The 50th anniversary of The Winston Churchill Memorial Trust by Shelagh Creegan

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Shelagh Creegan, an occupational therapist from Dundee, attended a special event at Sir Winston Churchill’s birthplace of Blenheim Palace, on Wednesday 27th May, to mark the 50th anniversary of his living legacy – The Winston Churchill Memorial Trust (WCMT), and 50 years since his passing.

 blenShelagh went on her Travelling Fellowship in 1993 to USA and Canada to investigate vocational programmes for adults with a severe and enduring mental health condition.  Her visits to a range of programme models clearly demonstrated that employability is achievable if the person is provided with appropriate services and support.

From the institutionalised care of the 20th Century, fast forward to 2015 and Scotland’s dynamic health and care policy environment has focused its ambition on delivering integrated health and social care, reducing or removing the damaging impacts of health inequalities and ensuring the provision of safe, effective and person centred care for everyone accessing health and care services.  The strategic and operational contributions allied health professionals (AHPs) make to progressing this policy agenda is clearly set out in the national AHP delivery plan,  AHPs as Agents of Change in Health and Social care.

Mental health is a core component of this policy context, spearheaded by the Mental Health Strategy for Scotland: 2011-2015 and Scotland’s National Dementia Strategy 2013-2016.  Realising Potential, launched in 2010, explicitly set out the role AHPs can play in supporting people with mental health problems and their carers and improving mental health and wellbeing in Scotland.

The new ways of working Realising Potential promoted – co-production, intersectoral partnerships and collaboration, person centred approaches and self-management – are very much in tune with the wider policy agenda.  Notable success has been achieved in the promotion of vocational rehabilitation with AHPs adopting a range of creative approaches that are enabling people with a mental health condition to maximise their potential and achieve their aspirations.

For example, the national Strategic Mental Health AHP Leadership  Group has supported the creation of a national vocational rehabilitation network with an AHP vocational rehabilitation lead identified for each Health Board.  In Tayside, as in many Health Board areas, this has led to the development of a local vocational rehabilitation network which has focused on improving clinical governance and the development and implementation of evidence based practice including :

  • creation of a Tayside page on the national Good Work: Good Health, Knowledge Network, VR Community of Practice
  • training for all mental health occupational therapists in the standardised work assessment, the worker role interview (WRI)
  • training of a small number of AHPs in the Individual Placement Support (IPS) model with the intention being to roll out IPS programmes across Tayside to support people with a mental health condition into paid employment
  • development and testing of an employability pathway
  • collaboration with local colleges to deliver supported education programmes improving access for people with a mental health conditon into further education
  • supporting people in forensic and adult mental health services to develop employability skills through engagement with local social enterprise companies
  • through volunteering, the development of work habits, routines and skills in preparation for return to work
  • the provision of work placements for NHS Tayside Healthcare Academy students
  • showcasing best practice at national conferences and publications

Returning to the special event and over 1000 Fellows and their guests, from every decade since 1965 attended the day, which was hosted by the Duke of Marlborough’s sister – Lady Henrietta Spencer-Churchill, who is herself a generational cousin of Sir Winston, and a member of the WCMT Advisory Council.

Shelagh joined a small gathering of Scottish Fellows at Blenheim Palace.  It was a wonderful opportunity to renew old acquaintances before going on to meet Fellows from all parts of the United Kingdom.  The rich diversity of Fellows travel experiences, the learning gained and the leadership displayed in translating evidence into practice was truly inspiring.

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Members of the Churchill family, including Sir Winston’s grandson Jeremy Soames; and his great-grandson, Randolph, were also present; as well as many of the Trustees and Advisory Council from the WCMT.

Highlights of the day included presentations given by Fellows from 1968 to 2014, about how their Fellowship has shaped their lives and careers.  Internationally acclaimed Churchill experts, including historian Sir David Cannedine, also gave talks.

The special day was rounded off with a spectacular Spitfire Display, followed by Lady Henrietta Spencer-Churchill and Randolph Churchill taking the salute at a Beating Retreat given by a marching band.

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Since 1965, over 5000 British citizens have been awarded Churchill Fellowships, from over 100,000 applicants, to travel overseas to study areas of topical and personal interest.  The knowledge and innovative ideas they bring back are widely shared, for the benefit of their profession, their community, and, in lots of cases, the nation.  For many people a Churchill Fellowship proves transformational, and they go on to achieve great things – effecting positive change within society.

To mark its half century, the Trust has awarded a record number of 150 Travelling Fellowships in 2015 – investing over £1.3m in British citizens.  This year’s Fellows will travel to 58 countries between them, across six continents, where they will carry out a wide range of projects.  The average length of a Fellowship is 6 weeks.

Many events are being held throughout the year to celebrate Sir Winston’s life and legacy.

“It is fitting to hold our 50th anniversary event at Blenheim Palace, and to come together with hundreds of Fellows from across the past 5 decades, to celebrate the life of this great leader.  Sir Winston’s legacy lives on through our Fellows – individuals who, like him, have vision, leadership, a passion with a purpose, and a commitment to help their fellow citizens” says Jamie Balfour, Director General of The Winston Churchill Memorial Trust.

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For further information please contact:

The Winston Churchill Memorial Trust on 020 7799  1660 or http://www.wcmt.org.uk or @wcmtuk

Shelagh Creegan is the Associate AHP Director for Mental Health and Learning Disabilities with NHS Tayside.  Email: screegan@nhs.net  Twitter: @ShelaghAHP

References

AHPs as Agents of Change in Health and Social 2012-2015 Care  www.gov.scot/resource/0039/00395491.pdf

Mental Health Strategy for Scotland: 2011-2015 http://www.gov.scot/resource/doc/357051/0120639.pdf

Scotland’s National Dementia Strategy 2013-2016      www.gov.scot/Topics/Health/Services

Realising potential 2010 http://www.gov.scot/resource/doc/314891/0100066.pdf

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Can you see what I mean? by Laorag Hunter

My definition of successful communication is broad. For me, successful communication is communication that works. Simply put, a message “works” when the person I am communicating with gets the meaning I intended. When you hear, read or see something and communication “works” you have a confidence that I call the “I see what you mean” feeling.

My closing the office routine includes checking the answering machine. On Friday I am glad there is only one message, thinking that it won’t take up much time. The message is from a female asking me to call her on a specific number. Perhaps she’s also in a rush to start the weekend as her message is delivered at high speed.

The message starts well enough, “Please can Mrs Hunter call…..” but then I am not sure if she says Liz, Louise, Lois or perhaps even Lesley on “01382……” I can only think it is numbers something, something, something and something as she reels the figures off so fast that there is no way I can remember them (especially while I am still trying to work out the Louise/Liz/Lois part). I don’t recognise the voice.

Three listenings later I have finally got the number by writing each digit down as quickly as I can, but the name still eludes me. I am left feeling irritated at the time this has taken and mildly concerned that without knowing the name I have no clue as to what it is about.image However, at least I think I have got the phone number and that might be sufficient to respond. Having got part of the message reminds me that understanding is not all or nothing, and that it comes in degrees or shades of grey.

My machinery for understanding is, as far as I know, only mildly impaired. I have some reduction of visual acuity (correctable by glasses). My hearing is good and my knowledge of word meanings is reasonable, above average in some topics (such as knitting) and poor in others (such as musical terminology). My speed of understanding is variable and I notice that I like radio presenters with a slightly slower speed of delivery (for example, Eleanor Bradford, the BBC health correspondent goes at a comfy speed for me). If I am tired, then I really don’t cope well with words coming thick and fast. It’s a double whammy if the subject matter is a difficult or unfamiliar one and causes the disturbing “in the dark“ feeling. And, I know that when I have something on my mind or my anxiety is raised I also can’t process messages so efficiently.

My capacity to understand is robust in comparison to the people with aphasia who I work with everyday. Aphasia describes difficulties using and understanding language and is a common consequence of stroke, head injury or brain illness. Recent mainstream publications have done much to improve recognition and understanding of aphasia. I recommend Grace Maxwell’s account of her husband Edwin Collin’s brain haemorrhage and rehabilitation, and neurologist Jill Bolte-Taylor’s personal account of her own stroke and aphasia. Jill Bolte-Taylor’s TED Talk has had 16 million views (please do watch this fascinating talk if you are not one of the 16M). Difficulty using language is the most obvious feature of aphasia. Communication partners can see and hear any struggle for words; mis-pronunciations; word substitutions such as saying “tiger” when meaning “cat” or replacing words with nods, sounds, gesture and pointing. Understanding cannot be seen; it is a private matter and the tendency for communication partners to over-estimate understanding leads to problems.

Some examples from patients who have recovered enough expressive speech to describe their problems with understanding help to illustrate this.

  • “Judy said to me put on your armani. armani? What on earth is my armani? I don’t know what she means.”
  • Jim puzzles over the word grapefruit. “Grapefruit? That word seems remote to me as if it is somewhere out there on a headland.”
  • Susan is shocked when the waiter brings her a plate piled with various seafood (she hates fish). When Susan chose “fisherman’s platter”, in her mind she saw a plate of cheeses, breads and pickles. In her mental store of word meanings, she has connected Fisherman’s platter onto her entry for Ploughman’s lunch.
  • Martin doesn’t understand the instructions the consultant has given him verbally at his recent consultations to increase one epilepsy medication and reduce another. The consultant is frustrated with what he wrongly perceives to be a lack of compliance.

Some people with aphasia are able to indicate they have difficulty understanding. One gentleman, Eddie, makes a sweeping gesture backwards above his head to express an idea along the lines of “the words are going over my head.” Not all people with aphasia are able or willing to admit they don’t understand. Jill Bolte-Taylor cautions partners to “be aware that I may want you to think I understand more than I do.” For any individual, with or without aphasia, admitting to being somewhere in “shades of grey” of understanding might be avoided in order to save face. Admission of comprehension failure can provoke feelings of shame and associations with lack of competence. Eddie has got it sussed. He recognises that the incompetence rests with an environment that doesn’t provide the support he needs for his communication, both his understanding and expression, to be the best it can be.

There is much you can do to increase the likelihood that the receiver “sees what you mean.” Another analogy from a patient likens this to cleaning a dirty window, “suddenly it cleans and I can see it.” Here are just 10 tips on how to clean up your communication so that more people get more meaning from your messages. You may notice these are all things that assist your own understanding.

  1. Be unhurried. Communicate that you have plenty of time, give the individual your full attention, be friendly and behave in a way that puts people at ease.
  2. If you are not sure, ask the individual if they need any special help with communication.
  3. Say things more than once and chunk information into bits to avoid information overload.
  4. Make the topic clear, perhaps even writing it down. Give a little extra information to help make sure the topic is understood, for example Judy quoted above could have said “wear your Armani, it smells wonderful.”
  5. Write down key words while you speak or write down important information for people to take away and re-read. Even if reading is compromised a combination of hearing and seeing words helps many people with aphasia.
  6. Use technology to assist, for example, make documents so that computers and digital devices can speak the text; use sub-titles on TV and YouTube videos. Record your instructions or messages into the person’s phone so they can listen to it as often as they need.
  7. Add an illustration to your communication, a drawing, diagram, symbol, photograph or map. Use cameras in mobile devices to give people images they can take away to help them understand, such as an exercise sequence.
  8. Show as well as tell when possible. Maybe you have an image on your phone of the event or place you are talking about? Can you mix up a thickened drink while you talk through the instructions?
  9. Speak clearly and write legibly (have you ever been unable to read your own writing?).
  10. Use clear signs in departments with symbols that are commonly recognised.

More detail with signposts to useful resources can be found at the Talk for Scotland Toolkit and the Stroke Association Accessible Information Guidelines.

There isn’t one solution and it is unrealistic to believe that strategies like those above guarantee understanding. The goal is to provide the support that best helps that individual to understand at the highest level of clarity they can.

Finally, if you do leave a message on my phone, especially if it is a phone number, a name or a CHI please speak Notlikethis But like this.

Laorag Hunter is a Speech and Language Therapist at NHS Tayside’s Centre for Brain Injury Rehabilitation.  You can follow her on Twitter @LaoragHunter

June is “Speak about Aphasia month”. If you would like to learn more about aphasia these are the books Laorag mentions in her blog.

Maxwell, Grace (2010). Falling and Laughing: the Restoration of Edwin Collins. Ebury Press.

Bolte Taylor, Jill (2009). My Stroke of Insight. Hodder Paperbacks.

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The Home Based Memory Rehabilitation Programme by Emma Coutts

This blog was first published by our sister health blog, DGhealth in 2014.

When I took up my post as an Occupational Therapist (OT)  within the Mental Health, Substance Misuse and Learning Disability Service in NHS Dumfries and Galloway as a new graduate, I was unsure what to expect. Having had a placement within the service I was familiar with the client group and the team, however coming into this as an OT, is very different to being a student! And my first initial thought was ‘what will I be doing as an OT?’.

This is where the Home Based Memory Rehabilitation (HBMR) programme comes in! First suggested to myself and Corinna Sidebottom (OT, who started at the same time as me) back in 2012 as a possible piece of work we could develop within the service, who knew the success this would have?!

HBMR was originally developed in Belfast City Hospital in 2007 by Advanced Specialist OT Mary McGrath. It was developed as part of the cognitive rehabilitation approach for the treatment of people with acquired brain injury; however was found to be equally appropriate for the rehabilitation of cognitive deficits, including memory due to early stage Alzheimer’s disease.

It has been recognised that the main approach to helping people with memory difficulties to engage within their activities of daily living is to try to find ways to compensate for impaired memory, through memory rehabilitation strategies.

The idea of cognitive/memory rehabilitation interested me – we often associate rehabilitation with the likes of having had a broken bone and regaining the function within the specific limb, but we don’t commonly associate this in relation to Dementia (or at least, I didn’t!).image

Cognitive rehab is defined as an individualised approach which should focus on real-life, functional problems a person experiences. Central to this, is an understanding of the person’s strengths, abilities and deficits from a holistic approach, which as a profession, incorporates our core beliefs.

So what exactly is the HBMR programme? And how as new band 5s, were we going to develop this and pilot it within our service? After various meetings we developed a modified version of Mary McGrath’s programme and we were then ready for a 6 month pilot.

Our HBMR Programme

The HBMR programme is a 4-6 week programme, delivered to the client, in their own home with caregiver/family support where appropriate. The pilot programme consisted of 4 sessions:

  • Remember where you have put something
  • Remember what people have told you
  • Remember what you have to do
  • Remembering people’s names and coping in social situations

Each session covered a range of memory strategies such as a memory book, memory board, post-its, safety checklist, using a calendar, medication checklist to name a few. These are all things any one of us could use within our daily lives to remind us of daily tasks.

The key to the programme is the structure and repetition of emphasis placed on the strategies and so each time a new session is delivered, all previous strategies are revisited to ensure the client is using these and is confident in doing so. It is this repetition that encourages new learned behaviours within people with early stage memory impairment and creates the habits that are more likely to be remembered as memory loss continues.

HBMR Programme – Pilot Results

Following our 6 month pilot, we compiled our evaluation – which in imagemy opinion not only demonstrated the effectiveness of HBMR but also highlighted that people with early stage Dementia, can learn new skills!!

This graph clearly demonstrates that following completion of the programme, at 3 month review there was a significant increase in the number of memory strategies clients were using. And as a result, a slight decrease in the number of reported memory difficulties they experienced.

Our Success!

Since completion of our pilot we have been working on promoting HBMR and how we can further develop this.

A key highlight of the whole process for me has to be winning ‘Best Community Support Initiative’ at Scotland’s 2014 Dementia Awards in Glasgow. Although probably the most daunting, as this involved making a small speech!!

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Our poster has also won at national events and was displayed within the poster presentation at Alzheimer Europe conference 2013.

The HBMR programme also features within Alzheimer Scotland’s ‘Allied Health Professionals Delivering Post-Diagnostic Support: Living Well with Dementia’ Publication.

The future of the HBMR programme

We are currently looking at how to develop the programme, with a view to sharing this locally and nationally. Since pilot completion, we have reconsidered the session topics and we have now created additional areas we feel are important to cover. The programme still takes place over 4-6 weeks however now covers the following areas:

  • Remember your priorities
  • Remember what people have told you
  • Remember what you have to do
  • Remember people’s names and coping in social situations
  • Remember to keep your brain active
  • Remember your bearings

We are also considering other possible ways to deliver the programme such as the use of technology.

We have also been looking into the branding of the programme and we hope to share this both locally and nationally.

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I am probably very biased about the programme as I have been involved from the beginning but I hope reading about the effectiveness of HBMR has encouraged you to think about the ability to learn new skills in early stage Dementia and how this may impact on future practice … after all … Dementia is everyone’s business!!!

Emma Coutts is an Occupational Therapist in NHS Dumfries and Galloway.  You can follow her on Twitter @EmmaAHPDem or contact her at emma.coutts@nhs.net

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Early Years Collaborative: a positive impact on low income families in Leith by Graham MacKenzie

Inspired by Carol Barnett’s blog about the Healthy Start programme in Tayside, Graham MacKenzie, Consultant in Public Health explains how the introduction of improvement science has seen this programme grow in NHS Lothian …

The Early Years Collaborative (EYC) launched in January 2013 as a way to bring “improvement science” to community development work. Changes are made at a small scale initially (single member of staff, single patient or client), tested, progress plotted regularly, and successful approaches rolled out after testing in a range of circumstances.

Healthy Start, a UK-wide food and vitamins scheme for families on low incomes seemedimage like a suitable area for attention. We knew that a quarter of families eligible for Healthy Start were not signed up for vouchers, and those that were eligible often experienced delays in signing up or missed vouchers at key points. We also knew that the number of families receiving vouchers was falling at a national level, despite clear evidence of increasing child poverty.

The Leith EYC Pioneer Site started in March 2014. Rather than the usual approach of sending out a leaflet to all patients, or providing all staff training, we focused on the experience of one midwife signing a pregnant woman up for the vouchers. This midwife identified and removed key obstacles: some women were only signed up following ultrasound to prove pregnancy (not necessary), and the midwife was able to sign the application form at the booking visit, before the woman had completed her section of the form. A parent support worker helped families to call the centralised help line once the baby was born (otherwise the vouchers stop coming for weeks or months) and shared this information with local midwives. Midwives followed up women at the 16 week antenatal visit and identified that half were struggling to complete their part of the application form, so we linked in literacy and parent support workers. Run charts and control charts showed real and sustained change in process and outcome measures.

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The approach has since been shared with all neighbouring teams (a simple email cascade – the usual way to attempt spread quickly – did not have any impact). We are now seeing the impact of the work on midwife teams across Lothian, and are extending the work to health visitors and community settings (e.g. nurseries, early years centres). By December 2014 this work had:

  • increased documentation of Healthy Start eligibility at antenatal booking across Lothian from 73 to 95%
  • boosted the % of women identified as being eligible for Healthy from 14 to 21%
  • supported an additional 50 pregnant women across Lothian to access vouchers (an increase of 17% from March 2014).

We can identify changes that led to these improvements and share successes with these and other teams. Work that started with a single midwife in March 2014 had been shared with colleagues across the country and at three national meetings by the start of June 2014. The speed of improvement, and genuine interest was exhilarating.

The next stage of this work started in February 2015. We have established a partnership with Granton Information Centre, a nursery, an Early Years Centre, midwives, health visitors, a family therapy centre and Edinburgh Community Food to help low income families access wider welfare rights advice. Women and families with money worries are being referred to Granton Information Centre, and following referral we will provide the detailed support that these agencies can offer. We are, again, planning and recording progress using improvement science. This work is funded by the Scottish Legal Aid Board until October 2016.

This EYC work has demonstrated the value of connecting with front line workers, testing ideas at a human scale, and challenging long held assumptions about a process that we thought we understood. It is having a practical and measurable impact on families on low income. It is not, however, directly addressing the causes of poverty, beyond adult literacy. That is a task that we will have to address in parallel…

Further information and the most up to date data are available on the #GetHealthyStart Facebook page and this film provides more. We are in the process of translating this film (with subtitles) for Polish families, promoting this with the large number of Polish families in Leith.

Graham MacKenzie is a Consultant in Public Health in NHS Lothian.

Email address: Graham.Mackenzie@nhslothian.scot.nhs.uk

Twitter: @gmacscotland

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A Relationship with Resilience by Grant King

#selfcare provokes #goodcaregrant

I believe that it was the above tweet that instigated a conversation leading to this blog post.   As part of a twit-chat looking at self-care in nursing, I noted the relationship between nurses’ self-care and the quality of healthcare they provide.   Around the same time I was teaching and writing about the concept of resilience in a healthcare context.   I came to reflect on the role of resilience in both the lives of those who provide healthcare and of those that may require it.

“The human capacity for burden is like bamboo- far more flexible than you’d ever  believe at first glance.” ― Jodi Picoult

Resilience is the ability to cope with, and then positively adapt, following a period of adversity (Haddadi and Besharat 2010).   There are a number of factors that act as risks to our resilience.  These include dysfunctional relationships, trauma and social disadvantage (Chesterton 2009).

Social connectedness, a sense of hope and rewarding opportunities all foster and protect our resilience (Chesterton 2009).  Research shows that resilience has a direct impact on the experience of ill health, across the health spectrum and across the lifespan (Min et al 2013, Caltabiano et al 2006, Shin et al 2006 and Payne and Butler 2003).   It is a quality that is dynamic and through experience and intervention can be positively enhanced (Earvolino-Ramirez 2007).

Resilience enhancing experiences and interventions include activities such as identity building work, learned optimism, emotional literacy improvement, strengths development and peer coaching (Grant and Kinman 2013, McAllister and McKinnon 2009).   Improved resilience offers improved health outcomes and so healthcare professionals should seriously consider its role in the lives of those they care for (McAllister and McKinnon 2009).    However is it just in the lives of those who receive healthcare that we should reflect on the role of resilience?

“Caring for others skilfully involves a high degree of self-giving.  Whilst the self can certainly grow and flourish in this altruistic experience, it can also suffer” (McCallister and McKinnon 2009 p. 371).

Aitken et al. (2012) report that 42% of nurses they sampled described themselves as “burned out”.   It is argued that resilience is a key characteristic needed in nursing to cope with and adapt positively to the demands of the role (McDonald et al 2013 and Stephens 2013).   To enhance occupational resilience Grant and Kinman (2013) discuss four evidence based strategies.  These strategies are engaging in reflective practice, utilising good quality mentoring, participating in relaxation and accessing experiential learning.  If we regard the literature’s view that health professionals, with nurses in particular, experiencing a disproportionate amount of stress in their work (McAllister and McKinnon 2009) then we can see the urgency in ensuring we engage in these resilience building activities and do so in a routinized way.

It is worth noting here that some other terms can be found and mistakenly used as synonyms for resilience.  One such is the concept of “hardiness”.  In 1979 Kobasa wrote a seminal piece introducing the concept of hardiness which was described as the ability to buffer, offer resistance to and cope with stressful situations.  Contemporary understanding of hardiness describes three core elements, consisting of commitment, control and challenge (Khoshaba and Maddi 2008, Jameson 2014).

What differentiates resilience for me is the positive adaption following adversity whereas hardiness seems to focus on the concept of adversity survival.   I think many of us can picture ‘hardy’ individuals.  They might be seen as strong and smart survivors.  And yet, it was Darwin in 1809 who said “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change”.

“This has been my vocation to make music of what remains.” ― Itzhak Perlman

 Resilience literature (McAllister and McKinnon 2009, Chesteron 2009) describes some of the common characteristics that resilient people display.  These qualities include the ability to set reasonable goals and maintain focus in attaining them.  Resilient people express their emotions appropriately including providing support and comfort to others in compassionate and helpful ways.   Finally another key characteristic of people described as being more resilient is their ability to cope with stress, risk and conflict in flexible and novel ways, while not feeling overwhelmed and defeated by the situation.   Are these the qualities and characteristics we’d like to see in ourselves, our colleagues and those we care for?

“When I encourage someone, I see it as an investment in their resilience.” ― Steve Karagiannis

 I believe that as we centralise the concept of resilience in our healthcare education and practice that we will observe a cycle of health improvement.    As healthcare practitioners build their personal resilience through the activities previously noted their ability to offer that necessary “skilful self-giving” increases.  Acknowledging and appreciating that will naturally encourage a greater resilience focus in practice delivery.  #selfcare provokes #goodcare…or perhaps even #greatcare? As we support people to develop a greater ability to positively adapt from adversity, their lives become richer and more independent.  As we support and see success, we feel success….#greatcare provokes #selfcare, perhaps?

“It’s crazy, how similar we are. Here’s both of us, working through our stuff, trying to make something positive out of something really bad.” ― Jenny Han

In conclusion, I refer to the image I’ve associated to this piece of writing.  Two people are walking down a hill.  The sun is low in the sky; it’s late in the day.  They both carry things with them.  Some things have been useful; some may have been a hindrance.  They both brought different types of expertise with them. It’s been a long journey.  It was unpredictable at times.  They endured the uphill together and now enjoy the gentler slopes, for a time.  It was their relationship with resilience that got them to where they are now.  It is their relationship with resilience that will take them to, and through, their next mountain to climb.

Grant King is a Lecturer in Nursing (Mental Health) and Associate Fellow of the Higher Education Academy at the University of Dundee  School of Nursing and Midwifery.  You can email him at g.king@dundee.ac.uk and follow him on Twitter @UoDMHN

References

AITKEN, L. et al. 2012. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.  British Medical Journal, 344, p. 1717.

CALTABIANO, M. et al., 2006. Resilience and health outcomes in the elderly. Proceedings of the 39th Annual Conference of the Australian Association of Gerontology, pp. 1-11.

CHESTERTON, J. 2009 Mental health promotion and prevention. In: P. BARKER, ed.  Psychiatric and mental health nursing the craft of caring. London: Hodder Arnold, 2009, pp.571-585

EARVOLINO-RAMIREZ, M. 2007. Resilience: a concept analysis.  Nursing Forum, 42(2), pp. 73-82.

GRANT, L. and KINMAN, G. 2013. The importance of emotional resilience for staff and students in the ‘helping’ professions: developing an emotional curriculum. Bedfordshire: The Higher Education Academy

HADDADI, P. and BESHARAT, M. 2010. Resilience, vulnerability and mental health, Procedia Social and Behavioural Sciences, 5, pp. 639-642.

JAMESON, P. 2014. The effects of a hardiness educational intervention on hardiness and perceived stress of junior baccalaureate nursing students. Nurse Education Today, 34, pp. 603-607

KHOSHABA, D. and MADDI, S. 2008. Harditraining: managing stressful change. 4th ed Hardiness Institute: California

KOBASA, S. 1979. Stressful life events personality and health an inquiry into hardiness.  Journal of Personality and Social Psychology, 37, pp. 1-11

MCALLISTER, M. and MCKINNON, J. 2009. The importance of teaching and learning resilience in the health disciplines: a critical review of the literature, Nurse Education Today, 29, pp. 371-379.

MCDONALD, G.  et al. 2013.  Personal resilience in nurses and midwives effects of a work based educational intervention. Contemporary Nurse, 45(1), pp/ 134-143

MIN, J. et al., 2013. Psychological resilience contributes to low emotional distress in cancer patients. Supportive Care in Cancer, 21(9), pp. 2469-2476.

PAYNE, H. and BUTLER, I. 2003. Quality Protects research briefing No. 9: Promoting the mental health of children in need. Totnes: Research in Practice.

Research in Practice available from http://www.rip.org.uk.

SHIN, Y. et al., 2006. Resilience and health related quality of life in children with chronic illness. J Korean Acad Child Health Nurs., 12(3), pp. 295-303.

STEPHENS, T. 2013. Nursing student resilience a concept clarification. Nursing Forum, 48(2), pp. 125-133.

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Realising Potential Together by Elaine Hunter

This blog was originally posted on the Alzheimer Scotland site Let’s Talk about Dementia on 19th March 2015.

imageMarch 2015 saw the launch of an allied health professional policy document called “Driving Improvement: Implementing Realising Potential an Action plan for Allied Health Professionals in Mental Health” (Scottish Government 2014). The policy document reflects on the progress that has been made through the implementation of Realising Potential (Scottish Government 2010) and considers how future AHP practice should be shaped. However the policy document was always about harnessing allied health professionals creativity and energy and did not “ask AHPs to do extra. It asks AHPs to do differently”. (Scottish Government 2012). I am delighted to showcase the launch in this week’s blog and share a bit more about what and who the allied health professionals are.

“Making the Invisible Visible” through Social Media

Realising Potential encouraged multidisciplinary and multi-sectoral team-working and helped people to understand the added value AHPs bring to mental health and dementia services. A number of us tweet and on the day we used the hash tag #RealisingPotential2015 where we had some great conversations and interest in our work. Thanks to everyone who joined us.

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“Tree of Celebration”

Like all great work, “none of us are smarter than all of us”. On the day we launched our “tree of achievement”. For the next year we will take the banner around Scotland inviting colleagues to add a leaf and share what they are proud of.

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“Journey to Work”

During the launch we were reminded of the many ways AHPs are helping adults of working age to gain the confidence and skills to return to the work environment – or indeed to take up employment for the first time. We heard from Robert Reid how important that was when he read his poem.

thank you for all you did for me
i connected well enough to now be a support worker
i fought you all because i was terrified to be happy
when you have lived in darkness you do not recognise light
deep is the only up you know
with the help of some truly amazing people i am healing
i have had two of my poems published
i have had two exhibitions of my poems
i am going to publish an E-Book soon
i still doubt
i taught myself that when you sing it is impossible to be unhappy
i am growing
i am smiling
i am writing
i am happy
i am poet!!
thank you

Dementia Friendly Communities: ‘It’s just so AHP’

We heard and celebrated the partnership approach that has led the way in dementia friendly communities in Scotland and heard from Sarah (@sarahahpmh) on the work in Highland to use technology to connect arts and health for therapeutic interventions in remote and rural communities. You can find out more by linking to this website. http://www.adementiafriendlycommunity.com/

Smile Please

On the day we had over 40 AHPs in attendance from all over Scotland, sharing their posters, their awards and their work. These are just some of the great photos.

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Where Next & What now

“…..the Realising Potential story is far from over. We have so much more to do and so much more to give”

We heard these words on the day and will continue to look forward and build on the momentum created to ensure the benefits gained of working together as a collective group of AHPs does not diminish or disappear. We were encouraged to inform people of who the allied health professionals are and what we can do with the aim to develop a shared understanding of the positive impact allied health professionals can have on the challenges facing services today.

If you were to add a leaf on our tree of achievement what would you answer when asked?
“What are you proud of? What has made a difference? What do you want to shout about?

Elaine Hunter is the National AHP Consultant with Alzheimer Scotland.  You can follow her on Twitter @elaineahpmh

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I am not a student anymore …. by Niamh Donnelly

Eight years of primary education, five years of secondary education, moved away from home for four years of university education. That’s seventeen years of full-time education, twenty-two years of developing as a person, twenty-two years of hard-work, developing friendships, collecting experience, months of job searching, job applications and interviews, all leading to this point.I am a qualified Occupational Therapist with a job in Dundee Community Mental Health Services. I have reached my goal  …. now what?

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My first day in the working world had arrived. On the day it felt like the biggest thing ever, today, one year later it feels like a lifetime ago. My first year of working has been very enjoyable and an invaluable experience.

love OTOn my first day, everyone was very welcoming; clients and staff. I was welcomed with a cup of tea which was very comforting. It started just like the first day of any placement that I had completed as part of my training. Induction and orientation, sorting out all the paperwork and computer accounts, meeting all the staff, fire safety, etc. All the usual questions just like when I was on placement, Where are you from? Where did you study? Are you enjoying Occupational Therapy?

I rattled off the usual answers as they are always the same, until the final two questions when this time the answer to “Are you a student?” was not “yes” it was “no”, and the answer to “How long are you here for?” was not “ 6 weeks” or “8 weeks”, it was “I am here permanently”.

cooking

After a couple of weeks when all of the induction and introductions were done, I began to gradually be introduced to my case-load and began doing groups. That I think is when it started to set in that this was it, I wasn’t on placement any more, I wasn’t reporting to a supervisor and having all my work checked and countersigned before it was recorded. Although I had excellent support and guidance from my colleagues, it quickly sunk in that I was now the Therapist.

keep calm

I was making decisions, I was doing assessments, I was not a student any more. It also was sinking in that I was a colleague to all the members of the team, I was a permanent part of the team now, not just a blow-in for a couple of weeks, experiencing maybe one assessment with a particular client and two or three follow-up sessions before passing it back to my supervisor as I went back to the books.

Sometimes on placement you can get a feeling from certain conversations happening in the office that you are probably not meant to be part of them and you suddenly need the bathroom or a cup of tea so you leave the office. Meetings happen that you are not allowed to attend and you spend the time in the office completing reflections. Now, being a member of the team, I am involved in these meetings, contributing my ideas and opinions to them.

groups

Just when I was getting into my stride a student started on their placement. This was another new and strange experience for me.  I was introducing the student to clients, she was observing my assessments and treatment session, she was helping out in the groups that I was running, she asked me to look over and countersign her notes.

horticultureThis gave me a whole new insight, I was seeing things from a completely new perspective. When the student was taking the lead with assessments and treatment session and I was observing, I realised how easy it is to input to the situation without thinking about it and feel you are helping. When this happened to me as a student I thought it was because I was doing something wrong but now I saw this was probably not the case, well not all of the time anyway. This explains why when my practice was being observed, my supervisor would sometimes input into the session but then I would still get good feedback at the end.

When I was involved with the Occupational Therapy student, I felt that I was still learning myself and I was sharing my knowledge with her.I know we are always continuously learning and I think this was a very beneficial learning experience for me.

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I feel it also improved my confidence in myself. It is a good feeling when someone asks you a question about practice and you are able to answer it with confidence. I think the experience has also improved my knowledge and practice, I feel that from sharing my knowledge and experience with someone else, I have more confidence in it.

I have been working here almost a year now and it has only been a couple of months since the last time I was asked “Are you a student?”. Just like it took me time to get my head around it, it took some of the clients time to realise this too. As most of the clients I have been working with are a great deal older than me, I thought at the beginning, “They will not listen to me”, “They will not take my advice on board”. However, just like any situation with clients in healthcare, the therapeutic relationship is the most important thing.

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It is so important to develop trust between you as the therapist and the client you are working with. As I developed therapeutic relationships and developed trust with the clients I realised the thoughts I was having were just that, ideas I had thought up myself, not the way it was at all.

I think the post I am in is a great post to start off your career. When I began I had a good induction period which gave me time to settle in and find my feet. I was given the opportunity to visit all of the different locations in the service and other organisations that I would be working with. I attended the NHS Tayside induction day which was very helpful. It was great to meet other people who were new to NHS Tayside, there was opportunity to ask any questions that I needed. We are all assisted in how to set up our computer accounts and how to use the systems that are unique to NHS Tayside. This has proven very helpful to me, and many of my colleagues, since I have been working here. I have also attended the Band 5 OT meetings a couple of times, this was a good experience, to meet other OTs working in the area that are the same level as me. It was helpful to compare our practices and to speak about flying start with others who are completing it too.

I have also been completing my Flying Start folder.This is a year long CPD programme which helps newly qualified practitioners with the transition from student to independent practitioner. flying startIt has taken a lot of time and work but it has proven to be very beneficial to me. It gives the opportunity to reflect on my experience and learning in my first year of practice and I feel it will be a very valuable resource for my CPD when it is complete. I have had great support for completing this from my mentor, I have also had monthly supervision with my supervisor. She has been very helpful and encouraging. In supervision we speak about different projects I have been doing, eg. Lunch groups and music group. We also speak about any difficulties or challenges that I am having and also learning opportunities for me. I have attended several training days training days which I will add to my CPD, these include, child protection, team working to improve healthcare, Adult ADHD- Amidst the Chaos is a Disorder.love

This has all been a new experience for me and I have enjoyed every minute of it, I look forward to all the rest of the new experiences that this job will inevitably bring as I progress in my post and in my career.

Niamh Donnelly is an Occupational Therapist based at Dundonald Day Service, part of the Dundee Community Mental Health Service.

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