All posts by Andy

NHS radical reform!

 

Simpler days - a fresh faced Staff nurse sets out to change the world (back row 2nd from Left)

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.

White paper tag cloud1

 (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’ 

 http://www.youtube.com/watch?v=ajSqkjpaKiI&feature=player_embedded

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

DSC_0007

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.

General Views Of The UK's Major HospitalsLess 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_by_Luis_Belmonte_jpg_240x240_q85
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 website

Reprieve Youtube video

Amnesty International reaction

Twitter – Akmal Shaikh

Facebook group

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

(See also)

Time article ‘Drugs in Portugal’

Half way through my first placement

This is the second guest post from Kate Hopley (first post here) who recently commenced a course here at BCU. Kate has also started a BCU mental health nurse student area on Facebook

I am now more than half way through my first placement, and I have had many new experiences since writing my last entry. I have been involved in all of the day to day nursing duties: meds round; ward round; helping residents to wash and dress; assisting residents with eating meals; completing all the relevant paperwork and, most enjoyably, getting to know each of the residents by spending time with them. 

A difficult time

I had a difficult couple of days a week or so ago, in the midst of several deaths. Over the week following the deaths I noticed how stories of those who had died were told over and over again in the staff room, alongside stories of other deaths which had been experienced. I reflected that the communal processing of grief was important for nurses, because fitting our experiences together and telling and re-telling them led to an acceptance of death and to moving on. We knew that we had done our very best to care for our patients during their stay at the unit, and in the end I felt honoured to have cared for them at the end of their lives, and no longer sad. 

Advocacy

Another subject which struck me forcefully over the past weeks is the need for nurses to act as advocates for people suffering with dementia, and especially for those who are in the stages of the disease where they may have lost the ability to communicate verbally. Most of the residents at my placement are not able to choose from a menu prepared to their liking – they rely upon the nursing staff to make informed choices on their behalf to ensure that they eat a varied and balanced diet. Many of the residents cannot walk about unaided, and so cannot choose whether to sit in a sunny window or right next to the television or who to sit by. Nursing staff must consider what they know of the person’s history alongside non-verbal clues as to what mood or preferences are being expressed on that day, and then make an informed choice. 

A good environment?

I have also spent some time reflecting on the physical and sensory state of the healthcare environment for those who are inpatients with dementia. If the rooms are moved around every day this may be confusing for the person with dementia; if different and unfamiliar staff help residents to wash each morning this may be confusing and frightening; if someone starts to offer food on a spoon without first explaining what they are going to do this could be frightening. If music is played or interesting sensory objects are available and nursing staff spend time talking to or sitting with the residents, then this creates a space for the residents to engage with the world around them and to express themselves. I have spent a lot of time getting to know the residents better, and over time I have learned to understand what they are saying to me better, and finding that it is indeed possible to have a conversation, one side of which consists solely of an array of meaningful facial expressions and gestures. 

I am absolutely loving my placement and I will be really sad to leave. Every day something happens that puts smile on my face, and every interactive response from a resident, be it a belly laugh or simply the raising of an eyebrow, makes placement feel nothing like a job at all, and everything like a satisfying vocation.

Kate

Schizophrenic man terrifies kids at party

This is a guest post from the people responsible for promoting an anti mental health discrimination campaign called ‘Time to change’.

We don’t normally do adverts but I thought that this would be ok – it would be very interesting to hear if you have any comments or observations?

 Time to Change is run by leading mental health charities Mind and Rethink, and backed by £16 million from the Big Lottery Fund and £2 million from Comic Relief. 

The Time to Change charity was successfully launched in Jan this year with an advertising campaign created by MCBD, with media planning by Naked and media buying by the7Stars.  The campaign featured a TV ad: “The Bridge”, celebrity and real people testimonial posters and press ads (featuring Ruby Wax, Stephen Fry and others) and a Mental Illness Myth/Fact press and online campaign.

 

The latest phase of the campaign includes a more provocative piece which tackles the stigma surrounding mental illness head on.  It was decided to launch these films online for a number of reasons, firstly because most mainstream movies are launched through rich media online and we wanted to ape this type of media placement.  Secondly a vital part of this campaign is to encourage people to pass on these films to friends so online is the perfect environment to facilitate the viral spread of the campaign.

 

Two films break online on 10th August, both of which play on the negative stereotypes that people hold about people with schizophrenia. The first film “Schizo movie” fools the viewer into believing that it’s a promo for a thriller. It purposefully takes its cues from horror movie trailers, using lots of dark imagery.  However once the film starts to play we meet Stuart who is a regular guy, just like you or I, but who also happens to have schizophrenia.  This approach allows TTC to challenge the perceptions people have about people with mental health problems without finger-pointing.

 

The second film “Kid’s Party” will be seeded into video sites with the title “schizophrenic man terrifies kids at party” with a still of a typical kid’s party next to it.  Instead of seeing youngsters being frightened by a person with schizophrenia, viewers see a normal children’s party with the person “scaring” the children with a giant spider made out of balloons.  As this footage is revealed the person voices over the film and explains how thanks to support from his friends he’s able to live a full life despite having schizophrenia.

 

1 in 4 of us will have a mental health problem at some stage in life, yet research shows that attitudes to mental illness are just getting worse. And for many the stigma is harder to deal with than the illness itself.  Time to Change aims to improve public attitudes and get mental health problems out into the open.

 

Sue Baker, Director of Time to Change, said: “Both films have been designed to attract members of the public who don’t realize they are causing stigma and discrimination.  Evidence shows that provocative films make a big difference to attitudes and both films will go a long way to reducing the stigma associated with mental health problems.”

 

She continued: “One in four of us will have a mental health problem at some stage of our lives. It can happen to anyone. Stigma and discrimination wrecks lives. Yet everyone can make a change in their attitudes now – you don’t need to be an expert to make a difference to friend, family member or colleague who needs your support.”

 

Michael Pring, managing director, MCBD said: “This is a very brave campaign for the mental health world to run with but we’re confident that getting people to nod along with prejudice and then confronting them with the reality will prove an effective approach”.

Life as a new Mental Health nursing student

This blog has taken a bit of a break over the last few weeks & I am pleased to say that we are back in business & looking forward to continuing where we left off.

I am delighted to start us off with a guest post from Kate Hopley who has recently begun her mental nurse training at BCU. Kate has also started a Facebook group for BCU students & wanted to let you know about this as well.

Don’t forget – we are always very keen to publish contributions from anyone who has something to say about mental health – from any perspective, see the ‘about us’ page.

Seacole Building at the Edgbaston Campus of Birmingham City University
Seacole Building at the Edgbaston Campus of Birmingham City University

I started this course in April to learn about and get involved in mental health, to pursue my own interest, and to get job satisfaction by doing something useful in society. These sound like laudable aims I am sure, but I honestly had absolutely no idea what to expect from going back into education approaching 30. I was not entirely confident that walking away from a secure (paper-pushing) career path after 8 years was the ‘sensible’ thing to do, although it certainly felt right…

  

 

So I am now almost 4 months into the course and about to start my first placement. I have enjoyed my first few months of university, especially the biology lectures since I used to like that subject at school, although I have found it strange to get back into the whole routine of study after such a gap. I have rediscovered the joy of reading text books and doing homework in bed, but I have also felt a strange unease about not being at work since that is what I am used to doing… I have a lot less cash than I had before, so we’ve adjusted the weekly shop and are eating like students and drinking endless cups of tea instead of wine. Which is good for the liver, I suppose.

 

I am excited about starting placement as it will be satisfying to get into a hands-on work-based routine again. I went with a fellow student to visit our placement earlier this week and we were both really enthused and impressed by the progressive approaches we were introduced to, and the whole ethos of person-centred older adult care.

 

Last time I worked in a nursing home (12 years ago) I can remember heated debates at handover between the night shift and the day shift about how many residents had been got up for breakfast. The idea had been to ensure that the routine of getting up, washed, having breakfast, lunch, afternoon tea, dinner and going to bed ran to the schedule which was most convenient for the nursing staff. My visit to placement showed me just how much things have changed.

 

Nowadays the emphasis is on the needs of the individual resident: if Doris doesn’t normally get up until 11, and prefers a shower rather than a bath, then she should be supported to continue her personal daily routine. For a patient with dementia or Alzheimer’s, any sort of change of routine or environment can be unsettling and can cause confusion, so person-centred care is important for rehabilitation.

 

 We were introduced to the local policies of the placement, and how they are founded in research. We were given an idea of how the placement planned to develop further, and were talked through examples of the change process in action. This helped me to see links to our university Personal and Professional Development module and to our placement documents – linking practice to evidence.

 

I am sure I will learn a lot on placement – I only hope I can remember what we did at university by the time we come back in October!

 

Kate

 

Pictures

1. BCU Flickr feed

2. sergis blog’s photostream on Flickr

3. A close reading of the text by khrawlings on Flickr

Guest post SCEPrE Fellowship : Trevor Adams

This is a guest post from Trevor Adams from the University of Surrey. Trevor is very well known for his work in the area of Dementia care and has been widely published. As ever, we are delighted to feature guest posters – so if you think you have something you want to say then please get in touch.

I have recently received a SCEPrE Fellowship (see http://www.surrey.ac.uk/sceptre/) from my own University, the University of Surrey. The award offers funding to undertake a project that will ‘promote excellence in Professional Training (placement learning) and enhance students’ experiences through enquiry-rich approaches to learning’. Over the last few years I have developed with others, the idea that there are three agencies involved in dementia care, people with dementia, family carers, and care staff. This is often called ‘relationship centred care’. This work has not just focused on ideas and theories associated with working alongside people with dementia and their carers, but has also described various strategies and skills that may be used to promote their well-being.  

My main aim within the Fellowship is to develop four films, each about 20 minutes long for publication on YouTube. This will make the films accessible to all and will hopefully, help nurses and other care staff develop worthwhile and effective skills in promoting the well-being of people with dementia and their family carers. The films will draw on relationship centred approaches, but will also include positive person-work that was developed by Tom Kitwood.  One of the films will concern the experience of care staff and will draw on the idea of emotional labour.

At the moment you can buy various teaching packages on dementia care, and I am sure they are very good. But they often cost a lot and I suspect, frequently lie unused on office shelves. I want to develop a package that was freely available and open to all. One reason for this is that teaching is changing. When I first became a nurse teacher I used to spend hours and hours preparing acetates. Now it is different and I have increasingly used films from YouTube in my teaching.  It is really good to hear Dr Niles Crane from Channel 4’s ‘Frasier’ talk about how Alzheimer’s disease affects the brain (sorry if you are not a Frasier fan! ):

These films offer students a really great learning experience and are a easy way of listening to experts, whether they are staff, carers, or patients.  I now want to use YouTube to help nursing students and others learn skills associated with dementia care.

As part of the Fellowship, I will be completing a wiki. As the Fellowship continues, I will be adding to this and sharing more about its progress. If you want to keep in touch, the wiki will be available here.

Photos Flickr creative commons

1. University of Surrey by Kai Hendry

2. Hand by Pamelaadam

Let me tell you a story : the Reading for Recovery project

This is another guest post from Julie Cresswell, one of our ex BCU mental health nursing students who is now a qualified staff nurse. (This is Julie’s second guest post – see her earlier post here)

Following a comment from a member of staff regarding the lack of reading material on our acute ward, I decided to raise funds by running the Birmingham half marathon in 2008.  We raised around £200 in sponsorship and also held a ‘Reading for Recovery’ party where friends were asked to ‘bring a book’ to donate to the ward.  100 books of all genres from classic novels to biographies were donated.  I also approached celebrities who have some connection to mental health awareness and received around a dozen donations.

A local blind gentleman who heard about the initiative donated a large amount of talking books for client’s who had difficulties reading or concentrating on the written word.  We were also able to purchase books to be used with clients to encourage them to share their experience of mental illness and material to further staff’s personal development and broaden their knowledge of areas such as substance abuse, managing diabetes and cognitive behavioural therapy.

We now have an in-patient Reading Group.  The aim of this group is to hold regular sessions where the written word (sometimes short stories, sometimes poetry) provides service users with the opportunity to read aloud, listen to others, interpret themes and more often than not, participate in lively debate!  I have found that the groups can be cathartic for some clients, tears are not uncommon and can reignite an interest in reading or the discovery of their own talents in story-telling or creative writing.

Clients often make special requests for further sessions to explore a particular poet/poem or writer.  I have also learnt so much in researching such information and the lively debate that it often invokes..…one that comes to mind is the theory that Shakespeare’s sonnets were focussed around a man, rather than a woman.  This session raised issues of sexuality, religion and how words can be interpreted at one point in history and reinterpreted in today’s world.  A contemporary story by Michael Faber about a ‘safe haven’ where the people that stayed there had their life histories printed on their shirts, prompted a lively debate about stereotyping. The most popular books that client’s read away from the group are autobiographies and special interest books such as militaria or sport.   

Research tells us that service users are not satisfied with the level of interaction with staff on acute wards.  In addition, boredom is often cited as a primary concern.  Our Reading group tackles both issues.  The Group has read texts as diverse as Chekov, Rudyard Kipling, Wordsworth to Benjamin Zephaniah.  My hope is that the service users who enjoy the group benefit in some way, whether they are empowered by the words they read, distracted for a short time from their difficulties, comforted or indeed grow in their confidence when mixing with others.

Images from Flickr creative commons

1. Books by Faryan

2. Leamos/ Let’s read by annais

3. Benjamin Zephaniah by jessallen823