#homesnothospitals #weldnurses & Overcoming Imposter Syndrome

I'm not sure how long I had been a member of Twitter when @weldnurses first suggested that I host a Twitterchat.  I said that sounds like a great idea and didn't go back on Twitter for about six weeks. 

I was scared at this suggestion, I didn't really understand how much support would be available (lots), or how to find out more information about hosting a Twitterchat, you can find out more here http://wecommunities.org/tweet-chats/host-a-chat.  A part of me thought why would people be interested in my thoughts on these topics, classic imposter syndrome http://www.emergingrnleader.com/imposter-syndrome-in-nursing-leadership/

Previously I had used Twitter as a resource, a way to find out the most up-to-date information hearing from experts in areas of interest and keeping up with the news (as well as what was happening in Brad Pitt's life…. Sad, I know!).  

After writing a couple of blogs for learning disability elf http://www.nationalelfservice.net/ I was gaining confidence with how to use social media and online resources and in the summer this year I started to really understand how I could use Twitter to engage with a range of professionals, carers, service users , family members and student nurses.  I used twitter to follow the #IASSIDD16 conference, making new connections, sharing resources and engaging in discussion with service users and some of the most high-profile professionals in our field. 

When @weldnurses approached me for a second time, sending me a private message and suggesting that I might want to write a blog with some links to the resources to support me, I thought why not? I told colleagues at work @teesunisohsc and in practice about it.  I discussed it with the SoMe group and the influential advocates of #SoMe in our school @jyaldren and @DrmarjWilson.  One of my colleagues accidentally sent the link around the school, which raised the profile further and on Tuesday I mentioned it to a whole cohort of second year students, during the start of our promoting positive outcomes module, making the links there and inviting them to get involved.

On the night of the event I started to feel nervous, I had prepared the information in advance and @weldnurses and other followers had regularly shared it in the build up to the chat, but as I was sitting in my living room with a strong cup of coffee, the laptop open, the iPad next to me and my iphone, I was thinking what if nobody engages with this, what if I'm just asking questions to the Twittersphere and @weldnurses are just retweeting them? 

I sent a couple of messages to colleagues, friend’s, students and asked them if they were going to get involved and thankfully some of them did! It felt great to see people so interested in this issue, giving up their own time to share ideas and experiences.

The Context:

Stephanie Bincliff’s death which occurred in an assessment and treatment unit felt so important to me when I read about it in 2014.  This was a very young woman who should not have died, she should have had a quality of life that we all are entitled to.  The comments I read from her family about what a unique individual she was and her ability to teach other people resonated with me, I will never forget interviewing a student nurse who said ‘I just absolutely love working with unique individuals’.  The role of the community learning disability nurse essential to enhance skills,choice, independence and inclusion, so it was an obvious choice as a learning disability nurse to share the story through @weldnurses.

The chat started with some introductions, reminders of Twitter etiquette http://wecommunities.org/blogs/15  professionalism and # to keep people focused and involved.  The @weldnurses team aka the twitter police we right at hand to make sure that this was reinforced.

Labelling and Health Inequalities

The first question about being labelled as challenging leading to health inequalities led to a number of discussions about what having a label means,why we need labels, are they useful? Are they damaging? Some discussion about why 'challenging' needed to be explored in terms of inequalities.  We agreed that things have moved on with suggestions about simplicity and changing language.  We recognised that a change of behaviour isn't described in the same way as previously, although still much to do for us as a profession in collaboration with stakeholders regarding these barriers.   

Some discussion that labels can lead to staff being scared of individuals, prejudicial practices and reducing individualised activities.  I was also asked to define what I meant by inequality, and there was a suggestion about separating the concept of care and treatment and examine the inequalities separately, perhaps this is a future Twitterchat @DrMariusAdamou.  Keeping up with all the tweets was an experience! 

It would have been great to have seen some family or service user discussion around this.  Overall the agreement was we need to be mindful of the language we use and the understanding that people get from that language.  Great point from @timspurs ensuring we don't just hear the language and forget the person. Overall I think change in the way that we talk about people is so important, but we have to find ways to include those very people in the discussion. 

An intervention can only be as goodas the people implementing it:

We discussed the coroners view that even if interventions had been in place they would not have been implemented effectively.  There were different interpretations of what this meant, some wondered if this was about the coroners view of Stephanie as a lady with a learning disability.  While others thought about and intervention only being as good as the people who are implementing it.  This obviously then led on to discussion about skills,training needs etc.  Safewards were brought up by @communityld and I think we have another Twitterchat in the making, I can't wait to hear more Glen!

The role of the LD nurse: this was highlighted repeatedly in the further discussion on how we can stop this happening again and how positive behaviour support might have been used.  Overall a sense that people saw a problem with Stephanie and her challenging behaviour are with you as a reason not to intervene, no skills teaching, lack of quality of life, containment and neglectful practice.

Suggestionsfrom participants included: 

• Education and awareness for all staff working with people with learning disabilities
• Increased training and opportunities for support staff
• Greater responsibility within clinical commissioning
• Recognising the staff’s needs, not just from a training perspective from an individualised perspective
• Measuring the impact of training on practice
• Involved in people with learning disabilities in the delivery of training
• Commissioning learning disability nurses to provide education to service providers
• Integrating health and social care further

One suggestion regarding positive behaviour support training led to further discussion in terms of accreditation and service providers who say they deliver certain specialist input and fail to deliver on this.  As highlighted by@samabdulla a specialist service for people with Autism should be able to evidence what makes them 'specialist'.

There wasn't a lot of time to discuss the role of positive behaviour support in this situation, however on Monday, 10th October follow #pbsconf16 for more discussion on this.

The hour flew by! From a personal perspective, it was fantastic to see that some of our students got involved from other fields of practice and one LD student @KirstyTaylor193 will be writing a follow up blog from the discussion that we had.  There was a nurse talking about re-familiarising herself with learning disability practice @nurse2coach.  I also saw a student saying that she'd started to love Twitter based on the Twitterchat,something that she previously only used for socialising.  I have had positive feedback from colleagues around the school who I didn't see engage in the chat but may have been 'lurking' http://www.adweek.com/socialtimes/10-lessons-twitter-newbies/451563 and keeping up with how the discussion went in the background, which is great!

While it would be great to have the opportunity to do it again, I'd also love to see some of our students and my colleagues taking the opportunity for this.  As learning disability nurses we have fantastic resources with a wealth of knowledge and clearly many people want to engage in these discussions and are motivated to do this in their own time while also nurturing others to dip their toes in twitterland.

Thanks to @paulahopes1 for hosting this chat and bringing Stephanie Bincliff's case to a wider audience. It's great to hear her person journey, from being invited to, grasping the nettle and now reading the outcome. It's an inspiring read and she has certainly posed questions for future chat subjects and hosts. I'm sorry to say that we are unable to bring the pictures that she peppered this interpretative blog with, however this does prompt a couple of questions to ask @wegizmos!

@dmarsden49