Mental Health Awareness Week - Anne Crook

Anne Crook - counsellor

Wandering around the supermarket last weekend, I hadn’t expected to come out of the shop with a guitar in my trolley. And, I certainly didn’t expect to be blogging about my efforts to learn to play it as one of my 5-a-day Mindapples. More about Mindapples later.     

As it is for most of us, music is a big part of my life. I’ve always been envious of people who can pick up an instrument and give us a great tune. When I saw the guitar, I said to myself,‘It’s now or never', particularly when I remembered that I had promised myself to try out new experiences as a significant birthday approaches later this year. One week on, I can just about play Swing Low, Sweet Chariot.

I am a counsellor and I work within the psycho-oncology team at The Christie. We offer psychological support to patients who have been referred to us by their healthcare team. Cancer and its treatment is a huge emotional challenge and it is a great privilege to listen to someone tell their story and to help them make sense of the rollercoaster ride of emotions.

Prior to working at The Christie, I was a counsellor working with people affected by blood cancers at a large, London teaching hospital. I loved the work but after 20 years in the frantic pace of the capital, the time came to move back to the North West. We wanted a garden rather than a window box, easy access to proper countryside for walking and to be closer to family. When a job came up at The Christie (and counselling jobs in cancer are extremely scarce), the pieces fell into place and we made the move. Having previously lived in Kenya and Amsterdam, I hadn’t expected it to be so difficult to settle again in a new location. We missed our friends. However, my lovely psycho-oncology colleagues made it very easy to make new friends, despite our differences in support for rival football teams.

Mental health is important for each one of us but we                         

often struggle to talk about it. I have great

 relationships with my colleagues but as someone             
 who is private, it seems strange to reveal my
 guitar-playing. I can imagine how much harder it
 would be to talk about  feeling l ow or anxious.
 As a team, we are keen to  make it as easy for
everyone at The Christie – patients,  visitors and
 staff to think and talk about mental health  as it is
 to talk about physical health. Mindapples are a
great way to get us thinking and talking about our
 mental health.

What are Mindapples? Well, just as we are all encouraged to eat five portions of fruit and vegetables a day to look after our physical health, Mindapples are those day-to-day activities that we can do to look after our mental health. When we asked patients, visitors and staff at The Christie what they do to look after their mental wellbeing, they told us that walking the dog, having coffee with a friend, watching a favourite TV programme and all of the other day-to-day things that we sometimes take for granted, made a difference to how they felt.

Research suggests five ways to help us feel well in ourselves:  Be physically active, be sociable and connect with others, be kind and do something for someone else, be aware and take notice of what’s around you and be open to try out new things.

I reckon that my guitar project ticks a few of those boxes although my current act of kindness is to practice in private. More Mindapples such as cooking for friends, walking in the Peak District, tending my veggie patch and screaming loudly at football on the TV all help me feel connected to myself and others.

The second week in May is Mental Health Awareness Week. This year, the theme is Stress - are we coping? Stress is when the pressure is too much and we feel that the demands on us seem to outweigh our resources to cope with them. Much of my work is helping people to rediscover that they do have the resources to cope with the challenges that cancer brings.

We begin Mental Health Awareness Week with Mindapples Monday - What are your five-a-day Mindapples that you do to look after yourself? Treat Tuesday is an invitation to share a random act of kindness for someone else, perhaps a smile in the corridor or a word of encouragement. Wake UP Wednesday reminds us that physical activity is always good, whether that be some gardening, a walk or a dance. Therapy Thursday invites us to take notice of what is around us and to be present in the ‘here and now’ – stop for a moment and notice the buds on the trees. We complete the week on ‘Friendly Friday’. We hope that lots of people will visit our display in Oak Road and post a thank you for a person, an experience or an activity that has helped their sense of wellbeing.

Come and visit our display in Oak Road on Monday 14^th May and tell us about your own five-a-day Mindapples. If I’m feeling brave, I’ll play you a song!

Patients really have been at the centre of everything we've ever done - Gillian Goodwin

Gillian Goodwin - quality improvement nurse

In the lead up to International Nurses Day this Saturday, Gillian talks about her nursing career at The Christie over four decades. Each day this week Gillian will share her experiences by each decade.

I have worked at The Christie as a nurse for more than 34 years and have seen many changes along the way; not just the many patients and colleagues who have come and gone, but the changing fabric of the buildings and the ever advancing treatment technologies and nursing practices. What has not changed, however, is the Christie ethos of always putting patients at the centre of everything we do. I witnessed this myself as a Christie patient back in 1982 and realised that The Christie was where I wanted to launch my nursing career. So in September 1983 I arrived at the Christie as a newly qualified staff nurse and have been here ever since!

2010s

A significant change in the 2010s was the move towards paperless working. For nurses like me raised in a computer-free environment this proved to be a challenge. However, the introduction of patient electronic records has enabled massive improvements in the quality of the data and information recorded.

Nursing was by now branching out into all sorts of new areas giving nurses many different career opportunities. Nurses were skilled in areas that had been the sole domain of doctors back in the 1980s – minor surgical procedures, diagnostic techniques, advanced intravenous procedures and treatment deliveries, prescribing of medication to name a few. Nurse-led clinics and services were expanding and nursing students were now being educated to degree level. As a member (between 1979 and 1983) of one of the early cohorts of pre-registration degree programmes (when ‘degree nurses’ were held in suspicion and seen as a threat), I welcomed this shift.

By the 2010s I found myself working mainly in quality improvement and this provided some great opportunities for developing QI at The Christie. I worked jointly with colleagues to devise a framework for improving quality in ward areas and recognise excellence. We named the scheme The Christie CODE. We developed nursing standards in the fundamentals of care together with measures against which care quality could be determined. The development of an electronic tool allowed wards to enter measurement data and review status against the requirements of gold status accreditation.

I have witnessed all our in-patient wards achieve the standard necessary to be accredited by the Trust. While proud of their achievements, I am also very proud of the success of the scheme itself which is recognised across the trust as being reliable and robust.

So as the 2010s draw to a close how do I feel about all the changes? Was it better then or is it better now?

While I have fond memories of my early years as a nurse; nursing now provides many more opportunities for both personal and career development. The 80s represented a gentler time when patient care was less technical and nurses had more time to provide supportive care. We had time to talk to our patients without the pressure to get a dozen other jobs done!

Today patients benefit from all the regulations and new technologies that were absent in the 80s. They are now partners in their care and treatment, and there are systems in place that ensure it is delivered safely and to the highest standard. That’s not to say we didn’t give great care back in 1983 – we did the very best we could with the knowledge we had at the time and the patients were then, as now, at the centre of what we did.

It's a new millennium and the time for a career move is fast approaching - Gillian Goodwin

Gillian Goodwin - quality improvement nurse

In the lead up to International Nurses Day this Saturday, Gillian talks about her nursing career at The Christie over four decades. Each day this week Gillian will share her experiences by each decade.

I have worked at The Christie as a nurse for more than 34 years and have seen many changes along the way; not just the many patients and colleagues who have come and gone, but the changing fabric of the buildings and the ever advancing treatment technologies and nursing practices. What has not changed, however, is the Christie ethos of always putting patients at the centre of everything we do. I witnessed this myself as a Christie patient back in 1982 and realised that The Christie was where I wanted to launch my nursing career. So in September 1983 I arrived at the Christie as a newly qualified staff nurse and have been here ever since!

The 2000s

By the time the new millennium dawned I had been a ward sister for 12 years and, despite continuing changes in nursing at The Christie, I felt I was in a loop. Challenges were just old challenges wrapped up in another guise. The time for change was fast approaching.

An opportunity arose for me to leave bedside nursing after 20 years for a role in quality improvement and staff support. I became co-leader of a project to achieve Practice Development Unit (PDU) accreditation for Wards 1, 2 and 3. This was supported by The University of Leeds from which PDU accreditation would be awarded. The biggest challenge was persuading ward nurses that positive feedback from patients was not a licence for complacency and that, in the new millennium, care quality would come under much greater scrutiny. Well we got there and the three ward ‘unit’ became an accredited PDU in 2005.

My role at that time also involved supporting newly recruited nurses during their first days on the ward and also nurses struggling to meet the needs of the role. Nursing performance was by now being formally assessed through annual appraisal and managers had become proactive in dealing with poor standards. Back in the 1980s poor performance among nurses seemed to be rarely challenged or acted upon.

This exciting, fulfilling stage of my career was quickly marred, however, by the advent of Agenda for Change and, in my opinion, the brutal affect this had on many nurses, including myself at the time. By now I had won promotion to H grade as a Practice Development Nurse and found myself virtually ‘demoted’ when nursing grades were replaced. This was the low point even when on appeal this was partially remedied, I still felt that I had taken a backward step.

My role and career direction moved about a great deal during the noughties. My role evolved, evolved again and eventually I found myself in need of a completely new job description.

The emerging revelations of events at Mid Staffordshire Trust resulted in a groundswell of change that affected nurses then and continues to affect nurses to the present day. Nursing has never been under so much scrutiny and mid-Staffs saw the advent of increasing amounts of nurses’ time taken up with recording evidence of the care they deliver. This was not just recording care given but participation in audit and other data collections. The irony was that nurses’ time to care started to be eroded.

Tomorrow - the 2010s

Computers and carpets on the wards, things were changing in the 1990s - Gillian Goodwin

Gillian Goodwin - quality improvement nurse

In the lead up to International Nurses Day this Saturday, Gillian talks about her nursing career at The Christie over four decades. Each day this week Gillian will share her experiences by each decade.

I have worked at The Christie as a nurse for more than 34 years and have seen many changes along the way; not just the many patients and colleagues who have come and gone, but the changing fabric of the buildings and the ever advancing treatment technologies and nursing practices. What has not changed, however, is the Christie ethos of always putting patients at the centre of everything we do. I witnessed this myself as a Christie patient back in 1982 and realised that The Christie was where I wanted to launch my nursing career. So in September 1983 I arrived at the Christie as a newly qualified staff nurse and have been here ever since!

The 1990s

By the 1990s things were definitely changing. Hats were finally abandoned and nursing specialism at The Christie was very much on the rise. Nursing hierarchies had been established with the introduction of pay grades A-I back in 1988 and we witnessed the demise of the enrolled nurse as many opted to convert to become registered nurses.

At The Christie nurses began to expand their roles. Ward sisters began to take on the duty manager role out of hours, and I remember many an hour wandering through the medical records library trying to trace sets of notes (usually to no avail – remember this was before electronic notes tracking). Ward nurses began to take blood samples from patients and more nurses were training to insert IV cannulas and administer chemotherapy.

It was a time of great change within the NHS and we saw the introduction of the patient’s charter which set out a number of rights and entitlements for National Health Service patients. Patients began to assert themselves.

The 1990s witnessed the emergence of ‘Project 2000’ nurses – those that trained to diploma level in higher education rather than schools of nursing attached to hospitals. The increase in theory and reduction in practice left many of them ill-prepared for their role as ‘hands-on’ nurses. Newly qualified nurses often needed a lot of support adjusting to the demands of the job.

It was a time when I really grew into my role as a ward sister, and for the first time sisters were involved in recruiting their own staff – shortlisting and conducting interviews. Prior to this you got whoever the nursing officers appointed for your ward!

At the beginning of the decade, The Christie became one of the first NHS trusts in the country and, for the first time, was able to manage its own affairs. A senior managerial penchant for hotel-like interiors rapidly came unstuck when carpets were introduced in ward areas. Over time, no amount of cleaning could eradicate the offensive smell that was inevitable through normal ward activity and the inability to mop spillages. I personally invited executive managers onto my ward to give them first-hand experience. The carpets were soon ripped up! One benefit of the Trust's newfound freedom was the decorative upgrade of many clinic areas including my own ward – Ward 4. Nurses had a say in selecting wall paper and furnishings for the first time.

Computers arrived on the wards in the 1990s – a foreign concept to all but the youngest nurses. Of course we couldn’t do much with them back then; they were largely used for reading blood results. Still, it was a step towards the 21^st century! Then there was a huge amount of panic over ‘The Millennium Bug’ which of course turned out to be a storm in a teacup.

Tomorrow - the 2000s

I have worked at The Christie as a nurse for more than 34 years and have seen many changes along the way - Gillian Goodwin

Gillian Goodwin - quality improvement nurse

In the lead up to International Nurses Day this Saturday, Gillian talks about her nursing career at The Christie over four decades. Each day this week Gillian will share her experiences by each decade.

I have worked at The Christie as a nurse for more than 34 years and have seen many changes along the way; not just the many patients and colleagues who have come and gone, but the changing fabric of the buildings and the ever advancing treatment technologies and nursing practices. What has not changed, however, is the Christie ethos of always putting patients at the centre of everything we do. I witnessed this myself as a Christie patient back in 1982 and realised that The Christie was where I wanted to launch my nursing career. So in September 1983 I arrived at the Christie as a newly qualified staff nurse and have been here ever since!

The 1980s

So what was The Christie like back in 1983? The hospital was managed by the local (South Manchester) health authority along with Withington and Wythenshawe hospitals and certainly did not enjoy the financial freedoms we have today.

This was eight years before the advent of NHS trusts. There were a lot more inpatient beds back then and there was just a fraction of the ambulatory activity we see today. The wards in the older part of the building – 1, 2 (now OAU), 3, 4 and 5 (now endocrine unit) were all long ‘Nightingale’ style wards with beds running along each side of the ward. The bed spaces still bore the wooden and brass plaques on the wall in recognition of the group or individuals that funded the first bed in the particular space in pre-NHS days. Ward 4 bore a plaque at the ward entrance to commemorate the ward being opened by the Duchess of York (later to become The Queen Mother), all sadly lost in subsequent refurbishments.

Every ward had a cupboard somewhere for storing the nurses’ paper hats which invariably tumbled out every time the cupboard door was opened!

Back in 1983, the ‘nursing process’ (holistic model of nursing care) was just six years old and was the nursing model used only on the Christie wards that had students. Other wards still operated a task orientated style of nursing which seemed archaic to my novice eyes. I thought ‘back rounds’ (backs and bottoms washed, rubbed, powdered one after the other) were a thing from the distant past

Much of the trust activity in 1983 centred on radiotherapy and surgery, with chemotherapy a much smaller service in its relative infancy. While the risks associated with radiation were well known, and we all had the inverse square law (distance) and time drilled into us, the same cannot be said for chemotherapy where personal protective equipment was unheard of!

Advances in cancer therapies have, in subsequent decades, seen the demise of some of the treatments offered to patients in the 1980s. Caesium needles (inserted into either tongue or rectum) and cobalt moulds (worn externally) have long gone and patients having abdominal CT scan no longer have the indignity of a warm water enema prep. Better anti-sickness medications have replaced the use of sedatives to enable patients to cope with chemotherapy regimens, allowing them to eat and drink properly. Our young men with teratoma had a difficult time back then.

In 1983 the hospital had one specialist nurse for delivering chemotherapy on ward 12 – that was it! Even the stoma nurses who visited wards 9 and 10 on certain days were based in another hospital. Research nurses were unheard of.

During the early 1980s most nurses lived in dread of ‘The Change List’. Staff nurses were routinely moved around the wards each month on a completely ad hoc basis and each month I would scan the list anxiously to check that my name wasn’t on it. Alas after six months working at The Christie my name appeared. During the 1980s I gained nursing experience in a number of areas – Ward 4, Ward 1, Ward 3, Ward 5&6, Ward 10 and Radiotherapy Theatre. It was to Ward 4 however that I returned as senior sister in 1988.

Movement from one ward to another would, in those days, often be accompanied by a dunking in the ward bath on your last day on duty. I had the dubious pleasure of this ritual when I left Ward 10 to take up my promotion on Ward 4!

Tomorrow - the 1990s

I'm running 150 miles through the Sahara desert for The Christie charity - Rob Duncombe

Rob Duncombe - director of pharmacy

Rob Duncombe

On Easter Sunday my mum leaned across the table towards me and told me I was stupid… about five minutes later she told me again how stupid she thought I was.

What had led to mum coming to this conclusion was that I had told my family about my intention to run the Marathon des Sables in April 2019.

For those who don’t know (and this initially included my parents and brother) the MdS as it is known is one of the hardest, most gruelling and challenging foot races on the planet. It takes place each year in the Sahara desert,over six days, and covers about 150 miles.

The terrain is sand and rock and part of the essential kit includes signalling mirrors and an anti-venom kit. If this was not hard enough, you have to carry your own kit (with the exception of a tent) and sufficient food for the six days, and water is limited.

During the lunch two questions emerged: Who are you going to run the MdS for? And why are you doing it? The first question was very easy to answer, the second almost impossible.

Who am I going to run for? I am going to run for The Christie – and hope to raise about £10,000 in sponsorship/donations. It is my intention to fund all my costs of entry and kit (about £5,000) so that every penny I raise will go to The Christie.

For those who don’t know me I am the director of pharmacy at The Christie. I feel extremely honoured and proud to have this role, and I believe I am fortunate enough to work at one of the best hospitals in the world. On a day to day basis I see the amazing work we do here, and the huge difference we make to patient lives – not just through the research we do, but also through the care and attention everyone gives to supporting our patients through what has to be one of the most challenging periods of their lives.

During the course of the year through blogs I’m planning to write I will share some more about the work of the pharmacy team at The Christie and my vision for a department devoted to improving how we use medicines in cancer patients.

Why am I doing this? In all honesty I’m really not sure. It is certainly not for reasons of fitness. It is quite possible to be reasonably fit without the need to run across the Sahara. I’m not doing it to prove anything to myself. In the past two years - having come to marathon running late in life - I’ve run five marathons, and if I wanted to I could run a marathon every couple of months for the next five to 10 years. So it has to be something deeper – a desire to do something slightly extraordinary, and to push myself to my absolute mental and physical limits.

People tell me that running the MdS is a life-changing experience and that after the MdS you have a different outlook on life. At the moment I am at the very start of this adventure, and everything I do over the coming year will hopefully get me in the very best physical and mental shape I can be to take on this challenge.

If you have taken the time to read this, can I ask two things: that you follow my progress during the year via Twitter @DuncombeRob and send me messages of support. The more people I know are supporting me the easier this will be AND when the time comes – please sponsor me.