Monthly Archives: April 2009

An expat in Mexico

This guest post is slightly off the usual subject. My brother,David has been living in Mexico for several years and after a telephone call yesterday I thought it might be of interest if he were to share some of his recent experience there with you. 

I have worked in a private school in Monterrey, Northern Mexico for the last four and a half years. Monday 20th of April, my first day back at school after the Easter holidays. As I fumbled to turn off my 6 a.m. alarm my first thought was “God, I could do with another week off!” Be careful what you wish for…


The first I heard about the swine fever outbreak was on Thursday night, on the BBC website. I was mildly concerned but didn’t lose any sleep; it was, after all, eight hours drive away in Mexico City. No one really mentioned it in work on Friday, just a few jokes about not kissing any pigs at the weekend, that was about it.


Saturday, after watching Birmingham City painfully lose, I went out for a few beers with my friends, we began hearing about 40 or so casualties in the capital.


I woke up on Sunday morning and went to get the paper where I read about the first death in the city. Later I spoke to a neighbour who told me that there were flu victims in the school five blocks from my house. I went to bed at 10-30 setting my alarm for 6 the next morning. At about 11 p.m. I received a text informing me that all schools in the State (Nuevo Leon) had been closed as a preventative measure. We are off until the 6th of May.


I went out today as I have run low on food. I would say 5% of the city is wearing a mask. In the supermarket there was a palpable air of tension. I couldn’t quite put my finger on it. I guess Mexicans are such happy folk, today they seemed nervous and keen to get about their business as quickly as possible. Most of the assistants in the supermarket had masks on; the majority of them were hanging below their chin as if they had had enough.


I have been checking out the availability of Tamiflu, nobody has heard of it. I went to two pharmacies. No masks are available. We have had no contact from the British Consulate, admittedly I have only just mailed them. They are always quick to invite us to cocktail parties though. I guess they have all left town.


I just heard that more infections have come to light in town. I have received one communiqué from the Mexican Government, the Mexican Agriculture department to be precise, this came via my work. It states that Mexican pig farms are very clean, please keep eating pork products.


An interesting story I heard was that 5 million people were without water for five days in Mexico City during the Easter holidays, I wonder if this is linked as hygiene standards were obviously not up to scratch during this time. About the time the infections would have started.


The news has just reported that the USA will not be sending any Tamiflu courses down here, they have 5 million doses and keeping them for themselves, understandable I guess.


I’ve decided to stop watching the news for a while.




From Student Nurse to Registered Practitioner – A transition fuelled with Anxiety!

I am delighted to introduce another guest post on the Mental Health Nurse Lecturers Tea party. This comes from one of our soon to be qualified student nurses, Julie Bennett.

Julie describes her feelings on coming to the end of her time at BCU – she has promised to keep us updated about how she gets on after this.



So, Three years draw to a close and what a wonderful experience. A wealth of friends, university life, fun laughter, tears and tantrums but on we go, pulling each other through with hope and optimism from peers, mentors and tutors alike.


More incentive came from the NHS via the generous bursary and dependents allowance, which kept my four children clothed and fed, not to mention the 85% contribution towards the very expensive child care costs, (as much as my rent per month)! Ok, the children haven’t loved going to the child minders some days, but hey, needs must!


The practice placement managers and clinical practice allocations staff have been very supportive; my final placements have been in the community, which has meant family friendly hours and have enabled me to complete my training.


And no council tax! What a bonus….many positives to being a student nurse not to mention discounts in many stores and the cinema!


Would it be fair to say that the transition period is full of mixed emotions? Yes, I did it, I stuck it out, jumped through hoops and achieved my ambition, before long that photo of me in my cap and gown will be on my mantlepiece, I am so proud. (if I still have a mantlepiece)!


So now for the anxiety part of it all, explained wonderfully by two of my peers during a workshop at the recent Mental Health Conference…..The BIG DIVE! Where is the water? Oh dear, there is none…….


Armed with skills and knowledge of  theoretical frameworks, before long my registration number will be in the post and off I go……to the job centre! Via the housing department and the council tax office and the search for a child minder who starts at 6.30am and finishes at 9pm.


A community mental health job would be ideal! But band 5 newly qualified nurse in the community? Mmm A prayer or two maybe needed for that one!


So what is my predicament? Frustration at my own lack of faith, I am sure though that these concerns are shared by many soon to be qualified nurses. All that hard work for nothing but personal achievement?


Unable to find a job with hours to fit in with my children, chuck in the council tax bill child care costs (minus the 85% contribution) and I am actually worse off.  Not to mention the loss of opportunity to develop my skills in an area I am interested in (CAHMS). My final hope of getting some income to keep the roof over my head was working on the bank as a HCA but I am informed, as a newly qualified you cannot work the bank!!


Well, it was a good three years, I have met some wonderfully inspiring people and it has all been for a good cause – an experience I will never forget.


So, all you young free and single peeps out there, the world is your oyster! Travel the world, get that job and nurse those people who need you, treat students how you would have liked to be treated and reach for the stars! Be Leaders and research best practice all the way, I wish you well.


Despite the lack of jobs compared to the amount of graduates (baffles me why they train so many of us when there are no jobs), there is a job for everyone if you can be as flexible as possible, have a supportive family network to look after your kids and a decent car that will get your anywhere!


I will remember you all when I look at my graduation photo and never regret my uni days. Oh dear how bleak it all seems!! lol


Now…..if you think I am going to give up that easily, you are mistaken! Yes! These are my very real concerns and if I let negativity in it will beat me! My Guardian Angel did not get me this far to leave me stranded, I will continue to pursue my goals and work with service users and their families regardless of how dire the job market might appear, there is something out there for me but I have to get of my ass and find it! (even if it is counselling the  old dear in the post office queue whilst waiting to cash our meagre benefits! Lol)


Keep the faith Guys, this transition is make or break, time to “sort the men from the boys” and as my dad would say….”What’s for ya, won’t go by ya!!”


Good Luck all you final year Students



Depot medication – the discussion continues.

The latest guest post on the Mental Health Nursing Lecturers Tea party comes from Bob Tummey. Bob is a mental health nurse lecturer at Coventry University and is becoming quite well known as a writer on mental health issues – see for example . In this post, Bob is carrying on an earlier post from Jim Chapman.


I would like to continue the rather interesting debate raised by Jim Chapman in an earlier posting. Jim raised concern for the administering of depot neuroleptic medication through IMI into the subcutaneous wall of fat and not the intended dorsogluteal muscle, leading to poor uptake of medication. This raises the question as to whether people receiving the medication this way are actually gaining any effect. (For a couple of research studies see Nisbet, A.C (2006) Intramuscular gluteal injections in the increasingly obese population: retrospective study. BMJ. 332: 637-638 and also Chan et al (2006) Intramuscular injections into the buttocks: Are they truly intramuscular? European Journal of Radiology.)

I was very aware of this issue when working in New Zealand. The depot can be administered into the dorsogluteal muscle but the needle may not reach due the thickness of the subcutaneuous fat wall (which is becoming thicker as the population become larger/obese). However, the medication is still absorbed; it just takes a longer period of secretion into the system. The ventrogluteal is the muscle of choice across USA due to concerns for litigation (hitting the sciatic nerve and so on). Therefore it does seem to be the natural progression for all MH nurse education to consider the teaching of depot IMI into the venrogluteal. However, this does have implications for practice and will require all mentors (for instance) to be competent and taught first.

In UK, New Zealand and Australia, best practice dictates the use of the dorsogluteal (upper-outer quadrant) but mainly due to tradition and training offered (For the NZ and Australian focus please see, Wynaden, D et al. (2006) Best practice guidelines for the admin of IMI in mental health settings. Int. J MHN. 15: 195-200.) This muscle is also supported by the drug companies which I suspect is due to their dated research and the product information they share. I believe all drug trials for depot medication have used the dorsogluteal muscle, although these trials now need updating.

Another point for discussion I would like to raise is on the ethical issue of actual site. If the ventrogluteal is reportedly the best site then should we not be evidence-based and comply? However, coming from another angle, when I worked as a nurse specialist in NZ I came across a number of NZ MH nurses who administer the depot every week/two weeks into the deltoid (upper arm) muscle with the IMI needle. This ensures direct penetration of the muscle and absorption of the medication….. The UK nurses in NZ would not provide IMI this way, but maybe some research needs to be undertaken to consider any benefits to treatment. From a brief look at policy in the UK it seems that the deltoid is only to be used as a one-off/stat dose into the less-dominant arm and mainly for adolescents. However, ethically is this right? Or indeed, should we consider its use to ensure effective treatment? One thing seems quite certain, the use of the dorsogluteal IMI is now redundant.

In a recent MHN conference I attended in NZ the most subscribed plenary session by far was about administration of depot injections, facilitated by Dianne Wynaden. It is an interesting debate, but what are the answers….

Please share your thoughts and experiences.


Bob Tummey



Musings of a newly qualified Staff Nurse….one year on !

Hi all

I am delighted to introduce another guest post – this time from Julie Cresswell an ex-BCU student who recently qualified as a nurse. Julie has promised to do the occasional post to let us know how she is getting on. 

(By the way, this space is open to anyone else – we would really like to hear from you) 

anyway, here is Julie’s post. 

Upon qualifying a year ago and gaining my first Staff Nurse post in an acute setting, I was concerned about two main issues. First, how would I be able to build therapeutic relationships with clients in an environment with a clearly unequal power base and where the ever present threat of enforced treatment loomed?  Second, is the acute ward simply a place of containment and control?


Establishing rapport with clients is the cornerstone of building a therapeutic relationship and the techniques that we are taught to do this are invaluable.  The one belief that guides me is that each client I work with is a complex human being who has a life outside hospital walls, with a multitude of needs to be fulfilled.  This may seem an obvious statement, but when working with the jargon of diagnostic labels, signs and symptoms of mental illness, the client’s role in the wider world can sometimes become overshadowed.


Acute setting


The acute setting I work within actively promotes a ‘recovery approach.’  During their stay, clients are asked to consider how they view themselves in the world and the aspirations they have for their future.  Such information forms part of their care record and can be shared with other members of the team. The value of such conversations should not be underestimated as it allows the nurse and client to find activities that are meaningful to the client that they can participate in during their stay in hospital and upon discharge to community services.


There are a multitude of activities that clients can access such as  complementary therapy sessions, occupational therapy sessions, art, music and reading groups.  Having facilitated reading groups in my work setting, I find that everyone who attended them has a valuable contribution to make, and provides professionals with the opportunity to ‘be with’ clients and explore topics of conversation that may not naturally occur during a shift.  Some may argue that these activities are better placed in rehabilitation or community settings, but I have found that spending time with client’s engaging in such activities is a valuable method of building rapport.


An unequal power relationship


I now accept the inevitability of the unequal power relationship between client and practitioner.  However, I strive to work positively within this powerful legal framework, by embracing the concept of collaborative care planning (working with the client to agree a care plan, not writing one then implementing it!).  The client is therefore, given the opportunity to be pro-active in their recovery, rather than an object that is ‘nursed.’


In stark reality, there are client’s who do not want treatment and will not accept their admission into an acute setting.  Some clients are clearly vulnerable in the outside world as they are experiencing acute mental health problems that make their ability to function in the community untenable.  In these instances, I  agree that we need hospitals that can contain and control clients, most likely to be at the beginning of their admission.  However, I believe that acute settings can provide sanctuary for many clients when they need this in order to restore their mental health to an optimal level.  Following this stage, professionals begin to do what I consider to be  the most important stage of acute nursing,‘*engagement,’ with a view to building relationships with clients in order to work together in their recovery.  *The fly in the ointment – the dictionary defines ‘engagement’ as to ‘bind by contract or pledge,’ but more interestingly, ‘to bring into conflict’.………..but that’s another debate altogether !


Julie Cresswell

A sporting yarn

There was once a cricketer who enjoyed his sport and got rather good at it. One day, the cricketer bumped into a footballer and said“Hello, I’m a professional sportsman just like you!”

A jolly good cricketer!
A chap playing cricket

The footballer looked at the cricketer with great disdain.

“No you’re not”
“Yes I am” cried the cricketer in dismay.

The cricketer went away and thought long and hard about what the footballer had said. He had spent years studying and practising his sport and wanted to be respected as a professional sportsman. How could the footballer treat him so? To prove his merit as a professional sportsman, the cricketer decided to learn to play football – if he could do this then he will be respected as a professional sportsman he thought.

After some time, the cricketer had indeed learnt to play football. He found the footballer and said:

“Look, I can play football just like you! Now do you see me as a professional sportsman?”

The footballer still had the look of disdain and said sneeringly

“OK. Whatever you say.”

And the cricketer continued to play football.

The cricketer stopped being a cricketer. He forgot to do what he was supposed to do. And the relevance….have nurses forgotten the nursing role? Are we trying to be every other profession (and one in particular) because we suffer with a pervasive lack of professional confidence? It seems to me that as a profession, we are ashamed to admit that we are a caring profession. Perhaps that nursing is the only health related profession where the entry level is not graduate (yes it will be changing shortly) has left us feeling a little embarrassed?

Some other chaps playing footie
Some other chaps playing footie