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Exploring ‘obstetric violence’ and ‘birth rape’

trauma hiding.jpg

Recently, the wonderful Ibone Olza (Perinatal Psychiatrist and Childbirth Activist from Childbirth is Ours, Spain) contacted me about her work on obstetric violence, birth rape and professional trauma. After reading her papers and watching her present her work, I was compelled to document and reflect upon some of the issues raised, here.

The following points are made within the paper: Fernández, Ibone Olza. “PTSD and obstetric violence.” Midwifery today with international midwife 105 (2013): 48-9.

Birth trauma has been defined as “Actual or threatened injury or death to the mother or her baby” (Beck 2008). Yet such trauma lies in the eye of the beholder, therefore, any trauma experienced by either the mother, newborn or the birth attendant may be due to a subjective experience of stress which does not need to fit any particular criteria necessarily. This means that some traumatic events may be subjective in their nature, and as such, we cannot judge what may or may not cause another person trauma. It is a personal interpretation or perception.

A meta-ethnographic analysis of studies about women’s perceptions and experiences of a traumatic birth reported that women are often traumatized as a result of the actions or inactions of midwifery staff (Elmir et al. 2010). Whatever, such inactions or actions may be…women often use words such as ‘barbaric’, ‘intrusive’, ‘horrific’ and ‘degrading’ to describe their mistreatment (Thomson and Downe 2008).

For Hodges, drugging or cutting a pregnant woman with no medical indication is an act of violence, even when performed by a medical professional in a hospital. Inappropriate medical treatment is also clearly abusive, although few women are aware that this is deliberate mistreatment (Hodges 2009).

The term ‘birth rape’ has been used by women who feel that their bodies have been violated. Kitzinger highlighted that many women who have experienced a traumatic birth display similar symptoms to rape survivors (Kitzinger 2006). The video below explores these issues in greater detail, as we can hear the lovely  Ibone Olza  sharing this work.

 

One of the things I was most encouraged about, was that  Ibone Olza  considers the wellbeing of the midwifery staff in her work. Birth attendants are often also traumatized by these acts, and may feel powerless to intervene. In a recent study by Beck, 26% of obstetric nurses met all the diagnostic criteria for screening positive for PTSD due to exposure to their patients who were traumatized (Beck and Gable 2012). Being present at  abusive deliveries can magnify staffs’ exposure to birth trauma.

staff use phrases such as…

“the physician violated her”

“a perfect delivery turned violent”

“unnecessary roughness with her perineum”

“felt like an accomplice to a crime”

“I felt like I was watching a rape.”

….to describe the guilt that ensued when they felt like they had failed women or they did not speak up and challenge/question…

Article 51 establishes that: The following acts implemented by health personnel are considered acts of obstetric violence:

  1. Untimely and ineffective attention of obstetric emergencies
  2. Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available
  3. Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breastfeeding immediately after birth
  4. Altering the natural process of low-risk delivery by using acceleration
    techniques, without obtaining voluntary, expressed and informed consent of the woman
  5. Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman

(D’Gregorio 2010)

trauma

Yet whilst people do bad things, it is important to remember that they are not necessarily bad people…

This work explains how professionals may exert obstetric violence due to:

  • Lack of technical skills to deal with emotional and sexual aspects of childbirth.
  • Unsolved trauma. The medicalization of childbirth produces more severe iatrogenic
    complications (Johanson, Newburn and Macfarlane 2002; Belghiti et al. 2011). If the
    professionals do not have a supportive space to reflect or to deal with this aspect of iatrogenic care, they may fall into a spiral of continuously increased medicalization as a defensive strategy. Childbirth is then perceived as a very dangerous event, “a bomb ready to explode,” without realizing that interventions cause more unnecessary interventions and pain.
  • Professional burnout in birth attendants will lead to increased dehumanized care and therefore never-ending figures of women experiencing childbirth as very traumatic.

..and so the challenge will be to identify and address these root causes to ensure that maternity staff are able to provide excellence in midwifery care. My work explores how we might support the psychological wellbeing of health care staff may increase levels of humanity and compassion in care. I hope to keep in touch with Ibone Olza and many others around the world who share the same passion for this work. Together we may collectively work towards a time where maternity workers are psychologically safer, and therefore better able to provide the excellence in care they strive to give.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

References and further reading

  • Soet JE, Brack GA, DiIorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 2003 Mar;30(1):36-46.
  • Creedy DK, Shochet IM, Horsfall J. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 2000 Jun;27(2):104-111.
  • Ayers S, Pickering AD. Do women get post traumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 2001 Jun;28(2):111-118.
  • Beck CT, Gable RK, Sakala C, Declercq ER. Post traumatic stress disorder in new mothers: results from a two stage U.S. national survey. Birth 2011 Sep;38(3):216-227.
  • Allen S. A qualitative analysis of the process, mediating variables and impact of traumatic childbirth. Journal of Reproductive and Infant Psychology 1998;16(2-3):107-131.
  • Beck CT, Watson S. Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res 2008 Jul-Aug;57(4):228-236.
  • Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004 Jul-Aug;53(4):216-224.
  • Beck CT. Birth trauma: in the eye of the beholder. Nurs Res 2004 Jan-Feb;53(1):28-35.
  • Ayers S. Delivery as a traumatic event: prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clin Obstet Gynecol 2004 Sep;47(3):552-567.
  • Olde E, van der Hart O, Kleber R, van Son M. Posttraumatic stress following childbirth: a review. Clin Psychol Rev 2006 Jan;26(1):1-16.
  • Elmir R, Schmied V, Wilkes L, Jackson D. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs 2010 Oct;66(10):2142-2153.
  • Nicholls K, Ayers S. Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol 2007 Nov;12(Pt 4):491-509.
  • Ayers S. Thoughts and emotions during traumatic birth: a qualitative study. Birth 2007 Sep;34(3):253-263.
  • Thomson G, Downe S. Widening the trauma discourse: the link between childbirth and experiences of abuse. J Psychosom Obstet Gynaecol 2008 Dec;29(4):268-273.
  • Goldbort JG. Women’s lived experience of their unexpected birthing process. MCN Am J Matern Child Nurs 2009 Jan-Feb;34(1):57-62.
  • Sawyer A, Ayers S. Post-traumatic growth in women after childbirth. Psychol Health 2009 Apr;24(4):457-471.
  • Hodges S. Abuse in hospital-based birth settings? J Perinat Educ 2009 Fall;18(4):8-11.
  • Kitzinger S. Birth as rape: There must be an end to ‘just in case’ obstetrics. British Journal of Midwifery 2006;14(9):544-545.
  • Beck CT. The anniversary of birth trauma: failure to rescue. Nurs Res 2006 Nov-Dec;55(6):381-390.
  • Beck CT, Gable RK. A Mixed Methods Study of Secondary Traumatic Stress in Labor and Delivery Nurses. J Obstet Gynecol Neonatal Nurs 2012 Jul 12.
  • Perez D’Gregorio R. Obstetric violence: a new legal term introduced in Venezuela. Int J Gynaecol Obstet 2010 Dec;111(3):201-202.
  • Callister LC. Making meaning: women’s birth narratives. J Obstet Gynecol Neonatal Nurs 2004 Jul-Aug;33(4):508-518.
  • Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ 2002 Apr 13;324(7342):892-895.
  • Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open 2011 Dec 21;1(2):e000514.

 

 

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Making Birth better: How research shapes practice #bbresearch17

Indulging in my passion for research, I am today reflecting on my time at  …an intimate conference made into a delightful day thanks to  & …More specifically …    &   …

I personally enjoyed this as a more intimate conference, where deeper conversations could get the brain working on what was really needed in maternity services and health research…Another reflection of the day can be seen on Steller here…

As you can see, we had a great line up for the day, and a fish and chip lunch no less!

Highlights for me include:

Stop sexualising breastfeeding!!!! The great presentation by

Learning about associated with at with

Learning so much about at with Prof. Soo Downe

Getting a wave from miles away from  across the miles sending & midwifery love to us all …..❤️

Powerful words from at …. how do we cope as midwives, & ensure excellence in maternity care?

And of course.. # learning all about making sure that blood goes to baby with  with ❤️

Learning about the barriers to identifying poor shared by prof at  with 🎓

Yet there were a couple of overarching themes that came from the day…including….

 

Thank you to everyone who came to see these wonderful presentations (including those who came to see my own presentation of course – you gave me lots to think about!)!…and thank you all for such an intimate and heartwarming day discussing my favorite topic…Research in Midwifery 😍…

 

And a last word from the Head of Midwifery at Hinchingbrooke  Hospital….(Heather Gallagher)…..

bbresearch

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

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Mindfulness and Self-Care in Midwifery

As my main research interests are firmly rooted within supporting a positive staff experience for healthcare workers, especially midwives in work-related psychological distress, I am always looking for new opportunities to share knowledge with others in this area. …The Global Alliance for Nursing and Midwifery (GANM) is a joint project sponsored by the Pan American Health Organization (PAHO) and the World Health Organization (WHO) Collaborating Center for Nursing Knowledge, Information Management & Sharing at the Johns Hopkins School of Nursing. This blog post provides an overview of a webinar session hosted by GANM entitled “Mindfulness and Self-Care in Midwifery:  Review of Current Evidence and Guided Mindfulness Practice.

For a preliminary introduction to this topic – check out an earlier blog post on this topic entitled “Midwife Burnout: A Brief Summary“.

downtimes

Erin Wright, DNP, CNM, APRN-BC, led the conversation…Participants were diverse, and originated from Canada, Peru, US (Baltimore, Urbana, Birmingham, Atlanta, Buffalo), Ireland, UK (Coventry University and School of Healthcare Sciences Cardiff), Brazil, Montserrat, and Trinidad.

The full webinar can be accessed here.

Much of the research covered, has also been captured within my earlier narrative review: Pezaro, Sally, et al. “‘Midwives Overboard!’Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.” Women and Birth 29.3 (2016): e59-e66.

However, there were some new and interesting comparisons made with more recent research here…

“Four common themes have been identified that traverse the different models of care. The NZ study provides insight into how case load midwifery can be sustainable enabling long term sustainability. The UK study highlights healthy resilient practices that enable practice. What remains uncertain is how models of care enable or disable sustainable long term practice and nurture healthy resilient behaviours within the different models of care”.

comparisons

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking as the notion may be interpreted as expecting midwives ‘to toughen up’ in a working setting that is socially, economically and culturally challenging.”

Sources (Crowther, Susan, et al. “Sustainability and resilience in midwifery: A discussion paper.” Midwifery 40 (2016): 40-48.)

So we are now much enlightened as to how and why midwives are experiencing distress, we also have some insights into how they try to cope (or not)…and where this distress may affect maternity services…but what we are yet to learn, is what may be most effective in supporting midwives in work-related psychological distress…although a few clues are emerging….

Mindfulness is coming forward as a potential tool of support..stress management, education and clinical supervision may also be of benefit to midwives in distress…But how, why and how much is not yet clear.

After exploring the literature in relation to psychological distress in midwifery populations, we were all invited to join in some mindfulness practice..What is mindfulness?

Image result for mindfulness

 

Feeling overwhelmed?…TRY….R.A.I.N

RRecognize What’s Going On

AAllowing: Taking a Life-Giving Pause

I—Investigating with Kindness

NNatural Loving Awareness

Source: Mindful.org

relation-ships

Recommended further reading

Youtube presenters:

  • Jon Kabat Zinn
  • Elisha Goldstein
  • Tara Brach
  • Sharon Salzberg

Websites/Audio Links:

Books: 

  • A Mindfulness Based Stress Reduction Workbook (Goldstein and Stahl)
  • Everyday Catastrophe Living (Jon Kabat Zinn)
  • Wherever you go there you are (Jon Kabat Zinn)
  • Mindfulness for Beginners (Jon Kabat Zinn)
  • Real Happiness (Sharon Salzberg)
  • The Mindful Nurse (Carmel Sheridan)

For more mindfulness exercises, visit the UCLA Mindfulness Awareness Research Center.

book-mark

Thanks for a very insightful and informative session!

Until next time…Look after yourselves & each other 🦄💫🎓

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💚💜❤Preventing Birth Trauma at #artofbirth16💚💜❤

Recently, I was asked by Dr. Gloria Esegbona from the @art_of_birth to share some of my thoughts on birth trauma at the latest  summit at Kings College London. My first thought, as always was…. do you mean physical? or psychological?… I was assured that her latest event would be addressing both. Time to learn & grow 💚💜❤

art-of-birth-event-with-sally-pezaro-2016

And so how can we as midwives prevent physical birth trauma?

“we can reduce ventouse to and with left lateral & slow head delivery

“Preventable physical to & caused by poor positions and outdated pushing practices

Quiz – Which methods of pushing during vaginal delivery and pelvic floor relate to which perineal outcomes?

(No peeking at the link to get the answers first!)

#Discuss #GetYourGeekOn

Methods:
-open-glottis technique?
-Valsalva pushing?
———————-
Outcomes:
-incidence of instrumental and cesarean delivery?
-incidence of postpartum hemorrhage?
-urinary incontinence
-Episiotomy rates?
-maternal satisfaction?
-fetal heart rate (FHR) abnormalities?
-Apgar score?

No peeking at the answers link before you comment/answer below!

(We are still awaiting more evidence in any case)!

The Art of Birth is promoting art in the science of to prevent #birthtrauma 

And so what about the psychological trauma and the 2nd victim…the midwife?

Can we begin to understand women’s experiences in relation to psychological birth trauma? How do we revisit the language we use during birth? Can we all be more compassionate in our practice?

I was quoted on this day when talking about “superhero midwives” – healthy, well-supported lead to healthy, well-supported mums. …It is true…so many people wanting to do good….some burning out. Some traumatised.

I thank you all for hearing about my work on the wellbeing of midwives in the workplace.

I had some really great panel questions too…What I loved most about this conference was that I managed to receive lots of  and create  with so many inspiring midwives, doulas, students and others wanting to support each other, share and learn  💚💜❤.. I can’t wait to see some of you in the near future and learn more about how you have turned these lessons into practice. 💚💜❤

Until next time – look after yourselves and each other #GetYourGeekOn 💚💜❤

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Reflecting on the #MaternalDeath report from @mbrrace as a midwife…💜

During the December of 2016, everyone involved in the provision of care for childbearing women (and the women themselves) began to reflect upon the findings of the latest Confidential Enquiry into Maternal Death. As a midwife, I am dedicated to supporting, protecting and caring for other midwives, childbearing women, babies their families. There is no doubt in my mind that these deaths have affected all of these groups profoundly, and society as a whole. But before we begin to reflect, let’s remember that the mortality surrounding childbirth (in the UK) is thankfully rare 

    

 

When we lose mothers…we also tragically effect babies…The Stillbirth and Neonatal Deaths charity (Sands) responds to new MBRRACE maternity report here

There is no doubt that we must learn from all of these  as the president of the explains here. Clearly there is much learning to do and many improvements to make. These key messages should remind us all to ask the question…start the conversation…notice the subtle clinical cues which alert us all to danger, react to risk and remain emotionally intelligent to the needs of childbearing women.

However, what struck me most was the sheer number of women who die from mental health related causes. The MBRRACE report found that “one in seven of the women who died during the period of review died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action”.

Image result for maternal mental health related deaths mbrrace

You can read the ‘expert’ reaction to MBRRACE-UK report citing mental health as main cause of perinatal death here. Maternal mental health matters – toolkit now available from for those developing a community perinatal mental health service.

Learning to save maternal lives and making change happen will not only improve the lives of mothers, babies and families. It will also improve the lives of midwives, as they will be better equipped to give the care they would like to give as their job satisfaction improves. When the psychological wellbeing of midwives is left uncared for, maternity services may see less safe maternity care. When we care for midwives, the safety and quality of maternity care may also improve. This will in turn contribute to a reduction in maternal mortality rates. So when we are looking to improve maternity care for women, their families and their babies, lets make sure that we also look to support those who are caring for them. It really is two sides of the same coin.

What can we promote?

= That it’s “OK to ask”

How can we support women & midwives? = With trust, compassion & respect

How can we improve safety?

= Evidence based care & excellent communication

 

Preventable maternal morbidity and mortality is associated with the absence of timely access to quality care, defined as too little, too late (TLTL)—ie, inadequate access to services, resources, or evidence-based care—and too much, too soon (TMTS)—ie, over-medicalisation of normal antenatal, intrapartum, and postnatal care.

Although many structural factors affect quality care, adherence to evidence-based guidelines could help health-care providers to avoid TLTL and TMTS.

TLTL—historically associated with low-income countries—occurs everywhere there are disparities in socio-demographic variables, including, wealth, age, and migrant status. Often disparities in outcomes are due to inequitable application of timely evidence-based care.

TMTS—historically associated with high-income countries—is rapidly increasing everywhere, particularly as more women use facilities for childbirth. Increasing rates of potentially harmful practices, especially in the private sector, reflect weak regulatory capacity as well as little adherence to evidence-based guidelines.

Caesarean section is a globally recognised maternal health-care indicator, and an example of both TLTL and TMTS—with disparate rates between and within countries, and higher rates in private practice and higher wealth quintiles. Caesarean section rates are highest in middle-income countries and rising in most low-income countries. Although researchers partly attribute the increase and variable rates to a shortage of clear, clinical guidelines and little adherence to existing guidelines, multiple factors—economic, logistical, and cultural—affect caesarean section rates.

Quality clinical practice guidelines need to be developed that reflect consensus among guideline developers, using similar language, similar strengths of recommendation, and agreement on direction of recommendations.

Strategies for enhanced implementation and adherence to guidelines need multisectorial input and rigorous implementation science.

A global approach that supports effective and sustained implementation of respectful, evidence-based care for routine antenatal, intrapartum, and postnatal care is urgently needed.

There is much work to be done. Until next time, take care of yourselves and each other 💜💙💛

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10 Tips for Success & Self-Care for Academics

cozy-dog

Another guilt trip about the importance of self care and being successful? That is why many people will read blog posts like this. We know we should be practising self care and succeeding, but do we really know how to thrive?

(I could not find a concept analysis for either success or self care – please let me know if you do)

We must presume that both success and self-care mean something different to each and every one of us. I am no expert on these topics…. is anyone?…But I think I am pretty good at caring for myself now and working towards success…having learnt the hard way. So I thought I would share some of my hints and tips. Feel free to adapt them, use them, completely ignore them, or ridicule them as ‘poppycock’.

Most people will expect to hear things like:

  • Take a bubble bath
  • Watch your favorite film
  • Curl up with a good book
  • Work hard
  • Network

But I am sure that you know about this kind of stuff already. So let’s look at self care and success for the academic, firstly by identifying the issues that some of us may face.

As an early career researcher, I am frequently told about the stereotyping and inequalities experienced by women in academia. I myself frequently worry about the insecurity of, and problems associated with being an early career researcher, especially a female one.…I worry about where I will find my next job, funding or co-author. I worry about whether I am making any impact at all and whether I will be able to reach my true potential as an academic in the current climate. Academic pressures are in no way restricted to those earlier in their career, many more established researchers are also feeling the strain. These experiences will undoubtedly result in some psychological distress for many academics. So what can we do both proactively and preventatively to improve the lives of ourselves and each other.

Research can seem like a lot of hard work for little reward.

Tip One: Keep your eye on the goal. Visualize yourself being happy, frequently. How would it feel to publish that paper? Get that fellowship? Collaborate on that project? Create your own self-fulfilling prophecy rather than focus on a possible spiral of doom.

How to do this? – Identify what makes you happy, or what will make you happy. Then do more of what makes you happy, or have a real go at getting what will make you happy. I personally love my research work. I know that many other academics feel the same way. Happiness to me is succeeding, making a difference  and making a real impact through my work. The stress I feel is associated with this not happening.

This stress and negative thinking serves no purpose unless it positively drives me towards my goal. Yet who wants to be whipped to the goal posts?  I use visualization as a driver for success. I see myself feeling and being the way I want to be…and I allow myself to believe that this vision will come true. This makes me much happier than thinking about the alternative. So I stick with it.

The practice of meditation may also assist you to work through your thoughts, direct them towards a more positive outlook and allow your goals to become meaningful and achievable.

As these tips continue, think about your own goals for happiness…whatever they may be…think about achieving them in relation to these tips and your own experiences.

I behave in the way I want to feel or be… Surely if I continue in this direction. Good things will come…

Tip Two: The problem of job insecurity for early career academics baffles me as Job security for early career researchers is a significant factor in helping research make an impact. Yet this seems to play on my mind recurrently. It is always a worry. However, worry really does nothing to resolve this issue, and only seeks to get in the way of my progress. In order to progress, I will need to ‘work smarter’ and embrace confidence in my own abilities. Worry and negative thinking has no place in this strategy.

Negative thoughts often lie, and so I swipe them away one by one by placing them on a train that is passing the station (Visualization) – I then sit for a little longer, and imagine the way I will feel and be once I reach my goals. My mood and stress instantly lifts once I do this. I am more confident and feel much stronger. I am ready to be happy.

 

Tip 3: Say No and be proactive – We need to look at what successful academics do. From my observations, they often say ‘No’ to anything that doesn’t suit their own focused agenda (they remove the ‘noise’ and toxicity), they ooze positivity, they are confident, they are assertive, they tell people what they need to succeed and they hang around with the most inspiring people. Therefore, the most obvious strategy is for us to do the same. Say ‘No’ to negativity, and to the people and things which do not enrich us as people. Let people know what you need in order to thrive. Embrace those you feel drawn towards as positive people.

Activity: Making the best of me…

1: Ask yourself how others can get the best out of you

2: Offer what you can realistically do

3: Communicate what inhibits your productivity with others

4: Actively describe what you need from others in order to thrive

Getting the best of me

Tip 4: Express gratitude and forgiveness for enhanced wellbeing. Not always easy, but worth investing in. This task not only unburdens your mind, but allows you to see all of the good things currently going on in your life. Regularly write down 5 things that you are grateful for. Also…try to forgive yourself, and others…often.

 

Tip 5: Address your work life balance as a fluid entity. I believe that the idea of a separate home and work life is changing. This is a good thing. It takes the pressure off and allows you to be a whole person, rather than one split in two…See yourself as a whole being, a working, living and family centred being. You cannot slice yourself into pieces.

See this blog -> ‘Work’ is a verb rather than a noun…it is something we do…not always somewhere we go…

Living in the ‘now’ rather than being at either home or work also allows us to enjoy more of ourselves and our lives. Notice where you are, what you are doing…Smell the flowers, look around you as you move, work, play and just allow yourself to ‘be’.

smell-the-flowers

Tip 6: Eat Sleep move, repeat. It really is that simple, but utterly essential for optimum productivity, stress reduction, health and wellbeing. Eat nutritious food regularly, sleep 7-8 hours a night and move…Exercise, walk, swim, run, cycle…Be outdoors as often as possible.

float

Tip 7: Write. Write your thoughts, your feelings, your ‘to do’ lists, your ideas, your goals down regularly. This not only means that they are out of your head, allowing your mind to be quieter, they are also made real…They are good to share..and worth addressing (when you feel able).

Tip 8: Talk about who you are. There is a tendency to talk about work first. What we do, what we are working on and what we are planning to work on. Start new conversations with how you enjoy your hobbies or your favourite music. This lets other people know that you are indeed human, and it also gives you an identity other than your work persona. Be authentic. It is healthy for you, and others to know the real and whole you. You are fab 🙂

Tip 9: Help other people and accept help yourself. Lift one another up, support colleagues, show gratitude, offer support and guidance where you can. Be a mentor. Be a positive role model. Be the change you want to see in the workplace and accept all of this in return. This will not only make you feel good, it will change the culture of your workplace, and bring about reciprocity for everyone’s success.

LiftEachotherUp_libbyvanderploeg

(Image via http://www.libbyvanderploeg.com/#/lifteachotherup/)

Tip 10: Celebrate the successes of yourself and others. Yes. Focus on the great things that you and your colleagues have achieved. However big or small, these feelings of success will snowball into a self fulfilling prophecy, where you feel valued, supported and part of a team that cares. Some people will feel uncomfortable about doing this, and feel icky when they see others wallow in their own brilliance. But what is the alternative? We all talk about how rubbish we all are? How will that make us feel?…

Spend time reflecting on what you have achieved. Write them down…use these achievements to inform your own vision of yourself…This is who you are. You are great.

As long as the feelings of celebration and success are reciprocated and directed towards others as well as yourself….Let the high fives roll.

Image result for the highest of fives gif

I do hope that these tips will resonate with some academics looking for something new to try. In the spirit of sharing, please feel free to add more tips below.

You deserve to be happy – Until next time, look after yourselves and each other ❤💙💜

 

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Why the health, wellbeing & engagement of #NHS staff matters..financially, practically & morally speaking…

wellbeing-of-nhs-staff-a-benefit-evaluation-model
I spend a lot of my time talking to clinicians, managers, commissioners, those outside of healthcare and leaders about the importance of promoting and supporting staff wellbeing within the #NHS workplace. Some are already on board with the reality that excellence in healthcare simply cannot happen in the absence of a workforce that is cared for and nurtured to thrive. Others feel discomfort at the thought of caring for staff when the ‘patient comes first’ and some simply don’t know what to do for the best. In any case, nobody seems to want to destroy the NHS workforce (correct me if I am wrong)!… and everyone seems to want to learn more.

A good staff experience where staff feel ‘engaged’ is critical to  achieving excellence in healthcare…What do we mean by ‘Staff Engagement’?

‘Institute for Employment Studies (IES), defined staff engagement as a positive attitude held by the employee towards the organisation and its values. An engaged employee is aware of business context and works with colleagues to improve performance within the job for the benefit of the organisation. The organisation must work to develop and nurture engagement which requires a two-way relationship between employer and employee (Robinson et al 2004, p 4).’
Recently, I was asked to provide some evidence as to why the wellbeing of NHS staff matters by someone else who was keen to make a difference in this area. They needed to make the case to others in order to make change happen. I imagine that lots of other change makers will be needing to provide evidence too, and so I have set out some arguments for the case below. I hope many of you will find it useful to have some of the arguments in one place.
Image result for staff engagement nhs employers

Please feel free to share this evidence widely with others…. If you have other evidence to add to this, please feel free to comment below…

(There can never be too much to share)!

Financial reasons to care for NHS staff:

Over 2014/2015, the NHS Litigation authority (NHSLA) paid over £1.1 billion to patients who suffered harm and their legal representatives, this coming year it will be c £1.4 billion and with accumulated provisions in our balance sheet of over £28 billion further significant increases are already in the pipeline. When staff are unwell, in psychological distress, communication is hampered by poor working cultures and there is a lack of staff engagement, NHS staff are more likely to make medical errors (Hall et al, 2016).

Good staff health, wellbeing & engagement = reduced medical errors = reduced litigation costs

Estimates suggest that recruiting a nurse from overseas costs between £2,000 and £12,000 and return-to-practice costs some £2,000 per nurse, while training a new nurse costs around £79,000. Additionally, recruitment costs to replace staff who leave owing to work-related stress and/or poor job satisfaction is estimated to be £4500 (More for senior posts). As such, in order to get best value for money, the NHS will need to work hard to retain and recruit a high quality workforce.

Good staff health, wellbeing & engagement

= Increased recruitment and retention = Best value for money

Staff sickness absence rates cost an estimated £3.3million annually per NHS organisation. When staff are absent, there is the added cost of agency staff to fill in gaps (The NHS Improvement team now expect the NHS to spend a total of £3.7 billion on agency staff by the end of the 2015/16 financial year).The Francis inquiry into Mid Staffordshire also exposed the consequences for patients and staff of not addressing this issue of staff morale and sickness. Typically, if an NHS organisation reduced staff sickness rates by a third,it would provide an additional 3.4 million working days a year for NHS staff, equivalent to 14,900 full-time staff, saving an estimated £555 million.

Good staff health, wellbeing & engagement = Decrease in sickness absence = reduced agency/sickness spend & therefore, improved patient care

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(Image source :http://www.slicedbread.co.uk/solutions/employee-engagement/)

Practical reasons to care for NHS staff:

Ultimately and practically, the NHS exists to provide high quality and safe care to patients. Evidence so far shows that better staff health and wellbeing is associated with improved patient outcomes.
Some of the many benefits to improved NHS wellbeing is that better staff health results in lower infection rates and lower standardised mortality figures. The Keogh review of 14 hospital trusts with high patient mortality rates found all these trusts also had higher levels of staff sickness, compared to national average.

Good staff health, wellbeing & engagement = Safer and higher quality patient care

When an NHS organisation invests in staff health, wellbeing and engagement, they improve their ‘Brand’. Branding is one of the most important aspects of any business, large or small, and its impact shouldn’t be underestimated when it comes to engaging staff with health and wellbeing initiatives.

Good staff health, wellbeing & engagement = Your NHS organisation looks good & therefore attracts more staff

A report from the Kingsfund suggests that job satisfaction, organisational commitment, turnover intentions, and physical and mental wellbeing of employees are predictors of key organisational outcomes such as effectiveness, productivity and innovation. Everyone wants more of these things..right? They all have the potential to save money and improve the safety and quality of care.

Good staff health, wellbeing & engagement = Higher productivity, staff effectiveness and innovation = Cash savings and better services

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Moral reasons to care for NHS staff:

Staff are entitled to a psychologically and physically safe professional journey. Caring for them is not an optional issue, it is an ethical one.

 

When staff are well cared for, they experience greater job satisfaction, improved morale and general wellbeing. Few aspire to be ill, and many feel great shame in letting others down or asking for help.
Where the emotionality of distressing work  remains unrecognised and void of support, distorted thinking, emotional distress, reduced productivity, increased sickness rates, poor decision making, and maladaptive patterns of behaviour may present. Physical symptoms can also result, where severe job stress evokes irregular menstrual bleeding patterns for female healthcare workers, poor sleep quality and bodily exhaustion.
The NHS workforce is one of the largest work forces in the world. They are patients, they are the public, as are their friends and families. As such, by caring for this group, we are also caring for a large part of society. Moreover, there is also a strong statistical link between the wellbeing of staff and patient satisfaction. This means that if we are failing to care for staff, we are also missing an opportunity to improve patient satisfaction.

Good staff health, wellbeing & engagement = A nice and decent thing to do for all.

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There are many more reasons for NHS organisations to care about the the health, wellbeing & engagement of their staff..Financially, practically & morally speaking… Please feel free to add these below.
I hope that these few facts and figures can be shared and used to convince everyone throughout the NHS of these facts. Many will say that it is the patient that must come first. However, I argue that excellence in health and social care may only be achieved if both the staff and patients are cared for equally, as they work in partnership to achieve the best outcomes.

Looking for ways to turn this vision into practice? See my blog on 20 ways to create a thriving NHS workforce here

Until next time, look after yourselves and each other 💛💙💜💚.