THE NEW HOME OFFICE How should we support our workforce? - TAKING NOTE - iOH
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THE OFFICIAL MAGAZINE OF iOH
Volume 27 Issue 3 Summer 2020
THE NEW
HOME
TAKING OFFICE
NOTE How should we
support our
Writing an OH
Report workforce?
LOOKING IN
THE MIRROR
A Critical Reflection
Guide
How should we help
persistent pain sufferers?
CONTENTS
Partners of OH Today
From the President 4
The New Home Office: How
Should we Support our 6
Workforce?
The Editor How Should we Help Persistent
Pain Sufferers? 10
Writing an OH Report 14
Investigating the Dangers of
Vaping 18
A Critical Reflection Guide 23
Lynn Pratt Interview: Loks Ksang, iOH
board@ioh.org.uk Director of Student Affairs 30
Investigating Mesothelioma in
Production Editor Healthcare Workers 32
Hamish Pratt
Returning from Furlough 35
Copyright © iOH (Formerly AOHNP) 2020
Derby: SCPHN Continues
Published by iOH (Formerly AOHNP)
Despite Covid-19 36
ioh.org.uk
61 Waverley Road, Kenilworth, CV8 1JLE
email: admin@ioh.org.uk Research Roundup 39
Views expressed in OH Today are those of
the contributors and not necessarily those
of the iOH.
Nor does iOH necessarily endorse any
Final Thoughts 42
products or services mentioned or
advertised in the publication.
2 OH TODAY OH TODAY 3
From the President
Lucy Kenyon
I
find myself writing from Italy again, those wearing personal protective
this time wondering not whether we equipment for extended periods;
will go into lockdown before I leave,
but whether the air bridge will be closed • My network of old and new OH
before I return, meaning that I have to colleagues who worked with me to
quarantine. develop a robust COVID clinical
assessment protocol to safely return
The last few months have been vulnerable individuals to a clinical
challenging for most of us. Never have environment;
Dickens’ predictions been so true: “it was
the age of wisdom, it was the age of • All the therapies, who ensure that
foolishness, it was the epoch of belief, it specialist assessment and
We need to was the epoch of incredulity, it was the rehabilitation supports COVID
ensure that we season of Light, it was the season of recovery and ensure fitness for work
are all geared Darkness, it was the spring of hope, it was before a phased return is considered;
up to move the winter of despair, we had everything
into the winter before us, we had nothing before us”. • Employee assistance programmes who
season with collaborate to review and develop
the additional I have learnt so much while supporting their contact centre and triage
pressures of the NHS through the first wave of COVID: processes to ensure a gateway back to
respiratory OH
infections and • The true impact that OH advice can
seasonal have on individuals’ lives, if it is based • Research by iOH’s own board
affective on health risk assessment and members, the Royal Colleges and
disorder delivered in a meaningful and Societies, alongside the Condition-
actionable way; specific Charities and Association of
Local Authority Medical Advisers
• The need to ensure that OH embraces which enabled me to navigate the
and incorporates Vulnerable Worker emerging evidence and implement
Risk Assessment into everyday equitable assessments in a timely
practice. manner;
• The value of my professional network • The importance of professional
and iOH providing me with resources collaborations with iOH, FOM, NMC
to get the job done safely, reliably and professional advisory services,
consistently for 25000 staff – thank Council for Work and Health and to
you to those who have supported me the leaders of those organisations for
– you know who you are! your professional mentoring to help
me to build bridges and find solutions;
• The benefit of formal partnerships
with our colleagues: Finally, remember that we are stronger
together. We need to ensure that we are
• Dermatology, specific thanks to Dr all geared up to move into the winter
Tanya Bleiker, who proactively season with the additional pressures of
engaged with OH to develop both respiratory infections and seasonal
advice and service in partnership with affective disorder. ⬛
the OH team to protect the skin of
4 OH TODAY OH TODAY 5
THE NEW
HOME OFFICE
HOW SHOULD WE SUPPORT OUR WORKFORCE?
Guy Osmond examines the steps that employers
BY GUY OSMOND should take to create a healthy, productive
OSMOND ERGONOMICS
workforce at home.
It is superfluous to point out that COVID-19 some employers started to think about the
took everyone by surprise, and even physical needs of their homeworkers. In
employers with comprehensive Business contrast, others elected to take no action for a
Continuity Plans were overwhelmed by the few weeks and see what happened.
scale and precipitousness of events. Before
suggesting ways to address the needs of It soon became apparent that this was not
individual workers in the future, it will something that would be over in a few weeks
help to define the context of how I and, progressively, we saw all employers
see the current situation. We drawn into Phase 2: ‘Getting a Grip’. At this
describe Phase 1, which stage, it is fair to say that levels of activity,
began with lockdown, as vision, strategy and commitment were
‘Rabbit in the Headlights’. inconsistent! Some enterprises began to
In the early days, employers provide for the physical needs of their people
simply had to make sure their with virtual assessments and products (chairs,
IT and communications systems laptop stands, second monitors, etc.), others
functioned before they could started to think about mental health as well.
consider anything else. If they had (or could Psychological wellbeing became a popular
find) enough laptops, that was a good start. topic in the press and on TV, and the more
Organisations with VOIP phone systems and dynamic employers soon realised that
proven team working tools (Teams, Slack, previous wellbeing programmes needed to be
etc.) had a head start, but many struggled. revised, reinforced or extended to
accommodate a very different corporate
Once they addressed the technological issues, landscape.
6 OH TODAY OH TODAY 7
At the time of writing, a large proportion home working? Working nights? On These issues span many disciplines and consolidated, anonymised report of all
of employers are still in Phase 2, but a furlough or unemployed? departments in any large employer. HR, personnel to highlight key issues for the
growing number have moved or are Occupational Health, Health & Safety, employer. This data informs the
moving into Phase 3, which we call • their other obligations: Dependent Wellbeing and Change Management development of a strategy to optimise
‘Command & Control’. This phase is the relative/s? Homeschooling? make a good list to make a start, but how both the effectiveness and the ROI of
point at which an organisation starts to do you begin? your wellbeing programme.
assess the data, take a holistic • their physical health and comfort:
view of its collective personnel Do they have equipment or resources I think it is I think it is essential to start from the The traditional workplace is recognised as
needs and create a strategy for to implement good ergonomics, essential to organisation’s corporate culture – the a tripartite environment where physical,
the future. This is not an easy adopt good posture and minimise start from the DNA as we call it in my business. How cultural and technological factors impact
task. Apart from the apparent musculoskeletal stresses? organisation's does that inform the relationships and employee experience. These same factors
uncertainty of the pandemic corporate behaviours in the company? are at play in the WorkNet, but each
trajectory and the likelihood of Next, we need to consider the individual’s culture - the individual has less of a shared experience
another wave, it is hard to resilience: DNA as we call The Dutch architect, Stephanie Akkaoui so interpretations are more diverse. To
anticipate government policy, it. Hughes, describes how we have now manage this, it is essential to consider all
guidelines or instructions and many • their physical, mental and social moved from Workspace and Workplace to the different environmental and
organisations are also trying to health: Are they getting exercise? WorkNet: a dispersed working personality issues referred to above, but
plan for some sort of Are they eating properly? What are environment where a business is defined this must be shared with everyone. It is
hybrid mix of home and their drinking and smoking habits? by its people and the nature of their not just a management concern.
office working. interactions rather than the place where
• their work relationships: Are they they interact. Interactions, she states, are We base our approach on a practice we
It is my contention, however, that even keeping in touch? What the fountainhead of innovation and have followed for more than 16 years. All
those employers who are striding communication methods do they use? relationships within an organisation and personnel complete a psychometric
confidently into Phase 3 are not taking a Are they enjoying home working? Do the basis for its survival and growth. profile at the start of their employment,
sufficiently holistic view. This may be they miss their colleagues? Do they However, while it is often easy to dictate and we use this and the related language
because of the enormity of the task. It still feel involved? Do they feel such interactions and maintain the in our day-to-day conversations. Our
may also be that the board is failing to neglected? corporate DNA within a traditional model is the Insights programme and the
take sufficient ownership and leaving workplace, you can only ever facilitate red-yellow-green-blue colour language is
interpretation and implementation to • their relationship with their line interactions within a WorkNet. part of our vocabulary. All personnel
middle management or, where silo manager: How often and by what understand the different character types,
cultures exist, essential inter- methods are they communicating? So what needs to be done? their respective strengths and
departmental conversations are simply Does the manager understand how to weaknesses, where they fit into the bigger
not happening. manage by objectives? (This is often a To make a start on this enormous picture and how that diversity creates a
significant issue and few employers challenge, you must identify your datum collective strength and capability.
To understand the scale of the challenge, provide enough training and support point and a snapshot of the current
let us first consider the homeworker’s in this regard for middle managers). situation is essential. Many large Once all of this is in place, ongoing
environment. The ability to be productive employers use the Leesman Index, which monitoring informs what other actions or
will depend on: Finally, the home worker’s personality: not only takes the pulse of the changes are required. It is easy to extend
organisation but also benchmarks it or adapt the wellbeing programme,
• the work location: Can they shut • are they introvert or extrovert? against other employers on a national adding or withdrawing services as
themselves away in a room? Are they and global basis. For our own necessary. The most critical are strong
working at the kitchen table with • what are their personality organisation, we have used the and consistent communications and a
their partner or someone else? Do strengths and weaknesses? recently-established Champion sustained and responsive training
they even have enough space? Health assessment. This 30-minute programme. Daily or weekly
• do they find it easy to survey provides an insight into the departmental Teams or Zoom meetings
• the work setting: Is there enough focus and buckle down? mental, physical and lifestyle health will help sustain the culture and promote
light? Do they have a view? Is there of all participating personnel, interactions. Training may include
any biophilic contribution – outside • do they need the providing each individual with a resilience, mindfulness or health
view or house plants? stimulus of human confidential, personal report initiatives such as physiotherapy,
interaction or are containing suggestions and alongside ongoing support for managers
• the other occupants: Are they they happy to work recommendations in response to to effectively manage a geographically
sharing with someone who is also alone? their answers. It also generates a dispersed team.
8 OH TODAY OH TODAY 9How should we help
persistent pain sufferers?
David Stevens is a physiotherapist with a special interest in pain.
He discusses that how we think about pain, can help improve the
quality of our life.
P
ain can have a huge impact on us. wouldn’t know that bacteria were making
It is unpleasant, both physically their way around our body. As we all
and emotionally. Once we have know, infection can kill rapidly.
experienced pain, we are reluctant to Evolution has come up with a system of
experience it again. alerting us to danger, so in the above
case, we would see a medical professional
As we get older, we pay more attention to and get treatment.
pain. Babies don’t really know what it
means - they just cry. As we get older, If we put our hand on something hot, we
pain doesn’t make us cry in the same way, have learned to take it away fast, to limit
but it does upset us. We start to learn the damage. If our back hurts, we tend to
more about what pain means and it do less physical activities. We
begins to have a more profound effect on instinctively want to protect ourselves
us. from further harm. This is generally good,
but sometimes it can be detrimental to
Why do we have pain? our wellbeing and livelihoods.
Most scientists think humans and other How does Pain work?
intelligent or higher-level animals
experience pain in order to survive. We We used to think that pain was
need a system that alerts us to when we experienced in the body part that was
have damaged ourselves or when we are damaged. So, if we stubbed a toe, we
in danger, to prevent further harm being automatically assumed the pain was
done. produced in the toe. However, we’ve now
realised that it is the brain that causes the
The Pain Alarm System pain – not the damaged part.
If we were to tread on a nail and it didn’t In simple terms, pain is produced when
hurt, we wouldn’t know we had a dirty the body is damaged. Chemicals in the
metal object in our skin and flesh. We damaged cells are released into the
10 OH TODAY OH TODAY 11– in this case, the pain doesn’t start to die central sensitisation. to a physiotherapist or chiropractor.
down until we get a plaster cast on it. A Injections or surgery may even be
few hours after it has been treated it's As the pain signals haven’t gone away, necessary. This approach works well if we
much better, and six weeks later it's our brain tries to deal with them. Now the have acute pain, but persistent pain can
usually healed. impulses travel to the parts of the brain be made worse by these approaches. Persistent pain
that are involved with fear, sadness, is maintained
The pain subsides as the pain nerves have emotion, anxiety, depression, worry, So, it is important to get an accurate by a
stopped being activated and our arm is beliefs and understanding. They even go diagnosis. Physiotherapists are best hypersensitive
fixed. We have also stopped worrying to the motor control and memory parts of placed to do this. nervous system,
about it. This type of acute pain goes our brain. it won’t go
away quickly. Different people also react differently to away, so the
The Pain Cycle various pain medications. Some more we treat it
What if the pain doesn’t go individuals get good pain relief and no in this way, the
away? At this stage, the pain is caused more by a side effects, whereas others don’t get any more we fail to
sensitive and malfunctioning nervous pain relief and lots of side effects. get rid of it.
surrounding area and chemicals end up Our pain system is not always correct. It system than tissue damage. This
activating nerves in the damaged tissues. can go wrong and can cause pain in a persistent pain is not like acute pain and Pain medications work very well with
These nerves then send a signal to our different place to the original injury. You cannot be treated in the same way. What acute pain but hardly at all with
brain. Only when these signals reach our may have heard of phantom limb pain - works for acute pain doesn’t work for persistent pain. Persistent pain is
brain and are processed by all the people who have lost a limb can persistent pain. maintained by a hypersensitive nervous
different parts of the brain, do we feel or experience pain that seems to come from system – it won’t go away, so the more
experience pain. the limb that is no longer there. Our Pain is all-consuming, unpleasant and we treat it like acute pain, the more we
nervous system is not perfect and can worrying and it starts to get us down. We fail to get rid of it. By failing to get rid of
After the signals are processed, the brain malfunction. Sometimes, the pain doesn’t end up not being able to do the physical it we learn there is nothing we can do,
decides whether to trigger a pain go away and becomes persistent. things we used to do. We don’t go out as and this makes us psychologically and
sensation. It is the brain that causes the much, stop walking the dog, stop sport emotionally suffer. We get trapped in the
pain – not the damaged body part. Nerve fibres become irritated and send and we can have problems with work. ‘pain cycle’.
impulses to the brain. If these nerve Anxiety can also be an issue. It can
When we feel or experience pain there is fibres don’t stop being irritated (if you impact us socially, financially and At this stage, wellbeing can be severely
a complex interaction between the have pain in one part of the body for psychologically. To deal with all the affected, and the cycle needs to be
tissues, peripheral nerves, the spinal more than 3 - 6 months) then they start negative effects of having a painful broken. Knowing how to manage your David Stevens is
cord, nervous system pathways and the to become so sensitive that they will still condition, people seek help. persistent pain will produce a significant Physiotherapy
brain. We know that it is a two-way continue sending signals to the brain, improvement in your wellbeing and Development Lead
system. The brain can send signals and even when the injury has healed. The Typically, a GP will give medications, take recovery. at PAM Group Ltd
nerve impulses back down these brain is then tricked into thinking there is blood, order x rays, MRI scans, and refer
pathways from the brain to the body part still damage and so the brain continues to
affected. Overall, there are a whole host produce pain.
of things involved in the pain experience. TOP TIPS FOR MANAGING PAIN DIFFERENTLY
As signals from the nerves travel to the
Acute Pain brain they pass through the spinal cord.
This part of the spinal cord helps to
1 List the problems and issues that you
want to change or overcome. 6 Challenge negative thoughts to help
change unhelpful behaviours.
Acute pain is what most people first think restrict or reduce the flow of nerve
of when discussing pain. Acute pain is
temporary and is caused when our pain
impulses. As it is receiving too many
nerve impulses, this area becomes more
2 Accept the pain may not go away, but it
can be reduced considerably. 7 Learn how to relax and plan so that
activities are successful and worry-free.
3 8
receptors get activated by an injury, for sensitive, and so it allows more impulses Pain doesn’t always mean harm or
Think about a plan if things go wrong.
example when we fall over and break a to travel up toward the brain. This danger and that it’s safe to move.
bone. There is an intense amount of pain process is known as peripheral and
When we feel or experience pain there is a very complicated
4 Understand the role of medications.
9 Pace yourself within your tolerance
levels.
interaction between the tissues, peripheral nerves, the
spinal cord, nervous system pathways and the brain.
5 Find what types of exercise are safe and
beneficial.
12 OH TODAY OH TODAY 13TAKING NOTE
Writing an Occupational
Health Report
Written by Janet O’Neill
RGN, Dip OH, MSc
W
riting a good Occupational • signed with full name and
Health (OH) report is an qualifications towards the employee. However, if the without providing the report – not
essential skill of any OH • answering the manager’s questions clinician indicated that the individual surprisingly the managers never made
professional. It is our product that we sell felt they were badly treated then it would the adjustments. As soon as they
and therefore needs to look professional The employer is paying for the report provide information to the employer and obtained permission to send the report
and be useful. Every OH report, whether either indirectly or directly and as such support for the employee (with consent to the manager; the adjustments were
we like it or not, reflects the OH the report should always add value. of course). made.
profession so writing a poorly constructed Although we aim to provide information
and written report with no added value to the manager; our goal is also to break If the individual has had poor clinical The report needs to be evidence-based.
gives the customer a poor view of the down barriers to work and support an care via the NHS then it is very useful for For example, if we say that an individual
usefulness of Occupational Health. individual to return or remain in work. the employer to know this. If the is not fit to attend a work-related
Whether an in-house provider or an individual could be making several meeting then we must base this on the
external provider, all OH professionals It is essential to read the referral and changes to improve their health and FOM evidence. If we state that their
have a customer and that is the individual understand what it is that the manager therefore workability, don’t say this in health condition will impact on their
who commissions the report. wants to know. Always keep the referral the report as they are likely to withdraw ability to concentrate or work night
information and questions in front of you consent. If you signpost to validated shifts then we need to back this up with
We always advocate that an OH report is when undertaking the referral to resources for self-help or make the evidence. Reports can be used in
only as good as the referral; however, understand the direction the consultation suggestions on how they can improve tribunals with or without our knowledge
there are some basics that we should needs to go in. An example is a referral of their health then by mentioning this in and therefore will be scrutinised. A
always get right. As a profession which is an individual recovering from a cardiac the report, you will be demonstrating thought to hold in our heads when
prefaced with qualifications such as a arrest asking if they would be at risk of your added value as a clinician and will writing a report is what impact it may
nurse; doctor; physiotherapist; COVID; the report in return advises on be allowing the manager to follow up have on the individual’s job. It may be
psychotherapist etc. as well as a specific the individual’s fitness to return to work with the individual. that the employee is wholly unmotivated
Occupational Health qualification; there and does not address the COVID risk. to return to work during your
will always be expectations that need to The report needs to justify the advice to consultation but in a week or two they
be met due to our qualifications. Points An OH professional (OHP) needs to The advice in management. It is not helpful to advise may change their mind. Never hesitate to
such as these aid the impression of understand their own bias and ensure this the report must that an individual is not fit for work or state (should the circumstances fit) that
professionalism: - not brought into the report. Our role is to be relevant to requires a phased return without although you feel someone could return
be independent of both employer and the substantiating this. It is not good enough to work; they disagree and do not feel a
• spelling and grammar; employee and therefore evident organisation to for us to say that managers need to return to work is feasible. That way, if
• professional language; judgement of either party would be make it understand that we are the experts. they change their mind, your report
• avoiding medical terms that the detrimental to both and OH would lose practical and Human nature means that we need to stands.
manager cannot understand; credibility. For example, if the OHP useful and understand why we are being asked to do
• presentation with a unified font; reflected in the report that the individual needs to something and we are more likely to do Always ensure that your report is
equal spacing; titled paragraphs had been poorly treated at work whilst answer the so if we understand. An example is an HR bespoke to the individual. Reports
• succinct and to the point only receiving this information from the employer’s manager who sent instructions to providing generic information about a
• not copy and pasting into the report employee; the report would be biased questions managers based on the OH report condition makes it look like the report is
14 OH TODAY OH TODAY 15being padded out and doesn’t help either to work.
the individual or the manager. It can be
useful to provide information about a In conclusion. A well-presented,
condition (with consent and based on the professional report which is relevant to
referral) but it must be matched to the the referral; evidence-based and justified;
person to make it relevant and useful. bespoke to the individual and provides
clear pragmatic advice which is useful for
The advice in the report must be relevant the manager will demonstrate the added
to the organisation to make it practical value of OH.
and useful and needs to answer the
employer’s questions fully. Any Further Reading
interventions that could support an
earlier recovery and return to work or https://www.personneltoday.com/hr/
assist with remaining in work, for guidance-on-occupational-health-case-
example, physiotherapy or psychological report-writing/
support must be advised even if it is only
to direct the individual to the GP (should https://www.personneltoday.com/hr/
the organisation not support this). Advice occupational-health-reports-top-10-tips/
needs to be qualified with a statement
that it is a management decision whether https://www.atworkpartnership.co.uk/
the advice can be actioned to ensure the journal/issue/11_1/contents/writing-a-
expectations of the employee aren’t good-oh-report
raised. Should they be disappointed, then
there is the potential that we in OH have Janet O'Neil is iOH Director of Professional
caused a relationship rift which would be Development and Clinical Director of PAM
contrary to our goal of breaking barriers Group Ltd.BEHIND
chemical which is highly addictive but resulted in death. The MHRA was accused
does not cause cancer. of downplaying the risk of vaping
illnesses “spreading” to Britain from the
A lower risk US.
Vaping is far less harmful than smoking, Public Health England (PHE) said most of
THE HAZE
experts from a number of key bodies the American cases “were linked to
including Cancer Research UK, Public people using illicit vaping fluid”, such as
Health England and the US National those containing cannabis products like
Academies of Sciences Engineering and vaping oils containing THC, the
Medicine have concluded. psychoactive ingredient in marijuana,
and pointed to the UK’s tighter safety
In 2015 PHE estimated vaping was 95 per regulations. The US Centres for Disease
cent less harmful than smoking. Vaping is Control and Prevention (CDC) has also
not risk free, but it’s much less risky than called vitamin E acetate a “chemical of
INVESTIGATING THE DANGERS OF VAPING smoking. Experts advise smokers who are
struggling to stop smoking, to try vaping
concern” and recommended not adding it
to e-cigarettes, or vaping products.
but buy your products from a reputable
source. And if you are a vaper, it is better In a case report in the British Medical
to continue to vape than relapse to Journal Stanton Gantz, director of the
I
n 2019, health officials in the USA By Bernard Garbe smoking.” centre for tobacco control and education
reported over 50 deaths and a further Chairman, Vitalograph Group at the University of California, San
2000 confirmed cases of a mysterious An estimated 3.6 million people in the UK Francisco revealed the case of a 34-year-
respiratory illness associated with vaping. vapes, allow users to inhale nicotine in use vapes compared to 7.2 million British old woman who was diagnosed with
In the UK so far there are only two deaths vapour rather than breathing in smoke. E- adult smokers in 2018, according to lipoid pneumonia after being admitted to
reported caused by vaping, but in cigarettes do not contain tobacco, official figures. But the proportion of a Birmingham hospital in 2016. Doctors
addition there are numerous other cases which creates harmful chemicals vapers to smokers is rising, including advised her to quit vaping after
of ex-cigarette smokers who switched to when burned such as tar, carbon people who both smoke and vape. identifying the cause as vegetable
vaping then starting to have breathing monoxide, hydrogen cyanide, lead glycerine found in e-cigarettes.
difficulties. and arsenic. Cigarette smoking in the UK causes
nearly 80,000 deaths a year. In the The death from lipoid pneumonia of 57-
There was also a case where a seventeen In order to create an e-liquid, USA it is the leading preventable year-old Terry Miller in 2011 was also
year old non-smoker took up vaping and nicotine is usually mixed with cause of death in the US, according to linked to the use of e-cigarettes after oil
damaged his lungs so much that he is water and a base chemical such as the CDC. It kills 480,000 people was found in his lungs. A coroner
suing the vaping company called ‘Juul’ propylene glycol, an ingredient each year, nearly one in five returned an open verdict at the inquest
because it “gave him lungs like a 70-year that’s widely used across the deaths. Tobacco is also one of the after saying he could not be sure whether
old". Then there are e-cigarettes that food, pharmaceutical and major causes of death and vaping was a contributory factor.
explode, in one case killing the victim as cosmetic industries. Flavours disease in India, accounting for
it tore his carotid artery. are also usually added. nearly 900,000 deaths every year. While the 200 adverse reactions listed in
the UK Yellow Card reports include major
The questions E-cigarettes are battery- Vaping ‘linked to 200 health health problems such as cardiac arrest,
powered devices. They problems’ epilepsy and spontaneous abortion, they
Why is the UK vaping-related morbidity work by heating a also include coughs, sneezing and
so much lower than the USA rate? Are e- solution called an e- In the UK vaping has been linked to 200 headaches. The MHRA said it is reviewing
cigarettes safe devices and what about liquid, causing it to health problems including pneumonia the information gathered by the Yellow
the substances consumed? Is vaping safer vaporise. This and cardiac disease. The illnesses were Card scheme and emphasised that the
than smoking cigarettes? What do the vapour is then listed in 70 separate “Yellow Card” reports of adverse reactions did not
health experts currently say? breathed in by the reports about e-cigarettes filed to the necessarily mean that they were caused
user. E-liquids Medicines and Healthcare Regulatory by vaping.
What is an e-cigarette? sold legally in the Agency (MHRA) by the public and
UK contain healthcare professionals. Many were A spokesperson said: “The MHRA
E-cigarettes, also known as vapourisers or nicotine, a classified as serious but none of them assesses all reports received in
18 OH TODAY OH TODAY 19association with nicotine-containing e- E-cigarettes as an aid to
cigarettes and should any potential safety stopping smoking entirely
concerns be identified we will take
appropriate action to protect public A major UK National Institute Health
health.” Research funded clinical trial found e-
cigarettes were almost twice as effective
COVID-19 and vaping at helping smokers to quit compared with
other alternatives such as nicotine
E-cigarettes (vapes) can be an effective patches and gum.
aid to stopping smoking. The evidence on
the health risks of e-cigarettes is still Teenagers taking up vaping
developing. However, it appears that who have never smoked
vaping is far less harmful to the tobacco products
respiratory system than smoking. There is
very little evidence on vaping and In the UK, 15 per cent of 11-18 year-olds
coronavirus (COVID-19) and it is tried vaping in 2019 according to a study
unknown whether vaping makes you conducted by anti-smoking charity
more susceptible to severe disease if you Action on Smoking Health. There was an
become infected. If it does, the risk is increase in the number of current vapers
likely to be much less than smoking. in that age group from 5 per cent in 2019
compared to 3 per cent in 2018.
Vaping involves repetitive hand-to-face
movements, which provide greater risk of In the USA just over 20 per cent of high
a route of entry into the body for viruses. school students were found to use e-
To reduce the risk of contact with cigarettes in 2018, according to the US There are also vaping products that
coronavirus (COVID-19), people should surgeon general. This was an increase of Regulators and legislators contain no nicotine. Non-nicotine
wash their hands more frequently than 78 per cent from the previous year. Since containing vaping products fall under the
usual, for 20 seconds, with soap and 2011 e-cigarette use increased by 900 per In the UK, e-cigarette products are tightly less stringent General Product Safety
water. Although Public Health England cent among this age group. regulated for quality and safety. The Regulations 2005, enforced by local
strongly advises against sharing any regulations restrict the amount of e- trading standards.
vaping devices their 2018 independent e- The UK has adopted a harm reduction liquid each e-cigarette can hold and the
cigarette evidence review found that approach when it comes to e-cigarettes. strength of the nicotine. Certain The black market
ingredients, including colourings,
caffeine and taurine, are also banned. Although e-cigarettes are tightly
THERE IS VERY LITTLE EVIDENCE ON VAPING AND
regulated in the UK, across the globe a
CORONAVIRUS (COVID-19) AND IT IS UNKNOWN WHETHER In the UK, all e-cigarettes and e-liquids black market vaping industry exists,
VAPING MAKES YOU MORE SUSCEPTIBLE TO SEVERE must be notified to the Medicines and supplying harmful and potentially deadly
DISEASE IF YOU BECOME INFECTED. Healthcare Regulatory Authority (MHRA) products to e-cigarette users.
before they can be sold. Nicotine-
there have been not been any identified While recognising that quitting smoking containing vaping products are regulated Some e-liquids bought off the street in
health risks of passive vaping to is always the best option for smokers, through the revised European Union the US have been found to contain
bystanders. There is currently no guidance published by the National Tobacco Products Directive (2014/40/EU) counterfeit substances, including ‘cutting
evidence that coronavirus (COVID-19) Institute for Health and Care Excellence (TPD), translated into UK law through the agents’ used to dilute the product.
can be caught from passive exposure to e- (NICE) supports the use of e-cigarettes to Tobacco and Related Products American health officials say they may
cigarette vapour. help smokers who are struggling to quit. Regulations 2016 (TRPR), which the also contain contaminants like pesticides,
government has committed to review by poisons and toxins, and they are testing
In the absence of evidence it is This is backed by an evidence review May 2021. Unlike cigarettes, they do not samples for traces of these substances.
recommended that vapers avoid exhaling carried out by Public Health England burn tobacco or produce tar or carbon
clouds of vapour in the presence of (PHE), which found that although not monoxide. However, they do contain There are also worries that dangerous
others. completely risk-free, e-cigarettes are at nicotine, which is addictive but relatively wiring found in homemade products
least 95% less harmful than smoking. harmless. could be heating e-liquids beyond a safe
level. Overheating can cause high
20 OH TODAY OH TODAY 21LOOKING IN THE
concentrations of compounds like Although vaping is allowed in most of
formaldehyde which could be harmful to Europe, in Norway the sale and
users, or result in e-cigarettes catching possession of all vaping products
fire. containing nicotine is banned.
Many of the patients affected by the In the US, Donald Trump said he planned
illnesses in the US have admitted buying to ban flavoured e-cigarettes in
their e-liquids off the street. About 80% September following a spate of vaping-
have reported using products containing related deaths. The Food and Drug
tetrahydrocannabinol (THC), a substance Administration will develop guidelines to
found in cannabis that produces the
‘high’ sensation associated with smoking
remove from the market all e-cigarette
flavours except tobacco. Two US states, A CRITICAL REFLECTION GUIDE
the drug. 33% reported exclusive use of New York and Michigan, have already
THC-containing products. THC is legal in imposed bans on flavoured vape products, Written By Neil Loach
some states in the US, but it’s illegal in while Massachusetts has announced a BSc (Hons) SPOHN, SCPHN (OH), RGN, EN(G)
the UK. Recent laboratory tests by The four-month ban on all vaping products.
Senior Lecturer in Post-Registration Healthcare,
CDC in the US have found vitamin E In Mexico, it is illegal to sell products
Pathway Lead for OH SCPHN, University of Derby
acetate - a substance used in some THC- that mimic tobacco products, including e-
containing e-liquids - in samples from cigarettes containing nicotine.
I
people affected. This is the first time that n the context of clinical practice, the When writing reflectively you, the writer, are the
scientists have found a chemical of India banned vaping after government following key features of reflection are widely primary subject. As such, your own thoughts,
concern in patients with these lung passed an emergency order banning the accepted: feelings, and experiences should form the bulk of
injuries. Vitamin E acetate, along with production, import and sale of e- the examples you use.
other vitamin additives, are banned as cigarettes. Currently Thailand has some • Critical Reflection results in learning,
ingredients in UK-regulated e-cigarettes. of the strictest laws on vaping with the through changing ideas and your However, it is essential to understand that the
sale and use of all e-cigarettes banned understanding of the situation. purpose of writing reflectively is not merely to
Different rules in different since 2014. People found in possession of describe your experiences, but rather to
countries a vaping device also face a heavy fine or • Critical Reflection is an active process of understand your experiences and your reactions
up to 10 years in jail. learning and is more than thinking or to them, with a goal of personal growth and
Governments around the world are thoughtful action. transformation.
divided about vaping. Thirty-nine In Australia, adults are allowed to buy e-
countries have banned the sale of e- cigarettes that do not contain nicotine • Reflection involves problematising clinical Critically exploring your own values, beliefs, and
cigarettes or nicotine liquids, according but it is illegal to produce or sell vaping practice by recognising that yours or others practices, in a structured and explicit way,
to the 2018 Global State of Tobacco Harm devices containing the chemical. practice is not without dilemmas and issues. facilitates life-long learning and allows you to
Reduction report. Possession of nicotine e-cigarettes is also develop as a practitioner. As Maya Angelou said,
illegal in some states. • Critical Reflection is not a linear process, but “Now I know better, I do better.”
a cyclical one where reflection leads to the
development of new ideas, which are then As reflective writing is a formal academic genre,
used to plan the next stages of learning. it is important that you still use published theory
against which to reflect and analyse your
• Critical Reflection encourages looking at experiences, with a coherent and cohesive
issues from different perspectives, which written structure. For some people, critical self-
helps you to understand the issue and reflection comes quite naturally, while for others
scrutinise your own values, assumptions and it requires a bit more work.
perspective.
Here we look at each of the well known models in
Therefore, when the term ‘critical reflection’ is a little more depth, you can use any of them but
used, it refers to a combination of the analytical, you may want to use different models as you
questioning (or critical thinking) and reflective become more confident. Make sure that you are
approaches. It is this combination that would not just superficially describing experiences but
characterise a critically reflective conversation or engaging meaningfully for personal development.
writing.
22 OH TODAY OH TODAY 23Gibbs Reflective Cycle (1988) Driscoll Model (1994)
Good for: Good familiar Gibbs. Basic,
great starting point, 6 distinctive stages.
Makes you aware of all the stages you go Good for: Organisational model. Easy to
through when experiencing an event. follow cued questions. Easy to remember
when you’re out and about using the
Criticisms are: superficial reflection- no simple “What? So what? Now what?”
referral to critical thinking/analysis/
assumptions or viewing it from a different Criticisms are: It does not lead to deeper
perspective (Atkins & Murphy 1993). reflection about yourself, only the
Does not have the number or depth of situation.
probing questions as other models.
Kolb Reflective Cycle (1984) Descrip�ve level of Theory & knowledge - Ac�on-orientated level of Rolfe et al’s Framework for
reflec�on building level of reflec�on reflec�on
Reflexive Learning (2001)
WHAT...? SO WHAT...? NOW WHAT...?
… is the problem/difficulty/ … does this tell me/teach me/ … do I need to do in order to
Good for: Basic starter? The reflective reason for being stuck/reason imply/mean about me/my make things be�er/stop being Good for: based on the three “What? So
for feeling bad/reason we pa�ent/others/our stuck/improve my pa�ent’s
cycle. Consists of doing, asking how/why, don’t get on, etc? rela�onship/my pa�ent’s care/resolve the situa�on/feel what? Now what?” questions, but repeats
care/the model of care I am be�er/get on be�er, etc?
making judgement,testing out, . … was the role in my using/my a�dudes/my these questions at three levels, with
situa�on? pa�ent’s a�tudes, etc? … broader issues need to be
considered if this ac�on is to
increasingly deeper reflection at each
Criticisms are: superficial reflection- no … was I trying to achieve? … was going through my mind be successful? level. The levels are descriptive,
as I acted?
referral to critical thinking/analysis/ … ac�ons did I take? … might be the consequences theoretical and action-orientated. This
… did I base my ac�ons on? of this ac�on?
assumptions or viewing it from a different … was the response of others? model is based on Borton’s
… other knowledge can I being
perspective (Atkins & Murphy 1993). … were the consequences for the the situa�on? developmental model. Working through
the pa�ent? For myself? For
Does not have the number or depth of others?
Experimental/personal/
scien�fic?
the same questions at different levels can
probing questions as other models. … feelings did it evoke in the … could/should I have done to
be used to develop from novice to expert.
pa�ent? In myself? In others? make it be�er?
… was good/bad about the … is my new understanding of Criticisms are: May be too complicated
experience? this situa�on?
for a beginner who is new to reflection.
Schön model (1991) LOOKING IN Johns’ Model for Structured
• Find a space to focus on yourself Reflection (2006)
Good for: Schön described reflection-in- • Pay a�en�on to your thoughts and emo�ons
• Write down those thoughts and emo�ons that seem significant in realising desirable work
action (in the moment surprise & Good for: Organisational model, examines
LOOKING OUT
puzzlement) and reflection-on-action (a situations in environmental context. Easy
• Write a descrip�on of the situa�on surrounding your thoughts and feelings
cognitive post-mortem after the fact). • What issues seem significant? to follow, used in any order. Useful by
• Aesthe�cs
Professional model: gaining professional ◦ What was I trying to achieve? individuals or groups. Based on Carper’s
◦ Why did I respond the way I did?
artistry and increasing professional ◦ What were the consequences for the pa�ent/others/myself? (1978) four types of knowing -empirical,
◦ How were others feeling?
confidence. ◦ How did I know this? personal, ethical and aesthetic- Johns
• Personal
◦ Why did I feel the way I did in this situa�on? adds a fifth one – reflexivity.
• Ethics
Criticisms are: highlights the difference ◦ Did I act for the best? (Ethical mapping)
• What factors (either embodied within me or embedded within the environment) were
between the two types of reflection but influencing me? Criticisms: Prompt questions aren’t rigidly
• Empirics
does not provide extensive guidance for ◦ What knowledge did or could have informed me? structured. Could be confusing for the
• Reflexivity
carrying out either. ◦ Does this situa�on connect with my previous experiences? inexperienced to know which ones could
◦ How could I handle this situa�on be�er?
◦ What would be the consequences of alterna�ve ac�ons for the pa�ent/others/myself? be omitted and which are salient for their
◦ How do I now feel about this experience?
◦ Can I support myself and others be�er as a consequence? particular reflection. Time consuming.
24 OH TODAY OH TODAY 25Atkins & Murphy Model Some General Pointers more detail. How did your behaviour or
(1993) actions relate to these moments of
Reflective writing is a process that change?
facilitates a thorough, transforming, and
Good for: Deeper reflections, building unique learning experience. The insights • What kind of result or response did
on your previous experience. It you will gain about yourself as you you receive from those around you?
encourages you to consider assumptions engage in the reflective process are not
things that can be learnt in a book or • What worked well?
Criticisms are: It may not be suitable for taught in a classroom. It is therefore
quick reflections on the job or for novices. important that you work carefully • What could be improved upon?
through by using an initial draft to
identify what you have learnt and how An academic critical reflection requires
you have developed. You can do this on a you to use academic literature to help
notepad and use this as a mind map. you analyse your experience more fully.
Consider what literature has to
It is best to use the headings as written contribute to the analysis of your
by the Model’s Author and describe why experience?
you have chosen this model at the
Kolb Reflective Cycle (1984) beginning of the work. In order to achieve a good balance of
critical ability with the piece you should
When you begin your reflection, you aim to have between 10 and 20
Good for: Basic starter? The reflective don’t yet know what will emerge as references for between 1000 to 2000
cycle. Consists of doing, asking how/why, important, so start with a broad general words. This will enhance your work and
making judgement,testing out, . description of the experience you are give it meaning and show a real sense of
reflecting on. As you write, you will find critical ability and therefore overall
Criticisms are: superficial reflection- no yourself drawn to describing certain credibility.
referral to critical thinking/analysis/ aspects in greater detail than others. This
assumptions or viewing it from a different is good, as it will start to help you Finally, it is time to apply what you have
perspective (Atkins & Murphy 1993). identify which aspects of the experience learnt and plan for the future. If you were
Does not have the number or depth of were most significant for you. faced with a similar experience again,
probing questions as other models. what would you do differently to achieve
Our thoughts and feelings motivate our a better result or response?
behaviours and actions, and
consequently the results of our Try to develop a practical plan for how
behaviours will lead us to new thoughts, you will approach or do things differently
feelings, and hopefully new behaviours. in the future that shows evidence of your
Mezirow model of Transformative Reflect on your thoughts and feelings professional and personal development.
Learning (1981) prior to the experience.
The Reflective Process
Good for: Personal development model. Involves critically Next consider your thoughts and feelings
evaluating assumptions and deep reflection. Frames of during the experience, and finally after When you write reflectively you are
reference, from different viewpoints. Reflection on content the experience. drawing on your own experiences,
is shallow, but progresses to reflection on process and thoughts, and feelings to understand a
reflection on premise which leads to deeper reflection, Firstly, ask yourself how your thoughts situation and/or yourself more fully.
leading to personal development. Suitable when person is and feelings motivated your behaviour However, you must remember that those
motivated for self directed learning. and actions? Next ask yourself if your who read your reflection will not have
thoughts and feelings have changed from access to your memories and they will
Criticisms are: only suitable if someone had the self before to during and then after the rely entirely on what you write to try and
motivation and time to integrate the learnings from using experience? Moments of change often understand the experience as you
this model into their own behaviour and schemas, so is a signal moments of learning. Focus on the describe it, empathise with your analysis,
long term model in this sense. Focuses heavily on rational moments at which your thoughts of and be convinced of your personal and
and not emotional aspects feelings changed and explore these in professional development.
26 OH TODAY OH TODAY 27Therefore, as you write reflectively, you • Use analytical language. E.g. because,
can consciously shift your language and as a result, critically, represent,
tone to help your reader follow your support, imply…
reflective journey.
• Integrate theory (and reference!)
When describing
When concluding
• Clarity is important. E.g. ‘Some
people’ vs ‘A few people’. • Draw the reader’s attention to
noteworthy findings. E.g. The most
• Use meaningful descriptive words. important realisation was… The
E.g. Significant vs Important. relevant issue is… The focus needs to
be on…. When developing an action
• Consider the context. Think about plan
how you chose to describe your
experience – what do your language • Use words that indicate the future.
choices tell you (and your reader) E.g. will, may, should, could….
about your assumptions? Your
biases? E.g. ‘A vibrant, bustling area’ References
vs ‘An informal settlement’ vs ‘A
Atkins, S and Murphy, K (1993) Reflective practice.
squatter camp’ Nursing Standard 9 (45): 31–7.
When writing about feelings
• Use ‘thinking’ and ‘feeling’ words.
E.g. thought; realised; sensed;
Bolton G (2014) Reflective Practice: Writing and
Professional Development. London: Sage
Boyd E & Fales A (1983) Reflective Learning: Key to
Learning from Experience. Journal of Humanistic
Join iOH Today.
Psychology 23(2): 99-117
experienced; felt….
Brookfield, S. (2005) Becoming a Critically Reflective
• Use personal pronouns to make it
clear to the reader you are drawing on
Teacher. San Francisco: Jossey Bass.
Gibbs G (1988) Learning by Doing: A guide to
teaching and learning methods. London: FEU
Only £10 per year
your own experiences. E.g. I feel…; I
realised…; It became clear to me
that…; My experience….
Johns, C. (2000). Becoming a Reflective Practitioner.
Oxford; Blackwell Free Student Membership
Johns C (1995) Framing learning through reflection
• Be consistent with the tone of the within Carper’s fundamental ways of knowing in
paragraph. E.g. try not to switch back nursing. Journal of Advanced Nursing. 22: 226-34
Member benefits include:
and forth between the first and third
Kolb, D. (1984) Experiential Learning. New Jersey
person with a single paragraph. • Quarterly OH Today Magazine, plus access to all back
Mezirow J (1981) A Critical Theory of Adult Learning issues
and Education. Adult Education Quarterly 32(1): 3-
• Use transitional language to make a • Members’ support line, for free one-on-one
24
sequence of events or realisations confidential advice
clear to the reader. E.g. then; next; Mezirow J (2006) An overview of transformative
subsequently; afterwards; finally;
learning. In P. Sutherland & J. Crowther (Editors) • Professional networking events throughout the year
Lifelong learning: Concepts and context.. New York:
lastly… Routledge • Exclusive discounts and deals on OH events, software
Rolfe, G., Freshwater, D., Jasper, M. (2001) Critical and more
When evaluating reflection in nursing and the helping professions: a
user’s guide. Basingstoke: Palgrave Macmillan.
• Use comparative language. E.g.
ioh.org.uk
Ryan, M., 2011. Improving reflective writing in
similarly, unlike, previously… When higher education: a social semiotic perspective.
analysing Teaching in Higher Education, 16:1, 99-111.
Schon, D. (1983) The Reflective Practitioner.
• Use disciplinary/technical language London: Temple Smithv
Student membership free for first year, then £10 a year
28 OH TODAY OH TODAY 29INTERVIEW Who has been your biggest
influence in your career?
helpful whilst
on a budget.
LOKS
The
Tenzin Gyatso, the 14th Dalai Lama for his membership
advocacy to help and show compassion to fees at £10
people; but because I have not met him, I after the 1st
would settle for two people that I have year is still
KSANG
met and made impact in my career. First, fantastic value
my manager Su Chantry, she does the job for money.
of three people. I don’t how she manages
this; but she is too good for her role. And I have
secondly, my lecturer Neil, he goes above benefited
and beyond whatever he does in his work from the large
THE NEW iOH DIRECTOR to help, a quality you rarely find amount of
OF STUDENT AFFAIRS anywhere. website
resources
INTERVIEWED BY LYNN PRATT What’s next after your which has
course? – areas of aspiration? been helpful
for me whilst doing my course. I also love Above: Tenzin
This is a good question. After completing the networking opportunities. Gyatso, the 14th
the course, I hope to find an OHA role Dalai Lama
closer to home. Areas of aspiration would How will your support help
What is your background? caring for my young son, Kai. I was be in the areas of employees’ wellbeing other students?
attracted to OH due to the more flexible promotion and promotion of mental
I started my career as a chartered nature of the work with some potential to health awareness. Although I feel that my experiences as a
accountant. I was made redundant and work from home. student were unique to me, I believe that
decided to train as a nurse. I qualified in Why did you volunteer to be a the same principles I used to complete
2017, and I worked in intensive care unit I had heard the OH speciality was hard to student director for iOH? my course can be used by other students.
at Royal Free Hospitals NHS trust. I also get into as the employer expects you to For example, studying as a mature
worked in A & E, Urgent Care Centres and have the relevant work experience. I believe in iOH’s efforts to inform and student has its own challenges -
GP practice. Oportunities seem to be rare. support OH practitioners, whilst childcare, coursework deadlines, work
performing a demanding job. I also want deadlines, long distance travels etc.
What are you studying and I wrote down my plan – first I listed down
where? all the necessary short courses I needed Developing trust among
to attend – Spirometry (2 days), employees to open up about
I am currently pursuing a post graduate
diploma in SCPHN (Occupational Health)
Audiometry (3 days) and Vaccination and
Immunisation (1/2 a day). After
mental health is a skill that takes
at the University of Derby; a University I completing these courses; I sought an OH time to develop
consider having a good reputation in technician role which became my
offering good quality education and steppingstone to OH. The rest is history. to encourage others to undertake OH post On occasions, these pressures may
support to students during their training. grad qualifications and support those overwhelm you but, you must remain
The University is also rated Gold in the What area do you find most going through training. focused and understand that every
Teaching Excellence Framework, top 30 interesting? pressure is a temporary, transient
by guardian and top 10 in international Students form an important part of iOH. situation and soon will be over.
students’ learning experience. I am Mental health, wellbeing promotion and More experienced practitioners can learn
currently doing my consolidated practice case management. Developing trust a lot from them and benefit from their How do you look after your
at Williams Racing F1. among employees to open up about current thinking and research. own wellbeing?
mental health is a skill that takes time to
How did you get into OH? develop; but I derive satisfaction when I What has iOH given you? I do simple things such as talk to friends
am able to listen and make a positive over the phone, walks in the park or
I was struggling working hours, impact to an individual’s mental As a student, I benefit from free jogging. These activities tend to relax my
unpredictable working patterns whilst wellbeing. membership for a year which is very mind and allow me to distress.
30 OH TODAY OH TODAY 31You can also read
