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Nursing’s grand Dame

Recently named Dame Commander of the Order of the British Empire for health visiting, professor Sarah Cowley may have retired from her position as adjunct professor of Nursing at Sydney’s UTS, but her work is far from finished. 

Her leadership in academic research is legendary. She has created the evidence base for modern health visiting. Here she talks about modern and old-fashioned nursing, her memorable travels around the world, and how it feels to be called Dame Sarah.

How does it feel being named Dame Commander of the OBE?

I was completely stunned and delighted, particularly because it was for services to health visiting. I have not seen that citation before, and I am so pleased because health visiting has had a very difficult time in England in recent years. It is being reinvigorated and expanded again by the present government, which is wonderful, and having it named in the honours system is a clear marker that it’s a profession worth offering “services” to. It makes me giggle still, when people call me “Dame Sarah”!

I am very excited at the thought of collecting the honour from the Queen, at Buckingham Palace next month and am so pleased my family will be able to come to the investiture too. I felt very humbled by the honour, because I have had so much support and been privileged to have so many opportunities that I would like to share it, instead of it being seen as a personal thing.

Now that you’ve retired, what do you miss about your previous work?

Well, I am still involved with a lot of the things I value most – finishing off research, advising PhD students and writing papers that I never had time to do when I was in the thick of things! I do miss teaching, but definitely don’t miss the commute to work, or all the annoying bureaucracies that seem to affect all work everywhere in the world!

What drew you to the nursing profession?

When I was about 14, I thought maybe I didn’t want to be a nurse after all, but nothing else appealed so I went back to my first choice. There wasn’t much choice for women in the early 1960s – teaching, nursing or secretary was about it.

And as I lived in a small village some distance from the nearest town, with very few buses, my choices were even more limited. I left school at 16 and was a cadet nurse for two years before going into formal training. It gave me a secure job, home and training.

Tell us what health visiting was like when you started focusing on it in the 80s.

I think it was quite a privileged time to train as health visitor, although, even then, there was talk of extending the training to two years, because one year was insufficient. We did work really hard to get through all the material, but it was a very thorough and focused program.

Things like child protection processes were far less developed than they are now, so things seemed less bureaucratic, but the informal support from colleagues was much greater because we had enough time to get through the work on our caseloads. There was far more autonomy in our practice, which is something we are trying get back to again.

It was also the beginning of the evidence-based practice movement and of demands that we demonstrate our worth. Some of the older health visitors then were very indignant at being expected to explain themselves to managers who, for the first time, were not all health visitors! As of now, there was some excellent practice and some that was less good. I visited all age groups, not just pre-school age – always for health promotion purposes, not clinical nursing. I loved the mums and babies of course, but also got a lot of satisfaction from visiting older people. Society was less violent and polarised when I started, but inequalities soon started to become much more noticeable in Thatcher’s Britain.

What are the most striking differences between nurses today and nurses, say, in the 1960s?

Perhaps the biggest change is in the variety of people coming into nursing – different ages and backgrounds, not all school leavers with white skin! Of course that is linked with the greater choice of career for school leavers as well as changes in the general population.

Also, the university level education is different: we didn’t have much in the way of theory or research in our training and a lot of the lectures were delivered by doctors. And the hats! Uniforms with long sleeves, which we had to roll up under frilly cuffs when we made beds or washed patients, then rolled them down and put on stiff white cuffs to serve the meals or do ward rounds with the consultants.

What brought you to Australia?

My first visit was to Perth – what a beautiful city, and I loved the countryside around, too – at the invitation of The Child & Family Health Nurses Association to speak at a conference there. I met Professor Cathrine Fowler at that conference and made sure to fit in a weekend stopover in Sydney (I was on my way to New Zealand from South Africa) a couple of years later, to catch up with her again. I have also been to Adelaide, again for a conference, after which I spent some time in Sydney with Dr Lynn Kemp finding out about the Maternal and Early Childhood Sustained Home Visiting program, which is now being implemented in England in a couple of places.

Which travels of yours around the world had a great impact on you?

Hard choice! I think visits to Japan and Brazil, because they are both very different to the UK. The vast favelas (slums) in Brazil, side by side with conspicuous wealth, were a very new experience. Our health inequalities are shameful and marked, but they are nowhere near as stark as those differences.

What occupies your time now?

Still busy! However, much more time to spend walking my dog along Bournemouth beach or to spend with my two grandchildren, one of whom now calls me “Dame Grandma” which makes me laugh. I am also involved as a trustee of the new Institute of Health Visiting (www.ihv.org.uk) which is an exciting new venture, just launched last November.

What do you consider your greatest achievement so far?

Achievement is difficult. In life, the greatest thing (though I’m not sure it is an “achievement”!) is certainly family – my wonderful son, his wife and my two gorgeous grandchildren.

In my work – well, the accolade of being awarded a DBE is, of course, the most amazing thing. I was also very pleased to be able to co-lead a large program of research about health visiting at King’s College over the last couple of years – started before I retired, and finished earlier this year.

I am very proud of having been a health visitor, which is really where my professional identity lies. I guess there is something about having “achieved” an academic career in the first place. My first degree was by distance learning from the Open University, and subsequent learning in polytechnics – for my health visiting diploma and my doctorate. Because I left school at sixteen, I had had no experience of conventional universities until I started to work in one!

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