Category Archives: 6Cs

The importance of trust between colleagues: It’s all about the little things

“Tea” by chumsdock is licensed under CC BY-SA 2.0

Simon Sinek’s Life Advice Will Change Your Future

That named above is billed as a motivational talk for business leaders, and that it what it is [with a typically borderline hyperbolic title]. However,  business leaders are not the only audience who might benefit. I am a big fan of Simon Sinek and I got a lot out of this talk. It has a large focus on the importance of trust between colleagues which makes it relevant to healthcare colleagues where trust is essential for effective team-working (and consequently on patient safety and the effectiveness of care). Check it out.

Trust is vital during this pandemic. More than ever we all need to trust each other – to follow the social distancing measures, to thoroughly wash hands, fully isolate if symptomatic of COVID-19 and other government requirements on our behaviour. In the front-line of the NHS that trust needs to extend further to instances where social distancing is not possible – trust between colleagues; trust between healthcare professionals and patients. This is a big ask for healthcare professionals who are risking their lives on the front-line of healthcare more than at any other time in the history of the NHS. Trust needs to be earned, true, but it needs to be earned quickly.

Brief, ordinary and effective

A little bit of practical advice might be to remind you (introduce you to?) of the ‘brief, ordinary and effective model’ of communication (which BU students can access here).  It is a neat reminder of how effective communication might be still be achieved despite trying circumstances. Trusting relationships are built on rapport, and rapport is achieved by opening up about ourselves to another, revealing an aspect of ourselves that we are comfortable sharing with a relative stranger who might then reciprocate – thus a connection is formed with a fellow human being.  It’s little things that achieve this meaningful connection – shared support of a football team, a love of food, music, whatever (even weather, if you can’t think of anything more interesting!) – it doesn’t matter as long as it promotes a connection. This is not always easy to do, revealing something of ourselves, as it makes us vulnerable.

Healthcare professionals have and will continue to make themselves vulnerable – it was ever thus. But the pressures the NHS is under and will continue to be over the coming weeks as the number of covid-19 cases peaks means that tempers may be more likely to fray as workload exceeds capacity, as colleagues need to self-isolate. Emotions may run high as as heart-wrenching decisions need to be made that would not be contemplated during more normal times, as tiredness and fear contribute to the risk of trust breaking down. That is why a focus on trust is so vital at this time, because trust is fragile – anything as fragile and as worthwhile as trust deserves to be carefully protected. Never stop valuing trust and, while some people will let you down, what this pandemic is showing, I believe, is way more instances of the best of human behaviour rather than the worst (outstanding book on this by the way – Behave: The Biology of Humans at Our Best and Our Worst by Robert Salposky, one of the best books you will ever read) – and it all hinges on trust. But how to adhere to the best side of our nature with the stress and strain of this pandemic invading and pervading our lives? We won’t always get it right, but especially when we go awry and our behaviour lets us down we can remind ourselves: be brief, ordinary and effective, and try again. I hope this advice will change your future.

Basic nursing care, done well, is complex, isn’t it?

Basic nursing care – what’s in a word?

What does ‘basic’ nursing care mean to you? This perhaps springs to mind aspects of care such as washing, mouthcare, and assistance for eating and drinking amongst other aspects of living that we normally perform for ourselves when well. Such Activities of Daily Living might be regarded as ‘basic’ as they are easy to learn and don’t require a great deal of mental effort to perform. For others, however, the word ‘basic’ is belittling to the art and science of nursing, reducing nursing to little more than the performance of a series of simple tasks. ‘Basic’ seems to involve what to do (e.g. clean mouth) and how  (e.g. brush teeth) to do it, but does not readily seem to encompass when, who, where, how; and perhaps the most important question word – why (e.g. to promote personal comfort, to facilitate meaning as being regarded as a fellow worthy human being, to maintain homeostasis and reduce the risk of nosocomial pneumonia). Just because the care is directed at basic needs, does that make the care basic too?

What’s better than basic? Fundamental? Essential? Something else?

Alternative terminology such as ‘fundamental’ or ‘essential’ nursing care have been proposed, yet ‘basic’ sticks (for example). This is a deceptively complex and controversial topic which deserves a much more thorough and referenced exploration than I will provide here. For now, I wish simply to propose an acronym, and I would like to know your views on it: BASIC.

Basic care, done well, is complex, but is BASIC nonetheless

Best Care ought to be the best possible skilfully performed care that the nurse can deliver (within the limits of experience, ability, time and cost), not a mechanically performed task
Authentic Care ought to be delivered authentically, that is, delivered purposefully with positive intentions by someone who genuinely cares and wants to care
Specific Care ought to be specific, in other words, patient/person-centred, not task/nurse-centred
Informed Care ought to be informed, in other words, evidence-based (remembering that evidence-based practice includes not just best research evidence but the expertise of practitioners and patient preferences)
Compassionate Care ought to be delivered compassionately, such that the patient/person feels cared for

What do you think?

Do you think that ‘re-claiming’ the word BASIC to show that, when done well (in such a way as to best achieve effective care i.e. maximise patient outcomes), basic care is in fact highly skilled with a good deal of mental effort required? Or do you think this would simply perpetuate the notion that a great deal of what a nurse does is low skill, low mental effort? Do you think my suggestion is nothing more than re-inventing the wheel? Whatever your view, basic or complex, I’d love to hear it.

End-of-life care: Getting it right every time

RCN launches new end of life care resource

Getting it right every time RCN

The Royal College of Nursing (RCN) has developed a new resource, Getting it right every time. This resource has been designed to offer support in the delivery of appropriate end of life care alongside existing training. It has been developed in line with the Getting it right every time: nutrition and hydration at the end of life online resource which can be used for more in depth learning around delivery of nutrition and hydration care at the end of life.

Who is it for?

This resource is for you if you are a registered nurse, student nurse, health care assistant (HCA) or assistant practitioner working in any setting or specialism. The aim is to give you an understanding of your role when it comes to meeting the needs of people with life limiting illnesses. You can work through this resource at your own pace either all at once, or by one of the “bite sized” pieces of learning whenever it is convenient for you.

It might also be useful for others in health and social care. Members of the public may also find the content of this resource valuable.

Acknowledgement of sources: The first paragraph is taken from the RCN Quality and Safety eBulletin and the second from Getting it right every time. 

 

Ever thought that emotional intelligence could save your life?

Emotional Intelligence Can Boost Your Career And Save Your Life
by Dr Travis Bradberry

Acute-Care-Nurse-Practitioner

We cover emotional intelligence in Fundamental Communication Skills so I’m not going to say too much here except to say that the post on LinkedIn by Dr Bradberry is an interesting and thought-provoking introduction to the possible benefits to you of this aspect of intelligence. Emotional intelligence is not just useful for yourself however but will make you a better nurse, hence it is an important factor in your ability to deliver effective care to your patients. Also on this topic ‘Emotional Intelligence’ by Daniel Goleman is definitely worth a read (yes, all of it!). For students at BU it’s available in the library. Happy reading.

 

 

Good communication and high quality person-centred care for people with dementia-free webinar

You might be interested in joining a free webinar, tomorrow (22nd September 2015) from 12 12.40pm, focused on good communication and high quality person-centred care for people with dementia. It is being delivered by The National Skills Academy for Health. Here’s what they say about it:

“Full of useful information, hints and tips, the webinar will give attendees the opportunity to:

  • Discuss the importance of good communication skills and the impact poor skills can have on those with dementia and their families
  • Consider how best to develop skills to ensure those with dementia receive high quality person-centred care
  • Review and discuss a new free resource designed by Skills for Health, the Association for Dementia Studies at Worcester University and other key partners to help the healthcare workforce understand how best to support those with dementia
  • Share thoughts and ideas with colleagues and peers from across the sector

Click here to register for the webinar

 

national skills academy logo

If you would like to have a look at Stand By Me before the webinar and have not yet registered to access it, please contact the Skills for Health e-learning helpdesk on 0844 770 3770. The course is free to all organisations but non-NHS organisations may need to provide some additional information as part of the registration process. Click here for further information about the course. 

Unable to attend? If you have an existing commitment preventing you from attending the live session, register anyway and we’ll send you a link to the recording so you can view the webinar at a more convenient time.”

I won’t catch this live as I’ll be in a meeting so if you do listen in let me know what you thought of it!

The poetry of compassionate care

The delivery of compassionate care begins with empathy, and I’d like to share with you the work of nursing students who clearly displayed their ability to inhabit the lives of the patients in the case studies they were set to consider; they showed that they cared. This display of empathy was particularly heartening from year one students and suggests already a commitment towards the delivery of compassionate care. The students kindly agreed to me publishing their pieces of writing for which they had less than an hour to produce.

6Cs logo

In the first piece of writing Grace Aston and colleagues emphathise with the predicament of the patient’s husband, Bert. They put themselves squarely in his shoes and imagined what he must have been going through when his wife, Winnie, would not wake up, therefore recognising that significant others require compassionate care too:

“This morning I couldn’t wake Winnie. I asked her whether she wanted a cup of tea, but got no response. I shook her but still nothing. I didn’t know what to do.”

In the second piece, Rebecca Soulsby and colleagues imagine not only what the situation must have been like for Bert but for Winnie too and from the point of view of the nurse:

“As the nurse I try to understand
how it must feel to be in no man’s land,
surrounded by strangers who try to be welcoming,
on a ward that is simply overstretched and understaffed.”

Above are snippets of what they wrote; read on for the full versions.

The case: Winnie and Bert

Winnie and Bert have been married for over 60 years and live in Bournemouth with their dog, Hoover. When Bert woke up this morning he couldn’t rouse Winnie so he called an ambulance. She arrived in the Accident and Emergency Department with a suspected stroke and has been transferred to one of the medical wards.

Nurse and patient

Response: Grace Aston and group

“Story 1: Dehumanised

This morning I couldn’t wake Winnie. I asked her whether she wanted a cup of tea, but got no response. I shook her but still nothing. I didn’t know what to do. Winnie was always talking to the neighbours, but I only knew them to wave. I didn’t feel able to go around and ask for help, so I called the ambulance. They were here within minutes, radios beeping, and talking to each other. They didn’t ask me anything, or keep me involved. They just said they were taking her to hospital, not even the name. I was completely in the dark. The phone rang in the afternoon, but I didn’t get to in time. No message was left. The only phone call I received after that was when Winnie passed away, and even then when the phone called ended I didn’t know why.

Story 2: Humanised

“This morning I couldn’t wake Winnie. I asked her whether she wanted a cup of tea, but got no response. I shook her but still nothing. I didn’t know what to do. I rung an ambulance, the operator was so helpful. She explained what I could do to help Winnie, and reassured me that the ambulance was on its way, and she stayed on the phone until it arrived – I instantly felt at ease knowing that help would soon be here. When the ambulance arrived they were calm, talking to me and asking questions about Winnie whilst seeing to her. They explained that she wasn’t well and she needed to go to the hospital. I explained that the dog needed to be looked after, but they said they could sort that afterwards – but it was important that I left with them. When we arrived at the hospital, Winnie was taken away. The nurse came over straight away, concerned for me, and asking if I would like a cup of tea – just what I needed. She sat with me for a while asking me about Winnie, and Hoover. I had completely forgotten about him, but the nurse said she would call the neighbours and get them to check on him, again putting my mind at ease. About an hour passed when a doctor came to speak to me. He explained that Winnie had had a stroke, but was in the best hands. After he left, I wasn’t sure what a stroke was, but the kind nurse who gave me the tea came back and explained in more depth, with a large print leaflet allowing me to make sense of the situation. The nurse also explained the ward layout, and where I could find the toilet. “Is there anything else I can help you with?” she said so gently. She was so kind, and so genuine to me. I don’t know what I would have done without her. After a while, I was told Winnie had been moved to a different ward – again that kind nurse showed me the way to her. She explained that Winnie would be staying at the hospital for a little while, and asked whether I had any support at home. I said that it was just me, Winnie and Hoover, but explained I could cope at home alone. She gave me the number of the silver line – people who would talk to me if I felt lonely at all. I thought that was a nice suggestion, as I knew I would miss Winnie at night. She called me a taxi to get home, and said I was welcome to visit within hospital hours, but could call any time for extra reassurance. The next day I came to visit Winnie, she looked much better. The nurse filled me in on her progress and really kept me involved. I explained all the foods that Winne liked, as she was unable to let them know. I also said how she always liked to have a face of make-up on – so she would appreciate it if they could make her look just as beautiful during her stay – they were only happy to oblige. After a few months Winnie was discharged with lots of additional care in place. The whole process seemed so simple and from the compassion shown to me, it really made the difficult time more bearable.”

Response: Rebecca Soulsby and group

“Winnie and Bert were old and grey,
Bert has been Winnie’s love forever and a day,
They have been together through thick and thin,
Having children was not part of God’s plan
So they depended on each other for everything.

Until one morning life took a turn,
And the devil called stroke arrived at dawn,
In a dark cloud shadowed by doubt,
What will life now be all about?

Now Winnie lies in a bed, I’m holding her hand,
We are surrounded by strangers that don’t understand,
Winnie’s day to day needs, thoughts and wishes,
which included Bert’s daily love and best wishes.

As the nurse I try to understand
how it must feel to be in no man’s land,
surrounded by strangers who try to be welcoming.
On a ward that is simply overstretched and understaffed.

I go and introduce myself and gauge a conversation,
Understanding what makes Winnie tick,
I find that it is the love of Bert and Hoover the Dog,
And their daily living and being together,
How Winnie likes to be washed,
What food she likes to eat,
and most of all how honesty and trust come foremost.

As the carers we make sure Winnie’s needs are met,
Bert is also included and not forgotten,
It is important that we meet both their needs,
Giving lots of care and attention, cup of tea or two
Even a simple “How do you do?”

For every look, hand gesture, bit of conversation
All adds up to the good care and attention
From the nurses to our patients

We have signed up to a moral obligation
To treat our patients, carers and families
To be truthful, honest, respectful and most of all compassionate
To enable us to give the best of our care to our patients
For they are not a number, they are unique.”

These pieces of writing give me confidence that these students are well on their way to being equipped for the delivery of the ‘6 C’s’ by the time they qualify. What do you think?