Championing the Science and Art of Nursing

Summer 2016 marks 30 years since I qualified as a nurse. In those heady last few weeks at Sheffield City Polytechnic I was caught up in the rush of finishing my last placement, celebrating completing a 4 year degree (especially the dissertation!) and experiencing the relief of getting my first staff nurse post. The last thing on my mind was considering what impact I might make or where my career would lead me. But as I sit here, 30 years older (if not necessarily wiser) – it seems an ideal time to contemplate these issues and reflect “why DO I do what I do?”

In the beginning, when I started my degree, this was something I often had to respond to and was simple to answer. I wanted to do a job that made a difference, that and also enabled me to channel my personality. I always loved learning, reading and questioning: By the time I was 18 I had evolved from the 11 year old ‘bookworm’ (reading 6 books a week) to an academic, knowledge seeking student. Conversely, my family will also tell you that same ‘bookworm’ was the proverbial ‘soft touch’ with an overdeveloped sense of responsibility for putting things right and an acute awareness of how some people had fewer lifechances than others – and that wasn’t ‘fair’. So from an early age, the need to learn and have an outlet for my desire to improve things for others was set. My fascination for the human body as a complex physical and psychological machine drew me towards nursing and healthcare. Being accepted on one of the few nursing degree programmes in 1982 was key – it provided the critical challenge and academic rigor to meet my continuous thirst for knowledge. Four years later I emerged with a 2:1 degree and a nursing qualification. I felt I had finally fulfilled my need to learn as well as ‘do my bit’ for those in my care.

But I was wrong.

Far from being the end – nursing marked a beginning of not only a long career, continuously balancing the scientific and caring aspects of my nature, but also opening up a range of opportunities which taught me much about myself (and still do).

I write this now as one of the few Black female Professors of Nursing in the UK. How we identify ourselves makes a statement that ultimately impact on ourselves, our chosen profession and how both are shaped in the future. Arguments have raged in the press, on hospital wards and among the public as to whether nurses are less caring now due to academic status than in the past….My choice of words to describe my role are personally and professionally important. Each word represents what I believe is the essence of “why I do what I do”. They reflect the experiences that have shaped my career sand ultimately keep me striving to do more.

Recent and past experiences, (my own, within the profession of nursing and the wider world) have reinforced for me the importance of knowing yourself and your purpose. Events in the USA, UK and elsewhere over the last few weeks remind me of the importance of retaining pride in my Black female identity and embracing the value of diversity in the 21st century. As a student nurse I was acutely aware of myself as the only black student, not least when patients refused to be touched by ‘that black nurse’. As qualified nurse academic I have since travelled to countries and cities I never imagined I would, working with national and international governments to inform policy, education and practice developments. I have also been fortunate to work locally with voluntary groups and individuals to ensure the voices of the less powerful are not ‘silenced’ in the push for change in the face of economic constraints. In these arenas my identity has at times been challenging to others but I believe my experiences have helped me to engage with and reflect the diversity of experiences at crucial points.

As nurses, our role is to ensure high quality equitable health care for all, irrespective of race, creed or social standing – over the years since my qualification, there have been periodic reminders (Mid –Staffs, Winterbourne View to name a few) that this has not always happened and nursing has at times born the brunt of the backlash from a disappointed public. These negative experiences are counterbalanced by positive experiences such as the unveiling of the Mary Seacole statue, last month, the first to a named Black Woman in England signaling not only a landmark for nursing, but on a personal level 12 years of fundraising and campaigning. My position as a clinical academic professor of nursing working in a university affords me the priviledge of shaping the future workforce through work with students as well as supporting frontline nurses in evidencing the unique and essential contribution we make to health care. Only last week my pride in the value and potential of nursing for leading change was reflected in the ideas, enthusiasm and innovation of frontline nurses in the urology outpatient department at the Royal Hallamshire Hospital, Sheffield.

These nurses epitomise the answer to the question – Why do I do what I do – because the Science AND Art of nursing is important – without both we fail to evidence the work nurses do to reduce suffering and improve the experiences of people accessing healthcare. Nurses are critical, reflective leaders, adding value to health services for people trying to manage their conditions alongside other aspects of their lives. I am a nurse, I am Black, female and proud. I cannot reduce my drive to prioritizing either the academic, ‘science’ or caring ‘Art’ of my work. They are personally, professionally and contextually bound.

In me and through my work, they are one.

Remember..Recall..Revisit:The human imperative

Remembering, recalling and revisiting the past are part of the human condition.

We use our recall and remembering to drive our actions – in the present as well as in the future. Whether that is remembering a shopping list, recalling where we put the car keys or remembering what we need to do next.

Revisiting the past is somewhat different.

Revisiting requires more than a list or an efficient approach to remembering details. Revisiting engages with recalling and remembering and infuses within these our feelings, thoughts and reactions at the time, which, even if long forgotten, completed the rich picture of our human experience. Thus in uniting these processes, revisiting gives us an opportunity to mature and develop. Revisiting enables us to ‘re-feel’ the pain…sadness…joy…or elation of the moment.

And in that ‘re-feeling’ revisiting enables us to grow.

It is in our own agency how we react and how we use the information that revisiting brings. Whether we use that to further bind ourselves to the negativity of an expereince – rebuilding our defences… closing ourselves off, insulating ourselves from future hurt: staying where we are…remaining stagnant, trapped in and by a past we cannot change.

My thoughts are that revisiting is also a positive experience. Through revisiting the pain and the sadness of the past for example, we are able to see a different option – thus hidden within our feelings lies hope for the future.

If we are brave enough to take it.

Revisiting enables us to reconnect with our inner strengths and coping strategies and not be condemned by a ‘bad past’ – George Santanya, a philosopher, once said “those who cannot remember the past, are condemned to repeat it” – I would say it is through our failure to ‘revisit’ rather than ‘remember’ that we are condemned. Through revisiting, we open up another part of ourselves: The ability to learn from our memories of the decisions we made, the actions we took and the situations which drove us to pursue those actions – this is more than the ‘playback’ we experience in recounting a tale – but recalling also the consequences of our actions and reactions, and the feelings or thoughts evoked as a result – moreover, revisiting offers the ability to remind ourselves that WE are the agents of our own destiny,

In the emotion of revisiting we recall and remember the power of our humanness…..remember our ability to rebuild, reshape and reform.

Revisiting, remembering and recalling..…all part of our human condition.

Revisiting, remembering and recall, are powerful resources at our disposal: Enabling us to pursue

a different future,
a different outcome,
a different option

…and in doing so, release and rediscover a newer, more positive sense of self.

Speaking to encourage growth…

Words are the foundation of ourselves as human beings…. with words we first begin as children to communicate, using our words to build bonds, forging links with our families, friends and our world. Through that early process we become individuals – distinguishable from our parents, siblings and peers – Our personalities are formed in the way we use words, which words we use and how we engage with others in using those words. As we grow older, we master the use of words in all its forms; written as well as verbal – We become wordsmiths, creating and building more complex pictures of ourselves and our understanding of the world around us. It is during this period of growth and development that we learn the importance of not just our own words but those of others. We become increasingly aware of the importance of not just what we say, and how we say it, but what is heard….it is then that our words have power.

The power to be supportive and the power to destruct

The power to encourage and the power to obstruct

The power to lift and the power to belittle

The power to express love and the power to spread hate

The power to heal….and the power to kill

The truth is that words do not have power in themselves, they have the power we instil in them by the way we use them, when we use them and who we include when we direct them. More importantly, words are given more power when we forget the ‘listener’ to our words…’speaking without listening’ is often a fundamental flaw in our communication: Failing to see beyond our own need to ‘have our say’ or even worse, adding our words to that of others without reflecting on not only what is said, but what may be heard and who could be listening.

In my professional and personal life I am acutely aware of the difference in the ways we use words in individual and group ‘speak’ -For me, whether speech is individual or group is determined by more than just the number of speakers involved.

Individual speak on the whole is rational and reflective, thinking about what is meant and using words to help make thoughts and feelings (whether positive or negative) understood. ‘Individuals’ speaking are able to easily tap into their early learning about communication ‘take your time, think about what you want to say or what you wish someone to know, then find the words’. This type of speech has a purpose, usually a positive purpose at its heart – even when we don’t agree with what we hear – if we listen carefully we will hear there is a message of growth behind the words used. Words which encourage and applaud at one extreme or identify our opportunities for growth within what may first appear to be critical comment.

Group speak is different, particularly in the professional sphere. Group speak instills no feelings of responsibility, group speak is more often used to distance the ‘speakers’ from the message in the conversation. The purpose here is not to leave room for growth or enable it to flourish, but to restrict and restrain growth. The act to restrain growth is couched in words that demean and belittle, negate effort or minimise experience and confer restrictive labels which are absolute – Group speak has more power to isolate the speaker from the subject, or worse still, the people under ‘discussion’ and render them less like ourselves, less important, less human….just less.

Our challenge as mature human beings is to recognise and harness the power of our words and use them with purpose. Our duty as professionals is to optimise our individual speak, encourage growth and thus sustaining the ability of others to develop. In doing so we are more likely to resist the temptation to use group speak ourselves…..or tolerate it in others.

 

 

The importance of ‘lifting while you climb’

Taking the lead, going first is always a daunting task. Whether you are the first to scale a mountain, the first batsman at the wicket (taking the harder and ultimately faster ball) or the first person to change the status quo – it’s hard. The rewards of bravery, perseverance and just plain ‘hanging on’ are often great: And as we become more adept at leading, others follow and may even look to us to inspire themselves.

However I have always believed that it is not enough to succeed. Success of ‘one’ can only every bring about personal gain, which is transient and has little impact beyond ourselves, rarely changing the world. Sustained changes and developments that have the potential to advance communities, professions and even the world require more than the power of one. But leading brings with it responsibilities. If we truly believe in the things that inspire us, we are also charged to actively bring others through behind us. Helping others directly and indirectly, through our efforts to meet their own challenges and add to the collective efforts for change.

We must remember the difficulties we faced on our own journeys and the lessons we learned as a result. These hurdles that we over came – whether we climbed over them, crawled under or found a way around them were our battles – but we do not have to leave them for others and watch them attempt to scale the same barriers. There is no virtue in “I did it ..so can they”, there is no leadership, or I would hazard to say, little humanity in ensuring we remain at the top of the Mountain by not sharing with others the solutions to those obstacles. Passive inactivity is as destructive as active obstruction… Success and leadership can be a lonely place. I urge you to do more than feed your own successes – lift as you climb – True leaders are enablers. They actively seek ways of supporting, encouraging and nurturing others to join them at their peak or climb towards their own.

This activity is time consuming, you may even appear at times to slow your own progress. But do not be fooled – lifting others during your journey adds to your achievements as much as to those you encourage. Through individuals’ actions networks are formed and seemingly insurmountable problems are overcome and rendered to the annals of history. More importantly you yourself receive support and friendships are formed. My mother, a very wise woman, always said “take care how you treat people on the way up – they can hold you up there, and remember should your rise be short lived, they are the same people you’ll meet on the way down”.

For me it is more than a fear of the fall which drives me to network, support and nurture others to fulfil their dreams.  Through the achievements of each of my mentees, each person I have made some contribution (however small) to their journey; I believe that it is my responsibility and an honour to see others soar father and I higher than I dared hope myself. In return I have made many friends and on many occasions have been spurred on by them when I in turn needed support.

So I urge you – lift as you climb – the rewards are immeasurable.

history is made…Herstory begins 

Here at the RCN congress I am almost moved to tears. For the first time in its history, RCN member have voted for a Black president. It marks a great turning point in nursing. Not simply because of the diversity which is now represented at the highest levels of this professional body. But because it signifies that “at last” the importance of selecting a candidate who can represent nursing looked beyond the visible differences that often separate us. Cecilia story is ALL our stories – one of a frontline nurse who has spent the majority of her nursing life working, supporting family and championing our profession by ‘doing’, giving the best of herself and more of her time for those in need. 

She leads by example showing us that leadership happens from the back as well as the front of the queue. As she takes the stand and accepts the new chapter in her professional life -the strength in her commitment as a year shines through – she charges us all “not to let the critics drown out our voices” her call to action is “We are nurses, WE are the nursing team!!”  My heart swells at the rousing ovation she received 

‘WE are nurses’ bound together in care and caring. No matter how we do our nursing now  or where we started from’

This is the central point of our new president. History is made with her starting …’Her-story’, and Ours begins today 

   

Wellbeing, identity and belonging

Stephen King is a prolific writer and while I have never read his books (too scared!) I have listened to his many commentaries on writing. He expresses the craft of writing as almost a duty. He describes being in a state where he is “swimming in a sea of language” – describing how we are driven as humans to express ourselves and in doing so invite others to know us – I like that, yet it leaves me wondering why with so much language around us, so many stories to be told, we hear so few? 

The importance of knowing ‘self’ and having your story recounted and understood is a recurrent theme in the writings of the black female writers ( whom I have read!) …bel hooks, Dadzie, Angelou, Campbell and Lorde. At the Making Diversity Interventions Count conference today (University of Bradford), I found myself thinking about these writers and writing – the links between King and those strong women I know so well: seemingly so different in their subject matter yet unted in the need to express themselves and I doing so we may understand ourselves better. 

King talks about the importance of having “no fear or shame in the dignity of your own experience or knowledge” ,something which is central to black women’s writings about their lives, identity and the importance of self knowledge. Angelou and others remind us of the importance of our own biographies, developed through a sense of ‘self’ an appreciation of ourselves and others. Through these writers we are reminded to acknowledge our own importance and be mindful to locate our experiences as part of what makes us unique, yet collectively human – failure, succes, pride, challenge and happiness find their form in ‘us’  and make us who we are.

But what does that have to do with wellbeing you may ask? 

Our personal and professional selves are forever bound. As individuals, families and members of communities, our feelings of belonging is key. It remains crucially part of our professional selves – as a nurse, manager or patient, our sense of belonging and self shape our world and experiences of it. These experiences are the roots of our wellbeing – our feeling of acceptance and purpose. This is not simply bound in the present but in the experiences of our recent and ancestral past. When we forget this, and disassociate our selves from our work, compassion and care struggle to survive.

There is a great site called Buttonpoetry.com where individuals are encouraged to share, through poetry their sense of self, that which reflects their identity and belonging, that which locates who they are and through which their personal and professional agency is channelled. ( take a look, it’s great!)

With that in mind, I have chosen to share my poem with you…

“I am from the ancestors . 

I am from a place of love.

A stargazer lily; single, bright – yet bound and clustered on a strong, single stem.

I am from laughter, love and tears.

I am from supportive challenge -“be the best YOU, no one else”

I am black, Dominican and proud. 

I am macaroni cheese and red snapper.

I am from stories about me, about us.

I am from the ancestors “

“The importance of a resilient self”

In these times of predefined actions – where abilities and activities are  measured and judged within sometimes rigid structures –  What makes us tick? What drives us to continue? How do we know ourselves? 

This is something that I have mused over from time to time – most recently as I observe the way in which we deal with changing and challenging environments. 

During my professional career and personal life I have faced many changes ( like anyone else) – some have been as a result of my own actions and choices, many have not… And in many cases I have been surprised and bouyed by a collective resilience found in my own agency, others’ support and the strength of our collective human spirit. These are surely things to celebrate – even in the darkest moments the “dawn” can never be far away.

I wonder therefore why we are so resilient – and conversely why at moments of challenge, our resilience itself is often questioned or held up as an example of how “bad things are” or considered in a negative light? 

Most recently my reflection on this point arose during discussions about nursing work and the changing (sometimes not ideal) conditions in which nurses strive to deliver good care. Very valid and occasionally challenging points were being made on all sides – and rightly so ( see previous blog: challenge is good!!) – however it struck me that there was an undercurrent of messages passing backwards and forward which seem to focus more on how each party thought “nursing should be” or what the profession “should be concerned with” from their perspective – most noticeably the question of whether nurses ‘should have to be’ resilient to deliver care in an often challenging environment.

listening and reflecting on the expressed views it struck me that nursing is no different to many other areas of life – in trying to find ways of making a difference, finding a meaning for moving forwards and galvanising that individual agency and collective human spirit “in the light of” rather than “despite” the difficult circumstances.

As in everyday life, finding a way to keep going is what we all do. Giving up or giving in is not an option. We understand fully where we are ( and occasionally how or why) – and we each find our own ways of keeping going.

Fundamental to this is a strong sense of self and a belief in that ‘self’- in ourselves and others- we are different ‘selves’ to our peers but individually and collectively nurses have a sense of belonging and purpose that’s speaks to us and drives us on. 

This neither makes us superhuman, silent victims or unaware of how much easier things could be. 

It makes us human. 

Resilient. 

“Challenge is good”

Challenge is good.

I have always believed this. Without challenge, without that human drive to question, to object or to stand against “accepted” ways of the world we would not have any of the advances we take for granted – clean water, medicines, transport, or even a good chance of surviving childbirth!

However as we challenge we must remain aware that challenging is not an end in itself.

I believe that to be effective, challenge must be accompanied by two things – respect and responsibility – respect enables us to hear alternative views and challenge them without recourse to demeaning or devaluing the holders of that view. Respectful challenge accepts that challenge may be difficult or unpopular but remembers it should never be personal. Responsible challenge arises out of respect for others – it recognises that as the challenger we have responsibilities to ourselves ( to challenge and be clear about the purpose of that challenge) and to moving forward the ‘ ’cause’ we are challenging (to suggest alternatives)

Too often challenge occurs without respect and responsibility. The result? At worst an undermining of an alternative viewpoint, without desire or action to contribute to finding a way forward – and at worst, heated exchanges which leave people and communities bruised and any prospect of improvement consigned to the wilderness.

Challenge is good. I believe that – but we are charged as inquiring, questioning human beings to ensure it is driven by respect and responsibility.

Or else chaos and stagnation ensues.

“Impermanence is part of our lives”

Change. Constant change can be draining. The continuous need to adjust, adapt and reinvent ways of being, ways of seeing and ways of doing. Everyday.

21st century lives move quickly and it can sometimes feel like there is little opportunity to perfect, reflect or even appreciate what we have achieved for ourselves, for others.

In this context of change one of the key issues that keeps being mentioned as a goal both personally and professionally is empowerment. But what do we mean by this? Certainly in the health and social care fields in which I reside professionally, empowerment is often linked to the wellbeing of people we care for, community action and workforce pride or achievement. For me, empowerment and my belief in its importance in research was certainly a catalyst in pushing me to developing my theoretical framework for conducting research – The Silences Framework – following my PhD. I produced it in the hope that it would empower researchers to engage with sensitive issues involving marginalised groups…and I certainly felt empowered (or was it humbled?) when my presentation of the use of my framework in an evaluation study undertake with my colleague Dr Martin Glynn was well received on the closing day of the TQR conference in Florida.

But how does empowerment link to change? or our experiences of it? The seemingly constant state of flux, of becoming that we live with today.

bell hooks ( yes, I am still reading Sisters of the Yam), reminds us of the words of Audre Lorde who calls for us to think about about Empowerment as being “our strengthening in the service of ourselves and each other, in the service of our work and the future ….”. While Valerie Jansick (At the TQR conference) raised the issue of impermanence (or change) being part of who we are. So it seems to me that taken together, impermanence affords opportunities for empowerment –  giving us scope to reflect and understand more about ourselves, who we are and what we are doing. This does not negate the feelings of anxiety or possibly reluctance that we may feel at the prospect of further change. But if we entertain the possibilities that could arise in this counter view of ‘impermanence and empowerment’ co-existing in harmony, we open up a range of ways of seeing ourselves, contributing towards our own goals and supporting those of others.

“The candle is not there to illuminate itself”

The first two days of the TQR conference in Fort Lauderdale has me reflecting. The words of Nowab Jan-Fishan Khan from the 19th century which entitle this blog were spoken by Patricia Leavy as part of her opening Keynote presentation. She spoke of her personal and professional journey so far – battling to find ways of helping the wider world to see and understand the experiences of others through use of the Arts (Arts based Research). My reflections were not so much about THIS research, rather a realisation that this, and other presentations through the conference were focussed on finding ways to ‘hear’ others’ experiences….and the importance of those efforts. Leavy called her efforts in the Arts a way of ‘accessing and expressing subjugated (hidden) knowledge’ and despite the academic language it was really a fancy way of saying ‘enabling people to speak using any means possible, anything that would help them to tell their stories’. This got me thinking abut the importance or recording what happens to us, what we think or feel and the impact it has on us, our families and communities. Oral histories are an interwoven part of my history, our history whether told through family gatherings, girlie chats or shared stories. These all have a purpose in helping to create connections and pass on knowledge and experience.

“The candle is not there to illuminate itself” – a powerful statement. It got me thinking – How does this relate to me and where I am now? How does this relate to the importance of my work, my contributions at this time? Am I a candle? And if so what am I here to illuminate by my actions?

My current work with the Compassion in Practice Team at NHS England is an opportunity to do what? Compassion in Practice – Compassion in research, how are they linked? For me its about enabling and valuing the importance and contribution of the health care workforce in human experience of care. Guiding and developing evidence with a purpose – the purpose is key. It brings me back to the quote of the Candle…its purpose is to illuminate a room. Providing a light by which others might see, be safe and the room in which it resides may be seen.

For me, here lies the purpose.

The role of Compassion in Practice (CiP) is to enable us to see, experience and promote the care that the people we care for deserve and that we as nurses (and other health care professionals) deserve to be supported to provide. The research, the challenge for me, is to formulate an evidence base for CiP; a candle – source of light so that its effects can be seen, experiences shared and its impact appreciated. Without evidence, without the research the impact of CiP cannot or would not be seen. Our efforts may provide solace for individuals or make us feel ‘we made a difference’ but no one would know, no one would be able to use our experience to inform their own and good practice would be more difficult to spread.

Without a Candle our efforts would remain in the dark…….hidden and silent. Illuminating nothing.