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Session. Um I'm Joe Haws. I'm the clinical director of Learn with nurses and I'm absolutely delighted this evening to be joined by Helen Donovan. Now, you may well know who Helen is because she's got multiple roles of jobs and she's a friend of ours here at Learn with nurses. And you may well have seen sessions that she's done, watched a nice chat with Michaela and you know, Mia can chat. So, but if you've not met Helen before Helen, would you care to introduce yourself? Oh, thanks so much Jo. And um yeah, really delighted to be here. So, yeah, my name is Helen Donovan and I work um in lots of different roles really. But um I suppose today I'm here as a role as an adviser in nursing for C three, collaborating for health. Um But I work as a public health nurse. My background is um in practice nursing, health, visiting probably mostly in immunization and vaccination, but in prevention of health um and, and managing people supporting people to have healthier lifestyles, which I guess is where we're at today, isn't it, Joe? Um We're talking about stops, stops. Tober, isn't it? And stopping smoking. Absolutely. And, you know, I II, you know, we have stop Tober every year we have done for a number of years, but I was just having a little look at it earlier thinking, well, what officially is it? And, um, I see that it, it's been running since 2012 now, which is, is a long time. And, um, if anyone doesn't know about it, it's the annual campaign that the Department of Health and Social Care run here in the UK to support people with stopping smoking and the evidence around it. Um I see the background. If people, if smokers manage to have 28 smoke free days, they're actually five times more likely to quit for good, which I thought was really interesting and since Tober has been running, it's helped 2.5 million people to um have a stop smoking attempt, which is absolutely phenomenal. Now, we, we have some um audience members, some guests with us this evening. So welcome to all of you. Um Hopefully you have found your chat box within the system. Um, so you can drop us a question, a message at any point and we will see that. And you know, as Helen says, we are going to be talking about smoking, particularly about nurses smoking this evening. So we would really love to hear about your experiences and for you to join in really. Now, if you're watching this session on demand and it is going to be available on demand afterwards. So, you know, do tell your colleagues they'll be able to find it via meal or via the learn with nurses website. And I think we're also gonna put a link on the C three collaborating for health website as well. So there'll be lots of places you can get to it if you're watching on demand. Unfortunately, you can't have any questions in the chat there. So as anything comes into the chat, I will just read it out so that people who are watching on demand will be able to benefit from that as well. Just in case you think I've gone slightly mad in reading out those questions again. So, Helen, um I know that you and I've had a little bit of involvement in a project that's running at the moment that's looking at nurses and smoking. Um Would you like to just tell us a little bit about that as a bit of a background? Yeah. Well, maybe it's worth just giving a little bit of background to C three as well. So C three for health is an international organization and for, for nurses and our, our chief executive director doesn't need any introduction because it's Christine Hancock. And well, certainly for those of you who are of the old desire, she was, she was the General Secretary chief executive of the RCN, but has done lots of different things and her, her real vision is about prevention of non communicable diseases. And depending on what sort of um analysis you're looking at it, it's estimated that you we could prevent 75% to 80% of non communicable diseases. And obviously smoking, stopping smoking is a really big factor. Um And so, so this is about the population, but it, it's really important for us as well to think about our health care professionals. Um and obviously, particularly nurses. So we've done lots of work over the years on supporting um nursing staff to be healthier. So we um went to b with a project proposal under sort of supporting respiratory health. And um so this project is coming from that angle, but really looking at first of all, do nurses smoke more than the rest of the population. And again, I've been looking up and our rates of the population have been coming down, which is really brilliant. So in 2023 we're looking at around 11.9% of the population um smoke, which from 2011, when this initiative stopped, October started, we were looking at around 20% of the population. So we have as a population come down, we know that there are lots of discrepancies in different groups in the population. Um But we wanted to find out, you know, do nurses smoke um in the same level. And what our early ana analysis is suggesting is that they actually smoke probably less than the general population, which is, which is good. Um But we also sort of like some of the pressures and um I'm going to sort of come back to you because you've been doing a lot of the analysis that we've, we've been surveying nurses and we've been asked interviewing nurses um to find out what the pressures are um around stopping smoking, first of all. So, so the first part of the project was to team up with the Edinburgh Napier University and actually do some qualitative data looking at the numbers through um OS figures as to numbers of nurses that smoke. And then the second bit of the work is actually they teaming up with um a smoke free app. So this is an app that's actually used in a lot of NHS organizations. Um but generally as well to support people to stop smoking. And it's, it's, it's great actually because it talks people through some of the, some of the tools and the tips and it also supports people, tells people how much money they're saving by stopping all of that sort of thing. Um And, and, and then the other bit is to actually then interview people and go and find out what some of the challenges are. We know that nursing can be a very stressful profession. Um So, you know, why is it that, that people smoke when, you know, let's face it, we all know that it's something that we shouldn't do, but we also know that it's highly addictive. So, um how easy is it to stop smoking? Um And is it something that people feel? It's just something for me and, and I'm going to bring you in a bit on that, but that's really the background of the project. And so it's a short project, it's only actually operating for a year. Um But what we want to do with this is to, as Joe says, is to have resources available for people on the C three website. So even after this in conversation is finished, there will be an opportunity for you to contact us at C three for more information and certainly to look at the resources that we, we have got brilliant. Thank you, Helen. Now, I mean, yeah, as you say, I've been helping out with some of the analysis of those interviews that have taken places with nurses. And I think, you know, it, it is a really complex business, isn't it? And as you say, most of us know that smoking is not really great for you translating that into actually not doing it isn't, isn't as straightforward as we might expect. I think one of the things that hit me the hardest when I was reading through those interview transcripts was around the perceived benefits for nurses of smoking. And specifically the bit around smoking being the only way that people feel they can get a break when they're at work which was astounding really? Because, um, you think of our, you know, you've mentioned it being an addiction and people needing to smoke, but we also need to rehydrate, we need to eat. What is it about smoking? Do you think that makes it, you know, that, that, that recognizable need beyond eating and drinking and all of those things that we need to do in our breaks? That, that seems to ensure that people are going to get a break if they're going to smoke as opposed to any other form of break. Yeah, it's, it's really, it is really interesting because we know from other work, um not just done from C three, but, you know, the, the Royal College of Nursing and other organizations that nurses don't always get the breaks that they are entitled to, they don't always get access to enough water even to hydrate. You know, there's lots of anecdotal and actual evidence around that. I mean, I think the situation has changed a little bit from not having water bottles at the desk and all of that sort of thing. But there is still a culture of nurses just getting on and finishing whatever they've got to do and not feeling that they need to. Whereas as you say, some of the interview respondents were saying that they felt that this was their only a way to get a break and what I found, I mean, you may remember this and some of the interview respondents vaping and, and I think there was one of the interview respondents who'd started vaping so that they could get a break, quite shocking and um really heart rendering really because, you know, whilst we know that vaping is certainly a very, very good way of supporting people to come off cigarettes, it's not something that we would encourage people, you know, we want people to get off nicotine as well. Um and so, you know, that was, that was quite telling. So I think it, yeah, does it sort of say something about the culture that we, um, in, is it in nursing? Is it something about our expectations of ourselves that it's sort of like the most to go without sometimes? Which is, and I'd be interested to see what people, whether anybody got any thoughts, comments in the chat function, please do drop, drop those in. Um, if any of this kind of resonates or it's anything you recognize, either, you know, from yourselves or from colleagues at work or any experiences that you've had, it would be really interested to hear about those. Um, you know, you, you've raised vaping Helen and, and yeah, it's that whole, yeah, we accept that helping people to stop smoking. But I guess, um, it, it is also surprising to learn how many people, how many nonsmokers have taken up the habit of vaping. And, you know, I think that we still have a lot to learn don't we about vaping, but there was, you know, a session I went to when I was at the European Society of Cardiology conference recently. And, and this was a study that, that was in, I think it was Sweden. Um, you know, and they sort of concluded that really the only helpful place was for it to stop, to help people to stop smoking. But actually taking up vaping as a new habit is not a healthy option, is it? Um But yeah, I think there were a few people, not only the, the one participant who said they had started vaping themselves, but I think a few people mentioned that many colleagues had, you know, even nonsmokers had taken up vaping to kind of enter in that world of, of the smokers during break, which brings on the next point of, you know, smokers from what we see on, there are a really sociable bench, aren't they? I mean, you know, people talked about that social side of smoking and actually I've met with a nursing friend today who I trained with and we were just talking about what we were doing this evening and she was saying, do you know? Yeah, I remember that. Um You know, I used to go with the smokers to break and I would sit in the smoking back in the day when we had smoking rooms in the hospital cafeteria, a little, a little offshoot. And I can remember too going in there with colleagues, I, II never smoked myself but going in with colleagues who did smoke because it was quite a sociable place to be on your break. Yeah. And I, II did smoke and I, I'm happy to admit I, and, you know, it is hard to stop. But, um, you know, that sort of, and so I certainly didn't go into the smoking room because you, that if you've got that sort of like addiction and you, you said that you, you don't want it. But, um, I do recognize that and that was certainly something, it's a social thing, isn't it? And people often say, you know, they want to have a cigarette, particularly when they're out with friends and that sort of thing. There's more than just the sort of pure nicotine addiction that people need. It's that ability to sort of like, I don't know, just sort of have that time away. And certainly some of the interviews that I conducted, um, people were saying it's that time away and we know that from other research into smoking, it's time for you and it's something that they can sort of really, sort of resonate with more so than, you know, having a drink, you know, having water, having food, all of those things, which as you quite, I rightly say, we need more than we need for this team. But do we allow ourselves to do it and time away from the ward, which people were telling us that they didn't feel that they could do in other ways. Yeah. Yeah. Yeah, that's so true. And particularly struck me as well that there were people that felt because they were perhaps working in most places are smoke free sites. Now, they were completely leaving the working area, moving off site to go and smoke. And that often meant going to perhaps a green space. I remember one participant talked about it was an opportunity to go and sit by the river and watch the wildlife. And I thought, yeah, I could relate to that would be a nice thing to do on your break and feeling that you have a driver to do that rather than just doing it. I thought was really interesting because it's probably not something that many of us would do because it is so busy. I think the other thing that came out was that it's something that you can do that's quite quick. So whether we need to give people another quick thing to do. So as you say, you going for a quick five minute walk, don't necessarily need to go. And if you don't feel you can have your full half hour break, which I wouldn't advocate because we all need to have that break. There's something about this giving people another wherewithal but also a culture within maybe managers and the organizations that a quick break away from the work environment is very productive for lots of reasons as well as being beneficial for people's wellbeing, I guess. Yeah, absolutely. I mean, you and you, you mentioned the kind of me time bit and that came through quite strongly as well that it was an opportunity for people to have that dedicated time for themselves. And some people felt it was a great stress lever and reliever and talked about perhaps not needing to smoke if they weren't in such a stressful job. Um But I also noticed that the smoking itself just kind of, you know, I've talked about all the, all the pleasantries of going and sitting by the river and, you know, having a nice chat in the smoking shelter and all of those kind of things. But people did talk about the smoking itself as well as being there, sort of stress reliever being a cause of stress as well, particularly when they're at work. Were they going to run out of cigarettes? For example, you know, would they get that opportunity? And then of course, the massive financial burden that it's placing on people as well. So, um, you know, people are recognizing that there are stresses associated with it before we even start on the health side of things. Definitely. And I think, um, as well as them feeling guilty, not feeling guilty because they're a healthcare professional and smoking and let's face it. You know, we all know that it's something you shouldn't do but guilty because of the cost pressures. Um, and, you know, should they be spending their money on something else? So, I think that came over, um, quite strongly and also then sort of feeling how did that sort of square with them being able to talk to their patients about stopping? Um, so that came over as well. And that was, of course, one of the, I suppose one of the drivers for us to do this particular project, how does it impact on nurses, ability to do the job? I mean, obviously you can still do the job. But actually having those conversations with people and some people would argue, well, you know, II, I've got some empathy there because II can understand some of the pressures but other people were sort of recognizing that they did feel a little bit of guilt. I don't know whether you saw that in some of the responses as well. Absolutely. I mean, I remember one particular respondent saying that they, that exactly that about the empathy that you were saying, but also they felt that they knew the product. So they felt quite well well versed to advise people on brands and where to buy and not to buy and all of these kind of things. But yeah, there was definitely a lot of guilt there and people sort of feeling the, well, you know, I can't talk, who am I to give this advice? And it, yeah, there were people that were definitely feeling guilty and, and feeling that they couldn't really broach the subject of smoking, even just asking people if they were a smoker and those kind of brief interventions that, you know, as healthcare professionals, we are encouraged to those three A s asking every contact and all of those kind of things that we all need to be doing. Many people said I don't really feel I can raise this. I'm a hypocrite. Yeah. Yeah. No. And I think that, you know, the other things that came out in terms of, sort of like people's challenges around this, which were very, sort of similar with other research on, on smoking was, um, you know, that time again for yourself and, but, you know, some people were sort of, um, a couple of people I remember who were talking about the fear of stopping smoking, um, which would then make them eat more and, you know, put on your weight and, and whether that's, um, I think stopping smoker, there is any evidence that stopping smoking makes people put on weight per se, but obviously not wanting to snack on unhealthy foods. And it's that treat self, which goes back this time away a little bit of time for you. Um, and, you know, and there was certainly one lady I remember speaking to who was really worried about her weight particularly and not wanting to start smoking or to stop smoking because she was really worried about putting on weight. Um, and I don't know, particularly sort of specific to nurses as such, but it's something that a lot of people who are trying to stop worry about. There were several people that raised the weight issue. And I remember specifically there being one participant who actually desperately wanted to give up smoking because they were overweight and were actually hoping to get into tier three weight management services. But it was a blocker for them that they were still a, a smoker. So I thought, well, that's quite interesting from a different angle of the whole smoking and weight thing. But, you know, there were people that said smoking keeps me thin and that was their perception of it. Um And you, I would have thought when I started looking at the interviews that it would have been a given that everybody recognized health and health would be the main driver because they're all nurses, we're all nurses and well, we kind of, we know, don't we, we know we know the negative health impact that smoking has. And I think many people did say that thinking about their health would be a driver that they did intend to quit. Most people did not see themselves as smoking forever and they did intend to quit at some stage. And many of them seem to link this to their health and say, you know, it it would be for health reasons. But it was also quite interesting to see that many people felt that yes, it would be a driver. Yes, they would want to quit for health reasons, but only when they started to see it having a negative impact on their health and as far as they were concerned they were healthy at the moment. Not a problem. Yeah, I know. And that comes out, doesn't it? And so it sort of like resonates with the fact that, you know, nurses are just generally not much different to other people and it's until you see that impact. Um, and of course, it's, you know, inherently that, you know, once you start seeing the symptoms, then the damage is done. We know that, you know, stopping smoking will start reducing BP and start, you know, there will be the physiological impact but you often not sort of see the symptoms of that. And so it's, it's quite an interesting one, isn't it? Because people didn't know that and they recognize that. But it, and a lot of the people I felt were quite young and it was sort of like something that they would do when they got older they would stop smoking. Um, and again, you know, that sort of is quite, you know, whether it's the stresses. Um, and that came out with many of the interviews. So it was, yeah, it's, and I, and I guess from our point of view, you know, we know that the Smokefree App talked about, it helps guide people. So it talks, you know, if you've sort of not had a cigarette for so many days, it will tell you that, um, you know, that will have reduced your BP and it will have, you know, sort of had this impact your cardiovascular. So, um, you can see it quite clearly. Um, it's quite a nice way to do it, I think. Um, and that was one of the reasons that we chose it. Um And obviously, you know, we want more people to sign up to using it because it does seem to help to have that support, you know, that sort of technology behind you, that sort of saying. Right. Well, you've had so many days and, you know, it's sort of like, it's a bit like the smiley face that maybe for Children are sort of like those charts that you use of behavior charts. So we all respond to those sorts of messages, don't we? Yeah, we do. Um Most of us like something visual and a few people did mention the app actually and said that they had, you know, found it helpful or were intending to use it in the future. But people did talk about stop smoking services as well and the availability in their area and, and, and what was on offer and they weren't always that positive about what was going offer in the area. And I think one of the things that's quite challenging is, I mean, although we've said that, you know, we don't want to encourage people to take up vaping. We do know that nicotine replacement has a really big part to play. So, one of the things that we did do with this project is we, we made nicotine replacement available to people who were taking up the, the app so that people could, um, could experience that and because that could be quite expensive as well and it could be quite, it can put people off trying it. Although sort of, in theory, it doesn't cost any more than the cigarettes. It can seem it at first prohibitive in terms of cost. So we didn't that in, we didn't start that immediately, but we soon started bringing it into the project so that people could experience that and benefit from that. And certainly the people that smoke free App were very, very clear that they had found that that helped. Um, obviously you do still, then you don't want people to start it just, you know, without a need, but it, as part of your challenge for quitting smoking, um, it's a very useful tool to have. So what do you think? Um, and again, please do join in on the chat. If anyone's got any questions, comments, I don't know what roles people have that are joining us this evening. Whether, um, you know, whether you're a smoker yourself, whether you have colleagues who smoke, what sort of roles you're in whether you are managing other people. But what, so obviously we talked about support available for people who do smoke, who would be interested in quitting, who would like to quit? Is there anything that those of us that don't smoke? Um What can we do to support and help colleagues beyond the making sure that they do get their break to go and smoke or, you know, advising that it's, it's not a great thing. What, what sort of things can people do to, to help their colleagues? Well, I mean, I guess the thing is, it's, I mean, everybody is different aren't there. And behavior change is always um an individual response. So we know that, um, you know, from a motivational interviewing perspective, it's sort of what will make an individual feel that now is the right time. As, as I said, everybody knows that smoking is bad for you. So there isn't that sort of message but what is going to make somebody stop? Is it because of somebody in their family who's had a health scare? Is it because suddenly, you know, they feel, I don't know, sometimes because people are a big life event, there's a big a wedding or there might be, you know, they want to get pregnant, they want to have a baby or they're having a grandchild or something is happening that triggers people to think right now is the time and I guess from a colleague perspective, it's about sort of giving people the permission to sort of own up to that. But also to sort of recognizing that there are often triggers in a person's day. So it might be, I don't know, after, you know, a certain time on the ward or on the unit or as they're leaving work, it might be the trigger. So what can we do to support people at those trigger points in the day to sort of stay not smoking as it were? Um So I think all of those things are really important and probably something that, you know, as, as caring professionals, we're quite good at doing. Um But are we do good at doing it for each other? Um And I sometimes, you know, wonder whether, whether we are, um I think there's also something from an organizational for anybody who is a board manager or a unit manager or a operation manager to sort of think about, you know, what other opportunities people can have to have that time out because that was really clear in nearly all of the interviews I think was just time out. And obviously people felt that as we've said, having a cigarette was short and sweet. Um So is there something that we can do from a sort of operational point of view to give people literally a five minute break from the ward something to do that isn't smoking. Um So, I don't know, we, we've had a few people have put in the chat who they are, which is lovely. Um, but it, it would be, would be really good to sort of see. Um, if anybody's got some lived experience, maybe we've got some smokers. You don't have to admit that. Of course, if you don't want to. Um, although I have so, yeah, it really would be great to hear from you if you'd be willing to share your and, and you know, what prompted you to come along and, and join this discussion this evening, you know, what, what sort of peaked your interest as it were, whether it applies to you, a family member and, you know, like I say, anything that comes out on demand, you won't see any of the chat. So, um you would be anonymous. You're not, you know, confessing all to the rest of the world. So, um if you do feel you'd like to comment on that, then absolutely, please do. It would be lovely to hear from you. Um I mean, ii just think it's so fascinating to be able to gather these insights and, you know, when you think about it, you think. Oh, ok. Yeah, that probably doesn't surprise me a lot of those things that we, that we have found, but it just seems, feel so much more powerful when it's coming from people's words, you know, and some of the things that people were saying and I think, I guess um for me there there's two things, there's the as nurses looking after ourselves, which we know we don't do enough of whether we smoke or don't smoke. We, we're not great always at looking after ourselves. But then also that impact that, that has on supporting others to improve their health as well. And it kind of put me in mind a bit of, of a, of another piece of work that, um, I was involved in with, with C three previously looking at nurses, weight and, you know, many nurses had had, um, you know, if they were talking to people about healthy eating perhaps, um, or weight loss, you know, getting people, patients making comments about their own weight in the kind of way you can talk kind of way. And I guess it's a similar kind of thing with smoking, isn't it? People feeling that they're not in the best position to do that and, you know, potential comeback? Absolutely. And I think, you know, particularly though it's more hidden in a way, particularly with vaping. Um, so, you know, cigarettes is not hidden because let's face it. You can smell it on somebody's breath, you can probably smell it on their clothes. Um, but vaping is more hidden. So it may well be that, that is, you know, being a bit counterproductive, but how do you know, people will feel? Oh, well, I'm not sure I can really, you know, sort of manage this. I'm not sure that I and as you say, you know, they know in themselves that they are smokers. Um, so, you know, how do they, how do they get over that? So, II, yeah, it's a, it's a really difficult one but I was involved with the weight in nursing as well and I think it's all of these behaviors, isn't it? We did looking at sort of, just because you're a nurse doesn't necessarily mean that you're going to automatically have healthy behaviors. So it's maybe it's sort of being kind to ourselves, being kind to our profession. Um, and saying, well, you know, we recognize that it, it is tough out there. Um, and you need some sort of time away, you need some time for yourself. Um, what can you do? What can we do, um, as friends, as colleagues, as managers to support that? Um, so I guess it's all of that really, isn't it? Yeah. And part of that bigger piece, isn't it about looking after ourselves and looking after each other? And, you know, the old saying that we hear so, so often about you can't pull from an empty cup and if we're not looking after ourselves, how can we be looking after others? And it goes across the board and I guess it also states that we're human, aren't we? We're all human. And, you know, knowing that something is unhealthy doesn't automatically mean that we're not going to do it or we're going to change our behavior because that's part of being human, isn't it? And I think, you know, a lot of people on the interview said, you know, the bottom line is they actually enjoy it. So, yes, you're asking people to stop doing something that they fundamentally they enjoy. And they also find it's beneficial even though they know there are some downsides to it. It's beneficial in terms of giving them that time away. Um, so I see from the chat, we've got people in Scotland, we've got people in London. So that's really lovely. But people are obviously just listening. She's great. It's fine. Yeah, absolutely. Absolutely. Fine. But it, it would be useful to sort of know what prompted you to join. Have you got friends? Have you got colleagues? We're sort of coming up to the end. I think we've given ourselves to a quarter pass. So we've got a few minutes if anybody feels. Um And as I say, we won't, we won't read out your name. We'll just put, read the comments. Absolutely. So, yeah, please do again, feel free. Um I will just mention while we're just waiting to see if any um, comments or questions come in before we wrap up that um, you will get a certificate of attendance for joining this evening. You'll be able to access that through meal. You will be invited to just complete a very brief evaluation form as well. And of course, we have a wide variety of resources. Um webinars both live and on demand. We have our quizzes, we have a whole host of stuff available completely free to you via the learn with nurses website. So please do feel free as always to make use of any of that and and tell your colleagues that um it's there. We are open and available to healthcare professionals, not just nurses which learn nurses because most of us are nurses who run it, but open to healthcare professionals all around the world. We've already reached participants in 88 different countries and almost 30,000 participants already. So please do feel free to take up anything that's there on offer and do share with your colleagues as well. And that's amazing, isn't it? That, that those figures are absolutely incredible. It just shows you that, you know, this sort of learning and virtual learning is, is so important, it gives you those bite size. I mean, I am a great proponent as well of having face to face learning as well. I think there's nothing that beats that interaction, but if you can't and you can't do it all the time, so let's face it. This is, this is, this is great and this sort of thing is, and we'll also make sure that the link to the C three nurses and smoking project is available. Can we do that? Yeah, we sure can. Yeah, that would be great actually. And of course, you know, people can access the all sorts of wealth of information and support resources that are available on the C three website as well. Um And you've made me think actually about some of the insights and the work we've done looking at how people participate in loan with nurses, webinars. And it just put me in mind of, um, we asked people about how, what's the strangest place you've ever accessed alone with nurses webinar from. And you know, we had people saying things like, you know, up a tree in hospital after just having brain surgery, you know, we had all kind of a range of things. So, you know, we always say people can join and do whatever they want because we can't see them. So perhaps some of you are mid making your supper, bathing the Children or walking the dog or any of those things whilst you're listening in this evening. And that's absolutely fine by us. We, we, we're very happy to have you with us in whatever shape or form you happen to be there. I love that. I love that. Yeah, we just wanted to think, you know, oh, how accessible are we, what sort of places of, of, of people watched us from? And yeah, it was really, really quite entertaining and quite humbling actually to see some of the situations that people have been in, particularly in, in, in some countries in the world where there are some specific challenges that they're facing um at the moment. So, um well, you know, I, I'm gonna draw us to a close um Helen um because I can't see um anything further coming through on the chat. And so thank you so much for joining us this evening on low nurses. You, you're, you're a great friend to us as an organization as is um scene three, collaborating for health. So it's always a joy to have you. And, you know, I, I've found this discussion and this piece of work um really, really interesting and I think it will make a difference to me in the way that I practice, the way that I think the way that I'm speaking with people and having that awareness, I think is really helpful and I hope it is to um our viewers that have joined us this evening. So thank you for your lovely comments as well. Um Yeah, really lovely to have you with us and thank you all for joining us, especially you Helen. And we'll look forward to seeing you all on another learn with nurses session at some point very soon. But for now, lovely rest of you and thank learn with nurses for courting this. And um yeah, I mean, I think, you know, people have put in the chat and how useful they find the sessions and that's fine. It's just as a sort of a background. So for those of you who did want that do have a look at the C three website because there's lots more sort of a bit more, there'll be stuff coming out as the project comes to a close as well. So, but hopefully this has given you a little bit of insight into some of the uh challenges around it. So, thank you. Lovely. Thanks very much, Helen. Have a lovely rest of your evening. Thank you. Bye bye. Take care. Bye bye.