Saturday, 25 May 2013

21 years. Time to reflect

21 years ago this month I set out on a new career, training to be a psychiatric nurse. I'd not particularly bothered with school in my early years nor had school bothered with me, we agreed to mutually part company when I was 13, moving to 'home education' which mostly consisted of playing sports. Exams hadn't been on the agenda either, so I was fortunate that nursing allowed those without academic qualifications to sit the 'DC Test'. Knowing very little about healthcare and even less about psychiatry, my first placement on a ward was only the second time in my life I'd set foot in a hospital (the 1st occasion was a result of concussion from a playground collision whilst playing 'Bulldogs'). I'd somehow come to the conclusion before stepping out as a student nurse that I'd make a great CPN working in forensic services and was pleased to find out my first placement was to be on a busy working age 'acute' ward. Six weeks of working on the ward, it was time to head back to college, to prepare for the next placement. Older Peoples Mental Health, or, as one staff nurse put it, 'enjoy your 6 weeks of wiping wrinkly bums'. Oh joy, not only was I going to be nursing older people, but I'd been allocated a mixed ward, which was staffed by RGNs & RMNs, some beds were medical, some psychiatry. Nightmare.

First day on the ward & something happened that was to shape the rest of my career, I met a 'patient' (that was the term used back then) who had dementia. She was called Grace. Grace was a bit of a handful for the staff, forever wandering around the ward, asking repetitive questions, wanting to know when she was going home. As I was 'an extra pair of hands' on the ward, I was asked to spend a lot of time with Grace, which I did and the more I got to know her, the more fascinated I became. I was hooked.

Training flew past and soon I found myself applying for my first staff nurse post. Bingo, got a job on a dementia care ward, which was about to relocate from an old asylum hospital to one of the new 'CUE' units. Loved it, enjoyed it, experienced the move and six months later spotted an advert for a senior staff nurse post. Got it and dropped so lucky. Within two weeks of starting in post, a colleague had to drop out of a training course at Bradford University about 'Dementia Care Mapping' which was to be co-facilitated by someone called Professor Tom Kitwood. What a course, what a concept. What an inspiring man.

Armed with this new knowledge, my next post was managing a unit in a dementia care home. It remains one of my favourite times looking back. It was a small, 16 bed unit that pretty much relied on dishing out Thioridazine & Diazepam to keep the residents 'quiet & content' or chemically coshed. I was lucky enough to be able to recruit some great care assistants and a couple of new RMN's to replace the old team who chose to move on and we agreed on a vision to work towards. We opened doors to the beautiful rear garden, we ended the routine of night staff getting people up on a morning, meals were available when people were hungry & we all spent time talking, sitting or playing activities with the people living in the unit. Within three months we saw significant reductions in prescribing of medication and after six months we'd eradicated all psychotropic medication. None of it was rocket science.

Possibly the most surreal moment looking back was during my time as a clinical team manager, leading a unit that had an inpatient dementia care facility, day hospital and community teams based in the building. All our staff team on the inpatient unit were trained in dementia care mapping as part of their induction when joining the unit. As a result, we were visited by some of the team from Bradford, who were hosting a delegation from the Japanese government, who arrived accompanied by interpreters and a film crew from their own TV channel! The hilarity at lunch time when we served our guests giant Yorkshire Puddings filled with beef and gravy will live with me forever. It was certainly a dish none of them had encountered before.

Having enjoyed my time as a clinical lead, it was time to try my hand at a new challenge. As luck would have it, a few miles up the road, there was an advert for a project manager to work across 4 PCT's on something called the Dementia Services Collaborative. Improving dementia services by consulting with and working alongside people living with dementia, their carers and staff. What a job! After two years, our team were fortunate to receive a lovely award from the Alzheimer's Society recognising their work. I'd got a taste of how collecting and sharing knowledge could really influence and lead to positive change. A part time post came up working for the National Institute for Mental Health in England on the older people programme in Yorkshire & Humberside. It was just one day a week, meantime an amazing chance came up to join a local team to work on improving the physical environment of a CUE unit that was for men living with dementia. The unit team was to take part in the King's Fund Enhancing the Healing Environment programme and WOW, was that life changing. Led by Sarah Waller, the course was so inspiring. We were taught about the influence colour can have on mood, how good building design can influence care pathways and healing. We visited Tate Modern and had a half day with one of the curators. We were taught to sing, we were videoed, we met table top magicians and a jazz singer who entertained us over dinner one night revealed herself the following day in further learning sessions to be CEO of a PCT! At the end of the course, we had to present our idea for the unit to an audience including Sarah. The team were somewhat reluctant to speak so I hit on the idea of making an automated powerpoint presentation set to music. I'd stumbled into making a digital story without knowing what one was! Set to Underworld's Born Slippy, it seemed to strike a chord with those in the room and it was a real thrill to hear the programme subsequently used it at the launch of future programmes.

A chance opportunity to show the story to the national lead for OPMH led to a new role with NIMHE, which had by now become part of the Care Services Improvement Partnership. Another stroke of luck. Within a week of starting the post, a spare place was available on a course to become an accredited knowledge manager (KM). Using the learning and techniques of KM my geeky side took over and working with the national lead, I had an absolute ball in building a website to share good practice. I was lucky to meet and work alongside some truly inspiring and visionary people, one particular highlight being involved in the launch of the Let's Respect campaign. This was a brilliant learning resource for acute hospitals, covering the 3 D's of Dementia, Depression & Delirium. We hit on the idea of filming interviews with people talking about their experiences of living with these conditions and the Let's Respect series of podcasts were born. At the same time, a group of us began a piece of work which resulted in the first 'product' of the newly announced national dementia strategy. Being on the editorial board of Strengthening the Involvement of people with dementia and their carers was a real learning experience and something I really enjoyed.

One little ditty I enjoyed putting together to try to show how networks, KM and the web could be effective was this 4 minute digital story 

Later Life Networks from Evolution Networking on Vimeo.

When the National Mental Health Development Unit was born, an opportunity appeared to work across all their programmes as knowledge and online lead. Geekdom, mental health, service improvement & a chance to work with a team of people absolutely driven by a determination to make things happen. Two years passed so quickly, in the final six months another chance to join an editorial board, Let's Respect for care homes was published.

My techy geeky side began to come out more and when the unit was closed, an opportunity to work with some great people led to an Australian adventure. Sadly my geekiness meant I only ever visited the country virtually, whilst working with the government in Western Australia on their vision for mental health. Keeping my hand in with dementia care, I'd joined forces with a number of folk who had an interest in the use of Life Stories & following the first national conference, co-founded the Life Story Network. After successfully delivering a government backed training programme on the use of life story to 500 people across England, I stepped down as a director to pursue other interests.

One of those interests included using some of my learning to write my first ever chapter in a publication. I was proud to be asked by Hari Sewell to share some of my thoughts on the use of technology and knowledge management in his book; The Equality ACT 2010 in Mental Health: A Guide to Implementation and Issues for Practice

Thanks to those 6 weeks of 'wiping wrinkly bums' I've had the most amazing journey in a career I've loved. Hopefully that journey will continue to be as enjoyable

Sporting Memories Network CIC