September 2007

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A while back I posted this anthropological account of the bizarre, pen-based gift economy that takes place on psychiatric wards. We now have need of an anthropologist’s services again, in order to explain this strange encounter.

A nursing auxiliary and a student nurse are sitting in the office of a psychiatric ward. A patient walks in and says that a visitor has come to see him, and wants to know if he can use one of the teapots in the kitchen to share a cup of tea with his visitor. The NA pulls a series of faces and then says, “Er….no, because the NHS Trust has to pay for the tea bags.”

To explain what is going on here, I asked Professor Humphrey G Escobar, Visiting Professor of Cultural Anthropology and Recreational Pharmacology at Miskatonic University. He was kind enough to reply to my e-mail.
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A comment left in the Live Chat box on our blog:

Hi my name is Phil and I’m organising a ‘Mental Health Day’ in conjunction with the Socialist Party of Great Britain The event will be held on the 24th november at SPGB Headquarters at 52 Clapham High Street London, There will be speakers on the subject of Capitalism and Mental Health and an Art Exhibition and Poetry Readings by Survivors I’ll be exhibiting some of my Artwork. The event will start at around 9am and finish at around 4pm

This left me wondering: what would a Marxist interpretation of Mental Health look like?

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Wear a red shirt today for Burma

The day began with brutality when security forces carried out dawn raids on at least nine monasteries.

At one, where soldiers rammed the gate with a truck, there were bullet casings on the floor and blood on the walls. A monk was reported to have died.

A rumour in Rangoon said that soldiers had disrobed an abbot and made him crawl on the floor like a dog.

Hundreds of monks were arrested. The raids incensed local people, who revere the monks.

But the raids, combined with the presence of soldiers posted outside monasteries, succeeded in keeping most of the monks away from the protests.

Later in the morning near the Shwedagon Pagoda, where the streets are lined with monasteries, there were few people to be seen besides soldiers lying in the shade with their guns.

The city awoke with an air of surreal normality. Policemen led pedestrians freely past their barbed wire, coiled in readiness for the afternoon’s demonstrations.

On the pavements where protesters were later shot down, people sold second hand books and caged song birds like on any normal day.

As usual, the demonstrations started at noon. In the absence of the monks ordinary people and students came to the fore, but the movement seemed leaderless.

It was difficult to estimate the number of demonstrators, who were more dispersed than earlier in the week, but they ran into tens of thousands.

They gathered seemingly spontaneously at different points in the city, and they were under no illusions about the violence they faced.

Trucks mounted with loud speakers warned them to disperse in 10 minutes or face “extreme action”. The protesters jeered.

As the loud speakers counted down the minutes, riot police slowly advanced, beating their clubs against their shields.

Behind them followed the soldiers dressed in green drab, with their rifles and their brightly coloured scarves to signify their platoon.

Soldiers roamed around the city in trucks mounted with heavy machine guns all afternoon.

Reports said that two battle-hardened units, usually deployed against Burma’s oppressed ethnic minorities in the provinces, had been sent to the city.

Cordons were set up all over Rangoon. Near one, the army reportedly ran into a group of students with their truck before opening fire. Yet another report spoke of troops opening fire at a shopping centre.

Hazy accounts of possible atrocities around the city were bewildering and hard to confirm.

Groups of protesters remained on the streets through four hours of this violence, refusing to be defeated by fear and brutality.

There were hundreds of arrests, of protesters or anyone deemed to support them.

“They are hunting us,” a Burmese journalist said by telephone.

Wear a red shirt

Read the full speech here, edited highlights here.

There’s only one little snippet directly about mental health: -

And we need a new deal for carers and a fresh approach on mental health - restoring dignity and security to the most vulnerable in our society.

Although, of course, the emphasis on improving access to primary care will also affect people with mental health problems, given that large numbers of people with mental health problems are looked after by primary care providers alone. The commitment to tackle health inequalities will also impact on people with mental health problems. The greater vulnerability to diabetes and heart disease, the poorer outcomes from both and the higher incidence of obesity and smoking among people with schizophrenia, for instance, is one little set of health inequalities that needs urgent attention.

But let’s engage in a little reverie here. If you were Alan Johnson, what changes would you make to the NHS? Not necessarily just mental health services, of course. What would you introduce to ‘restore dignity and security to the most vulnerable in society’?

Here’s a wee idea of mine. How about giving older people some proper purchasing power? Special grants for groups of older people (who could all be friends or family members, say, or who could have hitched up for the sole purpose of getting a group house) to buy and, if necessary, adapt houses for them to live in. Then, through an expanded and boosted direct payments scheme give them some cash to buy in the health and social care they want and need. Make them the employers, let them call the shots about who comes to - say - give them a bath and when. That’s certainly how I would like to run my old age.

Dear Zarathustra

You snivelling little worm. So you went and finished your nursing studies, did you? Well, you may have spent the last three years trying to live off £6000 a year, and as a result be about £8000 in debt, and you may be still waiting for your first month’s pay, but we’re still going to have our wicked way with you.

We want £76 off you. Just for the right to be able to call yourself “nurse”. Yep, 76 quid. Just make the cheque out to “My New Overlords and Masters, The Nursing and Midwifery Council”. While we’re at it, can you also bend over and drop your trousers so we can get some “executive relief” in your cornhole?

Yours Sincerely

The Nursing and Midwifery Council

PS You are now our bitch. And you will be forever. Well, at least until we decide to strike you off.

(Here’s a request from a reader - feel free to use the comments box to offer advice. Zarathustra)

I am new to all this so here goes!! I am a 3rd year Advanced Diploma in Nursing student and have just 5 months left till I qualify. I have been given a job interview on Monday for a staff nurse position on a forensic low secure men’s ward. I am extremely nervous as I do not know what sort of questions they might ask me, if anyone has any idea at all I would be eternally grateful!!

Many Thanks

Since Beakie’s post about nurse education seems to have sparked a lively debate, I think I’ll add my own thoughts on this subject.

I’ve just taken up my first staff nurse post, having passed the nursing degree with first class honours. From the tone of some posts on the blogosphere, this must mean that I must therefore consider myself far too posh/clever to give a patient a bath, wipe their bum or make them a cup of tea, the over-educated, sociology-sniffing little ponce that I am.

For the record, I suspect that if somebody said that to my new set of nursing colleagues, they’d be utterly livid and set them straight right away. I do all of those things, and more besides. I don’t think this is because I’m some kind of robo-nurse who has somehow managed to bridge the theory-practice gap where every other nurse has failed. I think it’s because the critics of nurse education are wrong.

To help illustrate why I think this, let’s make a potted summary of some of the criticisms of nurse education that are doing the rounds. Such a summary might look something like this.

Nurse education is far too much theory and far too little practice. Lectures ignore the practical stuff like wound care, bathing, dressing etc. There’s not enough lectures on anatomy, physiology and pharmacology. There’s too much sociology. Newly-qualified nurses just aren’t ready for the role as a result.

I’ll take those five sentences in turn, and craft a response to each of them.

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Thanks to everyone who offered advice in my last post. Was seen last week by a whole host of people – some said hospital was what I needed (and suggested detention if I “couldn’t go voluntarily), others weren’t sure and some said hospital would be the wrong place for me. So I was “offered” a voluntary admission although allowed to stay home if I chose not to go.

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The petition is currently sitting at 216 signatures, which means we will get a response from the appropriate government department!

Phase one is now complete. Yay!

However, more names are still welcome. Keep the support coming.

The deadline isn’t until 6 October, so still plenty of time to accumulate more names.

Incase you haven’t already signed, the petition is here

If you require more infomation, visit the FAQ

OK, so looking at the Britmeds blog summary on Dr Rant, there were a couple of posts from nursing blogs, one of which - it was purported - was about the parlous state of nurse education. It was, in fact, a moan about some tedious training provided by a medical devices company about how to use one of their products. However, a comment or two there that “of course, there’s something wrong with nurse education” made my hackles rise. Basically, I am more than a little tired of people whinging about nurse education. People see crap new staff nurses and their crapness is blamed on the education they received as if that was the only factor involved. So I’m here to set the record straight.

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Just a reminder to sign our petition for statutory minimum nurse: patient ratios if you haven’t done so already. The petition requires a minimum of 200 signatures in order to generate a response from the government, and we’re currently on 165, so sign it and tell 34 of your closest friends.

As regards the issue of blogs that are better than Dr Michelle Tempest’s, here’s a couple more to add to the pile.

Militant Medical Nurse
This nurse is bloody angry, but she writes damn well. We like her when she’s angry.

Nursing Student’s Musings
A student fighting his way through nursing studies. Fear not, there is light at the end of the tunnel. Sadly it’s a guy from the NMC holding a flashlight and demanding a bloody huge cheque off you.

Congratulations to those two blogs. You are both better than Dr Michelle Tempest.

A shiny foil gold star to Michelle Tempest, self proclaimed second best medical blog on the whole wide internet! As Mental Nurse has pointed out since, there are far better medical blogs out there. I share a liking for most mentioned, but it begs the question, what things make a good medical blog?

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(Bumped From Forums)
I will start by saying how refreshing your site is. I qualified as a mature (god that makes me sound realy old im 35) RMN March 2006 and due to the job shortages which we were told would improve I decided to take a year out and spend some quality time with my family who needed me at this time (my daughter is 10 and was having a few problems at school) admittedly I also felt really guilty as I had put myself first and put them on the back burner while I completed my studies. (who ever said woman can have it all was lieing,something has got to give)

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The government wants a big conversation about drugs: -

Today the Home Office is hosting a workshop in London to gauge opinion and seek fresh and constructive ideas on how best to tackle drugs and the devastating impact they have on individuals, families and communities. Ipsos Mori will be in town to hold a “drug chat”, one of four that will take place around England to discuss how we can build on our achievements in tackling drugs.

Since the consultation was launched on 25 July, we have sent 300,000 leaflets on the consultation to police stations, libraries, GP surgeries and Drug Action Teams. We have also sent 5,000 hard copies of the consultation to those who are keenly interested in tackling drugs. This demonstrates our commitment to reach out to people to ask for their views and ideas on cutting the harm caused by illegal drugs.

The current 10-year drug strategy was launched in 1998. The government needs the input of the public to inform the new drug strategy that will be implemented in April 2008. This is a real chance to help inform the government’s approach to tackling drugs, and I hope Comment is free readers will welcome this opportunity to respond to the government’s consultation.

We’ve had these big conversations before, and it’s amazing how they end up endorsing what the government intended to do anyway. But enough cynicism. What, of course, won’t be part of the conversation even though it should be, is legalisation. Legalise all drugs, make them available through pharmacies and you cut out a huge amount of the harm caused by them at a single stroke. Take heroin for instance. Heroin doesn’t make criminals of people: its illegality does that. People don’t die of heroin overdoses because they want to (on the whole), its illegality means that quality control is impossible to enforce and what may be a reasonable dose of one batch is a lethal dose of another. People don’t choose to support brutal heroin lords through their habit; thanks to illegality, they have no option. Oh, and let’s not forget how much legalisation would benefit developing countries for whom drugs are a major export but where the profits only end up in the pockets of crims instead of helping to provide healthcare and education for the people of said countries.

Our current drug policy is a joke. Prohibition costs a fortune to enforce and doesn’t stop one single person from taking drugs if they really want to. The cocaine barons go on getting richer, the poppy fields still flourish and people go on dying or getting assaulted or having their belongings stolen. If Jacqui Smith really wants a big conversation, she ought to open her ears to those of us who want to see all drugs legally available to adults. But I suspect the Home Secs lugholes will remain steadfastly closed to such an idea.

I’m still slightly miffed about Dr Michelle Tempest’s list of Top Ten Medical Blogs . Not just because she put her own utterly ghastly “Gosh, isn’t trite pop-psychology great! Vote Tory!” blog as second-best medical blog on the Internet. I’m also slightly annoyed that her list is composed entirely of doctors and medical students. No nurses? No ambulance staff? No OTs, physios…or Cthulhu forbid…some actual patients?

So, I’m going to address that by creating a list of Medical Blogs That Are Better Than Dr Michelle Tempest’s.

Yes, ladies, gentlemen and eunuchs, this is called catharsis.

Categories include doctors, nurses, ambulance service, managers and patients/service users.

Anyway, here goes…

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