Ep 82 Tom McEwan on NICU policy exploration in Scotland through a Professional Doctorate

Ep 82 (http://ibit.ly/Re5V) Tom McEwan on #NICU @policy exploration in #Scotland through a #ProfessionalDoctorate

@PhDMidwives #research #midwifery @MidwivesRCM @NHS_Education @ScotlandRCM #postnataldoulas #holistichealthcare

Research link - http://ibit.ly/eec1Z

What happens when an aspiring chemical engineer decides to shift gears and pursue a career in midwifery? Tune in as we sit down with Tom McEwan, a passionate midwife in Scotland, who shares his unexpected journey and the societal challenges he faced breaking into a traditionally female-dominated field. Tom provides a fascinating look at the evolution of midwifery education, stressing the importance of community-based care and reflecting on how modern placements have fragmented the continuity he once cherished. He also gives us a glimpse into the close-knit midwifery community in Scotland, and the supportive atmosphere at midwifery conferences that feel more like family reunions.

This episode also tackles the unique experiences male midwives face and the broader implications of gender diversity in midwifery. Tom discusses the often-overlooked needs of fathers and partners in perinatal support, suggesting the need for more male or non-gendered postnatal doulas, especially in the NICU. We delve into the emotional toll on partners, including the phenomenon of delayed postnatal depression, and emphasize the necessity of inclusive care that addresses the needs of all parents. Tom’s insights highlight the importance of holistic healthcare that supports families in every aspect.

Lastly, we explore Tom's academic journey and his efforts to revolutionize maternity and neonatal care in Scotland. He shares the advantages of pursuing a professional doctorate over a PhD, the value of free writing, and the significance of nurturing relationships with supervisors. Our conversation also touches on Scotland's ambitious "Best Start" program and its impact on neonatal care. We wrap up with a look at diverse and dynamic topics within nursing, from translating interviews into poetry to the performative aspects of various projects. Tom’s passion for midwifery, education, and research promises an engaging and enlightening discussion that you won't want to miss.

Transcript

Career Journey in Midwifery Education

Speaker 1 0:27

Thank you very much for joining me. As per usual, would you like to introduce yourself, please?

Speaker 2 0:33

Hi, thanks. I'm Tom McKeown. I'm a midwife in Scotland, recently completing my doctorate. I've been a clinical midwife a lot of my career in neonates. I've been an academic and a researcher and I currently work for NHS Education for Scotland, who are responsible for workforce education and training for the NHS Health and Social Care for.

Speaker 1 1:02

Scotland Cool. So let's start at the beginning. How did you get into midwifery?

Speaker 2 1:08

That's a good question. I didn't start off with that ambition right at the start. I actually went off to university to do a science degree with a plan to be a chemical engineer.

Speaker 1 1:22

Okay, that is a little bit different.

Speaker 2 1:25

Yeah, and had a very good time at university, so much so that at the end of three years I had a certificate of higher education in science and technology to show for my trouble, because I really didn't apply myself terribly well to my studies started to think I would probably quite like to do something in healthcare and thought about nursing, and then very quickly then started to think about children's nursing.

Speaker 2 1:59

And then I started to look further and looked at midwifery and really started to find that quite fascinating. And when I started to tell people that I was thinking about becoming a midwife I had lots of people saying, oh, you can't do that, you're, you're a guy, that's yeah, that's not what. And the more people said that to me, the more I thought no, I think I will do this. Um, I'd applied and I'd actually had a year out after my three years I was a sabbatical officer at the students union, so a year to kind of plan my application and did that, and that was in 1996 and applied and was accepted and that's where it all started. So I haven't looked back since.

Speaker 1 2:48

So how did you find your education then? Because you would have, because from the talks that I've had with a lot of people that did their education, it was very much community first and then kind of into the higher risk in in the hospitals. So was that the same kind of process that you had?

Speaker 2 3:05

it was. It was very similar. We started in 1996. It was direct entry.

Speaker 2 3:10

At that point midwifery education was still delivered in schools of nursing and midwifery education in hospitals. But during my three year programme it then transitioned into the university. But when we started we were in a small classroom in the basement of Paisley Maternity. There was 15 of us in the class that started. Only seven of us completed. But we did a kind of common foundation programme.

Speaker 2 3:38

So in that first year we had a lot of our theory with the nursing students, both mental health and adult, but absolutely it was very focused on physiological childbirth. It was a very focused on physiological child birth. It was very much focused on that role of midwife and the placements were very much focused on community-based care initially. But given we were from the basement of the hospital, you were doing your clinical placements as well and I've got to say that's the bit you felt like a part of that family right from the start. And when we moved into university I did feel a bit of a pang when we were no longer having our our theory classes in the in the ground floor. You felt a bit displaced. So I do think that's that's been a. It's a significant change. I think it. It's much harder for students to feel part of that community from day one.

Speaker 1 4:35

And that's, I think, the advantage. If you can have placements at one venue or majority in one venue, you can have that sense of belonging which helps. But we're so fragmented now and I know that over here we are so fragmented that they go to so many places almost every two weeks and so, yeah, there's no chance to even just get your feet comfortable and get to know the paperwork, and then suddenly you're off again and you're kind of moving around.

Speaker 2 5:02

That's right, and I was very fortunate I also got employed there as my first staff post. So you know, it did feel amazing because you affected the new, everybody, everybody. You, you'd grown up with them, you had, you know, grown with them, you'd learn with them.

Speaker 1 5:22

you really did feel part of that, that entire community, right from the very start, so of your training and that's what some students don't realize is their whole three years of their course is actually a prolonged job interview at every single venue that you go to absolutely, absolutely and certainly in Scotland we're, fortunate, a relatively small country.

Speaker 2 5:46

We've only got three, three main universities that provide education and they provide education to the regions of Scotland, so they are by and large going to join that workforce.

Speaker 2 5:59

It doesn't always work that way, but in most cases that's how it works. So whether they are in the hospital that they will or in the health board where they will finally work, they will have probably worked there at some point. So it allows them to see if they fit that, because midwifery is a very it is like a family, it is a real essence of a team and even if you are not working necessarily with the same people every day, you will by and large know most of the people that provide modificating that service, because there's not a huge number of us. So you know, you do really everybody kind of knows who everybody is. That's a lovely bit, much, much more different to colleagues in nursing who might know a ward very well or a particular community very well. But you know, we're quite fortunate that we know, and they often know people from other boards as well, quite well, because we aren't a big, big, huge community oh, it's definitely.

Speaker 1 7:03

You can notice the difference when you go to conferences. Um, I noticed that with midwifery conferences. I love that there are so many hugs from people as you're catching up with people. Nowhere near does that happen in other kind of like conferences, and it's a very midwifery kind of thing which I just love, because we all love oxytocin, no matter which one.

Speaker 2 7:24

Well, that's exactly it Follow the oxytocin.

Speaker 1 7:27

So how long did you stay at that venue then? Because you kind of wandered and kind of found different pathways.

Speaker 2 7:36

Yeah, so I was there. So I started in 1999. I was a team midwife at that point in the pink team, which I was very pleased about. So it's coloured teams. I thought pink, that's perfect, perfect, um, so joined the pink team.

Speaker 2 7:51

I always liked neonates. I I really loved my placements in neonates and I always thought it was somewhere I would gravitate back to. And about three years into my uh post there, a secondment came up for neonates and I thought, well, do you know what? I'm going to give this a bash and went into neonates. It was really only supposed to be for six months and it ended up being there for almost 10 years. Yeah, um, in clinical practice, and it was the same hospital, it's in the same unit. So, again, it was not wanting to stray very far. Um, and paisley is my hometown, so my wife and kids and family are all in Paisley. So neonates gave me a great opportunity. I did my neonatal training and then went on to do advanced practice, clinical practice in neonates, and then had a kind of senior post within the neonatal unit there in Paisley and I always loved teaching. So that then led on to then thinking about the next step, which was getting into education. So, 2013, I managed to to get a lecture in post at the local university again the same university that I'd been part of all those years before being taught by or working with the same people that had taught me, which was lovely, and the same mentor, jean Rankin. Professor Jean Rankin, who started as a lecturer just with me in 1996, that was her first post. She just not long finished her PhD and a PhD and come in and Jean to this day, is still my mentor and good friend. So working there was. I loved love teaching. I loved being in the university, loved being with the students, seeing them go through their their education and training, seeing them change from that year one to graduation and seeing employment. Then visiting was just phenomenal. Uh, absolutely loved it, and it really was there until 2021, so that was about eight years.

Speaker 2 10:08

But the pandemic I took on the role of practice learning lead for the School of Health and COVID hit and that was really a phenomenally challenging time compared to people who were working clinically. It was not challenging but a really difficult time trying to support our students and I think, certainly when you were getting messages from students who were saying, if you put me out of placement. You know my father's really unwell. He's, you know, gonna kill my father. You're gonna kill my, oh my lord. And that's not what it's about. But everybody was scared. Nobody really understood what was going on, but there was certainly a, a big push I don't know what it was like, um in australia, but a big push for our students to continue their training and about in placement um, certainly my deputy students were a little more protected than our nursing students and so those kind of responses were a little more protected than our nursing students, so those kind of responses were from nursing students. And so really at that point I thought, right, I need a new challenge, it's time to look for something else. And so the post came up at NHS Education for Scotland, still related to education, but in a very different, more strategic role. So joined that just during the pandemics.

Speaker 2 11:33

Again, strange having a change of career in the middle of pandemic and a new employer that you don't go and visit and everything's done virtually it's. It's. It's tricky, but I was fortunate I had new people that were at NESS, people who I'd worked again, other mentors that you then get the chance to work with again. So it felt a very natural move and that's where I find myself now. So I have, and during that space I had the opportunity to do research and various other things as well. So it has been. I've had a really privileged career to be, a very fortunate career, which I'm very happy about. I do always worry a little bit if I'm the beneficiary of some positive discrimination and that's always lingered and I try to tell myself no, you work hard for what you do. Everything I've done has always been competitive, but I've just had such a fortunate career and such great opportunities available that you know, that's always been a little lingering thing in the back of my mind.

Speaker 1 12:41

And you've written in 2014,. I think you wrote a fabulous article which, going back to the thing that you're a bloke, you can't be a midwife, which is really poignantignant, and the fact that, like I read it this afternoon again, and the fact that, even though it's 10 years old now, you could have written that today like it still holds true today it's it's going to be an ageless piece. So well done, um, but also how sad that it will be an ageless piece for, I think, for the foreseeable future anyway yeah, it's it was.

Supporting Fathers in Midwifery Care

Speaker 2 13:18

It was interesting because at that point I I really felt I wanted to put it down in paper, to get it out my head, because I had been thinking about it and I was very thoughtful about it and I had a very positive experience during my my training and education in Driftway, partly because I wasn't the first man who trained at Paisley and there was actually another midwife there, martin Cassidy, who was there before, and there had been another man before that, fraser, before that. So the team were it wasn't a new concept, so I was very fortunate that somebody else had blazed that that trail before me. Interestingly, we were we were probably all very different personalities and I think that that was the one of the key differences because I probably had a slightly easier time in a lot of ways than those colleagues. But it did strike me as really always very odd that this prefix would always be added on, and certainly the only times I ever encountered any anxiety from women of birth and people was usually on cultural grounds, which was completely understandable.

Speaker 2 14:37

But what was not understandable was they didn't really get a choice when it was an obstetrician. They didn't really get a choice in any other, but it was definitely a choice for me because then the obstetrician would bring past into the room and you think, well, I actually prefer, and you couldn't even get the words out and they were in and I know for a fact that they wouldn't have asked if it was okay and they would prefer someone else and there are small numbers. But I'm also very thoughtful that you know people say well, there should be more men midwifery. There's a big debate about that in nursing and my argument has always been well, in nursing you are caring for the entire population.

Speaker 2 15:22

You're caring for all genders, all ethnicities, all races, everything there. But midwifery. We are dealing with with women and birthing people, and therefore our service really needs to reflect those that we provide care to, and we're not there yet. We're a long way away from being representative of of that. So that's the wrong question. The wrong question is well, we need more midwives that represent that diversity that we have of those that we provide direct care to.

Speaker 2 15:54

Is it beneficial in other ways? Yes, did I have a different relationship, I think, with fathers and parents? I think undoubtedly. I can think of numerous occasions, particularly in the neonatal unit, being able to support fathers slightly differently.

Speaker 2 16:15

You know, in every other regards I was providing, hopefully, the same care as as my colleagues, and I think John Pendleton, who's just finished his PhD as well, has been looking at this area as well, and I'd spoken to John about my experience and he tried to speak to other men in midwifery as well. So he's also, I think, uncovered some interesting insights into that as well. And in terms of the, in our current climate and world where we are seeing other emergent groups and identities, then it does make that all the more present and that we do need to be considerate of that and not make assumptions. And I think unfortunately there's probably still a lot of that, because it's not malicious and it's not with poor intent. It's just a lack of understanding or a lack of feeling able to ask those questions. But ultimately, if you don't know, then ask the person who's got that lived or living experience.

Speaker 1 17:29

Ask them which kind of reminds me that I saw a beautiful photo the other day of we have events here called bubs and beers, dad's kind of like meet at the pub and they's usually a midwife there. But I was thinking maybe there's there's a niche role for postnatal doulas who are male or non-gender, because then you've got that person you can talk to, you've got that kind of similar lived experience that you might feel. That kind of you're someone who you can identify with and talk. So that could be something in the future as well.

Speaker 2 18:09

Absolutely. I think it is. We probably don't take a step back and think about the needs of fathers and parents.

Speaker 2 18:18

enough about the needs of fathers and parents enough. And we do know that perinatal mental health, yes, absolutely impacts the mother or parent the most, but there is absolutely impacts in other ways and I saw that very acutely in you, nene. It's because you would have a dad or father or parent however they chose to describe themselves who had a couple of weeks leave and then were back at work Yep, and you know, often difficult jobs and they were coming in and you would see them at the end of the day and they would come in for their bit of time. And the number of times I would walk in and see them sitting next to the incubator, frightened to put their hand in, frightened to do anything. You think, oh, if I couldn't see, let's get this baby out.

Speaker 2 19:06

And you know, do you want a bit of skin to skin? Do you want exactly? You know you've got to be there and just remember that. You know they're not the one that's been there and learning all the tips and tricks and the staff during the day and getting the confidence and holding their baby. But that early connection, that early bonding, is so important for for them as well, and so it is. We do. We do that. There is so many other other ways that we can support, not always within our traditional rules, um and and staff. There is absolutely other space as well, but men can be part of that in a different way.

Speaker 1 19:45

And we know that research is showing that the partners also go through, especially in NICU. They'll go through postnatal depression. But the partner's postnatal depression is quite often delayed because their primary focus is their partner and supporting them, while they're kind of going through their own issues. And so it may be six, ten weeks later that they end up dropping their bundle and they don't know how to call. They don't know how to ask for help because they don't want to put any more burden on their partner or anything like that, and I think that's coming out sadly, stronger and stronger in the research yeah, it absolutely is.

Speaker 2 20:28

And if you think about for the, for the women, um, she will often feel like a mother during the pregnancy yep as soon as she realizes that she's she's pregnant, um, or the birth in person, will feel like that parent.

Speaker 2 20:43

Right from that start, the other parent, the father or other parent, will not necessarily feel.

Speaker 2 20:51

I certainly didn't feel anything remotely like a father until my children, my son, was born, and it is a different relationship and, yes, I probably had a different experience because I had other knowledge and experience of of that before. But I definitely didn't feel that same connection until much, much later. The same for the mother or parent in that circumstance. So we do need to be really thoughtful and our health service is not designed to meet that need or recognise that need. No, it's not, because health visiting, which we have following on from midwifery care, has very limited opportunities of contact for even for the mother, and that's often happening at a time when the other parent is working, so they're not there anyway. So there's no assessment being done and you see that other parent is trying really hard not to burden their partner. So it's it's it's a real hidden, hidden harm that's happening, um, that we need to make sure that there is support networks available for those who feel they need that. But we also just need to ask people how you do?

Speaker 1 22:11

yeah, and then kind of people feeling safe enough to kind of say, no, I'm not, because it's like toughen up kind of like you're meant to. Yeah, all that we could talk about that for ages but um no, it is fascinating because it is kind of highly important stuff that we go into. So you've chosen.

Benefits of Professional Doctorate in Research

Speaker 1 22:29

So you said you mentioned that in this new position that you've gone in since 2021 that you've been introduced to the opportunity for research, so what type of research have you been involved with, and did that influence the pathway that you took to a professional doctor as opposed to a PhD pathway?

Speaker 2 22:51

Yeah, yeah, it's a good question. So probably research started a bit earlier being introduced to research. I started an MPhil, actually when I was still in clinical practice and it was very much focused on a clinical neonatal concern. It was to do with thermoregulation, yep. So that really started me in research.

Speaker 2 23:16

And then I, when I went on into becoming an educator, there was at that point and I think universities have changed, I think post-pandemic it's, it's difficult, but certainly when I started it it was that real university life. You're encouraged to be involved in research, encouraged to multidisciplinary and think about these things. So there was a great opportunity involved of lots of different types of research, most of it in the in the area of maternal and child health, um, and also because I had such fantastic mentors like gene rankin and other colleagues, um, it was opportunities to really just start to understand a little bit about the research process and understanding the different methodologies and approaches to deal with questions that need answered. And so the professional doctorate route after I finished my master's, when I came into teaching, and again, my master's was a phenomenological study looking at the experiences of newly qualified nurses going into work in units, so that. So there was probably quite a thread, a common thread in there at those early early days, but the opportunity for professional.

Speaker 2 24:33

I was very keen when I went into teaching and there was always the offer to start my PhD, but there was quite a lot of us in the team thinking we're doing that. There was a couple of colleagues already doing their PhD, so it was just a bit challenging. And then the university started a professional doctorate, so it wasn't so much a choice rather than it was available, and so I started that in 2016 and I think it's hard to compare because I haven't done a PhD, but certainly, speaking to colleagues who have done a PhD, compared to a professional doctorate, kind of taught doctorate, I certainly felt the benefit of those couple of years in a shared space, really digging into research skills, research methodologies, those kind of logics, inquiry, all of these things and actually having those weekends with a group of really mixed group although there was quite a few health colleagues, really mixed group. I mean we had a guy who was in advertising, we had people who were in social work, criminal justice, with. You know, it was a fantastic eclectic group, really passionate teaching staff, faculty that were on that and quite a small group of of teaching staff and it was another, uh, midwifery professor who kind of co started the prof doc. So I was fortunate I had someone else who was who I knew and and was supportive.

Speaker 2 26:02

But having that space to really think, try to think like a doctoral student, trying to make that transition to argumentation and being able to support and discuss and debate and have different views and present that using language of research, that two years taught was phenomenally helpful, and so much so that I would wholeheartedly recommend people to do a professional doctorate over a PhD. Because when I speak to colleagues that've done PhDs and that really quite lonely journey yeah, even though there's often a community of practice and other colleagues that you'll you'll join together but I just always remember looking into these rooms at university of the PhD students and you'd look in and they look terribly sad and terribly unhappy and were there to all hours, um, and you thought, oh, my word, that's terrible. I don't fancy that very much. Um, whereas you've done two years, you also had that safety net of if, if you felt this wasn't for you or something happened in your life, you had the ability to step off a bit more freely than you could do with a, with a PhD and you could also exit with credit that could be applied elsewhere. So I think it's so much going for it.

Speaker 2 27:24

And yes, I did still get a bit of a subtext from some, of a bit of snobbery and a bit of looking down and I think as well, even the viva examination I think there is.

Speaker 2 27:37

I've heard experiences of colleagues who, because professional doctorates are relatively used I'm not that new, but relatively new there's probably some examiners who aren't as familiar with what the difference between a professional doctorate and PhD, and I know vivas vary across the world as well, so there's different views of that across the world as well. So there's very different views of that across the globe. But the professional doctorate was great and I again was very fortunate having you did have some influence on who your supervisors would be and you also had some influence on who your examiners would be because you were involved in that conversation. So the professional doctorate just followed on so nicely and it was a topic area that I felt quite passionate about. So it all just fit together and it felt like a nice way to continue and put the topping on lots of things that I'd done before, but then now the ability to look forward and say well, what other things can I look at, what other things can I look at?

Speaker 1 28:38

So even that was a taught one. You had topics and coursework, but you got to focus on an area that interested you did you end up right, doing a thesis component of it, because I know that the prof docs have developed differently in different countries and some are by publication, some are. You do a publication with each topic on a certain kind of a general umbrella theme. So how did yours kind of end up kind of coming together?

Speaker 2 29:07

Yeah. So this kind of will give you an insight into my very long term friend, jean Manken, as my mentor and supervisor. So the professional doctorate had three modules. Two modules ran in year one, one module ran in year two and the year two module effectively, you were writing your proposal, a very detailed proposal, to prepare for submission to ethics, and so that incorporated a fairly hefty literary and methodology chapter, really in essence providing you a large amount of work that you could then translate into your finished. So that was the intention.

Speaker 2 29:48

So my initial idea I was I was wanting to look more at health visitors and taking over the care of preterm babies and community, because I was very conscious that our health visiting programs and the diversity of registrants who are going to become health visitors in the UK is very mixed. Traditionally it was often midwives who then became health visitors, but now we have acute nurses, mental health nurses, children's nurses, any registrant becoming a health visitor, so not necessarily with that broad perinatal background, and I was just very conscious that there was probably a knowledge and confidence gap in there and I wanted to understand what that might be and how we might be able to fix that. So that was the entire focus of my second year of my top doctorate and I was very pleased with that. I thought that's great and did very well on the assignment. I thought, oh, this is perfect, let's get started with research.

Speaker 2 30:44

So then had our supervisors, and I had Jean Rankin and I also had another professor, margaret Arnott, who was a social policy sociologist, social policy expert as well, and those are my supervisors and went to the first meeting and gene's response to it was that's a bit boring, you can do, you can do better than that. And I said, oh, you'll be bored about that. And gene's done research for years. And so I thought, all right, okay, well, you might be right. So I basically had to start again. So I didn't start completely from nowhere, because my eventual topic, which was a kind of examination of the influence of a neonatal policy in Scotland, I'd already incorporated into some of my discussion because it was loosely related to what I was doing.

Speaker 2 31:40

But I basically had to write my proposal again yeah but I've got to say I'm glad I did, because in hindsight she was right, I would probably not have it, would not have kept my attention as well as as my venture topic did. So I think I find that quite a helpful thing as well, because I kind of reassured colleagues who are doing it, said don't worry too much about it, you're allowed to change your mind and if you've chosen something it's not the end of the world, because really very little. And even colleagues who were very strict and they stuck to their topic, they probably didn't use very much of that work in the final thing because the thinking evolves and changes and even the methodology might change and everything else and the literature will be out of date anyway. So you'll be doing that again. So you know you kind of feel to say to people look, don't worry too much about it.

Speaker 1 32:33

Just you really do need something that does hold your interest or you will burn out very quickly and it is that that kind of you've got to love it because you may end up hating it. You'd have to have the passion for it and I never understood that.

Speaker 2 32:49

When people said that you will hate it, I said, no, this is a baby, I've not tried this bit, I'll love this till the day I die. And you think, as soon as you've written that and submitted that, and if you have to go back to it, you think, oh, my word, I would happily burn you a steak thesis. I don't want anywhere to do with you because it is. It is you put in so much effort in it, um, that it does become something that you can barely open again.

Speaker 1 33:14

You think, oh, my word, I have to look at this again that's why I have a six month post um completion buffer zone for anyone I talk about, because if you get it within that six months you're still in that go away. But after that six months they've had a chance to decompress and then they've had a chance to kind of like restart life again and now it's kind of like actually I don't hate it as much. It's like now I can actually see some of the good things to it. You've got to have that distance because I've spoken to people too soon and, yes, six months is a nice buffer zone.

Speaker 2 33:50

I think you're right. I think you're right. It definitely does need that time because it is such a huge part of your life, it's a huge part of your family's life. If you do try to protect them and not impact too much, inevitably it does. If you're working full-time, I mean, I do think the one advantage of kind of full-time phds is that when you're picking up and putting it down picking up, putting it down, it you are.

Speaker 2 34:16

There's a lot of wasted effort because you've got to keep going back and reading back to research yourself, new research, and it's so, so time consuming that you say, well, I've blocked out two days, but actually a day and a half of that. You're just refreshing your memory, so you've only got a useful half a day, whereas colleagues that are doing it full time and are immersed in it entirely. I think that must be lovely because you'll never have to keep going back to it. It's just keeping going and it's you've got. You're able to hold that train of thought and probably be far more productive, even though it must be incredibly difficult. I don't underestimate how challenging it still is, but just that different pattern and rhythm to it is so different.

Speaker 1 34:59

Chunking off time is really important. So how did you maintain your balance? By working and doing study and having a family.

Speaker 2 35:09

Yeah, I, I am quite a bad procrastinator if I'm honest, but I am reasonably good. If I can get myself in the right zone, I will be productive. Um, so I tried not to put too much pressure on myself, and I was trying to be quite realistic and say, well, look me spending an hour a night, even though some people would say, oh, just even just a couple hours a night and every night at all. That's not good luck. And so I did just try to chunk times as much as I could. If I'm completely honest, I'm not sure I would have finished my doctorate if I was still at university, which sounds completely ridiculous. No, I'm not sure I would have finished my doctorate if I was still at university, which sounds completely ridiculous.

Speaker 1 35:48

No, I get that. Working at a university completely understand that.

Navigating Challenges in Academia

Speaker 2 35:52

But I honestly, I really, really, really struggled for time when I was teaching and in my role at university. It wasn't until I moved role to a very different organisation and I was in much greater control of my diary and my time that I was. I was absolutely able to to power on and complete, but I did not feel I would have completed as easily if I was still at university. So it was about for me it was blocks of time, um, and really just sitting down and saying wait, just get this done, just get this bit done. And quite a big believer in free writing and encourage people to do that. You know, don't worry about the structure of it, just get it down on paper.

Speaker 2 36:32

It's much easier to work with something than nothing and you will even have a sense of achievement if you've written two pages and it's absolute nonsense. But I guarantee you there will be at least a couple of paragraphs in there of gold and they're just a bit polish and a bit of change and they'll be good. So nothing will be wasted, wasted effort, um. But I think the other thing is everybody's different. How people work is different, so it's the same as we tell students. You know, you've got to understand what kind of learner you are and and do what works for you. Don't do what your colleagues are doing because that won't fit you. So it is a bit of self-discovery with it as well, and understanding what actually makes a difference very much.

Speaker 1 37:16

How did you maintain your mental health and your sanity in those moments when you just wanted to give up? Did that happen often, or was that more so when you're at university and became better when you could have that more control?

Speaker 2 37:32

yeah, I think there was lots of points and I think part of what was helpful was it at the university there was an expectation, and there's now an expectation that you know lecturers will have a doctorate yeah which makes no sense in.

Speaker 2 37:47

I can understand that in science courses where you've got very bright people that do their degree and go straight from their honours degree to phd and they're rocking out their phd at 23 24. The reality for nursing and midwifery education is that you're required to have clinical experience and it's a bit of and some of my colleagues hate when I say it's a vocation, but I think it's a big vocational element to what we do. It's been academicized over the years and, I think, sometimes to the detriment of our, of our professions. But in terms of what it is that we need to do and what we're trying to achieve, it was more the pressure that you have to get this done, this is expected, but we're not going to give you any time, or we'll say we'll give you time, but there's no time right now.

Speaker 2 38:44

So there was lots of moments I thought what's the point? What's the point in doing this? And it wasn't until you had your supervisors giving you that point of contact with them where they said no, this is good, you're doing well, it doesn't matter if you don't get that written. Even just having this conversation and I did I left every one of those meetings feeling a real boost, and I think that's the key thing. If you don't have that, if you don't have that type of relationship, it doesn't need to be a relationship that's necessarily that you know them well or you're really friendly with them. It's just if they do the role which is to nurture and support you and encourage you, um, and be honest with you and say actually, yeah, this isn't at the level it needs to be, or this this you can do better than this.

Speaker 2 39:38

Unless you've got that, there's a there's a real danger, yeah, that you, you don't have enough of that self-determination to to complete it. But I absolutely I'm sure that it wasn't till I I did change role and had had the headspace, had the ability and the people that were not. It made no difference whether I complained to the doctor or not, so that pressure was off. That wasn't a part of the deal, um, and if I hadn't been successful with it, then it wouldn't have measurably changed my life or my role. Nobody would have given a monkey's, whereas not completing it but working at a university would have been a very different reality. So there was moments, but I've got to say I'm a fairly chipper person, so I never really felt really low about it. But I know lots of friends and colleagues who did get to those months and, sadly, friends and colleagues who decided, yeah, this is not helping, uh, my health and well-being.

Speaker 1 40:37

I really need to stop this and we know so many people that do fall out of it. Even though their intrinsic motivation is genuine and is real, absolutely the reality of doing it in their, in their reality isn't, isn't sustainable no, it's not and it is.

Speaker 2 40:57

It is a. It's the highest level of academic work that you can do, so that there is absolutely. It's not easy, um, and it is important that we have within our profession colleagues that have studied at that level and worked at that level, but research can happen at every level. Yeah, but it's about our responsibility, as you go further up in those kind of studies, to be able to encourage and nurture that right from year one, student midlife, and giving them the knowledge and skills to be curious and to ask questions and, if they can't find the answer, to try and get an answer.

Speaker 1 41:40

We're an evidence-based profession, so we have to understand it to be able to use it properly and safely.

Speaker 2 41:47

And it's also, there's still. I think there's still a bit of it, but I don't think it's much now. But you know, I would say to the students oh, all these doctors are so clever. I said oh you know, you're doing a degree programme and some of our students are doing a master's programme.

Speaker 2 42:10

Our medical colleagues, most have done a joint honors degree.

Speaker 2 42:12

You know, don't ever be put off or think you're less than yeah there, and you know good medical colleagues don't make people feel that way. But there are some who do um as same in other professional groups but ultimately, you know, their level of education very quickly surpasses that level of education and beyond. So people doing research who don't have formal education, who produce brilliant research, it doesn't require all of that level, it just requires elements of that and the ability to do that and the support of people who have great experience, because some of the best research ideas come from people saying I don't understand why this is working. They say do you know what? Well, find out why it's not working or why it's working that way or why it's not working.

Speaker 2 42:58

Ask the questions, go and look for an answer. Um, and that's that's the bit that makes research, that's the bit that sustains you is finding out an answer or explanation to a question that you've posed. And if the question isn't sufficiently itchy, then you will continue to scratch away until you find an answer and hopefully the answer you get gives you some belief, something, something that doesn't. It just gives you more answers and more itches in other places than you could have scratched with the other receptors.

Speaker 1 43:30

And sometimes you get the responses that you don't realise that you get and you're not getting, but it's still an answer. It just takes you in a completely different direction.

Speaker 2 43:39

Absolutely, absolutely. And how wonderful is that. You think you would never have got to that new place if you hadn't started on that journey and started to ask some questions and and and ask people, and it is shaped so much by your connection with others, and who you have around about you absolutely influences what you do, what you think about so surrounding yourself with good people, people you trust, people that that are going to encourage you, people that are going to be there for you at the points that you're feeling less motivated. So that's why having some influence in who your supervisors are is so important, because, whether they realise it or not, their role is important.

Speaker 1 44:21

So that brings us very nicely to how did you celebrate so that?

Speaker 2 44:27

brings us very nicely to how did you celebrate? So that's a good question. When I went through my viva, I had a really, really good viva in terms of it was exactly what you expect a viva to be it was collegiate, it was was friendly, it was not adversarial yeah it was definitely a conversation around about your research and about your thesis, and the examiners were were asked really good questions.

Speaker 2 44:59

It really gave me the chance to to give really full answers a A couple of quite challenging questions which then hinted at the revisions they were looking for. But it was a chance to kind of talk through and, I suppose, reassure them that I then understood what it is they were looking for. But a really, really good experience in the Viva. I then came out of the Viva and was sitting while the examiners were debating the outcome, and it was about two hours, and so I sat and I thought, and my supervisor was there and gene had just retired just as I was finishing my, my doctorate. So another professor, moira lu, who I'm good friends with, took over as the as the lead supervisor. So Moira was in the Bible with me, jean was waiting outside, and so we sat outside and Moira said you did really really well, really really good. I thought it went well.

Speaker 2 45:56

Minutes ticked by and I said, oh my word, and I could see them getting quite anxious as well at the whole thing. So we went in and it was a very, very flat end to it which was, effectively, you need to make some revisions and resubmit your thesis. But really good, fiver, you did very well. Blah, blah, you've got 12 months to do it and one of the examiners said but you could do it much, much sooner. So I got the hint that there was maybe some disagreement in the in the discussion, but that was fine, so I'd left with that. So it felt it felt a wee bit flat, if I'm honest. When I came out I thought, well, did I?

Speaker 2 46:37

and they said pass your library, just get right. Oh, that's great. Um, and then after that I parked it for a little bit of time, because I think there's always a danger that you just rush into it and and I hadn't had the the formal feedback. So I went away on apology with my son and while we landed where we're going, I got the email through and read the email. It was the worst thing I did was open up the email because the the written feedback was quite, quite hard to read. I'm honest it was. It was difficult to read because it it didn't really match my experience of the okay, yeah and they had said at the end of I would you want us to take?

Speaker 2 47:22

and I said no, no, I'm happy enough. I'll wait for the formal thing I don't point to tell me here, but I probably should have said, yeah, please tell me what it is you want me to. Yeah, but then again, it's that example. As you said, elizabeth, you know you got it too soon. I actually read it and I thought, right, read this but take all the emotion out of it. Yeah, right, okay, no, that's doable. Yeah, I can do that. Well, that's actually straightforward. Yeah, yeah, and you just read it again.

Speaker 2 48:00

And then I met with one of the examiners who was going back to it and they said I said, well, you know, I'm just conscious, it says major revision of Eisenhower. I said, no, no, you just need to reframe it. It's just a bit of tweaking. You know that goes really strong. And I thought, all right, ok, well, that's not really how I read that and how that's written. But, um, so you know, did that and and followed the advice and it went through no problem.

Speaker 2 48:29

Um, but again, that's advice I would give. You know people be clear on what it is you're looking for, but also just read it a few times, but give it a bit of time, because your, your emotions will be high because somebody that's criticizing what you've done, even if it's constructive, it still hurts. Yeah, a big failure. And you think I've fooled that and you think, no, you've not. And and I suppose the other thing is that it made me realize that, with all examinations, it's relatively subjective, oh yeah, even though it's designed, but it's, it's very subjective and it is down to two people really or three people in this case.

Speaker 2 49:10

But you know it's down to the interpretation of it and it's not a personal thing. They're reading your thesis code, they're having a conversation with you and they might just have a different feeling on how. But I actually have got to say that one of the parts that had to reframe it made it a stronger thesis. Yeah, even though it was difficult and it was a lot of work. It's actually stronger because of that and it just needed just a slight change of framing. And they were absolutely right, yeah. But to be told that you thought what do you mean? And they were absolutely right, yeah. But to be told that you thought what do you mean? But that's that's the reality of it. So, but it you know it is. Could you? Could you use so?

Speaker 2 49:52

And I think the other thing is your story. People can never have the walk out, no connection to mine or this and you think but at the end of the day, there is no comparison, there's there's no rhyme or reason to it, and you hear people that have dreadful experiences and people have great experiences. I was thought I had a good experience, a good vibe, I've got the outcome and it's done. So do you know, at the end of the day I only look back with with kind of pride and relief. So celebrations were muted because I was yeah, it was just enjoying time with family and supervisors were delighted and colleagues were really pleased. So I didn't promise that I bought myself a pen, a pen.

Speaker 1 50:36

A nice pen. That's appropriate for something that you spend too much writing, absolutely.

Speaker 2 50:41

So that was it.

Examining Neonatal Care in Scotland

Speaker 1 50:43

So what's next? What have you kind of got coming up in the pipeline that excites you Actually? No I should go back first. One more question. Yeah, thinking back now to your actual PhD the professional doctorate, sorry and the thesis component and the study you did, what still kind of comes up that surprised you or something that you weren't expecting in doing that study?

Speaker 2 51:14

yeah. So what I was examining was we have got the best start in scotland, which is a was a five-year program to absolutely revolutionize maternity neonatal care in scotland and it was published in 2017. Very ambitious, a lot about continuity of care and carer, but for neonatal, one of the key recommendations, which is just being realized just now, is reducing the number of intensive care units. Neonatal intensive care units in Scotland from we did have eight down to three to more centralize that care in Scotland. And what annoyed me and really was the hellfire that raged me through my doctorate kept me going was the fact that it was based upon a quality framework for neonatal care that was published in 2013 that had never been evaluated. They'd never really looked at that to say has this actually worked? Do we have a neonatal service that resembles this quality framework? And I thought how dare they create a, a plan that's based on in a huge part not entirely, but in a huge part on a policy or a document that has never really been tested? So it was quite a historical bit of work and looking back and really speaking to clinicians to understand what they understood to have happened in terms of neonatal care. So we're using a realist evaluation approach to really driven by theories that were then tested and refined. So the learning from it was really quite fascinating that there there was, on the face of it, the recommendations that were in this framework. The clinicians all felt, yeah, absolutely, they're all there, yeah, we're achieving all these things and that's great.

Speaker 2 53:08

I thought, well, right, okay, well, that's kind of not what I was expecting, but okay. But then when you dug into it and said, well, how are we achieving that? So what is the how and what is the impact that's having, it was a very different reality. But what was very clear is that the group of participants I spoke to, across a range of different disciplines and areas across the country, all had different realities of what that looked like, of what that looked like.

Speaker 2 53:38

So what it then provided was a range of mechanisms and potential outcomes in different contexts that may be happening. That then informed that if we want to really achieve high quality neonatal care in Scotland now, we need to learn from what has happened before, rather than just get another policy and put it out into the wild and hope that it works. And just now we are right in the flux of that. So it's now the pressure's on to try and write up some of that to get out to say well, actually, here's some of the learning here. So, while we're in the middle of this, I've got some things that might be helpful to inform our thinking and and understand what is working and for whom and in what circumstances and why, to try and lead that delivery of care in.

Speaker 1 54:26

Scotland. Cost savings you can imagine if you bring it down to three units definite cost savings. Centralizing of staff and equipment is good. However, you're then putting a much more larger burden on the families that are having to move away.

Speaker 1 54:44

You're separating those families. Their cost to them, financially and emotionally, is huge, and especially when you're looking at where you've already got, within the islands and the remoteness of Scotland, a lot of kind of women and birthing people who already have to leave home early to go to a venue large enough. So that added. And how does that, how do you put that on a budget sheet for return of investment? Yeah, oh, that would be interesting to read.

Speaker 2 55:12

Yeah, so I mean it's really and you've hit the nail on the head it is about. We've not factored in the impact on maternity services as well as the impact on birthing people, women, their families and all the impact on there by centralising this. The evidence is very clear that actually for the most vulnerable and sickest babies it's much, much better, much safer to care for them in a centre that is doing that relatively regularly. For that and you got staff that are well trained and well prepared. It's unequivocal. The evidence for that is is absolutely clear. Much better for these really sick babies to give them. But the trade-off for that is that well, that may well mean that ideally, in an ideal world in the west of Scotland, where Glasgow would be the neonatal unit of choice, that someone who's having their baby in the west region would go to Glasgow, but only if they've got a cot. If they don't have a cot there, you could be going to Edinburgh or Aberdeen.

Speaker 1 56:09

Yeah.

Speaker 2 56:10

So that is monumental for a family and while it might be easy to move the baby relatively easy in easy terms in terms of in transport or in utero transport, whatever that might be they are then displacing that family and we're also not measured and we've not examined what's the impact on the maternity service in that area, because someone from another area is in there, maybe it will be there for a number of weeks then occupying a maternal bed. We've not done the proper mapping of that and so there's a lot of unease about it in Scotland just now, a lot of unanswered questions, so it is a very pressing concern.

Speaker 1 56:49

So it is an area that is very alive and open for discussion, debate and discourse, which is is exciting because we need to get this right because, absolutely, and when you look at the fact that putting up people into hotel rooms is actually cheaper than keeping them in a hospital bed, um, the alternatives, kind of like open it up to um a whole pile of kind of innovative ideas. So that's where you've got for the future.

Exploring Diverse Topics in Nursing

Speaker 2 57:19

You've got writing up that, you've got focusing on that yeah, writing up that, opportunities to do books as well and various things again. Um, other research involved with paramedicine I'm really interested to do a lot of work with our paramedic colleagues for obstetric and neonatal calls that they have. So we've actually got a kind of international. It's an unfunded study so we're all doing it at our own time, but a study that's got started off with Belinda Flanagan, who's an associate prof in Tasmania and working with colleagues in the ambulance service in Scotland, canada, america, to really understand the actual and perceived knowledge of paramedics in relation to perinatal subjects.

Speaker 2 58:04

To try and understand well, we know it's a really anxiety provoking experience for our paramedics and it's low acuity, so it's really high stress but low acuity and low volume experiences. So really to understand what would be most helpful to them, to feel more confident, to deliver the best possible care in these situations. So, um, and lots of other little areas and still some of the performativity stuff. So we're we're looking to do another round of those kind of interviews and translation into poetry, some work and family nurse um partnership as well. So it is, it's, it's, there's, there's plenty of stuff to be looked at and thought about you never get bored no, definitely not, definitely not thank you so much for joining me oh, pleasure, real pleasure.