Re: nursing contribution to quality

[Guest guest]

Interesting to see the idea of 'nursing metrics' to identify the

nursing contribution to quality at last. This penny has taken a long

time to drop. Belgium has has such national datasets for more than

10 years and they don't even have a common national language. Other

European countries like the Netherlands, Austria and Switzerland are

working on the same model. The USA may have the most unequitable and

costly health care provision in the world, but even they have

realised that bad nursing and underfunded nursing both result in

higher costs, worse outcomes and expensive litigation for providers.

It's a no brainer, but you have to have data flows which are relevant

to practice, accurate, real time and allow for adjustments when

things are going wrong.

CfH has failed to reach the ambitious targets it was set and I'm not

sure that the current SNOMED data sets will actually reach relevant

areas of nursing work and nursing sensitive outcomes anyway. Nurses

like June & Anne Casey are putting in the work on SNOMED, but

who knows whether it'll be adopted?

Here in UK, we just don't collect real health visiting, midwifery or

nursing data - we collect adminstrative targets related stuff and

some medical data, most of which we never use and some of which is of

suspect quality. If hard pressed, poorly paid and undertrained admin

staff realise that nobody ever uses the stuff they have to enter into

computers, they soon realise that nobody cares whether it's accurate

or not. Local timely information feedback to the people actually

providing care is empowering and really improves data quality.

Does anyone in SENATE have access to a local child health system

which gives them real data on health visiting and school nursing

outcomes and the needs of children in their caseloads? I know that

easy caseload profiling and mapping of needs & outcomes was a doddle

because I did it myself. The IT was clunky and one had to be able to

write queries and export data into early spreadsheets, but it was our

data, our feedback and it was surprisingly relevant and effective.

Currently, we're just data collectors in the NHS and rarely

information users in their own right. For nursing metrics to be a

reality, they'll have to change this. But it's just as likely that

they'll continue in the same old coercive style and set some more

targets. Like measuring performance on a production line, where

workers are just another component of the production process to be

squeezed for maximum output.

There is a neat little summary of nursing data sets at

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61286

The Belgians are now looking at how they can cost care in terms of

the workforce and skill mix models which work best for patient

outcomes.

This stuff has some weaknesses. For instance, I find NANDA and Omaha

data sets quite appealing, but the empirical basis is no better than

the medical data sets. This was clear from the evidence for pressure

sore prevention in the NICE/RCN guidance. What we had was

professional consensus at best, when what we really needed was decent

actuarial models of risk and the ways in which our interventions

could change the course of skin necrosis. But we have start

somewhere, don't we?

A.N. Anorak...

From: Cowley <sarahcowley183@...>

Date sent: Mon, 28 Jul 2008 11:57:23 +0100

Subject: nursing contribution to quality

Send reply to:

This is the next document from CNO, available on

http://www.dh.gov.uk/en/Aboutus/Chiefprofessionalofficers/Chiefnursing

officer/DH_4049335 for anyone who does not get attachments.

CNOssuitcase is already half packed, and I must be in a mellow

holiday mood, because I quite like it (probably just as well, because

when I got to the last page, there was an acknowledgement to my boss,

Anne Mare Rafferty, for her input!). There is a chapter about what

nursing is all about and why it matters to define/describe, which

seemed surprisingly meaningful and did not immediately alienate, like

most of these yukky lists of 'key roles' or functions for nurses:

Vision of the future of the registered nurse

Role of nurses

<

[Guest guest]

Thanks for this thoughtful response, .  Like you, I would be very interested in any data collection systems that really work for child health and public health/preventive work.  Much of the really hard stuff to do is also very hard to capture:  like helping relationships and working alongside people that are unhappy and rejecting of professionals and themselves/own family alike.  We are making collective inroads into understanding how that happens and what it takes to make it work: thinking here of Robyn Pound's excellent PhD about alongsideness; and Bidmead is looking at the measurability of helping relationships, and Sinead Hanafin's PhD about the process components that need to be taken into account for a model of quality in preventive work.  They may like to comment!  But still, these are a long way from a national dataset, even if precise measurements of such things would ever be feasible.  Probably (I can hear advice from statisticians here!) go for the simple:  like how long it takes to engage a young, single parent, compared to engaging a middle class professional parent.  Trouble is, such simple stats are liable to be misinterpreted; but without any figures they get disregarded.  best wishes from A N other anorak! On 29 Jul 2008, at 09:01, hwood@... wrote:Interesting to see the idea of 'nursing metrics' to identify the nursing contribution to quality at last. This penny has taken a long time to drop. Belgium has has such national datasets for more than 10 years and they don't even have a common national language. Other European countries like the Netherlands, Austria and Switzerland are working on the same model. The USA may have the most unequitable and costly health care provision in the world, but even they have realised that bad nursing and underfunded nursing both result in higher costs, worse outcomes and expensive litigation for providers. It's a no brainer, but you have to have data flows which are relevant to practice, accurate, real time and allow for adjustments when things are going wrong.CfH has failed to reach the ambitious targets it was set and I'm not sure that the current SNOMED data sets will actually reach relevant areas of nursing work and nursing sensitive outcomes anyway. Nurses like June & Anne Casey are putting in the work on SNOMED, but who knows whether it'll be adopted? Here in UK, we just don't collect real health visiting, midwifery or nursing data - we collect adminstrative targets related stuff and some medical data, most of which we never use and some of which is of suspect quality. If hard pressed, poorly paid and undertrained admin staff realise that nobody ever uses the stuff they have to enter into computers, they soon realise that nobody cares whether it's accurate or not. Local timely information feedback to the people actually providing care is empowering and really improves data quality. Does anyone in SENATE have access to a local child health system which gives them real data on health visiting and school nursing outcomes and the needs of children in their caseloads? I know that easy caseload profiling and mapping of needs & outcomes was a doddle because I did it myself. The IT was clunky and one had to be able to write queries and export data into early spreadsheets, but it was our data, our feedback and it was surprisingly relevant and effective.Currently, we're just data collectors in the NHS and rarely information users in their own right. For nursing metrics to be a reality, they'll have to change this. But it's just as likely that they'll continue in the same old coercive style and set some more targets. Like measuring performance on a production line, where workers are just another component of the production process to be squeezed for maximum output.There is a neat little summary of nursing data sets at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61286The Belgians are now looking at how they can cost care in terms of the workforce and skill mix models which work best for patient outcomes. This stuff has some weaknesses. For instance, I find NANDA and Omaha data sets quite appealing, but the empirical basis is no better than the medical data sets. This was clear from the evidence for pressure sore prevention in the NICE/RCN guidance. What we had was professional consensus at best, when what we really needed was decent actuarial models of risk and the ways in which our interventions could change the course of skin necrosis. But we have start somewhere, don't we?A.N. Anorak...Visit Your Group HealthAchy Joint?Common arthritismyths debunked.Meditation andLovingkindnessA Groupto share and learn.Biz ResourcesY! Small BusinessArticles, tools,forms, and more..  sarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

Dear

Yes, I agree - the ideas and concepts that we use need this kind of

exploration and clarification, otherwise they just mean what we each

say they mean at a given time. It makes things solid, somehow. If

we don't articulate this stuff, who else will? But how are we using

this rich knowledge? It should give us more than a warm feeling of

being understood.

I guess I'm looking at the time frame allowed for the policy (given

that there's no history of this stuff as far as I know in DH) and

wondering what kind of sources they'll bother to use. You know that

they reach for some horribly quick and dirty expedients when a

minister needs to make an announcement of something which sounds like

progress. There's going to be very little planning time between now

and the conference season. Does the quality of work coming out of

CNO's office fill you with confidence?

The NHS target culture has come in for a lot of criticism, but not

always accurately applied, I think. Sure, the current targets are

not really getting to the heart of what we do and yes, they're all

about inputs and processes, not so much about outcomes. But there is

an underlying problem of poor information in the NHS which makes the

idea of 'world class commissioning' look like a feeble joke. We just

don't have the basic data on what we're doing and whether it makes

any difference. This is fundamental stuff. Targets should be based

on this, not the current political whim or any recent service failure

picked up by the tabloids.

We shouldn't entirely blame the commissioning arms of PCOs, even if

they are pretty feeble. Few community services managers seem to have

the least idea of what's actually going on in their services, let

alone what the outcomes of their spending might be. The worst is

when they don't actually care either. It's a failure of basic

curiosity, a cop out by uneducated or burned out managers who 'just

want to get by' till the next reorganisation. Florence Nightingale

may have been unsound on HAIs, but by 1855 even she knew this

approach to service management didn't work.

Many HVs and others resented the old systems which collected their

work & outcomes data because it never gave them any information back

and data collection methods were usually laborious and absurdly low

tech even by 1980s standards. So staff supported switching the whole

lot off and dumping the data - it's probably rotting in landfill if

they couldn't be bothered to archive it for public health purposes.

We threw away more than 20 years of public health data on child

health because we failed to use the capacities of the systems for

what they could give practitioners and managers. So now we struggle

afresh to find a baseline for child health, let alone families and

communities.

It would be so inspiring to really be able to measure the difference

we make to our communities, ideally before we all get replaced by

nice, well meaning Family Aides, or whatever they'll call them.

Sometimes I wish I'd never studied history - this stuff repeats like

raw onions!

(still an Anorak)

From: Cowley <sarahcowley183@...>

Date sent: Tue, 29 Jul 2008 10:38:01 +0100

Subject: Re: nursing contribution to quality

Send reply to:

Thanks for this thoughtful response, .

Like you, I would be very interested in any data collection systems

that really work for child health and public health/preventive work.

Much of the really hard stuff to do is also very hard to capture:

like helping relationships and working alongside people that

areunhappy and rejecting of professionals and themselves/own family

alike. We are making collective inroads into understanding how that

happens and what it takes to make it work: thinking here of Robyn

Pound's excellent PhD about alongsideness; and Bidmead is

looking at the measurability of helping relationships, and Sinead

Hanafin's PhD about the process components that need to be taken into

account for a model of quality in preventive work. They may like to

comment!

But still, these are a long way from a national dataset, even if

precise measurements of such things would ever be feasible.Probably

(I can hear advice from statisticians here!) go for the simple: like

how long it takes to engage a young, single parent, compared to

engaging a middle class professional parent. Trouble is, such simple

stats are liable to be misinterpreted; but without any figures they

get disregarded.

best wishes from A N other anorak!

On 29 Jul 2008, at 09:01, hwood@... wrote:

[Guest guest]

and ,

The only way I know how to capture the essence of what is happening between practitioner and family is through accounts of the story and only then can you get to the heart of what its all about - client need and practitioner interpretation and action. I have never come across any data collection that captures what we are really doing in the series of unique situations that people-work is and which is so valued by clients. I don't have an aptitude for numbers and systems (probably why I became a health visitor) but I recognise fully the problem for managers when the data they need is not forthcoming and they need to commission appropriate services and balance the books. Reading stories about one tiny aspect is too time consuming, only relates to one practitioner (not generalisable across a service) and does not suit the frame of thinking of people who gravitate towards managing

large organisations. No criticism here. We need all types of thinkers for the job to get done but the dilemma brought into sharp relief in people-work in the nursing profession is magnified by thinking style differences between health visiting and interventionist nursing activity and organisational management - Concrete Sequential mind style compared with Conrete Random for educationalists who know Anthoy Gregoc or Sensor Judgers compared with Intuitive Perceivers for those who know Myers Briggs (Do your own free by googling Myers Briggs).

I don't know that there is an easy answer and I am so very grateful to those of you who have such relentless energy to keep the issues live in the ways you do. My dream solution is that health visitors and school nurses are trained in an entirely reflective action enquiry way. By this I mean that they and their tutors approach every single topic from the starting point of 'how can I/we improve my/our practice?' Whether it be epidemiology, immunisation regimes, public health perspective or parenting and child protection ... whatever ..., the focus is on the practitioner (includes tutors) developing their own understanding of what they need to know to practice effectively. Their knowledge would be built on what they already know about what motivates them and how they are assimilating the new ideas into their individually constructed beliefs and values. Involves developing the confidence,

humility, openess and collaborative impulse essential for effective practise. Every assssessment of learning would be founded on trust in the individual's ability to know and create their own accounts of what they know, why they know it and how they live what they know in practice. I am speaking about individuals creating their own knowledge about how to practice right from the beginning - using the academic resources to inform rather than dictate what they are learning from what they are doing. I know students need holding and some won't make it but I do not believe the fall out would be different. The workforce would then be well practised in reflecting deeply and articulating what they are doing. The more CS/SJ (as above) thinkers might even find a way of collecting data that CR/IPs (like me) find it hard to get around to because we are too busy in the blue sky

possibilities that don't fit any boxes.

I became so disheartened by the mindset I met during a couple of attempts at developing active reflective practice support with colleagues locally that I gave up and have moved on to other passions (but I haven't changed my mind about what is important). I found only brief glimpses of wide eyed 'ahah yes!' understanding and openess amongst the deciders before minds closed down again and rushed towards quick fixes and short term goals. The 'Leadership through alongsideness' chapter in Community Public Health Practice came from one of these ventures. Everything I have written is personal and not generalisable so is of little interest to commissionsers but it is where I need to be with the communities I work with. It feels important to be doing and I cannot always be active on all fronts at once. I don't know where I fit as activator for change because I have gone quiet but

I am still here as health visitor. Stay with the force those of you I read, we need you!

Robyn

[Guest guest]

Dear Robyn

You're so right about the need for reflective practice and a

constantly questioning attitude about practice! If you lose it,

you're dead professionally. It becomes a matter of ticking the boxes

and some slick patter without really picking up on individual needs.

It's vital for practitioners and their managers too. But I would

argue that data and information feeds our thinking about practice.

I worked for some years in a PCT where the management of health

visiting and community nursing was so laissez faire that they neither

knew what was being delivered to families, nor cared enough to go

looking. Whenever anything in terms of poor practice or

unprofessional conduct arose, they'd pull a senior HV out of her

caseload for a few weeks to investigate the issues and then

righteously discipline the individual involved. But they never ever

considered that it might be better to keep some kind of involvement

in what practitioners were coping with and what their level of

practice was. As far as they were concerned, bad practice was just

the fault of the individual. By the time they spotted any problem,

there was usually enough evidence to sink a cruise liner, let alone

an individual's career. But many of these problems were exacerbated

and allowed to persist through systemic failures and lousy

management.

We're responsible for our own proper professional practice standards

(though a yardstick of sorts is handy here). We also have

responsibility for junior staff and assistants, plus our peers if

they seem to under particular stress, or things seem to be going

wrong for them. I've shared an office with a colleague who had a

mental health problem, which was tricky because there's this line

between simply being supportive and protective and telling someone

that they really shouldn't be trying to work right now. But

pretending not to notice doesn't help either.

Managers have to really understand their patch and be able to judge

the service they're supposed to be delivering. If they don't know

what's going on till staff or services fall apart, they're not paying

enough attention to their core job, IMO. They need to stay in touch

with people, they need information about services and they need to

work with both effectively. Otherwise they're blind, deaf and

decerebrate.

It bothers me that some managers haven't a clue about the real

practice and education needs of staff who're working in isolation in

the community. How can you have a health visitor who's had no

training input and no updates since the mid 1980s and think she'll

cope? How can you have a member of staff who's always missing

meetings, supervision sessions, case discussions and think there's

nothing to worry about? At the very least, whatever support you're

offering may not be meeting her needs. How can you just avoid

looking at those heavy caseloads and workloads and worry how people

are managing? How can you not know what the main health and welfare

problems are across your area and what your service is doing to

address them?

I guess it's a matter or bringing together your deeper understanding

of practice and learning with the perspective we need for an

oversight. Information's not just for managers - every individual

practitioner needs to know whether what they're doing is making a

difference. Data helps, even if it's just to start a discussion or

enable an individual practitioner to find a way forward.

Hope this isn't nonsense!

H.

From: Robyn Pound

<robyn_pound@...> Date sent: Thu, 31 Jul 2008 01:32:38 -0700

(PDT) Subject: Re: nursing contribution to quality Send

reply to:

[Guest guest]

Dear RobynThank you for a typically humble but actually very inspiring response!  I think you are right that we have to keep trying to push forward, between us, on a whole range of different fronts, preferably helping people to find their own particular aptitude and using it to the greater good.  There are so many different needs and pieces of work to be done across the spectrum.  I do think there is a willingness in some quarters to hear powerful testimony as one element of the evidence gathered, but you are right that the numbers game usually overshadows.  But perhaps there are some generalisable insights from your work?  It is interesting that there seems to be an increasing awareness of the centrality of relationships:  perhaps it is just that the work I am involved with is leading me this way, but I think not.  Certainly Olds stresses the importance of the relationship in his Nurse Family Partnership work.  I know that the more narrow minded will then claim it only matters to have a good client-helper relationship for disadvantaged families, but that is just is to try and keep costs down, not because of any evidence!On 31 Jul 2008, at 09:32, Robyn Pound wrote: and ,The only way I know how to capture the essence of what is happening between practitioner and family is through accounts of the story and only then  can you get to the heart of what its all about - client need and practitioner interpretation and action.  I have never come across any data collection that captures what we are really doing in the series of unique situations that people-work is and which is so valued by clients.  I don't have an aptitude for numbers and systems (probably why I became a health visitor) but I recognise fully the problem for managers when the data they need is not forthcoming and they need to commission appropriate services and balance the books.  Reading stories about one tiny aspect is too time consuming, only relates to one practitioner (not generalisable across a service) and does not suit the frame of thinking of people who gravitate towards managing large organisations.  No criticism here. We need all types of thinkers for the job to get done but the dilemma brought into sharp relief in people-work in the nursing profession is magnified by thinking style differences between health visiting and interventionist nursing activity and organisational management - Concrete Sequential mind style compared with Conrete Random  for educationalists who know Anthoy Gregoc or  Sensor Judgers compared withIntuitive Perceivers for those who know Myers Briggs (Do your own free by googling Myers Briggs). I don't know that there is an easy answer and I am so very grateful to those of you who have such relentless energy to keep the issues live in the ways you do.  My dream solution is that health visitors and school nurses are trained in an entirely reflective action enquiry way.  By this I mean that they and their tutors approach every single topic from the starting point of 'how can I/we improve my/our practice?'  Whether it be epidemiology, immunisation regimes, public health perspective or parenting and child protection  ... whatever ..., the focus is on the practitioner (includes tutors) developing their own understanding of what they need to know to practice effectively.  Their knowledge would be built on what they already know about what motivates them and how they are assimilating the new ideas into their individually constructed beliefs and values. Involves developing the confidence, humility, openess and collaborative impulse essential for effective practise. Every assssessment of learning would be founded on trust in the individual's ability to know and create their own accounts of what they know, why they know it and how they live what they know in practice.  I am speaking about individuals creating their own knowledge about how to practice right from the beginning - using the academic resources to inform rather than dictate what they are learning from what they are doing.  I know students need holding and some won't make it but I do not believe the fall out would be different.  The workforce would then be well practised in reflecting deeply and articulating what they are doing.  The more CS/SJ (as above) thinkers might even find a way of collecting data that CR/IPs (like me) find it hard to get around to because we are too busy in the blue sky possibilities that don't fit any boxes.  I became so disheartened by the mindset I met during a couple of attempts at developing active reflective practice support with colleagues locally that I gave up and have moved on to other passions  (but I haven't changed my mind about what is important).  I found only brief glimpses of wide eyed 'ahah yes!' understanding and openess amongst the deciders before minds closed down again and rushed towards quick fixes and short term goals.  The 'Leadership through alongsideness' chapter in Community Public Health Practice came from one of these ventures.  Everything I have written is personal and not generalisable so is of little interest to commissionsers but it is where I need to be with the communities I work with.  It feels important to be doing and I cannot always be active on all fronts at once.  I don't know where I fit as activator for change because I have gone quiet but I am still here as health visitor.  Stay with the force those of you I read, we need you! Robyn    sarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

,

Thanks for sending Marg Bigsby from NZ to see me. It made me think about similarities between alongsideness I try to practise in an inner city estate and Family Nurse Partnership (I believe we failed to appear deprived enough in BANES to qualify for FNP). Marg's visit highlighted for me both the value of being alongside the most disadvantaged families through a combined family visiting and community-based way (that only health visitors can do) and the difficulties I have in showing what I am doing to anyone coming in from outside. Our community group lurches between projects - fathers' arts, breast feeding group (well, in name), cooking, community learning activities, just being together, parenting discussions, street parties, school holiday chaos, but the products are eaten or disappear because the product is not the point of it. We are working on creating a

sense of community amongst very isolated (usually young) families who are often suspicious and afraid of each other and would prefer to live somewhere else. Magic and change is tiny and only an uncynical eye can spot it (I smile). We face birth, death, drugs, catastrophe, acceptance, love and hate - life really in some views of life. The most unlikely people turn up, competing factions don't, serious disagreements never kick off in the building, we often have fun and a few people have given up smoking or gone to college. Most important of all may be that we have a reputation for being there on the estate in an acceptable way. I waver between why the hell am I here and loving it. Is it health visiting? If its not, don't tell anyone how I spend a large chunk of my time.

Robyn

sarahcowley183@ btinternet. com

http://myprofile. cos.com/S124021C On

[Guest guest]

No , it isn't nonsense. I have also seen situations such as you describe and realise some practitioners need more holding. It just isn't my style and I am grateful for a bit of neglect if I am honest. I am grateful to have manoeuvred a situation where I am left alone to do my thing and feel valued by my immediate colleagues for taking on a number of priority/cp families while they do the lion share of the rest of it. It works for us. I need my HV colleagues as much as they need me to talk to - emotional support. Practical support comes from Community Learning, Vol.orgs and Charity funded projects.

The voices that in the past said services had to be equitable (ie dumbing down to uniform sameness rather than enabling innovation) have happily quietened. Too busy doing other things hopefully. I used to be a bit nervous that people would come and look and ask me to quantify. Time has taught me that as long as the only vibes coming from this patch are not trouble but positive I will be left to grow and discover. Its just a different point of view that arises for a million unique reasons (as people are). We know when we are making a difference, the families and me, and in the thick of it, time for counting stops progress while reflecting together is worthwhile growth on so many fronts. I try to share it at moments like this.

I am supposed to be writing something else!

Robyn

From: hwood@... <hwood@...>Subject: Re: nursing contribution to quality Date: Thursday, July 31, 2008, 10:49 AM

Dear RobynYou're so right about the need for reflective practice and a constantly questioning attitude about practice! If you lose it, you're dead professionally. It becomes a matter of ticking the boxes and some slick patter without really picking up on individual needs. It's vital for practitioners and their managers too. But I would argue that data and information feeds our thinking about practice.I worked for some years in a PCT where the management of health visiting and community nursing was so laissez faire that they neither knew what was being delivered to families, nor cared enough to go looking. Whenever anything in terms of poor practice or unprofessional conduct arose, they'd pull a senior HV out of her caseload for a few weeks to investigate the issues and then righteously discipline the individual involved. But they never ever considered that it might be better to keep

some kind of involvement in what practitioners were coping with and what their level of practice was. As far as they were concerned, bad practice was just the fault of the individual. By the time they spotted any problem, there was usually enough evidence to sink a cruise liner, let alone an individual's career. But many of these problems were exacerbated and allowed to persist through systemic failures and lousy management.We're responsible for our own proper professional practice standards (though a yardstick of sorts is handy here). We also have responsibility for junior staff and assistants, plus our peers if they seem to under particular stress, or things seem to be going wrong for them. I've shared an office with a colleague who had a mental health problem, which was tricky because there's this line between simply being supportive and protective and telling someone that they really

shouldn't be trying to work right now. But pretending not to notice doesn't help either.Managers have to really understand their patch and be able to judge the service they're supposed to be delivering. If they don't know what's going on till staff or services fall apart, they're not paying enough attention to their core job, IMO. They need to stay in touch with people, they need information about services and they need to work with both effectively. Otherwise they're blind, deaf and decerebrate.It bothers me that some managers haven't a clue about the real practice and education needs of staff who're working in isolation in the community. How can you have a health visitor who's had no training input and no updates since the mid 1980s and think she'll cope? How can you have a member of staff who's always missing meetings, supervision sessions, case discussions and think there's nothing

to worry about? At the very least, whatever support you're offering may not be meeting her needs. How can you just avoid looking at those heavy caseloads and workloads and worry how people are managing? How can you not know what the main health and welfare problems are across your area and what your service is doing to address them? I guess it's a matter or bringing together your deeper understanding of practice and learning with the perspective we need for an oversight. Information' s not just for managers - every individual practitioner needs to know whether what they're doing is making a difference. Data helps, even if it's just to start a discussion or enable an individual practitioner to find a way forward. Hope this isn't nonsense!H. From: Robyn Pound <robyn_pound> Date sent: Thu, 31 Jul 2008 01:32:38 -0700 (PDT) Subject: Re: nursing contribution to quality Send reply to:

[Guest guest]

But I'm so glad you took the time to write this instead, Robyn!  Thank you, too, , for the discussion.  On 31 Jul 2008, at 15:32, Robyn Pound wrote:No , it isn't nonsense.  I have also seen situations such as you describe and realise some practitioners need more holding.  It just isn't my style and I am grateful for a bit of neglect if I am honest.  I am grateful to have manoeuvred a situation where I am left alone to do my thing and feel valued by my immediate colleagues for taking on a number of priority/cp families while they do the lion share of the rest of it.  It works for us.  I need my HV colleagues as much as they need me to talk to - emotional support.   Practical support comes from Community Learning, Vol.orgs and Charity funded projects.    The voices that in the past said services had to be equitable (ie dumbing down to uniform sameness rather than enabling innovation) have happily quietened.  Too busy doing other things hopefully.   I used to be a bit nervous that people would come and look and ask me to quantify.  Time has taught me that as long as the only vibes coming from this patch are not trouble but positive I will be left to grow and discover.  Its just a different point of view that arises for a million unique reasons (as people are).  We know when we are making a difference, the families and me, and in the thick of it, time for counting stops progress while reflecting together is worthwhile growth on so many fronts.  I try to share it at moments like this. I am supposed to be writing something else!Robyn From: hwood@....co.uk <hwood@....co.uk>Subject: Re: nursing contribution to quality Date: Thursday, July 31, 2008, 10:49 AMDear RobynYou're so right about the need for reflective practice and a constantly questioning attitude about practice! If you lose it, you're dead professionally. It becomes a matter of ticking the boxes and some slick patter without really picking up on individual needs. It's vital for practitioners and their managers too. But I would argue that data and information feeds our thinking about practice.I worked for some years in a PCT where the management of health visiting and community nursing was so laissez faire that they neither knew what was being delivered to families, nor cared enough to go looking. Whenever anything in terms of poor practice or unprofessional conduct arose, they'd pull a senior HV out of her caseload for a few weeks to investigate the issues and then righteously discipline the individual involved. But they never ever considered that it might be better to keep some kind of involvement in what practitioners were coping with and what their level of practice was. As far as they were concerned, bad practice was just the fault of the individual. By the time they spotted any problem, there was usually enough evidence to sink a cruise liner, let alone an individual's career. But many of these problems were exacerbated and allowed to persist through systemic failures and lousy management.We're responsible for our own proper professional practice standards (though a yardstick of sorts is handy here). We also have responsibility for junior staff and assistants, plus our peers if they seem to under particular stress, or things seem to be going wrong for them. I've shared an office with a colleague who had a mental health problem, which was tricky because there's this line between simply being supportive and protective and telling someone that they really shouldn't be trying to work right now. But pretending not to notice doesn't help either.Managers have to really understand their patch and be able to judge the service they're supposed to be delivering. If they don't know what's going on till staff or services fall apart, they're not paying enough attention to their core job, IMO. They need to stay in touch with people, they need information about services and they need to work with both effectively. Otherwise they're blind, deaf and decerebrate.It bothers me that some managers haven't a clue about the real practice and education needs of staff who're working in isolation in the community. How can you have a health visitor who's had no training input and no updates since the mid 1980s and think she'll cope? How can you have a member of staff who's always missing meetings, supervision sessions, case discussions and think there's nothing to worry about? At the very least, whatever support you're offering may not be meeting her needs. How can you just avoid looking at those heavy caseloads and workloads and worry how people are managing? How can you not know what the main health and welfare problems are across your area and what your service is doing to address them? I guess it's a matter or bringing together your deeper understanding of practice and learning with the perspective we need for an oversight. Information' s not just for managers - every individual practitioner needs to know whether what they're doing is making a difference. Data helps, even if it's just to start a discussion or enable an individual practitioner to find a way forward. Hope this isn't nonsense!H. From: Robyn Pound <robyn_pound> Date sent: Thu, 31 Jul 2008 01:32:38 -0700 (PDT) Subject: Re: nursing contribution to quality Send reply to: sarahcowley183@...http://myprofile.cos.com/S124021COn