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So welcome, welcome, welcome. Hi, good afternoon or good evening, depending on where you are and actually some people, it might be good morning. My name is Michaela Nuttall. I'm a nurse and, oh, goodness is here. Hi, Vane. Look at Va is here from Los Angeles. So Vanessa is going to be joining us on one of our in conversation sessions soon. Um So my name is Michaela Nuttall. I'm a nurse and I'm the founder of learn with nurses and this is one of our new style sessions called in conversation. And unlike the others, these ones are being recorded and we will turn them into podcasts. Now, the in conversation sessions are really aimed at exactly what they say just to have a chat and a discussion with other nurses and other healthcare professionals about areas and topics that we think would be interesting for other people to listen to or to what at this point in time. So I'm joined today by Dawn Stevens and I've known dawn now, but actually we met probably a couple of years ago, I think, Dawn and before we jump into er, start with the session, I'd just like to invite Dawn to, um, say a little hello and who she is and where she's from and just to say she's been a bit, she's been a bit, well, not unwell, but she'll explain what she's had done, I think. But she's, yeah, lived experience is where today I think, aren't we done? You? Thank you, Michaela. That's lovely. Um, so I don't normally look like this. I don't know. I've had a possible skin cancer removed from my, my face only on Wednesday. So my lip is very swollen. I don't normally have pouting lips that look like they've just been filled with Botox. I have to say so, but good, thank you. Good opportunity to say, get your skin checked out. Make sure you go to the GP if there's anything that's amiss. So, um yeah, my name is Dawn and I have been a registered nurse for 22 nearly 23 years. And most of that I have to say has been in secondary care. So, in the acute sector in the NHS. And then um about eight years ago, um I discovered something called parish nursing. So I trained as a parish nurse and I set up service which I'll probably go into a little bit more um in my community and did that for a while. So I still work in the NHS. Well, actually I work in primary care now I've left secondary care. So that's kind of a bit about me. But lots of experience in lots of areas. So I'm a bit of a generalist. Perfect. And, you know, until I met parish nurses before, I've never heard of parish nursing. And certainly we're gonna spend a bit of time later on. Just, just finding out a bit more about just what is parish nursing. But before we get to that point, um I think that, you know, our main aim of this session to start with was thinking about holistic care. And I think as any nurse or I'm a health care professional, our aim is to strive for holistic care for patients and to really give the best that we can. And I'd like to just ask you do because I know this is something you're really passionate about is what is, what is holistic care for you. I think, I mean, I've always, like you say, been passionate about holistic care and ever since being a student kind of that, you know, when you're looking at the nursing models and about um holistic care, and we talk about holistic care and actually what does does it mean? And it just means looking after the whole person and not um separating out the physical ailments, the mental health issues, potentially the social issues, the financial burdens that people have the spiritual um issues that people either carry or they openly want to talk about and bringing that all together under one roof really and, and recognizing that every part of somebody's life has an impact on another part. So, um for example, a relationship breakdown can have a massive impact on your, on your physical health, your mental health. If you have long term mental health issues, it has an impact on your physical health. And actually within that you, the spiritual element, some, we all have a spiritual element regardless of whether we have a faith or not. And that is about our purpose in life, isn't it? And it's about the things that are important to us. And I think when you've got, you've got that purpose or that importance in your life and, and you're talking about it, it makes somebody become really animated and excited and passionate and, er, and it lifts somebody to a different level and I think that when you then have that as alongside physical health, mental health, it just changes somebody's um, I don't know outcomes really. And actually, if I think about that, that's wrapped up in when I, you think of the terminology, wellness and wellness is so much more than that absence of ill health, isn't it? It's not about a lack of infirmity. It's having all of those elements in, I wanna say in place. But you know what I mean? It embraces all of that sort of stuff. So, and, and you, you mentioned back to the nursing models and I, and I, and I've been a nurse for longer than you have. I'm afraid I've been there and I was just thinking mine was n Rope and Ro. Ro was it Roper and something Rope Logan and Tierney. That's the one, those were the nursing models when I awful now I've forgotten them. I don't know if they're still in play. Um But, and, and I think, you know, we all start out with these absolute dreams that we wanna do everything we can and, and exactly that holistic, that holistic nursing and that holistic care, but nursing is, and the health care profession has never been under such pressures as what they are now. And, and so what, what for you do you think are the real challenges at the moment? And we have the classic ones, but also the challenges. But also, have you ever seen, what are you any examples of when people have overcome those challenges and still able to provide that, that wonderful holistic care that, that we know that can happen and it makes us feel good when we do it. Yeah. Well, I think the challenge is, it's like you say that rope and that, that's the nursing model that, that I know that's the thing that we trained on and that, you know, the kind of does the patient have um have a religion or you know, that kind of, you either tick the box, you didn't tick the box, you kind of know the question, that kind of thing. That was my experience and, and that was because of lack of confidence. I think for me to know how to ask that question. And, and I'm not just talking about sort of faith or religion. I'm talking about, you know, as nurses, we often just ask the questions that are in front of us that are important at that very moment, but we don't ask the questions that are behind the person, do we? And so, um I think the frustrations are often lack of time, more often than not lack of staff. So you have more patience to look after and therefore you only gather the information that you need at the time because you can't do it all. And that's the one thing, no matter what um nursing career you take, you can't do it all. And so the things that I've seen work really well, especially with holistic care is when somebody, a nurses just asked a particular question, for example, or offered them something that means a massive amount. And that could be anything from allow allowing a visitor to come in just outside of visiting times. You know, that's that we're so rule based, aren't we? You know, in no, it's not two o'clock. So you're not coming in. But sometimes people need that little thing. Sometimes it's like, would you like me to refer you to the chain team just asking that one question opens up a, a conversation? You don't have to be well versed in anything but you just have to be interested in the person. Er, one thing that worked really well for a patient that I had was, um, she was going to have a huge operation. She, she was not going to be able to manage in the house that she was in at all and this was going to be a long, long, long process. Um, so it was for me, um, referring her to the housing team so that she could be reassessed now that, that probably wasn't within my remit. But actually to her, it was extremely important and all it was was an email. It wasn't anything really difficult to do. Um, but it was looking at the whole person, she was no way going to be able to go and have that operation without having the support when she got home and it was just looking at the bigger, the bigger picture and that, I mean, a lot of my experience has been in a hospital. Yeah. What I find in primary care is it's a whole different ball game totally different, isn't it? Yeah. Honestly, the language is, it's like learning a whole different language and I'm new to it. So I'm like, still like a rabbit in headlights. I have no idea what I'm doing. But, um, but the, even those little questions that you have in Ro Logan and Tina, you know, do you have a faith? They're not even asked in primary care. You have no idea. People's understanding, er, you know, what they believe, what's important to them, anything you don't have the time to ask them. So, I think in those situations it's literally about finding out what is important at that particular moment and being able to do something about what you can do there and then not what you can do down the line. Yeah. And, and if I think, but when we talk about holistic and going back, you know, that we kind of think do we have to do everything for everything for that person? And I think what you've just highlighted, it's not, I do absolutely everything. It's about doing something, something over and above what whatever is the bare minimum, you've got to get through to keep safe throughout your shift or throughout your clinic and things. And there are those extra little things that will make, as you say, a massive difference to patients. And I think we, we probably, we probably don't always realize the value of that and that if we realize the value of that, we maybe would do it more because we get rewards from, from those extra little things as well. Just you just reminded me of something that I many talking about 25 years ago now, 28 years ago. And I was on my Cardiothoracic ward and we had um a patient that had been in for a little while and he had one pair of his own pajamas, his no family nearby, one pair of his own pajamas. And I think he was in for about 10 days, maybe two weeks. And so, um, on about day four, I was chatting to him and I said, are we going to let's change your pajamas? He said, well, I've got to put the hospital ones on otherwise, and I don't want to put the hospital ones on. I want to put mine on. So I said, I said, well, tell you what, I think I was on a late shift and I was coming back on an early, I said, let's put you in the hospital ones for now. I don't know if you're allowed to do this anymore. I'll take your pajamas on and I washed an eye in his pajamas for him and brought them that the next day and, and it was, I mean, you know, you can't do that for every patient but just sometimes something. And that guy, I know he bought me, you know, when he bought me a special tin of biscuit and he was lovely. And I mean, that wasn't why I did it, but I know that that made a massive and I did it every couple of days pajamas. We do it when I'm on a late give us yours and I'll take him home and I'll wash him out of them and I'll bring them back and just something as you know, that is not so beyond the scope of what we're supposed to be doing, made a massive difference for him. Feeling like a person while he was in hospital. I'd forgotten about that, washing his pajamas that's there. So, you know, I think whilst we're talking about really good stuff, I think we have to acknowledge that sometimes we can be and maybe it's when we're on the sticky end when we're either a patient or a relative that we get the flip side. And that feeling of when what it's like to not be treated as a person and not, we, we understand that the staff are really busy, but when we're on the flip side and we think, gosh, they're really, they're really not, they're really not being kind and looking after me, do you have any experiences or anything you might want to share about that? I think uh my own personal experience, um being a, a patient. Um I think is, is I, I went in for an operation. I share with everybody. No, I share with everybody. I'm, I, I overshare for hours but, but just you go in for an operation. It was a day case, you know, and it was a laparoscopic procedure and you've blown up with lots of air and then you're told to go home, but actually you're in absolute agony because you've blown up with air, you know, and all that. And I wasn't listened to at all. I was told to take some paracetamol and go home. And, um, anyway, I sort of put my foot down and said I'm not going home because I'm in absolute agony. They allowed me to stay for an extra night. Um, and then I had to go home. So, like, out, you go, this was only a few years ago. It wasn't very long ago. And then I ended up and I knew something was wrong. So I ended up with sexist. At the end of the day, I ended up with sepsis. I was at home and I had to go back into hospital and that was a very different experience because then the staff were quite aware that I was poorly and they knew that I was a nurse. I made sure that they knew I was a nurse. And this is the thing I think, um you've got the language to be able to say to people, haven't you? Like, even when you're poorly, you've got a bit of language to be able to say I feel this, this and this. I am tachycardic, I am pyrexia. I am this, that and the other. Whereas a lot of people don't have that language. So I was, I was there, I was really vulnerable and I felt so vulnerable. I felt completely out of control. And it was the communication from the nursing team that just made me feel a lot safer and they didn't do anything necessarily that was any different to if I'd gone in and hadn't had that language. Um, but they just made me feel very secure in their ability to be able to care for me. And I think that was for me that made me think that changed my practice because I went back. Yeah, I went back thinking actually that made me feel a lot safer because I was being understood. I was being listened to, I was having eye contact. Um, you know, and they told me what was happening all the way along. So that, that was quite interesting. And another, I suppose another um scenario was a patient. And actually it was after I'd been to a learn with nurses webinar. So this was like, put, put into practice. I've come to come into like, I've done the women in cardiovascular disease. We're repeating those in, I'm telling everybody about them because I, you know, and then about a week later this patient came in, lady complaining of the symptoms that had been discussed in the webinar won't give it away if anybody has. And I was like, I think this person needs an ECG and lo and behold on this ECG, she was in bi Gemini and all sorts of different things. And she was, had just been told that it was um gastric pain, it was, you know, it was reflux, it was, it was, you know, the typical um and she now is getting the treatment that she needs, which is fantastic. But it was just, I know it is and it was just looking at the picture slightly differently, you know, and not just going, actually, she doesn't meet all of our criteria. She doesn't, you know, have these symptoms. Therefore I'm not gonna do anything about it. It was just listening to her story and saying this is not good, this is not right. You know, I don't feel right in myself and I, well, that's, that's amazing that, you know, I, I, you like to think that you do all of this stuff and it makes a difference to people and it, well, it sounded like we are, which is just fantastic, just fantastic. Um, I want to, I want to delve a little more if I can around this, um, particularly looking at holistic care, but also looking at, um, because we can't escape the challenges of being a nurse at the moment and we know people are going to be listening to this. Nurses have gone from being like held up to being like the most amazing things to at the moment, potentially gonna go on strike or, you know, and that, and so, and I know that being a nurse, it's not easy, it's really not easy. And I'm not talking about the actual job itself because the job itself, but everything that's wrapped around it because most nurses at the moment are of a specific age, the average age I think is in their sort of middleaged with Children. They've got the parents. So we're really in that sandwich generation as well as working as well as doing everything else. And I wondered if you would think about if we are a and, and most of us are flying on fumes and got nothing left to give. I think that's the way it kind of is. But almost if we could tweak what we give, could we feel better about ourselves? Could we feel, you know, is there a way that there's a sort of I'm thinking a feedback mechanism that by, by trying to approach things in a more holistic way, will that at least make us feel a bit better about the shift, the clinic, whatever we've done rather than thinking that was awful. I never want to go back there, but I've got to go back tomorrow. Do you think there's? Yeah, I think, I guess so. Yeah, I think um quite often we think about what our employer wants from us on a particular shift, don't we? And I know you go into nursing and you go into nursing because you want to make a difference for the people that you're caring for, don't you and whatever that will be. Um But we get caught up, I think quite often in what needs to happen from a business perspective regardless of whether that's NHS primary care private sector. Um And sometimes we lose sight of the patient that's in front of us and there's a lot of talk about person centered care at the moment. And why is that? Is that because we have lost focus of the person in front of us? And actually, we're thinking a little bit more about the boss behind us of what we're doing. So I don't know whether there is a shift in, um, in our thought process when we come to a patient. Um, it's, I know we've got targets. I know we've got pressures all the time. But actually, um, the, it's going back to the reason why you went into it, isn't it? I think, and I think a lot of it boils down to, I know it's the word kindness and, and it is about, and it's almost irrespective of faith, but it is about being kind, isn't it? It's, it's, and I always, I mean, we all try to be kind but, but it's easy to not be as kind as you could be when you're absolutely flat out and we know that lots of people are and I'm really not trying to say nurses have got to give a bit more because I don't think we can give a bit more. But I wonder if there's a way we could give things a little differently to, to get that positive feedback that, that we might be able to get. You just reminded me now of a conversation I had with a colleague of mine. I said she was sat in a meeting a while ago. She said, and they were talking about, she said she was, you know, drifting I/O of the meeting as it were, it was, it was all a bit complicated. And lot of people, you know, they were talking about units and she said she, they talk about units. She, she hang in, she said, do you mean patient? And actually in that meeting, patients were being referred to as units and that, that, you know, that brings me out and goes because that's just awful. Patients are not units. They are with us. We've all been patients and we're all likely to be a patient. We're not, um, we're definitely not units, so I'd like to move us on a little bit now because I think we could wax lyrical about. So, you know, we've had a little talk about what we think holistic is and it's not actually everything, it's like doing something small and meaningful I think is where it's at and how it can be done really fantastically in that, in that small way. And then also some of the ways that it hasn't worked quite so well. Um, we first met when I came to talk about, there was hypertension. That one, wasn't it on, er, in parish nursing? And that was the first, I think I traveled up to Birmingham for that one and it was the first time I'd come across parish nursing and I just, you know, and I was blown away by the nurses in the room. I was blown away by the passion of the nurses in the room to care. It was lovely. But actually I want to feel like I was up to my armpits and nurses, which was really quite nice in the room, you know. Um, but I think many people have never heard of Parris Nursing. And so I wonder if you'd just like to let us know a little bit more about that. Yeah. Um, well, parish nursing is something that has been around since 2004 in the UK. And actually there's parish nurses all across the world and they're not always called parish nurses. Sometimes they're called faith community nurses, but they're part of the same network. So there's, there's 16,000 across the world, which is amazing. And yeah, so, so we in the UK, we have something called Parish Nursing Ministries. UK, which is a charity that helps to support registered nurses and educate registered nurses who have a Christian faith and they also support churches to then employ those registered nurses that have done the education and um set up um um a health um project or service in the community of the church. So it's not necessarily always for the people that go to the church. It's actually the surrounding communities often and they're people that um so, so what um a parish nurse would do this is like a bit of a basic kind of, um, no, er, idea. So a parish nurse will be employed or they're sometimes volunteers as well. They will have a look at the health data around their church. So they will look at um, where the inequalities are the sorts of people that they're likely to come into contact with and then they kind of, um, set up a service for the people that need health care or health support, for example. So, er, we've got, er, parish nurses that look after or support homeless people. Er, we've got people, parish nurses that support elderly, lonely and isolated. We've got those that work with students, for example, in, um, university towns and cities, that type of thing, they set it up for anything. So, when I became a parish nurse, I'd heard of it, I'd been in the NHS, I'd left a substantive post. I was doing bank for about three years because it worked with, um, er, with my Children and things. So I was doing bank night shifts, generally a bit rubbish. Um, and, um, I, I went to a church and my minister said to me, have you ever heard of parish nursing? And I said, no, never heard of it. Went away, looked into it. And, um, a few years later realized actually I was, I was supporting somebody that was in the church and doing everything that a parish nurse would do. But, um, so then I was like, oh, perhaps I can do it. So I contacted them, I did the course. Um and then I um went back to my church and kind of said, right, these are the, there were no GP practices in my community. There were some like a couple of miles away, but there was none in this housing estate of 11,000 people. There were no GP services at surgeries. And so I really felt and, and the people that were setting up this service with me felt that this parish nursing service needed to be for them. They were not getting their BP check. They were not having any health education. They didn't know how to access health services. So they'd go up to the A&E department that was on their doorstep, but they wouldn't go to the GP. And so it was so that's what we set it up for. And I only worked five hours a week. It was like minimal amount, but I was seeing over 400 people a year and being able to direct them to the right place. Give them the right information, take their BP, send them to the GP if I needed to. So I would advocate for them. I would, um, phone up the GP surgery, explain that I've got somebody that's got high BP, that type of thing. There was some skin cancers that I was able to identify. Ironically. So, um, so there were loads of things and, and actually there were, there were people that I went to see in their homes that never left their home because of Agoraphobia. So they've not got any support network whatsoever. But I was able to go in because parish nurses offer home visits, they set up um support groups, peer support groups for people with a similar um issue. So I set up a women's mental health group young. So it was a young Mu's mental health group actually. So it was just identifying the health need in in the area and then doing it. But parish nursing ministries UK provide you with the guidance and the governance that you need in order to be able to do that. So you've not got loads of maffick going out there. So how, how does that structure? How does that? And so and I can see there's lots of questions coming in on the chat now. So I think shall we? Because II I am just blown away by it. So I'm blown away by it and that so, but before we get to the question, so you get, so it's quite an autonomous role. You, you get to decide what and work with your community of what, what is needed, which I love. Yeah, I mean, and the community work, it's amazing being in a community, I mean, and district nurses are in communities and you know, there's lots of nurses already in communities and what parish nurses are really good at and recognizing is they can't do it all. You know, we as nurses feel like we've got to do it all. So they work and they partner with the people that are already in the community. And so, um, they, um, and it might be the local authority, it might be the community nurses. It might be the local GP surgery. It depends because when you've got independent nurses, I suppose they're classed as independent nurses. Sometimes it's hard to try and articulate that to a professional who's already busy dealing with all the pressures that there are. And so, um, you've got to have people that are quite open minded, to be able to say actually this person, I mean, social prescribing is a great one, isn't it? They are doing a lot of that sort of thing that I'm, I'm I'm saying, but, um, what parish nurses do is they do all of that, that social prescribing do, but they also can make decisions, can see what the clinical need is and then be able to navigate the health care system for the right help and support. Brilliant. So I've got, so we've got quite a few comments coming in and Karen's got quite a few. So I'll read it out for you because I know not everybody is able and particularly when they turn into a, a podcast, nobody will be able to read the screen because they'll be listening so someone wants to know and, and maybe they missed it when he said it, it was saying is it, does it pay or is it? I have it again. Yeah. So we have some that are voluntary, more and more are paid. So more and more churches are recognizing that the value and the need to pay to be able to get the skills and expertise. Sometimes you've got nurses already in churches that want to do that as part of their giving, giving of time. So some people, for example, would go and work at the local charity shop. Whereas if you're a nurse in a church, some and you've heard of parish nursing, that's often what you would do, but more and more paid, we've got quite a, a few now that are almost full time. So 25 plus hours, we've got a couple that are 37 hours. Um So it is increasing and I think some of so some of the other questions that are coming in before I come back to the Karen's other one. So how, how do patients get referred to you? How do, how do you find out about them? So, we've got, um we've got a, a website and on the website, Parish nurse Aries dot org dot UK, there is a find a parish nurse button. Um So you can go on to that and it will tell you where your nearest one is. So you just put your postcode in and it will tell you where your nearest one is now. Um, sometimes there might not be any right near you and your community. But this, um, I guess it's, it's awareness of what parish nursing is because you can come across people, um, nurses who have a faith that I've never heard of parish nursing. And then all of a sudden they want to do it and then you, that's how it's gaining momentum. It's telling people about what parish nursing is. But if you've got one in your area and you want to contact them, it should give you the name of the church and then you'll be able to contact them through the church website or you can contact us at enquiries at parish nursing ministries. Can I ask you really before this, can I ask you a possibly a, can you be a parish n and not have a faith? So you can't because, ok, yeah, because one of the things that we offer is the spiritual element. So we will see absolutely anybody, regardless of faith, one of the things that we will do, if somebody wants to have prayer, we can offer prayer. And, um, that, that's only in an appropriate situation when somebody asks for it. So we're not in the, er, we're not into sort of convincing people to join the faith. That's all, that's not what it's about, it's about offering everything, you know. So if somebody has a different faith. We would, er, contact their faith leaders and link them in that way. So we would, you know, it's of communication. Yeah. So it's not that you say, ok, it's a Christian faith there. So we'll only see people who are connected to the church or have, have a Christian faith. It could be for any. So, I like that now. So there's been a couple the comments and I'm just going to try and pick them from Karen. Who wants to know, do you work with the district nurses? Um because she was saying that she's not had very good experiences with possibly the district nurses because there's not been much paperwork left in the house and that actually there's a massive shortage of staff in the community. So I guess it's how do you and people who are listening can't see me put my fingers together but how do you, how do you work with? There may be existing services that already go in. So you, yeah, how does that work? Yeah. So we've got lots of parish nurses that do work with district nurses and community nurses. I say work with, they work in partnership with. So I don't mean that they, you know, have the same access to patient records or anything like that. Parish nurses are autonomous, like say they have their own records that are kept confidentially but they work with families. So what they can do is they work, they find out what the need is from the patient and from the family and then liaise with the district nurses and community nurses and any community teams that are out there. And I think because nurses have that language to be able to express what's needed, it's often easier than it is for family members to do that because they often don't know what is around what's available out there, you know, and what should happen and what is best practice. So, um we've got, you know, and parish nurses do highlight the things that should be happening that perhaps aren't. And I guess in some ways like we were saying, but before you realized about parish nursing, you were already providing support for somebody who was there and this was almost formalizing that and I suspect many nurses do that already. I'm just in the last couple of minutes. And I think we, because I think that answers the question about how does it fit with social prescribing? It's how do you fit with all all other agencies that might be involved isn't there? And there's that there is that way to work together. But I'd just like to go back to what you said earlier on about the, the the nurses across the world and the 16,000 was it you said, and that, and that's blown me away because this is, you know, this is something that's really new to me. So, um and so do you do you connect, do you get together? Do you, how does that, how does that all work? So, there, there is a, there is um a network. Um, we obviously can't be in touch with everybody. But um, so we do have, we are linked to um the Westburg Institute, which is based in Chicago in the USA and they are the ones that provide the education for us and we, obviously we're allowed to adapt it to our setting, but they are also connected to other um er countries and, er, the founder of Parish N in Helen Wordsworth, er, is absolutely amazing at keeping in touch with people, parish n in, in other countries. And she has now gone on to develop that work in terms of communicating with parish nurses across Europe, mainly because obviously the world is a big place. So we've recently had communication with the Ukraine parish nurses, for example. Er, and you know, the, I mean, your heart just absolutely goes out to the people of Ukraine, don't they? And those, those nurses have been there, you know, we've been able to encourage them through communication through email. We've got a link here in the UK that speaks to them fairly regularly. And so, and then there's conferences and symposiums that, that happen in Europe that we are able to go to should we want to? And if we can. And I think that the last one was held actually in Scotland. So Er, yeah, so that, that was fabulous. So we do have links. Um, yeah. Yeah. Brilliant. Brilliant. Well, I, I'd want you to just close us out before I say the final goodbyes. And really think in a way is there any take away, take away messages that you think, um, anyone listening might any little gems for them? Have you got any advice? Well, I think it is just that little, the little bit that you can do. Um, you know, um, it's that looking at the person that's in front of you and having real conversations, not just the tick boxes, you know. Um but, and then really identifying what the real important thing is to them, it might not be staying on the cardiac monitor, for example, because, you know, because they're not interested in staying on the cardiac monitor. What they're interested in is being able to look out the window, you know, or, you know, being able to access a book or those sorts of things. I just think it makes, they are so simple and anybody could do them. But I think alongside all the stuff that nurses do, it just adds value and they're the things that we can do and we can change about our practice apparently. And I'm sure the vast majority of people listening to this with the term holistic, what is holistic care on the title are already doing it. But they are the things that we can change. And I guess, I suppose a bit like Karen has been asking the questions, if you're wondering if there's a parish nurse around. Have a look, go and have a look on the website. If you've got somebody in mind that might actually benefit from it. See if there's one nearby. Brilliant. Well, thank you very much for that. Darn. I, I've learned lots more about Paris nursing and you've made me think differently as well about holistic care. So, because I do think, oh, you got to do everything. And I was, before we did this session, I was almost thinking, I remember in the days when I felt like I used to do everything, I made the bed and I came the cups of tea and I did the washes and I used to think, well, how can that, how does it work when you don't do all of that now? But, but it is about those little things and I think it's, I use a term not necessarily for, for this but called join in small places. And, um, and that, you know, when, when the world feels like it's, you know, everything's going in the wrong place, going the wrong way. But actually you can find those little seeds, those little bits of joy in small places. And I think that's what for, for, for what you're saying, is it be that little bit of joy in small places? It doesn't have to be everything everywhere Um So yeah, so um and anyway, Karen's just put the Dutch community nursing is more of a wrap around care. Maybe we need to go and have a look at that one, Karen and we'll ask you more about that. So. Well, I think that's done. Thank you very, very much, Dawn Well, for several things, one for being a big fan of Loma nurses because I know that you are and I see you. Thank you for letting me know that um that we've influenced the care that you give and fantastic about that lady and three becoming joining us on one of our learned nurses in conversations. We'll get you back next year. You never know. Thank you for having me. It's been brilliant, brilliant, lovely. So thank you to everybody who's listening and um hopefully we will be able to have this up and running. It will be live. That's what's been recorded so anyone can watch this. So if you're watching this as a catch up. Absolutely brilliant that you're doing this this way and lovely done. Thank you very much and thank you for the for the for joining us. Take care. Thanks a lot.