to be honest with me.  I ask them to sell me what they have just read… “Come on tell me about it….....why do you like it…....is it believable….....do you trust it and, what do you get from reading it?”

The sucker punch on the whole is my  “Are you inspired by it ?” question.

There are simple steps to recovery if we are truly asking health and social care students to connect with their subjects and be inspired. Curriculum designers should not focus on the assessment so much but the process of getting there.  Students need shown how to move from casual reading to researching with intent, cognitive intent. 

When I am in marking mode, I don’t really want to see an array of soulless referenced material. For a good mark, I want to know what has been gained from the student reading the referenced material and for a higher end mark at undergraduate and postgraduate level, how it will help them innovate and create new ideas. It’s not really asking too much.

          

They don't give gold medals to academics but a worthy one is James Atherton - a very modest education guru who deserves more praise. His blog and explanation of education processes are sound e.g Bloom’s Taxonomy Model  [classifications of learning] . All too often students achieving lower end marks [and a disappointing fail] misunderstand Bloom’s hierarchical framework and their knowledge of it is dated and just not useful. Atherton highlights changes made over a decade ago to the stepping stones of movement through Bloom’s 1956 Taxonomy Model and the “create” challenge is probably more applicable now, half a century on, as we struggle to empower nursing, midwifery and healthcare students to feel strong, lift their shoulders up and tackle change in today’s NHS.

Critical analysis comes from thinking critically and reading critically.

It's in print...black and white....its not necessarily true.

Thinking critically is about being professionally suspicious, being sceptical about what is seen or read.

Get students to think with some cynicism before getting them to take on frameworks to critically evaluate research  or asking them to have the confidence of Tricia Greenhalgh [despite her being a brilliant author]. 

Take a look at these two You Tube films and although they have nothing to do with health care [perhaps a few injuries maybe] viewers should be inspired by the effort, practice and skill that has gone into all the tricks, stunts and general tomfoolery. However, view them with some cynicism. Before you start talking them up, take a moment to think about the pillars of deeper thinking and critique:  is what you see credible, and wholly trustworthy ???

[Sadly I had to burst the bubble of belief in my teenage son with some of the content....1000' s of Google contributors and hard evidence of editing mischief can't be wrong].

Film One

Film Two

1    Reading [and writing] critically is a also skill. So in order to make the leap to undertake critically analysis, time must be taken to be disciplined and master the demands [and art] of answering other key verbs [known as active or action verbs: doing words] as stepping stones to reach the depth of writing required, regardless of the order tackled first:

Define, List, Outline, Name, Explain, Evaluate, Compare, Summarise and Analyse


Students must master these first...don't let them drift along.

So, if you are reading this before making a call for some help, or steering someone else to call…..my opening questions will be:

What have you been reading-  what do you remember about it?

Did it inspire you ?

Did you understand it?

Could you tell me about it in your own words?

Can you apply it?

Was it credible, valid and could you trust it?

Can you use it to analyse?

Why are you not including this in your repertoire of skills already, what has been stopping you?

Evaluate

Whats it’s value perhaps or is it valid?

Creativity

How can you use this to influence or modify your leadership or management of care?


Good luck.

2012........Whistling to a new tune

                        
                    
Well…as castings go, a few questionable appointments have been immortalised on film:

Steve Martin as Inspector Clouseau in the Pink Panther

Nicole Kidman as a brain surgeon in Days of Thunder

Denise Richards as a nuclear physicist in The World is not Enough

Colin Farrell as in Alexander the Great in Alexander

Now, the casting of hard man Vinnie Jones in the British Heart Foundation campaign for cardiopulmonary resuscitation, supported by the Resuscitation Council, could have been another mistake on celluloid but its not.

Whoever risked their skin to put Vinnie Jones as the front man for the “ Hard and Fast” bystander or Joe public "Hands only" TV CPR campaign has scored a complete coup. Jones is brilliant. The TV advert is brilliant – from the sliding of the body, the bouncers swaying in the background, the placing the hands on the “Sovereign” is priceless imagery...."visual gold" if you like. All the way to the final stare, it is genius.

The campaign is spot on but it’s a shame that it is being chopped up in terms of time depending what TV channel you watch it on. I have heard some criticism of the new tune this week when out and about … “Stayin Alive is too fast”  “…it's to bouncy”, “.. it’s too high” . Come on it is the Bee Gees, you are not meant to sing or dance to it...not here.

Those of us more used to teaching cardiopulmonary resuscitation to small groups are more traditionally used to embarrassing ourselves by asking the audience “Nelly the Elephant or the Archers theme tune…do you know it? Can you hum it?”  Its 2012, We need to whistle to a new tune now. Stayin Alive is corny but at least the intro is better! Come on, it was even on the BBC’s Sherlock final episode last night....there is public service for you. The appeal of music in CPR has been around for a years though. Basically anything over 100 beats per minute is fine but Stayin Alive seems cool.

It’s the science bit that won’t get through with the TV campaign though…how can they in just a few minutes between a Tesco and WH Smith advert?  We inhale [need] 21% Oxygen from the air and exhale 17% Oxygen as well as waste gases – hence the need for a quick 999 call to ensure that help comes without much delay as higher concentrations of oxygen are needed as mouth to mouth resuscitation is helpful but cannot deliver nearly enough oxygen. We know through common sense and guidance from the Resuscitation Council that the almost endless distance of arteries within our adult bodies will still retain some oxygen for a short time if the heart ceases…we just need to pump it round, albeit without much delay.

[Best practice and guidance does change for children and victims of drowning however]

The Hard and Fast motto [whoever thought of the knuckle tattoo is still dining out on that]  will hopefully stop any wasted time. Shout help and get on with it.

Get yourself on a CPR course and start whistling.....

Dave

Happy New Year to all.

Well, as we kick of 2012, it is good to see that David “Call me Dave” Cameron still has the NHS as a spinning plate.  All hail the recent visit by Dave to Salford Royal NHS Foundation Trust where valuable light was shed on the innovative leadership being demonstrated across the hospital as part of the NHS Institute Time to Care and Productive Ward initiative - good old fashioned ground-up change with common sense at its heart. 

It appears that Dave knows a good thing when he sees it.  The introduction of walking the floor style of leadership inspired by Salford Royal's Chief Executive David Dalton  appears to have made some dramatic effects on important patient safety statistics as well as the patient experience. It's not rocket science but “drop in visits” or lurking around long corridors (even the lovely PFI funded ones at Salford Royal) could be perceived as having sinister or punitive connotations but spare a thought, it might just be persuasion.

Allow me to just straighten my rose tinted spectacles, but I remember with great pride as a student nurse (adult) being shown how to straighten bed wheels and align curtains: this wasn’t to make Stirling Royal Infirmary just look nice, it was to allow the ward domestic a free passage or route to properly clean below and behind beds. As a post-registration student nurse (paediatrics) at the Sick Childrens Hospital in Edinburgh you needed to stand when the Nursing officer entered the room or ward, not on ceremony but as a matter of respect – you were about to whisk them round without a pen or scribbled note to explain who was in your ward and report their status.

Dave has just introduced great plans to ‘reset’ Britain’s approach to caring for patients. This reform will include as “common practice” a Matron, Sister or Team Leader on every ward. Come on Dave, we have all of them already – everywhere. What is lacking is not the titles, but the numbers…on the ground. As part of the discussion forum in a recent Guardian article discussing the pending “radical shake up", blogger "schrodingerscat85" dismisses Dave’s ideas and, well, just makes great sense:

"I am a qualified nurse working on an oncology and palliative care ward, and I think this is ridiculous. What do they think we do if we are not making sure our patients are comfortable? Every time I see one of my patients, whether it is whilst administering medication, assisting with a wash, helping them to the toilet, or just going in to a bay to get something, I am talking to them. We do not need prescribed hourly 'rounds' to do this.

In any case, I do not know how this would work. It takes at least 90 minutes to complete a morning medication 'round', then making up intravenous medications. After this, I will catch up with my HCA to make sure all our patients are washed and comfortable. By this time, patients may be being discharged (paperwork, phonecalls, chasing up other services- 'discharge facilitators' who sorted all this out for us were recently made redundant) and family arrive on the ward, often wanting to discuss their relatives progress. Whilst this is going on, people are requesting pain relief (generally controlled drugs, two qualified nurses to administer), become acutely unwell, die, need tracheostomy care, need dressings changed, need the toilet etc etc. If we stop every hour to do a 'round' then patient care will be affected negatively- how will people get medication, pain relief, blood transfusions etc in a timely manner if we are spending our time on this guff? This will only be another piece of paper to sign and file, and then be audited.

In addition to this, all wards have a senior sister / ward manager / team leader who manages the team and oversees standards and care on the ward. This has been the case for as long as I can remember, so I don't know what Dave is talking about. "

We better be careful what we wish for. We need a balance, some synergy if you will. Former Matron Hazel Halter offers us an insight into an era we will never have again in terms of hard graft and respect. However Modern Matron Hilary Loftus  [He is real isn't he?] offers us an insight into the perils of taking the training manual to bed.

Have a good shift “schrodingerscat85”

Putting the boot in............

I think I may be in trouble with this posting…we’ll see.

The papers last week [and media in general] were awash with stories about a rugby team/Fleet Street/ poor independent nursing care in elderly patient’s houses and, again today, with a rugby captain- all accused of bringing their businesses into question over integrity and professionalism.

I used the shenanigans [or reported shenanigans] of the England Rugby Team as an example last week in a session [I know, as a Scot, I accept my first “be careful” from you] to explore and unpick with a group of nurses and health care support staff the meaning of professionalism, professional practice and what happens when it all goes wrong.

Being hot off the press, there was a lot to talk about but there was also that luxury of being able to critique, but not criticise. The opportunity was too good to miss, to analyse while on neutral territory - what is professionalism and what makes “you” a professional.  Not always an easy one to facilitate as it can spark heated debate especially with different groups of healthcare staff in the same room. 

Now, the Nursing and Midwifery Council, as gatekeepers, make a good case for what is appropriate in the role of a nurse and midwife and set underlying rules on what a professional must do within the code. There a four core principles of the code for trained staff and they give direction but, alas, no solid template for those in support roles:

Make the care of people your first concern, treating them as individuals and respecting their dignity.

Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community.

Provide a high standard of practice and care at all times.

Be open and honest, act with integrity and uphold the reputation of your profession.

Being the facilitator last week, with most of the cards up my sleeve, I wasn’t expecting

“Hello…it’s you isn’t it…the man who was clamped?”

Now as introductions go, that’s a good one! Left field for sure.

It transpired that an impromptu anecdotal story to explain professional behaviour [damn that media projector] I gave to a large crowd of promising student nurses [and their collective parents/partners/ children] on a university open day, was evidently more interesting than I thought. 

While trying to kindly ask two sizeable wheel clampers to remove a clamp from my front wheel on a very damp late afternoon [just after work] in a train station car park in North London, let's just say that feathers were ruffled. To cut a long story short, the clampers were illegal and brazen. 


With a large wheel wrench in hand they were pretty secure in their aspirations that my wallet would be a few hundred pounds lighter that afternoon, before I went on my way. It’s true to say that a small scuffle [note: pushing and general shouting] took place and it was only when I caught the reflection in my car side mirror of  me wearing my NHS name badge that I stopped in my tracks – I knew the consequences, professionally, of a vigorous push becoming a living nightmare and my NMC Registration being put at risk [the Register, quite rightly, is well protected]. The boys in blue were quick on the scene to remove the wheel brace from my facial vicinity but nonetheless, it could been a different story. The moral remains, you are always on duty- "professional" duty.

So interestingly then that a recent publication sheds some decent guidance, where the NMC fail consistently to, on what professionalism actually is and what you really need to do to be a professional within the delivery of healthcare. A research report from The Health Professionals Council (HPC) offers helpful wisdom about the term professionalism and clarity on it’s meaning:

"It is not perceived as an absolute, but constructed in the interaction of individual and context."

The HPC offer :

Definition of Professionalism

Adherence to codes / regulations / protocols, appearance,

appropriate behaviour / attitudes / communication, context, development over time,  external perceptions

good clinical care, holistic construct, ongoing development (keeping up to date), part of self and role boundaries

They also note contributing factors to professionalism as being:

Source of Professionalism

Education / training, learning on the job, organisational environment, personal background, previous employment (paid / voluntary), regulations as source, role models and, the media.

 I think we’ve seen enough in the media last week about what professionalism is not.

Let’s hope the healthcare and education professions are represented/reflected fairly and come across well in the media this week during the planned strike action.

Britain's Hidden Army -Load your pencil case ...aim...fire

         
If like me you are still licking your lips after a slice of cake and a lovely cup of coffee at your local Macmillan Cancer Support “Worlds Biggest Coffee Morning” event last Friday, then you should  feel glad that your contribution has gone a long way to support the great nurses and support staff who work across the Macmillan teams.

I have had the privilege to have a clinical and educative involvement with Macmillan Cancer Support over a number of years. Their involvement with families at a grass root level so soon after the worst of all health news is broken, and anxiety and helplessness sets in, is second to none.  However, little is known about their work,  their holistic approach to supporting families and particularly children and young people who find themselves helping to care for a parent, guardian or sibling. 

                                                           
The term Young Carer  is not new but probably one we feel a little confused about as to its full meaning, or our possible input as professionals in education or health and social care  or in a policy making capacity.


Children and young people are likely to have jobs around the house as part of regular family life and want to add to pocket money for sure but where is the line between washing the dishes and say, washing your mum?


How normal is it to be responsible for organising your younger siblings breakfast and then making sure that dad has had his medications before you head off to school . Not that normal really for most children but a growing concern. 


It will soon be the BBC Children in Need 2011 campaign and following last years round of great appeals, the plight of young carer’s was highlighted in terms of the "hidden army" (please spend some time to consider the audio and video stories).

This year’s BBC Children in Need will revive our awareness as to the intimate involvement children and young people have in the care of a loved one and already funding for young carers is being discussed as a national concern.


I see in today's media that the Health Lottery (with Melinda Messenger as their new TV presenter) is promoting its credibility on the back of the funds that will be directed to young carers (seriously …only 20p in the pound going to charity....shame on you). I am not plugging that one, you can find it for yourself.
So in the real world, a prominent name in the drive to raise awareness of the work of the hidden army of carers is Professor Saul Becker  who is a well published and respected contributor in this field. Dr Jo Aldridge and Chris Dearden and are also invaluable contributors as is their work with  Loughborough University’s Young Carers Research Group.

Probably a better known personality to be affected by the experience of being a young carer is X Factor’s new judge Tulisa Contostavlos (although in the Education and Social Care arena.... Saul Becker is huge). Regardless of your thoughts regarding Cowell’s weekly pantomime of nonsense (sadly my children are hooked), Tulissa presented a touching and stripped back account of her experiences as a young carer on BBC 3 in Tulissa: My mum and me  

The programme offered an enlightening insight into the separation anxiety and pressures experienced by young people who grow up far too early. 

Britain’s broken, Britain’s sick

Following the recent riots in parts of the UK, the picture of childhood, or at least early adulthood, seems to have been imprinted firmly on our minds of feral children: hooded gangs either legging it into a looted shop or legging it out, adorned in new shoes or carrying a flat screen telly. Sky TV...you are naughty.

          
With the dust having settled and glass swept away, attention has turned to identifying and criminalising those involved. We now learn that David Cameron’s “Broken Britain” and the association with said young people, may not be as it seemed. Statistics have shown [despite the rolling TV coverage] that the vast amounts of children and young people were little more than spectators on the whole - obviously the large numbers shown on TV were not caught but many appeared to be adults and data remains scant regarding the numbers of perpetrators being from the care system.

As a viewer, the rolling coverage did serve as a talking point with my own children. However, there was no apparent solidarity to join the masses masked and in need of new shoes. 

Thankfully.

Given the blame being pointed at parental control [or lack of], my family appear to have done well to influence our children on the straight and narrow- so far.

Thankfully.

Not so fast though at self-praise.  Just where is the line between observation and discussion during the news and, our own children tooling up and having a go at the glass frontage of the local Argos?

According to initial comments from David Cameron "Plc", it was obviously an easy one:  it's all due to broken families, broken homes, broken lives and, wholly, the fault of a failing social care system and dysfunctional families. No high horse then, it is the Big Society after all.

The vulnerability of families in, or very near, the care system may just have made a faint blip on the radar of professionals involved in the health and social welfare of children and young people but it has not escaped others.  One blogger whose profession is as a family lawyer recently identified: “ … I won’t have been the only family lawyer watching the cctv footage of the looting and violence with fingers crossed, hoping that I won’t see one of my care clients or their children peeking out from under a hoodie. I’d like to see the stats on the proportion of care leavers, looked after children, and children with a CP [Child Protection] or CIN [Child in Need] Plan.”  

There may not have been an obvious avenue for those directly involved in the healthcare of children and young people to consider while watching the coverage of the riots, but look around...the gauntlet has been well and truly thrown.  The statistics on looked after children are easily found and are the numbers are worryingly increasing with typical examples in the press now being reported.

Reflecting on previous job roles I can speak with experience of supporting children in the care system over a twenty year period from clinical roles to education: as a neonatal nurse [while working in one post in middle England] and having to explain more regularly than I wished for to teenage girls of 12 and 13 yrs old in the presence of their social workers that the imminent births of their babies would likely require a stint in the neonatal unit. Also, as a looked after children’s nurse (or LAC nurse) in inner London, when children and young people would typically [as was a reflection of other areas] spend most of their lives being cared for in and out of the borough [with families from Land’s End to Aberdeen] up to a dozen times in their scholastic school life - they may have reached late puberty without ever having seeing a dentist or a GP, never mind their immunisations having been completed. All wrong, very wrong.  

The personal experiences of children within the care system have been previously aired on BBC Radio 4's Womans Hour, on BBC Panorama (*) and more recently with Lord Adonis lending weight to raise awareness. Little may have changed when reading recent reports over the past few months regarding rising numbers of children entering the care system, with effective strategies not in place to cover increasing job cuts with social workers and, children and young people taking solutions into their own hands.

It is worth exploring therefore that health professionals who come into contact with vulnerable children and young people should fire on all cylinders and learn from each other to play detective when admitting or caring for a child who is in the care system. We should anticipate the likelihood of such an encounter happening given current statistics showing them as being in higher risk groups: teenage pregnancy, lower educational attainment, depression, alcohol and substance abuse and other health concerns related to potential poverty of children who are looked after by the state.

So, to fellow professionals, get yourself on local child protection and vulnerable children awareness study days and acccept the likelihood of meeting a child or young person in the care system – a hoodie is not likely to worn on that day or ever. Embracing a hoodie is unlikely either!

               

Despite the forthcoming new series of Jacqueline Wilson’s award winning fictional children's home resident now carer, Tracy Beaker [whose depiction of life in care is that of as a Nancy Drew heroine [of a fashion], can I remind the medical students whom I met at a recent study day........ please [please] don’t base your knowledge of children in care on that alone.

Anyway, children's care homes may soon be gone, long gone.......... 

[* sorry, will not link via ipad: try  www.bbc.co.uk/iplayer/episode/b00v77vn/Panorama_Kids_in_Care/  ]

Switch it off ..wait a minute and try again

Thank you to the geeks at Blogger... we are now back online....


They're good....indeed very good....they're just not quick though!!


Anyway, thank you to those interested and for your messages behind the scenes.


Forthcoming blog... Looked After Children. Inspiration came from a teaching session last week with a group of senior medical students who said "Looked after what? Is it just like Tracy Beaker??"


Eh...no!