Sunshine and sea

GENOA, Italy—The vagaries of air travel mean I arrive here on Monday, 16 September, at 10 p.m. instead of 2 p.m. After an unexpected night in the Radisson at Manchester Airport and an unplanned visit to Rome, I miss my first meeting. I meet my good friend and translator, Guiseppe Aleo, professor at the University of Genoa (Università degli Studi di Genova), in the lobby of the hotel to catch up on what I have missed and to plan the week ahead. I am an honorary docenti (teacher) at the university.

Genova—for some reason we call it Genoa—is on the Ligurian coast of Italy, where the food and wine are superb. This was the home of Christopher Columbus—remind me again, what country did he discover?— and Marco Polo. I have been coming here for several years to work with colleagues in nursing at the university, in particular Loredana Sasso and Annamaria Bagnasco. I teach postgraduate nursing students and advise colleagues on research and publishing in English-language academic nursing journals.

Tuesday, 17 September

My first full day here is spent with colleagues at the university, reviewing several research projects underway. The range of what is being studied here is impressive and clinically oriented. Academic nursing is relatively young in Italy, but there are some active centres where research into nursing issues is making great progress. Today’s meetings progress slowly, however, as I have to work through my translator.

The weather is superb. One of the main local news items is the righting of the liner “Costa Concordia,” which sank nearby last year. Over dinner, a colleague with vast knowledge of the safety systems on these ships explains how difficult it is to sink one of these vessels.

Dinner is in a formaggio (cheese) restaurant outside Genova. The Ligurian coast has a backdrop of mountains, and most of the towns here seem, in a clichéd but literal way, to “hang” off the mountains. Most remarkable is the network of high bridges and tunnels that run parallel to the coast. Moving along the coast, you either are looking down—vertiginously—from one of these bridges on the regular series of roads with hairpin bends that run below to the coastal towns, or up from those same roads. Italian driving means that the transition between the bridges and the roads is seamless.

Wednesday, 18 September

I spend the day with University of Genoa postgraduate research students. I meet these students twice a year. In the past, they have listened to me lecture, from morning until night, on a range of topics. Apart from the fact that I am on the verge of repeating myself—some of these students have been in the group since I started visiting here—I feel it is time to catch up with their projects, to give me the opportunity to question them and for them to question each other.

I work without my translator, because the rules state that the projects are to be presented in English. They all do very well, helping each other—and me—with the language. The projects range from educational to clinical work. I have always been impressed by the students’ ability to think clearly, apply best research practice to their projects, and deal with hard questions. I am especially heartened that they interrogate each other. Using this format, the students are able to learn and understand what the others are doing. I would like to see this approach adopted with my own research students and others at the University of Hull. Several of the students are on Twitter. Gianluca Catania and Milko Zanini are two who are worth following.

At dinner this evening, we discuss the Francis Report (blog passim), and it becomes evident that criticism of nursing in the U.K. has a negative effect in countries such as Italy, where our system of nursing education is held up as a good example of what can happen if you educate nurses at university level. Politicians and policymakers in other countries, opposed to raising educational standards in nursing, are quick to cite problems in U.K. nursing.

This evening, I am taken on an unexpected tour of the historical heart of Genoa. Superlatives are hard to find, but this is one of the biggest surprises of my life. Rows of palaces with relatively modest and mysterious exteriors hide courtyards, architecture, and elaborately painted ceilings, glimpsed only through doorways and gaps in curtains. All of these buildings are now businesses, mainly banks. The tour ends in the historical port where the galleon “Neptune” from Polanski’s 1986 film “Pirates” is berthed. Many people do not recognise it and assume it to be an historical ship, to the amusement of the Genoese.

The "Neptune," built to full scale for filming of Roman Polanski's
"Pirates," is a popular tourist attraction in Genoa's harbor.

Thursday, 19 September

This is my final morning with the research students, and I hear about two new projects. The remainder of the day is spent looking at research projects with colleagues and advising on the analysis. I am one of the few people who regularly use Mokken scaling, a form of item response theory. Some of the datasets being established here are suitable for analysis. I am especially pleased that a large dataset of older people with dementia is being gathered, including the Edinburgh Feeding Evaluation in Dementia (EdFED) scale—translated into Italian—which will soon be ready for analysis, at which point I will have my first co-authored paper with Italian colleagues.

Friday, 20 September

My final day is spent with colleagues, reviewing projects and planning potential publications. Already, I have several short visits planned for next year, which should give me a view of Genoa in all seasons. Combined with a planned visit to Rome, I feel that Italy has become a firm fixture in my professional life.

I have run here every day, building up from three to six miles over the course of three evenings. The Corso Italiana, a tiled promenade approximately two miles long, is ideal for this. There are many runners, walkers, and others taking various forms of exercise, and the view of the Ligurian Sea, especially as the sun goes down, is worth the effort. It is a great segue between the end of a working day and the start of an excellent Italian dinner. According to my Garmin webpage—where my runs are recorded from my GPS watch—I have burned 2,500 kilocalories in the past three days, a drop in the ocean compared to my calorie intake over the same period.

Saturday, 21 September

On this last morning, a last run, coffee by the coast, and a midmorning beer in the sweltering heat before going to the airport. I reflect on the title of this blog—a climbing term—and think how little outdoor climbing I have done this year. Back home, the season is almost over, but I still enjoy indoor climbing two or three times weekly with my children. As a form of exercise and mental rest, it is unbeatable. I have a fairly busy week ahead at my own university, then back to the airport on Saturday for a visit to Hong Kong. 

A significant piece of news is that The Lancet, one of the leading medical journals in the world, has invited me to lead a commission into U.K. nursing. I have accepted the invitation and am in the process of appointing commissioners. Although the commission will focus on U.K. nursing, it will not be completely composed of U.K. nurses. That’s all I can say for the moment, but I will keep you up to date on progress over the next two years.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Gender problems

MUNICH, Bavaria, Germany—“Don’t you have a gender problem?” I was asked as I sat down to dinner in a Munich restaurant last night. I thanked the questioner—a distinguished Austrian physician—for his concern, prodded myself in all the appropriate places, and assured him that all was well in the gender department. The Germans and Austrians do have a sense of humour!

What my colleague was referring to was nursing. In German, there is no word to denote a man in nursing. The German word for nurse—“krankenschwester”— is a feminine noun. Spain and Italy simply had to change “enfermería” and “infermiera,” respectively, to “-o” endings to indicate masculinity, but this is not an option in German. Gendered nouns mostly fell into disuse in English centuries ago so, while we tend to associate nursing with women, the word itself is neutral.

Bernd Reuschenbach

I was in Munich to address the 47th Kongress für Allgemeinmedizin (general practice) und Familienmedizin (family medicine) this morning. The theme of the conference was “Komplexität in der Allgemeinmedizin-Herausforderungen und Chancen,” essentially “complexity in care.” I am here at the invitation of Bernd Reuschenbach, a lecturer in psychology at Katholische Stiftungsfachhochschule München (the Catholic Foundation University of Munich) and Antonius Schneider, chair of general practice at Technische Universität München. Reuschenbach is engaged here in nursing education, and Schneider was one of the main conference organisers.

Antonius Schneider

The title of my presentation was “Nurses and doctors can and should work together.” Addressing the issues of complexity and interprofessionalism, I tried to illustrate the advanced and specialist roles that nurses play in some parts of Europe and the United States. Such developments are only starting in Germany, and the question-and-answer session was challenging, to say the least. I learned that I should stop referring to “the UK and Europe.” as if the UK is not part of Europe. I was asked, if nursing took over a range of advanced roles, what would be left for doctors to do, and could nurses replace general practitioners (family doctors).

“Of course not,” I replied. In answer to what was left for doctors to do, I answered, “Diagnosis, that’s what you’re trained for.”

I thought I had gotten away with it, but someone approached me afterward to say she was “astonished” (not in a good way) about the things happening around interprofessional learning in the UK that I had seemingly ignored. It was maybe a lesson to be more thorough in the future, but I also warned her that what many people say they are doing is not, necessarily, what they are actually doing.

On a lighter note, I was linked up to a mobile tie-clip microphone. When I visited the washroom, the microphone was still turned on, and you can guess the rest. Further demonstration that the Germans have a sense of humour.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.