Undertaking change shows really clearly what we are wedded to in terms of the status quo. Change really holds up a mirror to where we are rigid and more fluid in our understanding of ourselves and how this plays out in our day to day lives. If challenged, all this bubbles to the surface and with some delving, prompting, exposure, reflection and feedback - my, is it possible to realise the current state of play!
Fixed thinking can be helpful at times, through being able to assist with making rapid decisions or in giving expert advice. However it is important to re-evaluate and freshen knowledge and skills to adapt to the various circles that we live in. It is easy sometimes to stand as a facility to change and feel at ease, but when it is you doing the changing - that can look very different. My greatest fear is to be stuck, and to wake up years on with a eureka moment that I wished I actioned years ago. Yes, hindsight is a great thing, but it is better to be able to say you changed and tried than to have stayed static for fear of the unknown. In my experience, the unknown soon becomes the comfort zone and time to move on is much needed.
Look for your encouragers and opportunities, they are there waiting, for when YOU are ready...
Assessment is the mainstay of nursing, it is the basis of all ongoing plans. It informs, and if robustly undertaken with the patient at the centre, can be facilitative in many ways. It relies on the holistic overview of the individual at a point where they are at now, prior to current touchpoint with healthcare services, as well as where they are anticipating that the they will will be going forward.
It is possible to slip into siloed thinking with some frameworks, as although often holistic completing does not necessarily facilitate a consideration of how they interlink, one aspect impacting on the other - that comes with practice and skill. Whilst models are helpful, they are not to be undertaken in isolation, without fully understanding how systems are linked. This informs the questions to be asked and being mindful of the matrix of enquiry creates the holistic overview.
What is being assessed, and guiding the assessment process is paramount, as without self-awareness, it is possible to limit the assessment with assumption and misguided focus. If for example someone is coming into the healthcare with a physical issue, the focus for the individual may be the psychological impact that is most disruptive, whilst being resilient to a condition that may have been an aspect of their lives for some time, or not deemed as consequential.
With all nursing, the assessment is so crucial in fully understanding what is going on for the individual. How their current presenting issues impact on the day to day functioning in their lives, it is essential to fully understand, and also to explore ability is an appropriate element.
The assessment is a powerful multi facetted tool requiring skill and knowledge - embrace it from the first day of nursing and all the rest will fall into place in all paths that open up to you.
I read recently an advisory, suggesting that looking back over achievements and adversity whilst considering the key benefits and challenges can support forward planning. This is in understanding better what the elements were that brought you to be where you are today and how these may take you forward. When it referred to looking back, it meant with a lens of self evaluation, not pointing fingers of blame or crediting others, but really seeing what the internal response was and how this affected the outcome. Look out for patterns that may emerge and what you might have done differently for taking forward, and again, whether there is a pattern to that too. Are there new skills needed? Elements of emotional intelligence that need work? Are there common situations that bring out the best/worst in you? All questions that support positive change, but also define recognition to flag any potential repetition in the future.
Reflection can be really positive, but it is essential, to glean benefit from it to do so with a self-awareness hat on, to derive emotional intelligence and learning.
I have been thinking recently about work related stress and whether this could be applied, in principle, to both the school and working environments. There is considerable impact on our economy at the moment in terms of the amount of sickness absence there is in our society, and as we are all too aware this is statistically weighted as being due to mental health conditions. In my experience of managing cases within the workplace, the themes that impact are relationships, workload and the competency/confidence to undertake the work. The effect of these are of course reliant on the individual resilience and perspective of the person, which should be taken as a given.
Having observed the stress for some students, it may be possible to correlate the term of “work related stress” to both environments. The polarity with this however is in the management and advice provided by the relevant advisors, guided by misled policy being administered in a blanket response to all children and young people. In the workplace there should be a solution focused approach to return to work balanced with an approach of giving a period of reflection that often supports a review of practice and work/life balance that supports putting relationships into perspective and appreciating the key issues that require support, and plan for them collaboratively. How work related stress can be observed is often irritability or insular behaviours, a strong sense of avoiding attending work or certain work activities, as well as a general sense of low self esteem or not coping. In our school environment, where equivalent symptoms may be experienced the consequences are being labelled as "school refuser", potentially face exclusion or slip through the net in regards to behaviours and struggle with relationship issues with peers and teaching staff alike, potentially compounding a negative sense of self worth and ability. Of course in both environments this is experienced and perceived as some or all of these parts. This does give rise to the question of, if this is the experience in school , then what are the knock-on effects for the perception of facing adversity later on in work?
Considering an asset-based approach that coaches individuals in the school and workplace, there may be an opportunity for building resilience and improving mental health going forward. Instead of fighting these issues it is about facing them, head on with a public health approach that is applied across schools/organisations. There is of course variability and this could be altered through a collaborative approach being applied by creating an integrated system overview of school, college/university, transitioning into the workplace, and beyond.
Whilst we are considering the implementation of the NHS 10 year plan, it is essential to view the system as a whole and not a string of silos co-existing to manage people in part, instead of supporting the whole - a public health approach is the way forward.
I was reflecting the other day on what Christmas might mean for people in general. I have recently been listening about people, who are experiencing distress as they transition through a time that they would have otherwise shared with a loved one, but that person will no longer be there. Others that are victims of domestic abuse and enter the season with trepidation, more so than other times, because of increased alcohol use and misaligned expectations. There may be those that will be enjoying what may be their final Christmas with a loved one and every moment is savoured, drinking in memories for later retrieval. Children who might in term time get a free school meal, unlikely to have a turkey roast with all the trimmings to look forward to, let alone any gifts. Of course there are those where this is a religious celebration with deep spiritual meaning. Others it is an opportunity to reflect on the gifts life brings regardless of religion or belief. There are those that will share their time with friends or family, from a select few to a crowd. All there through choice, obligation or a mixture of both, loving it or getting through it, being at ease or challenged. There are those that are alone.
So what have come from these reflections…
That when we greet or pass the time in small talk, to try not to make assumptions, consider that Christmas time may be a glorious one, but it might also be a tough time too for some, for any number of reasons. All this considered it brings to light humanity in all its diversity. It demonstrates the ebb and flow of life and provides an opportunity to consider the humble beginnings of the Christmas story, a story of life in a world of judgement and expectation, but where the essence remains the same - that of life in adversity which requires love and understanding from within ourselves, to make anything possible. No one else can do this for us, it is using our circumstances to learn about the person within, and letting your light shine.
I have always had a passion for music and singing, and for me one of the greatest aspects of it is that complete strangers can come together and create something beautiful. Why does this work so well? There is a common goal and a passion to make it happen, that’s why. It doesn’t even matter if you are singing from the same hymn sheet, or if you are doing a jazz improvisation, the aim is the same - to give others pleasure through music.
So why not apply this to our every day. Instead of arguing over what the notes are and how they should be interpreted, have a go, and see what it sounds like, what the feedback is and whether the mood is right. Music making is about testing things out, communicating and working through it together through rehearsal. Testing out new things seems ok in rehearsal, it’s fine if you get it wrong, that’s what rehearsal is for. Rehearsal is also leading to something, a final goal, a vision. Often it is said “bad rehearsal, good performance” and in my experience, never a truer word. This embraces a sense that we falter, that we try things out, that we feedback to one another about how the mood, the style, the sound comes across. Apply this to other areas of life and it takes the pressure off. Yes of course, there is an ultimate finished product, like a concert for example to equate with our musical definition, but we understand that there is a process of refinement and that is OK, accepted, expected. Apply it elsewhere in life and accept the pitfalls as learning, the missed notes as the perfected ones in the long run. Enjoy the ride, laugh through it and make interesting deviations, be music makers of life - maybe try putting on some music and reflect on how it came to be - through trial and error, persistence, collaboration, love and passion - that doesn’t just reside in music you know, it’s life.
So give life a go, the creative way, and enjoy…
It is incredible how loneliness can impact on health and wellbeing. It is important though to be mindful that there are some that prefer to be alone, with equal necessity for health and wellbeing. These are two very different things yet can be interconnected. If someone is lonely, it is often because they are missing contact due to circumstances beyond their control. Loneliness is much more common than we think. You can be around people and be lonely - it is about the interaction. Some people say that their pet is company, that they talk to them, stroke them, feed them and there is that interaction, even without speech. Those who like to be alone, may be quite content in the company of others but do not wish to engage with the interaction.
There are conditions that can contribute to either of these, but there is also something about the nature of others too that requires that deeper knowledge and understanding, that they are not imposed upon but being communicated with. This is a fine balance and requires an empathic sensibility.
So how do we tackle loneliness and the need to be alone, maybe talk to the person in the queue next to you or on the bus ride into town. Invite one of the parents at the gate for a coffee. Ask a close friend if they are getting enough time to themselves to rebalance in a world of noise. We are better connected than ever, but there remains something about the solidarity of a look, or a smile or a touch on the arm that can bring that special something that is, being connected. Just being, when someone wants to be alone in your company, shows true understanding.
Loneliness and being alone, different yet connected through the ability to understand one another at a truly human level.
It always strikes me the difference of the worker perspective on work given the style they experience. You can have two individuals with similar issues, but one can have a whole different perspective due to that supportive and trusting relationship provided by an effective and responsive line manager. It is about the manager having the tenacity to understand that life happens, but at the same time if it is time to move on in order to facilitate growth of the individual, that this is done in a coaching manner with the person at the centre.
It is a position that people can find themselves in and there is an expectation often that this should come naturally, or there should be a persona of authoritarian or paternal approach. Management is not for everyone yet managers find themselves there, lacking confidence, that, given the opportunity to develop competence, could be encountered in a very alternative way that is of benefit to all. This demonstrates how, through the chain of escalation, that the variables could be reduced by the development of shared values and the effective provision of an active appraisal and professional development system. This does not need to be hierarchical but in a coaching and mentoring manner that allows for growth and development whilst nurturing talent in an inclusive and equal way.
So reflect on what kind of manager you are, how you would like to be managed, what are the traits of a good manager in your experience. If you think it doesn’t matter, it really does and this is observed every day in the make or break of whether workers are able to be resilient through the diversity of life and work or struggle.
I have been reflecting on a speech that was given at the most recent Florence Nightingale Commemoration Service back in the Summer asking directly to recall the rationale for taking the path of nursing. As revalidation comes around again I have been looking over the past three years to collate all the various elements that I have put together, and this was one of them that was impactful on considering my relationship with nursing.
As with many careers in healthcare, the paths are not always straight and many other avenues can be explored. For me though, my nursing background has provided a framework of a person-centric approach that is a fundamental in any role within healthcare. Why? - because healthcare is about relationships, whether with patients, families, colleagues, other sectors and providers, the list goes on. I have always been fascinated by people and my training gave me the opportunity to explore humanity in so many varied states, having the headspace for enquiry into the many aspect of the human self both looking inward and outward alike. I came out of my nurse training a very rounded person, far more ready for the world and life than I imagined possible. The most incredible aspect for me was the trust that existed within relationships with patients and most colleagues too. However over time I have recognised and observed that this alters between stakeholders due to the competitive nature of business. I do believe that this will be recognised further in the pursuit for change. Coming back to the centre of nursing you see the person, a sum of many parts, intertwined, needing to have needs met and independence promoted, individuality respected and uniqueness lauded. So when looking at collaboration, put the person at the centre and you have your focal point for vision and implementation - seek their engagement and you will progress with precision.
So nursing, for me, is a template that has shaped my self both personally and professionally. The demands and expectations have changed within nursing since Florence Nightingale’s time, however the words within the declaration of passing on from generation to generation holds the essence of sharing of knowledge and skills from colleague to colleague, nursing and multidisciplinary alike. For me this also includes the patient as the expert on themselves, and by doing this, we are facilitating self management and empowerment through a trusting relationship.
I have been reflecting very much on systems and aspects that we have as well as the part we all believe we have to play within it. Everyone has a varying viewpoint and may not realise, positively or negatively, the impact that they have. Is the bit that we do needed anymore, or is it time to evolve? Have we evolved and we hadn’t seen this until we are reviewed at some point?
I have been fascinated also about the thought of systems being circles within circles, all interconnected and having a shared goal, however responding in a unique way. This unique response is indeed a pebble in a pond and the ripples, even those subtle ones are felt. There are many theorists who interlink systems, sociology and psychology, which is to be expected as we are holistic beings. With this is mind we need to consider our actions carefully, and plan for what may be an improvement in one area, but detrimental to another. This is why organisations need to recognise that targets are sometimes misleading in identifying progress. Thinking big, looking outward, finding your links in the system, allow for a collaboration in a shared understanding, where change is inevitable and actions fluid.
There is also something about how we are viewing this system - is it viewed as the earth once was, as a flat disc? Or is it more of a global view that we understand now, rounded and deep, equality all round? Take the first scenario here, if we are working horizontally then we are only seeing one level, this is not inclusive, and may involve a group of people that could potentially be a far cry from the interface of provider and user interaction. All could be excellent work but not connected at all levels. The global concept provides depth, equality, an understanding that if something happens underneath the surface there is a reaction at the top - like a volcano. Because of observations and communications globally we are able to understand, plan and make provision with a better shared knowledge and ability to respond. Also, as with the natural world, the fluidity of change can at times be predictable, but this is invariably abundant in unpredictability also.
So whichever part of a system you are in, consider who is in the global circle around you and keep moving outwards, communicating, identifying, building, trusting...