Personalisation: Where are we going?
In mental health and learning disability nursing what does Personalisation mean and what impact does this new wave of ideology and policy have on nurses?
In the context of mental health and learning disability services, Personalisation accommodates mental health promotion and maintenance: having choice and control over one’s life contributes to well-being. Personalisation is about meeting the needs of individuals in ways that work best for them,(Carr, 2008)
In specialist mental health and learning disability nursing there appears to be a number of competing paradigms in terms of how our clients are perceived. For those nurses who suscribe to a psychodynamic/behavioural school of practice how does personalisation fit, when after all, Carl Rogers has influenced person-centred practice?
So if determinism is part of your frame of reference for therapeutic relationships, where does the concept of freedom of choice feature in the eyes of mental health and learning disability nurses, who are required to promote individualism,where a full range of psychosocial interventions can be delivered?
Skills need to be developed by professionals so that genuine person-centred assessments incorporating the person’s own view of their needs become the norm.
Supplementary prescribing is another area where in developing clinical management plans – concordance of medication is strongly advised from such prescribers, but where the client may see things differently in terms of personal choice and not wishing to endure adverse side effects!
Additionally, how can we apply the concept of person-centred practice across secure settings, in prisons and young offenders institutions? where a balance is required to be achieved between order and freewill. There are particular concerns about the management of risk in certain situations for people choosing to opt for a personal budget,(Spandler,2007).
In communities, individuals who attain either individual or shared tenancies and therefore become tenants not clients in residential care – how do we safeguard against vulnerabilities where the evidence clearly identifies hate crime on the increase for individuals who are vulnerable,yet perceived by society as having equal status and rights when living independently?
I suggest we need to take seriously the fact that personalisation is now in the mainstream and as mental health and learning disability nurses. As a Profession we need to decide how best to move forward with our clients whilst developing new ways of working across agencies (such as housing consortias) whilst remaining responsive to possible negative effects on clients in a variety of situations and environments.
References:
Carr S (2008) “Personalisation: a rough guide” SCIE, www.scie.org.uk/publications
Spandler H (2007) Individualised Funding,social inclusion & the politics of mental health.Journal of Critical Psychological Counselling,7 (1): 18-27.
Another great reform
Another Great Reform.
Ha, Ha, Ha finally the management are getting their come-uppance. These people who have oppressed the working nurses for years are all going to be put out of work. After all it’s their fault that the NHS is in the trouble it is. Isn’t it?
Before we celebrate let’s take time for some sober reflection. Having been in the health service for over forty years I have seen many great reforms. From Salmon in the seventies, through the establishment of trusts, the move to the community and agenda for change we have all seen how Government policies have improved the service for workers and patients.
Do we know enough about the work of PCTs and SHAs to be able to judge their worth? Everyone is aware that in some areas there are non-jobs that could be swept away, but could we be chucking out the baby with the bath water? For example, who will commission the number of nurses to be trained from Universities? If G.P.s are to be given control of huge budgets there must be some questions to be answered before this happens. Are they capable of administering these monies? Do they have the time to balance clinical work with the need to run a business? Given that G.P.s have a personal relationship with their patients will they be able to look them in the eye and say “we can’t fund your treatment”? Will mental health and learning disabilities be given the same priority as neo natal or cancer?
A Government spokesman says that G.P.s can be trained and that they will employ managers to help them. So we are not removing a management tier just replacing it. Plus ça change, plus c’est la même chose.
Finally, we have struggled in nursing for years to get our voices heard; we had great hopes for nurse consultants and modern matrons. With all the power being placed back in the hands of medics where will this leave us? So before we sit back and enjoy the cull of the faceless ones let’s take a long hard look at the alternative. We should demand consultation on this as it is our area of expertise and we should be involved in the process.
NHS radical reform!
Simpler days -- a fresh faced Staff nurse sets out to change the world (back row 2nd from Left)
1979
In my life, 1979 saw two important events, firstly it was the year in which I started my nurse training at Hollymoor Hospital in Northfield, Birmingham and secondly, Maggie Thatcher became Prime Minister.
In so many ways, life seemed simpler back then -- for example, you knew where you stood with politics and politicians.
My early political understandings were informed by Clash lyrics, the NME and the Anti-Nazi League. Down the road from me, Red Robbo was stirring up the Car workers at Longbridge & UB40 were composing their first album ’Signing off’. I remember a feeling of pride about working for the NHS.
In the opposing corner was.. Maggie
At least with Maggie you knew where you stood. The Tories were the party of privatisation, anti-Union and we all knew that given the chance they would have liked to run down the NHS. Of course, even Maggie didn’t manage to do away with the NHS, despite attempts to boost the influence of private medicine etc.
Nowadays of course, things are not nearly as clear.
(Tag cloud made from White Paper ‘ Equity & Excellence: Liberating the NHS’)
2010
Apparently the NHS is safe in Conservative hands and they were keen to point this out before the election.
”We are the party of the NHS today because we not only back the values of the NHS, we back its funding and have a vision for its future.” (Conservative Party Manifesto 2010)
David Cameron has previously stated that the Tories were wrong to weaken the NHS and has been keen to distance his party from it’s percieved anti NHS bias. If you really want more reassurance see Hector from Abingdon who had never voted for the Conservatives before but was doing so now to protect the NHS.
In common with everyone involved in the NHS we have been talking about the implications of the proposed NHS reforms. Amongst the proposals are plans to hand control of NHS budgets to GP consortia to spend on behalf of patients whilst cutting Primary Care Trusts and strategic health authorities. According to the DOH, the reforms will ‘Liberate’ the NHS leaving it ’streamlined with fewer layers of bureacracy’.
Why am I so worried?
This is what I think is really going to happen:
- Look out for an increase in Private involvement in the NHS (see Tag cloud reference to ‘consortia’ & ‘choice’)
- Private companies have to prioritise the interests of their share holders therefore..
- NHS Job losses
- Skilled workers increasingly replaced/ supplemented by unskilled workers (this blog details this really well)
- Foundation Trusts opting out of the NHS, local pay & conditions, reduced entitlement to leave, reduced redundancy payments, pensions etc
- An increase in (profitable) patients recieving private medical care
- A decrease in care for less profitable patients, i.e. long term conditions, people with mental health problems etc (see White paper ”begin to introduce choice of treatment and provider in some mental health services from April 2011, and extend this wherever practicable”)
I could go on but like to keep posts short -- feel free to add your own to the list though.
The RCN campaign ‘Frontline first’ is an attempt to defend patient care -- one of the speakers in the launch says that ‘when nurses speak, people listen’
What should we be saying & is anyone really going to listen? I am not so sure they will -- hope I am wrong.
Any comments?
Medication errors
I was just reading a report from the National Patient Safety Agency entitled ‘Safety in Doses’ (See link below). This report gives a review of medication errors reported to them during 2007. The majority of these involve general medical settings although 9% of them (6551) happened within mental health services. Luckily, 96% of all incidents are not serious, in that nobody got hurt – however there were 100 cases of death and severe harm.
In mental health and learning disabilities settings the most common problems are caused by omission of anti-convulsant medications, generally, omission of medications is a serious problem. Incidents involving methadone and clozapine were also frequently seen. A big problem is found in the interface between primary and secondary care settings. Given the complexity of modern mental health care provision the number of such interfaces and the potential for confusion is greatly increased.
I can remember a couple of incidents from practice in which medication was administered incorrectly. Fortunately neither case caused any harm to anyone but I will never forget the feeling of absolute horror when I realised what had happened.
Less fortunate were the patients being cared for by these Nurses practising at Heartlands Hospital in Birmingham – I can remember reading about this truly dreadful incident. It is very easy to understand the anger felt by the widow of of one of the patients killed.
How many of us can say that we have never made a mistake when working with drugs?
Those of you who are a little older will remember the ‘drugs assessment’ that every student nurse had to pass. This involved studying the contents of a drug trolley, learning the nature and purpose of every drug as well as it’s usual dosage and most common side effects. It was a tough test to pass!
I just wonder if we need something like this now?
I guess a lot of people will say that nurses are often working in stressful situations, there isn’t always the level of staffing & resources needed to do things as well as we would like. I certainly don’t think that all errors are down to nurses lacking knowledge.
What others think? Do you as qualified staff feel that students are as well prepared as they ought to be? – what about students, are you ready to take responsibility for administering medication? Also, if there are errors being made then why do you think this happens?
I would really love to hear from people.
Link to National Patient Safety Agency report
Photo at top of blog from Flickr creative commons by Charles Williams (click on picture)
PS On an unrelated note I had an email from the RCN asking that I draw your attention to the RCN election website – there are two links below for your attention
www.rcn.org.uk/generalelection
http://www.facebook.com/pages/Nursing-counts/268071293877?v=wall
Akmal Shaikh
Akmal Shaikh RIP
Despite a clear history of mental health problems in the period leading up to his arrrest and conviction for drug smuggling, British citizen Akmal Shaikh was executed in China this morning.
Anyone with any experience of working with people who have mental health problems will easily identify elements of mental illness in descriptions of Mr Shaikhs behaviour. It seems clear to me that there is a very obvious history of mental health problems and it is puzzling that the Chinese Government is still insisting that there is no such history.
People with problems such as those experienced by Mr Shaikh often do not have a firm grasp of reality and would be very vulnerable to manipulation by unscrupulous individuals. The likely influence of such factors appears to have been completely ignored by the authorities in China.
I hope that mental health nurses worldwide will join me in condemnation of this dreadful action -- please take a moment to click on the links below.
Reprieve Youtube video
Amnesty International reaction
Happy Christmas & Merry New Year!
Seasons greetings from everyone at the Mental Health Nurse Lecturers Tea Party
This blog is now one year old – thanks to everyone who has contributed, commented & most importantly read it over the past 12 months – see you in the new year.
Registered Nurse Plumber?
I have noted with interest over the years that nurses (and I am one) have had an attitude of “I can do that. Give me that job” and indeed nurses have expanded their role quite considerably. When accused of trying to be ‘mini doctors’ nurses have responded ‘no we are maxi nurses’. We have clearly demonstrated that we are capable of so much.
So…with the latest MHA nurses can (after appropriate hoop jumping) can be the responsible clinician or the approved mental health professional, posts previously filled solely by doctors and social workers.
Surely nurses (and the Act) are missing the point?
The greatest strength of any team revolves around the idiosyncrasies that each individual brings to the table but now, oh no, we are removing this uniqueness to leave one ‘new’ professional that simply changes hats to fit the job in hand.
I am strongly in favour of social workers retaining their role – it is after all a vital position to ensure that the medical model does not dominate. I remember as a newly qualified nurse being impressed by a social worker refusing to ‘sign off’ a detention after two doctors had recommended it – this social worker exerted his own standards and whilst I disagreed with him, I thought that he was doing a splendid job that he was trained to do. He was able to step away from the medical needs and look at the social needs in a wider context.
Nurses, whilst we strive to be separated from it, are biased in the ways of the medical model -Face it.
What is wrong with being a nurse anyhow? I plumbed in a washing machine the other week but I am not asking to be registered as a nurse plumber. Leave the plumbing to the person who trained to be a plumber and who does it day in and day out and the plumber can leave me to nurse.
And another thing….following on from nurses saying “I can do that. Give me that job” there is the follow up call of “Hang on. Have you seen my workload? I’m not paid enough you know!”
Images from Flickr creative commons:
1. Plumber James #2 by MoToMo
2. Plumbing by basykes
3. Day 719 / 365 – Wrong Setting by JasonRogersFotographie
The value of human life
After reading Simon’s blog post last week I got thinking about why his ideas made me feel so uncomfortable. I can’t help agreeing with many of his points, but when you add them all up – well, I felt there is something in the middle of it that is a larger issue, and one that I think we in nursing need to get to grips with.
In trying to say how we feel about the value of human life – our own and others - it is hard to articulate it without using spiritual language – there’s nothing wrong with that, but if you are not coming from a spiritual perspective then an alternative is required.
Being human is, I feel anyway, more than just rights and responsibilities, and more than comparing ourselves to a ‘beloved pet’. Maybe it’s also about acknowledging how difficult – and in fact impossible – it would be to ‘press the button’ on another person’s life.
In this situation, the difficulty would not be for the person leaving, but for those left behind. What do we become once we have agreed to sign away another person’s life, even if they themselves ask us to do so? Does this mean that life is only worth something when we are intellectually and functionally 100%? What does this say about our relationships with other groups of vulnerable people?
To me, this discussion is not just about what a person loses when they have dementia, or another life-limiting and damaging condition, but about the culture which we live in, and which it is our responsibility to guide.
The ‘right’ to say you want to die in certain circumstances does open possibilities for foul play, as Simon suggests, but more importantly, I believe, it damages our sense of community, our cultural heritage and recognition of our inter-dependence. Individualism seems to be increasingly prioritised in our society and in nursing itself – the trio of autonomy, independence and intellectualism seem to be valued above other qualities with little argument.
To me this route ignores the reality that we are all strong and vulnerable in different respects and at different times, all have hidden or visible disabilities, all work better together than we do apart, and all are damaged when one (and who’s next?) chooses suicide or euthanasia.
Instead, we should be campaigning for inclusion and for investment in sensitive provision of excellent standards of care. For those who need it now, and for those who are planning ahead, we shouldn’t be assuming that lack of intellectual ability makes us less of a person, and thinking about how to ‘jump before we are pushed’.
How can we recognise and celebrate the individual differences that make us all who we are, in different parts of our lives, as part of a caring supportive and accepting community with mutual interests at heart?
(all images from Picapp - click image for info re source etc)
Thoughts on assisted suicide?
The Royal College of Nursing (RCN) recently carried out a survey on assisted suicide. It was only open to their members, quite rightly as it will inform the policy of the RCN, but this restriction will result in a flaw in their research.
It is right that we have this debate – but it will only be worthwhile if we involve much broader opinion. There have been legal arguments in court about what will happen to people who assist suicide abroad. Is it right that terminally ill people have to travel abroad to get relief from a life that is painful and miserable?
Gordon Brown has come out against assisted suicide, but is it right that MP’s legislate for their own private convictions or should they only be allowed to represent the wishes of their constituents?
I have long held the belief that I should have the right to die with dignity and free from pain. No one has ever objected to people making the choice to end the lives of much loved pets but to help a person that we love to end their lives is illegal.
The most used argument against relies heavily on the premise that the right to die could be abused. Relatives may pressure people to die in order to inherit, or people may feel guilty for being a burden. I believe that effective regulation would prevent this.
If I were to get a diagnosis of dementia I would worry more about the pain inflicted on my wife (who would have to witness my suffering) than I would worry about dying myself. Furthermore the cost of nursing care, with no hope of recovery, would seriously impact on her quality of life.
These are my personal views and do not reflect any Institutional views and I very much look forward to hearing from you your opinions.
Photos fromFlickr creative commons (Click images)
‘One day later’ : by Bolshakov
‘Solo la muerte puede salvarte de este mundo : Rodrigo Basaure
A losing battle?
British Royal marine with captured Opium - from Flickr commons - see also below
I was just reading this story from the BBC about a suggestion that the Scottish cannabis crop (worth an estimated £100 million) may now be bigger than the Scottish vegetable crop.
This comes in the same week that we had the story about the sacked Government drugs adviser. As usual then, plenty of stories about drugs.
Just ask a CPN
Of course, if I wanted stories about drugs then I would need to go no further than my own students in practice or my clinical colleagues. Any of these people would be able to reel off hair raising stories about drugs in the communities around us -- often we hear about the effects of these substances and their widespread availability (ok, far more often we hear about legal drugs i.e. alcohol)
Not so long back a local CPN told me that in their particular area they may as well stop asking ‘do you take drugs of any sort’ -- in favour of asking ’what do you take?’ When I was last a CPN it was pretty obvious that in some parts of town it was probably more convenient to buy Crack Cocaine or Cannabis than it was to buy, say -- five portions of fruit & veg a day!
Crime
How much crime is all of this promoting?
A litle example -- Not so long back my daughter was in Church with her Nan -- whilst the service was in progress she noticed a man going around collecting unattended handbags. As soon as he had gathered enough he ran from the church. ‘Money for drugs’ was the assumption of the (mainly elderly) theft victims -- it may not have been, but would you bet against them being right?
As well as a great deal of petty crime there is a colossal amount of organised crime -- both here as well as in poorer countries. There is a suggestion that Mexico is close to buckling under the strain of fighting the drugs war as well as other Latin American nations (See link) (also this)
How many members of our armed forces have been killed or injured in Afghanistan by weapons and explosives partly funded by illegal drugs?
What do you think?
I can’t help thinking that eventually we are going to have to face the fact that the we need to look at this -- where is the war on drugs heading? -- are we just here to pick up the pieces?
I don’t have the answers of course but I wonder, what would you as Mental Health Nurses do?
Is my assessment over pessimistic? -- or are the streets of our major cities awash with illegal drugs?
Do you think that we need more of the same -- or some degree of legalised supply of drugs?
I think that Mental Health nurses are ideally placed to comment given our knowledge of what is going on.
Get back with your comments if you get a minute -- feel free to do so anonymously if you want.
NB Photo at top of post from Flickr commons also on Helmandblog
Time article ‘Drugs in Portugal’