August 29, 2010 at 11:52 am (*A NIGHTINGALE SANG)

Images

Music (Full performance)

Music Extracts (Click Download files to my computer and then choose individual tracks)

Texts

Programme

….in a war zone, in Indian slums, in schools, churches and hospitals, in science and politics (and in many a famous London Square).

Florence Nightingale was a pioneering nurse and a complex, passionate social reformer concerned with a range of human issues that are as pertinent today as they were at the time of her death a hundred years ago. At the heart of her life and work was a simple, universal value – care for our fellow human beings.

A Nightingale Sang is a community cantata reflecting on nursing and midwifery and in particular on the nature of empathy on the personal, collective and spiritual levels.

The school’s Nightingale choir will be augmented by  the esteemed choir of King’s College London, Mind and Soul – a choir of mental health patients from the South London and Maudsley NHS Foundation Trust – and a 200 strong choir of nurses, midwives and healthcare students and professionals, specially assembled for this event, King’s College London Symphony Orchestra, and a nurse’s gamelan group. The piece also incorporates dance and soloists singing first-hand accounts of human suffering and healing.

A Nightingale Sang is part of the Chorus series taking place during the Festival of Britain Celebration.

Find out how you can join us and be part of this very special event – or buy tickets.

QEH, SOUTHBANK CENTRE, 13/05/11, 8pm

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Affecting Moments

March 20, 2010 at 5:46 pm (*A NIGHTINGALE SANG)

I sent out the following email to all staff:

CALLING ON ALL STAFF TO SHARE SOME AFFECTING MOMENTS.

I have a range of works that I’m composing as part of my residency here and I’d really like to get some input from staff in a number of ways:

TEXTS – related to the art of nursing or care more generally, and/or to illness or anything else you can think of that relates to the business of this school. Texts may deal directly or obliquely with these topics and the form could be anything from poems to newspaper articles, from a thank-you card from a patient to a patient’s notes – its wide open. These texts may then be set directly to music or be the inspiration for a new work.

STORIES – anecdotes, memories, accounts of affecting moments in your nursing career and/or in the life of this school.

IDEAS that you may have for a piece of music or particular context where you think music might play a role.

FLORENCE NIGHTINGALE – anything you may have on the great woman herself that inspires you.

Now this brief is wide enough for me to get something, however small, from almost every member of staff…….otherwise I may just have to come a-knockin-on-your-door.

If you have anything then please post it below or email me at john.browne@kcl.ac.uk

Here are some of the responses so far:

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FEAR

African refugee couple, dad land-mine victim with prosthetic leg, both HIV positive with a premature baby boy requiring 02 via CPAP.  This was my first patient in a neonatal unit as a qualified nurse.  A very frightened mum wanting so much for her child to be well, her grief (yes grief) written all across her face.  A frightened father trying to be very masculine and tough. And a frightened new nurse.  We all wanted the best for the infant, so had the same needs but requiring a very different approach for all of us.

ANXIETY

The infant was distressed at one stage and would not settle after a nappy change and feed.  Mum asked if she could give him a cuddle, the look of pleading in her eyes would break any ones heart.  I said yes.  A key role, in my opinion for a neonatal nurse is to give the child, in a sense, back to the parents.  They lose their baby to use the professionals.  Its their baby. yet they ask us permission for things!  Bonding and attachment is a massive part of the neonatal nursing role and trying to establish and maintain that in the family. That begins by giving back the ownership of the infant.

DESIRE

Anyway mums asked me and I have agreed.  Dad immediately and sternly said No!  On asking why he felt it was a bad idea he informed me that in Africa it was felt this would make the man weak and he did not want a weak son.  I said okay, lets talk about that in a few minutes and try to understand what were all looking at.

EDUCATION

I then took my 30 minute break grabbing all the literature I could on kangaroo care, attachment and bonding etc.  I went back the family and sat at their feet on the floor and asked them to look at the literature I had.  I let them read for a few minutes before talking over the points I felt important.  We discussed the fact that in Africa the baby would’ve been swaddled against mum regularly from birth whereas his son was in an incubator and been denied that contact.  Reinforcing the points in the literature as a trio we managed to talk through dads fears.

ELATION

End result, dad agreed that it was appropriate for his son to be cuddled.  Mum had tears in her eyes, her first cuddle and it resulted from a bit of nursing I am very proud of.  It grew to dads first cuddle and the silly ‘ole sod had tears too, and st me off with the man coughing and glass eyed look.

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I love that Florence Nightingale was such a gifted statistician who actually invented the pie chart. The media often portray modern nurses as too tied up with science and statistic to care, and they portray Nightingale as somebody who did nothing but clean – but that’s not true, she used her intelligence to change nursing. I think that’s the most inspiring thing for modern nursing students: we must provide physical care to the best of our ability, and apply our knowledge to improve care as far as we can. The two are not mutually exclusive, and nurses who can combine the two are the nurses who will make the changes that will improve peoples’ lives.

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Here’s my diary entry from my first experience of death at work:

I dealt with my first child death tonight. It was a little girl, aged 20 months, who has been brain stem dead for over a day. She had been totally healthy, then had a cough and high temperature, and then got really sick and her brain stem herniated and caved in. The exact cause of death is not known, there will be a post-mortem today. This should give the family the answers they will be desperate for. She is one of twins, they were conceived by IVF: one of the family friends said to me that they are “very precious babies”. Just adds an extra level of tragedy, knowing how long they had to wait and how hard they had to try to have her.

When we came on shift, we were told they weren’t going to decide about transplant tonight, and to keep her stable on the ventilator and inotropes. Then, her blood pressure started to drop, so the consultant came to say that we were coming to the end of what we could do, so they needed to make a decision. Parents both said they would like to donate. The consultant and another doctor repeated the brain stem death tests, and confirmed that she was. The transplant co-ordinators came. Everything was ready, and then they rang the coroner (as a “formality”, they said) who refused the donation as they cannot guarantee that the cause of death wouldn’t be in one of the removed organs. Parents were distraught, as it had been a comfort to them that their daughter’s organs could save so many children. The transplant co-ordinator was wonderful, and said they must always be very proud of their decision to help others at such a difficult time, and that the decision was taken away from them.

So then the doctor who had worked with them the most came and discussed when and where they wished to withdraw care. We gave them time to discuss it, and they decided not to keep her hanging on unnecessarily, and decided to withdraw then. Anita (my mentor) and Alice (the doctor) turned the drips off, and then detached the ventilator and put her in her parents’ arms. She died very quickly and peacefully in the arms of those who love her. They took the tube out, and we left the family to it. Alice had to go back to get a muscle biopsy, and then we left them for a little longer. When they were ready, Anita and I helped Mum to wash and dress her – she was starting to stiffen, but we got there before the worst set in. Then we took photos of her clean and without tubes. We already had hand and foot prints and a lock of hair, so parents have all of the keepsakes we were able to offer. They then said their final goodbyes and left.

We then took her to the mortuary. This was the most heartbreaking part for me. It was horrible. Anita carried her down – she was stiff as a board by this point. We found an empty shelf in a fridge, which was hard as it was very full down there. The fridge absolutely stank. I hadn’t been expecting that: Anita said it was the worst she had smelt. I looked at the front, one of the bodies had been in there since 5th December, so that explains the stench. I thought they had freezers for that sort of length of stay. It broke my heart to leave the beautiful girl there. We had cared for her so beautifully, kept her in such a nice condition, and then we had to leave her in that stinking fridge full of other dead bodies. The comfort is that her parents will never see her there: they will see her either in the chapel of rest, or at the funeral directors, if they choose to see her again. It’s just not how a nurse wants to leave their patient, but I had no choice.

I’m proud of myself tonight. I faced a massive fear of mine, which was that I would be unable to support a bereaved family as I would be too distraught myself, but I was professional and did as much good as I could. I cried, but crying is OK so long as you can function enough to support the family you’re caring for. I carried out the last offices for the first time. I took photos of a dead child, because the family wanted those photos. I contacted the chaplain early in the shift, and she was blessed when they thought she was going to go for organ retrieval. I did all that I could.

I spent my long break (before we took her down to the mortuary but after we washed and dressed her) on the balcony garden in the hospital. I just wanted to see the world outside carrying on, and to view every person I saw as a life, which suddenly seemed so much more valuable and fragile. I sat there, watching the world, with my ipod. I listened to Carl Sagan reading his “pale blue dot” speech, it tend to make me cry and it seemed fitting to listen to how tiny this planet is, and why we should treat one another kindly. It’s the closest thing I have to a prayer: it affirms my beliefs about the universe, our planet and the human race. I listened to Concerto Aranthurez: Adagio because I know it was written in memory of Rodrigo’s son – and I can see how the music so perfectly embodies the power of the emotions involved in a childhood death. I sobbed my heart out, on my own, on that cold balcony, and I felt that this was the least I could offer for that child. She had every chance, she came to one of the best children’s intensive care units in the country. She was just unlucky. And we did all that we could given the circumstances, and we gave her a dignified death in the arms of her parents, in a quiet and calm environment. We gave them mementoes of their beautiful daughter, and we gave them as much choice as there is in such situations. Nobody can fix a brain stem.

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The role of the student nurse is essentially one of privilege. Our first role within the hospital is to begin to understand our patients, to develop our empathic skills by spending time with them, and as we develop we gradually develop our skills and so our time is more productively spent elsewhere. On my first placement, I was given the opportunity to accompany a patient to surgery, to be some continuity for the patient, to witness some surgery, and to gain some exposure to what is commonly called “the patient journey”. My patient was a spritely 58 year old who was having an above knee  amputation, the result of an RTA many years previously. She was very anxious pre-op and we talked at length about what this meant to her. She was tearful in the lift down to theatre, and held my hand while the anaesthetist explained the procedure. I offered my reassurance that I would be staying with her, and would see her in recovery. After the operation I was one of the first faces she saw, and sat with her while she looked down the bed to her singular foot for the first time. I spoke to her relatives back on the ward, and subsequently enjoyed the familiarity with which I was introduced to her friends and members of her family. I enjoyed our subsequent conversations and the opportunity to watch the remarkably quick way in which she adapted to her new body and the many challenges her mobility was going to raise.

It was not long afterward that my placement finished, and having been removed from the intensive recovery bay of the ward, and into the general bed space, I had not been directly caring for her. I went to see her when my shift finished, to say goodbye and wish her well.

She held my hand, looked me straight in the eye and said “Thank-you for everything you have done for me”

I was quick to leave the ward, and get into the anonymity of the London night, where my emotions would not be noticed. I was full of enthusiasm and was hurriedly banishing the doubts that had been lurking at the back of my mind about changing my lucrative career in the City for the glamour of Nursing.

Of course not all days are as affirming, but this is one which I will hold onto through-out my career, and probably my life. I hope this offers some insight into our role, and I wish you every success with what appears an extremely demanding mandate!

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To be honest what springs to my mind, on the basis of some of my experiences at the school, is something along the lines of very poor military band music.

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One of the most moving moments of my nursing career was when I was caring for a woman who was dying.  I had been looking after her for a few days and was going on two days off and we both knew she would be gone by the time I got back.  I was driving home the next day and I swear to God she came into the car to say bye.  There was a moment of complete calm and peace.  I stopped the car and said bye and looked at my watch noting the time.  When I got back to work the time this happened was the time she died (no one died alone they always had a nurse sit with them until the end so the time was accurate).  I have never forgotten her.

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There is a poem called the crabbed old woman which was found in a locker of a patient many years ago. I do not know where you could get a copy, but I bet a nurse lecturer would (I am midwifery).

There are may happy times, but of course they never make such good stories. The time I left the bath running in the ward and went to lunch. The first we knew about it was the nursing officer getting wet in her office below! The water fights we had with the patient who were young and fit enough. We only ever did that when sister was at tea or lunch and got caught a couple of time. The baby born to a couple who had been trying for 20 years and we all cried as much as the newborn!!

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I’m not sure if this is what you’re looking for, but i have a semi music related anecdote from my placement. This one patient was a physicist and he liked to see logic and rhythm in eveything. He loved looking at the drip he was attached to becuase he worked out that there was a rhythm to the drips in the small chamber between the bag of fluid and the pump. They would be two drips, then rest for two, then three drips. He’d stare at it for hours. He’d hum a tune to it. Then we had to put the rate up and the rhythm changed. It was as if the time signature to the drip had changed and the drip was his metronome! He also never minded the beeping sound the pump used to make if it had a problem. He found the consistant, predictable pitch soothing.

Needeless to say he was one of my favourite patients!

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A memory of someone I cared for

I worked on a team that looked after young people (age 16-25) who were having their first episode of psychosis. This particular client was called Adam and he was 19. He was a student in London and living in ‘Halls’. Myself and another community psychiatric nurse used to visit him in his room on most days. If his mum was there she would let us in. Otherwise we would stand outside his door talking to him and he would usually tell us to go away or just completely ignore us. When we did get to see him, he would usually sit on his bed, avoiding eye contact and saying virtually nothing. On one occasion, I was sitting on his bed trying to get him to talk to me and tell me how he was feeling – no luck – he continued to look at the floor. I got up and started to look at his CD collection.

“You’ve got some good ones here Adam – I love some of these – you like ‘Beth Orton’ so do I – she’s brilliant.”

Adam half smiled and actually looked at me. He didn’t say anything for a while. Then he told me to leave his music alone so I did.

A few days later we visited Adam as usual but this time I had brought something with me. I had made a compilation CD of songs that I thought he might like to listen to. I had called the compilation ‘Music to recover by’ On the CD was particular track by Beth Orton called ‘I wish I never saw the sunshine’. This is a beautiful song but really quite melancholic. Sometimes sad songs are really good to listen to even if you are feeling sad – I listen to this song a lot and I love it- but actually it often makes me cry. Adam smiled when I gave him the CD. His mum rang me later to say that he was playing the CD and seemed to really like it. We continued to see Adam for another month or so and his health began to improve. His health probably started to improve as a result of the anti-psychotic medication he was taking but I also think music played a really important part in the beginning of his recovery. He went back to Scotland which was where he was from as the family decided that he couldn’t carry on studying in London. We never saw Adam again but I often wonder how he’s doing. I gave him another CD when he left (volume 2) and he thanked me and shook my hand – a big improvement from not even being able to look at me!

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Something on the fear/unknown when going into hospital then the easing into it as the environment becomes more familiar and the care reassures and brings peace?

Perhaps this could inspire?

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My particular interest is in pain management where nurses clearly have a central role in all different clinical areas (in fact comfort and relief of distress is part of the International Council for Nurses code). So the experience of pain and relief may translate quite well into music. In acute pain (surgery, trauma etc) there is a general stress response similar to the fight or flight which drives people to seek help and can threaten their recovery. For people with persistent pain, the burning, shooting, stabbing, pins and needles dominates their life affecting their physical and emotional health, social roles, finances etc. I have a very good book by Deborah Padfield that gives some visual imagesof pain with narratives from patients attending Guy’s & St Thomas’.

Nurses have a role in assessing pain, promoting relief through drug and non-drug approaches and helping people regain their independence.

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I could describe a piece that I could call…

‘Symphony of stress’

something on the lines of  this…

Vaguely at the tempo variations of the Carmina Burana

a cacophony of white noise sounds from the overtiredness of doing a full time placement- that  buzzzzz and hummmm in the ears.

That deafening sound of silence when you want someone to reassure you that it’s all ok.

interspersed with bleeps from obs machines and call bells

with the beautiful -peaceful hum of the bus on the way home ( and the happy background chatter of the eastern europeans on their mobile phones and  the group of young adults on a night out) after my 11.5 hour shift that lasts from 7.30 am til past 8pm..being watched and assessed every minute-and nerveous sounds to match- with heart in the mouth mistakes as being watched.. and silently judged til the last day – when they name your faults and obliterate your confidence.

. having to bolt your food and scald tounge on coffee-to keep awake – or pour in cold water as breaks not long enough to chew- and 2 minute call home to check all ok…the silent howl of the unthanks as you leave..unpaid..yet all the time the nagging stress that there is a huge exam the day that you finish placement..and  yet too tired to study for it..wnat to read up on ward cases -and a fight between priorities til nothing gets done.

with an hour and a half of travelling time each way in the dark of winter. With a sick child at home…who needs as much nursing as any patient.. clearing up  with half shut eyes from her looking after children looking after themselves (it’s ok – my son is 24- but has not as high standards of my lodger)…. then  triple checking of alarms…just incase…the worst fear of being late and the joyous  melting into  my empty bed…and brief swirly swirls as if stopped a fast roudabout and it’s all still moving.

3 alarms ring at 5.30..onelast heard  tune left in head from radio..that reappears now and then during the day….like a chorus….

the black  bus journey in the pitch dark with silent Slavs..getting on and sleeping..

then the cheerful Goodmorning of the night porter- that you saw as you left last night..in clothes to disguise you are a nurse…

and the welcome feel of the hospital .. the cheerful greating to the ward night staff- ad the jo and exitement of the new day…

the disappointment of a day off when you want to follow a patient’s  journey

Was on a cosmetic surgery ward- in a private hospital.

-had a different sound to NHS

carpetted

and closed doors on patients rooms

and  reverent silence

no cackle!

even a chapel there-

could do a verse or two in there.. popped in for 1minute recharging

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Holism, Music and the Brain, the NHS etc

March 19, 2010 at 12:26 pm (*A NIGHTINGALE SANG)

I’ll be posting occasional reflections on the context of this residency here.

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