Parallel Practices: The Threadbare

The ‘Threadbare’

 

It’s the first day of March and one month of my residency remains. A lot has happened and this either becomes a very long blog or the first of a mini series, because it’s hard to work out what to write about first. My three main projects are well underway, and the repair one, Patching Up, has brought some real gems into my hands. These have included worn through socks, broken cups, moth eaten jumpers and treasured blankets. I have enjoyed passing on repair skills and techniques – such as Swiss darning - and the conversations that happen as we work away together.  

 

One ‘Patch Up’ likely to become a regular companion in these last few weeks is Amy’s ‘threadbare’ Pooh Bear.

 

Whenever a project arrives for patching up I carry out a process that I realise has some parallels with taking a patient history, something with which every nursing student is familiar; listening to the narrative, assessing the problem, measuring, weighing and noting down particular concerns and hopes. Amy arrives with her sister and together they tell me the story of Pooh. As I turn him in my hands it is clear that he is a properly cherished and at real risk of being loved to death, this bear is going to need plenty of TLC. Stuffing that has lost all of its bounce, worn through patches across all areas of his body and split seams at every turn. There are clear traces of earlier repairs, fragments of clothing patched into the worn out surface, stitches made by much younger hands and threads of different colours. Later, when I look back at the photos on my camera, I realise I have taken more than twenty images when more usually three or four are plenty.

 

We talk about Amy’s hopes for this project; she wants Pooh to be more durable and to look less scary. She tells me that his face worries her most, his nose bitten off in an encounter with a dog. This will be a challenge, how to get the balance between a sensitive visible repair and retaining something of the old bear. I am especially concerned with what we might do about that nose and mouth, alongside those, all the other holes and split seams are child’s play! Amy is very anxious about working on the bear herself, telling me that she is useless at stitching, but is also unable to leave it with me for long periods so that I might do it for her. I need to enable her confidence.

 

I share the colour palette of threads with Amy.  She chooses mostly muted shades punctuated by a post box red wool yarn, then she leaves him with me for ‘an hour or two’ and I can barely control my excitement. I notice, right from this moment, that I am a going to find this project difficult. Not because of the material challenge, which is very evident, but because I would like to do all of it, to make it my own and this is not what the project is about. And so I have to find a way to manage this, to control myself, which is hard, because I can sense that I risk taking over. I would like nothing more than to do all of this and nothing else.

 

I lay ‘Pooh’ onto white tissue paper, bring the desk light closer and take up tweezers and small scissors to begin the task of undoing. I find myself touched by the evidence of Amy’s earlier repairs, stitches of varying lengths that look like they were made by a young child’s hand. I’m unsure what to do about all these stitches, should I remove them or should I cover them, should I be removing all the traces of previous repairs? This brings to mind the difference between restoration and conservation. I can’t hope to restore Pooh to his original state - that time is long gone - so I guess this work is about conserving him, of making him more durable, which was Amy’s wish. So some of the stitches stay, and some are cut, unpicked and removed from the cloth. These tiny threads I place inside a small plastic bag. I settle to work on the abdomen, teasing apart the stitches that run vertically along the main seam, taking out the most matted of the stuffing, again into a bag. It all feels a little forensic, but I sense this is going to be a very satisfying journey. 

                                                                                                     The Threadbare: Amy's Pooh Bear

                                                                                                     The Threadbare: Amy's Pooh Bear

Parallel Practices: Sharing the Mental Model, Reflection in Action

One of the biggest challenges of this residency is the scale and also timetabling. Getting contact with students in a meaningful way can be a difficult, especially in November when most of them are on placement, either in hospitals or in the community.  When on placement, students work proper shifts alongside their mentors and other qualified practitioners. For the ‘first timers’ it can be pretty tiring, physically and emotionally. Still, I have recruited a few more to ‘Patching Up’ and have had meetings with staff teams from Midwifery, Adult Nursing and Child Health…next is Mental Health.

 

I’ve also observed a multi disciplinary high fidelity simulation scenario involving final year students from adult nursing, child health, medicine and physiotherapy. This was a series of deteriorating patient scenarios in the simulation centre at St. Thomas’s hospital. All the students take part in a scenario and those not immediately involved observe elsewhere on a live feed, before taking their turn.  Oh, and the patient is a manikin, so no risk to life and limb but still plenty of anxiety for the students who understood the need to ‘get it right’ with only a few months before they are qualified practitioners.

 

In hi-fidelity simulation scenarios the manikin is managed by technician, who remotely manipulates it to exhibit symptoms of rapid deterioration in health; such as loss of consciousness, very raised temperature or falls in oxygen saturation. The success of the scenario depends on communication and teamwork, and most particularly the willingness and ability of those taking part to ‘suspend disbelief’, to accept that this might just be a real life situation. Students are introduced to the manikin before the scenario begins, they observe how its eyes move, mouth can be opened and how vital signs are indicated on an adjacent monitor. A few manipulate its limbs and prod at its skin. The technician also acts as the voice of the manikin, which adds a surreal dimension to the situation, a human voice issuing from the moulded body of a life size manikin. And, unlike some giant toy, this voice responds to questions, even laughs a little. I am surprised at how quickly the students accept this, how well they have suspended disbelief.

 

In all the scenarios the staff are particularly concerned with how the students work as a team, communicate with each other, follow established protocols and ask for help when they need it. We are encouraged to focus on these issues in the debrief that follows each scenario, a time when the students are also asked to share their reflections on their performance.

 

One thing I have been trying to do in my own research practice is to make tacit decisions around making more explicit, to share what I think of as my embodied knowledge, the things we do and decisions we take or make seemingly without thinking. This has involved me giving voice to decisions, literally talking out loud my process. Doing this with spinning – to which I am fairly new - enabled me to see that, for me at least, spinning is not that different to swimming! So it was very exciting to see a similar process in action in the simulation scenarios. One nursing student was actively ‘talking out loud’ her process to her colleagues and patient; introducing herself, explaining each step and justifying it, working in a way that synthesised thinking and action. Apart from giving everyone in the room confidence - always a good thing - it also struck me as very satisfying and that she was working in a well-crafted way; showing empathy and respect for her subject and simultaneously managing the situation through reflection and adaptation. Afterwards, she was praised for sharing her ‘mental model’, and I was left thinking how other acts of care, such as the material empathy we develop as makers, are not that dissimilar to roles of care involving ‘live’ subjects. I’m not sure whether she instinctively shared her ‘mental model’, or had been working on it, but observing her do this will stay with me as a transformative moment of this residency and will encourage me to keep sharing mine.

 

 

 

 

Parallel Practices: How to Make a Zig Zag Notebook (and keep the carpet clean)

I guess it’s fine to feel a bit anxious right at the very beginning of something and I spend a few sleepless nights wondering how this project will work out. Apart from spreading the word that I am here, it seems important to get making with students really quickly, to connect with them. I’ve met more than 150 of the first year adult pre registration nurses (this is the term by which they are known because nurse training is an apprenticeship culminating in registration) but that’s less than half of the cohort, and only one year. I’ve watched them learning to take blood pressures, assess urine and stool samples and carry out skin analysis, especially important for patients who will spend a lot of time in bed or are recovering from long surgery and are at risk of developing bedsores.  Now it seems time for me to do something.

The first years are all off on placement in a couple of weeks, their very first one, and I like the idea of giving them the opportunity to do something with me beforehand. I decide on a simple bookbinding workshop, hands on making with something to take away at the end.

A room is booked and an email sent. I do all the preparation ahead of the day: cutting the card, stiff book covers and so on, this turns out to have been a good move. The room is smaller than I had imagined and set up very differently to the familiar art college layout. Only one table and all the chairs with pop up integral tables that are very small, it’s also a carpeted floor – I imagine myself scrapping EVA off this at the end of the session. I’d thought there might be twelve or so students in attendance, so was pleasantly surprised to find well over thirty coming through the door. I’m glad that Beatrice (who is my Crafts Council link) offered to help out; she kneels in the corner cutting book cloth for the covers.

I demonstrate how to make a concertina or zig zag book, circulate a few I’d made earlier, give everyone a handout and then we’re off! Well, we do it all in stages – folding the paper, gluing book cover cloth to card and so on. It all feels a little chaotic, but there’s lots of chatting and laughter. Everyone manages really well with the space restrictions; they are good at improvising. Most of the students came alone and they are mostly from adult nursing and mental health. There’s lots of commentary and they all seem to get along, they are particularly excited when they come to choose their book cloth from the vibrant selection.

One of the things I am interested in is how they follow instructions for unfamiliar processes. Some are meticulous, following my handout and checking in with me every step of the way. Others seem to make it up as they go along and quickly become unstuck - concertinas that don’t zig zag, glue on the wrong side of the fold, glue on the right side of the cloth cover – most things are easily fixed. A couple are quick to work out that they can make their book bigger by adding in another length of concertina and this causes a run on card, which is pleasing. They laugh when I suggest that the best way to fix the folds and flatten their book is to sit on it.

The session flies and we are soon choosing hemp threads to tie the books together, this often involves requests for advice of the ‘what goes best with this?’ sort. I take a few photos; get them to fill in a feedback card and one by one they leave. I look at some of the comments, many write about feeling relaxed, how they feel good to have accomplished something new or different. One student tells me he will gift his book to his little brother, another that he will use it as his notebook on placement. After the tidying up, and there’s lots of it, we look down at the carpet – no evidence of us being here, mission accomplished. 

Parallel Practices: The First Day, October 3rd, 2016

Monday was my first day as maker in residence in the Florence Nightingale Faculty of Nursing and Midwifery at King’s College, London. For the time being I am in the Chantler SaIL (Simulated and Interactive Learning) Centre at the Guy’s site. This is where student nurses and midwives learn, practice and rehearse clinical skills that will take them into the community and onto the hospital wards. I am sitting in on a few sessions to get a ‘feel’ for how students are taught and learn before I move forward into ‘hands on’ work. Today’s session, which is led by Carol Fordham Clarke, is with first year students in their second week of training and they are going to learn how to take blood pressures. A few have done this before, some have worked as health care assistants, but most are complete beginners and a couple do seem to be ‘all fingers and thumbs’. Yet in just three hours Carol has taught sixty students an essential skill that will take them through the rest of their nursing careers.

Carol explains that it is usual for blood pressures to be taken electronically nowadays, particularly on hospital wards. She explains that students must learn the ‘hands on’ skill using a manual sphygmomanometer, this means they can take accurate readings without relying on electronic machines, which aren’t always available, and she tells us: “Don’t deskill yourselves before you even begin.”

Early on it becomes clear that this isn’t going to be easy and Carol reassures everyone that taking a blood pressure is one of the hardest skills to acquire. It is a skill with two elements; manipulation and hearing and both happen simultaneously. Students practice on each other, and occasionally me when we are an odd number. I’ve had my blood pressure taken many times, but I’ve never taken one and I am particularly satisfied when I finally manage to hear the two Korotkoff sounds we are told to listen for. These sounds correspond to the two readings associated with a blood pressure measurement, the systolic and diastolic pressures with which we are familiar. To measure these pressures blood flow to the artery is occluded, or cut off, by the expansion and tightening of a cuff wrapped around the upper arm. This cuff is inflated manually by squeezing a rubber bulb, which is held in the palm. When the cuff’s pressure is slowly released, blood begins to flow and this is where the listening comes in because as blood begins to move down into the artery it produces turbulence and becomes noisy. We are told to listen out for the first sound and the last sound. These correspond to the systolic and diastolic pressures – the pressure at which blood begins to flow and the pressure at which blood flows freely, after this there is no turbulence, so we are really trying to listen for the last sound before the absence of sound, this is the hardest bit – for me, at least. I look around the room to see how everyone is getting on, there are lots of concentrated faces; eyes are carefully pinned on the dials and ears tuned in. I notice a couple of students smile broadly when they ‘get it’ and one jumps back in her chair, it does feel a little bit like magic.

When we chat later, Carol explains that doing blood pressures the ‘old fashioned way’ enables the sort of skin-to-skin contact unavailable with digital testing. This means that students learn how a patient’s skin feels, perhaps clammy or cool, and this can give them other clues as to their patient’s well being. I think too that this contact might be reassuring for an anxious patient.

My work here requires me to find and explore parallels between nursing and my own field of practice, textiles and to help develop haptic skills. It doesn’t take long for me to realise the similarity between nursing fundamentals and textile ones. How both fields have foundations from which everything begins. I think of warping up, casting on, even threading a needle. All first steps that we can sometimes take for granted but out of which everything else comes into being. How in both fields we need a proper grasp of these things before we can become well practiced – I notice the link here between the hand and the grasp. Perhaps, in this respect, textile makers and nursing students both need to become properly ‘handy’.

There’s a long way to go and I must confess to being anxious about how this will all work out, I guess I am just like the new students in that sense and that we are all just starting out. Our next session together is all about elimination and skin assessment, now that will be interesting!

 

                                                                                    Listening in: Learning how to take a blood pressure manually

                                                                                    Listening in: Learning how to take a blood pressure manually