Major anniversaries seem to come thick and fast these days: 100 years ago, the First World War raged, and associated centenaries seem to have been constantly with us for the last couple of years. One of the happier centenaries celebrated this year is 100 years since the founding of the Royal College of Nursing.
Back in January this year, I saw an ad in the RPS Journal announcing a competition to celebrate the RCN's centenary. The RCN is planning an exhibition of photographs that will tour the country to show the modern face of nursing. Professional and amateur photographers were invited to submit pictures for a competition, run with the RPS, to select the images for the exhibition.
For the last few years, my wife has worked as an administrator and manager with the Kent Community Health NHS Foundation Trust (KCHFT). Through her, I've met some of the nurses who work for the Trust, and this spurred my interest in taking part in the competition.
My wife very kindly made contact with the Trust’s Communications Team; they in turn put me in touch with some of the nurses who agreed to take part and be photographed. They also provided permission and release forms that would have to be signed by anybody recognisable in the pictures; the RPS also provided a model release form, so there was no shortage of bits of paper to be signed by all concerned.
Even before starting to take pictures, I came up with a fairly clear brief to myself of what I wanted to achieve. I wanted to get pictures that represented some of the key concepts in modern community nursing: the ageing population; care that keeps elderly people independent and able to live in their own home with an enhanced quality of life; that nursing care is provided by both men and women; and most of all, I wanted to show the nature of the caring interaction between nurse and patient. This seemed to me to meet the overall brief of the competition, which was to record UK nursing in all its diversity.
My first assignment was with the Wound Medicine Centre team based at the Queen Victoria Memorial Hospital in Herne Bay. There I met Tissue Viability Link Nurse Tina Burton and Staff Nurse Chris Sharp. They provide care for all patients with chronic wound conditions. Many elderly patients suffer from poor circulation, especially in the extremities of the limbs: lower legs in particular can swell as a result of poor tissue drainage, and in the end this can lead to venous ulcers that open on the skin; this is distressing, painful and debilitating. Often, the effects of type II diabetes exacerbate the condition. Careful treatment with dressings, compression bandages and diuretics make a real difference to healing the wounds: with really good care patients can carry on living independently and in much less pain.
Tina and Chris were very welcoming to me, and they completely got the idea of taking part in the competition. Quite rightly, they are extremely proud of their achievements in the Wound Medicine Centre. I’m told that in addition to the benefits to patients, chronic venous ulcers if not treated by a dedicated team can cost the taxpayer around £12,000 per year per patient; the Wound Medicine Clinic has got this down to about £1000 per year. If ever there was a case of everyone's a winner, this is it.
The thing about taking pictures in a clinic setting is that my number one priority was to do nothing that would get in the way of the nurses and patients. I was helped in this by the way the clinic manages the patients. There is a comfortable mechanical chair that allows the patient to be lifted and their legs extended for treatment. I was able to position myself beside the chair, out of the way of the patient, facing the nurses. Because I wanted to make the nurses, rather than the patient, the subject of the pictures, I managed to place myself on one side of the chair, so that I was beside the patient looking towards the nurses. To help with lighting, I had brought along a speedlight flash, a lightweight soft box and a lighting stand. These were put on the other side of the chair with the flash facing the nurses, with the aim of blending the flash with the ambient light.
As the patients came in, it was clear how much genuine, thoughtful care both Tina and Chris gave to each patient. Because they were "regular customers", the nurses knew each patient personally; they took the greatest care to make them welcome and look after them in the tenderest way possible. Usually, they came along with a relative or other carer who sat on the other side of the room, and joined in with a cheerful conversation. Some of the wounds are large and extremely painful. I suppose it comes from long professional experience, but there was never anything other than a positive outlook from the nurses that transmitted itself as confidence to the patients. Chris and Tina never once allowed themselves to be distracted from their patients by my camera. As a result I was able to get a set of pictures that represents a true fly-on-the-wall record of what they do.
My second assignment was with community nurse, Lucian Smith, on a weekend shift towards the end of February. I met him at the nursing base just outside Canterbury before he set off to visit patients in their own homes.
The gentleman we visited lives in an apartment complex in the centre of Canterbury: he’s in his 90s and as bright as a button. If I am half as switched on as he is at that age, I will count myself tremendously lucky. Of course, there are swings and roundabouts with all these things: time has taken its toll on his mobility, and, as before, wounds on his legs needed attention.
I set up the same lighting arrangement so I could photograph towards Lucian, being careful to balance the flash with the ambient light to make the point about independent living in the patient's own home.
As with Tina and Chris, Lucian took the greatest care over the patient's treatment. It's not just a case of old-dressing-off-new-dressing-on, but of quiet professional conversation, checking on the patient more generally, and ensuring that everything that can be done is done. The patient and Lucian clearly had a great rapport.
The thing that was evident from both my visits was the impact that the nurses have on the everyday lives of their patients, and way that the quality of life really is enhanced by all that they do. I feel deeply privileged to have been able to witness and document this.
Back home, I made my selection of images and chose five to upload to the RCN site. To my surprise and delight, my picture of Lucian at the top of this page, has been selected for the exhibition. Only 50 out of more than 800 entries have been shortlisted so I am completely knocked out. The winners of the various categories will be announced at the RCN Congress on June 18.
My thanks again go to Lucian, Tina and Chris, and everyone at KCHFT who made it possible for this to happen.