Tag: nhs

nhs, Uncategorized

Do you want to build a snowman?

clcopeland

What a mad few days!

It started on Tuesday with the warning that the ‘Beast From the East’ was coming.  Although it was predicted to only hit the east side of the UK I thought I’d best prepare.  Or at any rate buy some thermal tights.  To be fair we’ve had these kind of armageddon warnings before so no one was really that concerned ‘it’ll be a pussy cat by the time it gets to Scotland’.

However this was to be no fluffy kitten of a storm.

Waking up on Wednesday morning it became apparent that we were in for a rough day.  Waiting for the train in a snowy Queen Street Station my phone buzzed constantly. Our rota WhatsApp was rammed with messages from the trainees saying they’d either be late with some unable to make it at all.

Despite that I honestly didn’t think it was going to be anything more than a really rubbish day.  Then came the news a 1.30pm that a red weather warning was to come into effect at 3pm.  People were advised to leave immediately and public transport stopped running.

It became clear that this was going to be more than just a rubbish day.

A mass exodus ensued for all non essential staff.  WhatsApp, email and my page was going constantly.  In the midst of the chaos people were still turning up to my clinic despite having been phoned not to come.  Trying to manage the situation was, how they say, ‘challenging’

As with any crisis you get to see a wide spectrum of human behaviours.  Now I’m writing from the perspective of a doctor who also happens to be in charge of all things junior doctor related.  It’s not to downplay or ignore the work of all my other colleagues.  It’s just how I experienced it.

To say I was impressed with how our junior docs stepped up would be a gross understatement.  I was blown away.

As the hospital emptied they took the initiative to arrange a meeting for everyone who was left to sort out what was needed.  I was acting as support/go between (or gopher for want of another description) between the trainees and the remains of the management team.

There were many rumours circulating which made trying to manage the situation more tricky:

  •  ‘your insurance is invalid during a red weather warning’
  • ‘will I be made to work nightshift if I’ve been on days’
  • ‘the buses are running – no they’re not, yes they are’
  • ‘the canteen has run out of food and is closing at 3pm’
  • ‘THERE’S NO CHIPS LEFT!!!!’

We tried to get advice from the BMA only to be told the office had been temporarily evacuated due to the weather – much to the amusement of everyone at the meeting.

Whilst it seemed to be getting a little silly it seemed to only further fuel the trainees enthusaism.  I didn’t hear one word of complaint/moan/whinge.  That was until the news broke that the pub at the Premier Inn had shut. Deflating balloon would be an accurate description looking round the room – however hero of the hour Dr Dan Beckett went out into the blizzard to source some supplies.

I did manage to get through to the BMA. Rumours were clarified.  Patient care was sorted. It was all good.

As Wednesday morning arrived the reality of what we were dealing with became apparent.  The hospital huddle was reporting next to no staff had made it in.  It had the feeling of a war zone.

Still everyone pulled together.  It was phenomenal.  We had senior management out and about in 4x4s picking people up.  Serco doing everything they could to ensure patients and staff were fed and the place was clean.  Our nurses continued to deliver excellent care. That doesn’t even cover our other colleagues in pharmacy, the labs, rehab and countless others.

All the while I was bouncing around seeing thrombolysis referrals, doing a ward round and manning the texts and WhatsApp.  Adrenaline may’ve increased my average working speed to 1000mph but I did force myself to slow down as I spoke to worried relatives/carers.

So the day went on. As did the snow. It. Never. Stopped. All. Day.

We were all getting tired at this point.  The hero in my story was my Charge Nurse Nyree Philips.  Living across from the hospital she came in off her annual leave as well as providing me with chat, an ear and later in the night, gin!  All this despite my laughing at her when she face planted in the snow as we walked out of the hospital.

I spent time with colleagues I rarely see and got to know others better.  A thought that went through my head was ‘you just don’t know’  – you don’t know what people are dealing with or going through.

We also talk a lot about how we’ve lost that sense of team spirit and camaraderie with all the rota changes.  On reflection I disagree.  I don’t think it ever went away.  We just lost sight of it.  Now I’m not suggesting we should get snowed in on a regular basis but I do think we need to try harder to make time.

As the past few days has shown even when we were at our most stretched and busiest we were still able to make the time to ask ‘You alright?  Fancy a coffee/chat? That’s what’s going to stay with me after this experience.

However now that I’m finally home you will need to excuse me.  I’m off to build a snowman…..

snowmaggedon team photo
Team Snowmaggedon

 

nhs, Uncategorized

Here comes the sun

clcopeland

When I started writing this blog a couple of weeks ago there had just been the GMC ruling over Dr Bawa-Garba.  Not surprisingly it sent shockwaves through the medical profession.  One of the main issues was around rota gaps and trainees being stretched even further in order to cover them.

As I’ve mentioned before I am the Forth Valley medical rota lead.  Some refer to it as the ‘Poison Chalice’.  I roll my eyes whenever things like this are said in my presence.  Why?  Because it shouldn’t be so difficult or complicated to run a rota.

With that in mind I think it’s important to remind people that rotas are a fundamental necessity of the NHS.  A service that is about patients.  Or people.  People who are sick. People who are vulnerable. People who need people to take care of them.

This service can only operate if the doctors, or people if you will, are not over tired, stressed or lack the skills or support to do it safely.

This service of caring also requires processes to help facilitate the safe delivery of it.  Sometimes we refer to these processes as people too.  Behind every flow chart, piece of paper and email are people whose job is the smooth running of this mammoth organisation.

However in every high pressure service there can be obstructive, confusing behaviours or opportunists trying to push personal agendas.  I’m sure we’ve all experienced this at some points in our careers.

Now I can appreciate that people are apt to do to unusual things when they are under pressure.  I can also accept that some lack the insight or self awareness to recognise when they do.  What I can’t accept is when it appears to be wilful.  Blaming others for their mistakes, not taking responsibility or being accountable in any way.

So how does this change?

You need formal governance around any rota work. Without it there can be no consistent management, cohesive policies, guidance, processes or decision-rights to allow the safe running of the service.

The GMC have said there should be a ‘guardian of safe training’.  Now I would love if Chris Pratt came and fixed it all but this seems far fetched.  Well is it so far fetched to have processes and people that work for the service instead of against it?  A service that strives to care for people.  Well I don’t think it is.

This week I had several conversations with those instrumental in improving it.  They were long, they were at times difficult but we made progress.  I could not be more proud or impressed with the way people showed up.  I don’t just mean physically.  I mean actual showed up and had the uncomfortable conversation from a place of honesty and willingness to change.

It’s been a long, cold, winter and I think we could all use a little respite.  So as the sun begins to creep through, I think it’s going to be alright…..

nhs, Uncategorized

Shine bright like a diamond

clcopeland

Happy New Year!

We haven’t exactly got off to a flying start.  To be honest the NHS is usually hit pretty hard at this time but nothing like we’ve experienced this year.   However I don’t want to waste what precious time you have talking about the flu or the so called ‘NHS crisis’.  It’s well documented and I’m pretty sure most of you are still in the midst of it.

No, what I’d like to talk about are the conversations I’ve had.  While it’s felt like working in a pressure cooker at times, it is this pressure that can turn a black situation into a gem.  You just need to see its potential.

For example, talking about death.

As a Geriatrician it comes with the territory.  However if you ask hospital doctors or nurses, most of these conversations are had with people who we know are going to die.  What do I mean by that?  Those with a cancer or a progressive chronic disease like heart failure or COPD.  It’s expected and we’re comfortable in talking about it. What we’re not so good at is when the person doesn’t fall neatly into one of those categories.

How do you tell someone they may be dying  when they’re alert, not confused and want to know why they’re not getting better?

To look someone in the eyes and tell them ‘I may not be able to make you better’ when that’s what you’ve been trained to do is hard. However I have always taken the view that I don’t want the person (or their family) to be surprised. I certainly don’t want to deny what time they might have left by not being as honest as I can.

I think it would be fair to say that as doctors we tend to shy away from these kind of conversations.  There is a gradual shift in this however as people are becoming more comfortable with being uncomfortable.

Some time after I listened to a podcast with Dr Jil Bolte talking about her book ‘My Stroke of Insight’.  In it she spoke about how she lost the power of speech and understanding due to an intracerebral haemorrhage.  The part of her brain that dealt with perception of tone, intonation was still there.  What struck a chord was the way she spoke about people including doctors needing to ‘show up’  when they came to see her.  Don’t just go through the motions but really connect for the time you’re in the room.

This may sound an obvious thing to say but working in such a pressurised environment it’s something that’s easily forgotten.  Not on purpose I might add.  Its just we become very task orientated when the place is so busy. I totally understand how that may come across but do not confuse it with not caring or not doing a good job.  It’s just sometimes there is very little left to give.  You need energy to make a connection or have an uncomfortable conversation.

On that note she spoke of being accountable for the energy you bring to the room.  So with that in mind I try hard (not always successfully) to leave whatever baggage I am dealing with at the door.

It then becomes about compartmentalising. How do you teach that?  I’m not sure you can to be honest.  Stopping to reflect is key.  Even mid ward round.  I’ll often throw out questions with no expectation of an answer. It can generate some interesting discussion though.

It was during one such conversation I was reminded by one of the FY1’s that medicine is taught as black and white but life and people are colour.  You need to allow for that.

So that’s whats made this flu crisis so interesting in some respects.  People are being forced to behave in ways they don’t like or are used to. They’ve had to not only show up for the patients but also their colleagues.

One things for sure people are having to dig deeper to find that reserve.  Let’s see if 2018 will lead to something more sustainable for the future……

nhs

Día de los Muertos

clcopeland

My previous blog generated a fair bit of discussion around mental health and it’s something that’s still on my mind a couple of weeks later.

Since adopting (or at least trying to adopt) the 4 agreements the one I’m having the most success with is ‘take nothing personally’.  It really is quite liberating!  That said it still needs a degree of self awareness.  You can’t really blame someone else for projecting their reality on to you when in fact it’s you that’s being an arse in the first place.

It also doesn’t mean letting people away with behaving badly either. I’ve become much more aware of other people’s sense of personal responsibility for someone else’s bad mood or perceived injustice.

What I have been less good at is being ‘impeccable with my word’.  Man alive it’s hard!  It’s all good and well when everything is plodding along and you’re full of energy.  However after a day of constant paging, emails and bouncing from one thing to the next the only thing I’m impeccable with is my choice of expletives.

However it was with this fresh perspective that I went to our Consultant away day.  The day had been organised to bring together senior clinicians and management.  I’m not going to get into the detail of the day as the whole premise was to have a safe space to air views.  I would however like to make some observations based on the many away days I’ve been to over the years.

I am beginning to think that the NHS is being run by ghosts.  You know they’re there, you just can’t see or hear them.  Traditional thinking is that they are dead inside however judging by the comments made on post it notes or feedback sheets there is in fact spirit.  However that spirit is in pain, feeling frustrated and not being valued.

I always think the purpose of these days is to exorcise feelings in something akin to a purge. So is it merely enough just to write them down or stick them on a wall?

The reason I think many of these well intentioned days fail is precisely due to this.  It all gets written down and not followed through.  Many assumptions are made about whose fault it is and life goes on the same.  It’s all a bit depressing.

So why not try something different and call these days what they really are: ‘Day of the Dead’ and no, I’m not being facetious.

The Mexicans believe that the day celebrates the cyclical nature of life in particular how new life can come from death.  Why not in these team building, management away days openly talk about the past but with one major difference – let ideas and life evolve and flourish.

I know some of you will be thinking ‘but we do that’ however I’m here to tell you it’s the exact opposite that happens. Why else do we keep having the same conversations if things are moving forward?

What we need to do is restore a little faith and breath renewed life into our workforce. Acknowledge the past but not stagnate in it.

Let the spirit of our NHS live…..

nhs

A Change Is Gonna Come

clcopeland

This week I met up with Jenni Burton (@JenniKBurton) she’s one of the smartest people I know and I love when we get time to have a proper catch up.

Predictably as two medics we got to talking about all things work related. In particular education, training and rotas

I’d been involved in meetings this week about how the medical rota was running.  It’s no secret that we’ve had problems and I’d come on board in recent months to help.

Managing a rota can be a bit of a poison chalice to be honest.  There’s a constant tension in trying to deliver both training and service so it can seem that no one is ever happy!

Of course what doesn’t help is some people going down memory lane and thus any discussion turns into the Four Yorkshireman, Monty Python sketch.

‘You were lucky to work 100 hours a week,  we used to work a 100 hours a DAY!’ 

I think that with any rota it’s important to acknowledge that in many ways things have got better.  However we are working in a different culture.  One where the focus seems to be on the training experience and less about the work itself. I don’t think the balance is quite right.

So I think we need to be honest about what we can and can’t deliver training wise while trying to maintain a proper service.

It occurred to me as we were talking that while I spend a lot of time ‘clarifying understanding and expectation’ with my patients and their relatives, I don’t always extend that to our junior medical staff.  What I mean by that is clearly defining expectations and explain some of the decision making process.

As an organisation we need to be up front about saying there are two choices:

1. The best training experience you will get is not through going on umpteen courses, it is by being at work.  Going on ward rounds, getting to clinic, talking to relatives, running the acute take etc. This is enhanced by continuity i.e. keeping you on the same ward most of the time. In order to deliver that it is going to mean compromise.  In this case fixed annual leave, less study leave and few swaps.

Or you can have this experience:

2. You get to go to all your study leave, have your holidays when you want but the overall team will be spread extremely thin.  The compromise here is you accept that you will be moved around a lot to cover gaps.  You may even have to do more on calls.

You cannot have both.

There is a service to run and sick patients who need doctors of every grade to look after them.  There’s also the fact that you also get paid for this and quite well, relatively speaking. That in itself comes with professional T&Cs that come with taking on this job.

It’s not just Forth Valley that haven’t got the rota quite right yet. I do think we need to try different things and see what works.  Jenni was telling me that when she worked in Leicester they offered exit interviews for trainees.  I think this is a great idea and much better then the trainee surveys (they always seem slightly out of date and skewed depending on the number of replies).

Potentially real time change could be achieved by allowing trainees to shape and deliver their training while keeping it in line with local needs.

What we don’t need is a talking shop where we are seen to be engaging with trainees but won’t follow through with the difficult conversations or decisions.  Of course none of this should be done in isolation.  It is as important to have these discussions with Consultant and Nursing colleagues.  I don’t really think we have really acknowledged that their role is also changing as we have more gaps/less trainees.

I do believe we will ultimately get this right. It may be a long time coming but I do believe a change is going to come…

Holiday, nhs

Club Tropicana

clcopeland

Holiday resolutions – full of good intentions and emphatic declarations of how things will be different but how long does it take for them to be broken?

In my experience…. a couple of hours…. then the familiar feeling of never having been away sets in *sigh*

This time I decided to try approaching my return to work rather like an extension of my holiday.  It has many similar features after all.  Not convinced?  Well lets look at the evidence……

Packing

The night before I pack my work rucksack, sadly It’s not nearly as exciting as actual holiday packing.   For a start there’s no inflatable unicorn drinks holder. However it does contain the same essentials – a form of ID, portable air con in the form of my lovely Spanish fan, a variety of snacks and money, well at least a card that’s been paid off this month. I think…

The fragmented night before sleep

I wake up. Again. It’s 5.20am, it’s dark and I suddenly realise that my alarm has been set to 6.30am instead of 6.00am?!?  I leave at 6.45am for my train.  Horror of horrors I could’ve slept in!  Thank goodness I woke up except now I have 40mins before I actually needed to be up and I’m proper awake.  Oh joy. Yes the sleep before you head off on hols is pretty much the same as that the night before heading back to work.  Rubbish!

 The journey

I have no pre allocated seat and there’s no drinks trolley bringing me gin (this is a work commute people, not the time zone freedom that international air travel permits!)

I do however have my own entertainment system in the form of noise cancelling headphones, podcasts and music. Sometimes the white noise of people snoring or tapping on their phones can be perfectly pleasant too.  Rather like the background hum of a plane. Must not fall asleep. Must not fall asleep. Zzzzzzzzzzz

You have reached your destination!

The destination

It’s bright and sunny as I arrive at the Costa del Larbert.  I see some people outside enjoying the ‘fresh air’. The aroma of freshly ground coffee and muffins greats me as I walk through the doors. White washed walls of the building remind me of the Mediterranean.  Yes, my brain is beginning to fall for this being just like on holiday. I wonder if I’ll have any messages……

The welcome pack

Good morning Dr Copeland – you have 204 new emails. That is so nice!  I bet it’s all good news.

Ooooo – what’s this? An animated email trail.  I forgot to pack my holiday read so lets see what’s this about. Right…. They said what?….. . So I said…… And then he said…. And then I was like ‘no way’ …. So I said to her…. And she said…… And then…… Lol, a winky face emoji…..

Well I’m glad that didn’t escalate and everyone is still talking to each other.

I best head to the where all the action is – off to the ward.

Good morning welcome meeting

Hello everyone and welcome to sunny Costa Del Larbert.  It’s great here – lots to see and do.  On that note Mr X fell last night and doesn’t seem quite himself.  The family of Miss B wants to speak to you.  And can I ask who’s covering….

Beep, beep, beep

It’s my welcome back page – how many have phoned in sick?  Well that is a problem….

Back to reality

While all this is going on my brain keeps popping up ‘Club Tropicana’ while I wait for the computer to load or the person to pick up the phone.  I smile at the ridiculousness of it all.

Holidays are, by design, a break from reality.  A chance to recharge and switch off from work.  However today tells me that by injecting some of my holiday mood into everyday work life, occasionally there is fun and sunshine.  To be honest all that’s missing is the sea….

Holiday, Uncategorized

Hey, how you doin’ Sorry you can’t get through. Why don’t you leave your name. And your number and I’ll get back to you….’

clcopeland

There’s been a lot of chat on twitter about annual leave and email checking.

My colleague tweeted that he’d managed to clear  500+ emails of the thousand or so he’d come back to post hols. What followed was an interesting thread discussing the pros and cons of auto deleting emails.

Now I have a small confession to make at this point. The volume of emails my colleague received…. I’m pretty sure were generated in part by me and rota discussions (well he did go on holiday at changeover).  For the first week he was copied into every email. I’d assumed he would want to know.  I stopped doing it in week 2 as it was starting to get ridiculous not to mention pointless. As long as emails were being actioned did it matter if he knew about every, single, decision? I decided no.

So that’s what made this twitter thread so interesting.  This idea that you could delete 1 – 2 weeks of your professional life hoping that people would understand and leave you alone to relax in peace.

Now while I support this concept, I know others do not.

My experience is that there are quite a number who use the excuse you’re on holiday to email about things knowing that you’re not around.  And not in a good or helpful way.  There is definitely power politics at play while your out of office is on.

‘Oh I’m sorry, were you not aware of that?  I did copy you into the email’

Hmmmm…..

Of course there was a time when I would get quite wound up about this.  However I have come to realise it says more about them than me.  I can choose not to react/care.

A further dilemma is how to manage the return to work email overload.

What would be lovely is if some reliable, trustworthy person from each facet of your professional life did a ‘return to reality handover’.  Rather like the handover you might do about your patients before you go on holiday.

It would be succinct and available on the morning of your return.  I have tried this with said colleague who went on leave – I even messaged him with a ‘of all the c**p in your inbox could you read mine first?’

Then there’s the welcome party when you get back to your clinical area:

‘Can I just ask you about….. I sent you an email’ 

‘I’ve literally just got here, I have no idea what you’re talking about’

You usually need to wait a few minutes for shocked expression to disappear from the persons face.

Again the expectation is that while you say you’re not checking your emails, they believe you secretly are and that you’re lying if you say you don’t because who doesn’t check their emails on holiday?!

I do believe the sincerity of those who are trying to get people to take an actual break and encouraging them to auto delete.  I just don’t believe that everyone will do this.  I’m not even convinced that it’s needed if I’m being entirely honest.  People will do what people will do.

My response:

‘Hiya, I’m on my holiday at the mo.  I start back on September 11th however it’ll take me a few days to catch up.  If it’s important then page me or resend on that day.  Thanks.’

I usually add a bunch of who to contact at the end too.

Ignorance is bliss as they say but mental health, well, that’s priceless…

nhs, Uncategorized

Hi, my name is. Who? My name is. What? My name is…..

clcopeland

We live in a world of constant connections and yet most of the time people do not know who you are, never mind anything about you.

We had a campaign in the NHS called ‘Hello my name is….’ to remind people to introduce themselves and restore a little humanity into a busy workplace.

People like to be called by their name and I try very hard to remember it.  However I’ll be honest if the nurses move people around in the ward for whatever reason it will completely throw me.  I always refer to my patients by their preferred name but I will map them in my mind as a bed space number.  I then need a hook.  The lady who loves watching Strictly.  The man who worked on Christmas Island during nuclear testing.  The lady with the pink fluffy dressing gown.  Once you give me the bed number and hook I can rattle off all kinds of specific facts about them from blood results to the CXR findings;

‘Oh yeah, Mrs Smith Rm 9, bed 2. Has pneumonia, delirium and acute kidney injury.  CRP was 102, now 86. eGFR was 23 and is now 29. Lives alone, Package of care three times a day.  1 daughter and 2 sons. Loves Strictly Come Dancing’

Move her to a different room and I will think she’s either gone home or worse that she’s a brand new person.  I have been known to look blankly at the junior doctors until someone whispers ‘was a Louise & Kevin fan…’ 

‘Oh yeah, Mrs Smith…’ and off we go again.

So what is the big deal about a name if I can recall all that detail?  Well, no matter how much detail I can remember nothing is as important as the person’s name.

This was reinforced when I called a person by the wrong name in clinic recently. I had been talking about someone else with a similar first name and I stupidly used that name when I went to call them in.  They were understandably annoyed. I was mortified. Despite apologising and going through all the detail it took some time before I could convince them I knew what (and who) I was talking about.

I have even more trouble with colleagues.  It’s not just about taking them out of their work environment and seeing them in civvies.  It’s when I meet them at a conference or in a different work environment (think rotating trainees).  Not only do I struggle with their name but also in what context I know them from.  It’s a nightmare!

I have often joked that people but especially doctors should wear a badge stating; ‘Hello my name is… you may know me from such things as your FY2 on nights, that ALS course we did 7 years ago, that time I referred you someone at 2am etc etc’

Admittedly my response is something along the lines of ‘was I crabbit?’  I always assume the worst of my harassed past self.

So while a name is without question important, I do think we ought to see beyond it.  To me it’s the person behind it that matters – so come on then, what’s your hook?

health, nhs, Uncategorized

Lovely day

clcopeland

It’s that time of year again – changeover week. This changeover, more than others, is a particularly busy time.  It’s when our new FY1’s start.  No longer are they on the wards or in libraries learning the theory. Now it’s time to put it into practice.

It’s both terrifying and exciting!

This year I was again involved in the ‘Preparation for Practice’ course that our Resuscitation team and Simulation Centre organise.  The day takes our new doctors through an array of simulated scenarios using Forth Valley specific paperwork and protocols.

The team involved is huge and varied reflecting the breadth of the expertise involved in caring for our patients and keeping them safe.  What I particularly liked was the involvement of our current FY1’s.  They were brilliant in offering practical tips but more importantly reassurance that it will all be fine. It was also lovely to see how far they’d come since taking part in the same program the year before.

For some though the reality of it all became a bit much. The day came at the end of a long week of induction and shadowing. The scenarios are specifically designed to be as realistic as possible but with an emphasis on a safe learning environment.  However no matter how much you tell yourself the ‘patient’ bears a striking resemblance to your FY1 shadow buddy the situation is real.

There was a dawning realisation that patients don’t behave like they do in textbooks.  They don’t tell you what’s wrong straight away.  You have to work it out based on the clinical exam. You have to have the confidence that you are hearing crackles in the chest and not just the rustle of the sheets on the bed. Then there’s the tests.  Why do they not come back straight away?  Of course that’s assuming you can get bloods off them – some don’t have great veins or are so confused they wont let you near them.

However there’s a sigh of relief when it becomes clear what’s wrong. A plan can be made and treatment started.

In my scenario however our patient didn’t respond to treatment and began to deteriorate.  In real life that happens and it is stressful.  As a doctor (or a nurse) to try your absolute best and see it not working is the worst feeling.  The time that you were willing to speed up to get the person better you now wish would slow down to give you more time to fix them.

One of the objectives of our scenario was how to have those difficult conversations when things are clearly not getting better.  My role was to demonstrate a positive discussion about a treatment escalation plan. Any conversation that involves resuscitation has to handled with great care and sensitivity but always with the intention of doing the right thing by your patient.

After the scenario had finished we had 15mins to debrief and discuss what had just happened.  Pretty much everyone thought they had done terrible.  Of course this wasn’t true but that’s what this particular stress does to doctors and nurses.

In real life what also tends to happen (especially out of hours) is they will be asked to immediately go straight into another high stress situation.  There is precious little time to write up notes never mind reflect on what went well and check everyone, including yourself, is ok.

This kind of chronic stress was something that was never really talked about or acknowledged when I first qualified.  Some twenty years on and induction programs now include sessions on well being and stress management.

As I was writing this Bill Wither’s song came on the radio with the lyrics:

‘When the day that lies ahead of me
Seems impossible to face
When someone else instead of me
Always seems to know the way’

I took this as a sign!

So as our new doctors take to the wards I can’t make the patients behave in a more predictable fashion.  Nor can I take away the feeling of nausea.  I can however ask how it’s going and buy the coffee. So to that end I know it’s going to be – a lovely day…..

 

Dementia

Is this the world we created….?

clcopeland

I’ve been asked to talk at a Masterclass on Design for Dementia and Ageing at Stirling University this week.  The brief is 10mins on the environment, dementia and acute care. The focus is on the real world aspect rather than reams of data.

So what do we mean by the environment? Type that into Google and you get this:

’the surroundings or conditions in which a person, animal, plant lives or operates’

They often like to provide an example of how to use the word and given the subject matter this one really struck a cord:

‘survival in an often hostile environment’

That is exactly what coming into hospital is like for the person with dementia.

Now before I get into this some more I want to be clear from the start that the people working in hospitals do not deliberately create this nor do we go out our way to make it as horrible an experience as possible.  That said you will frequently hear colleagues talk about how hospitals ‘break people’.  Even in my recent visits to care homes staff would tell me about how residents would seem both cognitively and physically worse after an admission to hospital.

We know that people admitted to hospital are not there because of their dementia but due to conditions associated with it e.g. falls, hip fractures, chest infections, delirium etc.  With that in mind hospitals are perfectly designed to deal with this array of illness. What it was never designed to do was be a place that met the needs of a cognitively impaired person.

Years ago I heard a talk that somewhat poured scorn on the notion of ‘artificial’ dementia friendly environments.  At the time I could understand the frustration – how does a mock 1950s kitchen or living room help?  If they’re well enough to be in a sensory garden should they not be at home recuperating/rehabbing….?

However people with dementia get sick just like everyone else.  So when you need admitted with pneumonia or a fracture then I do think hospitals should do more.  It is not the person’s responsibility to adapt to our broken systems and processes.

There is evidence that if we invest in the environment we can reduce length of stay, falls and violent/aggressive behaviours.  Not to mention the positive effect it can have on staff caring for these people.

The evidence points towards simple, inexpensive measures having a big impact.  Clear signage, quiet, well lit clinical areas.  Ironically the move toward single rooms in new build hospitals has prompted discussion about resurrecting the Day Room as a place for social interaction.

Perhaps one of the biggest challenges is in creating an environment where families/carers are welcomed.  If we are striving to have the person with dementia feel safe and secure then we need them.  They very often point out things that we have become blind to ourselves.

So I would like to see the hostile environment of acute care become a place where the person with dementia thrives and not merely survives….

For more info:

https://www.kingsfund.org.uk/projects/enhancing-healing-environment/ehe-design-dementia

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4075017/19870707-ace6-4c5c-b3df-0556816f61fe.pdf

http://futurehospital.rcpjournal.org/content/2/1/63.full.pdf

http://dementia.stir.ac.uk/design/virtual-environments/virtual-hospital

Thanks to Janice McAllister (@janicemcalister) for providing some of the refernecesIMG_4304