Reflections on the Florence Nightingale Foundation Conference 2013


It was a real pleasure to attend the Florence Nightingale Foundation Conference 2013 a couple of weeks ago. It was a real nursing leadership conference – the hall was rammed with some of the most inspirational nurses you could wish to meet; nurses committed to making a real difference for patients. It was a real change for me – a nursing focussed conference rather than an IT one!
We also had the opportunity to hear some really good speakers and this blog is my reflections about some of the messages that resonated with me – a personal reflection rather than a full account of the event.

First of all I attended a really interesting session about Schwartz rounds, presented by Jocelyn Cornwell from the Kings Fund and Vanessa Snowdon-Carr and Martine Price from Musgrove Park Hospital, Taunton where Schwartz rounds have been implemented. Schwartz rounds provide monthly one hour sessions where staff can discuss the emotional issues that arise from delivering care. The originated in the US where healthcare attorney Ken Schwartz, who died at 40 years of age of lung cancer, left a lasting legacy of a center that nurtures compassion in care-giving.

You can find out more about the Center here:
http://www.theschwartzcenter.org/aboutus/ourstory.aspx

The Kings Fund is running pilots of Schwarz rounds in the UK and is looking for more sites. You can find out more here: http://www.kingsfund.org.uk/projects/point-care/schwartz-center-rounds

I found the idea of staff being able to talk about topics such as ‘the patient I remember’ very moving and I found that I could remember a number of patients who had stayed ‘with’ me for many years.

We also had a fascinating presentation from Professor Davina Allen, a Health Foundation Improvement Science Fellow. Davina’s research is looking at what nurses actually do, how their work is organised and structured and hopes to describe the complexity of nursing – it’s a fascinating analysis that she described as ‘An Articulation of Healthcare’. Davina observed 40+ hours of nursing activity and has analysed this to describe in new ways some of the complex things that nurses actually do; issues like negotiating transition and information. Davina was describing her early findings and I’m looking forward to hearing more. There has never been a more important time for us to be able to describe and evidence what nurses actually do in more than a task orientated way.
[It was interesting to see and meet Davina – she is one of my fellow Johnson & Johnson/Kings Fund leadership group (please see previous blog)! As is Martine Price from Musgrove Park Hospital. – It’s a very small world!]
There were 2 speakers who said things in their sessions that really resonated with me. Ros Moore CNO for Scotland said two important things:

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Ros indicated that she even used this language and approach when talking to ministers – interesting! I thought this was particularly important in terms of achieving a change in culture and emphasis. If we share a common language and it is orientated towards improvement surely this will help us to improve safety and care? Ros’s point was also reinforced later by a presentation by Jason Leitch (@jasonleitch) – equally impressive and consistent. It may be that consistency is important?
More about Scotland’s improvement policy can be found here:

 http://www.healthcareimprovementscotland.org/welcome_to_healthcare_improvem.aspx

Ros’s second point was a line on her strategy slide:

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I thought placing trust in people in the system demonstrates value and encourages people to perform at their best. I liked it.
Finally, the one point that has really stuck with me was a point from Dame Ruth Carnell. Ruth was a great speaker, she was honest warm and engaging but she also said some very important things. The most important for me was about the leaders of the future.

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Ruth said that we needed to think about inversion of leadership. What I think she meant was that the elder leaders in the system needed to focus on bringing the new generation of leaders to the fore, to supporting them to mature as the brilliant leaders we will need in the system for future generations.

This made me reflect again on my blog on eldership:
https://anniecoops.com/2012/11/04/role-modelling-and-eldership
I definitely will be focussing how I can help/support/coach and mentor young leaders and I have made this one of my #NHSChangeDay pledges!
Watch out for next year’s Florence Nightingale Foundation Conference. If it’s a good as this one I hope to be there 

What a fantastic opportunity! Being a Florence Nightingale Foundation Scholar


I am a nurse who has always believed that leadership is important. I also know that as an individual I perform better if I have time to reflect, take on board feedback; that thinking space helps me to understand where I want to go, how I might get there, about my passions and to better understand what my unique contribution to nursing and the NHS might be.

My leadership journey started many years ago where I was privileged to be one of the nurses in the early 2000’s who was a Kings Fund/ Johnson & Johnson leadership programme graduate. The whole experience was almost life changing for me and looking back made a significant difference to who I am.

But that was 10 years ago. Since then I have new challenges in my life. I find myself in my middle years, with a gorgeous grown up son, a still happy marriage and facing perhaps the last decade of my working life. I have a long-term condition and I have found a new passion linked to this about new ways to hear the patient’s voice in the complex system that is healthcare. Work over the last year has been complex and challenging but also fantastically rewarding and the rise of social media has given me a new zest for exploring new ways of doing things. Nevertheless, I felt it was time for renewal and a new focussed challenge to again push myself into a new space – I would like to leave my career on a high, having continued to participate in the development of nursing right through to my retirement – a tall order!

The Florence Nightingale Foundation was where I found the next step and this blog is about my first year as a Foundation Scholar. This first blog sets the scene.

Florence Nightingale from Carte de Visite

The Florence Nightingale Foundation supports nurses and midwives with scholarships, mentoring and perhaps, most importantly, to give them some recognition they so richly deserve. The leadership scholarships enable study at home and abroad, giving an opportunity to promote innovation in practice, in addition to extending knowledge and skills to enable nurses and midwives to meet changing needs and improve patient care. At the heart of the Foundation is the continuation of the work of Florence Nightingale who began equipping senior nurses and midwives with the confidence to represent their profession at the very top levels of our health system.

More about the Foundation can be found here:
http://www.florence-nightingale-foundation.org.uk/

I applied to be a scholar in 2012, with an application that focussed on how nurses might us social media to help provide better care for patients. Leadership scholars are blessed with the funds to deliver a project but also, and this is where it gets very special, a bursary to design a personal leadership programme.

I have decided to focus on social media for my project – I see emerging digital spaces as providing new opportunities for patients and nurses. I am interested in exploring the skills that nurses, midwives and health visitors might need to practice in a digital space. The scholarship and support from my employer gives me the space to start to do this. I aspire to write materials that can be used in the professions that might help us all on this new journey. Aiming high is good!

My journey has already started. The 2013 scholars have met and we come from a wide variety of backgrounds. Sharing and meeting other leaders is a key part of the process, giving new networks and new connections that help develop thinking as well as friendships. The Foundation promotes the sense of alumni and already I can feel my network widening.

So my new challenge has begun and I want to use this blog as a reflective diary on my journey as a Florence Nightingale Foundation Scholar.

I feel that I have been given a fantastic opportunity and I really want to do the best I can to make the most of it!

Its the little things too – moral courage


It’s been a week and a half since the Francis report was published and there is much media attention on whistle blowing and having the courage to say when things are not right. I always worry; I’m a ‘worrit’- a northern expression for someone who consistently worries, in this instance I worry that I might not be up to the mark – would I actually have the courage to whistle blow? The answer is – I don’t know but I hope so.

The media of the past week has made me reflective and think about how I might respond if I was in the position to see something that wasn’t right and it took me back to 1987 when I was a second year student nurse. In those days we always did a 6 week rotation into psychiatry as part of our general training.

Anne 1986

The hospital we spent this time at was an old fashioned hospital that had originally been a workhouse. Looking back I think the accommodation was poor for good care. It was dark, stark and formal. There was little in the way of homeliness for anyone. There was a charge nurse on the ward who I was afraid of; he was austere and unapproachable and I avoided him where I could. The ward was full of very unwell people and we had a patient called Fred, who was so severely depressed he was catatonic. I remember observing him having ECT but more than that I recall how we had to encourage him to eat and remind him to go to the toilet. He was a very poorly man.

One day I was on duty and I was shocked and horrified to see Fred in the loo, with his trousers around his ankles and the Charge Nurse trying to force feed him a drink supplement by holding his nose and forcing it into his mouth, with his head tipped back. I went straight to the nursing officer and reported what I had seen. I don’t remember much of what happened after that. I know that I never saw the Charge Nurse on the ward again. I remember writing down what I had seen. I don’t remember much more – although I can still see, in my head, Fred on the loo, being force fed.

My memory of this was only stirred up this week and I took courage and strength from what I remembered. I think I must have just gone straight to the senior nurse and reported what I had seen with no hesitation and no fear – because I knew I was doing the right thing.
But having moral courage isn’t always about big decisions – it’s about the small things too. It’s about knowing what is right and speaking up when that doesn’t happen. I know that sometimes that it difficult to do but I believe that is what nursing is about. Cultures are about people and behaviours and if we fail to speak out when things are not right we are colluding and are ourselves part of the problem.  So, we need both the leadership skills to create effective cultures but also to take responsibility for individual actions.

In a paper called ‘Moral Distress and Moral Courage in Everyday Nursing Practice’ (Gallagher 2010) it discusses the concept of moral professional courage. It is seen as part of everyday practice, and as I say, not only the big things but the little things that confront us every day in professional working life. Gallagher also makes it clear that while the culture and organisational climate are important for us to be able to practice moral courage it is also an individual responsibility. It’s an article that is worth a read!

I took strength from my memory and hope I will be strong enough to have moral courage wherever I am and not just for big things – but for small everyday things too.

Anne York 1986

Me in York around the time of being a second year student.  I look very young!

The Queen Alexandra’s Royal Army Nursing Corps


This week was special moment in my career so far for very personal reasons.  In 1986, the year I qualified as a nurse I wrote to the Queen Alexandra’s Royal Army Nursing Corps in the long-shot chance that they would accept me as a nurse.  I knew really that someone with Type 1 diabetes probably couldn’t join up but I asked anyway – it was what I wanted to do.  They of course said ‘No’.  I would have been privileged if they had accepted me.

So, bearing this in mind, I was delighted that Col. Pete Childerley the current Director Army Nursing Services (DANS) and Matron-in-Chief (Army) invited me to give the 2012 Glover Memorial lecture at their annual dinner.  I had been nominated by one of the Corps, Lt Col Jacky Phillips-Harvey who had attended one of my Leadership for Informed Practice Programmes.

The Glover memorial lecture is given in memory of Lt Col Gill Glover who was a nurse with a passion for exceptional training for combat medical technicians. She served 22 years as a territorial member of the armed forces and 7 years on the committee of the QARANC Association. She was fondly remembered on the evening by some of her colleagues.

The QARANC is a fabulous organisation who have a history going back to 1854 and it was with that in mind that I started my lecture with a focus on communication, the past and a reflection of the challenges faced by Florence Nightingale at Scutari.  But  the focus of my lecture was the use of social media in health today.

You can read more about QARANC here: http://www.qaranc.co.uk/

The chance to be a nurse in this environment is I’m sure a challenge but also a great experience.  Of course not all of the work is in the front-line. Soldiers and their families need healthcare just like people in civilian life and there are many opportunities in the role.  They work in front line field hospitals but also alongside civilian nurses in NHS settings.  There are fantastic opportunities and if you are interested look here: http://www.qaranc.co.uk/becomeanarmynurse.php

The notes I used for the lecture can be seen here – Good evening ladies and gentleman  I didn’t read it word for word, as it turns out, but used it as a structure.  I hope they enjoyed hearing my thoughts.

The evening included the very special experience of a formal mess dinner and the honoured guest was HRH The Countess of Wessex who was delightful and I even had the chance to show her my insulin pump!  She was very interested :0)

Role Modelling and ‘Eldership’


Nurses love story telling; I have spent many very happy hours with other nurses telling stories about my experiences and comparing our histories.  We enjoy the humour and fun that we often experience in the day to day delivery of care, its also part of how we share experiences across the generations.

In leadership conversations we often talk about role models and inevitably the conversation turn to stories about our personal role models.  The stories vary – I have my own; a sister who was one of the scariest sisters in the whole hospital but, gosh, did she know her stuff!  It was my final ward, I had sat my finals but was waiting for my results – a brand new shiny ‘almost staff nurse’.  Hodge accepted nothing less than the best and one of my proudest moments was when I was finishing my placement and she offered me a job – I actually got tearful.  I couldn’t take up her offer as I was moving towns but I can still remember her striding around the ward and her knowledge – when I got to be a ward sister in my own right I remembered some of her traits and I tried to be like that.  When I was a student on her ward I always felt safe, which gave me great confidence to practice and I wanted students on my ward to feel the same way.

Recently I started to think more about the conversations we seem to have about role models and how one sided they might be.  We share the stories of our role models and seek to be like them but perhaps don’t think carefully and reflect about our personal position as a role model and leader.  I even did a bit of searching in the literature and while there are some papers there is not as much as I would have expected.  Are we too busy looking at our own role models to reflect on our own position as a role model in an active way?

The term role model was first coined by Merton who was an American Sociologist and has gone on to be a common term in nursing.  Perry (2008) looked at 8 practising nurses who were cited as being exemplary.  They took on responsibility for passing on ‘craft knowledge’ but they also attended to little things, made connections, actively role modelled and affirmed others.

I wonder if we need to think more about our own position as a role model.  We are all role models, whatever we do, and I wonder if we need to reflect more on how we can actively do this?  I do try to ‘set a good example’ but is that enough?  Am I a role model? Certainly I hadn’t actively considered how I might improve this aspect of me, perhaps because I had never even considered that anyone would want to be ‘like’ me!  Perry found that some interventions could only be learnt through effective role modelling and uses the example of silence as advanced nursing intervention and how observing a skilled practitioner use silence is a good example of role modelling a skill that is difficult to learn.

If we are to be positive role models we need to understand who we are; personal insight can play a critical role. I was given a recommended book called ‘Coaching, Mentoring and Organisational Consultancy’ by Hawkins and Smith (2006).  (Thanks to @DTbarron for the tip off).  In here there is a section called ‘letter to Hans’ where Hawkins describes how individuals need to understand where they are on a progression from experimentation, experience accumulation, full leadership and eldership (p 44-45).

It was the concept of ‘eldership’ that intrigued me.  The idea is that leaders move away from a focus on individual to collective achievement and become practising elders; the move from ‘what can I achieve?’ to ‘what can I help others achieve’ (Hawkins and Smith 2006 p. 48).

I think there may be some lessons here.  I wonder if leaders in the system, particularly those who have been around for a while (I am one of those), need to think carefully about whether we are practicing ‘eldership’, focusing on how we enable emerging leaders to make a real difference through encouragement and a focus on collective achievement, and that this might be through role modelling eldership style?

All comments are welcomed – these are early thoughts.  I certainly am going to reflect on whether I act as an ‘elder’ supporting the development of others to achieve the best that collectively we can.

PS If you Google Eldership you get loads of results relating to eldership in Christianity – that’s not what I’m referring to! – you need to read Hawkins and Smiths’s book:

‘Coaching, Mentoring and Organizational Consultancy – supervision and development’ Hawkins, P., Smith, N., (2006) Open University Press   

Perry, B., (2008) Role modelling excellence in clinical nursing practice, Nurse Education in Practice 9, 36-44

The Anything-but Unremarkable Lessons of the Quiet Leader


I’m quite a noisy, bouncy person.  I can also be loud and bossy, asserting strongly a principle or point of view.  Of course I know that and I try hard to be balanced and make sure I listen carefully and attentively, but I can’t help being attracted to other noisy bouncy people.

I did a leadership programme (the Kings Fund Johnson & Johnson Programme – I was so lucky) a long long time ago.  I loved it.  One of the things we did was to look at ourselves and compare ourselves to others and to think about the impact that we had.  It was great fun.  We did our Myers-Briggs assessment and then all split into our respective groups and looked at ‘the others’.  Of course I was in the noisy bouncy group and we had great fun unpicking our preferences and trying to understand each other.  We had the task of describing an empty bottle of wine; I saw parties and laughter, others (not so bouncy and loud) a green bottle.  What I learnt was that differences are a strength and we should not be afraid to work with people different from ourselves – diversity is fun.

A conversation recently with someone on Twitter about a leadership programme reminded me of the story above. I can almost feel myself in the room back all those years ago.  The loud bouncy people were in the majority.  Those more reserved in smaller groups, with a lower volume buzz.

I work with lots of different people.  In an informatics environment there are maybe less energetic, loud and bouncy people.  I think I’m sometimes treated like the enthusiastic Labrador; when I first started working there I felt terrible.  The office is a large open plan one.  Studious silence reigns, mainly men – how was I to survive?  In the first few weeks I was nearly exploding with the need to talk!

What happened was that I discovered that I work with some remarkable people.

The title of this blog is from a paper from the Ivey Business Journal by Joseph Badaracco.   I was reminded recently that’s its too easy to think that outspoken people are they only ones who can lead; phrases like ‘Step up to the plate’ and ‘Lead from the front’ imply a type of visible heroic leadership that is well documented.  So what about quiet leaders?

Badaracco says that we spend too much time on the heroes.  He isn’t dismissing the need for courage and high ideals but he thinks we are preoccupied with those leaders who display these characteristics and we assume no one else is pulling their weight, that if the ‘movers and shakers’ are not making a noise then nothing is happening.

Badaracco makes a great case for dilemmas where people need to make right vs. right decisions.  Most heroic leaders are seen facing ‘great challenges’ but what about the day to day dilemmas people face, about the ‘small and obscure’ deeds.

Quiet leaders, according to Badaracco rely on 5 basic guidelines:

1 Don’t kid yourself

Quiet leaders are realistic and have open minds to the complex world around them.  Unlike heroic leaders they are not focused on a single task but can see the complexity around them

2 Some skin in the game

Quiet leaders recognise that they have ‘skin in the game’ and can see how their own self interest can be channeled to help others.

3 Buy-time

Quiet leaders recognise the complexity and uncertainty of the problems they face and often buying-time is a useful approach.

4 Drill-down

They use the time they buy to try to tackle the uncertainties around them, they consult, they listen and learn about what needs to be done.

5 Bend the rules and look for compromises

In contrast to heroic leadership, where leaders take the ‘last stand’ to defend principles,  quiet leaders are more pragmatic using their understanding if the complex landscape to make complex decisions about what to do.

I would commend the article to you.  In the current landscape of the NHS where we need stability as much as change I value those of us who are quiet leaders and vow to respect and value them as part of the teams I work with.  In the new NHS we need heroic leaders but equally we need remarkable quiet leaders.

Badaracco JL., (2002) The Anything-but Unrtemarkable Lessons of the Quiet Leader Ivey Business Journal May/June 2002

How do I know if I’m being compassionate?


I’ve been working on a real ward with patients for a few months now.  I don’t go often but I do it to try to make sure I still understand the experience of nursing.  So far, my experiences say I do, as when I’m there with the patients it feels like I’m 25 again, it feels real and true.

Unfortunately I’m not so sure I look 25!  When I go to the ward I put on my blue dress and sensible shoes; the dress is no longer a size 12.  Ironically I wear a staff nurses dress which is the same colour as my old sister’s dress but no hat and no lovely silver buckle.  I am wider and greyer – I don’t quite look the same as I did 25 years ago!  You will understand the relevance of the way I look now later on in this blog!

 Anne as ward sister 1989

Last week Jane Cummings CNO and Viv Bennett Director of Nursing at the DH started a consultation of a vision for nurses, midwives and care-givers; the vision includes dimensions of nursing characterised by the 6Cs, one of which is compassion.  I would encourage you to read it and respond.  You can do that here:

http://www.commissioningboard.nhs.uk/files/2012/09/nursing-vision.pdf

But it got me thinking – ‘Do I give compassionate care?’

Last time I was on the ward I was caring for a bay of 4 patients; its an elderly care ward but focussed on rehabilition.  I love it.  On my last shift there was one man in particular who, towards the end of my late shift as I was helping him to have a drink, said to me ‘I wish when I wake up in the night I would see your face.  Its lonely here and so dark.’

What he said made me feel sad but also made me reflect.  What did he mean?

Now, I’m pretty certain its not because I look like a vision of beauty in my dress.  I never wear makeup on the ward and as I decribed earlier I’m not sure I look as I did 20 years ago.  So why did he say it?

I reflected on the shift.  This particular gentleman looks reasonably well but in fact has real problems with his mobility.  I also noticed that he struggled to hold his glass to have a drink.  Once I realised that he just needed a small amount of help I tried to go to him often to help him to drink his juice.  When meal time came I sat quietly down with him and offered my help.  He was grateful, I think, as all he needed was help to put the food on the fork, he was quite shaky, but once it was on he could manage.  We chatted a little bit but I am sure he was just happy that I was sat next to him. He ate all his dinner.

At the end of that shift I felt that I had made a difference to that man.  I don’t want him to feel sad in the night but his feedback to me was that he felt better when I was there. Perhaps I was being compassionate?

So how do we know? We do know that kindness is part of compassion and that kindness needs to be attentive.  Ballatt and Campling (2011) say that attentiveness is key to compassionate care, and cite examples such as noticing, thinking, feeling, learning and understanding as important.  That these actions then lead to attunement characterised by empathetic warm engagement, responsiveness and sensitive caring (p. 44).

I think I was compassionate that day leading to a sense of trust, but critically I only knew I was through feedback from my patient.  We need to listen to what they have to say be attentive and give them more opportunities for feedback that goes beyond ticking boxes of satisfaction.  Story telling is powerful, allowing them to tell the story of their experience would help.

So I am resolved; be attentive, notice and give sensitive caring.  At the end of the day I don’t look 25 any more but I hope I still have the skills I need to be a great nurse and to make sure I’m using them through listening carefully to what my patients have to say.

The references to ‘kindness’ and ‘attentiveness’ are from the book ‘Intelligent Kindness’ by John Ballatt and Penelope Campling which I would commend to you.

Its really very complicated!


I got ‘O’level Maths at school; at least I have the certificate to say so. It was 1979 and yes I am that old; I got a grade A too.  I got my sciences as well – good grades. I’m also a nurse; one who is supposed to be a lead for informatics but don’t be misled – I’m no nurse geek.  That leads me to believe, at least on paper, I’m reasonably competent in that sort of ‘mathy-sciencey’ sort of way.

More recently I wasn’t so sure as my story, this time, is about how very complicated it is to manage diabetes. 

A few months ago I decided it was time to be brave and take the plunge; I asked my Diabetes Specialist Nurse (DSN) if I could borrow a Continuous Glucose Monitor (CGM).  A significant step, as it allows you to see what your glucose levels are 24 hours a day and helps you to assess whether the basal (base amount) of insulin you are getting via your pump is about right – so far so good.  My DSN is a real star; we don’t have CGMs where I get my care so she had to ask for a favour from the rep for me to loan a CGM.  I think, (unfortunately – you will see why) she was using me as a ‘test’ patient.  I suspect she thought ‘lets see how anniecoops gets on with this’.

In my case the CGM is a small electrical sensor that is inserted into tissues and wirelessly transmits glucose readings to my insulin pump – with me so far?  Here is a picture of the exact one and my pump:

I’ve learnt to use the pump well over the last three years and have gradually adopted most of the things it will do and added them in to the management of my diabetes.  The pump ‘stuff’ (tubes etc) gets changed around every 3 days and the sensor lasts 6 – still OK?   The results from the CGM via the pump can be seen on a computer programme that shows your readings over the period of time that they were taken.  In this way you can see what’s been happening over time.  A bit of a miracle for me who was brought up with urine testing tablets (but that’s another story).

Ok, so off I go; I have to say having taken the plunge I was vaguely excited!  I had an appointment with my DSN and the CGM lady to get going.  The transmitter is small but it is VERY dependent on the correct insertion of the sensor.  The sensor even has a special ‘insertion device’ like this:

 

It looks harmless and useful doesn’t it – don’t be fooled! The technique for inserting the device is 16 steps long (I’ve just counted from the manual they gave me).  I could go on……. but I feel too traumatised.

What happened over the next two weeks was upsetting as I couldn’t manage to do the inserting myself and being of stoic  nature (see my previous blog) I was so determined to go alone and in doing so have wasted 3-4 sensors.  Physically inserting the device is really hard as there are so many rules about where it goes and how to do it but essentially I needed to put it somewhere where I could see it to remove the attached transmitter for showers etc.  In my experience with my pump your tummy is the best area but my boobs were a major barrier for me to see anything!

The upshot of it all is that I am now waiting for some more sensors and this time I am clear that I can’t do this on my own.  Maybe I can over time but I’m going slowly for now.

Hopefully it doesn’t stop here as once I have the results perhaps then I can use my ‘mathy-sciency’ sort of skills, as we will have to interpret the results; make sense of patterns, ratios, timings and hormones.  There is also the dreaded ‘dawn phenomenon’ (don’t ask). Perhaps then I will impress the DSN with my skills…..

So, if anyone ever tells you managing diabetes is a piece of cake then punch them on the nose for me.  I struggled with the technology and we still have the maths to face, although I really do think I’ll be OK with that…….

If we are going to use all of the devices that are available to help people help themselves then we really do need to think about skills and what sort of help is available.  When I couldn’t get the sensor to transmit the most helpful people were the CGM helpline team who were calm and unflappable.  My DSN was nearly as under confident as I was – bless her (I guess I was her test patient).  If we are going to use all this technology stuff we need to think carefully about how we help patients to understand and be self sufficient, if that’s what they want; I certainly do – it really is very complicated you know!

On being stoic


This is my very first blog and musing!  I hope if you read this you are indulgent with me and add some comments at the end so I can use them to reflect and learn!

This first blog is a story that starts with a trip to the dentist.  I have been having trouble with a tooth for a while.  My brother-in-law is my dentist: ‘I think we need to take it out, Anne’ he says.  Now, let’s just put this in context, it’s a big tooth, a daddy one.  I’ve never had a tooth out before; only those that I wobbled out as a youngster. ‘OK’, say I, meekly (my heart started to pound – OMG thinks I).

The next part isn’t pretty.  I sat in the chair while he wrested the tooth out.  I didn’t like it, not one bit.  When he was done he came and looked at me, properly looked, and then gave me an unexpected hug.  My feelings must have shown in my face. 

‘I’ve been a good patient, haven’t I?’ I asked.

I have no idea why that was the most important thing to ask at that time. What on earth did I mean ‘good patient’ and why did I ask?

I started to think about how health was viewed by me and in my family and what was deemed to be important.  I’m a northern girl, brought up in a hard community of working class families.  Ill health was not part of any discussions I can recall as a child.  My thoughts took me back to my granddad.  He is dead now but I loved him very much.  He was a little hardy man who I know loved me unreservedly.  Later on in his life he had chronic obstructive pulmonary disease.  He walked his little dog, Trixie, nearly every single day of the last decade of his life.  As his condition got worse he just adjusted the length of the walk and went more slowly.  More importantly, I never once heard him complain about his breathing.  If he was puffed we would just stop for a few minutes.  I suspect what he was demonstrating was ‘being stoic’.

 Grandad and Trixie 1979

So what is being ‘stoic’ and does it/should it matter to those providing care?

I decided to have a look at nursing literature and explore whether behaviours such as stoicism were considered, when we are looking after patients.  There wasn’t extensive literature but I found one very interesting paper by Spiers (2006).  Spiers (2006) links stoicism to a determination to endure and also comments that endurance allows the patient to remain in control; patients can present ‘themselves as a stoic person who was able and willing to tolerate pain’ (p. 296).

This presents a dilemma for nurses, the need for patients to remain in control and yet support them in dealing with issues where they may be close to their edge of tolerance.   I would argue that in these circumstances nurses need sophisticated communication and assessment skills that allow patients to express stoicism at the same time as dealing with complex symptoms such as pain.  These are difficult skills to teach and learn.  Spiers (2006) cites some interesting examples of the interactions between nurses and patents.

So it appears that not all patients are the same, no surprise there then, and that nurses need to have complex communication skills to deal with patients like me who have a desire to remain stoic and in control.  I’m not sure these are conversations we have often enough as the ‘do you have any pain today, Mrs. Cooper’ may not work for me and I hope in future if I need nursing care I have a nurse who can think beyond a pain assessment scale.

Thank goodness my brother-in-law (aka Dentist) had good enough skills to assess that I was feeling a bit grim – a hug that day went a long, long way!

Spiers, J., (2006) ‘Expressing and responding to pain and stoicism in home-care nurse-patient interactions’ Scandinavian Journal of Caring 20 pp 293-301 Abstract available online http://www.ncbi.nlm.nih.gov/pubmed/16922983