via Flickr user Alyssa L Miller

I Wish I Could Cry With You, But I Can’t

Nurse Eye Roll blogs about her life as a nurse. Most of her posts are pretty funny, but this one hit us hard. You can see what a lot of emotional labour it takes to do this job right. That’s why we think it’s so important that nurses (and everyone else that does this type of intensive work with the public) get proper support to do it well and with dignity for everyone.  

I just saw the doctor walk out of the room…the room of your husband on a ventilator, who after 12 days of no improvements, has had set back after set back. I talked to the doctor before he walked into the room. I know what he told you.

Forgive me. I have to avoid you for a short time. I’m going to go do something else for a little while.

You see, I’ve seen that look before, that look on someone’s face where they are about to sob uncontrollably and throw up from the sheer emotional pain. People usually put on a strong face when the doctor delivers the news. And as soon as the physician has vacated the area, they allow themselves to break down.

But guess who is still in the room?

The nurse.

Through their tears, they ask us the questions they were either too shocked or too scared to ask the doctor. Somehow, what we say stings even more.

Shift after shift, we see lives permanently altered. We see people walk into the hospital with hope and we see them walk out with despair.

It never gets easier to do this. You just get used to it. You figure out how to do it.

So, I’m sorry. I’m sorry to the wife who needs me right now. I know you have questions you want to ask me. Questions you didn’t think to ask the doctor. Questions you didn’t want to ask him because you didn’t want him to think you were stupid. Things you want me to explain. I know you want my honest opinion.

I need to collect myself first before I walk into your husband’s hospital room. I need to put up my wall. I need to mentally prepare myself to not compare you and your husband to my mother and father. I need to disconnect the dots.

I have to do that because as soon as I’m done being there for you, I have to go see my other patient. My patient that will probably recover from the massive stroke he suffered, but is a little down today. I have to go in with a smile on my face and tell him that he’s doing great. I have to be happy for him. I have to motivate him. I have to inspire him.

So, please forgive me. I know that because I’m not emotionally upset with you right now, I may look cold and heartless. I promise I’m not. It is out of self-preservation that I am not going into that deep, dark pit of despair with you right now. I’m going to get as close as I can without losing it. I’m going to take a ladder down into that pit with you, but I’m going to stay on that last step. I’m going to stay on that step because I have to be able to quickly climb out on a moment’s notice for the man in the room next door.

You see, I’ve gotten pretty good at that. I’ve gotten really good at lowering myself into that pit and getting as close as I can to your pain, but not quite there. And I’ve got even better at running up that ladder and out as fast as I can.

I’ve gotten good at that because I’ve had to. If I take that last step, I cannot continue on. I cannot do my job. I cannot be there for any other patients. I cannot talk to physicians and coordinate your husband’s care or the care of any others. I cannot hold myself up. All I will think about is my husband dying. Or my father.  Or my mother.

So, I put up my wall. My boundary of empathy. I will get as close as I possibly can for you. I want to support you. I want to be there for you. I want you to feel cared for. So I will give you as much as I can bear. I pray that will do, for I have no more left.

You can read the rest of this post, and lots of other interesting comments from her fellow nurses, over at the Nurse Eye Roll blog where this was originally posted. Thank you so much Kati for allowing us to share this here. 

Photo by Alyssa L. Miller, via Flickr Creative Commons.

via Flickr user feggy

Afraid of visiting the doctor? You’re not alone.

Lots of people get anxious about going to the doctor. As someone who works in a GP clinic, I can assure you that everyone there wants to make your visit as anxiety-free as possible. But there’s a reason this is such a common fear. At the doctor’s office, we can hear news about the state of our health that can be frightening. It could be a diagnosis you didn’t want, or a warning that you need to change your lifestyle to avoid trouble in the future. It represents a new reality you’ve got to adjust to, whether you were planning for it or not. And that can be quite scary.

In fact, this type of fear can be a difficult thing for doctors and nurses to handle as well. As anyone who’s ever googled their symptoms can tell you, there is a thin line between straight talking and scaremongering when it comes to health. The very short time that doctors have with patients makes it even trickier to get that balance right. If you’re in a rush to convince someone they need to take action, the results can be counter productive.

Yes, straight talking is necessary to help a person face their reality. However, from my experience I have seen that often, many of us need time and support to process this information and the reality of how this news fits into our daily lives. Knowing that a lifestyle change needs to happen, but not really knowing what to do or how that looks can prove crippling for many. Often after receiving such news, a person will attempt to make changes in order to manage their own health. Many of these intentions/attempts are set on, unsupported, and for many these attempts will be unsuccessful the first time round.

There may be a number of reasons why following through on your intentions can be difficult e.g. the person has attempted to change too much, too quick. A person’s confidence and belief in the fact that they can make this happen may be low. They may not have been fully aware of the positives that could be gained from making such a change. Such unsuccessful attempts can have the power to leave a person feeling less capable and even more anxious.

With our Wellogram programme, we’re trying to help both GP staff and patients handle these types of health worries a bit more smoothly. Doctors and nurses refer people to us who know they need to change their habits, to adjust to a new diagnosis or to avoid one down the line. We spend 30-60 minutes together one-on-one to talk about what they want to achieve for their health and wellbeing, and then support them to come up with a strategy that works for their lives and where they’re at. With a little support, most anyone who wants to can make sustainable differences in their habits. With some help from your GP clinic, friends and neighbours, taking care of your health looks a lot less scary and a lot more manageable.

Tara Hackett leads on Wellogram, Participle’s social health service. You can find her online at @Tara_A_Hackett

Photo by Feggy Art, via Flickr Creative Commons.

via Flickr user mo pie

Fear, austerity, and public service

Continuing our series this month on fear and how we handle it, here’s guest blogger Dr. Catherine Needham of 21st Century Public Servant to see what austerity looks like on the other side of the desk. 

In our interviews with people working in public services, for the 21st Century Public Servant project at the University of Birmingham, we have come across fear as insecurity among the workforce.

Given the level of cuts that local government is experiencing, most of the people we spoke to were in teams that were shrinking fast, and they did not necessarily know if they would have a role in the new-look organisation.

There is a lot of talk about how the lean new commissioning organisations that will be left at the end of the local government cuts process will have new relationships with citizens, based on relational working and coproduction.

But in the meantime people working in public services are expected to work in more relational ways despite the cuts and the threats of outsourcing or redundancies. For some interviewees the current ‘narrative of doom’ was inhibiting their practice. Some talked about a sense of loss and grief for the past, with organisations paralysed by the impact of the cuts, and unable to provide a new vision to work towards. As one put it, ‘No message of hope – leadership is putting council into survival mode by the language they’re using. Nobody is planning for post austerity.’ One interviewee spoke about the effect of losing large numbers of staff: ‘You hear the language of loss everywhere. I get affected by it.’ Another described: ‘The weekly sound of handclapping for another leaving do’.

Trying to reconcile this environment, and the drive for cost-cutting, with the desire to work more relationally can be very challenging. Another interviewee described the difficulties she encountered in reconciling the efficiency/austerity agenda with more relational ways of working:

There is a complicated tension between the desire on the one hand for efficiency and rational processes versus the expectations and needs of customers which is more relational and focused on the personal and local. Public service workers have to find their way through that knot.

We are expected to do both, to move to the more relational in the government’s commitment to localisation and neighbourhoods. But elsewhere we are moving to customer relationship management and call centres. You phone or visit a call centre, pick up a ticket, it’s not a holistic relationship with the person on the other end of the phone.

Call centre type services are in many ways the anti-thesis of relational working. Interviewees talked about the gap between the ways they wanted to work and what was possible in call centre working: [Staff] want to go the extra mile because there’s a satisfaction in good work well done and in solving someone’s problems. There’s an end point… Answering phones in a call centre has no end point.’

One clear finding from our research was that the widespread calls for ‘whole person’ approaches to care and support necessitate working practices in which staff are also able to be ‘whole people’. Even for those staff who aren’t limited to call centre working, and who do get out into the community to meet people, more attention needs to be given to their support needs. As one interviewee put it, ‘You need to be prepared to get out there and mingle with the real world and other people. And that’s emotionally draining. So when I go home in the evening (I’m actually an introvert) I’m really drained.’ In the government response to the Francis Report into events at Mid-Staffordshire NHS Foundation Trust, the government explicitly evoked the concept of ‘The Emotional Labour of Care’, writing: ‘Working in health and care is inherently emotionally demanding. To support staff to act consistently with openness and compassion, teams need to be given time and space to reflect on the challenging emotional impact of health and care work.’

This increased awareness of the need for resilient responses to emotional labour constitutes a new dimension of public service practice. However there are challenges here for traditional notions of professionalism and distance. More humane services in which ‘authentic’ connections are made between people using and providing services, challenge the assumption that professionals should preserve distance and restraint. Yet professional boundaries may be an important part of self-care, and it is important to consider what support staff themselves need in order to sustain good relationships with citizens. The current environment in which staff are fearful of job cuts, of outsourcing or of being asked to work in call centres, gets in the way of those relationships.

Dr Catherine Needham is a Reader in Public Policy and Public Management at the University of Birmingham. You can find her online at @DrCNeedham. Do visit the project blog at http://21stcenturypublicservant.wordpress.com.

Photo by mo pie, via Flickr Creative Commons.

19-Staton-Island

Gig Buddies: Fighting FOMO

FOMO (or fear of missing out, if you must) is a slightly silly term. It’s meant to evoke the anxiety one feels when reviewing social media at home and seeing that all your friends are up to something cooler or more interesting than you. #FirstWorldProblems.

But actually, there are people out there whose social lives are at the mercy of the care system. A lot of the time, their fear of missing out is quite justified. People with complex needs, such as learning disabilities, often have to depend on their carers’ schedules and ability to arrange transport in order to do anything outside their home.

Heavy Load, formed in the early 2000s, were a punk band made up of 3 people with learning disabilities and 2 support workers. They noticed their shows would experience an exodus at around 9pm while everyone rushed to get home before their support workers had to finish at 10pm. That didn’t seem fair. From there, they got together a group of like-minded people and formed Stay Up Late, a campaign and an organisation that promotes full and active social lives for people with learning disabilities. Their latest project is Gig Buddies.

Gig Buddies pairs up volunteers and people with learning disabilities on the basis of common interests, including musical tastes. With proper training and help from Stay Up Late, the buddies go out to shows together and form a friendly relationship. Stay Up Late support this by asking that the buddies go out to a gig at least once per month, and ask the volunteers to commit to at least a year, so that they’re a stable presence in each other’s lives.

I love their punk rock ethos – for example, they decided to change the name of their Service User Advisory Group to “Storm and Thunder Team”, which sounds so much cooler I imagine it inspires them to get a lot more done. But they’re also great because they prioritise A) really listening to their members and finding out what their goals are and B) helping them make those goals happen, especially around having an active social life that they determine, on their own schedule. This is a recipe for better relationships, a better network of support in the form of Gig Buddies, and helping people feel capable of taking control of their own lives- all things we want to achieve for everyone through Relational Welfare.

Asked what they set out to do, former Heavy Load bassist and founder of Stay Up Late Paul Richards said:

Listen to what disabled people want to do, how they want to lead their lives, and support them to do that.”

Couldn’t have said it better myself.

Kate Bagley is Campaigns and Content Manager at Participle. You can find her online at @kate_bagley

Photo courtesy of Stay Up Late.

drwho

A light that never goes out

Continuing our series this month on fear and how we handle it, here’s guest blogger John Wade of Bromford

Whatever book I’m reading or TV programme I’ve been watching I can’t help but see themes and links with our work at Bromford. When I read this recent Relational Welfare blog post I was pleased to see that I’m not alone.

I was listening to astronaut Chris Hadfield talking on a TED podcast about fear. It struck me that he was talking about what we might call ‘external fear’. That’s to say fear generated by something real….out there….like being in a rocket heading into space. That sort of fear seems entirely understandable. We’d all feel afraid wouldn’t we?

Chris did feel afraid but he wasn’t crippled by his fear. He’d spent years learning what to do. He knew why he was afraid, what he was afraid of and knew it couldn’t control him because he’d learnt what to do to overcome it.

But what about the kind of fear that starts as a little thought in your head before growing and twisting its way around until it has you routed to the spot….the kind of fear that seems able to tailor itself especially to you?

Singer Morrissey has a knack for summing up complex emotions in a seemingly effortless lyric. He nails this kind of ‘internal fear’ perfectly in “There is a Light That Never Goes Out

And in the darkened underpass
I thought oh God; my chance has come at last
(But then a strange fear gripped me and I
Just couldn’t ask)

He takes us straight to that underpass…..words stuck in our throat…..words we really want to say but which just won’t come out. Terrified at the thought of what might happen if we do makes the world close in around us. We feel completely alone and frozen in the moment.

Anyone seeking to influence the behaviour of others will be familiar with these special internal fears.

Fear of failure or rejection or ridicule.

They can trap people in destructive relationships; stop them taking up opportunities; stunt people’s lives. When we are somewhere we don’t want to be but feel completely alone…..can’t see a way out….then the fear can be overwhelming.

We need someone to reach through our fear to connect with us and help us believe that the thing we are afraid of can be faced, can be overcome; that there is another, better future out there.

Achieving the belief that this thing can be faced is not easy. It needs to be built up over time through a deepening relationship of trust in that other.

Building deep, trusting relationships is vital for any individual or agency that wants to help others overcome their own personal fears and make changes in their lives.

Building that trust can’t be rushed. It has to be developed over time through being open, being honest about consequences and risks, doing what you’ve said you’ll do.

This was summed up perfectly by Clara Oswald in a recent episode of Dr Who, “The Caretaker”. Clara’s boyfriend Danny had witnessed her carry out amazing acts of bravery to defeat an alien threat. Later he reflects that Clara hadn’t seemed afraid by anything she’d done:

“I saw you tonight. You weren’t even scared and you should have been,” he says.

“It’s because of the Doctor. I trust him. He’s never let me down”.

If we want to help our clients…customers…..service users….be brave and overcome their fears then we have to start by building their trust.

John Wade is Director of Bromford. We recommend you check out his wonderful blog, Joining Up the Planks, where he shares ideas and really entertaining stories from his years working in the community. You can find him online at @John_A_Wade

Picture courtesy of nerdalicious.com.

strike

Why midwives matter

Though the brief strike earlier this week is over, tomorrow is the final day of action around their campaign to get a mere 1% pay increase. Unrelated to the NHS Strike but related to the issue, there will be a rally for the Living Wage, Britain Needs a Payrise, in London on Saturday, 18 October.

We believe better pay and better working conditions for those on the frontline of public services makes it much easier for workers to form connections with the people they work with, which results in better outcomes for everyone. Better pay also makes the statement that we as a society care about the work they do. 

This is an amended re-post from the educational and charming Gas and Air blog, where Clemmie relates her life working on the frontline as a midwife and mum.

This week I took part in something I feel very strongly about. I joined my fellow colleagues shoulder to shoulder in the pouring rain to strike. This is the first time in 133 years that midwives have taken industrial action. Us Midwives saw our pay frozen back in 2011, frozen again in 2012, before it rose 1% in 2013. On average the typical midwife’s pay had risen in line with prices since 2010, we would be paid over £4,000 more per year than we’re actually getting. What we’re really asking for is just a 1% rise. Yes that’s all, 1% and to make this point we were on strike from 7am to 11am that morning.

Midwives really do love their jobs, in fact it’s more than just a job (ask anyone married to a midwife). As fellow midwife Pam Ward describes today ‘Midwifery is a busy but fulfilling profession, and the care of women and their babies is paramount to us all. This is why my colleagues regularly work over their hours to meet the needs of the service. Most work very unsociable hours and many are on-call overnight, going out at a moment’s notice to give care to women in labour or at other times during their pregnancy or postnatal period. This is what the job demands, and we love it.’ I wouldn’t give up this profession because I believe all women deserve excellence in midwifery care, something the NHS is striving to do. Staff work flat out, often staying late and doing large amounts of unpaid overtime, as they try their hardest to give women the best possible care they can,” said Cathy Warwick of the Royal College of Midwives. “After years of stress, pressure and overwork, being told they face another year of rising bills – but static pay – is just too much.”

And it doesn’t sit well when I hear politicians claiming there’s no money left in the pot to accommodate the proposed 1% when these politicians got a 10% pay rise!

Within my little but amazing midwifery team on Tuesday, 3 midwives managed to safely deliver 3 babies. 1 in hospital and 2 at home, that’s 6 lives in their hands. I won’t go into detail if any of these midwives got a break yesterday but I do know one quick thinking midwife hailed down a Police van to to take to her to one home birth quickly, and she just made the birth.

I’m not here to dissect the down sides of our profession so to end on a positive note, my fellow colleagues have described why they love being a midwife. And as I sit here with my soggy placard drying on the radiator, I stare at my pager in anticipation as at any moment one of my women might need to call their midwife.

Seeing how amazingly strong and funny women can be. Oh and drinking a lot of tea. And driving home at dawn after a lovely birth feeling on top of the world!’ 

Making a difference regardless of the circumstances‘.

The unpredictability of each day.

The joy of seeing students become midwives at the end of a course’

To be a part of the most intimate journey in a woman’s life and to be trusted with that journey is such a privilege. To witness the miracle of birth and motherhood is a dream come true. I hope I forever love my job!’

Being privileged to share in the most awesomely intense time of a woman’s life, being reminded how amazing women are on a daily basis,  feeling supported and respected by my wonderful colleagues’

Being part of such a special journey… Giving support and encouraging through good times and bad’.

Tucking a couple up in bed in their own home with their baby. Seeing the strength of women to deal with what is thrown at them when things go far off script. My amazing midwifery colleagues who teach me, inspire me and humble me on an almost daily babies’. 

Wow that’s some pretty inspiring stuff there from other wonderful midwives out there.

Clemmie Hooper has wanted to be a midwife since the age of 4 and now works as one in Southeast London, supporting women through their pregnancies, birth and life with a newborn. Find her online at @midwifeyhooper or the Gas and Air blog

Read the original post here.

via Flickr user Terraces Tenements and Tower Blocks.jpgTenem

Neighbours: a dirty word?

I wonder how you view your next door neighbours? Do you think of neighbours as being noisy, nosey or a nuisance? Or do you see your neighbours as “good”?

For many people “neighbours” is a bit of a dirty word. What’s behind this? In part it is a fear of the stranger. Driven by scaremongering in the media (and a picture that does not fit at all with the facts), there is a growing sense that anyone we don’t know should be given a wide berth. This distance leads to fear and fear leads to isolation.

This isolation is getting worse. In the UK, more people of working age and the elderly live alone [1] and the proportion of the population that believes that other people can be trusted has fallen from 60% in the 1950s to 29% in 2000. [2]

I'm sharing my DVD collection2This really matters. As the Joseph Rowntree Foundation has noted, “The evidence shows that neighbourliness contributes to people’s health, wellbeing…child development, crime reduction… safety, belonging and protection. Good neighbours may be particularly important for those who spend more time in their local area – flexible workers, young families, the young, the elderly, the unemployed and the disabled.”

The good news is that the direction of travel is changing.

The Royal Wedding and The Queen’s Diamond Jubilee brought people together and have led to an upswing in neighbourliness. The average adult in the UK now knows eight of their neighbours by name (up from seven a year ago) and each day an estimated 26 million conversations between neighbours take place (an increase from 21 million).

What is more, technology, is bringing people together. One such idea is Streetbank.

The idea is simple. Streetbank shows the things and skills your neighbours who live within a mile are offering. It brings people together and enables neighbours to help each other.

Started in Hammersmith and Fulham and ranked by The Times as one of 50 websites you can’t live without, Streetbank has spread to become the largest hyper-local neighbourhood sharing website in the UK with 57,000 members.

People are sharing all kinds of things from giving away sofas, to lending ladders, to helping out with dog-walking. These small acts of neighbourly kindness have a number of positive effects including saving residents money, reducing waste and creating happier, friendlier, more connected communities. What is more, 40% of requests made on Streetbank are from 30% most deprived households (as measured by the Index of Multiple Deprivation).

The effect on the individual is remarkable. A year ago Richard, from Witney, was struggling with some serious mental health issues. He has bipolar disorder, agoraphobia and social anxiety disorder. He decided to come off his medication, leave facebook (which he found wasn’t helping) and joined Streetbank. It helped him start to connect with his neighbours online, and that gave him the confidence to meet in person. Soon he was promoting it himself and building community in his neighbourhood. You can hear his story here.

Technology need not isolate people in their own homes, playing games and communicating with avatars. Technology can be a force for good. The good news is that neighbours are not noisy or a nuisance but almost invariably, surprisingly nice…. Once you get to know them.

Sam Stephens is the Founder of Streetbank. You can find them online at @street_bank and www.streetbank.com

Photo by Terraces, Tenements and Tower Blocks, via Flickr Creative Commons.

1. Research by Malcolm Williams (2005) shows that while population has grown by 5 per cent over the past 30 years, the number of households with just one occupant is up by 31 per cent. The research points out the propensity to live alone among working age men (25-44) and women (40-50) as well as older people.
2. Halpern 2002, Life Satisfaction Cabinet Office Analytical Paper

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