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SoWhoCaresAnyway E20 The Silent Strength of Resilient Teams · SoWhoCaresAnyway

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Hello and welcome to So Who Cares Anyway, the podcast that shares learning, innovation and ideas from the world of health and social care and beyond.
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My name is Ruth Germain and I'm inviting you to join me each week with my inspirational guests to hear about who cares.
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What they do, their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and wellbeing of people in our communities.
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I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
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People from healthcare, social care, the voluntary sector, community groups, and more.
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To join me each week to find out, so who cares.
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Anyway, to find out more about me, who I am and what I do, please head over to my website, www.reflectiveruthconsultancy.com,
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where you can also catch up with previous episodes and read my blogs.
Hello and welcome to the next episode of So Who Cares.
Anyway, and today I'm delighted to be joined by Grace Cook.
Now, grace works for the Foundation of Nursing Studies.
I've said that correctly, haven't I? Grace? Yes.
So yeah.
And who works there as a person centered practice facilitator.
And I've been really quite interested in the foundation of nursing studies for some time.
And particularly what's interested to me is the resilience based clinical supervision that links in with the emotional labor that Dr.
Rebecca Myers was talking about in one of my earlier episodes.
So I went onto an event and Grace was there, and I also messaged the Foundation of Nurses Studies as well and said, I'd really like to have somebody on the podcast.
So.
Welcome, grace.
I'd just like to rehearse over to you and just ask if you can give a little brief of a brief introduction please.
Um, thanks Ruth, and it's lovely to be here as well.
So yeah.
Hi everyone.
My name's Grace.
I am a, a person-centered practice facilitator at the foundation of nursing studies or funds as we are known for short.
So I'm a registered mental health nurse by background and I've been with funds.
Oh gosh, for about nearly four years now, which feels like it's flown by.
So, uh, I lead resilience based clinical supervision program and do a lot of facilitating both with resilience based clinical supervision and then some of our other programs, which are, well, everything we do at funds is underpinned by person centeredness, and that's what we do.
Okay.
Thank you, grace.
So before we go into that, and I'll get you to talk about some of those bits a bit later on, the resilience based clinical supervision, that person centeredness, because probably there's a lot of people listening that are wondering what they are, but I just wonder if you could take us back a bit.
So you've said that you're a registered mental health nurse.
What brought you into nursing and mental health? Nursing.
Well, well, I kind of fell into it to be honest.
It is interesting.
We've just done it for International Nurses Day.
We developed a booklet about our inspirations, and I come from a family of nurses.
My mom's a nurse.
My auntie's a nurse.
My grandma was a nurse.
And my mum thinks I went into mental health nursing, 'cause she was a lecturer when I was born.
And she used to take me to work with her on a Friday when I was a baby.
And she used to work in these porter cabins that were in the grounds of a mental health hospital at the time.
And she said that they'd often have the same people kind of walking past each day.
So she.
Thinks it's 'cause of that, but actually when I left school, I wanted to be a psychologist and I went to university.
I did psychology and criminology, and then I thought, well, what do I do now? At the time, there wasn't really any jobs in psychology.
You had to volunteer basically, and I didn't have enough credits.
To do psychology or criminology solely.
So I would've had to do a master's, and my mom was working at the University of Nottingham at the time and said, have you seen this program? It's mental health nursing.
There's a bursary you can live at home.
And so I did it and I just completely and utterly fell in love with it.
So I did the postgraduate diploma.
In mental health nursing at the University of Nottingham, and I loved every minute of nursing.
I loved connecting with people on a long term basis and helping make people's lives that little bit better.
So my dream of being a psychologist went to the side.
I.
And yeah, I stuck with nursing, so that was about 10 years ago and I suppose I kind of follow suit.
I'll carry on if you want me to.
I do.
I was very lucky with my experience with nursing.
I mean, it was a tough, it's tough being 22, isn't it? It's, and there was a few things happening.
I was doing a condensed course, so the postgraduate diploma was in kind of.
Two years, you couldn't have any time off.
We had family bereavement and I was finding it really, really tough, but I had clinical supervision as a student nurse and it was part of my placement hours, and that for me was like a lifeline.
So I was finding things quite challenging.
And when we were on placement every two weeks, we'd go back into university and we'd have clinical supervision, and then I qualified.
I'm like, well, where is it? You know, we had it to some extent.
In where I worked when I first qualified, but.
Not massively and not the type I was used to.
I was used to going back to university and having this safe space where I could reflect with a facilitator that I trusted and it was focused on me and my experiences.
Whereas when I went into practice, it felt like it was very much focused on even management and if you finish your preceptorship stuff yet, or focusing on a particular patient that we were looking after, which was really useful.
But actually there was nothing for me.
And that's when I fell into developing resilience based clinical supervision with the University of Nottingham because I'd found this really helpful when Professor Gemma Stacy reached out to all her old students.
'cause she was my personal tutor at university.
So another thing I was very lucky at.
Yeah.
So the people that don't know Gemma developed resilience based clinical supervision as part of her PhD and she asked for some volunteers.
So.
I mean, I look back now and I think, what was I doing? I was working full time.
I lived three hours away from Nottingham, and I decided to become a volunteer at the University of Nottingham, and because it was something I was really passionate about because it had kept me in nursing, and I think without that, I never would've finished my course.
Wow, that's incredible grace.
And you've taken us through, you've done it quite succinctly actually.
It's really nice.
So you've taken us through from what brought you into mental health nursing, and I'm gonna go back to a question about that in a minute.
But you've taken us through that bit and then you've taken us through to the fact that you had this clinical supervision as a student.
Realized it was missing when you went into practice and what was, there was very sort of management focus to say, have you done this bit? Have you that done that bit? So probably felt a bit tick, boxy.
Would I be right in saying yes? Yeah.
And then there was this opportunity for you to go and develop something that would work with somebody at university.
And you've done that in your own time, presumably.
'cause you were volunteering.
Yeah, in my own time to start with, but then I was very lucky 'cause part of my volunteering was to put in for a grant.
So we got some money from Burette Trust for nursing to develop this model and then to evaluate it for student nurses and then for newly registered nurses, so.
That kind of taking that first step and saying, yeah, I want to be involved in this.
It's something I'm passionate about, meant that I then on top of my full-time job, had a second job after about a year, I think I did get a bit of money for it, so that was good.
Yeah.
But obviously quite full on.
Yeah.
So there was quite a journey there, but you've obviously achieved quite a bit and we're, we'll carry on with it in a minute.
I just wanna ask a brief question for people that might be listening.
So you talked about earlier on.
It does.
Just a brief answer is gr fine grace, really.
But you talked earlier on about the fact of being a clinical psychologist or going into psychology.
Yeah.
And then going into mental health nursing.
So for anybody who's listening, who's perhaps been for, been to a clinical psychologist or perhaps hasn't, how would you describe the difference? And I might be putting you on the spot here, grace, but is, is there a way that you can just sort of sum up to people so people can perhaps start to visualize that there is a difference in what that is? Yeah, so I suppose a clinical psychologist offers psychological therapies.
Often they might be time limited, they will have a certain psychological theory behind them.
For example, it might be a cognitive behavioral therapist, and they would offer you CBT and.
With a mental health nurse, you would often see much more often they would do therapeutic work that may be influenced by psychological therapies, but you tend to go on more of the full journey with them.
So they would look at other things as well.
So when I was a care coordinator, for example, in the community as a mental health nurse, it wasn't just people's.
Mental health, but actually them as a whole.
So people would see the clinical psychologist to have psychology, and then I would talk to them about, you know.
Their home lives, social things, so lots of other things, not just the psychology.
Sorry.
I'm not sure if that's very succinct or not.
Or if it makes sense.
No, that's, yeah.
Yeah, that makes really good sense.
Yeah, and I think it brings us back onto the next question that I was going to talk to you about, which is about that person centeredness.
Because you talked about, and I'm not saying that a psychologist isn't person centered, but you, the way you've explained it there, I think a nurse has more time to look at that.
Holistic care and that person centeredness.
And I just wanted to visit with you as well.
How would you des describe person centeredness and what does that actually mean? Yeah.
Yes.
So there is the person centered practice framework, so I would highly recommend if anyone is interested in person centeredness.
There's a book, tried to see it from here.
Called, I think it's called Person Centered Care, but I can send you the link afterwards, Ruth.
Yeah.
And it's in show notes by Brendan McCormack and Tanya McCance.
And so this is the only theoretically underpinned framework for person centeredness, but essentially for me.
It's seeing the person.
We are all persons.
And what makes us persons is our experiences throughout our life, the people we spend time with, and what's important.
It matters to me.
And I think the simplest way of saying that is, and people may have heard it before, instead of asking someone.
What's the matter with them? It's asking what matters to you, and actually when we can think about what matters to a person that helps us to care for them in a way that is going to help them to thrive, I'd highly recommend people look at the person-centered practice framework.
I.
It's really useful.
Thank you.
And we've put that link in the show notes, but it does, it links in really well.
So last week I spoke to somebody to a lady called Dear who is an expert by experience, as well as other roles, but she was talking about her love of travel.
I.
And how difficult that was or is, should I say? And actually, by understanding that that's what matters to her, then rather than seeing her as somebody who is disabled in a wheelchair, which is how many people see her.
They see her as somebody who has lots of assets and has hopes and dreams just like everybody else.
So actually, how can you facilitate her to achieve her dreams rather than thinking about, oh, actually for me, I just see all these problems because obviously that's not.
The way that she lives or thinks from a day-to-day basis.
So I think you've described it nicely.
Yeah.
And it's empowering people to not be done too, as nurses.
We don't have to do to everybody, but it's about finding out what they want and helping the, supporting them, doing with and Yes, and helping them do for themselves and do the things that are important and matter.
To them.
And as you say, that will be really different depending on the person.
And unless we ask that, we are never gonna know.
And I think we do have a challenge, don't we, in health and social care that people are getting more unwell.
There's lots of people in hospital.
All the time, resources are low, and actually it's really hard to be able to spend that time, but that doesn't mean we can't have person-centered moments and we can't develop person-centered cultures of working where staff are treated as persons as well.
Because if we as staff members, as nurses, staff don't feel that we are valued and what's important and matters to us happens, then we can't provide that for other people.
We give what we get, if that makes sense.
And so unless we feel like we work in a person-centered culture where the leadership treats us like people, and we get to work with what's important and matters to us, then it's really hard for us to be able to do it.
Not impossible, and it can still be done, but it makes it tougher.
Of course.
And really that's what you were saying about the clinical supervision.
What you did see when you first qualified was very tick box like, 'cause it wasn't really person centered around you as staff.
Um, yeah.
And members of the team.
So by not having that, um, supervision done in the, in the right way, you weren't feeling that you were in a person centered team.
So therefore it was.
Harder, and you were presumably aware of that impact on how you were caring for people.
So I wonder if you want to come back round to that resilience based supervision.
I was taking you on a little circle there it feels like, but it was just interesting to hear about it.
So thank you guys.
Yeah, so I suppose resilience based, clinical supervision, as I said before, it came out of um, gem's.
PhD and she was looking at when she was doing her PhD, that transition period from being a student nurse to a newly registered nurse, and I think.
We can all probably relate to the feeling of not knowing what you're doing.
And what she found was that it was really high levels of this, what we'd call in compassion focus therapy, which I'll talk about in a bit of an inner critic.
So that kind of voice in the back of your head that that's very critical of you and others all the time.
And the idea then came to develop a model of supervision that not only supported people in the moment.
But actually help people to develop skills to be able to challenge this inner critic and notice their emotions.
And so it was.
I suppose it wasn't, it wasn't called, uh, co-production at the time, but it was created with the people that were gonna use it.
So there was people within university, the lecturers, I was there as a newly registered nurse.
There was students involved and the Compassionate Mind Foundation in developing this model of clinical supervision for student nurses at the time.
And so it was implemented.
For the last six months of their placements.
And we did some focus groups and we did some scales and then the same again, but with newly registered nurses.
So six trusts across the Midlands implemented it as part of their perception program for for nurses and some AHPs at the time as well, which was a really quite new MDT preceptorship.
'cause this was around 2016 and.
So it was then called resilience based clinical supervision, very specifically because of the outcomes that we found from this.
And I can't talk about all the theories behind it and where it was developed from.
I think one of the key things is thinking about what resilience is.
And resilience is a fairly new concept.
New words used the old Greek philosophers, never spoke about resilience.
And there's different kind of schools of thoughts on it.
And we seem to have gone in a way, particularly within nursing down this engineering model of resilience, that kind of bounce back ability.
You know, something happens and you spring back like an elastic band and you just, it's like keep calm and carry on.
That we're very good at saying within the uk.
Yes.
But actually what we found was it really matched this ecological idea of resilience and this ecological resilience is very much used in the military and it works really, really well.
But it's the idea that.
When we come together as communities and we focus on positive outcomes and we work together, that builds a resilient community as opposed to you needing to be a resilient individual and have to cope with everything that's thrown at you.
So within an ecosystem, if something changes, then everything within that ecosystem will adapt slightly to meet that change and.
I think working in health or social care, it's not that easy, is it? You know, I, I think back to when COVID happens, I learned a lot about myself during COVID.
I'm never gonna go back to the same person I was before that.
And because our brains are really complex.
We are complex as humans, we have things that happen around us that we have no control over.
So you never bounce back to the same.
We are always learning and always adapting, and the ecological definition of resilience takes into account this complexity of where we work live, who we are as humans.
But in order to do that, there has to be different things that, different levels, so, so.
Myself and Gemma did a scope and review and looked at all these resilience things, and all of them were resilience training.
And you go for three hours and they'd say, you do this, this, and this, and then you'll be resilient.
But actually, that's not what makes people resilient.
What makes people feel resilient is feeling that they're part of a community.
They have a sense of belonging and validation, as well as having some tools to be able to cope with distressing situations and that they feel supported.
So.
We found that there was this compassionate flow, so where resilience based clinical supervision really worked, and this probably feels quite familiar to any kind of clinical supervision or thing that people tried to implement by culture change, but where the organization really supported it with resources.
Time that compassion flowed through to the facilitators.
They felt really supported.
A sense of belonging, a sense of achievement, and that kind of came through to the people engaging in the supervision process.
Gave them a sense of belonging, a sense of feeling valued, a sense of containment for the emotions they were feeling, as well as developing these skills in kind of positive reframing, understanding their emotional regulation systems.
And then that came through too.
The people they worked with, so obvious staff members, their patients, colleagues, family members, because they felt that they had a sense of value and belonging.
But it needs that kind of input of resources to be able to get there, because without it, the facilitator can only do it for so long.
You know, I know it's, um, at age I'll saying, but you can only pause for so long from an empty cup.
You have to have it refilled from somewhere.
So it's really important that everybody within the system feels that they get that sense of being valued and different things will help make different people feel resilient.
And I think that's a really key thing when we think about the resilience in the health system.
It is not just on individuals to be resilient.
We have to develop resilient teams and communities and a resilient culture for the individuals to be able to be resilient, and that's how it works.
Yeah, that's really nice because so often I've been to things and it's exactly as you talk about people talking about your bucket being half full and then you go to work and there's some more stress and eventually everything happens and it all tips over and you haven't got any space for doing anything.
You know, sort of one of those analogies and how you can become resilient.
But actually what you're talking about there is that much bigger picture about a team that values people, cares for people.
And the people doing the resilience based clinical supervision, them actually receiving that supervision themselves.
So that whole chain of events and how that makes a difference to the people that being cared for.
So I'm just wondering, grace, if you've got a story or an example that you could share, obviously that might be anonymously, it might be about yourself, or it might be where you were working with a team or perhaps a team that you were supporting where you can demonstrate how this worked and the difference that it made, if that's something you can share with us.
Yeah, and obviously I'm talking for other people, so since I've kind of come out of clinical practice, I get the secondhand, and we do have some stories on our website, but one person in particular.
Comes to mind and they implemented it as part of their preceptorship and for student nurses within a small team and found that people, students were, they went from not recruiting any students to, students really wanted to come and work with them 'cause they knew they would be supported within their new role as an newly registered nurse.
So I think their recruitment went up to like from zero to something like 12 within about two years or something like that.
And this same team then also implemented mindfulness.
So not just saying to internationally educated nurses, this was with not just saying do it, but actually we are gonna do some mindfulness together before your asks.
And the pass rate went sky high.
So from people failing lots of things.
'cause Oscar's, I mean, it's a horrible situation to be in, isn't it? You know, you've got all these tables and you've gotta pass them on and people are staring at you and that pass rate.
It was nearly a hundred percent after they started it.
I just get you to explain oss.
Oh, sorry.
Yes, yes.
The OSCEs are for, so for internationally educated nurses, they have to pass a certain amount of practical exams, so sometimes students have to do them as well.
I add to a hand washing one, so you get watched doing some kind of clinical skill, and then you're signed off on being able to do it.
So it could be like.
Aseptic technique, hand washing, and often, well, sometimes for the internationally educated nurses when they first come here, they don't have their pin until they've done these O skis, so they have to do them, but there's quite a few to do, so they often do them all together.
So it sounds very stressful, to be honest.
Yeah.
I under TKIs when I was doing my advanced nurse practitioner training, and then there was a number that we had to do on the day and you had actors there, mock setups where you went in and everything that you done was ticked off to make sure that you with the different questions to ask or the procedures of clinical skills.
So they are really stressful.
So that's an example for the staff.
And then I'm not sure if you're aware.
But we've been commissioned to offer resilience based clinical supervision programs.
So these programs are to help people become.
Supervisors, so facilitators of this type of supervision across social care.
So we're about 18 months into this program, so we're starting to collect some stories from people and we will be sharing, but one of the stories that we had from someone was, the way they're reflecting it as a team is completely changed, and in particular using something called positive reframing.
And they've been using that as a team and it's changed the way that they respond to challenges within.
The place that they work.
So this is within social care, and they talked about they had a patient that was ringing the bell constantly, like 60 times an hour or something like that.
And you can imagine that it's quite easy to get frustrated with that.
And if we go into psychology, you'd absolutely feel.
The staff getting frustrated, but actually what they've done is they've talked to each other about it and they've positively reframed it and it's changed how they've responded to this person, which means that this person is much more settled and not using the bowel and they working together.
So much more, and this is an example of how when you are coming from a place where you're feeling valued and sense of belonging and you're happy at work, you are able to respond to challenges and frustrations that you have within the workplace in a different way, which has an impact then on the people that you look after.
Wow, that's really good.
That positive reframing, the way that you're describing it there sounds so useful because I know that I've worked on a wall as well where you'd always have the person who was constantly ringing their bell.
I am going back into the eighties, really early nineties, and you'd be thinking, oh gosh.
And you go back and it didn't matter what you'd done, there was always something else that that person might need.
And it is quite.
Difficult to actually deal with at the time.
Um, especially when you've got a whole lot of other people there.
You know, at the time I was on 28 bed ward and it was quite acute, so there were lots of other people to see.
So how do you manage that? So, yeah.
Grace, you've given us a little bit about it.
Could you able to give a little bit more.
Detail or sort of story.
I know that it wasn't you that was doing this, but you've talked about using the positive reframing with the bell.
What, do you know what they've actually done or what that looks like or, so I don't, would it be helpful if I took through what the process of resilience based glucose supervision is and then what? Yeah.
Yeah, because I just thought, I've not actually said what you do.
So resilience based clinical supervision is a restorative module of clinical supervision.
So it's a structural process that people can follow to be able to facilitate.
Clinical supervision that helps people feel supported in practice.
And so one of the other bits of theory that comes under it is from compassion focused therapy.
And it's the idea that we as humans have these three emotional regulation systems and we need these for survival.
So we have a threat system which keeps us safe from danger.
Both very physical dangers.
So you know, if you, for some reason a little bit earlier today, I was talking about buffaloes.
If you go into a field and a buffalo starts snorting at you, you're, you're going to fight, flight, freeze.
So that's why we need the threat system.
It's the same if you're on an ward and someone goes into cardiac arrest.
You need to just respond.
You don't need to think things through, you just need to respond.
The challenge we have as humans is that our brains are really powerful.
So like Ruth for example, you just said there, you were thinking back to the core buzzer going off.
That can trigger off your threat system as well.
So when we think about these challenges that we have or ruminate on things, that kind of gets us full of adrenaline and we go into fight flight mode.
And so it's a really powerful system 'cause it's built for survival.
And then we also have the drive system, which is what gets you up and going in the morning.
So seeking food, shelter, and resources.
And this is linked to dopamine.
So you know that kind of buzz feeling you get when you've got a, a sense of achievement and you feel excited, motivated, and.
So they're two of the emotional regulation systems.
And within society nowadays, you could argue that we spend most of our time between threat and drive because we're always on the go.
Yeah.
We've got constant distractions and constant threats.
You know, we as humans, we're originally not de designed, but.
Evolve to live in small communities and take on the threats of small communities, whereas now we know everything that happens everywhere.
So there's lots of threats around, and we have this pressure also to keep going and keep achieving.
I.
And so the third system is called the affiliative system or the soothing system.
And this is what we need to rest.
So when we rest, when we are present, when we truly connect with other people and we give and receive care, compassion, kindness, and when we do things we enjoy, that releases endorphins and oxytocin and it makes us feel better, feel soothed, wellbeing, a sense of wellbeing, and.
Because we spend most of our time in the threat and drive system, we need to be conscious about resting to try and bring balance to these systems.
And this is where the kind of process of resilience based clinical supervision comes in.
So the whole process isn't just about the learning in the moment, but actually it's giving people a moment to access their soothing system live within a place of work.
So we start.
With developing what we call a safe space agreement, and this is making it really explicit how we're gonna work together for us to all be able to share and to feel safe in this space, and really connect with each of them.
And then we do a grounding exercise, so something that helps us to be present.
So it could be a breathing exercise, it could be, I've done laughter yoga before.
That was quite fun.
Or doing a jigsaw together.
It's just anything that helps us to be in the present moment and then following during that.
So we're in the room, we're present.
We do a check-in, and the check-in is partly about giving a space to think how I'm actually feeling about something.
If you dunno how you're feeling about something, you're not gonna do anything about it.
We really need to kind of be in tune with our feelings because they're warning signs and they tell us.
About what's going on around us.
So we do a check-in to help people identify how they're feeling, but also share how they're feeling.
'cause when we spoke about before that sense of belonging, when you share and you realize you're not the only person that's feeling that way, it really does give us a sense of, I'm not on my own in this, which in itself makes us feel better.
And then this check-in helps us to then move forward to think about what do the people in the room want to focus on today? So what do we as a collective group.
Want to reflect on and we have a reflective discussion.
So part of that reflective discussion is using those emotion regulation systems to think about where you are coming from and where you might want to be coming from.
So for example, you get an email, see red, it's really annoyed you.
It might not even be anything to do with that, but you know, you might get an email asking you to do something and it makes you feel really, really angry because you don't wanna do that.
You've not got time.
Something like that.
If you respond to that email in that moment, you're coming from the threat system and how you respond is probably then gonna make that person that you're emailing back come to the threat system.
But actually, if you take a moment, you do a couple of breathing exercises, you think things through, you might respond in a different way.
But if we don't notice where we are, we don't do anything different.
So reflecting on the emotional regulation systems can help us understand where we are coming from.
And where other people are coming from and make decisions about how we want to respond.
And so one way we can look for different solutions is positive reframing.
I love positive reframing.
I think it's brilliant and there's different ways you can do it.
So.
I've seen things about turning your language you use into a positive.
So rather than calling someone a challenging person, so they have behaviors that challenge me.
So you can change the way you speak and that when we speak in different ways, it triggers off the different things in our brain that helps us think differently and feel more positive.
But there is a four steps to positive reframing, which is really useful.
And people particularly find the first two steps really useful.
And the first step is accepting what's not within your control.
The reality of life is we don't choose a lot of stuff that happens to us.
We don't choose where we're born.
We don't choose the friends we have growing up where we go to school.
The reality of life is we just find ourselves here somewhere.
Yes.
And this has a massive impact on who we are as persons and what our values are, what matters to us, and how we respond to stress as well.
And within our working lives as well.
A lot of the things that happen.
And not within our control.
I mean, I could argue that my mom forced me to become a nurse because she used to take me to work when I was a baby.
Yes.
And I had no control over that.
But yeah.
So a lot of things that happen to us are not within our control.
And there's something about just say, well, what within this situation is not within my control, and I've just gotta accept that there's nothing I can do about this.
The next step is then thinking about, so what actually is within my control? And often what isn't within our control is how we choose to respond to something.
It's easier said than done.
Yes.
But when you make it explicit and you can reflect on it, and you can know yourself a bit more, it makes it easier.
So how we choose to respond to something is often what is within our gift.
So we.
Think about what's within our control.
And then after that, you think about actually what are your strengths in this situation? And this isn't just individual strengths, but what are your strengths as a team as well? And then you think about how can we use these strengths and think about what's within our control, ignore what's not within our control to find and use the positives within this moment.
What can really help us to.
Get through in the short term, what can we maybe do differently using these strengths and thinking about what's within our control to make things a little bit better for ourselves.
And it's a really useful process to go through on your own, but also in a group.
'cause sometimes you can't see the wood through the trees, but actually talking through it together.
It can really help to think and I, I personally find the first two steps, think accepting what's not within my control and then really thinking about what's within my control really helps me to respond in a different way when I feel challenged.
I.
That's really interesting.
Did you say there was a fourth step as well finding and using the positives? That's the one.
Okay.
Sorry.
I did the third and fourth step together.
Yeah, no, that's fine.
I just wanted to clarify.
I wasn't too sure.
So it's finding and using the positives and I wonder that's such a different way of thinking about things.
And I keep thinking about the buzzer scenario that you talked about and I can remember happening myself and people would be labeled and depending who was responding, would vary on.
What the responsible that that person might get at the time, and depending on how tired you were and whether or not you were busy with other people.
Um, so I'm trying to sort of think through it, that actually what you're doing is that when the call buzzer goes off, it makes me feel however, but actually it's not in my control.
I'm not responsible.
I can't stop.
That person pressing the buzzer, we need to make sure they have an access to the buzzer.
It's causing me to have that fight or flight feeling or to feel panic.
That's one of the things I remember thinking, how will I deal with this situation? Because I don't wanna just not.
Look after this person.
'cause they obviously have a need, but I've got all these other people that I need to think about as well.
Yes.
So that's your threat system kicking in and saying, there's something wrong here.
We need to protect ourselves and everyone around us.
And as you say, it feels like panic.
Yeah.
It can feel like panic.
Yeah.
Yeah.
I mean it probably feels like lots of different things, but to me I can remember feeling it, especially if I was in charge of the ward at the time.
I'd feel quite panicked.
And then there's the bit that you say with the next step, which is what is in your control.
It's the way that you respond to that person.
But because you're doing that as a team and you're all thinking about that together, actually that's a lot more comfortable.
'cause it's not just me on that shift at that time with whoever else it is that.
That supported me, who might be a student nurse, might have been an agency nurse at the time, so not always a big backup of people there.
But actually in that handover period, we could have sat down and talked about and gone through this in a resilience based clinical supervision way you've just put to us and thought about actually what is there that we could do for this person and what might change that.
Yeah, and you know what's within your control is ask why.
The question, why are they continually pressing the buzzer? What is it? What need is there that hasn't been met? And you can't meet everybody's needs all of the time, but you can have a conversation about how you can work together to help.
I.
Person and that's responding in a different way.
'cause often when, when we respond from a place of threat, our ability to think just really goes, yeah, it's not our fault.
This is how we are designed as humans.
This is the adrenaline causing through our body just thinking, I've gotta protect you, I've gotta protect you.
And it's not just those kind of very physical things that our brains are really powerful.
So.
The imagination of what could be happening on the other side of our buzzer.
It's as if it's happening.
Our body doesn't know the difference between whether it's happening or not happening, and because we tend to be between a constant state threaten drive, and we have to be very conscious about kind of having the affiliative and the soothing.
What we do is we develop strategies for survival.
So when you're kind of constantly, particularly in threat, we develop ways of managing that and that can be distancing yourself from patients.
So it's always like that flight, but it's in a bit more subtle way.
So I don't get put close to patients.
I don't see them.
I'm not gonna see them as a person because actually to see them as a person is.
It's too much for me at the moment because I've got too much threat, and it's a way of protecting ourselves from danger.
People do different things.
We've got a very good ability as humans to shut down our emotions.
If you knew that.
No.
Yeah.
So I think they call it shut down within compassion focused therapy.
Brene Brown calls it numbing, and what we can do is we can just shut that.
So a way of dealing with threat, but then we don't feel.
The nicer ones, either the more comfortable ones, like excitement and happiness and love, we just kind of numb.
But if we're constantly in threat, that's what we do and you can kind of see how that then has an impact on everybody around you.
And it's not good for us either.
So finding ways to access the soothing system and ringing balance is really key.
And using positive reframing can be a really good way of doing that.
And that the knockout effects of this, I think are are tremendous.
Because you spoke earlier on about how by doing this and using mindfulness, through that resilience based clinical supervision framework, teams found it much easier to employ people, presumably.
So it wasn't just the recruitment, but their retention people stayed.
But then that takes people back to the fact that.
When you do this, then you're more likely to give person-centered care.
And when you're more likely to give person-centered care, then you're more likely to reduce demand.
'cause that buzzer, and it might be people going for constant appointments because they're not getting what they actually really need and people think, oh, they're back for another appointment.
People are actually demanding services.
But actually the reason why they're demanding them is 'cause their needs aren't being met.
So that person centeredness, or people centeredness, however you like to say it, is really important because.
What we are seeing at the moment on our health and care services and so many other sector services is massive demand because people have needs, but they're not particularly being met.
So this is a really important tool, I think, and I suppose staff needs aren't being met either.
I choose and I would like to believe that people come into nursing to help people.
We still get all this stuff around a vocation.
I could go and talk for hours about the kind of vocational element and it being a professional, it's a professional job, but actually people tend to go into it because of personal experiences or because they want to help other people.
And when you are not able to do that.
That is gonna have an impact on how you feel because then the staff aren't living for their values and what they want to achieve through life.
So actually it's about what matters to everyone, because if people had the time to be able to spend with patients or really make a difference, then that would make them feel good as well.
Yeah, it's a different way of thinking about wellbeing too.
It is.
It's completely different and it takes us back to that bit that you were talking about at the beginning, do with which it takes me back to Adam Lent episode of the Do with Movement, but it's not just about doing things with people in our communities, but actually what he said right from the beginning, it's about doing things with our staff, the staff that are actually providing in our public sector.
To whatever sector and whatever profession that are providing services and care, actually doing things with them so they feel involved and they are a part and they're able to meet that need that they've gone into whatever their profession or their role is.
They've gone there for a reason.
And I think you're right.
You know so many people, nurses, but others as well go in because you know they do care and that's something that's important to them.
Yeah.
When they're allowed to care, they feel good, but done.
Two people will do two others as well.
So it's, it's a chain.
It's like the compassionate flow.
It's a chain.
How people are treated is how they will treat others.
So it really does take a, a culture of valuing all the people within the community really.
Yeah.
Yeah.
And that's a really good bit that you've just said there.
Done two people will do to others.
Yeah.
Yeah.
Thank you.
So I'm just aware of time and I'm thinking.
You know, there's quite a lot that you've given here, but I wonder if there's any either key messages or even challenges that you'd like to give people.
And we do have a bit extra people listening, so not everybody who's listening is gonna be a nurse or a healthcare professional.
So what would be your thoughts? What would you want people to take to away from today? Ooh, that's a good question.
I think that.
It doesn't matter whereabouts you work in the health or social care service.
We all need to have a space to reflect, and that's both for ourselves and for the people we look after.
Because if we don't have that space and we continue going, we will not get it.
So whatever your role is, you can ask for that.
Or if you were in a role.
A, a leadership role.
You need to be looking at how you're providing that for the staff that you work with and you look after.
Thank you.
Yeah.
And there's lots of kind of national initiatives that people can look at as a professional nurse advocate, professional midwifery advocate that are available in all NHS trusts.
We have resilience based clinical supervision available for registered nurses working in social care, which is completely free of charge.
So they can come and they can connect with other nurses in social care, have that safe space themselves, but also then learn how to facilitate the people they work with as well.
So think about how you're providing and or accessing supervision in your area.
Or how you're allowing people Yeah.
To, to access that.
So in a way they're sort of key messages, but they are also really a challenge.
Yeah.
So if you're listening today, how are you accessing? Your clinical supervision, how are you making sure that people are accessing clinical supervision? And I'm just thinking for those people that are listening who perhaps aren't clinical or working in those roles, they're just listening 'cause they're perhaps interested.
I think there's something about how are you tapping into, you gave those three different areas, I'm gonna ask you to repeat them, grace, but how are you tapping into the third one? Will you just repeat.
Inform me.
'cause I think that's something that'd be really useful to everybody and I'll send you a link with some more information about it if you wanted to.
Yeah, share it with people, Ruth.
But yeah, so we've got the threat system.
So when you're feeling under threat, it's your protective system.
We've got the drive system, so that's what gets, gets you up going in the morning, what gets you going to work, so like achievements.
Then we've got the affiliative or the soothing system.
So it's things like truly connecting to put your phone down, and truly spending time with people, giving and receiving care, compassion, kindness, being present.
So practicing mindfulness, and I don't just mean kind of practicing mindfulness in a.
Breathing exercise way, but act mindfulness basically means being present in the moment.
So doing things where you are truly doing what you are doing and noticing when your mind wonders and bringing it back.
When you do things like that, that helps to bring balance to the drive and threat system.
I.
I'll also say clinical supervision, although it's got clinical in the title, is not just for clinical staff.
Anyone that works within the health and social care sector can benefit from reflecting because actually no matter what your role, we work in a complex system where you are exposed to lots of different emotions and lots of different challenges, and it can be really useful too.
Access a supportive and reflective space no matter what your role within that.
Thank you, grace.
That's really helpful.
And as I say, I think everybody can tap into that restorative process for themselves and how they become more mindful and present in the moment.
So thank you so much for joining me today.
I've really enjoyed our conversation.
Hope you have too.
And yeah, thanks for having me.
No, it is been really nice.
I'm really excited to have you on today, so thank you so much.
Yeah, thanks.
No problem.
Thanks, Ruth.
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