Music and creative opportunities in healthcare.

During a hospital or visit to a healthcare setting the senses can often take a major hit- and not always with a positive impact.
If we take a moment to visualise a setting such as a hospital our senses will be required to take a high level hit -stimulation overload in order to separate and work out what is a threat and what isn't.
The announcements, the buzzers, the people, the smell, the lights and that is before a department is reached.

For children and young people what they see, hear, smell and feel impacts on how they respond and react.

The Playroom- a colourful and non clinical space- complete with musicians can immediately minimize the fear of what a children's ward feels like.

The coloured window decorations are plastic strips- curtains from IKEA!

(so easy to clean)

(Christmas 2015 Music in Hospitals Concert) 

The environment plays a vital role in how we provide and facilitate healthcare, and what we do to that environment needs careful consideration.

Working with children and young people it is important that their needs are met, and this requires their voices to be heard in order to deliver, not what we think looks great, but what actually fulfils their need.

It is tricky- adhering to trust policies and infection control guidelines is a must- but it can be done and achieved if the whole team is involved.
Research and evidence shows us that the least amount of trauma children and young people experience in-between clinical interventions - the better in terms of recovery and well-being.

We know that staying calm, relaxed, and having the opportunity to experience joy and laughter allows the body to produce increased amounts of serotonin which regulates mood and increases happiness - even for just short moments.
This has a major impact in the way children, young people and their families react and cope with periods of time in hospital.

Music and the creative arts is another way we can enhance an environment- opportunity to paint, draw, sing, dance, make music, tell stories and be a bit silly- have moments of stillness and of relaxation- allows them to break down sterile boundaries- creates a calm environment and provides children and young people a space to explore, create, and have a voice.

There are many charities and organisations that can support this type of play and exploration within a clinical setting.

www.createarts.org.uk

Create uses the creative arts to transform lives, there priority groups are carers, children in hospital, older people and people with additional needs and disabilities.

www.musicinhospitals.org.uk

To improve the quality of life for adults and children with all kinds of illness and disability.

Further reading-

Exploring the impact environments have on children and young people's experience of healthcare: a review of literature - Alison Tonkin

www.hpset.org.uk/environmentsofcare2015.html

Copyright- Sian Spencer-Little Dec 2016.

The Big Conversation.

Stress in children and young people is being highlighted both within education and healthcare, this weeks blog discusses the impact this has on children and young people accessing health and social care- and how opportunities could be developed to allow these conversations to happen naturally, and without pressure.

I also want to reiterate that this all depends on your training and experience, the setting,and time and space logistics.

Resources can be paper, pens, paint, but equally a cup of tea, a cup of hot chocolate or a movie with pauses.

There has been much written and shared in regards to how the evidence is presented, within health settings, and educational settings in both the national press and within articles shared.

We also know that much work is being done by many organisations, charities and individuals as well as children and young people taking the lead.

I wanted to share some observations and conversations taking place between children and young people ,the language they use, the ideas shared and how this may influence healthcare professionals and the positive changes that may occur naturally.

The best way is to share a piece of writing, a collection of sentences and thoughts because sometimes it is just about the honesty of children and young people.

  " Lets have the big conversation

        Please give me the space to say how I feel.

           Let me express my anger, pain, joy and my hopes

              Be there to hold me, not physically, but with your words, if that's want I   

                  want, I may not know that's what I need.

                     I don't know how I feel, I do know that it hurts like hell.

                        I am not always brave, because its not about being brave.

                          I am human.

                            I am strong, but I can also be broken, please help put my pieces

                               back together.

                                 Please support me so I can talk, so I can be me.

                                   If I can't talk,I might be broken again.

                                     Help me to find the "something" to give me a

                                       voice.

                                           When I see a glimmer of hope- please help me to embrace it-

                                                I might not know how that feels"

There are many charities and organisations that are pushing the boundaries and sharing resources, many individuals offering there experience and support.

A few are detailed below.

                  

• ollieandhissuperpowers.com  (@bemoreollie)
• youngminds.org.uk (@YoungMindsUK)
• byc.org.uk British Youth Council (@bycLIVE)
• Papyrus-uk.org (Papyrus_tweets)

Sian Spencer-Little

(C) Nov 2016

The Power of Metaphor.

What is a metaphor, is it something that is provided to make things up, to avoid talking about worries or concerns, can a metaphor really open up a time and space where exploration of emotions can happen?

Metaphor can be  a word or phrase that is used to describe a object or an action, an emblem, to paint a picture or create an image.
Some children and young people use the work of metaphor as it offers a visual description of a thought, feeling or action- with the focus being shifted away from talking about deep feelings, or events that have impacted their lives.

When I started working alongside children and young people using metaphor  felt clumsy at times, I struggled with finding the right language and when I did, my responses felt like I had adopted some new dialect that only made sense to me, so it took a lot of practise, reading, learning and observing others using metaphor to find its natural place in my work,  to the support I can offer children, and young people coming into hospital and those living with a long term and life changing health condition.

Using the medium of play and specialised distraction with children and young people lays a platform for using different techniques and skills, it is something that requires training, and mentoring, and time.

Working in metaphor using play gives children and young people the space and tool to create and work through an unknown thought,  using metaphor allows them to name the thought, then it can be explored, it can be felt, and it can be held safely, and acknowledged.

Often children and young people store and bury feelings that are so powerful, they just don't know what to do, what to say or how to be.

Spending time with children and young people allows you to gain a snap shot of their lives, and if they give permission and invite you in, play and metaphor is a powerful tool and skill to have, but as always the right level of training and practise - and care should be gained first, this is a skill that requires specific training, working in metaphor is powerful and shouldn't be under estimated.

Children and young people use metaphor a great deal when trying to describe an event or emotion that is just too painful to say out loud, using metaphor removes the attention from them, and allows them to communicate in another way.

Here are some examples.

" Its like this you see, a straw works really well with water, but if you put it in milkshake or it gets blocked, nothing moves, and when the straw is used, nothing happens, everything is blocked, full up, doesn't work"

An example of a description from a child who tried everything to tell others that she was sad and anxious and worried - but she just couldn't find the words, she was fed up and she was too full up of worry and uncertainty, why does the bad thing happen to me.

"There was this thing and it had fallen out of a suitcase, it tried so hard to get back in but the suitcase was so full up and heavy that it just couldn't find a place to hide anymore"

"There was a spaceman and he was attached to the rocket by a long elastic band, one night while he was out exploring space, the elastic band snapped, and he floated away from the rocket, and he just kept floating and floating, lost, and alone"

A young person full up with hospital appointments, so many that her life consisted of nothing else.

Using specialised play opportunities allows the child or young person the option of sharing in a way where the attention isn't solely on them- they feel slightly removed, but if metaphor is introduced - exploration and testing of the waters takes place- as a practitioner my role is to hold and keep safe the experience and narrative, offering creative resources to enhance the experience how ever tricky that might be.

Weather and the range of powers it has is often used as a metaphor to describe the inner fear and upset being experienced, and the pressure of keeping everything alive.

Further Reading

• Creative Metaphors of life experiences seen in Play Therapy www.counselling.org
• Using therapy stories and Metaphor in child and family treatment www.lianalowenstein.com
• Using storytelling as a therapeutic tool with children - By Margot Sunderland

Training and courses

There are many places to undertake further study and training, I have done the bulk of mine here.

Centre for Child Mental Heath- www.childmentalhealthcentre.org

@CCMH_London

Sian Spencer-Little

Copyright 2016.

Words have impact.

Its been a while since I wanted to blog, I felt I wanted to have some time to engage in face to face conversations, having been involved in lots of different projects has meant I have been busy, I have also been able to read more, meet some amazing people, and take part in teaching- all of which enriches my work.

During that time I have thought a lot of about the language we use, the language others use to tell a story, to convey instructions, to support, to care or to describe an event.

I have been able to talk to young people, children, families, and other healthcare professionals about how words make you feel and the language others use.

I was able to write about my experiences in blogging, in the use of social media and how using and sharing words and language could impact on how specialised play, can be delivered to children, young people and their families for The Journal Of Health Play Specialists (NAHPS)

I have listened to other languages- the pattern, rhythm and tone, the use of animation and inflection in voices, the volume and the way it is used.

I am often in awe of the range of words and the way families use language to support, cherish, nurture their children and young people.

The way they describe an event, the way they comfort and show love, the way they connect to each other.

I have also observed the negative impact that words and language can have, how quietly spoken words often carry fear and upset, how the volume of words can leave someone devastated and frightened- and have a lasting impact.

                                                       
It isn't always the loud voice that makes the biggest impact.

                                                                                                   BUT

The way we use language and words - does have an impact on a child, young person or adult - it is the foundation of their learning, there understanding and development.

We know through research and studies that words and language and the way they are used  at home and at places where we work and study and care matter.

Taking the time to listen and describe an event, a procedure, what happens next isn't always easy, it is understanding what you are trying to explain, and thinking about the person you are explaining that too.

This comes with time, and experience, and having mentors that can support you.

But words and language for some is tricky, it fills them with fear, of not being able to convey the information, not being able to understand, which leads to fear, frustration and the unknown as they haven't understood the information shared with them.

                                                        
 If that is the case how can we expect them to feel supported, nurtured, cared for?

Working with children and young people who use words and language with pictures, signs, and their bodies opens up a whole new world to them, it allows  freedom, independence and a voice.

The key is learning how we can develop our skills - so we can communicate, share information, describe events or just as simply to allow a child or young person the option of agreeing or disagreeing.

Its not easy- we have to seek out resources and teaching- but isn't it worth it, if words and language are so important to us in our work, it should be just as important to those we work with and share our life experiences with.

                                                    
Language and words, how we share it, and what we do with it, matters.

So I wanted to share some words with you, some words can make you feel worthless, they can crush your dreams and hopes, they can also fuel your desires and aspirations- if you have the right people shouting and singing on your behalf. 

" So I see that you have brought your daughter to the Careers evening, it is nice to meet you both, and I am glad she is here with you.

   What does she want to do as a job?  (mother replies) Oh she wants to be a nurse and work with sick children.

  ( Careers Advisor replies) Ha ha ha well that's never going to happen, I cant believe she thinks she will be able to do that, there is so much written work and reading that she will not even get into college to be able to do that- no I think she needs to think about something else."

The next time you need to share some information, or you hear something that requires you to reply, either verbally or written- take a moment and pause.

How would you want that explained to you?

How would you support the understanding?

Who could you ask to help you?

Just this week I was able to be with and listen to what a young person had to say about his care, and those who work within the care of young people

His words will stay with me forever.

"How can kindness and passion for your work and that of your patients be given without some level of love, of integrity, of authenticity "?

Sian Spencer-Little

Oct 2016

Resources- There are lots of services and resources around to support us all- here are just a few.

www.makaton.org sharing resources around the Makaton signing course.

www.british-sign.co.uk  BSL courses and info

www.communicationmatters.org.uk Information about PECS - Picture exchange communication system and Eye Gaze

www.mefirst.org.uk Dedicated to improving communication, and what matters to them for children and young people through training, resources and support

First Introductions.


I have been thinking a lot about introductions of late.
Of how we inform another of who we are and what we do.

First introductions, are key, they establish a connection, an understanding and offer respect to both parties.

They set the scene, the tone and begin to allow trust to grow and develop.

They offer kindness and compassion, and say I am here and I am interested.

A key message to all the new doctors starting their rotational placements this week.

A Key message to all who work in healthcare and beyond.

#Hello my name is Sian.

Dr Kate Granger and her husband Chris- paved the way, set the standard, reminded us all of what power a human connection has.

@PointonChris we shall continue to hold Kates shining light, high and for all to see and say #Hellomynameis.

4 words, make the connection and lead the way.

I also wanted to share a story with you- a moment in time of connection, trust, and wonder.

" I always wanted to be a princess and wear a sparkly tiara, and a big fluffy pink dress, didn't you always want to be one when you were little" asked the young person I had been supporting through out a long adventure through chemotherapy.

I replied " well if I am really honest I didn't want to be a princess, I really just dreamed of wearing a nurses uniform and looking after lots of children"

The young person looked at me and said "isn't that strange how we had different dreams when we were young, I don't suppose it will ever happen for me now"

I replied " so what would stop you from dressing up now?"

She took some time to reply and said " Well look I'm not exactly attractive at the moment, nor do I feel like it"

I asked " so what could we do to change that?"

"Oh Nut Nut you are funny, always wanting to make a change or a difference, have you always been like this" The young person giggled and laughed.

I smiled and said " so what can we do to make this happen?"

The ending of this story is one that I will never forget, as this young person really shaped who I am, and who I have become.

Lots of pink dress material and lace was acquired, sparkles and tape and over the next week her room turned into a dress designers studio, there was laughter, tears, honesty, fear, love and wonder.

On the last day- of her last chemo - she emerged, dress on, tiara on, - a Princess she was.

The smile on her face..................... just beautiful, and I felt so honoured and humbled to be just a tiny sparkle enough to allow her to shine.

Never under estimate the drive and value of first introductions, of wanting to make a difference, of having the courage when around you has lost theirs, of hope and of dreams.

Maybe you could be the one who makes the connection- go on try it.

(C)   Sian Spencer-Little

Values to hold.

Values in Healthcare.

I have spent some time thinking about the way we observe people whether it be at work or in other environments- how they build relationships with their patients, their friends and how they interact with each other as colleagues.
I have seen the building of beautiful moments,  - of pure care and understanding- and watch as senior nurses inspire the next generation with wisdom and skill

I have also been thinking about core values- and how these impact our relationships.

I think about what makes each person act the way they do, whether at work or in their personal space- Are the core values different - for different spaces?

What drives there actions and reactions?

Does this impact decisions they make or how they can be?

If there is a physical shift- is it something that is tangible- or is it intrinsically linked to how they are in the world- and how they would want to be and work?

Core values in healthcare is something that many of us as healthcare professionals intrinsically bring into our daily lives- the work and commitment around the 6C's is for some who we are- and we hold these values dear with care,  they are part of everything we do- they enable us to provide care enveloped with love and understanding, respect and compassion.

They allow us to share, teach and gain strength and fulfilment within our roles in caring for our patients and our work colleagues.

Whilst writing this entry I have thought about many things that have underpinned the health care professional I am and the person who I have become.
I remember a teacher at primary school who was a beacon of light in an often scary time of primary school, who was direct but caring and would listen.
My first Matron- who instilled that you must always make sure your patients knew who you were by name, always wash your hands, and never lie.
A professor who agreed that above everything in the clinical setting when all around are loosing their heads- there must be time for play- as a steadying ship, as a way of reaching out.
I recall moments spent with children and young people, and family members at the most worrying and frightening times- and of the words used, and of the skills learnt from many colleagues.

I think about the families and the children and young people who I cared for on the bumpy and often stormy and unknown roads to palliative and end of life care - who were the care givers for them?
Did we always get it right?
Who did we learn from?
How could we make a difference to them and the most vulnerable children and young people?

We cannot change the diagnosis or outcome- but we can offer them love, warmth, care, a hand to guide them.

Some years ago during my first qualified post I had the honour of working with a remarkable family- a family who had had their inner world rocked by news that their only child had a palliative diagnosis.
The immediate first few days were spent in a darkend room, with just a small glimmer of sunlight peaking through the curtains, those days were filled with emotions that could make a volcano erupt.
My role- to let them be, to sit and listen, to hold their hands and their tears, to try and support them to make sense of the information, to care, to hold them in mind, and to be honest.
I remember stepping out of the room occasionally and thinking- Am I really making a difference?

In healthcare we want to make a difference- the smallest of things as we know have the biggest impact, the cup of tea, rather than a plastic cup, a proper cup.
A extra blanket, the curtains being opened, the sharing of the latest headlines in the newspaper.
The acknowledgement of a life, and of all their achievements.

How can we do this?
Our core values now come into their own- as they are part of our very being and so support us to provide the very best care we can give- to be kind, offer warmth, listen, be interested and hold them in mind, for the greater purpose of what we do is there in the very core of us.

However to do this- we must be offered kindness, warmth, and have the opportunity to be listened to.
To us these are moments to re-charge and re-ignite our passion for patient care, of patient experience and the use of our knowledge and skills.

I wanted to share part of a letter I received from a  family- a family experiencing loss.

" We felt like we had be hit by a lorry, and the lorry just kept reversing over us again and again, but each time there was this figure providing a bandage or a kind word, before being hit again.
 This figure returned each time, and the lorry slowed down a bit, we couldn't see out, or a way out of this mess, yet the figure remained- this was our only glimmer of hope, of love even though we were unkind at times- the figure never left us- we now know it was you and this place that has been our home for the last 2 weeks- we don't know how you did it, but you allowed us to be just be without any expectations, only that our child would be loved, and honoured and lived"

Please take care of each other, and then we can take care of children, young people and their families.

Together For Short Lives @Tog4ShortLives and @NICEcomms have published draft guidelines for end of life care for children, if you can please take a look.


Sian Spencer-Little
Copyright July 2016

What if....

When I sit and compose a piece for my blog I think about what and who I want it to reach out to, the essence of it, the core value, it is always for me a reflective piece of writing, perhaps of the events that have happened over a few weeks, or of things to come, more often it is about moments I have shared with many amazing children, young people and families, or about listening and sharing with fellow health care professionals.

It has been a while since I sat and put into words, my thoughts and episodes of learning as there has been much going on in both my professional and personal life, both of which has taken me down a positive path, and a bumpy with many stones in the way path.

Sometimes these are interwoven with stormy weather, of course I had forgotten my umbrella for those ones! 

Then little surprises- like a rainbow would appear to remind me why.

Of course no-one knows how we will react to such events- but recently having walked for many miles  it has always returned me to the place I know best, and where I am at my best.

My beautiful bookcase is a reminder during the storms, always look for rainbows, for there lies the sparkle.

I have been fortunate to have recently been a delegate at a national conference in Liverpool, I was thrilled as well as a little apprehensive, the RCPCH 2016 conference was for me a little bit of an ambition, almost a rite of passage finally after working for almost 20 years in acute paediatrics, and it didn't disappoint.

It was at times overwhelming, and the level of learning and of thought processes was immense, I felt very honoured to be able to listen and attend some powerful and ground breaking research presentations, listen and share the floor with junior doctors, consultants and professors all working so hard for the good of child health and medicine.

My cup was overflowing at the interest in specialised play in health and the range of people I was able to talk about this with, that patient experience and parent experience was so high on the agenda- it was thrilling to meet and listen to C&YP speak to a room and delegate hall about how it is for them- it packed a mighty punch, and really set the theme for the week.

I then got to thinking "What if"

"What if" we each took 1 thing back to our workspaces to  enhance our practise,  how would we share with our fellow teams what we had learnt

"What if"

together we learnt a new way of listening and working-  the outcomes and possibilities are endless.

We know that effecting changes takes time, and can be profound yet frustrating, as I am all to aware- this in its self feels like a waste of energy.

 "What if" we put all that energy  to use in creating those small ripples- because starting off at a tidal wave is counter productive.

"What if" when we got stuck, and our energy levels wavered - we took a moment to look up, or made a connection with another HCP- in person- what would that look and feel like- would that be our light bulb moment.

"What if" we then were able to connect with a child or young person in our professional capacity - who would impact and connect with the reason we do what we do- the powerfulness of this would be priceless and would enhance our skills.

Recently having completed further training and learning in Counselling Children and Young People using the creative arts- and in observing and working therapeutically with CYP- I put together this, sometimes what we see on the outside is just a superhero cloak- the true depth, feeling and power is what lies underneath.

"What if"

We have the big conversation.

Please give me the space to say how I feel.

To express my anger and pain.

Be there to hold me- if that's what I want, and to walk alongside this part of my being.

I don't know how I feel.

But I do know it hurts like hell.

"what if" I am not brave, but human.

Please support me so I can talk, or not.

I am strong, but I can also be broken.

When I see a glimmer of hope, or laugh, or dance, please let me embrace it- run with it, celebrate it.

For who knows what tomorrow brings.

"What if" I know that tomorrow will not come for many days.

Sian Spencer-Little

Copyright May 2016.