@BloggersNurse Challenge; What might #FlorenceNightingale think now?

Well, I will just make it. Posting on the last day of May my thoughts on what #FlorenceNightingale would think of nursing now.

First an amazing bit of history, from a BBC World Service programme called Witness History. This is 9 minutes on her achievements including a recording of Florence Nightingale’s voice from 1890, along with memories of her life from her great-nephew Harry Verney and her private doctor May Thorne  https://www.bbc.co.uk/sounds/play/p05bdb7d

So 200 years after her birth I think she would be a bit worried that modern nurses are perhaps not as political as she was. If nothing else once she became a recognised public figure she lobbied and advocated for better training, higher standards, better care and better working conditions. She managed to influence and promote health reforms, often from her bed, using research and statistics to convince others that policies needed to change.

So what about now? Thanks to the global pandemic caused by #COVID-19 nursing as a profession has a worldwide profile that it has never experienced in my lifetime. Nurses have a voice that the public are prepared to listen to. Hopefully that extends to the ears of politicians who ought to sit up and take notice. Will they reward us financially for our current pain? I hope so, but I’m not holding my breath. However, we should remember that we are a limited resource.

The world is desperately short of nurses (about 9 million short). Nurse education needs to be reformed to better reflect the many roles nurses now find themselves in across the world. Nursing organisations need to work together in a way they never have before to improve the standing of the profession particularly in countries where the work of nurses continues to be undervalued. We can’t be handmaidens anymore, that is an inefficient and ineffective way to work. As Lord Nigel Crisp of the @Nursing Now Co-chair has said

“…Investing in nurses and enabling to work at the top of their license will have the triple impact of improving health, promoting gender equity and strengthening local economies.”

Covid-19 has shown the public that nursing is not menial work and the work of women. It is skilled, research-based, emotionally and physical taxing yet remains hugely rewarding (except financially).

My own thoughts are that we can’t let this opportunity be swept under the carpet. We need a new ‘Florence’ in every country. Someone to champion the cause in each and every legislature. Locally, nationally and internationally. Nursing is about politics, policies and bringing about #HealthForAll. I am sure there are other ‘Florence’s’ out there. It’s time for them and us to get out and influence the future. If #COVID-19 is going to create a new normal it is time for nurses and midwives to go and get involved.

@WHO Good News! #WorldHealth Statistics

On the 13th of May the World Health Organisation(WHO) published its statistics for 2020.  The WHO’s World Health Statistics is an annual check-up on the world’s health. It reports progress against a series of key health and health service indicators, revealing some important lessons in terms of progress made towards the United Nations 17 Sustainable Development Goals and gaps to fill.

What this years statistics are saying is that both life expectancy and healthy life expectancy have increased, but unequally. The biggest gains were reported in low-income countries, which saw life expectancy rise 21% or by 11 years between 2000 and 2016 (compared with an increase of 4% or 3 years in higher income countries).

One driver of progress in lower-income countries has been improved access to services to prevent and treat HIV, malaria and tuberculosis, as well as a number of neglected tropical diseases such as guinea worm. Another was better maternal and child healthcare, which led to a halving of child mortality between 2000 and 2018.

Unfortunately though in a number of areas, progress has been stalling. Immunization coverage has barely increased in recent years, and there are fears that malaria gains may be reversed. Worryingly there is an overall shortage of services within and outside health care systems to prevent and treat noncommunicable diseases (NCDs) such as cancer, diabetes, heart and lung disease, and stroke.

This uneven progress broadly mirrors inequalities in access to quality health services. Only between one third and one half the world’s population were able to obtain essential health services in 2017. Service coverage in low- and middle-income countries remains well below coverage in wealthier ones; as do health workforce densities.

In more than 40% of all countries, there are fewer than 10 medical doctors per 10,000 people. Over 55% of countries have fewer than 40 nursing and midwifery personnel per 10,000 people.

In 2017, more than half (55%) of the global population was estimated to lack access to safely-managed sanitation services, and more than one quarter (29%) lacked safely-managed drinking water. In the same year, two in five households globally (40%) lacked basic handwashing facilities with soap and water in their home.

The overall message from the report is clear. As the world battles the most serious pandemic in 100 years, and we are just a decade away from the Sustainable Development Goal deadlines there is a need for action from High, Mid and Low income countries to work together to strengthen primary health care worldwide and focus our attention on the most vulnerable in order to eliminate the gross health inequalities that still dictate who lives a long, healthy life and who doesn’t.

A fantastic visual summary of the WHO Health Statistics Report 2020 can be seen at: https://www.who.int/data/gho/whs-2020-visual-summary 

For Carers in Scotland During #Lockdown

Yes folks, this is what I look like! With Dr Barbara Sharp a friend and colleague.

Anyone who knows me will be aware that I have great admiration for everyone who is an informal (unpaid) carer, perhaps because I have been one several times myself.  There are almost seven million informal carers in the UK – almost one in ten people. A figure that is rising. It is often forgotten that 42% of carers are men and 58% are women. There value of the contribution made by carers in the UK is £119 billion per year and without them the NHS and social care system would be overwhelmed many times over COVID-19 or no COVID-19.

So at this time it must be particularly difficult. This Blog is a set of resources for them. Recently, Carers Scotland noted that currently reduced or closed care services meant that family members in Scotland were picking up even more care for older, sick or disabled relatives with many of them feeling overwhelmed and at risk of burning out. See their report HERE . So this seems like the least I can do.

Firstly, you can go to the Carers Scotland Website, where you will find a really useful list of Sources of Help and Advice for Carers in Scotland. To find it CLICK HERE.

Secondly, the Scottish Government’s own carers page is HERE 

Thirdly, If you are looking for advice on mental health, adults and the law there is a really useful guide for families and carers on THIS WEBPAGE  from the Mental Welfare Commission. This page also has Frequently Asked Questions guidance for practitioners and formal carers. (Both guides were released last week).

Finally, my own contribution, the video at the top of the page, alongside the contributions of some of the team I work with @AlzScotCPP  All we have done is available on the Alzheimers Scotland COVID HUB.  Where there are some more videos and the accompanying leaflets for my video and the others which we hope will help. They are useful for many carers not just those looking after someone with dementia!

#StayHome #StaySafe

 

Covid-19 and the crisis in residential and nursing home care

I don’t do this very often but this is the newest Blog from the British Society of Gerontology. In the current situation this is what people working in older people’s care need to hear although its tough reading. When this is all over can we re-evaluate the value of very large care homes and look at other options for those needing 24/7 care. The “warehousing” model is broken and has been for a while.

Ageing Issues

Posted by Chris Phillipson, Manchester Institute for Interdisciplinary Research on Ageing (MICRA)

Can society be trusted to run care homes? An age-old question but one which has come back with a vengeance with the emerging catastrophe caused by Covid-19. Of course, the signs have been there for some time, that disasters – such as those linked with climate change and pandemics – create havoc for institutions built to protect older people. In Europe, the impact of the 2003 heatwave is well-known – causing 35,000 excess deaths. France was especially affected with around 15,000 deaths – 1 in 5 occurring in residential and nursing homes. Despite claims that lessons were learnt from that disaster, the Covid-19 crisis is confirming once again the vulnerability of people living in residential and nursing home care.

Across Europe, thousands of people are dying in care homes: in Madrid, Spain, out of 3,000 deaths reported in…

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March #NurseBloggers2020 Challenge: Who Inspires Me?

After a bit of thinking about this I decided to consider what I have read that has impacted the most on my teaching. Strangely it was a team led by doctors and sociologists not nurses, which is disappointing considering the reasons behind taking up this challenge.

So who was it? The End of Life studies team at the University of Glasgow who are based in Dumfries.

In March 2014 Professor David Clark and his team published a paper showing the likelihood of death within 12 months among a cohort of all hospital inpatients in Scotland on a fixed ‘census’ date. It was the first time such a study had been conducted anywhere in the world.  As they say themselves the study was a call to action for hospitals to give greater priority to identifying inpatients who might benefit from palliative care. Clark et al (2014)showed that among 10,743 inpatients in 25 Scottish teaching and general hospitals on 31 March 2010,  3,098 (28.8%) patients died during the one-year follow-up period.

The likelihood of dying rose steeply with age and was three times higher at one year for patients aged 85+, compared to those under 60.

Most striking of all was the finding that in Scottish hospitals on any given day, 3 out of 10 people in Hospital in Scotland are in the last year of their life and almost one in ten patients (9.3%) will die before they leave. 

That is why I think every hospital based nurse needs to be aware of this and take seriously the idea that a significant amount of their care is not curative or restorative; it is PALLIATIVE care and as a result all nurses and healthcare professionals need to be advocates for their patients and try and see a bigger picture.

Very few of the people that they work with would choose to die in Hospital or spend a significant amount of time in hospital in their last year and we should all be responsive to this. Knowing these facts should have a significant influence on all end-of-life care strategies but particularly those created for hospital use.

You can find out more about the work of the team in this are by going to: https://www.gla.ac.uk/research/az/endoflifestudies/projects/imminence/#thefindings

 

Getting to Know Me: Supporting a Culture of Person-Centred Care

A blog piece from Susan Holland, Dementia Nurse Consultant at NHS Ayrshire and Arran who also works with us here @uwshealth and @AlzScotCPP. This was written for the Alzheimer’s Scotland Blog “Let’s Talk about Dementia” which I have contributed to previously. Another appropriate message for #DAW2018 in Scotland. Blogging is so much easier when others do the work for you !! Thanks, Susan.

Let's Talk about Dementia

Blog1

Improving outcomes for people with dementia within acute care settings has long been recognised as a commitment by the Scottish Government. Yet, with the recent launch of Scotland’s National Dementia Strategy (2017-2020) (Scottish Government, 2017), there is recognition that although significant progress has been made over the last ten years, wide variations in dementia care and treatment remain evident across Scotland.

People with dementia are estimated to occupy approximately 25% of acute hospital beds (Alzheimer Research UK, 2018) and are known to have longer lengths of stay and poorer outcomes than people who do not have dementia. With a growing ageing population and incidence of dementia, there is no doubt that acute hospital settings require ongoing support to meet current and future dementia care needs.

Person-centredness is at the heart of high-quality dementia care provision. This involves knowing the person and tailoring care to meet their personal abilities, needs, likes…

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Dying Comfortably

Last month saw the publication of one of those papers that helps confirm something that you always believed you knew. So what did it confirm?

Very old people are more likely to die comfortably if they die in care homes or at home when compared to hospitals. The study carried out by a nursing team at the University of Cambridge found that the oldest old do not always receive effective symptomatic treatment at the end of life. While that is true in most settings up to four times more are likely to die comfortably in a community setting when compared to hospital. So what’s the message? Training for end of life care needs to be improved for all staff, at all levels but perhaps more telling is the need for governments (not just in the UK) to review the funding of long-term care so that more people have the opportunity to die in their home/ care homes than currently so that late admission to hospital is less likely. Not a new message but maybe its time to sit up and take notice. To download the paper go HERE

Sticking with the same topic an End of Life Care resource called “Let’s Talk About Death and Dying” has been produced by Age UK and the Malnutrition Task Force. The materials were produced in a response to a survey showing yet again that conversations about death remain a taboo topic. The new video is below:

 

Finding Happiness and ‘At the Fringe’

Happiness

Something a bit different this week. Last month an interesting article appeared that was about happiness. Now, the pursuit of happiness is often viewed as a human right along with life and liberty (so says America’s Declaration of Independence); so much so that there is even an International Happiness Index, a UN International Day of Happiness on the 20th. of March and a World Happiness Report, which suggests that to be happy you need to live in Norway, Denmark, Iceland or Switzerland.

OK, so what’s this got to do with older people, I hear you ask, who invariably are amongst the happiest people alive!

That was a surprise I bet. See the work of Laura Carstesen if you don’t believe me!

Well this reserach report looks at how best you can spend your wealth if you want to improve your well-being. So can spending money effectively make you feel better? Well, possibly, but you have to be careful what you sepnd that money on and the results are quite surprising.

No spoilers… if you want to find out what the research says and how you could spend money more wisely then click the link to

 

August is only a few days away now and in Scotland that signals the start of the World’s Biggest Art’s Festival, the Edinburgh Fringe. If you are planning to spend some time in Edinburgh between the 4th. to the 28th. of August when the Fringe is on, you should check out Alzheimers Scotland’s guide to exploring Dementia at the Edinburgh Fringe Festival. Go and learn something new or get more insight by visiting their page at:

Fabulous Fringe Festival

 

Ten Things We Need to Know About Dementia

alzheimers-2069835_1280

This week the Lancet Commission on Dementia Prevention and Intervention and Care published its findings which included 10 key messages that are the things we need to know!

Quite a lot of the media reports of this important paper have highlighted only the lifestyle changes that need to be made to reduce your risk of developing dementia but very few highlight the bottom line… which is even if you make the positive  lifestyle changes suggested that would reduce your potentially modifiable risk factors by  about 35% of your overall risk. The other 65% of dementia risk is thought to be potentially non-modifiable.

The paper though, says a lot more than this and “Being ambitious about prevention” the one the media focussed on is only No 2 on the list, so there are 9 more messages that got a lot less attention! To see the Lancet Paper click here Be warned it’s not short!

So what else caught my attention? Well this did the Commonwealth Fund, which surprisingly is a private American foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency in US Healthcare recently reported on a comparison they had made between 10 high-income countries health care systems performance: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Worryingly the USA came last in nearly everything. Surprisingly the top country was the UK! Who says our Health Care system is failing? I think it’s actually being failed by a Government that wants to adopt an American Healthcare Model.

The time has come to ask why when they, the USA, should be learning from us!

As the Commonwealth Fund report states, based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries’ approaches if it wants to achieve an affordable high-performing health care system that serves all Americans.

To read more about this report and to access the full version click here

Looking back at #DAW2017 and Looking Forward; Anticipatory Care Planning

ACP toolkit

As my followers will know it was Dementia Awareness Week in Scotland last week so for those of you who got involved here are some things you might like:

  • #DAW2017 went viral with a video of PC Marshall visiting a Musical Minds group in Kilmarnock during DAW. The video on the ALZScot Ayrshire page was shared across Scottish media including The Scotsman, The Scottish Sun, The Sunday Post and many more!
  • Check out the Dementia Awareness Week gallery over on Facebook and tag yourself.
  • To support the week AlzScot also shared a blog a day from Allied Health Professionals who wanted to share who they are and how they CAN help if you are living with dementia. If you can review the blogs by visiting Let’s Talk about Dementia

Last week also saw the publication of ‘My Anticipatory Care Plan’ (ACP). An anticipatory care plan toolkit designed by Healthcare Improvement Scotland.

Antipatory Care Planning ahead can help many people with chronic health problems to plan what they would like their care to look like on a daily basis or help them to plan fro and manage situations which they may find threatening, like sudden hospital admission.  ACP’s are not legally binding in any way (in the UK) and can be updated at any time to reflect changes in the person’s thinking. Remember this is designed to be their plan and it’s entirely up to the person to decide who to share this information with.

For more information about ACP’s and to access the toolkit please click here

You can also download their ACP App for both iPhone and Android when you visit the site. It really is a fabulous resource and although it may originate in Scotland, it could be used anywhere!