The Care Deficit

                      

                                       
Can you teach someone to care? This could be the shortest blog so far because the answer is no. People come in all shapes and sizes but you can roughly divide them into two groups; those with a warm heart and those without. It’s a kindness thing, a basic ability to empathise and if you haven’t got it, no amount of teaching is going to help. So should we all just give up now? Again, no, keep reading.

Whatever the headlines, it’s not just nurses. If you go into a shop you are most likely to be served by someone who’s competent and friendly but there are the shop assistants who carry on talking about their night out when they serve you and those who simply ignore you. No big deal, but transfer this into a caring profession and the people who struggle to understand the needs of others have a much bigger impact.

The chief nursing officer for England, Jane Cummings, is right to say that there is too much poor care in our hospitals but is it a wider problem? Could it be a symptom of a much bigger issue in our society?  Like most big, national organisations, the culture of the NHS is a reflection of our culture as a whole so it shouldn’t surprise us that some care staff are failing to care. Compassion is becoming an endangered quality. We notice it more when we’re thrust into the intense and unfamiliar environment of a hospital and where simple acts of care and kindness can make such a big difference to the lives of patients and those around them.

Let’s not fall into the tabloid trap that all nurses are “angels” but equally, not all patients or families are easily definable either. If we want to understand this issue then we also need to shine a light on the often unmentioned difficulties facing health professionals. Anyone working in the NHS can tell you about toys stolen from children’s wards, even bedding or curtains being taken from family areas. Then there’s the elderly relative or even a sick child being dumped at Christmas or holiday time because no one wants the stress of looking after them. 

Yes, it breaks my heart too and yes it is extremely rare but it happens. In 21^st century “caring” Britain nurses also regularly face people who are drunk and aggressive, people who are dishonest, people who are trying to play the system for everything they can get. And then there are those with dementia and mental health problems who deserve every single ounce of kindness and compassion but who can be challenging to deal with and the lack of training in this area is already well documented. It’s not a pretty picture but if we’re to stand even half a chance of solving the crisis of care in our hospitals we need to have a very real debate, not one that paints hospitals, and modern life, in rose-tinted nostalgia.

The good news is that most of us have a heart and although you can’t teach care, with good training and proper support we can nurture kindness and balance compassion and competence alongside clinical excellence and care.

Improving care comes done to a simple battle between good and bad but it requires a much less simple ability to empathise in the face of difficulty, get your hands dirty, stick your neck out and do what’s right, even when time, and the times we live in, are against you. If we can teach right from wrong, teach strength and courage over the easy way out, then we can address the care deficit. If we can find the nursing leadership to deliver that, their next task is to look at the rest of our society.

Links

BBC Radio Four, Call You and Yours, have we forgotten how to care? 

Lynne Wilson
Guest Blogger

Fifty Shades of Grey …. Matter

Builders and make-up artists agree on one thing. A good foundation counts for a lot. Now neuroscience is backing what a lot of parents have always believed and hoped, the foundations you lay in the early years can have a positive impact in later life.

A 20 year study led by Martha Farah, from the University of Pennsylvania, has found that mental stimulation around the age of 4, leads to greater brain development, including development of the cortex and language comprehension.

Not only did the researchers look at the books and educational toys a child was exposed to but also the support and care given by the parents to the child around that age. The data, including home visits and brain scans, showed a correlation between early years stimulation and the way the brain could function in the teen years.

This is not just good news for parents but for health professionals and anyone involved in the care of young children. This “magical” period, around the age of 4, when a child’s brain is sensitive to so much around them is a great opportunity to optimise wellbeing and skills needed for later life. It encourages anyone working with youngsters to look at what’s around them, what stimulation they’re getting. Not just material things like books and toys but warmth and support, and those two things can be especially challenging in a busy hospital or caring environment. It’s what play specialists and therapists already understand, it’s not just about making today fun but about building that all important grey matter, layer by layer.

The good news is that the average four year old is so much more receptive to any kind of adult input than the average teen. So although your fourteen year old may look at you as if you couldn’t possibly have anything useful to say (ever) just remember all those bedtime stories you read, the questions you answered and the stuff you took time to explain. They won’t thank you for it but somewhere there’s a part of that teenage brain that’s working just that bit better because of you.  

Consider this

...and this 

Lynne Wilson

Guest Blogger

Digital Kids

                     

“What’s the parental security code on the tv?” I ask my 11 year old daughter. She rattles off the four digit pin. After a couple more questions about HDM1 versus HDM2  I’m happily watching my recording of Grand Designs while my daughter wearily shakes her head and goes back to her ipod. 

Digital kids eh, if they’re not filling up the recording box, they’re laughing at your lack of followers on twitter or, worse than any of that, giving YOU a tutorial about how to use your own TV!

Ever since the heady days of being allowed to eat sausage rolls in the living room while watching The Generation Game I’ve held a few unshakeable beliefs about television.  These are mostly centred round the principles that too much is bad for you and it shouldn’t be on if you’re not watching it. Recently I’ve added a couple more such as the more channels you have, the less there is to watch and don’t let the dog have the remote but overall the sentiment remains, use it properly and it’s a force for good.

But that’s the problem, what is “proper” use of the big/small screen for the digital generation? It was easy for my parents, children’s programmes were only on for a short time each day and even the presenters on those were urging us to go out and do something more interesting than watching TV. I wasn’t allowed to watch ITV just the BBC (because “we were paying for it”), imagine trying to stop the kids watching X Factor with that logic!

Now, even babies have 12 hours of TV just for them and that’s before they can talk or walk.  Throw in other screen distractions such as addictive birds with anger issues, war games and any number of ways to interact via screen time and it’s a heady mix of free babysitting and 24/7 entertainment. So when does harmless entertainment become a health risk? And, more importantly, if too much time on the sofa is bad for healthy kids how much more complex are the issues for youngsters already living with health problems? Limiting screen time for kids who can easily go and do something else is tough enough but what about youngsters with more complex needs?

It might not feel like it when all you want to do is watch your favourite programme and can’t quite break into your own security settings but TV, and screen time in general, is not the enemy. The challenge is how and when to use it. Social media can be a lifeline for anyone with communication problems, as the daughter of campaigner, Tony Nicklinson described movingly in a radio interview shortly before her father’s death. Twitter, she said, had given him a voice and he loved being able to talk directly to his thousands of followers in a way he couldn’t with any other medium. Similarly there are stories of youngsters who love one particular show, character or game with powerful and liberating results such as sharing that common interest with others and escape from anxiety or pain.

This digital generation has an unlimited and thought-provoking world of education and entertainment at its very fingertips. The best we can do is make sure they know how to use the off switch. Let’s face it, they’re more likely to know which remote to use for that than we are.

Bringing up Britain – challenges facing the digital generation – BBC Radio Four

Lynne Wilson
Guest Blogger

Compassion is costly

The Duchess of Cambridge used her first official speech on foreign soil to praise hospice care.  

While visiting a centre in Malaysia she described the support given to the terminally ill children as, “life changing.”  What a great way of putting the work of the hospice movement onto the world stage. What better way to raise awareness and appreciation than the backing of such a high profile Royal and the positive media coverage it would attract. Ahh, coverage, there was the problem.

When the Duchess walked forward, looked at her audience just a little nervously and delivered her carefully prepared speech, all about care and compassion, she could have little idea that on the other side of the world a magazine Editor was planning to disregard any notion of care or compassion for her and was making calculations of an entirely different kind, based on money, sales and sensation.

Within a few hours of the speech being given the front pages were not devoted to the ringing endorsement of hospice care, they focussed on coverage, or rather lack of it, of a very different kind. Even though newspapers in the UK didn’t print the actual photos it didn’t stop the issue dominating the news agenda.  That, in itself, is not the problem. Privacy and the treatment of the young royals is an important issue, not least because of what happened to the Prince’s mother,  but we have a media in this country that tends to underestimates the ability of the audience to understand multi layered stories  so “topless” became the story almost to the exclusion of everything else.

The Duchess’ speech was important, not just because it was a first, not only because of who she is, how she sounded and what she was wearing but because centres providing hospice care are relatively rare in the Far East. Palliative care is a growing area of expertise and is becoming increasingly available and understood. This makes the Duchess’ support even more important and raises some big questions. Could she become a worldwide champion for palliative care, able to highlight the difference it can make to children, adults and whole families? If so, what global impact might that have? What possibilities for the care of the dying around the world? These are big questions with potentially life changing answers.

Topless sunbathing,  peeping tom photographers, privacy for the Royals? There could be an answer to those questions in the French courts this week but it won’t change my life and I suspect it won’t change yours and it certainly isn’t as “life changing”  as what’s going on in the hospice in Kula Lumpur, and hospices around the world, right now.

Useful reading:

http://www.malaysianhospicecouncil.org/

Lynne Wilson

Guest Blogger

"I am what I am"

Over recent weeks we have been introduced to some of the fittest and fastest humans on the planet. And yet they are also some of the most disabled and impaired. The Paralympics has raised all sorts of questions about our understanding and our attitudes and also, our use of the word, “disability”. How can people so breathtakingly able, be described as disabled? One Paralympic swimmer pointed out that he was far better in the pool than most able bodied people so who’s got the disability?”

The word inspiration has also come in for some stick. A caller to BBC Radio Five Live said he was fed up with people coming up to him in his wheelchair and asking if he’d been inspired to run or swim or play sport as a result of the Games. His reply?  “You’ve got two legs,  does that mean you’re gonna start running like Usain Bolt.”

We could spend the next decade debating the pros and cons of all the available words and how inadequate they are, we could waste that time and still the world would be no fairer, no more equal. I’ll never be able to run like Usain Bolt or Jonnie Peacock for that matter but it doesn’t mean I can’t be inspired by them. Fresh from watching Bradley Wiggins I did what a lot of people did and dusted off my bike. I haven’t cycled for about a year but as I pushed up the hill, resisting the urge to get off and walk, I had Bradley’s flat back and grim determination in my mind. I made it to the top and my teenage son was very impressed (and slightly relieved that the heavy breathing wasn’t life threatening!) Small steps, but isn’t that how every journey begins.

Let’s not get stuck on the sidelines with a list of words in one hand and a big red pen in the other. Words are never going to be enough for the feats of strength, agility and speed we’ve been watching. Feel the moment, cherish that feeling and if it makes a difference to you consider yourself a hero, or even an inspiration.

Some good listening......

BBC Radio Five Live, have the Paralympics changed attitudes toward disability? 

BBC Radio Five Live, Beyond Disability: Adventures of a Blue Badger 

Lynne Wilson

Guest Blogger

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 to 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.

Even if it is in print...black and white....it's not necessarily true.

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

Think with some cynicism before taking on frameworks to critically evaluate research  or exuding 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

Master these first...don't just 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.