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The ‘Magic’ #Resilience Pill

There are no consistent definitions for what resilience actually is, yet I am beginning to actively dislike the word. It is beginning to sound as though it might be the magic pill everyone within the #NHS might need to take in order to survive. I am not so sure.

We don’t know much about resilience, yet it has been suggested that healthcare professionals need to be supported, not trained in resilience. I am inclined to agree.

Resilience building has a hidden cost in that “By introducing this focus on developing ourselves into “happy”, “positive” leaders one could argue that we are merely buoying ourselves away from, and in effect delaying, what is inevitable – the call to deal with the reality of our current state of play.”

Having ‘resilience’ puts the ownership of survival upon the beholder….. Does this mean that “You have had your resilience training (or ‘pill’) therefore you should be resilient now”? …. Will there be no room to show anything other than a new found ability to ‘cope’?

The NHS is a challenging place to work, and healthcare professionals are doing their best to survive and deliver the compassionate care that they wish to give. So should we be making the NHS a less challenging place to work? or be toughening up those who work there to become ‘resilient’ to adversities?

This is going to be a relatively short post, but I wanted to write down a few analogies that may help us all in thinking about what ‘resilience’ may really mean for us.

If you were being punched repeatedly in the face, would you:

A) Try to become resilient to the pain?

or

B) Try to reduce/stop the punching?

Perhaps a bit of both, but you see my point. The girl in the street who gets attacked does not need to wear a longer skirt, fight back harder or scream louder. Her attacker needs to stop attacking her.

The danger comes when staff feel that they should become more resilient rather than seek support for any pain they may be suffering. NHS staff health is vital to safe and effective patient care, and we would all like to see staff engaging happily with their work.

Yet perhaps the ‘Magic’ #Resilience Pill may actually be the placebo that masks our incredibly valued sensitivity as healthcare professionals.

It has been suggested that:

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking. Resilience may be interpreted as expecting midwives ‘to toughen up’ in a workplace setting that is socially, economically and culturally challenging. Sustainability calls for examination of the reciprocity between environments of working and the individual midwife.”

Whatever the case, it is time to be kind to each other. Always.

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The #WoundedHealer a reflection on #resilience #empathy #Support & #compassion in the #NHS workforce

Last week I attended the Wounded Healer – Helping Each Other to Care in the Modern Health Service conference on Tuesday 15th September 2015. I have a certificate to prove it and everything 🙂

I have spent the whole week reflecting on this conference, which brought together many experts who are passionate about exploring the plights of the wounded healer, and supporting those in need to care compassionately in challenging healthcare workplaces. There were also many who shared their own experiences of being a wounded healer (Including me)! Many had left the profession, moved to another part of the profession, or were still struggling to cope in challenging times. These stories were powerful, moving and also uplifting, as we also heard many stories of recovery. The main challenge of the day was of course focused upon finding new ways to help each other in practice to care compassionately in the way we all want to when we enter the health profession as ‘eager & excited puppies’ wanting to change the world.

This conference was facilitated by the practitioners health programme (PHP). The NHS Practitioner Health Programme is an award winning, free and confidential NHS service for doctors and dentists with issues relating to a mental or physical health concern or addiction problem, in particular where these might affect their work. The conference was also led by the Medical Director of the PHP, Dr Clare Gerada (). Clare is one of the advisors to my own research project, and I always draw so much strength from her knowledge, passion and wisdom. I am sure I will be consulting clare again once my Delphi Study has drawn its conclusions.

One of the highlights for me was meeting Professor Jill Maben, Director of the National Nursing Research Unit at Kings College London. Her work focuses upon the workforce issues facing today’s nursing populations (). Jill disclosed that she had left clinical practice as a result of unhealthy levels of stress in the workplace. She outlined to all of us her own work in discovering how new nursing students are indeed ‘eager & excited puppies’ wanting to change the world. These students quickly then realize that these dreams may never become a reality in the current working cultures of the NHS. As a result, they may choose to give preferential treatment to ‘favored’ patients or ‘poppets’ (Maben et al, 2007). I myself was privileged to finally make contact with such an inspiring research team.

We also heard from Professor Ivan Robertson, Mr Julian Lousada, Mr John Ballatt & Dr Penny Campling who all spoke about the importance of intelligent kindness, compassion for one another in the workplace and about how challenging workplace behavior may actually indicate a deeper pain. How do we cope? Do we deflect our pain on to others?

My thoughts were “Unkind people are unhappy people” and perhaps this is why we are seeing a lack of compassion between colleagues in the workplace. Those who display adverse behaviors need support too. There were certainly some stories of challenging workplace behaviors that suggest that this might be the case.

It was suggested that NHS staff enjoy hard work in their profession of choice. But this demanding work is only satisfying if it is matched by adequate support, resources and control.

This was followed by reflective sessions where professionals shared their own experiences, suggested advice for others and new forms of support. I think I was the only midwife there, and I am still concerned that there is little focus placed upon the well being of other nursing professions. I always find it cathartic to reflect among my own kind. I may have been the only midwife, but we are all one big professional family. This is my tribe. The people that understand and can empathize with the wounded healer. I hope that our insights can propagate among those who need it most.

The workshops that followed included:

Dr Derek Chase – Mindfulness and its Benefits

Dr Jane Marshall- The Addicted Professional

Dr Caroline Elton – Under the White Coat

Dr Peter Ilves and Mr Nigel Praities – GP’s, Resilience and Burnout

Mr Gary Marson, Dr Clare Gerada and Ms Pip Hardy – The Wounded Healer

Ms Debbie Sandford – Schwarz Rounds

Although these workshops largely focused upon the experiences of GP’s & Doctors, I could consistently relate the issues being raised with any other healthcare professional to a higher or lesser extent. The issues remain the same in any healthcare profession.

Along with the health practitioner programme, the  were referred to as a valid source of support for health care professionals. Schwartz Rounds are a multidisciplinary forum designed for staff to come together once a month to discuss and reflect on the emotional and social challenges associated with their jobs. The rounds are designed to offer emotional and social support for staff – not look for clinical outcomes.  Yet my concern is that these rounds require face to face talking and the time to attend a meeting at the planned time and location. I hope that the online intervention I intend to build in order to help midwives in distress can compliment these rounds in supporting all health care professionals in time.

For more information and reflection upon this conference, I would like to direct you to this blog post by Jonathon Tomlinson, as it holds some great references to other reflections and narratives in relation to the wounded healer.

I would particularly like to quote this from his reflective blog “There is a distinction between strength – to carry on regardless, and courage – to admit ones’ vulnerability – which is key to overcoming shame.”

It concerns me that the NHS may indeed be unwell. I reflect lastly upon the NMC Code of professional conduct which states that nurses and midwives must: 8.7 be supportive of colleagues who are encountering health or performance problems. However, this support must never compromise or be at the expense of patient or public safety.  We are in fact duty bound to look after one another for the safety of patients and the public.

So be excellent to each other.

Always.

Maben J, Latter S, Clark JM. The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal qualitative study. Nurs Inq 2007;14:99–113. doi:10.1111/j.1440-1800.2007.00357.x

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The Emotional Labour of Care

This resonates so much with my own experiences of caring and the experiences of others who have come to tell their story. Re-blogging in support of a subject close to my heart. Working on the solution.

A Better NHS

A response to Medicine Unboxed Voice 2013

I was 17 years old, working as a health care assistant on an elderly care ward at Winchester hospital in 1988. I remember a morning shift when I was responsible for helping six patients get washed and dressed. No matter how demented or unaware of their surroundings, we wanted every patient to be properly dressed and “sat out”. Maureen was 81 years old, suffering from Alzheimer’s disease, her confusion compounded by a recent stroke and a urine infection. She was lying in bed, calling out, “Na! Na! Na! Na! Na! Na! Na! Naaaaaa!” I pushed my trolley with a bowl of warm soapy water, wipes, fresh clothes and clean linen up to her bed and pulled the curtains around. I squeezed her hand and said, “Good morning Maureen, I’ve come to help you get ready for the day”. She looked at me and…

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Designing a platform to support midwives…The Research Protocol is out!…are you in?

As I was preparing for my yearly performance review this week, I had a new maternity unit want to learn more about my research. More and more people are wanting to join the swell of participants, willingly giving their time to help shape the design of a platform designed to support midwives in psychological distress. This is becoming a powerful collective movement just in time for the launch of the first round of Delphi questioning. By the end of this month I will be sending out the questions whose answers will shape the design of an online intervention. These are indeed exciting times.

Midwives online support

I wanted to thank those who have shown a last minute interest in taking part in this study. Your opinions will be valued ones and I cannot wait to see the ideas and opinions that will shape this project. There is still time to get involved if you, or someone else you know would like to enhance the evidence base for this project. You can read more about becoming involved with the project here.

For those already invested, I wanted to share the full protocol with you in the interests of transparency. This has now been published within the Journal of Medical Internet Research protocols, and you can read it in full here or below.

Pezaro, S, Clyne, W (2015) Achieving Consensus in the Development of an Online Intervention Designed to Effectively Support Midwives in Work-Related Psychological Distress: Protocol for a Delphi Study. JMIR Res Protoc 2015 (Sep 04); 4(3):e107

This paper details how this study will generate a consensus around the development of an online intervention designed to support midwives in psychological distress. With your involvement and support, the ideas you contribute will inform the design and build of a new platform, which I hope will go on to make a difference.

Thank you to all of you for showing your support and giving your time to this research. I am so looking forward to launching this study with you in a couple of weeks! – Until then my friends…be excellent to each other.

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#Expo15NHS #MatExp & #HealthyStaff4HealthyPatients: Sharing passion for #NHS staff well being at @NHSExpo

As I come to the end of my 1st year as a doctoral researcher, I have also become very busy in preparation for my yearly performance review. I am definitely keen to share all of the exciting work I have been doing, and I hope the performance review panel will share my enthusiasm for this research journey. It has certainly kept me busy, hence the lapse in blog posts!

This week I had an inspiring experience at the #Expo15NHS conference with colleagues from @NHSEngland@NHSEnglandPX , @MKHospital@CovUni_CTEHR and @SheffieldHosp. The agenda was jam packed with the showcasing of innovative ideas, new models of care and collective movements for positive change. I was definitely among my ‘Tribe’.

As I moved from presentation to presentation, chuckling at the amusing quips from @RoyLilley I quickly saw the widespread passion for creating a healthy future within the NHS. The exhibitors were also really inspiring, and it was amazing to see new technologies emerging within health and social care. Secretary of State for Health Jeremy Hunt MP challenged the NHS to ensure all patient were able to access their full medical records online by 2016, accompanied by a commitment to a review of data security. I know that there are many change agents ready for this challenge (myself included). I am indeed excited for the future.

Day one of #Expo15NHS saw NHS England Chief Executive Simon Stevens announce major new work to support NHS staff to improve their own health and wellbeing, with specialist packages for GPs suffering signs of burnout. This of course was music to my ears. I am now even more certain that the research I am doing to support healthcare professionals (starting with midwives) in psychological distress is relevant, powerful and firmly on the national agenda.

This theme of NHS staff well being dominated NHS Expo. As such, I was keen to follow this with the honor of presenting a scoping view of the literature in relation to #NHS staff health and well being, and exploring the impact that staff health may have upon work performance and staff engagement. Delegates, commissioners, clinicians, academics and policy makers came to this seminar in search of supporting healthy staff for healthy NHS organisations. It was encouraging to see that this seminar had been over subscribed to in advance of NHS Expo. Indeed, some people were turned away from the session!

NHS Expo

Myself and Rhian Bishop (Staff Engagement Lead at Sheffield Teaching Hospitals Foundation Trust) presented workshop 20 of the pop-up university sessions at @NHSExpo : Improving staff experience to improve performance….

The session focused on the impact staff engagement and experience has upon organisational performance, specifically patient experience. The session was aimed at commissioners and policy makers, and outlined why staff experience is so important. It also offered examples from an organisation has has improved staff experience to great effect.

This session was very well received. I saw smiling faces, engaged thinking and delegates taking notes. So I wanted to take this opportunity to thank those who shared our passion for the health and well being of #NHS staff at NHS expo. The future definitely looks brighter in this respect now that we have you on board.

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#MatExp @ #Expo15NHS

Aside from my own session, I also wanted to raise the profile of an amazing midwifery movement known as #MatExp. #MatExp is a powerful grassroots campaign using the Whose Shoes?® approach to identify and share best practice across the nation’s maternity services. I had the privilege of becoming a part of their seminar at NHS Expo. Their enthusiasm is contagious! They engaged all of us to reflect upon the importance of kindness, empathy, and compassion in midwifery care. As I reflected upon my own practice and personal experiences, I also reflected upon the need to show ourselves compassion, look after colleagues and create #healthystaff4healthypatients. I am definitely proud to be part of #MatExp ..they are raising the profile of the midwifery profession and flying the flag for better maternity services. I hope the #MatExp crew can become a part of this research journey and share their rich wealth of knowledge and experiences.

But for now…In the words of Bill and Ted “Be excellent to each other”….