The Code

Earlier this year,  new changes were made to The Code for nurses and midwives. The Nursing and Midwifery Council (NMC) has set updated standards that all registered nurses and midwives must apply to their practice.

There has been mixed discussion today from healthcare professionals and from the public, some of whom are in favour of the updated code of conduct and revalidation process; others who believe it to be somewhat condescending towards nurses and midwives. After the Francis Report and the Keogh Report highlighting flaws, concerns, dangers and poor practice across poorly-performing trusts, I find it puzzling that there is so much variation in care delivery across what should be a well-performing, unified organisation, theNational Health Service. Will updating a code of conduct for some of its workforce be enough to drive up standards of care delivery, or is there Something Missing?

I’ve worked in several different trusts as a nurse – both in primary care and secondary care – as well as in the independent sector for a while. Wherever I have worked, there have always been various issues ranging from money shortages, poor standards of care, mistakes, anger and disenchantment, to job dissatisfaction and stress with burnout. I’ve seen the best and the worst of care; with some incredible, caring staff who will go the extra mile for their patients. I’ve heard people say that the NHS runs on the goodwill of those who work within it. I’ve always done my best as a nurse to work to the best of my ability, for the benefit of patients. And if you were to ask any other nurse or midwife or healthcare worker, they would almost always say the same.

I have always said that if I ever stopped caring about my job or my patient, it was either time to change job or leave nursing. I often wonder if standards of care delivered by the NHS workforce reflect the standards of care delivered by the trusts and by the government…if as healthcare professionals we are expected to uphold standards and codes; if NHS Trusts are expected to comply with statutory regulations, targets and standards; what targets, standards and compliance are in place for the top governing bodies and government which control the NHS from the top down? Where does this drive for improvement, delivering high standards of care, behave compassionately and respectfully to the patients begin – the individual, the government – or both? Where does it begin for the staff? Why are staff bullied? Why are there failures in care? Will a code of conduct be enough to ensure that dreadful things don’t happen in the NHS, any more, or is there Something Missing?

I believe there is: one of the fundamental elements of mindfulness practice is based on connection. Connection with the Self. This connection, in the form of reflection or a moment to sit still and contemplate a situation or event that has taken place allows a more meaningful experience. Regular mindfulness practice and other forms of meditation, such as Metta meditation has a positive impact on ourselves: it makes us “nicer”. This connection within, when practiced regularly, can enable us to connect, empathise and act with compassion towards others. I would like to see this connection embedded with everyone, including patients, staff, trust boards, local and national government. The connection works both ways, though – even I struggle with that bit – I find it difficult to have compassion for the current political mess the NHS is faced with, at the moment.

So, this new code…I hear (and connect with) all those who have positive and negative experiences in their care delivery or as a patient; I understand and agree with much of the revised code; but  I also see that mindfulness deserves a high profile space in clinical care, starting with training student healthcare professionals. Influencing our thoughts towards ourselves and how we relate to others begins within. If this happens, who knows: perhaps others will begin to be influenced positively, too – including the public having a greater sense of trust and empathy for what NHS staff face on a daily basis.

Nikki teaches mindfulness and meditation to adults and children, and works as a nurse in an acute NHS hospital.

Be Brave!

Last summer, whilst out running in the woods, I headed towards a path I tend to feel wary of. It was a gloriously warm summer morning, and as I ran along the sunlit-dappled path, I became mindful of looking out for Adders. Now I used to be terrified of snakes as a child; and even as an adult, I’m really not that fond of them.
Despite my fear and dislike, I have never seen a snake anywhere other than behind a plate of glass at the zoo: a sanitised, safe environment – perhaps not so much for my benefit – as for the snakes themselves.

I reflected upon this as I left the woods and entered an open space, that the fear I have of meeting a snake on my own well-travelled path, has little basis. Why must I place the emotion of fear into a situation I have never encountered, and may never face? Surely it would be better to experience the fear and react accordingly if need be?

As much as I love being amongst woodland, I do tend to run a bit faster in the areas where I am likely to encounter an Adder. This might knock a couple of seconds off my time, but if I run too fast, I may miss the beauty all around me – even that of the adder itself.

To confront a fear allows us to learn something deeper about ourselves. If we permit the fear to control our decisions on, say, which paths to take in our life, we restrict our choices, and may inhibit our own growth. Although it might feel easier to avoid anything scary or unknown in order to protect and preserve – to sanitise – our comfort zones, these seemingly easy decisions can prevent us from learning more about ourselves, and forming a deeper connection within.

By facing our fears, we can begin to open up to what it is that has influenced our decisions and perceptions. If we fully experience our fear, we can then see the beauty of our deeper selves, learn as we conquer our fear, and evolve on a spiritual level.

So look for your own strength and courage in your heart, and allow the light within you to be the sun dappling upon your path less travelled.

Planting The Seeds

 My beginners mindfulness group were asked at the beginning to sit quietly for a few minutes. In this time, once they had begun to settle in to the session, I asked them to feel a sense of love for themselves at that moment and feel the sensation grow from their heart outwards. Then I asked for them to feel a sense of peace. Connecting the sense of peace and love (there is a hippy inside us all) I asked for each individual to consider a positive intention (a goal to work towards) for themselves; and lastly, to connect this sense of peace and love with the goal or intention. After a few moments the group were asked to choose some seeds to plant into a tray, all the while remembering the intention, as well as maintaining or re-creating the sense of love and peace. Then, to visualise the seed growing, changing, sprouting shoots and growing into the flower it will become. In this flower is embedded peace, love and the happy goal or intention. Each person was asked to take their seeds home with them, to nurture them as they grow and each day sit for just a few minutes, re-creating the sense of peace and love, even connecting with their seed. Today was about planting for peace. Imagining the plant sending out the peace and love through the roots and into the ground, to spread beyond ourselves and lead to others.Yes, this may all sound very hippy, but there is a point to this. The plant is a metaphor for a goal: the goal (intention) is to bring about positive change in the individual. By nurturing the seed (watering it, maintaining just the right conditions for it to grow) the plant has a much greater chance of survival. By feeling a sense of love for the seed, the love is actually for the self – an unconditional love with which to grow the individual’s self-belief and desire to succeed in their intention. Setting an intention gives the plant a deeper meaning. Feeling motivated to succeed and practising the commitment to succeed is a self-fulfilling prophecy. The plant is receiving the individual’s energy through the commitment to preservation.This exercise is loosely based on Metta meditation, a Buddhist practice which focuses on love of the self; love of a friend; love towards someone the individual doesn’t know/know well; sending love to someone the individual doesn’t like; and finally, sending love out to the individual’s community/the world. It is a powerful exercise, one which can invoke all sorts of emotions – positive and negative – but when practised regularly, it can harbour greater coping mechanisms in everyday life, particularly if the individual faces conflict in any aspect of their life; but can have a positive influence on self-esteem.So get planting for peace and love in your life and in your neighbourhood!

Presence

There have been frequent occasions where, whilst on a run, I have been greeted by this wonderful sight. The sun, reflecting on the ocean as a silvery-white glow, its gentle yet persistent beams striking through the clouds. Today's view, however, got to me so much I was almost breathless with awe (and it was not the result of running away from the inquisitive cattle in the adjacent field).
There was just something about the scene that was so powerful I could feel it in my chest, a rush of love and happiness to be able to witness the beauty that was there, in front of me. Free for anyone who could see it, to soak up the gift the eye gives to the soul. Who could look at this and not feel a stirring in their heart? The simple pleasure of being able to tune in to the surroundings and experience that moment of happiness.
I stood still, and drank up everything around me: the crisp, cool breeze that danced around the field; the chattering birdsong, mingled with the occasional "moo" from behind the hedgerow, and the loud sighs of waves meeting land; the delicate salty smell lingering in the air and the taste on my lips; the contrast of the dark blue sea, the heavy clouds, against the green of the fields and the striking sunlight on the water. I stood still, and took everything in. A few moments of stillness, where I closed my eyes, and listened to myself. I could only hear the quiet of my breath, and the joy of the moment, a tangible sense of peace for myself, the words "thank you" whispering in my mind, and gratitude for everything around me. What more could I ask for, at such a moment, other than the gift of presence?

pill-popping or hearts and minds?

Today's news has included an article about a new pill for men and women who drink excessively, to help them reduce their alcohol intake. It has made the headlines and induced discussions in the media, with the slant of being a new "wonder-drug" that will help many people.

That's great, isn't it?

Yes, it is great,

I don't think there is anything wrong with taking medication. I am a nurse, so I spend a great deal of my time administering tablets, medicines, drips and antibiotics to help make the people I look after, better. This is fine.

But...

I do also feel that as a society, we are easily swayed by medications to combat illness. We are conditioned to believe that a pill will make everything better, again. I find myself telling my children that "this medicine will make you feel better", or telling my patient, "this tablet will take the pain away", or "this antibiotic will kill the bug you have". Yes, they may well do, and invariably, that is what happens.

But...

Why do we think that we are only capable of fixing ourselves with a pill? What is it about our fixation with medicines to cure all ills? As a nurse, if I have a patient who is agitated, anxious or confused, the planned route would be to speak to the doctor to get a tablet to calm the patient down.

But...

With increasing frequency, I am using mindfulness techniques in my clinical practice to help my patients. I have had some surprising and successful results, from children to the elderly; from the scared and confused to the acutely ill, climbing-the-walls-with-pain patients.
For example, about a year ago I did a shift in A&E and was looking after a very scared, confused elderly lady. She did not know she was in hospital, and was desperate to go home. She had fallen at home and was very unsteady on her feet in the department, which was dangerous because she repeatedly got up from her chair to try to find her way into the cold, wet morning in her dressing gown and slippers. I sat down with her, did some breathing and focusing work with her, and then did a 5-minute meditation with her. As she relaxed in her chair, she settled, and then dozed off! In the time it would have taken me to either speak to a doctor about getting something to make her less agitated, or tried to get her to sit in her chair by telling her where she was, what had happened to her, and answered the repeating questions, thereby increasing her agitated state, I had simply taught her to relax her body and her mind for long enough for her to fall asleep.

So...

It works! So much so, that I am taking this further, starting with teaching mindfulness and meditation to my colleagues and other staff at the trust I work in.

Coming back to the news today, though, makes me feel a slight disappointment. Not because I don't think the tablet will work, as it sounds very effective; but because it compounds the all-round belief that we can only be fixed with conventional medicine. It reinforces the increasing belief in our society that the NHS can be relied upon to fix everybody, and it increases the "clinical" perception that society's health can only be managed "clinically". We are generally losing our ability to see things more holistically, that there can be some other frameworks that support an individual to take better care of themselves, manage their existing conditions as a "bundle" of care rather than singularly; and that by teaching people to connect within to understand why, for example, they feel the need to drink 3 pints of beer a night, they might be able to reduce their intake and feel healthier as a result.

Zen and Jam

I was given a windfall of plums, this week, by my friend the Jammy Bodger. Today was my only chance of getting some jam made, as some of the plums were starting to look a bit mouldy.
I love making jam. But I make such a horrible, sticky mess that the processes of washing up, and scraping dried jam juice from my oven and pans take the edge off the occasion.
Today was no exception. Well actually, it was an exception, because today I made more mess than I've ever made, before. I let the pan boil over; the bowl I used for the stones and the skin wasn't big enough, so plum juice dripped down the sides, onto the worktop, and down the cupboard door.
For a while, I wondered why on earth I was creating such chaos for myself, when normally, I would at least try to keep things organised.
Eventually, I realised what I was doing; I was inappropriately multi-tasking, resulting in something Not Quite Right. Whilst the plums were bubbling away, I went off to do some jobs on my laptop, in another room. One of the jobs on my long to-do list for today involved making a phone call. The phone call reminded me that I needed to send someone an email; and when I opened up my email inbox I found 3 emails I needed to respond to. In the midst of this, I could hear my oven timer beeping, telling me it was time to dredge the skin and stones from the bubbling pan in the kitchen.
So then, it was no wonder I was finding the process of making jam very frustrating; the emails I needed to take action on seemed difficult to do; and my to-do list was starting to annoy me, with my inner voice sarcastically mocking me: "Ooh, you think you're so clever with your list-making, why not add to the list just to prove how much you can do in a day!"
After an hour of pacing up and down the hall between laptop and sticky pan, I decided enough was enough, and focused on the one task. The jam-making. But I found myself rushing, trying to get on to the next task, whilst separating plum stones from flesh, and making a terrible mess of it. My patience was starting to wear thin.
At this point, I stopped, and thought about what was happening. Today I have had some big challenges to deal with, including life-changing decisions which I'm now following through on; the to-do list had to be completed, it couldn't wait until next week because I'm back at work; the jam needed making before the fruit rotted away; and it's Friday. Fridays are supposed to allow me to be a bit more gentle with myself, instead of over-analysing, over-reaching, and doing too much at a time. No wonder I was feeling impatient.
I changed. I took a deep breath, and completely focused on those plum stones. I had over 3Ibs of plums to go through, which were checked carefully before placing back in the pan. I ignored the mess, I'd clean it later. I just concentrated exactly on the task in front of me. I began to enjoy it. A sense of fulfilment about completing the task filled me, and at the end, I had a taste of the fruits of my labour: not too sweet, slightly sharp, and with a hint of spice.
That pretty-much sums up my Friday!

Spark or Sparkle? Get connected!

I've been reading the latest reports on what's happening in our world, this week. Ebola; the conflict in Gaza; Syria; Ukraine and Russia; misguided/greedy/clueless politicians around the world making decisions affecting their country and not listening the the masses; then there's the rising obesity, cancers, poverty, famine, the global economy; the death of Robin Williams. All of the above interspersed with adverts trying to influence what car I should buy, what I should be wearing, where I should be holidaying, and how to be thin. Social commentary on facebook/twitter about the above, and the radio making sure views are adhered to. Or to give people a chance to rant about a subject. No wonder I'm feeling glum. In the time it's taken me to even type this list, I'm feeling lower than before I started.
This can't be how life is supposed to be...is it? Are we all hard-wired to strive for our own individual wants, over and above what others needs are? At what point did the human race move from looking after their basic needs - as being satisfactory to a happy life - to tearing apart someone else's to satisfy one?
 I know this is not the case: the outpouring of grief over Robin William's apparent suicide has been immense, and why? Because he was a fantastically funny human being, who demonstrated his ultimate fragility. A fragility which exists inside all of us. His death has struck a chord with many.
What's happening in the middle east is becoming a prominent news feature every day, and as such is no longer hard-hitting. A couple of weeks ago, whilst eating breakfast in a hotel dining room, the TV was showing the BBC news and weather. As the news items rolled, it reported the latest death toll of the Palestinians: nobody moved. Nobody watched the item. Heads down, shovelling in their food. A moment later, and the weather forecast came on the screen: heads swivelled to watch in anticipation of how hot it was going to be, and whether raincoat or sunscreen would be required, for the day. A hush fell in the room. As soon as the report had finished, people went back to eating. How can this be? Is this English-ness? Is this apathy? Is this a tolerance thing? Is it tolerable to hear how children are dying because of an arguement over land and religion as a means to power and control? I feel the answer to this is "yes" - because we are flooded with the news all the time. We are becoming hardened to war atrocities, because it is something happening far, far away, and it doesn't affect us, at all. Does it?
You know what? It does! It bloody well does, you know. Why?
The fact that someone is more bothered about the weather in their town than fighting and killing going on in another part of the world, is a worrying symptom of how our societies are becoming disconnected with each other. My ability to continue to empathise and feel the need to help relies on my emotional intelligence, that which lights me up inside. How would I feel if I were in a refugee camp in Syria with my children? Not being able to go back to my home. How does it feel to be too scared to leave the house for fear of being raped, killed, or arrested? How does it feel to bury a child? How does it feel to lose everything in the blink of an eye? How does it feel if I forget my umbrella and it rains because I didn't listen to the weather report that day? I get wet: so what?
The thing is, it seems that there are more people who are willing to loudly complain about getting wet before they go home to shower and change into something warm and dry, than those who are shouting about the injustice in the world, and who are prepared to hold out their hand to help a fellow human being. A disproportionate power who want to seek revenge and kill, in comparison to those who are prepared to connect with themselves and others, and find out what has made them feel that urge and make a change. That's why we are all affected by apathy or a lack of empathy. I know that there are movements, campaigns, and positive ways in which social media is helping to influence societies and governments and those in power, but we need to make more of a connection with what's going on in the world, and pay attention. We are all affected in some way by the actions of others.
I was waiting to pay for my food in the supermarket a few days ago, where the store is being refurbished. It was quite busy, and there was an older couple behind me getting really cross and complaining about having to wait to pay for their trolley full of items, despite a free till which was for "baskets only". "So what?" I thought. "The man at the till is doing his job. There are a number of people walking around with baskets, and a larger number with trolleys stacked full of food".
The woman started to raise her voice in annoyance at this, referring to the "stupid idiot" at the till who had refused  to serve her. I wondered whether the young assistant had heard her, and if so, how he would have felt to be insulted like this. I made eye contact with her. The woman continued to complain. I smiled as I listened, then said, "Ah well...never mind. Let it go! There are worse things going on in the world, right now! A few extra minutes queueing won't do you any harm." She stopped in her tracks, took a step back from me, then whispered, "You're right. Of course not." She was so wrapped up in her own head, thoughts, irritation, that everything else had become insignificant. But given an opportunity to see another view, she made a connection with her own feelings, and realised that it didn't really matter, in the grand scheme of things. After I'd paid for my food, I went up to the woman, and wished her a lovely weekend. She smiled back at me and wished me the same. Ta-da! Connection made: spark turned into sparkle. Job done!

This is what this blog post is really about: taking a moment to step back from a situation and connect with your self. Just a moment to track what's going on, back to the "spark", and decide whether it is a sparkle to light your inner glow (that which makes you shine); whether that spark starts an unstoppable fire (that which provokes a sense of a need for revenge or retribution); or whether that spark should be extinguished before it causes any damage (the awareness of negative feelings and acknowledgement  before letting them go without consequence). And if it ain't gonna make you shine brightly enough for others to see and share their light with yours, then don't set the sparks off in the first place. As Ghandi said, "You must be the change you want to see in the world".

Meditating Play

I love these big bowl swings. I find my inner child coming out to play whenever I'm near one: there's nothing like sitting in the swing, and the feeling of swaying back and forth through the air. Today we went to the park for a play, and opportunistically, I gave a guided meditation.
Being comfortable, lying in the swing, and being aware of the feeling of the pull of the earth as the swing sways back and forth. The body being pulled down and up as the swing moves. Breathing easily and slowly, in time to the sway. Closing the eyes, to really experience the feelings of movement; and that barely perceptable pause before the swing moves in the opposite direction. Each sway is a moment in time. Experience that present moment, before it's gone and replaced by the next. Like a clock ticking: tick...tock...
Each moment is different to the next. Each sway is slightly slower, slightly shorter. A fraction of time slower. As the swing continues swaying, so the present is ever changing, so the moment is different. Focusing on each moment. Each sway leaves a greater feeling of calm, of peace. Relaxing into the seat. A constant change. A constant movement, whilst the body stays still, the mind is quiet. Feeling the body react to each sway, slowing down...slower...slower...almost still. Quietly resting, a tiny movement in the swing. Calm, slow breaths, calm, quiet mind. Peace. Being held in the air, supported by the swing as it gently moves in the breeze. Quietly resting in body and mind, feeling calm and peaceful. Happy.