@BloggersNurse Challenge: My Best Days in Nurse Lecturing

I am posting for the challenge at the last minute again. I have to say that this is one of the most difficult topics for me to write about. As a Nurse Lecturer I often think the best days are behind me and that I was probably more effective when I was working in Acute Care. My students probably think the same most of the time, even though they are too young to remember me from those earlier career days.

So I am not attempting a history/reminiscence lesson here. I am going to be quite predictable and pick my student’s graduation days. They are a once a year reminder of why I do my current job.

It’s not about me at all; the day is all about them and how they feel when they are finally awarded their Master’s Degrees. Nothing makes me happier in work than seeing how proud they are when they finish. Many have overcome many obstacles to get to the end of their programmes. These can include, family hardships including deaths within the close family, financial concerns, acting as carers to their children and often a carers to their parents as well. Many deal with personal illness and in some cases are also faced with a lack of support for all their effort within their workplaces, that I sometimes fail to understand.

They all show great perseverance to get to the end no matter what good or ill befalls them. (More about this whole topic at another time when I finally get to the end of my own Doctoral studies.) So the picture I have chosen to head the article is my favourite picture from last year’s graduation and I am not even in it.

For the sake of balance I thought I’d better show a few more successful students with my colleagues. You know who you all are (and a big sorry to the students who are not here!)

2019
2018

For those of you who don’t know, I am the Programme Leader for the Gerontology Programmes at the University of the West of Scotland. You can find out more about our MSc in Gerontology (with Dementia Care) programme by CLICKING HERE

You can also find out about the other work I am involved in by following @AlzScotCPP on Twitter or going to the Facebook page of the Alzheimer Scotland Centre for Policy and Practice. You can get to this by CLICKING HERE.

Please ‘Like’ us when you get there!

State of the World’s Nursing Report-2020

In a week and a day on the 12th of May 2020 it will be the bicentennial of Florence Nightingale’s birth. This year as always the International Council of Nurses (ICN) leads global celebrations on International Nurses Day, the anniversary of the birth of nursings most famous pioneer. This year the celebrations should have been “extra special” because 2020 has been designated the Year of the Nurse and Midwife by WHO but it really is the year of the nurse for much more sombre reasons. In the UK has now become more dangerous than being in the army.  https://www.nursingtimes.net/news/workforce/in-memory-a-list-of-nursing-staff-who-have-sadly-died-from-covid-19-20-04-2020/ 

If you are a nurse though what has probably passed you by completely is a landmark publication by the WHO’s State of the World’s Nursing Report 2020, which should have been one of the highlights of the year. So it has now been published and its interesting although somewhat depressing to look at. This is some of what it says.

  • The global shortage of nurses, which was estimated to be 6.6 million in 2016, had decreased slightly to 5.9 million nurses in 2018. An estimated 5.3 million (89%)
    of that shortage is concentrated in low- and lower middle-income countries, where the growth in the number of nurses is barely keeping pace with population growth, improving only marginally the nurse-to-population density levels.
  • Countries with lower numbers of younger nurses (ie under 35), like the UK and many other westernised economies  will have to increase graduate numbers and strengthen retention packages to maintain current access levels to health services.
  • To address the shortage by 2030 in all countries, the total number of nurse
    graduates would need to increase by 8% per year on average, alongside an improved capacity to employ and retain these graduates.
  • 78 countries reported having advanced practice roles for nurses. There is strong evidence that advanced practice nurses can increase access to primary health care
    in rural communities and address disparities in access to care for vulnerable populations in urban settings.
  • One nurse out of every eight practises in a country other than the one where they were born or trained.
  • Nursing remains a highly gendered profession with associated biases in the workplace. Approximately 90% of the nursing workforce is female, but few leadership positions in health are held by nurses or women. There is some evidence of a gender-based pay gap, as well as other forms of gender-based discrimination in the work environment.

The report suggests 10 key actions to address these international nursing problems.

  1. Increase funding to educate and employ at least 5.9 million additional nurses worldwide
  2. Strengthen capacity for healthcare workforce data collection, analysis and use.
  3. Nurse mobility and migration must be effectively monitored and responsibly
    and ethically managed.
  4. Nurse education and training programmes must produce nurses
    who drive progress in primary health care and universal health coverage.
  5. Nursing leadership and governance is critical to strengthening the workforce.
  6. Planners and regulators should optimize the contributions made by nurses to make use of their full scope of practice.
  7. Countries must provide an enabling environment for nursing
    practice to improve attraction, deployment, retention and motivation of the nursing
    workforce.
  8. Countries should deliberately plan for gender-sensitive nursing workforce
    policies.
  9. Professional nursing regulation must be modernized.
  10. A huge amount of collaboration, more than we have ever witnessed before is required to achieve key actions 1-9.

The report concludes that if the investment in nursing is made then the returns for societies and economies can be measured in terms of improved health outcomes for billions of people, creation of millions of qualified employment opportunities, particularly for women and young people, and enhanced global health security.

The full report can be accessed at: https://www.who.int/publications-detail/nursing-report-2020

A summary in English of the report, which this Blog has been based on is available at: https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf

The case for investing in nursing education, jobs and leadership is very clear when you read this. Relevant Governments, professional organisation and all  stakeholders must commit to taking action.  SOON… the clock is already ticking.

April @BloggersNurse Challenge: the Retention of Healthcare Staff

Last week I said I’d look at the topic of retention and said that would be interesting once this lockdown phase of the COVID-19 story passes. However, before we get to my thoughts on this you need to understand the context.

So rather than give a history lesson this article by Poly Toynbee in the Guardian on the 25th April does a much better job than I would ever do. See https://www.theguardian.com/commentisfree/2020/apr/24/year-nurse-tories-10-years-bad-care-nhs-crisis

As Poly says

…retention isn’t difficult, there is nothing insoluble about it. Pay them decently, give them as clear a career path ahead as doctors enjoy, and see what happens.

So getting beyond the politics of a pay rise, cancelling healthcare workers student debt, improving healthcare workers working conditions and terms of employment and providing a career path that includes recognition of health care workers in the care home and social care sectors… what does the professional literature suggest.

In a systematic literature review published last year Brook et al (2019) looked at the issue of retaining early career nurses. Early career nurses are important because it is in the transition from student to registered nurse that that the losses to the profession are at their highest.

So what did they say about retaining staff in the first year of practice. Firstly, employers have to offer a transition to practice programme. The form that the programme takes, be it preceptorship, mentoring programmes, residency programmes, internships, externships,orientation to practice programmes or clinical ladder programmes is not as important as having one in place. That is because of the message that it sends out; that the organisation by doing this is indicating the importance attached to their newly-qualified staff and this alone is enough to positively influence recruitment
and retention; especially if the organisation is perceived to be investing in the workforce to a greater extent than competitors.

Interventions with the highest benefit appear to be an internship/residency programme
or an orientation/transition to practice programme that incorporates formal teaching, a preceptorship element and possibly the addition of a mentorship element. They suggest that programmes need to last 27–52 weeks in duration. These findings align with
support that is already offered in USA, Canada and Australia. In the UK preceptorship and mentorship are embedded in our culture so we may be starting from a good position.

Unfortunately most of the studies done looking at this topic have been done in high income economies. The quality of their findings have also been affected by inconsistent and incomplete description of the interventions, missing detail of some components of the intervention and variations in methods of evaluation across the studies Brook et al (2019) reviewed indicating that many of the studies on this topic so far were not conducted using rigorous research methods of evaluation. The quality of this review, like many others has been  limited by the quality of the study reports that are available.

What is of interest is not the interventions but a need to refine and review already established transition programmes. If the programmes focussed more on the elements of teaching, preceptorship and mentorship and considered how these added to the new staff nurses experiences then more successful programmes might result. However, variation in the quality of mentors, preceptors and teaching are bound to affect the outcome of support programmes; so Brook et al (2019) suggest reviewing these before you start out.

The full review is available and published as follows

Brook, J., Aitken, L., Webb R., MacLaren, J., Salmon, D. (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review, International Journal of Nursing Studies, Volume 91, Pages 47-59,
ISSN 0020-7489.
https://doi.org/10.1016/j.ijnurstu.2018.11.003

Unfortunately it does not appear to be open access.

So to the UK response to Coronavirus. Effectively all 4 nations in the UK have just sent all their students out into practice prior to completing their education at a time of crisis. It is not likely that the usual transition programmes that most hospitals and employer they are being sent to are running, or will be in place for them, or even considered, until this lockdown ends and something like ‘normal’ service is resumed.

What happens this month and over the next few months may well shape the outcome of hundreds of new students attitudes towards their profession. Are they going to transition well into their new roles with more limited support? Will the NHS and other employers consider offering better support to those who have commenced ‘early’ to help them out in the current situation? Will the Government follow through on the plans it says it has to better support and reward front-line health and social care staff? Will the COVID-19 situation encourage people to join health and social care professions or will it put them off?

I really don’t have the answers to the above questions. We will just have to wait and see… but I am worried already and angry at how depleted the nursing workforce has become and how badly the successive Conservative governments have treated Nursing and  other AHP professionals.

If nothing else, its time to change or my profession will become less attractive and the recruitment and retention problems existing at the moment will only worsen.

(You can follow me on Twitter @uwsraymondduffy)

 

Suggestions for Things to Do While Isolating

I am going be quite choosy here and not give a huge long list. So let’s start with a brilliant initiative called Luminate@Home. Luminate runs a diverse range of activities and events that celebrates our creative lives as we age. It holds avery successful annual festival here in Scotland that usually takes place in May. In response to the fact that lots of older people at home or in care homes right now who are having to isolate from the wider world for a while they have launched a new programme of online creative activities

Luminate@Home are uploading short films every Tuesday and Friday at 2pm, on Luminate’s facebook page and on their YouTube or Vimeo channels. The films are designed to inspire and guide you through a creative activity that can be done at home or in a care home. The activities are presented by professional artists and feature different arts forms including crafts, poetry, music and dance. The films will be left online so you can access them at any time.

My next suggestion is a Scottish Care initiative called Tech Device Network. They are inviting businesses, organisations and individuals with spare technological devices to donate them to care services. All you have to do is click here to get in touch and tell them what you are able to donate. Scottish Care will then connect you with care services who would benefit from receiving the devices and jointly will arrange delivery/collection. As they state at this time this could have significant benefits for mental wellbeing, reducing distress and maintaining connections with loved ones for a vulnerable population and those supporting them. A meaningful way to connect our communities at this time and hopefully one with long term positive outcomes.

Last suggestion is from the Centre for Better Ageing who put up a useful blog post about keeping active in isolation. Its at https://www.ageing-better.org.uk/news/how-we-can-all-keep-active-home-during-coronavirus-crisis

Remember everyone its important to keep up your strength and balance at this time. Let’s get back out fitter than we were when we got locked-down.

That would be a positive achievement!

 

 

 

Health Advice for Older Women: Diet

I am not really in a strong position to do this as a 55 plus older man but I am going to try anyway.

Having blogged recently about exercise its time to look at food. Specifically for women. I am inspired a bit this week by the book released last year called  “Invisible Women: Exposing Data Bias in a World Designed for Men” by Caroline Criado Perez Reviewed Here and by the fact that it was International Women’s Day last weekend. 

So this is not my advice, this comes from neuroscientist and nutritionist Lisa Mosconi the Director of the Women’s Brain Initiative and Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College (WCMC)/NewYork-Presbyterian Hospital, where she serves as an Associate Professor of Neuroscience in Neurology and Radiology. So her views are worth taking note of. In a recent Blog for IDEAS.TED.Com she outlined 8 steps to take if you want to adopt a brain-healthy diet, which she says is a powerful tool in maximizing cognitive health, helping prevent dementia and may even ward off common ailments that affect many women, from slow metabolism to insomnia and depression. So if you want to know more then click the link below:

https://ideas.ted.com/heres-what-women-should-eat-to-maintain-a-healthy-brain/

The link also takes you to her TED talk on how menopause affects the brain so two peices of health advice at once and not even a mention of COVID19. I’ll maybe save posting about that until next week.

“Five Wishes” and #YearoftheNurseandMidwife Gets Nearer

It is very rare for me to make a TV recommendation particularly since this one is only available via the BBC iPlayer   and therefore not internationally available yet. So for those of you that can, then you should take some time over the holidays to watch Five Wishes a programme marking the 50th anniversary of Scottish Ballet. This year they ran a very special project in Scotland, asking the public to make wishes that could only they could grant.

After hundreds of wishes, and thousands of votes, the final five were chosen and this is the documentary is the story of what happened next.

It follows the ballet troupe every step of the way as they make five unique wishes come true. From 11-year-old Lily battling with cancer to the Every Voice Choir in Dumbarton, these are stories of love, hope and courage – all told with a balletic twist. To view the programme click the link below.

https://www.bbc.co.uk/programmes/m000cwlb

As we approach the new year there are perhaps two more things I should mention. On the 23rd. of December 1919, the Nurses Registration Act was passed and so we have now had UK registration for 100 years!

The NMC have posted an interactive timeline that is a great reminder of some key moments in nursing history in the UK. To view this click HERE

For those of you who don’t know the World Health Organisation announced early in 2019 that 2020 is to be the International Year of the Nurse and the Midwife If you want to get involved go to WHO Get Involved and/or follow the hashtag  #YearoftheNurseandMidwife

Also, look out for the WHO’s State of the World’s Nursing in 2020 report to be launched in April which will provide a global picture of the nursing workforce and support evidence-based planning to optimise the contributions of nurses in improving health and wellbeing for all.

 

Who Said That an Ageing Population is a Bad Thing?

I’ve missed another week, but here I am back again. This week I am bringing a new report by The International Longevity Centre (ILC-UK) called “Maximising the Longevity Dividend”.  While older people and an ageing population are often painted as a risk to our economy, this new research shows that the UK’s ageing population brings economic opportunities through older people’s growing spending, working and earning power.

Their research has found that households headed by someone aged 50+ have dominated total expenditure (excluding housing costs) since 2013. And spending by older consumers will continue to rise significantly over the coming decades, from 54% (£319 billion) of total consumer spending in 2018 to 63% by 2040 (£550 billion).

Those 50+ also shift their spending towards non-essential purchases such as leisure, transport, household goods and services.

People aged 50+ are also making an increasingly significant contribution to the economy by continuing to work.. The share of the workforce aged 50 and over rose from 26% in 2004 to 32% in 2018, and it could account for 37% by 2040. People aged 50 and over earned 30% of total earnings (£237 bn) in 2018 and this is expected to rise to 40% by 2040 (£311 bn). The ILC have said that supporting people aged 50 and over to remain in the workforce could add an additional 1.3% to the UK GDP a year by 2040.

To read and download the report CLICK HERE.

AS David Sinclair, Director of the ILC, says

As the population ages there are enormous economic opportunities, but these are currently being neglected. We’ve become accustomed to hearing our ageing population talked about as a bad thing – but the reality is it could be an opportunity. However, we won’t realise this ‘longevity dividend’ through blind optimism about ageing. Instead, we need concerted action to tackle the barriers to spending and working in later life.”

Bad News and Goods News on Dementia

This week if you can see past the Brexit clamour two very important pieces of news about Dementia appeared. Firstly, the bad news. The fears of many people who have been trying to bring this to public attention, like the Sports Legacy Institute in the US and the Jeff Astle Foundation in the UK, that there may be a link between concussion injury in football/soccer and mortality due to dementia and other neurological illness, seems to have been realised. A team based at Glasgow University published a paper in the New England Journal of Medicine examining the link found that former professional footballers are three and a half times more likely to die of dementia than those in the general population.

It’s not possible currently to examine the paper in full easily at the moment but one of my favourite sources for this blog  Behind the Headlines an NHS critical guide to the science that makes the news, have published their review of the paper which you can read at

https://www.nhs.uk/news/neurology/dementia-fears-for-former-footballers/

If you want to look at the abstract of the published paper you can find it at

Mackay DF, Russell ER, Stewart K, et al. (2019) Neurodegenerative Disease Mortality among Former Professional Soccer Players New England Journal of Medicine. Published online 21/10/19

So, secondly what’s the good news then? Biogen an American drug company and Eisai a Japanese company they are working with said on Wednesday that they will seek US FDA approval for a medicine to treat early Alzheimer’s disease, a landmark step toward finding a treatment that can alter the course of the most common form of dementia. The announcement caught everyone by surprise because Biogen stopped two studies of their new drug earlier this year, when partial results suggested it was not likely to be successful. It now says a new analysis of more results suggests that the drug helped to reduce a decline of thinking skills at the highest dose.

The drug, called aducanumab, aims to help the body clear harmful plaques from the brain. If they are right, this is the biggest step forward in 20 or more years as finally there may be a drug that tackles the cause of the disease. Current drugs only temporarily ease symptoms of Alzheimer’s and do not slow the loss of memory and thinking skills.

For more about the announcement see

https://metro.co.uk/2019/10/23/drug-can-slow-alzheimers-disease-soon-available-millions-10966879/

It’s Allied Health Professions Day! Let’s Celebrate Their Work #AHPsDay #AHPsDayScot #ProudToBeAHP

There are fourteen different healthcare roles recognised as Allied Health Professionals (AHPs); each one of them carrying out an important role in the lives of the people that they are caring for. If you want to find out more about the 14 professions see the following page at Health Careers

So this week rather than focusing on a paper or a topic that’s in the news let’s  just highlight what the 14 professions do and how they make a difference.

As part of the day a Google site has been created and on the site is a whole lot of material of use to help people understand AHP roles and the contributions they make. The site can be found HERE 

It includes video, NHS Recruitment information, some materials from the AHP’s  professional bodies and some teaching materials.

The Nursing Midwifery and Allied Professions group at NHS Education for Scotland have also released a series of videos from their AHP staff on the programmes that they are currently involved in which you can view at https://twitter.com/NESnmahp

This week the Alzheimers Scotland Blog “Lets Talk About Dementia” are also running a serieds of Blogs on AHP contributions to Dementia care which you can access at https://letstalkaboutdementia.wordpress.com/

So lots to celebrate and be proud of if you are an AHP. AND if you are an AHP reading this Blog have a great day and keep up the good work!

Dementia Stigma is an International Concern

Its the end of September so as always at the end of World Alzheimers Month,  Alzheimer’s Disease International publish a new World Alzheimer’s Report.

The report reveals the results of the largest attitudes to dementia survey ever undertaken, with almost 70,000 people across 155 countries and territories completing the survey. It spans four demographic groups: people living with dementia, carers, healthcare practitioners and the general public. Analysis was carried out by the London School of Economics and Political Science (LSE).

Some of the key findings of the report include:

  • Almost 80% of the general public are concerned about developing dementia at some point and 1 in 4 people think that there is nothing we can do to prevent dementia
  • 35% of carers across the world said that they have hidden the diagnosis of dementia of a family member
  • Over 50% of carers globally say their health has suffered as a result of their caring responsibilities even whilst expressing positive sentiments about their role.

For me the two findings that cause the most concerns were that almost 62% of healthcare providers worldwide think that dementia is part of normal ageing.

Perhaps worse 40% of the general public think doctors and nurses ignore people with dementia and and 33% of people thought that if they had dementia, they would not be listened to by health professionals.

Now those figures are bad, but unbelievably over 50% of healthcare practitioners agreed that their own colleagues ignore people living with dementia.

The report reveals that stigma around dementia still prevents people around the world from seeking the information, advice, support and medical help that could dramatically improve their length and quality of life for what is globally one of the fastest growing causes of death.

“Stigma is the single biggest barrier limiting people around the world from dramatically improving how they live with dementia,” says ADI’s Chief Executive Paola Barbarino.

“The consequences of stigma are therefore incredibly important to understand. At the individual level, stigma can undermine life goals and reduce participation in meaningful life activities as well as lower levels of well-being and quality of life. At the societal level, structural stigma and discrimination can influence levels of funding allocated to care and support.

“…currently, there is very little information about how stigma manifests in relation to people with dementia and how this may vary around the world. This detailed survey and report now give us a baseline of information for dementia-related stigma at a global, regional and national level. We’re hopeful these findings can kick start positive reform and change globally.”

If you want to read more about the report and download a copy go to https://www.alz.co.uk/research/world-report-2019