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Saturday, 29 March 2014

Using Insights Discovery to help unlock potential

Have you ever wondered why you get on better with some people than others?  Why people's reactions to you are not always what you expect (positive or negative)?  Have you ever looked for ways to connect with people better?

For the best part of last week, I was busy attending the most inspiring, motivating course I've ever been on; the accreditation to become an Insights Discovery practitioner.

If you're not familiar with Insights Discovery, its a set of skills and knowledge aimed at improving self-awareness and is based on the Jungian theory of preferences.  The purpose of Insights is to create a world where people truly understand themselves and others, and are inspired to make a positive difference in everything they do.  As they put it, the possibilities are endless (and they really are!).  Whilst the underpinning principles of their work is complex, the basics are simple to understand and easy to relate to.

The basis of the Discovery journey or experience is around four primary colour energies;

Fiery Red: 
Task focus, clear on direction and how to achieve goals, ability to create clear plans

Sunshine Yellow: 
Exude positivity and enthusiasm,engaging in their interaction with others, involved

Earth Green: 
Considerate, sensitive, loyal and accomodating

Cool Blue: 
Analytical, able to maintain a detached and objective viewpoint

Whilst most of us tend to make use of one colour energy more than the others, all of us have a blend of all of the colours and will use them to different degrees in response to circumstances and level of self-perception / awareness (consciously and less consciously).  The theory focusses on the positive attributes which each of the energies has and how they can be used to help us adapt and connect successfully with others as well as improving the way we work together / our relationships with people in general.

My dominant energy is Earth Green, though I also make consistent use of Blue energy.  This was not hugely surprising to me and just on this basic level, will not be surprising to those who know me.  However what was revealing was the extent to which I use both red and yellow energies and how they manifest themselves.
And of greatest inspiration has been in terms of learning how to use my green and blue energies to adapt and connect with others more successfully, as well as developing a greater appreciation of the strengths of the other colours.

Improving the perception we have of ourselves and how others see us is so powerful.

Once there, understanding how this impacts on how we communicate and learning better ways of adapting and connecting can only bring hugely positive benefits.

My Insights Discovery journey has only really just begun but I would encourage anyone with an interest in any the above, to seek out an experience and to begin their journey as soon as possible.

In the meantime I cannot wait to support people to unlock their potential using the skills and knowledge which Insights have given me.

Monday, 11 November 2013

Setting goals, the importance of being able to change them and rolling with resistance...

I recently went on holiday to the Lake District (my favourite place in England) and experienced something which gave me cause to think about the notion of both goal-setting but also the importance and value of being able to adapt goals and to 'roll with resistance.'

One of the most important aspects of the work I do with people is talking with them about effective or meaningful use of time; providing them with encouragement to consider ways in which they can use their time differently and to be of overall greater value to them.  What they decide to fill their time with is clearly a very personal decision; they may have a list of (potential) interests that others wouldn't have the slightest interest in but that matters little.  

How someone chooses to fill their time in a meaningful way is all about personal decisions and interests.

One of the ways I choose to make 'meaningful' use of my time is mountain walking/running.  For me being in the mountains makes me feel energised, 'in touch' with the world.

Running up a hill and getting out of breath, feeling my legs burning causes a sense of exhilaration.

Experiencing the silence that can often be found in remote places but which is an increasingly unusual feeling in the world we live is somehow powerful.

What represents a meaningful use of time to one person can be completely different to how another person sees it; mountain walking/running is not how everyone would choose to spend their time.

So for me walking or running in the mountains allows me to feel energised though it also requires a good deal of effective goal-setting; which route am I going to follow today, how many mountains can I reach the summit of in the time I have, how will the weather impact on these plans?  Poor goal-setting in the mountains can mean genuine risk or peril.

...so I had decided on a route which I had never previously run or walked, but one which I had wanted to do for some time.  I knew I was capable of running / walking the distance and had the correct kit.  I checked the weather forecast and let the relevant people know where I intended going.

When I arrived at the start of my run I could see that the weather at the summit of my route looked partially cloudy but that at lower levels, it was clear with patches of sunlight lighting the fells.  As I set off I could see that the cloud at higher levels was building, becoming increasingly dense.  As I climbed I quite quickly ran into mist and low cloud, the wind increased.  It became harder to find the path in spite of there being numerous cairns along the way.  My original goal was to reach the summit, continue along a ridge to the next summit then consider my options - two more mountains and descend, or descend immediately after the second mountain.

I wasn't far from the summit when the weather rapidly changed for the worse - the wind was gusting to around 70mph, the visibility dropped to around 50m and it started to rain heavily.  I was perhaps 500m from the summit but couldn't see it; I looked at my map again and again but couldn't be confident of which direction I needed to go in and knew that there were dangerous cliffs nearby.  I desperately wanted to reach the summit but would have been taking a huge risk. Having said that I knew that if I didn't reach the summit it may be a while before I would have the opportunity to return.  

And I didn't want to 'fail' in achieving the goal I had set for myself...

Setting goals is vital, making sure that they are realistic equally so.  However there is also a skill is being able to amend goals when circumstances change.  To ensure that they remain realistic.  To appreciate that there will be other opportunities. 

As I commented on someone else's blog recently, often the amendments you make to goals along the way are sometimes as rewarding as achieving them.

Sometimes knowing when to change tack is the real skill.

Sometimes changing your goal is the bravest thing to do.

Needless to say I chose not to find the summit in the fog but descended and climbed a lower mountain on the other side of the valley....there will always be another opportunity if you persevere.

Friday, 8 November 2013

Are we using social media enough to enhance alcohol working?

In recent years, the use of social media by professionals has increased exponentially, and health organisations are no exception. Whilst there should be some caution in terms of the type of information and comment that is broadcast, on the whole it has had a positive impact on the way we provide healthcare.

Social media has clearly led to improvements in communication between staff and patients, enhanced dissemination of information, learning or messages. In addition it has greatly helped networking between staff in ways that were previously not possible.

I currently work as service lead for the Hospital Alcohol and Drug Liaison Team at Chesterfield Royal Hospital NHS Foundation Trust (Derbyshire, UK). The team consists of 2 nurses providing a range of specialist interventions where substance misuse is a feature of patient’s lifestyle. It also plays a vital role in improving the knowledge and skills of the hospital workforce and enhancing the effectiveness of the local treatment system.

Around 5 years ago, the majority of hospitals in the UK did not employ substance misuse workers; only a handful of services existed, which to some extent caused isolated working and pockets of good practice. It is now thought that more than 65% of hospitals employ at least one worker, whilst a significant number have services of 2 workers or more, with growing evidence of the importance of these roles.  Further benefits to patient care and increased opportunities to engage with people on substance misuse issues are also apparent.

However despite a significant number of hospital-based substance misuse services across the UK there is limited sharing of good practice, asides from a forum on the Alcohol Learning Centre and a Liaison Network. As a result there are many missed opportunities to highlight the excellent work being done. The same can be said for the brief interventions agenda.

In my experience social media should be considered by all those working in the substance misuse field or delivering health interventions like IBA for the following reasons:

  • ’Tweeting’ can be an excellent way of commenting on good practice, sharing innovations in your area of work, and providing links to useful articles and comment.
  • Using hashtags to bookmark discussions allows for debate amongst like-minded people in regard to contemporary issues: #wenurses is an excellent example of this, providing a weekly platform to debate contemporary issues. An #alcoholiba tag is sometimes used too.

  • Writing a regular blog on a variety of issues can be a great method of sharing good practice and encouraging others to improve their knowledge and skills in a particular area.
  • Many blogs will offer ‘guest posts’ such as the one you are reading now!

  • What was traditionally a truly ‘social’ media has increasingly become a platform for all kinds of professional information, events and information sharing

Social media does not provide a single answer but can be a useful tool to enhance our practice and foster healthy debate about substance misuse work and IBA. Whether it’s exploring specialists’ role in the provision of IBA, or issues such as the treatment of the alcohol withdrawal syndrome, social media is an opportunity to highlight the good work that we do, enhance knowledge, improve the consistency of approaches and share learning and innovative practice.

Greater use of social media has the potential to bring with it significant benefits to our practice and the care that we provide to patients.

This blog was also kindly published recently in the Alcohol IBA blog: http://alcoholiba.com/

Saturday, 6 July 2013

Abstinence vs. 'controlled drinking'

Firstly I chose the title of this blog in order to highlight what I think is a significant challenge to anyone working in the field of alcohol misuse (or other substances for that matter)....because the two ideals are not entirely opposed and because neither is right nor wrong, better or worse...its not about versus.

The issue / subject of being abstinent from alcohol or aiming for a reduction and ongoing 'controlled' drinking (ideally within lower risk guidelines) comes up time and time again with both patients (the people I speak to and support) and staff (those I provide training to).  It is a debate that is continually being held, a debate which can never be entirely resolved, but also one which can be damaging in terms of whether patients achieve their goals or how well staff are able to promote and reinforce lifestyle change.

On the one hand, many people believe that abstinence (preferably lifelong) is the correct goal to aim at when alcohol has become a significant or prolonged problem in someone's life.  'Many people' may mean those who have drunk alcohol problematically, the carers, relatives, friends of someone who has struggled to control their alcohol use and also people employed in roles where they care for such individuals.

On the other hand there is a similarly sized group of people who believe that controlled drinking is an entirely valid path to choose when alcohol has been or become a problem.

And in my line of work I would say I meet about 60% of people who would choose controlled drinking and about 40% who would choose at least a lengthy period of abstinence from alcohol if not lifelong.

Neither group of patients are right or wrong in their opinion on what their future plan around their alcohol use should be, but unfortunately all too often this area is hijacked by stereotypical viewpoints.  I have spoken to many people (patients and staff) over the years who feel so strongly about either of the two ideals that they have become closed off from considering that the one they don't believe in is valid; "all alcoholics should be abstinent, they cannot have 1 drink because it is bound to lead to another" ... "everyone can control their drinking and abstinence is not realistic - we don't live in a world where people don't drink."

I say unfortunate for a number of reasons; firstly people's goals are personal or should be if they are likely to be achieved - it is not for other people to judge, secondly neither school of thought is entirely right or wrong - many people who have drunk problematically will achieve control over their alcohol use and continue to drink occasionally and in a non-problematic way, on the other hand others fail to do this in spite of numerous attempts and eventually come to the conclusion that abstinence is the more appropriate goal.

When people become so caught up in one argument or the other, that is where the problems begin because they can either repeatedly fail to make realistic or personal goals, or if they are someone who's role it is to support a person may attempt to impose their ideals on the individual in front of them.  A good example of this which occurs fairly regularly is in terms of staff who may judge people who say they don't want to give up alcohol as being "in denial."  They subsequently struggle to provide positive messages to the patients or to encourage them to develop realistic goals.

I believe that my role is to assist the individuals I'm working with to firstly decide that action needs to be taken of course, but in terms of developing a longer term plan around alcohol use, for them to carefully and rationally weigh up the pros and cons of either path.  For them to develop so-called SMART goals, not unrealistic, inappropriate ones that are more likely to fail than be a success.

It is not for me to provide them with goals in the same way of course that is is for ME to decide my own path and my own set of goals in life.  I will be influenced and probably supported at times by others but in the end the goals have to be mine.

However I do believe very strongly that where appropriate it is my role to challenge people to analyse their plans in order that they develop a strategy / set of ambitions which are not only realistic but 100% in line with them as a person and what they genuinely believe is the 'right' thing to do.

I have seen many people over the years who have become completely obsessed with notions of abstinence from alcohol; believing that they cannot control their alcohol use, that "1 drink is bound to lead to another" and that the only goal they can set themselves is a one of a life without alcohol in any form or in any circumstance.  Sometimes this is tragic to see; where all the evidence is that a person has no particular reason to aim at lifelong abstinence but does so mainly because of pressure from family or because that is what they perceive those with 'an alcohol problem' must or should do; their is no other option for them.

Equally I have witnessed the continued failed efforts of people attempting to 'control' their alcohol use when all the evidence suggests that at least in the near term this is not going to be possible; their goal is neither sensible nor realistic...and similar to the paragraph above will typically be based on society's views rather than personal ones: "I want to be able to enjoy a drink like everyone else."

My point is not that people who choose abstinence have got it wrong, or that those who aim for controlled drinking have got it right....more that people need to make goals which are as personal as possible.  Goals that are based as far as possible on what that person believes will be realistic to achieve.  Goals which are influenced as little as possible by stereotypical perspectives / societal or media portrayals / messages.

We live in a society (in the UK at least) where around 90% of adults drink alcohol on at least an occasional basis.  Alcohol is deeply rooted in huge sections of our life and our society.  No matter how inappropriate it is, the reality is that people who are abstinent are frequently regarded as having "something wrong"" with them.  This demands that anyone considering long term abstinence must think very carefully about their reasons for pursuing it the first place and to rely as little as possible on what others think they should do.

Similarly although the vast majority of adults in the UK drink alcohol, that in itself should not be the main reason for someone wanting to pursue controlled drinking.

I think that both schools of thought have equal merit and that neither should be dismissed.

I believe that anyone working in this field must be open to either path being a potential option for those we provide support to, but that it must also be a part of our role to probe into the reasons behind someone's goals in order that they are become as robust as possible.

Monday, 18 February 2013

Some thoughts on patient feedback...

I'm sure that by now there have been about a million or so blogs written about the Francis report...and rightly so.  This blog isn't about the report per se, more a nod to certain parts of it.

(I think its also important to add given the heightened concerns currently in regard to the NHS that none of my comments below are reflective of my witnessing poor / bad practice, more observations based on a number of years experience working in the NHS as well as my experiences as a service user / visitor; my over-whelming feeling is that the NHS and its staff do a superb job).

One of the main things that I have taken from the report is that the NHS is not broken - far from it in fact; there are many, many parts of the service that are highly effective and efficient, where high quality care is delivered and outcomes for patients are world class.  Without the NHS, the UK's healthcare system would undoubtedly be in a worse place.

I have worked in (various parts of) the NHS for 15 years - the whole of my nursing career in fact (student nurse to nurse specialist / service lead).  I am genuinely proud to work in the NHS and the hospital in which I am based, and passionate about enhancing care and the overall patient experience.  I feel aggrieved that the NHS has come under such attack as a result of Mid-Staffs, it saddens me that an institution as worth while as the NHS is at risk to an extent because of the actions of people that work in it; patients should NEVER experience some of the things that they did, there can be and are no excuses.

However if the Francis report is to be effective and to have a true meaning, it has to be seen as an opportunity to learn, to improve and to enhance the organisation as a whole...

One of the key features of the report was the importance (or lack of) given to listening to and acknowledging the views of patients / service users / customers.  This is crucial and the NHS as a whole definitely hasn't done this as well as it should.  As an organisation / business it cannot afford to do it in a half-hearted manner, it must make every effort to become world-class in service user involvement, in much the same way as it is able to deliver world-class in so many areas.

And there are so many opportunities to do so...

We need to ensure that patients are genuinely involved in their care; the decisions we make around care-planning should be first and foremost FOR the patient and done with the patient at the heart of those decisions.  There will be many good examples of this already but too many times, patient involvement is not central to the care process.

We need to manage our work as far as possible around the patient; not the reverse which happens all too often, whereby patients come to see us at OUR convenience for example.

We MUST listen and be open to feedback in a variety of formats - patient forums, social media, patient surveys, ad-hoc opportunities...the list could go on and should be as innovative as possible.  We have to make it as easy as possible for patients to provide feedback and for Trust's to respond to this, and Trust's must show how they've responded.  Again there will be numerous great examples of this already.

Crucially therefore the NHS needs to abandon it's 'silo culture' and share good practice, allowing others to use in part or full guidance that already exists.

I certainly don't get all of the above right all of the time....however in the last 8 years whilst working as a hospital-based specialist, I've learnt so much about the importance and benefits of patient involvement.  Whether that be from abandoning the age-old practice of staff booking patients into a clinic and turning this on its head, allowing the patient to choose an appointment on a day and time of their convenience to the greatest possible extent (DNA rate 10% compared to others running similar clinics and expecting >30-40%), to sending a copy of the GP discharge summary letter to the patient it refers to.  Ensuring that patients have access to the service's office number (direct dial), staff bleep numbers and email addresses, encouraging (anonymous) service feedback in a variety of mediums.  Being prepared to listen...

None of this particularly ground-breaking (I hope) and yet it all adds to the patient experience.  We need to clearly hear what our patients / service users think and strive to use this to enhance what we do...whether this is positive or negative feedback.

On a final note and pertinent to this blog, the service I currently lead was recently mentioned in a story on Patient Opinion; I am genuinely appreciative of this positive feedback, which was not requested or asked for.

However mainly I am pleased for the individual whoever he is, that he was able to use his experience of being in hospital so positively and to make changes to his lifestyle  that are obviously beneficial to him, his health and therefore to those around him.  Whoever you are, WELL DONE and keep up the great work you're already doing - I'm glad that we could be of assistance at an opportune moment:

Brilliant support helped me reduce my drinking

Saturday, 12 January 2013

Thoughts on 'Dry January' 12 days in...

31 days without having a drink containing alcohol...surely can't be a bad thing...

Alcohol Concern and Cancer Research UK have publicised this idea - http://www.dryjanuary.org.uk/ - on the following premises: no hangovers, an opportunity to think about your drinking, lose weight, save money and improve your skin condition, as well as raising money for the two charities in the process.

So far so good; no obvious problems with this as such....and yet over recent weeks criticism has emerged.

Most of the criticism focusses on the following problems; will people 'reward' themselves over the following months by drinking excessive amounts of alcohol, is having a month off alcohol a 'major achievement' at all and if so, what does this say about our society / a particular individual and lastly concern that the main point that alcohol related initiatives should focus on (all of us who drink alcohol should have at least  2 or 3 days off every week) is being over-looked.

I decided to 'sign up' for Dry January simply because it seemed an appropriate initiative to support given my line of work but also from a personal perspective; although I drink well within lower risk guidelines a period of time without any alcohol is not a bad thing per se.  My personal reasons were not to avoid hangovers, lose weight or raise money for charity.

So is Dry January a good or a bad thing?  To be honest, I don't think this is the right question since the answer is both in equal measure.

Good because it offers an opportunity for individuals to consider their own level of alcohol use, their reasons for drinking at this level and a chance to consider what it feels like to not have a drink for a reasonable length of time.  In my opinion this is likely to have the most positive benefits for people who typically drink on the cusp of lower risk and increasing risk rather than those who consistently drink at problematic levels.

Bad because a month 'off alcohol' alone is unlikely to hold any long-term health benefits and because it may lead to people into a train of thought whereby they then 'reward' themselves for 'being good for a whole month' and drinking excessively from 1st February onwards on at least an intermittent basis.

Good if the reasons for pursuing this were in order to consider behaviour change over the longer term and not necessarily because someone had particular concerns about their alcohol use up to 31st December and then decided to dramatically alter their lifestyle on a whim.

Bad if the main reason was to prove a point that someone can go a whole 31 days without a drink.

Given where UK society is currently at in terms of alcohol use, messages and initiatives encouraging people to consider how much they drink and the context in which they do it can only be a positive thing.  However I am not convinced that the concept of a month of abstinence is necessarily the right way of going about this.

The British Liver Trust and others are entirely correct to point out that liver damage from alcohol is unlikely to be repaired by a month of abstinence (though in fairness to 'Dry January' they never claimed that it would).

My biggest concern is the one I briefly mentioned earlier in this blog - all of us who drink alcohol on any sort of regular basis should be constantly considering how, when and why we use it.  We should be thinking about the context of our use of this potentially dangerous drug, especially since problems relating to it are typically insidious in their nature.  And for the majority of us who drink alcohol, a month without it alone is not as powerful or useful as ensuring that we have at least 2 or 3 days every week without having a drink.

In essence then I don't think that Dry January is a bad idea, I just think that the bigger messages about considering our alcohol use over the longer term potentially get lost in an initiative which focusses on potentially short-term thinking.

I think whether the initiative ends up having positive effect for a particular individual will be more about their reasons for pursuing a month of abstinence in the first place.

So to everyone who is 12 days into abstinence, well done.....and good luck for the remainder of the month; I hope you achieve your goal.  But while you are pursuing this goal, take a moment to think about your alcohol use over the coming months and year - ultimately this will be more important than having 31 days without alcohol during January 2013.

Tuesday, 18 December 2012

Using personal experience of behaviour change to inform how we motivate and inspire others

Encouraging positive behaviour change is not something that should exclusively be aimed at people with substance misuse problems or indeed any problem that we might regard as being hugely significant.  Notions of positive change can be applied to all aspects of our lives and not necessarily in response to traumatic or devastating circumstances; such as being admitted to hospital because your alcohol use led to a diagnosis of pancreatitis or because your injecting drug use caused septicaemia.

These 2 examples may be obvious examples of moments when people may reconsider their behaviour and decide to make some changes, but at some point in our lives we will all have a behaviour or set of behaviours that for a given period of time (it might be a day or it might be 10 years) we were happy with and which later on we decided to change for one reason or another.

Think for a moment about a behaviour you have that you would like to change... 

...we all have them; for some us this will be dramatic and highly significant, something that the majority would agree is necessary to change, whilst for some of us the behaviour may be something that would seem to be relatively inconsequential to others.  It's significance to other people matters little; the only thing that does really matter is its importance to you.

For how long have you had this particular behaviour...

...is it something you've done for years or is it something that you only started doing recently?  Time can be a significant factor in us deciding to change or conversely a major part of our rationale for carrying on ("why should I change now, I've done it for years and its not really causing me a problem?") .

Now think about WHY you would like to change this particular behaviour...

...is it because it is damaging / having no positive benefits to your physical or emotional health, is it because its costing you money that would be better spent elsewhere, is it harming your relationship with friends and family, is it negatively affecting the way you feel about yourself?

Its highly likely that your reasons for wanting to change this behaviour will be associated with at least one of the above scenarios to a greater or lesser degree.  Its effects may be subtle or dramatic, life-threatening or relatively innocuous.  Again the significance to others is not relevant, defining your reasons for change is the most important thing.

After considering the above, you may realise that you feel really strongly about making changes; you may regard it as being one of the most important things you've done in your life - it might just be that important.  On the other hand, you may continue to feel ambivalence towards changing things.

Assuming its important to you now think about the challenges you will face when you start to make changes...

There may be few or many, they may be easy to overcome or seem like impossibly high hurdles.  This will depend upon the nature of the changes you want to make, to some extent how long you've done the behaviour for, whether you have support to make changes and crucially whether you believe that you can make them.

Belief is key; the easier path is probably to carry on with the behaviour, unchanged.  The alternative path represents a test, a greater challenge.  It is the one where we start to make changes and these may initially cause a feeling of discomfort.  Having the faith to continue at this point is vital and this faith will come from the personal reasons we gave ourselves for wanting to change in the first place. 

The point of this is that for all of us, the decision to change a particular behaviour is a deeply personal one; it can obviously be positively (or negatively) influenced to some extent by the opinion or actions of others (your family, a health professional and so on), but we will only sincerely regard it as a necessary change when we decide to that it is important enough; when the benefits of changing outweigh those we can think of for continuing.

We may have done the behaviour for many years and never regarded it as a problem (others may have told us it was but we didn't hear or believe them), we may have tried to change it on many occasions but struggled to overcome the challenges or struggled to maintain it.

Whether such decisions are about reducing your alcohol use, not injecting drugs, stopping smoking, eating a healthier diet, doing more exercise, being a better listener....the list is endless.  Whatever the change is, realising that it is personal, that it is going to take time, energy and perseverance are all extremely important factors.

If we use this knowledge of the challenges we have faced when changing our own behaviours to inform the way we encourage and motivate others to make positive behaviour changes, our interventions / advice are more likely to be effective.  

The decision to change may be a deeply personal one but we should never under-estimate the influence, both positive and negative, that we can have on this.

Cycle of Change - Prochaska and DiClemente