I like many people woke to the shocking news that Diana, Princess of Wales had died over night in a car crash in Paris. It was a Sunday morning, and like much of the nation I spent quite a bit of the day watching the TV as her body was returned to the UK. The next morning, listening to the radio on the way to work I have to admit I cried as Everybody Hurts by REM was played. Not many peoples darkest days of mourning are played out hour by hour day by day but her family’s was. To some people the Queen and her family were some kind of awful ogres who had thrust her out from the family into the wilderness. We were treated to newspaper and magazine articles and tv programmes showing her life, the news showed us all of the people queuing to sign books of remembrance, people placing flowers outside Kensington Palace. All of this to a woman most of them knew only from those photos and her ever presence on our TV screens. We were told this was an out pouring of grief. Psychologists, who hadn’t yet been called upon to discuss big brother, discussed the phenomenon earnestly. Finally (well if only it had been finally) we had the funeral. For the first time in my memory the streets were deserted, the shops closed on a Saturday in September.

My own memories of the funeral are actually quite special as I had my Grandmother and Aunt over to watch the events unfold. Special because just two years later my nan died and her own reaction and comments have stayed with me. She was someone who had no real time for Diana. She felt that the Queen, who she considered to be one of the only Royals worth bothering with, has suffered because of her actions. Once Diana had died, however, she made out she was her biggest supporter and stated that she had been a misunderstood woman. Those thoughts make me smile today, both in relation to Diana’s effect but also my nan’s reaction to the whole thing.

Since that day in 1997 there has hardly been a day when we haven’t heard some reference to Diana. There have been numerous conspiracy theories, re-enactments of her last hours, films about her and in some newspapers a daily diet of various theories of her life and death.

I am glad that her two son’s the Princes William and Harry wanted to have the memorial service today, and I am equally glad that the Bishop of London said during his address that a line should now be drawn, that she should be allowed to rest in peace, for their sakes and really for all of our sakes. I only wish it were going to happen.

Click here for the BBC message board about other people’s thoughts of today.

Seeing is believing - on page on of google images if you type in Diana, princess of Wales, you get the picture of the crashed car, how horrible is that?

I am not quite sure how I came to be a participant of consumer surveys, though it might have been the promise of vouchers for my favorite department store. So I signed up, completed a few surveys, and quite enjoyed it. It was a fun thing to do between writing essays, cooking dinner, working, eating, watching TV and generally living. Ok so some of them were long winded but companies pay to ask us what we think of them and who am I not to take some of those rewards. I took my first voucher shortly before Christmas and spent it on a couple of presents. Then they suddenly decided they were being over generous, and I got busy and did less surveys. This week though I have had another couple of goes, one was a survey about the department stores I use and what I buy there, another was about my tissue buying habits (I kid you not). Also on the site they have a few polls and today I voted in one of those because it was about blogging. These are the results:

This of course is not scientific and I have no idea how many people have voted. The first thing of note to me is the  number of people who say they don’t read or write blogs, which would suggest that the chance of someone you know reading your blog could be reasonably small. I also wonder how long your blog would last, and who would call by if you wrote a blog but never read anyone else’s.

I guess no one will be surprised (as England is often portrayed as a wet place) that this year we have officially had our wettest summer since records began (about 300 years apparently). This in a year when experts (probably old men clutching sea weed) predicted a very hot and dry summer with water shortages and general mayhem. Instead there has been flooding, days without a sign of sunshine and a day last week when I resorted to putting on the heating. According to the Meteorological  Office they judge the end of August to be the end of summer (although of course that is not official in terms of seasons), and I for one say good riddance wet and cold summer, bring in warm and dry autumn, please!

It is not often you wake with a vivid memory of your dreams but last night I seemed to have one of those episodes that appear (though no doubt haven’t) to have have gone on all night. I was responsible for making sandwiches for room service. All the time letters would appear through the letter box of my front door and they would give me instructions as to what the sandwich filling was to be. Consequently I woke feeling tired (well you would be tired if you’d made as many sandwiches as me).

I am no expert on these things, and to be honest I don’t necessary want to look deeply into the meaning of these things. However I have felt slightly disengaged today, a feeling made worse by the 2 conversations I had with the same woman this morning and afternoon. I am beginning to gain an insight into the type of person the professional campaigner for saving hospital services might be. Well how they are round here. Elderly, busy being busy, slightly confused in that they can’t remember either what you have told them or what they have told you, therefore a lot of rambling is involved. I am however kind, I am happy to listen to the rambling (for a while), happy to kindly put them right on certain aspects of accuracy, like the fact that you can’t report on a public meeting before it has happened and like the fact that I don’t know the opinion of local GPs and midwives about a service before they have voiced them. I was also happy to say that just because an elderly gentleman of her acquaintance would like a maternity service reopened, he interestingly is unlikely to use it and therefore is not the person I need to hear that from. Its a crazy world that I now inhabit.

Sometimes your mother has the habit of winding you up slightly (well mine does and has done). I would be true to say that I am not entirely sure what she said that made me so irritated, apart from her assumption that her grandson’s poor showing in his maths GCSE is the end of the world. she has been on holiday so is only just catching up on news, but I had to firmly tell her that his other results were in the main very good and that maths could be and must be retaken and that actually he was completely up for this. Of course my strange night and stranger day might be affecting my ability to hold a reasonable conversation and not feel irritated and of course he is my son and I am going to stick up for him.

I am not sure I should be allowed to engage with the professional public activist when I struggle so much with my own mother, but then sometimes you are left feeling you have never quite grown up and stopped being some kind of disappointment.

It certainly seems that everyone calls each other by their first names these days. This seems to have been perpetuated by the email where formality seems pretty taboo. Even people you neither know nor want to know address you by your first name. There is a great risk in this approach, as what is listed as your name on your email address is not necessarily what you wish to be called by.

Life was so much simpler in the good (or bad old days). As young nurses we were in awe of the more senior nurses, particularly the ward sister and nursing officer (as the matrons had turned into) and of course the doctors. Sometimes the junior doctors and staff nurses addressed each other more informally, but then there was always the possibility they were sleeping together (but then that is a whole different topic for another time).

As a more senior nurse I generally conversed with my doctor colleagues on first name terms, but in front of patients I always preferred to be more formal. So what do you think?

Nursing voices is a forum for nurses all over the world, where people can get together to discuss topics that are important and interesting to them. Why do you tell us what you think?

Do you call the docs you work with by their first names?

One of the best things about blogging is that you get to (or actually should) read lots of other peoples blogs. What is more, you find yourself reading about things you wouldn’t normally go out of your way to read through books, newspapers or other forms of media. I have discovered that people post some wonderful photos of people and places and some fantastic images of pictures they themselves have created. People write about themselves, sometimes in the third person (a number of medical bloggers do this) which I personally find odd mainly because I can’t imagine myself doing it. They write about others, they write some very intimate things about their personal and work lives (indeed people have lost their jobs over the things they have written). I tend not to write about two of the very prominent blogging topics you find on the internet, by this I mean religion and politics. However I like to read other people’s opinion about these two subjects and their own involvement in them so long as I don’t get the feeling that I am having either rammed down my throat. Where a religious or political topic is written about as if it was the only view that any ‘normal’ person could have (which would suggest that if I don’t agree with it I am of course wrong). Interestingly I find that quite a few medical bloggers write in this kind of preaching, I am right and you are wrong, way. Having said that, there is nothing like boiling blood to spur you on to write a post of your own on a topic even if it not quite the one originally stated.

There are a number of widgets and clock like things you can get to measure things. I have my weather girl who sadly has spent much of the British summer this year in her warmer clothes and I have my sitemeter gadget which tells me who has visited. Other people tell us how many days till their holiday or wedding anniversary and a number of more religious Christian sites have taken to telling us how many babies have died through abortion since the start of the Iraq war. The same sites do not sadly tell us how many innocent Iraqi children have died in the same time span but then that doesn’t fit in with their theme.

I guess the point of this is that as bloggers we have a duty to visit other blogs and read what has been written on various topics. We may or may not agree with what is written, but it is often the very topics that we strongly agree or disagree with that fire us up and make the blog world go round. So ends Julie’s sermon for today (with that bit written in the third person for those people who like that kind of thing!)

See how well purple and yellow go together? Why should I care about this? Well, this has been a long weekend; a bank holiday which started purple with a prince concert and ended yellow with The Simpsons Movie. In the middle I have read some Harry Potter (I am currently on book 2 as teen son is making me read them all before allowing access to the most recent edition) and bought myself a new vacuum cleaner. So what do I now know?

Firstly, Prince was excellent and the O2 arena is pretty good. Having said that, I would rather have been sitting on the other side of the nicely set out prince symbol as he spent most of his time over there.

Secondly, you are best to stay outside the inner arena area as long as possible, as there are some great places (including a beach) to sit and have a drink and to have a meal, and they are much cheaper than the places inside.

My new vacuum cleaner is not a dyson, and costs much less. I do not know if it will turn out as good long term, but right now my house seems cleaner than it has done in a while, which can’t be bad.

Lastly the simpsons, well, I laughed and laughed quite a bit, but then I like those yellow folks particularly Marg and Lisa. Also I went there with my brother and his family and we had a great afternoon / evening back at our place with Lasagna, fruit salad and some great chat. You can’t beat a weekend like that pound for pound.

To top it all, today is my send blogging birthday!

The usual outcry has followed the annual GCSE results which were sent out yesterday. So my question is this:

Is my qualification in English worth more than my son’s on the basis that less people received top grades in the subject in 1978?

My Answer:

My qualification in English is now worth little if anything at all. If I were to apply for a new job today, I doubt a prospective employer would be as interested in my grade at ‘O’ level English as long as my application form or CV contained good spelling and grammar.

I am more interested in the education my son has received during his 12 years at school so far. The quality of the teaching, the challenges presented to him, the way in which learning has been promoted within the classroom and school generally. In the last two years there have been issues over teaching quality when a teacher left and the use of supply teachers by the school. There have been problems with general behaviour within the classroom and the way in which different teachers have been able to control their classes. On the other hand there has been excellent levels of encouragement and support particularly during the run up to the exams. The school let students know how important they felt the exams were, obviously for their own reasons which relate to league tables, but also because many of the staff actually care about the children they teach. My part was in encouraging study and revision to take place, to show an interest in the subjects being studied and to be slightly strict when appropriate levels of work didn’t seem to be being done and too much partying seemed to be taking place.

Back to English; I was taught during the progressive 70’s when content was given a higher value than the grammar and rules of English. I would assess the level of education Matt has received has been superior. He has a greater understanding of nouns, pronouns, verbs, adverbs and the like, either that or I have forgotten what I learned. It is easy to criticise, easy to say everything has been ‘dumbed down’. But if I were a 16 year old who had worked hard for my B grade in English I’d be a little fed up today that so many older people are belittling my achievement.

You are The Sun

Happiness, Content, Joy.

The meanings for the Sun are fairly simple and consistent.

Young, healthy, new, fresh. The brain is working, things that were muddled come clear, everything falls into place, and everything seems to go your way.

The Sun is ruled by the Sun, of course. This is the light that comes after the long dark night, Apollo to the Moon’s Diana. A positive card, it promises you your day in the sun. Glory, gain, triumph, pleasure, truth, success. As the moon symbolized inspiration from the unconscious, from dreams, this card symbolizes discoveries made fully consciousness and wide awake. You have an understanding and enjoyment of science and math, beautifully constructed music, carefully reasoned philosophy. It is a card of intellect, clarity of mind, and feelings of youthful energy.

What Tarot Card are You?
Take the Test to Find Out.

This week’s edition of Change of shift, which you can read now over at Nurse Ratched’s Place contains some great posts, presented around a wild west theme. What is particularly great for me is discovering some new blogs that I hadn’t read before, and what is more learning some new stuff as well as being entertained. To think that 2 years ago I barely knew what a blog was, let alone that so many nurses, doctors and others were around sharing parts of their work and home lives with us.

At the beginning of next week I reach the milestone of 2 years as a blogger and boy has that time gone quickly. I have in the past started diaries at various times but have never carried them on, and I expected that this blog would become another short term attempt. Instead I have found that I have maintained my interest, and whats more used my blog as part of my reflective practice journal for the masters in leadership I have just finished. The biggest surprise though has been ‘meeting’ other nurses online, getting to know so much more about nursing practice in a variety of specialties both in the UK and across the Atlantic.

Today has been something of a nerve wracking one. I had never appreciated how nervous you could be for your offspring as they go to collect their exam results. So much emphasis is put upon exams these days, by schools, parents, the media and of course employers who have a vested interest in these things. My teen son has done pretty well, and particularly in the subjects he wants to continue with in the 6th form. In one or two subjects he has done less well, but actually in the long run I doubt that will be a problem. I have told him I am proud of him, and I am very proud. I suspect the whole process of exams and results will never be quite as bad again, I also suspect he now understands what I am going on about when I nag him to work hard, do his homework and revise. I have a nephew who is possibly not having such an easy and pleasant day. He has received similar results to Matt, but his parents have spent the last 7 years or more telling him, us and all who would listen that their son was fantastically bright, and was so special that they needed to send him to a fee paying school. The experience has caused them extreme hardship, so much so they have lost their house, it has almost broken up their home, as the parents considered splitting at one point and the pressure on their son has been immense.

I am a firm believer that the education you receive is important. It is vital in giving you the grounding you need for your future life. It can make or break your future in fact. However the results you receive at 16 will be superseded by those that come along at 17, 18 and so on. Plus, learning should continue throughout life so that it is ok to study for a masters in your 40’s if you want. Education is vital, good results should be celebrated, but a couple of poor results at 16 are definitely not the end of the world.

I am not meant to call it a diet. At slimming world it is a programme and actually I don’t really feel like I am on a diet most of the time. For the first time in ages I feel that I might actually be able to do this and to get to the kind of weight I was in my 30’s. At the end of the 3rd week I am 7lb down and I have lost inches off of those places inches need to be lost (waist, hips and chest). The lateral thigh trainer is proving so far to be a good buy. I have managed to do about half an hour on it most evenings and am gradually building up so that now this is only in 2-3 sessions (the first few days I couldn’t even do 5 minutes continuously). This is just as well, as we have stereotypical weather right now - cold, dull, wet. This is not what I expected when we were told were in for a hot summer this year! For the first time ever (I think) I have put the central heating on in August!

Tomorrow is GCSE results day and that means Teen son. So depending on how it goes, my blog post tomorrow will be a happy cheery one or it will be about something else!

According to David Cameron, he and the Conservatives must save us all from the Hospital cuts taking place all over the country. It is true that reviews are taking place everywhere to examine how health services should look in the future and it is highly likely that those involved in making the decisions will not make friends in every area but is every review actually going to constitute a cut? Most towns in the UK appear to have some kind of hospital service along with smaller intermediate care and primary care services. Most of those hospitals have traditionally tried to deliver all services to local people on all sites, including accident and emergency, surgery, medicine and paediatrics. In the last 15 years the hospitals have become NHS Trusts and then have merged together so that each ‘trust’ may now have 2 or more hospitals, often providing identical services a few miles apart. This has made it difficult to develop services which are of sufficient size, able to deliver the kind of technology 21st century health care demands and to recruit and adequately train and supervise its staff. While the NHS deficits are often thought to be both recent and due to mismanagement by managers, they tend to date back years if not more than a decade, and during a time of almost continuous change.

In our area, where I both live and work, the three hospitals are now part of one trust. One hospital, badly built in the 60s is falling down and in other parts of the area there is no ready access to acute hospital facilities.  The people in the whole area deserve a better deal, but how many accident and emergency nurses can be provided and indeed need to be provided? About 2 years ago I spent an afternoon in our local A&E awaiting an xray on an ankle that was painful but turned out to be sprained. I was not the only person that day who could have been seen in a locally based minor injuries / urgent care centre freeing up the A&E department for those most seriously ill or injured.

There are plans now to have just one large accident / trauma centre and several smaller centres where people can go for less serious problems. There are plans to merge the maternity units (actually run as one department currently but on two sites). No less babies will be born, but a brand new unit will be built which is better able to cope with the way in which women can and should deliver their babies in 2007. Perhaps these moves will make changes, perhaps if you currently live next to the unit that will close and in future will need to travel 12 miles you will consider this a cut. But I am not sure we can assume it is. This is a political issue with a little p, I would actually prefer it if local people could give their views on the changes without David Cameron muscling in and making it into some kind of pre-election vote winner.

Teen son loves music, and has an interest that ranges across the spectrum. I am extremely glad that the Beatles and Jimi Hendrix has replaced much of the rap / hip hop he liked about 3 years ago and it is great that he is becoming such a fan of real music. However I am not sure about his recent purchase, one made because he earned some money while staying in France; I am referring to the Electric Guitar and amplifier that appeared here on Saturday. I am impressed it is so loud, I am thrilled that all the practice that has taken place on his acoustic guitar throughout the year has paid off and he can string together some cords and play recognisable tunes. But I do wonder if he couldn’t go and play the thing elsewhere. Mind you, it could be worse, the rest of his friends could turn up with instruments and they could all play them together!

Apparently when we were out on Saturday, he and his friend experimented to see how much the house vibrates when the thing is turned up on full volume. Apparently they managed to make light fittings shake downstairs while the guitar was played upstairs. Apparently they tried to get passers by to look across as they walked by. What most surprises me is that no neighbours have been over to complain yet. Knowing my (quite elderly) neighbours though, it is just a matter of time.

Thirteen Things about The skills and abilities you might not know a nurse needs! My first Thursday Thirteen for a while is about the skills that I would never have known I needed to be a good nurse, but now I am older and wiser know that are vital.

1. The ability to not look shocked when you are told something shocking, shown something unpleasant or had something extremely noxious placed under your nose.
2. The ability not to throw up when someone hands you their artificial eye, false teeth caked in food or open sputum pot.
3. The ability to hold your breath without anyone noticing as you deal with other unpleasant bodily fluids.
4. The ability to act as if piles and piles of paper, boxes and other debris is the most normal thing to find filling up a person’s house.
5. The ability to smile and act as if you have not a care in the world when you move a patient into a bed just vacated by someone you had to lay out.
6. The ability to get the job done in the shortest time without the patient knowing you don’t have all the time in the world.
7. The ability to smile at someone who has just intimated that you are the monkey to the doctor’s organ grinder, when actually you would like to give them an injection with the biggest gage needle possible.
8. The ability to help a new doctor learn their job - perhaps you should get that patient flat before you start CPR is one that springs to mind.
9. The ability to understand that while most nurses show a caring nature towards their patients, they are much less tolerant of their colleagues, particularly those that have the audacity to be sick or go on leave.
10. The ability not to feel obliged to tell students and more junior staff that they have things easier than you ever did. After all in my day we had to work full time, study and whats more we were left to run the wards while the staff nurses skived in the office with the doctors and generally did very little (not sure that is true, but it is the kind of thing people say)
11. The ability to recognise that change is inevitable, constant if not continuous.
12. The knowledge that what you have learned by the time you take your state finals (as they were called when I took them) is not going to be enough to see you through the rest of your career.
13. The knowledge that much as you love nursing, that it is ok to want to go into management or education. That you will still be a nurse, because once a nurse then you are always a nurse.

Get the Thursday Thirteen code here!The purpose of the meme is to get to know everyone who participates a little bit better every Thursday. Visiting fellow Thirteeners is encouraged! If you participate, leave the link to your Thirteen in others comments. It’s easy, and fun! Be sure to update your Thirteen with links that are left for you, as well! I will link to everyone who participates and leaves a link to their 13 things. Trackbacks, pings, comment links accepted!

View More Thursday Thirteen Participants

As a young nurse I found caring for elderly, infirm people a bit of a challenge. While I got on well with my own older relatives none of them were actually that old. I found it difficult to relate to people who were confused, infirm and often incontinent. My elderly care placement during my training was not my favorite. I have memories of a night spent changing the bed of one patient probably 10 times due to her diarrhea and urinary incontinence. I am not sure if we had any pads but we certainly can’t have been using them. However I do know that we treated that old lady with compassion as we turned her washed her and made her comfortable even when she fought with us during her confusion.

Even though this wasn’t my favourite group of patients, I was a nurse, it was my job to provide the best nursing care to everyone I came into contact with. What’s more older people have always been pretty large users of the health services, so there was no real way of getting away from them (unless you went into children’s nursing and I didn’t really feel drawn to that specialty either). Gradually I discovered that having multiple illnesses didn’t render people senile just because they were over 70 and I also found that even those who couldn’t recognise their own relatives had feelings and could feel pain. These people had (often until days before) led active lives, they had been people with important jobs; they had managed large families and of course had lived through and often fought in world wars.

It is some time since I can say I nursed a patient but I have heard plenty of tales of things not being right when it comes to the care of elderly people I have heard the way nurses and those meant to be carers have spoken to older people and I have been told of the experiences of others. Today a parliamentary select committee report has stated that “an entire culture of change” is needed in the way older people are treated within the health care system. They say that people’s human rights are being abused as those who should be caring for them leave them with inadequate food and hydration, do not respect privacy, roughly handle them and generally handle these vulnerable people in a manner they would not (I hope) treat their dog. Age concern put the number of older people in the UK suffering neglect in this way at 500,000. This is taking place in hospitals and care homes alike and no doubt also in people’s own homes.

I have always tried to gauge the appropriate level of care to be that which I would expect for my own grandmother (or other close relative) and in my view this appears to fall pretty far short. If we are to believe this reports and the anecdotes that litter the newspapers and internet sites on an almost daily basis then nursing faces a major challenge. Many of these older people probably do not come into contact with a qualified nurse on a daily basis, but of course some will. It is however, up to nurses to set the standards here, to demonstrate the attitudes and level of care that everyone who comes in contact with them should expect. It is up to us to be vigilant, to listen to the stories of our patients and their families, it is up to us to report poor care and to make every attempt to change it. As relatives and as people who for example pass through a nursing home or hospital we must be prepared to blow the whistle on poor care, on verbal and on physical abuse. Elderly people account for a very large and growing proportion of our population. We must treat them with the respect they deserve. Don’t forget one day that will be us.

Picture from here