Feeling a Little Tense? A guide for Student Midwives and Student Nurses on Grammatical Writing Styles – Essay Tips

 

There are a few questions I get asked by students on ‘The Grammatical Person…’

• Which tense should I write in?
• Should I write in the first person?
• How do I get an A grade in my student essay?

So I thought I would write a short blog on this topic – I hope it may be of help to some people. However, I do not claim to be a grammatical ninja…so please do consult with your own tutors and refer to your own university guidelines and learning outcomes for a more personalised approach.

The Basics

Who is speaking in your essay? If it is an informal reflection, a diary or a blog, it will generally be your voice that we want to hear (first person). Speaking in the second person voice usually works well for advertising or promotional materials, however, it rarely becomes a feature in academia. Writing in the third person is usually the most scientific way of writing things… and so

• the person speaking (first person)
• the person listening or being spoken to (second person)
• the person being spoken about (third person)

First Person	Subjective Case	Objective Case	Possessive Case
	I, we	Me, us	My/mine/our/ours
Second Person	you	you	You/yours
Third person (Singular)	he (masculine) she (feminine) it (neuter)	him (masculine) her (feminine) it (neuter)	his/his (masculine) her/hers (feminine) its/its (neuter)
Third person (plural)	They	Them	Their/theirs/his/hers

There are four present tense forms in English:

Tense	Form
Present simple:	I work
Present continuous:	I am working
Present perfect:	I have worked
Present perfect continuous:	I have been working

So what about the student midwife’s or student nurse’s essay?

Well..Think of your essay/thesis/dissertation/research as a person/thing.

What is it going to do? What has it done? What is it doing?

Examples:

Introduction – “This essay will describe and explore the various factors relating to the experience of women during the postnatal period”

Background – “The literature suggests that new mothers find it hard to bond with their babies where they experience a lack of compassion from those around them (references)”

Methodology – “This research firstly looked to explore the literature in relation to wound healing in diabetics. It did this by ….”

Results – “The research data collected within this research via a series of qualitative interviews highlights that midwives feel better able to communicate with doctors if the doctors are nice to them. These midwives also became better practitioners as they communicated with each other more effectively”

Discussion – “It is interesting to note that the results presented within this research suggest that home birth is a less safe option for childbearing women, as many of these studies fail to look at home birth in the wider context and only focus upon…”

Conclusion – “This dissertation has outlined 32 interventions which assist medication adherence in patient groups who are reported to experience symptoms of poor mental health.”

Reflection – “Throughout the process of writing this essay, I found it refreshing to discover how I could enhance my critical thinking by synthesizing the results of my research in line with the findings presented. As a nurse, I have previously only tried to interpret the literature thematically, and so in taking this new approach, I have now been able to develop my skills.”

Do you see?… as the essay progresses…so does the past and present tense. Additionally, the research/essay/dissertation remains to be a separate entity from the writer. This is how most scientific papers are written. Only within the reflective section has the writer referred to themselves (this may be required for some essays, but generally not in scientific papers).

 

Lastly:

I hope this will help some students to clarify how they would like to present their work.

See my 15 Top Essay Writing Tips for Midwifery and Nursing Students here

Also…

See my guide to literature reviewing here

Until next time – Look after yourselves and each other 💛💙💜💚

Birth Rights & Attitudes Towards Autonomy in Maternity Care

This blog post shares some of my learnings from and reflections of a seminar I attended recently, hosted by the Birthrights group at University Hospitals Coventry and Warwickshire. I have always found medical law very challenging to understand, even having studied it at Masters level…I am still largely perplexed by the complexity of it all. Yet this session seemed to simplify things for me, offering case studies and easy to understand facts…for which I am very grateful! For further learning, please see more factsheets here.

Many of the topics under discussion were drawing from the work of the White Ribbon alliance, which I am highly drawn to in their quest to promote the wellbeing of midwives for the benefit of services around the world. Below I will discuss a few of the topics highlighted which have aroused my interest in relation to my own practice.

“Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk”. – (Lancet 2010).

This publication evoked moral discomfort within me immediately. Having previously practiced as a home birth midwife, I am used to challenging the notion that home birth is a less safe option where mothers put their babies at risk. As with many studies which examine the safety of various birth places, I often see biases where the skill of the birth attendant and other relevant factors are seemingly ignored to promote the argument that ‘It wouldn’t have happened if you had only been in hospital’…But the thought that women are putting their babies at risk (and choosing to do this) fundamentally goes against my own clinical knowledge and beliefs.

This paper has led to some women having forced cesarean sections…surely this is a path which nobody wishes to go down.

The discussion and debate around fetal rights has also led to mothers being prosecuted for drinking alcohol during pregnancy. This is a moral pathway which sees the woman become a vessel for a means to an end, rather than being an end in her own right. Again, do we really want to take this path? Having explored ethical arguments myself, I think there is a better way..

In this same vein, the issue of when a fetus has rights or not has also been debated and contextualized. Now that the 24 week limit upon abortions has been lifted (decriminalized), it is clear that the mother has more choice in her reproductive decision making abilities. For me, this can only be a good thing.

Human rights-based approaches guided by the World Health Organisation

• Non-discrimination: The principle of non-discrimination seeks ‘…to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation’.
• Availability: A sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes.
• Accessibility: Health facilities, goods and services accessible to everyone. Accessibility has 4 overlapping dimensions:
  • non-discrimination;
  • physical accessibility;
  • economical accessibility (affordability);
  • information accessibility.

Healthcare practices that violate human rights: Drawn from the Charter for Respectful Maternity Care

Physical Abuse: Episiotomy , non consensual force, restraint, unnecessary procedures, failure to provide pain relief

Disrespect: Verbal abuse, bullying, blaming, shaming and reprimanding

Non-confidential Care: Unauthorized revelations and psychical exposure

Non-consented Care: Anything performed without adequate information or dialogue to enable autonomous decision making, or with undue pressure

Misinformed Care: biased, non transparent information given, which inhibits a woman’s ability to make an informed choice

Depersonalized Care: Inflexible application of policies or guidance, which fail to take into account of a woman’s individual circumstances.

Discriminatory Care: Unequal treatment based upon personal attributes (age, race, religion).

Abandonment of Care: Refusal to provide care due to inability to pay or birth choices (or any reason)!

Check out the Birthrights info on human rights in childbirth here

Attitudes to Autonomy

Lastly, the following statement from a paper published in 2013 had me thinking about the impact of blame cultures within our maternity services.

“Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions.”

The statement outlines how both midwives and doctors are happy to accept that the mother has the right to make any final decisions, yet they were under the impression that it was them a the practitioner who would be legally accountable for any adverse outcomes which occurred. This may be in part due to the nature of our regulatory and litigation systems, which can invoke a fear in practitioners that they will be ‘blamed’ in some way for any adverse outcomes.

Yet adverse outcomes occur all of the time, in any case, and sometimes cannot be controlled. This is of course very sad…yet it is also an inevitable reality of some women’s childbearing experience. Nobody’s fault.

When women have true autonomy and the power to make their own decisions around childbirth, they also have inherent accountabilities in relation to the choices they make.

That is why it is more important than ever to make sure that we are recording the conversational dialogue that we are exchanging with women. Consent forms really have no use unless the information can be recalled and maintained. The law dictates that we must be open, honest and avoid influence in open discussion with women.

I personally believe that these conversations would be best recorded in digital format. See my paper on this here.

As always, it is the relationships we build with women that will always be the key to building trust, opening dialogues and beginning advocatory conversations which support women’s ability to make truly informed decisions. We must work in partnership with women and the wider multidisciplinary team in order to ensure that women can make the right decisions for them, and in turn take accountability for the decisions they make. We can only do our best in managing any situation to the best of our abilities as midwives (and as any other clinician). That is what we are personally accountable for.

(Image via http://hakam.org.my/wp/)

Until next time – Look after yourselves and each other  💛💙💜💚

Why the health, wellbeing & engagement of #NHS staff matters..financially, practically & morally speaking…

I spend a lot of my time talking to clinicians, managers, commissioners, those outside of healthcare and leaders about the importance of promoting and supporting staff wellbeing within the #NHS workplace. Some are already on board with the reality that excellence in healthcare simply cannot happen in the absence of a workforce that is cared for and nurtured to thrive. Others feel discomfort at the thought of caring for staff when the ‘patient comes first’ and some simply don’t know what to do for the best. In any case, nobody seems to want to destroy the NHS workforce (correct me if I am wrong)!… and everyone seems to want to learn more.

A good staff experience where staff feel ‘engaged’ is critical to  achieving excellence in healthcare…What do we mean by ‘Staff Engagement’?

‘Institute for Employment Studies (IES), defined staff engagement as a positive attitude held by the employee towards the organisation and its values. An engaged employee is aware of business context and works with colleagues to improve performance within the job for the benefit of the organisation. The organisation must work to develop and nurture engagement which requires a two-way relationship between employer and employee (Robinson et al 2004, p 4).’

Recently, I was asked to provide some evidence as to why the wellbeing of NHS staff matters by someone else who was keen to make a difference in this area. They needed to make the case to others in order to make change happen. I imagine that lots of other change makers will be needing to provide evidence too, and so I have set out some arguments for the case below. I hope many of you will find it useful to have some of the arguments in one place.

Please feel free to share this evidence widely with others…. If you have other evidence to add to this, please feel free to comment below…

(There can never be too much to share)!

Financial reasons to care for NHS staff:

Over 2014/2015, the NHS Litigation authority (NHSLA) paid over £1.1 billion to patients who suffered harm and their legal representatives, this coming year it will be c £1.4 billion and with accumulated provisions in our balance sheet of over £28 billion further significant increases are already in the pipeline. When staff are unwell, in psychological distress, communication is hampered by poor working cultures and there is a lack of staff engagement, NHS staff are more likely to make medical errors (Hall et al, 2016).

Good staff health, wellbeing & engagement = reduced medical errors = reduced litigation costs

Estimates suggest that recruiting a nurse from overseas costs between £2,000 and £12,000 and return-to-practice costs some £2,000 per nurse, while training a new nurse costs around £79,000. Additionally, recruitment costs to replace staff who leave owing to work-related stress and/or poor job satisfaction is estimated to be £4500 (More for senior posts). As such, in order to get best value for money, the NHS will need to work hard to retain and recruit a high quality workforce.

Good staff health, wellbeing & engagement

= Increased recruitment and retention = Best value for money

Staff sickness absence rates cost an estimated £3.3million annually per NHS organisation. When staff are absent, there is the added cost of agency staff to fill in gaps (The NHS Improvement team now expect the NHS to spend a total of £3.7 billion on agency staff by the end of the 2015/16 financial year).The Francis inquiry into Mid Staffordshire also exposed the consequences for patients and staff of not addressing this issue of staff morale and sickness. Typically, if an NHS organisation reduced staff sickness rates by a third,it would provide an additional 3.4 million working days a year for NHS staff, equivalent to 14,900 full-time staff, saving an estimated £555 million.

Good staff health, wellbeing & engagement = Decrease in sickness absence = reduced agency/sickness spend & therefore, improved patient care

(Image source :http://www.slicedbread.co.uk/solutions/employee-engagement/)

Practical reasons to care for NHS staff:

Ultimately and practically, the NHS exists to provide high quality and safe care to patients. Evidence so far shows that better staff health and wellbeing is associated with improved patient outcomes.

Some of the many benefits to improved NHS wellbeing is that better staff health results in lower infection rates and lower standardised mortality figures. The Keogh review of 14 hospital trusts with high patient mortality rates found all these trusts also had higher levels of staff sickness, compared to national average.

Good staff health, wellbeing & engagement = Safer and higher quality patient care

When an NHS organisation invests in staff health, wellbeing and engagement, they improve their ‘Brand’. Branding is one of the most important aspects of any business, large or small, and its impact shouldn’t be underestimated when it comes to engaging staff with health and wellbeing initiatives.

Good staff health, wellbeing & engagement = Your NHS organisation looks good & therefore attracts more staff

A report from the Kingsfund suggests that job satisfaction, organisational commitment, turnover intentions, and physical and mental wellbeing of employees are predictors of key organisational outcomes such as effectiveness, productivity and innovation. Everyone wants more of these things..right? They all have the potential to save money and improve the safety and quality of care.

Good staff health, wellbeing & engagement = Higher productivity, staff effectiveness and innovation = Cash savings and better services

Moral reasons to care for NHS staff:

Staff are entitled to a psychologically and physically safe professional journey. Caring for them is not an optional issue, it is an ethical one.

 

When staff are well cared for, they experience greater job satisfaction, improved morale and general wellbeing. Few aspire to be ill, and many feel great shame in letting others down or asking for help.

Where the emotionality of distressing work  remains unrecognised and void of support, distorted thinking, emotional distress, reduced productivity, increased sickness rates, poor decision making, and maladaptive patterns of behaviour may present. Physical symptoms can also result, where severe job stress evokes irregular menstrual bleeding patterns for female healthcare workers, poor sleep quality and bodily exhaustion.

The NHS workforce is one of the largest work forces in the world. They are patients, they are the public, as are their friends and families. As such, by caring for this group, we are also caring for a large part of society. Moreover, there is also a strong statistical link between the wellbeing of staff and patient satisfaction. This means that if we are failing to care for staff, we are also missing an opportunity to improve patient satisfaction.

Good staff health, wellbeing & engagement = A nice and decent thing to do for all.

There are many more reasons for NHS organisations to care about the the health, wellbeing & engagement of their staff..Financially, practically & morally speaking… Please feel free to add these below.

I hope that these few facts and figures can be shared and used to convince everyone throughout the NHS of these facts. Many will say that it is the patient that must come first. However, I argue that excellence in health and social care may only be achieved if both the staff and patients are cared for equally, as they work in partnership to achieve the best outcomes.

Looking for ways to turn this vision into practice? See my blog on 20 ways to create a thriving NHS workforce here

Until next time, look after yourselves and each other 💛💙💜💚.

Masterclass: 10 Top Tips for Winning a National Institute for Health Research (NIHR) fellowship award

This week, I have been engaging with National Institute for Health Research (NIHR) funders, in a ‘bid’ to learn more about the fellowships currently available to researchers. This masterclass was held at @unibirmingham, and it really was a great opportunity to speak to the funders and get some sound advice on how and what to apply for. In this blog I will share 10 top tips which have been formulated as a result of attending this masterclass. I hope this may help other applicants (like myself) to maximise their chance of success.

1. Firstly, know which type of award is best for you and your future plans and ideas. I will be applying for a post-doctoral fellowship as an early career researcher.

 

 

2. Contact the Research Design Service early…talk through your ideas, take advice and learn all you can. This service can point you towards other team members, experts to talk to and new ways of thinking. They can be involved at every stage of your application and they really do give great feedback.

3. Once you have the basics of your project together, think about designing the right team. If you are planning at RCT for instance, who is on your team who can help you with that? Do they have the right expertise? Seek out the right mentors, collaborate outside of your institution, start building relationships with people who you can work with throughout your fellowship (and hopefully throughout your career)! The NIHR want to see that you will be well supported to succeed.

 

What are the chances of success?

Competition is fierce! – Make sure you stand out!

 

4. Make your application logical, clear and really show that you can demonstrate the impact and trajectory of your research. How will you disseminate your research (other than papers and social media) – Could you make a film? Hold a dissemination event? Additionally, make sure you answer every section in detail and check your application against the current guidance materials.

See full and official NIHR guidance here

5. Set out your own personal career goals and create a comprehensive training plan. This is where most applications fail. This is not just a list of courses you will take. This is about who will mentor you, where you will learn, can you arrange a secondment? Work experience? International conferences? – How will you grow and develop into an independent researcher? – Why should they invest in you as a person?

 

 

6. How will you involve patients, end users and the public in your research? Patient and public involvement (PPI) will form a key component within your application, and should feature throughout your research plans. Involve is a great place to start. You can apply for a small £500 grant to carry out PPI activities before submitting your fellowship application, ask your regional RDS service for more details, and be sure to include the results of these activities within your application!

 

7.What if you get called for an interview? Make sure you know your application inside out (it may be a long time since you submitted your application – and you may be asked some really complex questions by people who are not experts in your field!)

 

 

8. Be sure to have mock interviews with your peers (they will be much harder on you than the interview panel). Challenge yourself, be willing to change your ideas in response to feedback. Embrace every opportunity to improve!

9. Be yourself. Yes you will be nervous, but the panel wants to see who they are investing in. Its OK to show personality and be ambitious. They want to invest in new talent, the research stars of the future. Show them your potential. Don’t be afraid to take criticism – engage in constructive dialogue throughout, yet leave the panel with a punchy take away message where they can see your potential and future trajectories.

10. Be on time – don’t miss deadlines, arrive early to the interview and be ready to showcase yourself and your ideas. The NIHR want to fund you…they want to spend tax payers money wisely. Leave them in no doubt that both you, and your project are worth it. You are the future the world needs to see!

 

See full and official NIHR guidance here

Until next time, look after yourselves & each other..💜