Thriving, not just surviving: award-winning toolkit supports the mental health of student nurses and midwives in Manchester

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Tracy Claydon, PEF

As we highlighted earlier this week, Tuesday 10 October marked World Mental Health Day, an annual, global event recognising the impact of mental health on the lives of many and the importance of showing compassion to those struggling with mental ill heath, as well as looking after our own mental wellbeing. As student nurses and midwives, we may experience a broad range of mental health issues throughout our training as we adjust to our role; juggle placement, academic work and our personal lives; and because of the distressing experiences we may be exposed to on placement. Thankfully, the wonderful team of practice education facilitators (PEFs) at the newly formed Manchester Foundation Trust  (formerly CMFT) have our backs, creating an award-winning toolkit for mentors to enable them to better look out for and support our mental health in practice. We are delighted to share this Q&A with Tracy Claydon (pictured above), PEF for the Division of Specialist Medicine and the Corporate Division at Manchester Foundation Trust and project co-founder. She gives us an overview of the Mental Health and Wellbeing Toolkit and how it aims to support students and mentors in practice.

Firstly, what is the Mental Health and Wellbeing Toolkit?

We identified that there was no specific practical guidance to help mentors in supporting students who may be in emotional distress and/or be experiencing issues relating to their mental health when on placement; the Royal College of Psychiatrists’ (2011) indicated that as many as 29% of students may experience mental health difficulties at some point during their studies, while the National Union of Students (2015) have this figure as high as 78%. The toolkit was developed to support not only current nurses and mentors but also of course to support students to better manage the emotional demands of the role and feel supported to carry out their job confidently.

It is possible and also likely that a significant proportion of the students presenting in distress will not have a diagnosable mental illness but will be experiencing distress related to ‘life stresses’ and will need support to allow them to cope effectively with these rather than seeking to be prescribed an antidepressant or similar medication (NHS Choices, 2016). The provision of a toolkit that would provide a structure and framework for mentors to better support their students was clearly needed. The toolkit includes:

  • Tips for mentors including advice on how to discuss and identify concerns
  • Algorithms for accessing support
  • ‘Having the Initial Conversation’ guidance for mentors
  • Top Ten Tips for students to look after their own mental wellbeing
  • Agency Directory

The toolkit was launched in November 2016 and re-launched in May 2017 to coincide with World Mental Health Awareness Week which had a theme of ‘thriving or surviving’ which reinforced our message… we don’t just want our students to survive, we want them to thrive!

Where did the idea for the toolkit come from?

Students will often experience quite harrowing situations during one single placement that possibly other members of the public will go through their entire lives without seeing.

We talk often about resilience, but how do we build this? And crucially, what can we do when anxiety becomes more than a transient emotion? From a practical guidance we recognised that there were gaps in our support mechanisms within the organisation and also that we had the underpinning literature to evidence this.

The Nursing & Midwifery Council and the Royal College of Nursing recognise the potential for students to experience difficulties in their mental health and yet surprisingly neither agency has/had provided any guidance for nurses or mentors to support them.

At Manchester Foundation Trust (MFT) we wanted to fill this gap and the toolkit was developed as a resource to address this. Equally, it was also incumbent upon us to acknowledge how anxiety or a sense of isolation when not managed in the early stages can then escalate into something more concerning.

The goal was to support our students at the beginning, end and at all points in between on their placement and learning journey, so that they will recognise and regard MFT as a caring and compassionate organisation that enables students to thrive and not just survive and that they would wish to return as qualified staff.

How did you go about developing the toolkit?

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Ant Southin, Specialist Mental Health Liason Nurse

It came as a result of a real life situation where I as a PEF was supporting a compassionate and kind mentor who was struggling to support a student on placement struggling with mental health issues. Myself and my PEF colleague Sharon Green, began working on the toolkit as a resource however, the toolkit only truly started to develop when we were able to access the knowledge and skills of Specialist Mental Health Liaison Nurse, Ant Southin (based at MRI, pictured right) who was able to provide the expertise that we as registered adult nurses by background lacked. This enabled it to have a real MDT approach and became a wonderful collaboration!

How has the toolkit been used in practice so far?

For some students the situations they observe or are involved in will be the most distressing thing they have experienced. It is important that they have a means of communicating and understanding these feelings and recognising that there is help available. The Toolkit has been used in a number of situations where students were struggling to cope emotionally: including supporting students who were affected by this year’s Manchester Bombing.

What are your plans for the future of the project?

Despite having been awarded the MRI Fellowship Award at the recent Nursing and Midwifery Conference and also having been acknowledged as an example of Best practice by Health Education North West (available as an E-Win) we feel this work is still in its infancy; while it is currently aimed at students, we recognise that the messages are important for all of our staff. We hope that we can develop it to be used to support any member of staff experiencing distress. The Human Resources department have requested a meeting to begin discussions around achieving this within the wider organisation. We will be presenting at the upcoming Midwifery Forum at St. Mary’s Hospital and we have also had heard nationally from other NHS Trusts interested in adopting the toolkit within their own organisations.

The MRI Fellowship Award 2017 included a £1000 monetary prize which will be used to support ward areas to develop their own ‘buddy box / soothe box’ resource which they can then continue to develop to meet the needs of their students and staff.

…and finally, what advice would you give to student nurses and midwives to take care of our mental health while on placement?

Student nurses and midwives need to feel prepared and supported for the career they are about to embark upon. The profession is challenging and demanding but with huge personal and professional rewards. Mental health issues can affect any of us at any time in our careers and should be considered a priority for all of us whatever stage of our career we are at. By making them a priority for students it is hoped that they will continue to see this as a priority as they progress through what we hope will be successful nursing/midwifery careers. Using our dedicated #icareforme approach we will continue to maintain the profile of the huge importance of self-compassion for staff working within such challenging and complex environments. It is vital that mental health has the same parity with physical health and we can only achieve this by making it the priority it deserves and needs to be.

Thank you Tracy!! If you’re interested in learning more about the toolkit, you can find it here – in particular, take a look at the ‘Top Ten Tips for Good Mental Health’ on pages 8-9 for simple ideas that we can all use to look after our mental health.

Remember that if you are struggling with your mental health or feeling anxious, worried or depressed then don’t try and suffer on in silence. If you feel confident to do so, speak to your mentor, PEF or academic advisor (AA) or the University of Manchester has a fantastic confidential Counselling Service. Often speaking with your peers can ease the burden – you may find that others are feeling the same – or if you simply want a kind, listening ear then Nightline is another brilliant option, you can find the contact number on the back of your student card.

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A moment of CALM: de-stress with new wellbeing workshops for student nurses and midwives

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It’s well known that in order to properly care for others, we must first take care of ourselves. I’m sure many of us have shared that advice with our friends, family, patients or their carers, yet how good are we at following it ourselves?

As the term progresses and the list of assignments builds up, it is tempting to put our health and wellbeing on the back burner. There are so many competing demands, especially as many of us juggle uni work with part-time jobs, family commitments or other personal issues. It can be overwhelming at times: every student nurse I have spoken to has felt the pressure at one time or another, yet you can often end up feeling quite isolated, thinking ‘is it just me?’ Believe me, it’s not.

Don’t fear – help is at hand! After feedback from previous students, a brand new project has been set up to support students throughout the year. CALM has been designed been designed specifically for student nurses and midwives, aimed at tackling some of the regular issues we might face during the course.

On offer is a four week Mindfulness course starting this afternoon which will give an introduction to mindfulness and share techniques to cope with anxiety and stress. Mindfulness is about being present in the moment, switching off from the endless distractions and learning to calmly accept the emotions and thoughts that fill our minds. Over the four weeks you will be given an introduction to acceptance and be taught some simple stress-busting tips including how to carry out a body scan and breathing exercises. You will also learn how to recognise stress cycle and ways to build mindfulness into your everyday routine.

On top of that are drop-in sessions on money management, for practical tips on how to make your bursary and student loan go further, and a session on housing for anyone who wants advice on finding accommodation that fits our hectic schedules. A series of free sport and fitness classes are also in the works, so watch this space!

meditation-1000062_960_720Starting this afternoon, the Mindfulness course will run every Wednesday for the next four weeks between 1-2pm and there are a couple of one-off money management and housing sessions planned for the rest of this semester. You can book a place on any of the sessions here or contact Eve Foster at sso.intern@manchester.ac.uk – and if you’re interested in the Mindfulness course, it’s fine if you can’t make the first session today.

Don’t forget that the university also offer a fantastic counselling service and a massive range of wellbeing and relaxation courses, from daily meditation sessions to longer courses on low mood and self esteem. There are also plenty of online resources and apps like Headspace that can help you unwind and de-stress.

You don’t have to become a incense-burning zen master to build mindfulness into your everyday life. Mindfulness expert Andy Puddicombe says in this TED talk that we only need to spend 10 minutes doing absolutely nothing to feel the transformative effects of mindfulness.

So kick back, switch off and just breath.

What a difference a year makes…..a message to those starting uni in September

This time last year I was 2 weeks away from packing up my beautiful little counselling room and walking away from a career which I had worked in, enjoyed and become competent in for 15 years and I COULDN’T WAIT!

office-1Don’t get me wrong I loved….LOVED being a therapist and in some ways it defined me but I had pondered long and hard about the decision to change careers and it had been an exhausting slog getting to the stage where I felt confident to finally end my practice and leap into this new world of placements, essays, exams, university life, uniforms, night shifts, long days, hospitals, babies, women, families, doctors, midwives, HCAs, colleagues, blood, faeces, vomit, paperwork, paperwork, paperwork and STRESS but I was ready I WAS READY TO GO …or at least I thought I was!

What would I say to me this time last year:

“read everything you want to read which isn’t midwifery related because in a year you will feel guilty every time you pick up a non-midwifery related magazine/book”

“knit what you need to knit, sew that skirt and dress you’ve been desperate to get on with and RUN for hours in the evening when the kids are in bed whilst you still can as that time will swiftly become ‘study time'”

“play with your sons, read with your sons, cwtch them at bedtime and in the mornings before school because these are times you won’t be around for and you will be intoxicated with guilt for all the times you could’ve done this and didn’t. Enjoy taking them to school and picking them up as this will soon become a treat not a chore”

“go and visit your parents and explain to them that the next three years are going to be tough and you will work weekends and when you aren’t working weekends you will be studying over weekends as you have worked all week and yes, this is dreadful as dementia is slowly taking your dad away but drink him in now, absorb him and how he is in 2015 as 2016 will bring a bit less of him”

“go out with your husband-he’s a good, decent man and over the next 12 months he is going to prove time and time again that he can and will step up and be both parents to your sons and keep the kids fed, the house clean, the washing basket empty and the animals fed and you sane(ish) despite you doubting his ability to do any of these things at this moment in time”

“invest in the right people. You have amazing friends in your life, some will still be around this time next year and some won’t-friendships have seasons but you will meet the MOST amazing friends on this course and, along with a couple of decent friends already in your life, they will hold you and wipe your tears and tell you that you can do this despite you truly believing, in your soul, you have made a massive mistake. The friends you make over the next couple of months will be your ticket to making it through the next 3 years and hopefully the rest of your career because your midwife sisters are the ONLYpeople who truly understand what it takes to make it through this career choice. It is HARD but MY GOD it’s worth it”

“and most of all EMBRACE every opportunity….you are going to be scared at times, really scared; you’ve been really scared in your life before and you’ve managed to get through it but this will be a different fear; this is a fear of failure, a fear of actually causing harm because you don’t know what you’re doing, a fear or letting your family down, a fear of letting yourself down but don’t let the fear get in the way of being in the moment and experiencing every opportunity that comes your way because this job you are training for, this career, this vocation is a gift and a privilege and NOTHING that precious comes without a price”

Would I have heeded any of this advice….NAH! I was too excited but it’s nice to look back on and reflect!

To those about to start university-yes you’ll have doubts and you will probably cry and wonder if you’ve done the right thing at points over the next 12 months (& beyond I would guess!) but always force yourself to go and do your next shift as you just never know what might happen on that shift that confirms you’ve done the right thing! Plus-if you need support its there don’t be alone in your worry.

 

Be running up that road, Be running up that hill

Coming back to uni after a fortnight off was quite exhausting indeed! It was from the sublime to the ridiculous with deadlines for essays and presentations looming, exams lurking around the corner (first one in 8 sleeps….eeeeek!), skills to keep on top of and just the small matter of placement 3 days a week! PLUS the usual life things getting in the way of all the uni/placement stuff like children’s birthday parties, parents kids & husband with various health issues going on, stress with having 3 little children in school with all the drama they bring home (primary school seems far more dramatic now than 30 years ago but maybe I am gazing myopically through rose tinted specs!), money worries, dog worries, cleaning, bills, “am I being a good friend?”, “am I being a good daughter?”, “am I being a good sister/mother/wife/WI president/runner/student/midwife”….seriously MY HEAD HAS BEEN FULL!!!!!! Even writing that has caused by heart rate to go slightly tachy!

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I went for a run earlier and was thinking about a blog to do with juggling and keeping too many balls in the air which got me thinking maybe I shouldn’t be training for a 20 mile trail run in September and I started to feel guilty…..yes GUILTY….for running!!! “I should be at home revising for my exam/ I should be spending time with the boys they are back to school tomorrow/ I should be writing my skills up” …and so it goes on the should word! That vile internal dialogue or, as we used to talk about in therapy terms, the critical parent! I could feel stress rising in me on my lovely long Sunday run, my favourite run of the week.

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Then the magic of the run kicked in! I reach a lovely zen type place when I am running, it’s after the initial exhaustion of the warm up when my heart rate is increasing & I am finding my pace but before the heavy tired legs kick in in the last couple of miles. The middle of a run is where I find my peace and my mind quietens to a still I rarely reach elsewhere. It was during this zen time that I remembered a running gem of advice that suddenly seemed to apply to ALL areas of my life “just be in this mile Sam….don’t worry about the next 15 miles you are going to run or how painful that hill is going to be that you know is coming at the end of this run just be in this mile right now” …mindfulness at its best. Just be in the here and now as this is the only reality we have.

The past has gone and the future is yet to come we only have right now.

This is true of everything (not just running!!!).

I am going to be in just this mile and not worry about the exam after this one or the assignments due in over the next few months or the skills I still need to do as it feels overwhelming which causes me to be less productive (except at procrastination-I am GREAT at that!). I am going to be here and now taking life one mile at a time. I know the deadlines are coming and I am organised enough to know I will meet those deadlines, stressing about them won’t stop them coming!mindfulness

I can only be in this mile, right now, breathing, experiencing and being.