My @150leaders reflection, the Welcome Conference, March 2020.

Our cohort welcome conference, hosted by the Council of Deans 150 Leaders programme, exceeded my expectations. Pre-conceptions and nagging self-doubt did not stand a chance and were certainly not catching a free ride in my suitcase on the way home.  

‘Value your difference and think of your vulnerabilities as your strength’, powerful words from Stacy Johnson, MBE. ‘There is no such thing as imposter syndrome if you are being your authentic self’ more powerful words skilfully added with silent pause for reflection.

So, what is it that makes me tick, that inspires me and that drives me?  What are my vulnerabilities?

No individual’s life is ideal or perfect, but I do feel determined to make the most of my life. This might possibly be due to my status as a mature student, with a 20 year career ahead of me as opposed to forty years.  However, I think passion runs deeper than age status. Despite this, my nagging self-doubt regularly questions my right to study in my late forties. How irrational is this and what a waste of energy? I am here rocking it with some incredible individuals, as are lots of mature students throughout the four nations and globe.

I feel incredibly lucky to be able to undertake a nursing degree and to have a life where I can provide person centred care and work with some amazing people. Challenges inspire me and collaboration makes me happy. To be in a room with 50 passionate healthcare students from different walks of life was not just inspiring, it was incredible.  There was a diverse mix of age, gender, ethnicity and backgrounds. We each held a genuine eagerness to learn more about our unique routes to the 150 Leaders programme.  As we listened to the conference coaches and engaged in the weekend’s activities, there was a tangible sense of increased personal freedom. We found ourselves being given permission to keep doing what we are doing but with even greater focus.  Peer to peer feedback helped re-enforce this message. My peers’ words will remain with me throughout my career and beyond.

How does inclusive leadership translate into practice?  One of Stacy Johnson’s key messages is to seek equity, to focus on dismantling the fence, so exclusion does not exist. Why build different levels of steps behind the fence to help others see over it, when you can simply remove the fence itself?

Stacy also signposted us to discussions on the false perception that harmony will produce better effect, by Phillips, Liljenquist and Neale (2008). Teams are proven to perform better when diverse and so we should actively seek difference. ‘Seek to deconstruct your beliefs and step outside your comfort zone’ are words that continue to echo and inspire.  Being mindful of our pre-conceptions can help challenge the status quo and foster truly transformative leadership.

I feel attuned to @150leaders’ goals of promoting interdisciplinary understanding, diversity and inclusive leadership. My drive and passion for collaboration has been upgraded; petrol no longer fuels my tank, I’m now flying on rocket fuel. Thank you @150leaders for an inspiring weekend and to the incredible speakers for their generosity of spirit.

I look forward to the opportunity of engaging with my personal coach and peers and to seeing some amazing leadership projects unfold over the coming months.  No doubt you will spot some collaborative approaches in mine as I draw on inspiration from modern day leaders.

I would encourage any healthcare student to follow @150leaders and consider applying to their conferences and future programmes.  You will not regret it and can gain so much from the experience. I know I have and will continue to do so.

https://councilofdeans.org.uk/studentleadership/

Joy O’Gorman

Year Two, Adult Nursing Student, BSc (Hons), University of Plymouth.

References:

Phillips, Liljenquist and Neale (2008). Is the pain worth the gain? [Online]. Available at: https://journals.sagepub.com/doi/abs/10.1177/0146167208328062 [Accessed 18th May 2020]

A personal reflection to mark my first week of a ward placement (gastro surgical).

My placement team have been fantastic and it has been lovely getting to know patients and their loved ones.   I have to admit, however, I felt way out of my depth and comfort zone.

Ask me to perform renal peritoneal dialysis or do a trachea suction and I’m there; in the zone due to past training and experience as a complex care support worker one to one.  However, witnessing multiple patients deal with cancer prognosis whilst having significant bowel surgical wounds managed is a whole new level.  I was in awe of the ward team and how the MDT wheel of support cycled in a coherent way throughout the day.  I was moved that patients and nurses alike invited and allowed me to get stuck in and hands on.  Whilst I loved the thrill of encountering new clinical procedures, there was no time to digest the life changing experiences that patients and their families were undergoing before my eyes.  Compassionate care was evident, time to chat and bring normality to life was also evident as was excellent clinical post-surgical and ongoing care.  But, none the less, being new to this world, the impact hit me on the evening of day two.  Impressions of major wounds were in my mind’s eye and the privilege of being part of patient’s tough life and death care pathway decisions echoed in my ears.

How do you assimilate these experiences, which are so constant and fast moving without becoming immune to them or without emotionally bleeding your way through personal down time post shift?  Do we find ourselves performing on high focussed alert during shift and then processing after?  Is this sustainable?  I am intrigued about how others cope and hope to learn more.

By day three of week one I was overwhelmed.  During my first hour, 7am, the challenge of encountering a new/different obs machine seemed strangely overwhelming and I began criticising myself for feeling so useless. I did not know what role to step into; perform observations to ensure patient’s homeostasis were being maintained; be a listening ear to a patient in distress, ensure patient’s nutritional needs were being met; assist with surgical wound care, be a student and learn how to administer drugs safely orally and IV as well as learn how to safely discharge a patient or escalate their care needs.  Every facet of these multiple roles were required constantly. The HCA team were great, as I meekly explained I was having a moment to justify my embarrassment of feeling flustered by a simple new machine or not quite being in synch with the ward team and routine. An experienced nurse looked me in the eye, as I fleeted past her, told me to relax, not to be hard on myself and that I can’t possibly expect to know everything in week one; I was doing fine.  She did not take away her gaze until she was sure those words hit home. I relaxed, stopped beating myself up and cracked on.  My wobbly hour behind me.

I now have the weekend to digest, thus this reflection to help with that process. My heart aches from what I witnessed this week. I am not conflicted, but it feels alien to dismiss those experiences as just another day on shift. Perhaps the best insight I can offer myself at this stage, is knowing the strength of the MDT.  I can never be everything to a person in my care or their families, but what I can learn to be, is their nurse and fulfil that role to the best of my ability. I say this with confidence due to not just seeing the patient journey this week, but the strength of the nurses and others around the ward team.

Life as a student nurse is never easy, but I am embracing the challenges ahead, mindful of striking the balance between giving it my all and taking time out to reflect, wind down and look after myself.  It’s okay to wobble and its okay to ask for help even over the smallest of things like simply digesting the new world of ward nursing and all that entails.

Now to find time this week to complete our University Module assignment, plan my development plan and new NMC proficiencies, get to grips with new technology and work on some research projects I have the pleasure of being involved with…it is tough but an amazing and exciting journey to be on. Would not change it for the world but more grounded this week in the reality of the road ahead and how deep we need to dig to make it through.

So, my cohort and I (year one) had an assignment. The module was based on nursing theories, safe nursing practice alongside person-centred care planning and implementation.  The case study was an elderly gentleman, let’s call him Joe to create a person-centred approach, suffering with increased breathlessness, anxiety and reduced mobility.  Oxygen therapy was proposed as a next phase of treatment but needed to be risk assessed.  Joe was new to the care of the DN team due to his increased breathlessness. Our task: apply ASPIRE, choose an appropriate nursing model, research best practice (NICE, GOLD) and produce a 2000-word assignment on care planning and implementation, to include Pathophysiology and Epidemiology.

I was off. COPD was a new condition of which I knew not much about, but at long last after months of biology, law, ethics and other nursing degree grounding, this felt like our very first proper nursing assignment!

My enthusiasm was soon dented by the sheer volume of research and information available.  COPD is an umbrella term, different stages of the condition warrant different interventions, which commonly run on a sliding scale depending on the time of year. Inhalers and antibiotics, a constant juggling act. Pulmonary rehabilitation (PR) was proven to be effective, so much so that NICE states it no longer needs to be proved.  But have you read how much takes place during PR?

I started to realise what a complex and variable condition COPD is.  My heart went out to those struggling with the complexities of managing it; both the individual with COPD and front-line staff, challenged with growing need and limited resources.  COPD is set the be the third largest cause of death by 2030 (WHO, 2016). I felt overwhelmed with the enormity of our assignment, how do you concisely evidence knowledge of this condition and it’s person centred, safe management? It was time to close the research pages and books and get hands on. My reading brain had had enough, my curiosity and determination to understand how theory is applied in practice took over.

Here starts the synergy. Livewell SouthWest, who run regular COPD PR clinics, kindly allowed me to attend clinic and learn more about how PR is applied in practice.  I had the benefit of direct patient feedback, alongside pearls of wisdom from the lead respiratory nurse, OT and support workers. Inhaler technique, lung strengthening exercises, first aid home kit, O2 therapy and mindfulness were some of the areas covered. The patients were inspiring; clearly vulnerable, but gently encouraged. I learnt more in those three hours than weeks of research, but of course the research helped as I was able to grasp the terminology and what was being shown. 

PR is amazing, a real confidence builder, but due to limited resources the course is just six weeks long. It is designed to arm people with tools to self-manage and apply learned skills at home. Attendees are not encouraged to return for at least 18 months due to strain on resources, but to also empower individuals to gain confidence in their ability to self-manage, alongside standard GP therapy support.

Parallel to my assignment, I had just begun my seven-week placement at pre-op clinic. On my very first day, at least six people undergoing pre-op assessment suffered with COPD. It is clearly an added risk consideration for surgery. The pre-op waiting room TV, which my mentor had just installed, had some health information, but the team wanted more. Health education for optimisation, pre and post-surgery, was on the team’s to do list.

My assignment deadline was looming. I didn’t quite feel I had resolved ways in which to address Joe’s difficulties in a person-centred way.   Joe had recently become a widower and his family lived up north. He was not going out due to anxiety and breathlessness. PR was a good idea to help him learn how to address his breathlessness and anxiety, but how, by taxi?  Even this would be too much for him.  Home PR was available, but this was a possible gamble, due to resources.  It was important to address Joe’s difficulties before they resulted in an emergency hospital admission.  MDT involvement is clearly the way to go; arming Joe with confidence to self-manage his anxiety and symptoms is key to long term sustainability. Perhaps his late wife was a huge support to him, now lacking?

Finally, the last piece of the puzzle fell into place for me. I discovered on NHS digital, an NHS approved app called MyCOPD.  What a find!  Everything I had researched and seen in practice was on my phone/ipad screen at the touch of a button.  Video tutorials on inhaler technique with evidence to show 70% technique improvement by app users. PR exercise video tutorials, mindfulness, personal mood diary, medication support and more.  I could just see myself sitting with Joe watching these tutorials and advocating them as a potential home tool on how to manage his anxiety and breathlessness. I could also see how the respiratory nurse would be able to monitor Joe’s progress from the data interface, which is securely stored according to NHS Digital and data protection rules.  If Joe’s medication needed to be changed, the video tutorials automatically updated. This was a real contender in helping Joe and the MDT work together to address his day to day therapy needs. (If Joe consented and was able of course).  

But, what about person centred care, how does an app provide that, surely it is the opposite, as are you not removing the personal touch? I spoke to Mal North, lead clinical research nurse at MyMhealth, who helped design the app and get it through the rigours of NHS Digital.  His wise words remain with me to this day.  ‘The app is a tool, no different than a leaflet’. A good nurse would simply not hand an individual a leaflet and send them out the door, the nurse would educate and support that patient in the leaflet content and follow up’.  The app is no different, it is not a replacement for person centred care, it is a person-centred care tool for the patient, Nurse and MDT.

I felt inspired. The MyCOPD app seemed to round up my weeks of research and learning in a nutshell. It is also evidenced based and NHS approved. Nurses, so I am told, are problem solvers, we strive to seek resolutions to address our patients’ needs.  My heart was smiling because I could see solutions unfold before me.  I spoke to my mentor about my idea to upload the MyCOPD app onto the waiting room TV screen, and, to introduce awareness of the app to COPD patients during their visit.  This was not forcing the app on any individual, it was simply offering choice and a tool to better self-manage. It was also available free to patients in Cornwall, via local CCGs.  During my training as a digital health champion with @EPIC_ehealth, University Of Plymouth, I also knew of resources such as Age Concern’s Silver Surfers and other volunteer organisations working to address e-health inequalities, namely access.

Pre-op is an extremely busy environment.  If an RN fails to complete an assessment, surgery can get cancelled.  If an RN misses important medication bridges or unaddressed risks, consequences are serious. I witnessed first-hand how pressured the pre-op team are. I wanted to ensure any new introduction to practice merged into existing pathways and would not become an added burden/task.  I was also inspired by how the team, despite being busy, promoted health optimisation with each patient during their brief time with them.

The RNs assess breathing function during pre-op clinic. Each patient is asked about their breathing on rest and activity. This was a prime space to introduce the availability of the app to identified COPD patients, as tools in the app can help address breathlessness. The pre-op team supported my goal.  With consent, I would sit in on the first 10 minutes, discuss the patient’s breathlessness whilst introducing the MyCOPD app, if appropriate.  This gave the RN time to go through the patient’s prescription list and other aspects of their pre-op assessment paperwork, which includes logging breathlessness scale. Every patient responded positively to the app and were signposted to their GP surgery to discuss it further. RNs soon began to adopt this practice and HCAs were also keen to be on board; some knew of family members who they felt would benefit and could identify how the app can support patients.

To conclude: with the support of my amazing mentor, @Epic-health, MyMhealth and the Trust’s hospital communications manager, the myCOPD app now plays on the pre-op assessment waiting room TV screen. It is being merged into assessment pathway as an additional health promotion tool for COPD patients.  My usual placement training was of course maintained alongside.

We have since taken our work to the chief nursing associate of our local Trust Hospital. If we can achieve health promotion via MyCOPD, an NHS approved app at pre-op, why not adopt similar education/awareness in other hospital waiting rooms? MyAsthma, MyDiabetes and MyHeart are also listed on NHS digital. I was encouraged to pursue my idea and to consider gathering an evidence base on uptake and benefits.  Research is underway as we speak, so watch this space! 

END NOTE:

I volunteer with Epic as a digital health champion to add value to my nursing degree education.  Life is pretty hectic, so forgive me in keeping this blog to a conversation piece, rather than an academic referenced article. I just wanted to put out there some of the e-health tools available and a case example. 

At a recent event with @Switchecosystem I learnt of a neurologist who has designed a wrist band that supports remote symptom monitoring for people with Parkinsons Disease.  The technology is amazing, why not embrace it? 

Demand on services are on the increase. This does not let the Government off the hook for not tackling nursing shortages or the steady decline in nursing students since the removal of the bursary. We must continue to challenge the government on these issues.  But to ditch e-health tools, based on that argument, is, to me, short-sighted.

Smart phones and technology are becoming part of day to day life. Patients are often frustrated that NHS systems are not up to date (as are HPs). Do we really want to be left behind and in the dark? Yes, NHS records need moving out of the dark ages, how many people use faxes these days, yet the NHS is still one of the main purchasers of fax machines?  There are lots of issues to address; e-health is not the enemy, for me and clearly many others, it is a positive tool that can be embraced to support increased demand.  No one’s job is going to be replaced by an app, we are struggling to meet demand now and that is only going to continue.  I am one student nurse, with lots to learn, but am happy to embrace whatever tools I can as long as they are safe, ethical and evidence based. 

I’ve seen huge progress in this area and am inspired by the care driven innovative efforts of others. With any new proposal, mixed feelings will undoubtedly be present.  If an app is going to help my patient remember which lung exercises to do each day, how to sit and breathe during an attack of breathlessness and how to use their inhaler safely, why on earth would I not offer them that option, alongside my nursing skills and clinical reasoning and that of my MDT?  I would still advocate PR clinics, face to face, and use the app as a follow up, sustainable tool. It has been proven to be safe, data protection is self-governed on sign up and complies with GDPR. 

I would comfortably sit in front of an NMC panel to justify my rational in giving my patient choice, using evidence and clinical reasoning.  Wouldn’t you? Let’s be rational about e-health and what it has to offer. It’s not going to peform brain surgery, but it can be a helpful support tool, no different than day to day aids and adaptions in the home.

I’m interested in learning about other e-health projects taking place within the NHS and would encourage nursing students to act as advocates in helping to research and support sustainable e-health practice. University is a great opportunity to build confidence and networks in any sector that interests you, go for it!

Some great teams & resource links I’ve worked with so far:

NHS DIGITAL:   https://digital.nhs.uk/ https://mhealth.service.nhs.uk/daq.html	NHSx – Launched July 2019.    https://www.nhsx.nhs.uk/ @NHSx   NHSX has been created to give staff and citizens the technology they need.
EPIC – resource a/c to follow   E-health networking (national & international collaborations) based at University of Plymouth:   @EPIC_ehealth   @switchecosystem	MymHealth – as listed on NHS Digital.   Series of well researched and evidenced apps for long term conditions.   @MymHealth
RCN – guidance article on e-health https://www.rcn.org.uk/clinical-topics/ehealth/ehealth-technologies	Hi9 – Bot technology   @hi9io

ties, key);

Thanks for joining me!

Good company in a journey makes the way seem shorter. — Izaak Walton