Xxx

Not so much a word as simply the letter X which has prompted some musings for this blog post, a letter frequently associated with an expression of love for others. Today is Saint Valentine’s day. He was a third century priest martyred and since commemorated on 14 February and connected with love since the middle ages. There are many legends connected with Saint Valentine this video refers to one. Millions of individuals across the world today may be taking the opportunity to demonstrate their love for the important people in their lives.

Perhaps a suitable point to remind ourselves of what it was that made us want to be a nurse. It has been a pleasure and a joy to meet our latest cohort students as they begin their professional journeys. Whilst they may be at the start of their professional journey many of them already have experience of engaging with caring in various settings before they began their studies. Indeed, perhaps it is these very experiences which helped to consolidate their decision to commit themselves to become a professional registered nurse. Several of this new cohort already have an awareness of the 6 Cs and like many neophyte practitioners they have a great desire to exhibit care and compassion. Interestingly when asking students what are the other components of the 6 Cs they frequently refer to “Cs” which are not included in the chief nurse’s original thoughts. Perhaps you might like to contribute to a wordcloud of words beginning with C which help to explain the diversity of the profession of nursing and the individuals who are committed to being nurses.

For many students X may have negative connotations as the symbol is utilised to denote when they have misunderstood or expressed themselves incorrectly in their assessments and assignments. It is hard to be told that we have got things wrong and the majority of students probably do not relish the prospect of receiving an X place against their work. However, it also marks an opportunity for students to appreciate the limits of their competence, understanding and learning to date. It provides the spur to develop an action plan to address any identified deficiencies and so continue to expand and grow their individual professional knowledge base.

Turning that X around is a reminder of the amazing work of the British Red Cross organisation; with their mission to intervene when crises strike anywhere in the world; as well as in the UK, to help anyone get the support they need. Nursing has its 6 Cs and the British Red Cross have seven fundamental principles; humanity, impartiality, neutrality, independence, voluntary service, unity and universality. You may find it interesting to explore these principles in more detail and read about those principles in action all around the world today as the organisation seeks to bring hope in the midst of humanitarian crises. You may even consider supporting them either financially or as a volunteer yourself.

A significant part of the British Red Cross organisation’s work is to encourage individuals to learn simple first aid skills so that everyone, not just student nurses and registered practitioners, can be confident in helping others in an emergency. Students and registered practitioners must always be mindful of what the regulatory Code says they must do to achieve the standard “Always offer help if an emergency arises in your practice setting or anywhere else”.

The X turned around also is a reminder of the country of Switzerland, the destination for some individuals who have taken the decision to end their own lives. Under English law euthanasia is illegal and is considered manslaughter or murder. However, last year, the UK Supreme Court ruled that legal permission would no longer be needed to withdraw treatment from patients in permanent vegetative state. The judgement continues to divide opinion, as well as provoking ethical discussions and challenging religious beliefs. Some individuals regard such rulings as humane and compassionate whilst others are concerned that highly vulnerable group of individuals are affected by the removal of a vital legal safeguard. Earlier this week a video was released of a man who had motor neurone disease and decided to end his life rather than experience the final stages of the illness. In the video he and his wife talk candidly about their experiences of dealing with his condition and fulfilling his wishes. The video culminates in his wife saying “I just wish the law would allow me to have him for a little longer”. This issue is likely to continue to be a subject for much debate and reflection from all perspectives.

is also the means by which we express our opinions and our support. Whether this is in the political arena through our participation in general elections and referendums or engaging in the plethora of surveys which we encounter through our professional lives. Unfortunately sometimes we are sceptical about the impact of recording our X in the political arena but it should not stop us from doing so.
Reference was made to the work of the UK Biobank in a previous post. Respondents across the country; including me, are continuing to complete the surveys sent to us in order to improve the prevention, diagnosis and treatment of a wide range of serious and life-threatening illnesses. The latest survey has been in relation to chronic pain an issue which affects a significant number of individuals across the UK. Hopefully the X’s place within the survey will help to improve our collective understanding of this important matter and help us to develop mechanisms to alleviate chronic pain.

Finally also earlier this week X marks the spot as individuals who played key roles in the development of global positioning systems (GPS) were awarded the £1M Queen Elizabeth Prize for Engineering. GPS touches all of our lives, listen to the judges discussing the importance of GPS.

If you are reading this on 14 February 2019 there is still time to express the sentiments of the day if you have not yet done so to the people who matter most to you.

Wonderful

Wonderful news for the profession; the recent IPSOS Mori Veracity Index published on 18 November 2018 demonstrates nursing once again tops the chart of most trusted professions. When asking student nurses which theme of the NMC Code (2015) (revised on 10 October 2018 to reflect the inclusion of individuals on the new Nursing Associate part of the register from January 2019) is most important to them; first years typically cite prioritising people, second years frequently debate between practising effectively and preserving safety whereas third years consistently favour promoting professionalism and trust. Third year students frequently explain the rationale for this decision as that if nurses and midwives do not command the trust and confidence of patients, people receiving care, other Health Care professionals and the public it is impossible to uphold the other themes within the Code. Nurses occupy a position of trust and are expected to maintain the standards expected of them in upholding the reputation of their profession by the regulator and perhaps, more importantly the public. Members of the public appreciate nurses. It is the things we do and how we make others feel that count for the most in the eyes of our patients and clients not the things we say. Ask many individuals what attracted them to join a health or social care profession and they will respond with “an opportunity to make a difference to the lives of others”. Often it is the small activities we execute for our patients and clients and the way in which we implement our actions that make the biggest difference to their care experience and help to ensure the care received is described as wonderful. Perhaps the promoting professionalism and trust theme is the one which resonates most with the public. Trustworthiness was explored in a previous post in this blog and it may be beneficial to re-visit that post but in doing so please remember that the regulator continues to revise its guidance.

Why; if the public hold the profession in high esteem, do so many nurses seem to dwell on the negative aspects of their role rather than celebrating the positive? This has long been a mystery. It seems that as a profession we are more adept at expanding hours of our time reflecting upon the negative rather than celebrating the positive. Perhaps our engagement with television, radio, newspapers and social media help to fuel our interest in situations where significant improvements could be made. As professionals we should continuously reflect upon our practice to ensure that the care we deliver is based on the most up to date evidence and that we learn from episodes which have been identified as providing less than optimal care. However, we should also not neglect to respond to positive feedback.

Used with permission

Care Opinion recently held a learning event in Manchester for a variety of individuals who wanted to understand the value of feedback from clients. Care Opinion offers an online space where people can post their comments; good and bad, and those caring for them can respond. Many individuals are using the site to express their views about their care, and many experiences which are told are of a positive and complimentary nature. However, it is also apparent that many individuals do not receive a response to their comments or are even sure if their remarks have been received by the right people. The number of comments posted on the site is very small when considered against NHS England’s “Monthly activity data” which relates to the number of elective and non-elective inpatient admissions and outpatient referrals and attendances for first consultant outpatient appointments. Nevertheless the site provides a useful conduit for two-way feedback and has helped both clients and providers to improve upon services, staff morale and encouraged learning in care organisations who have begun to use the website. The patient or client stories are a useful way of helping student health and social care professionals explore and understand contemporary, real patient experiences. Review the site for yourself and read stories posted by clients and service users in the area where you live and work. We should be taking every opportunity, via multiple modes, to be patient / person centred and really listen and respond to the feedback from clients and service users to improve the quality and standard of care which is delivered.

Used with permission

Thinking about person centred care was the focus of an event hosted by the University of Salford on 30 November 2018 at which The Queen’s Nursing Institute (QNI) launched its report “Nursing Care for People Experiencing Homelessness”. The report shares the experiences which homeless health nurses face in the day to day challenges of delivering healthcare to this vulnerable sector of society. The event itself provided an opportunity for individuals, including nursing students, educators, practitioners and researchers; to learn and share ideas about delivering person centred care to individuals who are homeless through hearing from several nurses about their wide range of experiences in supporting homeless individuals. Listening to the person led care of individuals from a wonderful Gypsy and Traveller Community Outreach Nurse was delightful and insightful, emphasizing the importance of creating therapeutic relationships to underpin great care for clients.

Attendees of this inspiring event, were given a hard copy of the “Transition to Homeless Health Nursing Resource”. Hardcopies of the resource can be requested from the QNI’s website.  The QNI website declares “we believe high quality nursing should be available for everyone where and when they need it”. Take some time to explore the wealth of resources the QNI provides to help community nurses deliver the highest standards of care to clients and discover the exploits of some wonderful nurses.

Graduation took place last week at the University of Salford and it was a joyous and happy occasion celebrating the success of the hard work of individuals culminating in the awarding of degrees and acquisition of professional registration. Many students obtained first class degrees and can rightly congratulate themselves in becoming wonderful practitioners. Graduation was described by Jackie Kay; Chancellor University of Salford, as a shimmering, luminous moment as she urged our graduates to give their all, to work for the benefit of others, to be a catalyst for positive change, to seize the opportunities life gives them, to use the knowledge and skills they have gained and to be the best that they can be. Patients and clients across the North West will be recipients of these wonderful neophyte practitioners.

Perhaps you may concur with the Christmas song “It’s the Most Wonderful Time of the Year” that this is the happiest season of all. As you spend time with peers, colleagues, friends and family over the Christmas period why not consider telling them how wonderful they are in what they do and they might even believe you if you tell them often enough. Please also remember members; of all ages, in our communities who struggle all year round because of their physical and mental health challenges and for whom the bonhomie of the Christmas season can be especially painful. Thank you to all those wonderful practitioners who commit themselves to delivering high standards of health care all year round to those in need.

Vicarious

Creative Commons

Vicarious now that is an interesting word which is frequently followed by the word “liability”.  Is that just because we live in what in seems to be an ever increasing litigious environment?  Or is it because health and social care professionals continue to develop their knowledge and roles and responsibilities in relation to raising concerns?

There have been many significant reports following inquiries;  such as The Mid Staffordshire NHS Foundation Trust Public Inquiry, The Report of the Morecambe Bay Investigation and more recently The Gosport Independent Panel, which have reflected upon situations where patients and clients have not received a high standard of care.  Often the crux of what had gone wrong in the organisations, which were the subject of investigation, was a failure to ensure the protection of the very people the organisation existed to serve.  Students and practitioners are frequently encouraged to read and reflect on these reports as reminder of how not to care for patients and their families.  Several of such reports when reported in the media were accompanied by a phrase that went something like “these matters have been explored in great detail so that we might reflect and learn from what this situation has shown and so ensure that it will never be repeated in the future”. Sadly we all know that not to be true, otherwise there would be no need for any such further reports.

Many such reports have been influential in shaping the delivery of high quality care and improving the manner in which organisations manage situations which raise concerns. You might also argue that eventually there should be no need for disciplinary and fitness to practise processes and procedures within a health and social care environment if all health and social care practitioners consistently demonstrated the standards of conduct and behaviour that their various professional preparation programmes have carefully explained to them.   Whilst we still rely upon human beings for the delivery of health and social care there will always be the possibility of errors and mistakes.  In the wake of the Mid Staffordshire Inquiry Report 2013 chaired by Robert Francis, into the breakdown of client care, Professor Don Berwick, an international expert in patient safety, was asked in 2013 to advise about how to improve patient safety in the NHS. His report made a raft of recommendations including moving away from blaming an individual to looking to learn from errors. The report was subtitled “A promise to learn  – a commitment to act”. Individuals working within organisations such as the NHS should not fear raising concerns or speaking up when they make a mistakes or something goes wrong.  Merely dismissing or punishing people is insufficient if no attention is paid to helping people understand what happened in an open and transparent manner and apologising when things have gone wrong. The Freedom to Speak Up Report 2015 further emphasized the need to foster a culture of learning and safety in all organisations so staff feel safe when raising concerns. Organisations must cease to foster a blame culture which fuels fear and move to a culture “which celebrates openness and commitment to safety and improvement”. Several of these issues have been explored in previous posts within this blog such as Duty of Candour, Honesty, Integrity, Professional and Trustworthy.

There is a company in the United States of America called Vicarious which is concerned with developing artificial general intelligence for robots.  Human level intelligent robots may be a long way from completely replacing Health Care practitioners but they are certainly making a significant contribution to Health Care. Artificial intelligence permeates our lives. We travel in planes flown by auto pilots and driver less cars are becoming a reality on our streets.  There is conceivably a place for increasing artificial intelligence in the delivery of Healthcare but we should also possibly be cautious in giving vicarious authority to robots in place of human practitioners. You may be interested to view a video from the Chief Executive Officer of Vicarious talking about future data applications.

The NHS as the largest employer in the United Kingdom is the likely destination for the first post of the majority of neophyte practitioners. It is important to remember that the vast majority of professionals adhere to their professional Codes and are safe, competent and caring practitioners who consistently make a valuable contribution to ensuring the health, safety and well-being of patients, clients and service users. In so doing they also help to maintain the integrity of the NHS. The number of individuals who have their conduct and behaviour scrutinised by the regulators is tiny in comparison to the number of registered practitioners. The number of individuals who it is deemed necessary that they receive a sanction in order to protect the public is even smaller.

Professionally qualified staff within the NHS have the security of knowing that the NHS takes vicarious liability very seriously. The NHS accepts full financial responsibility where negligent harm has occurred as a result of the actions and omissions of its employees provided they were working within the sphere of their competence. All employees must exercise a duty of care and registered healthcare practitioners are accountable to their regulatory body for the standards of their practice and patient care. The Royal College of Nursing published their latest guidance on Accountability and delegation in September 2017.  It is a useful document to review, particularly for those for whom delegating tasks to others will be their experience in their new post rather than having tasks delegated to them as has been during their experience during their education.

The NMC (2015)

Appropriate Indemnity Insurance has been a legal requirement for all healthcare professionals since 17 July 2014.  It is a mandatory requirement of the Code that all nurses and midwives have an appropriate indemnity arrangement in place. The Nursing & Midwifery Council publish guidance on its website about professional indemnity arrangements.  It is important that healthcare professionals appreciate that whilst they may not need to individually hold an indemnity arrangement it is their responsibility to make sure that appropriate to cover for their practice is in place and confirmation of this is required from all registrants on re-validation.

Maybe over the coming month there will be many academics across the UK experiencing vicarious enjoyment as the students they have taught and supported conclude their Pre-Registration studies and embark on their professional careers. Personally it is a joy to read positive feedback from students confirming their knowledge and understanding of the demands of their future professional lives. These neophyte practitioners will be moving into their new posts acting under vicarious authority performing clinical care that is being delegated to them.  It is important that these, and all, practitioners remember their responsibilities under the NMC Code 2015 with regard to practising effectively when undertaking delegated tasks. Many of those practitioners will be meeting family members and carers who express the view that they wish they could vicariously suffer for their loved ones.  Countless times in a paediatric environment practitioners will listen to parents expressing the view that they wish they could endure on their child’s behalf or act as a substitute in their place.  It is hoped to that these neophyte practitioners will always deliver the highest possible standards of care, mindful of all they have learnt about professional conduct and behaviour, always putting the client first, treating them as individuals with dignity and respect. If the clients’ care and safety is paramount and enhances their health, practitioners may just have a vicarious experience of well-being themselves and feelings of joy and celebration rather than fear in their working lives. Make every experience count,