Monday 17 December 2012

Susanne Kean: Beyond Intensive Care


Early on in my Edinburgh residency, I met Susanne Kean, a former critical care nurse and now a research academic. It was Susanne who first sparked my interest in the world of intensive care, a thread that has run through my writing over the past few months. Over coffee that morning, she talked about the experience of the patient in ICU, mentioning delirium as one of the worst aspects.
‘What’s the difference between delirium and dreaming?’ I asked.
‘You can wake up from a dream.’ said Susanne.

It reminded me of a time, years ago, when my father was in intensive care in Dublin. The line our family took was that his delirium was a kind of blessing – he knew nothing of his illness, was ‘out of it’ in a dream of his own making. Looking deeper into the ICU experience I now realise we were comforting ourselves with a falsehood. Delirium is more usually terrifying for patients, nightmarish, and incorporates strange interpretations of the uncomfortable procedures necessary for their medical care. Patients often think they have been kidnapped, or subjected to torture.

Susanne’s current work is to look at the experience of ICU survival for patients and their families. When I asked what had motivated her to enter nursing, it turned out that concerns of families and intensive care were there from the very start. When Susanne was eight , her two-year old brother became dangerously ill with meningitis. At that time, children were not allowed to visit the ICU, so Susanne and her sister knew what was happening only through witnessing the upset of their parents. She hated being excluded and she resolved to become a nurse.

"I am the knitting one – this being ‘in’ in the 1980s. 
The other two are my friends and we were waiting for 
exams. We had to ‘dress up’ for those."

Susanne graduated in Germany in the 1980s, when the hospital system was very task based – wards served 38 to 50 people, which meant taking up to 50 blood pressures or temperatures each round, and not getting to know the patients very well at all. She then moved to Switzerland where a very different system was in operation. Nurses looked after all the needs of fewer patients, and planned the care with the patients. It was a radical change for Susanne, who at first found the new system very slow, until she realised it was not about completing tasks in an efficient time, it was about basing care around the patients needs, rather than the system’s. This principle has defined her work ever since.

This interest in developing a quality relationship with her patients brought Susanne into intensive care nursing, where there is a one-to-one relationship between nurse and patient. I’m struck by the way that Susanne, throughout her career, has constantly moved forward, questioning the way healthcare is practiced and searching for ways to improve the experience of patients.


 "Shift handover in our kitchen. I was working as a
nurse on a septic surgical ward and loved it!
The other person is our charge nurse."
Her bedside nursing career ended when she developed back problems – sadly common among nurses. She went into management and teaching, but was soon drawn to the relatively new area of nurse-led research.  Britain was further ahead of Germany in the development of this and Edinburgh University was especially strong. Susanne learned English to access the research and did her Masters, and Phd here. ‘Research gives you evidence, and evidence gives you clout.’ she says. ‘Otherwise, people will not listen to you.’

She is now part of the inter-disciplinary critical care research group based in the School of Health in Social Science, carrying out a ‘longitudinal’ study looking at how patients who survive the ICU experience fare over time, not only their physical health, but the psychological, emotional and social effects of the stay.  A recurring theme of her interest is not just the patient’s health, but also the effect on the families and circles of friends who support the survivor.

‘An important but invisible aspect of nursing is establishing a relationship with the patient. In an ICU it is difficult to establish a relationship with the patient as they are normally sedated and attached to a ventilator which prevents speech. Even so, you talk to them, explain what you are doing, even if you don’t know if they hear you or what they can make sense of.’

In this setting, families provide the opportunity to get to know the patients.
‘In an ICU you don’t withdraw when the family visits, you have to stay with your patient. Nurses get to know family members well, and the families have someone on hand to talk to about the patient’s condition.'

'Families are fascinating. Each family member is different, and have different needs. One may want to know absolutely everything in the tiniest detail, others want to know no more than the general direction we are travelling in. Balancing those needs in a single communication is difficult, but they are part of the story, they are the people we discharge the patient to, you need to include them.'

A lot has changed since Susanne was kept from her tiny brother’s bedside by a system more concerned with it’s own efficient running than the wider effects on the families concerned. A stay in ICU is always a traumatic event, and the ripples of that event change patients lives for a long time, and those of their friends and family too.



"I grew up and for a while I loved to ride motorbikes.
This was while working in ICU!"







Tuesday 20 November 2012

Plastic People


 I recently attended a lesson at the clinical skills centre at Little France  – I wanted to see students working with simulation models – dummies, in other words. The point of clinical skills is to get some hands-on experience in a scenario as similar to life as design ingenuity and latex technology can get you. And these days, that’s startlingly close.

The room was the size of a small ward, even had curtains and rails to divide the space into a three bedded unit. That’s not what you notice first, though, since you’ve just stepped into what looks like a charnel house. There are single arms everywhere, resting on bloodstained pads (as a dog owner, I recognise these as ‘puppy pads’ a central but largely useless part of canine toilet training – I’m glad they've found another purpose).  In the old days, apparently, you practiced your syringe skills on oranges. Now we have disconcertingly lifelike arms with veins you can inject into or draw from. The blood is a jollier, more fluorescent red than the real stuff. Each arm has a bag of it attached by tubing, giving the impression that someone has just stepped away from trying to revive it.

Around the edge of the room, a selection of anatomically detailed lower torsos sit on the countertop. I wipe the unbidden image of an Amsterdam sex shop window from my mind. The class I'm attending is a speedy overview of pregnancy and childbirth given by the cool-headed Carol Brown, who has brought many of these female parts with her, some in a box branded with the name of Adam, Rouilly, who specialise in such things. The box is printed with the jaunty strapline Limbs and Things. A lone male bottom is incongruously stranded amongst the female parts, very obviously waiting to have his prostate felt. Carol puts him aside.

She props up an entire pregnant female torso, and with a whisk of her wrist pulls down the outer skin to reveal an amazing sight: a full-term baby inside a see-through sac with placenta attached. There is pump to control the inflation level inside the sac, so that manual examination of the belly will be as near life as possible. Some speakers are fitted to reproduce foetal heartbeat sounds. It is both ingenious and oddly beautiful.

The first year students and I practice internal examinations, then deliver the model of a baby through a skeletal pelvis, then a fleshed-out dummy. Between tries, students absentmindedly cuddle or rock the plastic newborn. I even learn something about neonatal resuscitation. Although the lesson is intended as an overview, so persuaded am I by the experience of hands on dummy-nursing, I go away with a delusional idea that if someone went into labour in the aisle of Sainsburys, I might be of some help. A little learning, as they say.

Adam, Rouilly’s website is absolutely fascinating, with an overlay of weirdness for the casual visitor. The list of simulation models makes it clear that this kind of virtual practice concentrates on the more intrusive tasks – injections, intubation, catherisation, internal examinations, suctioning.  Ideally, nursing and medical students can use them to come to terms with the basic mechanics of the thing, so that, when it comes to dealing with living patients (I was going to say breathing patients, but some of these models do breathe) they can focus on the person as much as the task.

But – and it’s not a huge but, because I can see the good of all this. But. Look at the picture below.  As the mannequins become more sophisticated, could it be that healthcare professionals might start to compare us unfavourably with these plastic people – uncomplaining, unopinionated, can’t use the internet, don’t mind waiting for hours, extremely high pain threshold. The students have time to discuss things amongst themselves as these attractive ladies wait in wistful silence, putting the patient back into patients.





All photographs courtesy of Adam, Rouilly





Friday 16 November 2012

New Writing

I'm very happy to be publishing some more new writing on this blogsite, work that has arisen from workshops I gave within the School of Health in Social Science (of which Nursing Studies is a part) and also a poem sent to me by Denise Taylor, a nurse and writer based in the Borders. You can find Denise's poem along with a memoir piece by Marion Smith under the 'Writing by Nurses' tag above. 
Strictly speaking, it should read 'Writing by and about Nurses', as Marion's story deals with the patient's perspective, and a nurse you wouldn't choose to encounter.

In a similar vein, but a very different setting, Eliane Du's remarkable true story below, has at its heart our expectations about how healthcare professionals will treat us, and the painful shattering of those illusions.





The Doctor With A Gallon Of Water
By Eliane Du

We generally believe that doctors are meant to save lives within their power and ability, but from my experience that is not always the case.

Several years after the Vietnam War ended, my mother decided to leave the country taking her four children with her. It was a drastic decision, but like many Vietnamese “boat people”, we had to risk everything, including our lives, to find a new life. Our transport was a 19½ feet boat crowded with over 285 refugees.  I was about nine years old and was too young to understand how dangerous the journey was.

The night we left Vietnam, my mother dressed us in two layers of clothes and I was given a canteen of water to carry for the family. When we got on the boat, I was immediately separated from my family and was put to sit at the bow. My older brother and sister were pushed down to the lower deck.  My mother and youngest brother along with other children and mothers could remain on top.  

I was very seasick and the horrible smell from the diesel engine made me vomit. Terrified of moving around, I tried to lie still and go to sleep. I woke up with a terrible fever: I tried to look for my canteen of water but someone must have taken it while I was asleep. Our boat tossed and turned heavily in the strong winds and ferocious waves. A big storm was coming and everyone started to panic.

My mother was worried that I might fall overboard without anyone noticing, so she managed to persuade the people around to help and bring me over to her side. Right next to us sat a doctor and his wife. My mother asked him about my condition as I lay dehydrated. I could not take my eyes off the big gallon of water that was placed beside him. I whispered, “water”.   He looked at me and said that I had a high fever. Poor mother, she tried to beg him for a small cup of water but he refused to offer any. Eventually he poured out a little water using the tiny lid from the gallon and gave it to me to stop her from nagging. I was shocked by the amount of water provided, especially from a doctor whom I thought should be kind and helpful. I looked at him and tears were rolling down my face, but he was not bothered. I forced myself to sleep so that I would not think about the gallon of water.

I dreamed that I was happily playing in the sand with the neighbor kids. Suddenly, a big wave dashed in, knocked me down and carried me out into the ocean. I was waving my hands but no one paid attention. The waves kept pulling me under and I struggled to keep my head above the water.  I opened my eyes and felt terrified. It was only a dream but the thought of drowning made me shiver. Around the boat, dark fins loomed up through the water. My mother said softly, “sharks” and told me to pray hard and I again drifted into unconsciousness.

I was woken by something cold going down my throat. My mother was trying to squeeze some lemon juice into my mouth. Someone had thrown us a few lemons and that was how I survived for the next four days before we were saved by an oil tanker. I remember how much I enjoyed those lemons: every single piece that I could get from the little fruit. There was no sour or bitter taste in them but only juiciness and deliciousness and they were far better than the doctor’s gallon of water.



Photos from the journey:
This was the boat on which we left Vietnam. It was 19 and a half feet long and carried  more than 285 people







The rescue by oil tanker. Passenger had to board by ropes and a net.  I remember my mother was almost crushed between the two boats when trying to climb over. Fortunately, someone saw what happened and helped to lift her up!




Eliane Du is originally from VietNam. She has lived in Malaysia, the United States, and the United Kingdom. She received her BA degree from California State University Northridge and an MSc degree from the London School of Economics. She is currently doing her PhD at University of Edinburgh in the department of Clinical Psychology, School of Health in Social Science. Her research interests are in E-Mental Health and Human-Computer Interaction. Before starting her PhD, she had worked as a Software Quality Assurance Engineer for Autodesk Incorporations: an inventor of AutoCAD application and their 3D visual effects, media and entertainment software were used in Avatar movie

Thursday 8 November 2012

Story workshops with nurses



If you scrutinise the photograph (left), you may notice that an essential part of running a writing workshop for nurses is baiting the trap with a selection of finger food. There is no better way to lure busy team members in the middle of their working day.

Along with Dr. Deborah Ritchie of Nursing Studies, I ran four lunchtime sessions for mental health nurses at the Royal Edinburgh Hospital, under the theme ‘Telling our Stories’. Our immediate aim was to generate fresh accounts of mental health nursing today. Not only for the pleasure and satisfaction of the exercise, but because the voices of nurses are so often missing in debates around healthcare. In the long term, we are interested in seeing how these kind of creatively generated stories could be used to inform research, planning and advocacy.

We were assisted by the wonderful arts organisation, Artlink, who run a range of creative activities for patients at the hospital. They kindly loaned the big kitchen at their Glasshouses base so that we could get away from the usual training room atmosphere and have a space that was more homey and informal.

A big thanks to all the nurses who took part, none of whom had done creative writing before, but who rose fearlessly to the challenge, producing work that was moving, funny, sometimes frightening and filled with a tough-hearted dedication.

The following was written by staff nurse Jo Dunlevie in response to a challenge to find metaphors or images that would capture the transition between work and home. It’s a fine piece of imaginative writing.

Work

Unfunny clowns in dangerous big shoes
Stomping animals growling in the dark
Bright lights, Loud horns
Blinking light to dark
High wire ooh's and Ahh's
A moment away from a fall
A Disaster, head off in the lions jaws

Home

Slow steady smiles
Big laughs and tiny giggles
Quiet steady light, and the smell of growing things
Friendly voice, nudging concern
Big sighs and lashes on sleeping cheeks
Soft fall of turning pages
And the Dum de dum of life in Ambridge



Friday 19 October 2012

Good Nurse, Bad Nurse - read it here




I have just posted the text and photos from my public talk here (just click the Good, Nurse, Bad Nurse tag, above). It's quite a chunk of text to read onscreen, so those of you with fatigued eyes might wait for the audio version that we're planning to put online at Nursing Studies if the gods of technology allow it.

Above is one of the illustrations from the talk that I came across during my research. It was a campaign based in Oregon to shift perceptions of male nurses. Hmmm....

Tuesday 16 October 2012

Other Voices, Other Blogs


One of the many undone tasks that I carry around with me like so many virtual baglady encumbrances is the assembling of a blogroll for this site. Look to the right hand column and you’ll see that today my load is lighter.

These blogs and sites cover a wealth of ideas– from the ever-changing and ever-stimulating blog of Durham’s Medical Humanities department to the individuals who have set up blogs to reflect their personal interests and opinions (or vent a little spleen as in the case of The Grumpy RN) .

I’ve been putting out calls for nurses who write, not only through this blog, but also through guest posts at The Scottish Book Trust and writer’s magazine MslexiaAs I hoped, plenty of people have got in touch to alleviate my ignorance and point me to nurses who do write or sites that reflect the nursing experience.

I especially enjoyed Dovegreyreader, a blog by part-time community nurse Lynne Hatwell which has become very influential among publishers for its thoughtful book reviews, but also contains entertaining accounts of her nursing career. Annie Coops, both a nurse and a diabetes patient, uses her site to reflect on her experiences of caring received and caring given, while Nursing Writing, set up the University of Connecticut school of nursing is home to a range ‘scholarly and professional’ writing by nurses.

These and more riches – available at a click of the finger.

Sometimes, when I think of all the voices, all the opinions the web allows us to access, I have to go and lie down in the dark. Other times, it’s a giddy thrill.

Wednesday 19 September 2012

Good Nurse, Bad Nurse


Just to let you all know that I'll be giving a public talk at Edinburgh University on October 2nd. It's an occasion to mark the residency and to talk about the different and often distorted ways that nursing is reflected in our culture.

Here's the blurb:



‘Good Nurse, Bad Nurse’

Featuring a cast of drunkards ,saints, harridans, angels, sexpots, wimps  and mavericks, Nicola White, Leverhulme Writer in Residence at Nursing Studies Edinburgh, explores how nursing  has been portrayed in literature, film and popular culture and asks what part nurses play in their own stereotyping.

Hope that you get the chance to come along - it's free but ticketed and you can book HERE

Public talk, October 2nd.  Doors open 6.30pm, talk starts 7.00pm, Teviot Lecture Theatre, Doorway 5, Medical School, Teviot Place, Edinburgh, EH8 9AG 


Tuesday 18 September 2012

Story: Cecilia

This new story, Cecilia, is a companion piece to my previous story here, The Nurse My Father Loved 



















The wife brought me chocolates. She didn’t just leave them at the desk; she came right up to me in the ward.
‘Harry wanted to get you something,’ like she didn’t have a part in it, was just a means of getting the chocolates from him to me.
They were fancy, in a box like a gold brick with a little cardboard tag tied on the ribbon. Her sulky-looking daughter hung back at the doors of the unit, wanting to be away. I knew her name the other day, but I’ve forgotten now. She’s like a lot of teenagers that visit here, resenting having to look at so much illness and dying, and I’d probably feel the same in her shoes. Harry’s being moved to a general ward tonight, things are on the up for them. I search my head for the wife’s name.
‘You didn’t need to do that, Valerie,’ I say, but it comes out more harsh than I meant. I meant it like a thank you, not a brush off. Now I’m annoyed.
‘But I did,’ says Valerie, holding my eye, and I’m embarrassed, a bit, even though I’ve nothing to be embarrassed for.
He’s been with us for five days, out of it most of the time, a little delirious. When we removed his breathing tube yesterday he kept staring at me with eyes big as a boy’s, his cracked lips moving, trying to tell me something. I gave him sips of water, told him to take it easy. His hand in mine.
He started to cry then and I held on, telling him where he was, that he was okay.
He said he’d been living under the sea. People say all kinds of things when they’ve been sedated. They have dreams they can’t wake up from, nightmares often.
‘There’s been someone with you all the time,’ I said.
‘I know,’ he said, ‘you were with me.’
‘Well, not every shift – ’
‘They were trying to catch us, but you swam so fast. Pulling me through the water. Your lovely tail.’ His eyes dropped to my hips, where my tunic meets my navy trousers. He frowned. ‘Your tail….’
‘You need to rest yourself now.’ I said, but I couldn’t help smiling.
I passed by Frances at the desk.
‘Bed five dreamed I was a mermaid. He said my tail was lovely.’
Her mouth twisted up on one side, but she didn’t lift her eyes from the computer. ‘I heard. Are you sure he meant mermaid? You could’ve just been a big fish. Like a tuna.’
By late afternoon he had his head on straight, but he was still looking at me in that way, you know, sentimental. We’d shared some adventure in his head, something that might have seemed like years to him. When I leaned near him to check his lines, he said.
‘I should have married a girl like you.’
There were a lot of things I could have said to that. Like how if he thinks this is what I’m like at home, he’s sorely mistaken. Like what about his perfectly good wife, breaking her heart over him in the visitors' room. Some men get the idea that it’s to do with them, not with your job.
I’m good at what I do. Give me the sickest person in Scotland and I can take care of them. You do get attached sometimes, but it’s often to ones you lose, and we lose people in intensive care, that’s just the way it is. I work here because you get to take care of one person, properly. On other wards you’re running around chasing your tail, things you haven’t done yet stacking up in your head, never getting to the end.
Harry’s a lucky one, out of the woods. Too many days I’ve drawn the curtains around a bed and unhooked a quiet body from all the gubbins. Line by line. Cannulae, electrode patches, nasogastric tubes, ventilator tubes, catheters, drains. I cast them off from the machines to be themselves again, just a person. I tell them what I’m doing, all through last offices, even though they are already gone. I like to do it this way. Some nurses get nervous and chat about what they’re having for their tea. I hate that. I prefer to do it on my own.
Harry's wife is still in with him when my shift ends. He’ll be gone tomorrow, but I skip saying goodbye in case he starts to get soppy again. I don’t want her seeing that. I go behind the desk and find that someone has opened the box of chocolates. I take two for the bus stop and stand a moment, scanning the ward as it quietens towards night. The whooshing of the ventilators comes to me like the sound of waves.







Tuesday 28 August 2012

"You'll Never Make a Nurse"


Jan as a young nurse, Ayr, 1964

Jan Clyde is telling me about cycling through the Gorbals:

‘This was early 60s, the last days of gang warfare. Often there was trouble on the streets, and I remember feeling scared, but Sister would say, “Keep cycling. Look ahead. Don’t turn your head!” The thing is, they wouldn’t touch you because they knew you were there helping the community. They’d stop fighting to let you past.’ Jan laughs at the memory now. She was placed with the district nursing team in the Gorbals and would cycle out each day with her supervisor to attend the sick in their homes. ‘I had never seen deprivation like it. People had nothing – nothing but ten children – but they were lovely, and so grateful for anything you could do. The sister I had was terrific. I always say that I learned my complete basic nursing care from her.’

Jan is my neighbour on the Rosneath Peninsula. When we first met she’d just retired after more than forty years nursing in hospitals and the community. This year she celebrates fifty years a registered nurse. I told her that I was trying to write about nurses’ lives and she agreed to tell me some of her experiences.

Like many nurses I’ve talked with, Jan had close experience of illness in her childhood. Her father suffered the aftereffects of a severe fall at work, and became one of the first people to be given replacement hips. However, she credits her decision to become a nurse more to defiance than virtue. Jan, who has a flair for art, wanted to go into stage design, but her mother pressed her to get a ‘real’ job. The subject of nursing came up and her mother opined, ‘You’ll never make a nurse’ and that was it.

‘I was so naïve’, she says, ‘I thought it was all headaches and bandages. But I did take to it, and nursing has been good to me.’

Jan started nursing in an environment very different from today’s. Fierce ward sisters ruled and god help you if you were caught out, as Jan was, occasionally wearing nail polish or with too-high beehive hair or having a run in your stockings. The need for order was paramount. ‘But I liked the uniform, the stiff belt, the apron, you did take pride in it. It’s about respect, and having respect for yourself and your role. When they took the aprons away, and the caps, I just thought, I hardly feel like a nurse anymore.’

Working first at a hospital in Ayrshire, Jan was drawn to a surgical role. Having abandoned her early hopes of working in one kind of theatre, she spent seventeen years in another, as part of the operating team. ‘I like the drama, you see,’ says Jan, a light in her eye.  What she didn’t like was not knowing what happened to patients after they left theatre. Later, when working at a hospital in the Central Belt, Jan and other surgical nurses negotiated a system whereby the could visit patients in the wards to check on their recovery and talk with them. It echoes something I have heard from many nurses – the deep need to find out what happened next, what the outcome for ‘their’ patients was.

I can’t do full justice to Jan’s long career in a short blog post except to mention that she also ran an army medical centre, worked in a cottage hospital and spent the last fifteen years of her career as a practice nurse in a Glasgow community where she enjoyed the sense of continuity. ‘I was inoculating the children of people I had inoculated when they were small.’

Since retiring, Jan has re-connected with her creative ambitions and works as a textile and jewellery artist, but she remains a registered nurse and keeps in contact with former colleagues. Now her niece’s 19-year-old son has decided to enter the profession. ‘I tell him about life on the Nightingale wards and what is was like then and he looks at me as if to say, did you train with Florence?’

Jan is modest about her many skills and the thousands of people who have come under her care and passed out the better for it. At one point she uses the phrase just an ordinary nurse. I think that while the individual acts of nursing may seem ordinary to those that perform them, the accumulation of those caring acts over more than four decades is an exceptional thing.


Gorbals scene 1960s




Wednesday 8 August 2012

Calling All Writers



sculpture: Bourrasque by Paul Cocksedge


Okay, not ALL writers. I’m interested in hearing from nurses (past or present) , based anywhere in the UK or beyond, who would consider contributing a piece of their writing to the blog. It can be a short piece of memoir, a poem, a story, and opinion piece. All I ask is that it is no more 600 – 700 words long and can fit (even obliquely) under the theme of ‘Nurse Stories’. You don’t have to be a published writer, just someone interested in reflecting your experience in words.

To start off this new section of the blog, I’m pleased to be including the work of some fine new voices here – Rosemary Mander, Deborah Ritchie and Corrienne McCullough – all individuals associated with Nursing Studies at University of Edinburgh. Just click on the ‘Writing by Nurses’ tab above to see their work.

It’s easy to get in touch – my 'nursingwriter' email address is on the top right under 'Our Project'. I look forward to hearing from you.



Wednesday 1 August 2012

Professor Tonks




Tonks (centre) with some 2012 graduates

Josephine 'Tonks' Fawcett has been teaching in Nursing Studies since 1982 (‘Of course, I was a mere egg at the time!’). When you talk to students, Tonks’ name arises often – her humour, her habit of turning up during night shifts to visit her students, her perfectionism, her sayings. On first meeting, I was struck by her lithe energy and the individuality of her office – as much sitting room as workspace, with comfortable chairs, kettle ready for tea, and looking down from every wall and shelf, photographs and cards from past students and friends, an international web of nurses.


Tonks has just been awarded a Professorship at Edinburgh, providing an excellent opportunity to persuade her to submit to some questions.

One I have to ask – where did the name Tonks come from?
Well, I was the third girl from parents who really only wanted a boy. When I was born I was very dark, with ‘sticking up’ hair and my mother (a total blond) somewhat aghast, called me Tiddly Tonky. My eldest sister was known as Wimpy and my second sister Pepita (a mistake by my mother. She meant it to be Perdita) was called Pippity-Poppity-Poo, or Poo - though luckily that didn’t stick - and we once had a budgie called ‘Shivermetimbers’. It was all my mother’s doing; she was very creative with names! It wasn’t that Tonks was a pet name that stuck – it is simply my name’.

What for you is the core of nursing?
I always hope my students will see it as the caring understanding of each individual’s unique human response to the experience of illness (and health of course). Others would say communication – the heart of nursing. I would also add knowledge, always knowledge.


What achievements are you most proud of?
I am delighted by the professorship, and what I hope I can do with it, in a small way, as a catalyst for student learning. Also, Nursing Practice, the three editions of the book I co-edited with Margaret Alexander and Phil Runciman. (note: Nursing Practice was the first UK core textbook for adult nursing. The first edition was published in 1994. Grateful students refer to it as ‘The Bible’)



Who inspires you?
So many! My co-editors of Nursing Practice were, and continue to be, a great inspiration - Margaret for her energy and endless enthusiasm and Phil for her gentle ways and affirming understanding. Both are perfectionists. Also Annie Altschul, who was the nearest I had to a mentor (though she never called herself that) when I first started at the University of Edinburgh and who encouraged me to do my Masters in Nursing Education. I admired her capacity to be quite heretical at times in a way that only someone as respected as she was, could be; and of course all the wonderful students who go out into the world. So often when I write to them I find myself saying ‘…so proud of you’. They are an inspiration.  The patients also constantly inspire me with their courage and endurance and, again, my mother who taught me the value of resilience in the tough times and a little of how to ‘dare to be different’ - and to smile.

Which words or phrases do you overuse?
Gosh, probably too many. ‘We’ll get there’ a phrase so commonly said between nurses on particularly challenging days.  I give students lots of little phrases that I hope they will hold their heads like ‘Asepsis, Safety and Comfort’ –three all embracing principles of patient care and my three ‘Cs’ of bedside documentation – comprehensive, concise and (always)caring. And when the students first go on the wards and are nervous and a little unsure what to do, when everyone around seemed to be so confidently busy. I say, ‘Wash your hands, smile and circle the ward. Someone will need you’ Perhaps now I would be more likely also to add… find your wonderful mentor.


What was your first nurse uniform?
I first nursed on the degree course at St. Bartholomew’s Hospital (Barts) in London and the City University. My uniform had a wonderful cap, created from a large starched white square, an equally starched white apron, tight belt and detached collar with a brass stud that left a mark like a tracheostomy on your neck. I was smallish, and felt like I had been wrapped in a stiff white tube, but it really did give you a sense of yourself as a nurse and it somehow brought about a sense of mutual professional respect. The current universal uniforms, though necessarily serviceable, cannot have that ‘feel’.


Tonks (back row, centre) as a young nurse at Barts


Tell me one story from your nursing that sticks with you.
There are so many but probably one that has stayed with me from my earliest days as a qualified nurse at Barts was the day of the Moorgate tube disaster, when an underground train crashed into Moorgate station. I ‘grew up’ that day. I had only been a staff nurse for less than eight weeks, and at 8a.m. was preparing patients for surgery. The phone rang and the nursing officer (as they were called at that time) said ‘Are you ready to receive the disaster victims?’  Within two hours the whole ward had been re-organised. I saw the very best in people that day. Everyone pulled together, the nursing officers relinquishing administration priorities and literally ‘rolling up their sleeves’. One of our ‘firm’ surgeons particularly comes to mind, working in the darkness of the disaster tunnel to amputate a trapped woman’s foot. As well as the horror, it brought out amazing capacities in people. There was one young woman, a social worker, who had been badly crushed. We cared for her for six months but, in the end, could not save her. 
We can do so much more now.