October 2007

Those of you who signed our petition calling for statutory minimum nurse: patient ratios should have received the reply from the Prime Minister’s office today.

The reply is below:
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Our resident anthropologist, Miskatonic University’s Professor Humphrey G Escobar - distinguised scholar and author of The 101 Funniest One-Liners of Vlad the Impaler - is currently hunting Shoggoths in Antarctica. He was able to send us this e-mail via satellite link-up.

Professor Escobar writes:

Physicists now tell us that time is not the constant certainty we thought it was. Time is elastic and relative. It bends and stretches. It can be distorted and bent. This quality can be seen in long-term NHS planning.
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There’s an item in the Times today about the Rotenberg Educational Center in Massachussets, a residential institution for children with severe behavioural problems, where students are wired up to electric shock machines in an attempt to address their aggressive, self-harming or violent behaviour. This regime was inspired by the works of Skinner, who fathered behaviour modification, with its system of negative and positive reinforcers. It’s rather a long article, but well worth a read. Here’s a snippet (the GED referred to in the extract is the shock delivery device): -
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This post has the honour of being Mental Nurse’s first ever movie review, the movie in question being Michael Moore’s documentary Sicko, which looks at the current state of the US healthcare industry.

Sadly our blog is not yet of the status that means we get free invites to star-studded premieres, so I had to go and buy a ticket to see it at my local multiplex. Perhaps for the next one I’ll be able to give you anecdotes of strolling down the red carpet while Tom Cruise explains to me about Xenu.
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Part of the reason I’ve tried to use this blog to highlight the issue of nurse: patient ratios is the lack of coverage this issue gets in the media. Reduce a ward’s staffing levels from 4 RNs and 3 HCAs per shift to 1 RN and 2 HCAs and common sense dictates that standards of care will fall dramatically and patients will suffer.

All too often, journalists fail to spot this bit of common sense and fall into lazy, gratuitous nurse-bashing. Nurses are lazy. Nurses don’t care about hygiene and basic care. You know the sort of thing I’m referring to.

I mention it because Militant Medical Nurse has pointed to a prime example of pig-ignorant journalism. This time it’s courtesy of Minette Marrin, writing in last week’s Sunday Times.

The rest of this post may contain some strong language.
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This Week in Mentalists comes a day early, as I’ll be a bit busy tomorrow.

Anyone wanting to nominate a blog for future editions please send your suggestions to zarathustra at mentalnurse dot org dot uk

So, on with our weekly round-up of mental health-related blogs.

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On this blog, we’ve attempted to highlight the issue of nurse: patient ratios, and the extent to which understaffing of hospital wards puts patients at risk.

One thing we highlighted was the increased risk of hospital-acquired infections when wards are understaffed. We pointed to the body of published research evidence that shows that higher the ratio patients to nurses, the more likely the risk was of patients developing a HAI.

This point has been shown dramatically - and tragically - in the 90 deaths that occurred in the Clostridium Difficile outbreak at Maidstone and Tunbridge Wells NHS Trust.

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(It must be a day for readers submitting posts. Here’s another question from one of our readers)

I am due to attend an interview for a Band 6 position, any hints or tips about the types of questions i may be asked?

Kim

(A reader has submitted the following request)

Hi folks, have enjoyed reading your posts and finally got around to joining in. Lovin’ the dark humour, it reminds me why I wanted to get into this malarky of a business. However, having recently managed to scrape through the course I am now in a situation where I am quite content not to get a job. It’s as though I needed to prove to myself that I was capable of getting through with sanity intact, and now I’m here I’m not sure I actually feel the passion anymore. I’m so disillusioned with meeting so many disillusioned nurses who once had dreams and have had it battered out of them by circumstance, politics and by others who are disillusioned. I was randomly applying for any jobs that came up, and when I got some interviews and was offered a job I freaked out because I realised I didn’t even want the job! What the hell is going on?! Can anyone relate to this or offer any seeds of hope? Please?!

My NHS trust has a funny idea of rehabilitation sometimes.

My current ward is a “slow-stream rehabilitation” ward, except very little actual rehabilitation takes place there. It’s essentially a continuing-care ward for people with chronic mental health problems, and usually a fair share of physical problems as well. OT support is very limited, and the ward is so short-staffed that the “activities worker” invariably winds up being sucked into the general nursing. What little rehabilitation that takes place is more about trying to maintain existing skills than developing new ones. Few patients are ever discharged. New admissions tend to be literally a case of dead men’s shoes.

I thought the trust was being over-zealous in their definition of “rehabilitation”.

At least, until I discovered that the palliative care wards are placed within the Rehabilitation Directorate.

Where are they supposed to rehabilitate them to? Valhalla?

A big payout is on its way to Katrina Fairlie from NHS Tayside after therapy she was offered led to her accusing her father of rape: -

Katrina was undergoing recovered memory therapy in a psychiatric hospital in Perth when she made a series of allegations of sexual abuse by her father, former SNP deputy leader Jim Fairlie.

She later said those claims were completely untrue and a police investigation found there was no evidence of abuse

This wasn’t before her “memories” had ripped the family apart, however, and that is the basis of her claim.

Recovered memory “therapy” is now largely discredited and seems only to be available through various kooky organisations. But stories such as Katrina Fairlie’s are, I think, a useful reminder that talking therapies aren’t always the benign treatments they’re thought to be.

To prove that I don’t actually spend all my time sitting around thinking about poo and mankinis, I’ve decided to create a weekly blogs round-up entitled “This Week in Mentalists” - basically a more mental health-themed version of the Britmeds.

Any nominations for next week’s Week in Mentalists to zarathustra at mentalnurse dot org dot uk

So, here goes…
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On a previous post E made the point that assessment scales can often become a substitute for rather than an aid to clinical judgement. It’s a point I agree with, incidentally. Simply declaring that somebody, say, scores 15 on the Mini-Mental Scale Examination doesn’t really tell anyone whether they’re disoriented to time and place, or whether they have concentration difficulties. You have to sift back through the questions to get any indicator of that.

So, while we’re on the subject of assessment scales, let’s pay tribute to the greatest assessment scale of them all. It is, I dare say, the Mack Daddy, the Pimp MuthaShnizzle of assessment scales.

I refer, of course, to that clinician’s equivalent of Rate My Poo, The Bristol Stool Scale.

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Mental, the original founder and maintaining of this website, has asked me to let it be known that he’s standing down from maintaining it. He’s passed over the maintenance tasks to me.

In taking over, I’d like to thank Mental for being the person who built up this online resource, and I hope I can keep it at the current high quality.

Alan Johnson is to make £170m available to increase the availability of CBT in the NHS.

The new money, which will be spent over the next four years, will treat 900,000 more people for depression and anxiety and provide an additional 3,600 trained therapists.

All GP practices will also have access to nondrug treatments.

Mr Johnson said: “More than one in six people suffer from mental health problems at any one time. For many people medication is a successful treatment but we know that psychological therapies work equally well. Today’s announcement shows the Government’s commitment to mental health.

“Improving access to psychological therapies will give people a real choice of treatment, helping to reduce dependence on medication.”

I have a problem with CBT: it’s just far too fashionable. And that instantly makes me want to find some reason to reject it.

I would rather £170m was released to provide - say - sheltered employment schemes for people with severe and enduring mental health problems. But what do others think? Am I just an unreasonably cynical old scrote who should get CBT himself for his faulty thinking patterns? Has anyone had experience of CBT, positive or negative? I’d like to hear about it.