Friday, May 24, 2013


Having revisited my nursing days on the blog I thought I would share a poem written about those 
days so long ago. Click on link below and scroll down - poem called "Morning Routines"

Sunday, May 19, 2013

You tube excursion - making a Moral Compass Folded book

Prompted by a request on Twitter Lizzie and I have made a video to help people make their own little folded book like the ones on display and made last night  for the  Moral Compass.
Enjoy!! (third time lucky but Lizzie a good Director)

Saturday, May 18, 2013


My badges and buckle appear here - had to share that!!

Sneaky Peek - Moral Compass

Artists' Books - Moral Compass 

These books were created in response to the outrage levelled at nurses and the nursing profession following the publication of the Francis report that investigated the delivery of poor care at Stafford Hospital.

Accusations have been thrown at a profession once highly regarded with many commentators taking it upon themselves to suggest that the move into Higher Education in 1995 lies behind the demise in standards and the moral fibre of how nursing care is delivered. As someone who has worked in Higher Education since 1996 and thus my academic career has been alongside these developments I have taken many of these criticisms personally. Very little has been said about Nurse educators/Academics in the discussion but the inference is that we are not doing a very good job of making sure nurses are caring, compassionate and competent. The reason I moved from clinical practice to education was a belief that I could have more influence of the way care was delivered by encouraging reflective practice and learning from the students with whom I came into contact.  

If standards have slipped in nursing in relation to how we respond to vulnerable people in their time of need then it is most likely a reflection of a problem in wider society.

My first response was to wallow in the iniquity of it all and that nurse educators do not seem to have a voice in the debate, are rarely seen in the media and although crucial to the preparation of student nurses are invisible in the debates.

Fortunately with my Art Practice I found a way of expressing myself. The request to participate in The Late Shows at The Lit & Phil in Newcastle provided me with an answer and has given me an opportunity to be more constructive and creative in my response to this issue.

The creation of these small books has provided me with a way of expressing my standards and values in general and states them clearly and unequivocally for others to view.

The impetus for these books originates in a lesson I delivered with students influenced by Theresa Easton's work with folded books. Senior practitioners in health care, when invited to create a small book of values and beliefs about their practice, responded with enthusiasm, skill and commitment. This has led me to believe that this medium is an accessible and powerful way of people expressing and remembering their Moral Compass in practice. This is why I also offer passersby to add to this and create their own Moral Compass on an artists book to take with them as talisman that contains those ideals in and they can hold on to in everyday life. 

Dementia Awareness

It’s Dementia Awareness Week, next week, and it has given me pause for thought about the condition. I am very fortunate indeed not have encountered the condition personally, none of my close relatives have been diagnosed with the condition and I have had no close friends living with dementia BUT my next door neighbour’s Dad has it and boy has it impacted on their lives.

My neighbour now lives almost full time with his Dad, leaving his wife all alone most of the week. He had carers in for a while but did not trust them and now feels obliged, as the only child, to take his work and belongings over to his Dad’s and take care of him as best he can. Viewed from an emotional distance this has got be avoidable for all concerned, his Dad is diminishing, each time I see him; never a tall chap he seems to have shrunk considerably over the last few months. I also worry about our neighbour’s relationship – it just cannot be easy dealing with this and no one seems to be offering him the right support and resources. I can’t help feeling that if he had cancer or other life-limiting physical condition I would know exactly what to do and what agencies to get him to bother! The stigma of a mental health condition like dementia does not just sit with the person diagnosed but with the family and all of those around them. Reaching out for help is clearly really difficult and so many hurdles put in your way when no one single point of contact is readily identifiable. His Dad doesn’t live in the same village so the GP link is tricky and moving him to live with him was never an option as they have an old cottage that just would not be safe for his Dad to live in. His Mum is already in a Care Home following a stroke three years ago and that is costing him money. I can’t offer a solution but I can at least raise awareness of what people are putting up with and making do with!!

We have events at work all next week and I have been really heartened by the students’ interest and enthusiasm to sign up for sessions. It was never a condition we were really taught about when I was a student but it was one I encountered early on in my clinical practice, on my first ward. A little lady hitting me with her walking stick as she was agitated and upset; I am not convinced we did anything particularly constructive to help her back then. That memory reminds me of how fragile we all are ( to quote Sting) and how many of us will need help and support from increasingly creaking and brittle health and social care services in the future. Fingers crossed the current Government don’t destroy it.

Tuesday, May 14, 2013


Sunday was our daughter's 12th birthday and also International Nurse's Day (Florence Nightingale was born on 12th May - a bit of info I did not appreciate until I started noticing  the date when Lizzie was born!). Having always been ambivalent about nurses and nursing I entered into a tweet chat with some reluctance. Well I got swept up with the common experiences and dared to share a photo of me when a second year student.

Below you will see a photo of me meeting Prince Charles when he came to the hospital to open the CAT scan - 1981 just before he was getting married. This is not the one on twitter but the one I should have shown - Miss Howard one of our tutors also features. To my shame I cannot remember all the names of those around me, although there were third years there who we had little to do with!!. I do remember the event as I was sent to redo my hair three times as it was permed and very wayward (think I ended up with about 10 kirby grips keeping it in place) - we were in the School of Nursing at the time so we were lined up along the corridor to represent students - to Miss Howard’s alarm he stopped to speak to me and asked me how I liked Cambridge - I believe I gave an appropriate response - memories!!

Here it is enjoy!!

Can you spot me? - grinning under HRH's chin!!

Sunday, May 5, 2013

Reviewing the Past - Out patient clinics

Once, when I had a proper job, I asked a consultant I was working with, why he asked patients to come back to the clinic every 3 months - his answer was “to train the junior docs".  At the time I was a little surprised by his candid answer but when asked whether there might be any evidence to suggest the most appropriate frequency of appointments he did not appear to be interested.

I was a little surprised but that was back in 1992 when the purchaser/provider split first came along and I thought that as the purchaser we might have some leverage in examining what went on in OPDs and what we might do to improve the experiences of the people waiting in clinics and also increase the satisfaction of the professionals working there. Alas nothing came of it and I went off to do another proper job and in 1996 started my PhD research that examined people's experience of diabetes care. I didn't really appreciate it back then but the dominate experience of diabetes care IS outpatients and so my research was quite unique and that context of people's experiences was not fully explored at the time. The findings from my research identified how the experiences were often about uncertainty, disruption and anxiety leading up to an appointment, during the visit and for some weeks after. No one talked about coming away from the clinic feeling better about themselves and/or their diabetes management quite the opposite. The overall experience could be summed up as transitional a neither here nor there experience – betwixt and between.  

My motive for undertaking the research came from my complete and utter dislike of my role in OP clinics. I was a nuisance to the nurses in OPD as I would sit in the waiting area inviting questions and inciting dissatisfaction from the patients. I would not do what I was supposed to which was to stay in my room and be like the doctors, summoning people to the room when it was their turn. I also used to go to great lengths to delay my arrival at the clinic. In the days before mobile phones (i.e. no one could contact me away from the office) I could procrastinate a great deal; often fitting in a few home visits and a trip to a GP’s surgery on my way to the hospital from my office in a Health Centre. this was all just so I could put off the inevitable slog of the diabetes clinics. They ALWAYS ran over. We were there from 1pm until after 6pm most Wednesdays and alternate Fridays were nearly as bad. The diabetes clinic was notorious in the department and the OP nurses hated being assigned to the clinic.

I have been prompted to revisit my PhD beginnings and my “proper jobs” back in the day after reading Anne Cooper's blog about her experiences of outpatients as person with type 1 diabetes ( ). I am saddened to think that the way the clinics run and the experiences of folk attending the clinic sounds very much like the experiences in my research over 15 years ago. To satisfy my curious mind I did a quick search to see what has been written about the OP clinic – other than that by sociologists (1) and forward thinking folk like John Launer (2) whose interest in narrative and stories set him apart from the usual medical commentary.

Here I found remarks on teaching in OPD (3) – maybe the clinic is just about professional discourse and that the patient has little to do with it. The patient presents as a medical curiosity a problem to be solved – much better in OPD than on the ward (4) – a lot goes on that I hadn’t appreciated in the medial discourse – much food for thought and insightful. Yet again the patient presents as a site of surveillance and the vagaries of a poorly performing body as a problem to be solved rather than the human being with the appointment, someone to get to know and forge a relationship with..
I wonder if my PhD would have made any difference if I had got it. Somehow I think very little and maybe blogging about it in this way might get a bigger readership than that elusive thesis.
References and further reading

1. Strong PM . The Ceremonial Order of the Clinic: Parents, Doctors and Medical Bureaucracies. London: Routledge, 1979

2. Launer J (2012) Waiting Rooms and the Unconscious Post Grad Med Journal 88; 361-362 available from

3. Williamson J (2012)Teaching & learning in outpatients clinics The Clinical Teacher 9; 304-307

4. Watkins P (2004)  Outpatient departments: a unique opportunity for understanding illness Clinical Medicine 4,2; 97-98