Hi Guys!

I’m a senior nurse, working in a specialist challenging behaviour unit for the elderly - the only one in our county.

We’ve recently embarked upon the Excellence in Practice Accreditation Scheme (EPAS), with the help of Prof. Rob McSherry.

I’d love to hear from anyone else who has (paper)worked through this scheme. I’d also be grateful to see any of the related paperwork and documents/audits/questionnaires, etc that you used.

In particular, we’re trying to ’set our market stall’ or ‘blow our trumpet’ in our region and It’d be great if anyone would post or email me their philosophy of care statement and operational policy.

thanks

turboelf

I read a posting on the site about a person not sure about doing mental health nursing course due to their self-harming scars.  To put your mind at rest (hopefully!) you wear your own clothes at work so can wear long-sleeved tops.  In first year in England we have insights in to adult nursing which does mean you wear the nursing uniform but it is not for long (8 weeks) and just remember what the final goal is that you have been inspired to do this type of work.  Also, the insight in to this issue will give you understanding and compassion of people who struggle with themselves with mental illness.

I also have some scars on my arms and I won’t say that it has not caused me at times distress and regret.  However, I never ever thought in a million years I could train to be a mental health nurse as had a very chaotic life that involved an eating disorder and addiction.  What helped me was that I wanted a normal life and had to try to not prevent my arms from living life to the full. 

I still find it hard and get worried if I do Healthcare work whilst studying on a general ward that I will be judged.  I have survived so far though! I would hope that in this profession that the nursing team would understand that anyone can have a distressing point in their life and overcome it as most people have some kinda scars if not physical.

Bio-Oil has helped a bit which I rub in the scars twice daily.  Also, I did speak with a staff member at Uni who told me that it would not be an issue only if I was stilll self-harming.  My friends and family don’t even pay attention to it only me.  If you feel that this is what your meant to be doing at this point in your life I would say go for it and be real proud of yourself and how far you have come.  I do hope that the person who sent that email a while ago does get to read this one.  I wish you all the best xxxxxxx

I  feel sick, and shaky and angry.

What has happened is this.  One of my Section 3 patients is on leave and while at work yesterday I received an upset telephone call from this patient and a family member saying their solictor had called them and told them the section 3 had been renewed.

I checked the notes, nothing to indicate this.  I noted that the Section 3 runs out or needs renewal in a months time.  The patient had seen his consultant on the Thursday and no mention of this.  Their solicitor rang them Friday, then they contacted me for an explanation.

Well, I said, without seeing the letter in question, I suspect this is the standard letter to advise that the Section runs out in a month and will be reviewed and either renewed or taken off within this time.  Don’t worry, I’m sure the Doctor would not do this without speaking to you and while you are out on leave.  Try to enjoy the rest of your leave and I’ll see you when you get back on Saturday.

Couple of hours later . . . I see this patients care co-ordinator and ask them, just to be sure.  Yes, it was renewed!

What do the greater minds than mine on here think?  After 12 years in mental health I am gob smacked by this!

Timothy Pinkston was detained in a psychiatric hospital at the time and therefore I would presume “clinically insane” or whatever the term is. I can’t understand how they could send him to jail for something he said while he was officially mad and safely locked up in a psychiatric hospital.

I wondered if you guys could enlighten me how things would pan out if there were a similar incident in a UK psychiatric hospital. The case raises lots of issues but there are four main areas that concern me.

1) Personal responsibility while under the influence of alcohol

Up here in Smalltown, Scotland it is fairly common for people to threaten to kill each other when drunk. The usual scenario is two guys arguing in a pub and as one is ejected, he shouts, ”This isn’t over mate. I’m gonna get you. YOU’RE DEAD!”. Occasionally it’s all forgotten about the next day, sometimes there is a permanent rift between them and at worst a punch-up at a later date. The thing is, drunken threats are rarely taken seriously here, but I accept that may not be the case in all cultures.

Anyway, what is the situation in a psychiatric unit when someone is drunk, are they considered responsible for their actions? If I am admitted totally pissed and I get stroppy and start threatening people, am I likely to be charged? What if, as an inpatient, I become violent and punch a nurse, will I be charged?

2) Personal responsibility while under section

Can patients be held responsible for their actions whilst detained in hospital against their will? If I am violent whilst detained in hospital would you ever call the police? Similarly, if I am detained in hospital and during a restraint I threaten to kill you when I get out, can I be charged?

How do you judge the seriousness and potential consequences of each threat and avoid reporting thousands of people to the police?

3) Nurses responsibility and breaching confidentiality

At what point is it OK to disclose something a patient has said to you while under your care? If I tell you I smoke hash, I don’t expect you to call the police. If I tell you I plan to send hate mail to my neighbour, do you inform any external agencies? If I say that I plan to murder someone what would you do? Do you pass the buck to a colleague? What do you do if your manager poo poos your concerns and tells you to drop it? How do you actually respond?

4) Terrorist threat

What if I am not violent or threatening but whilst under your care, disclose extreme personal views on politics which lead you to suspect I may be a threat to national security, how do you respond?

Do have any set protocols or guidelines for these situations or is it left to your discretion? I appreciate I have asked loads of questions but I’m guessing there may be an all encompassing statement that covers most of the issues here.

(P.S. You may have may guessed that I’m a bit paranoid at the moment.)

My assignment is of a critical incident during my acure placement and i thought about increased obs; the problem is its due in 2 weeks on starting placement!! so in terms of leaving it to the last minute perplexes me some what, would there be any ideas of the roles etc of nurse and who is involved in the process from a “helocopter view” of services much apreciated and sorry for the annoying newbie to the site…looks really cool and i hope to be part of this forum for the distant future.

Hi, Ive finished NVQ level 2 Health and Social Care..and have almost finished NVQ level 3 Health and Social Care.. I’m just wondering what else i need to be able to apply for Adult Nursing? I’m really confused, don’t no if i need to do an Access course or Key Skills? Let me no please. Thank you.

I work on a PICU and we are currently having a debate about patient possessions on the ward. Some of our patients have large amounts of belonings in their room. These include TV’s, stereos, games consoles, vast amounts of clothing and even an air purifier! This has raised several points for discusion including health and safety concerns, fire risks, risks to self and others, property damage and perhaps most importantly engagement. It has become increasingly difficult to interact with some patients who have all the above in their room and are very comfortable in their new surroundings.

Whilst I realise that it is important for patients who are detained against their will and are unwell to feel comfortable and secure in hospital, the other issues raised are also worthy of consideration. Especially as they may impact on the health and safety and mental well being of others.

Any experiences, feedback or opinions would be greatly received.

Nurses Home

It’s been through some turbulent times recently, and is still in somewhat of a state of flux, but the new owner is trying to drum up trade. It’s mainly UK based, unlike a lot of nursing forums out there, has a broad membership (admittedly, most of whom are sadly currently inactive) including students of all varieties, adult nurses, psych nurses, midwives and health visitor type people and is in desperate need of new blood!

Please, if you can pop along and post, it would be most welcome. The new chap in charge is trying to get the place back to the vibrant, fun little “community” it once was. Everyone’s welcome, all you need bring is yourself and your opinions.

I thought the Mental Nurse readership might be interested to know that WISH’s campaign against the smoking restrictions in mental health inpatient units, Stubbing Out Our Rights, has been launched this week.

The arguments for and against the restrictions have already been debated here in a lot of depth so I won’t go into them again, but if you’d like to wander over to the campaign’s website you will see WISH’s take on the issue.

The starting point for the campaign will be 2 petitions: an e-petition, and a paper petition for those without internet access (current inpatients especially). A leaflet about the campaign to accompany the paper petition will be up on the website next week, as well as a template for a letter you can send to your MP.

As is the custom these days, there is also a Facebook group for the campaign.

Please take a few minutes to have a look at the website, sign the petition and let your friends and colleagues know about the campaign. Thank you!

I’ve just finished my second long day in a row (12 hours).
Only qualified on duty for both shifts.
Newly qualified.
No KSF supervision.
No supervision.
No band 6 or 7 on the ward for 3 weeks.

What do I do?

I am confusing myself! Do I take on the band 6/7 responsibilities that I know need to be done, but that I don’t know how to do?

Take one guess as to where I’ve spent most of my time ;
- In the nurses station making endless phonecalls, in a Kafkaesque nightmare?
- Or on the ward interacting with with the people I elected to serve?

I want to write an inspiring, rhetorical piece on my dynamic abilities and the power to overcome (trust me, I would have done 3 months ago).
I don’t want what I write to be fractured and exposed.

I’m a good fucking nurse and I don’t want to go into work.

How have you come through this people?

Please let me know!

A
Agenda - describes any collection of policies: ‘equality agenda’ for instance, which invariably need to be ‘taken forward’.
Assertive outreach - The process of actively soliciting trade for social workers and nurses. Generally employed when ‘customers’ fail to show required enthusiasm for services on offer.

B
Beacon of excellence - archaism: any organ of state that achieved - or ‘delivered’ - what it was supposed to.
Best practice - normally ‘established’ when a nurse academic wants to saddle a process with more complexity than is warranted. Replaces ‘working it out for yourself’.
Bench Marking - (management). Absolutely no idea.

C

Care Plan – (nursing), A magical talisman (see Alistair Crowley) to will into existence any action that a half competent nurse would do anyway.
Class - grouping people by the contents of their wallet rather than, say, how they think, feel or behave as individuals.
Consultant – (medical) Gives policy to God usually to be found on the golf course Friday afternoons.
Consultant Nurse – (nursing) see Nurse Consultant
Consultation - a formal system for ignoring public views while patronising them at the same time .i.e. “Listening to Patients” A service user survey.
Community leader - someone plucked from obscurity to represent ‘the views of the community’ for the purposes of ‘consultation’. NB never elected to this position.
CMHT (Community Mental Health Care) – Group of well meaning amateurs charged with looking after the psychiatric welfare of patients. (See MDT)
Crisis Team – (nursing) Sometimes called a “CATT” team for no adequately explained reason they are neither a team nor do they respond in the case of a genuine crisis. Crisis team members can usually be identified as the ones moving away from a problem. Often Nurse lead.
Critique – (academia) ‘. When a nurse academic alleges that someone’s writing is ‘riddled with factual inaccuracies’ then mysteriously fails to identify any.

D

Delivery - as in “delivered against targets”. Means ‘achieve’.
Disproportionate – (foreign affairs): Describes any act by others.
De-legitimise – (nursing/social work) what we do if we suggest that a favoured client group may contain members who are not wholly beyond criticism as individuals.
Delinquents - no such thing. Only people suffering from ‘root causes’ and ‘legitimate grievances’
Diversity - creating a workforce based on how people look rather than on their skills or aptitude
Duty Worker – Usually the least experienced most under qualified member of the team who has been asked to make life or death decisions regarding patient care usually by telephone without ever seeing the patient. (See CMHT, best practice, quality, BUPA, NHS targets etc)

E

Equal - as in ‘opportunities’: describes the desire to have a workforce resemble the population it comes from, rather than matched in expertise to the task in hand. See ‘diversity’.
Egalitarian - “if I can’t have one, then neither can you”. Shared misery much better than unevenly scattered joy.
Evidenced based – (nursing) Usually the opposite of common sense it is used to justify any action no ,matter how stupid because it is based on any old spurious piece of evidence dreamt up by a nurse theorist. (See progressive)

F
Fascism/Nazism - apparently the ‘opposite’ of Socialism - despite sharing party members, ideology and - in National Socialism - the name.

G

Gender issues - grouping people by their sex rather than how they think, feel or behave as individuals.
‘Green’ issues - “if we can’t control the means of production then we’ll close it down”.
God – not at home, presumed missing.

H

Hate-crime - same as ‘normal’ crime as far as victims are concerned - but much more distressing for Guardian reading Social worker types.
Hate-speech - “shut up!”.
HCA (Health Care Assistant) – (nursing), as brown was the new black and 50 is the new 40 now HCA’s are the new nurses
Health professional – Well meaning amateur (see duty worker)
House Officer – (medical) Un -housetrained Doctor who makes a fool of him/ herself by pissing on the carpet.
Human rights - using the legal system to pursue political ends.

I

Inclusive – (nurse education) Means ‘dropping the entry standards until anyone can get in’.
Impartial - media, the balance achieved by attacking the Opposition for being Conservative and attacking the Government for being insufficiently left wing
In partnership with… - (NHS policy): This way, none of us get the blame when it all goes horribly wrong.
Inappropriate - Means “I don’t like this” - no explanation why must ever be given.
Intolerance - Intolerance can only committed against certain defined groups of people. These do not include the white middle classes, or those who live in the countryside.
Institutional racism - ‘racism’ in a workforce that is achieved unknowingly and in ways that cannot be specifically defined.
Issues around… - Means “I may be out of my depth here.”

J
Justice – (Governmen)t: as in ‘social justice’. Means taking money earned by the general public to give to particular groups that Guardian reading social worker types approve of. Replaces market economics.

K
Key – (NHS policy/ Academia): most things are ‘key’, in particular: drivers, learning objectives/ outcomes, and health care outcomes. In nurse education, all ‘stages’ are ‘key’.

L
Liaise - the day-to-day business of a Nurse consultant. Replaces ‘work’.
Learning Objective/ Outcome - Means “lessons learnt” or not as the case may be.

M
Management Wonk – See policy wonk
Multi-cultural - All culture is valid - unless Western. Usually to be ‘celebrated’ and always found to be ‘vibrant’. See ‘diversity’.
MDT (Multidisciplinary Care Team) – All teams are multidisciplinary but usually consist of the duty worker and a secretary.

N
Nurse- see HCA’s
Nurse Consultants – (nursing) See Consultant nurse.
Nurse Led – (nursing) We can’t afford a Doctor.
Nurse Theorists (Peplau, Roper, Tierney, Logan et al) – (academia), Nurse academics whose theories cannot be disproved by observation, experience or factual evidence. See ‘religion’ and ‘post-modernism’.
Nursing Theory – (nursing). An inarticulate, meaningless jumble of ideas cobbled together from any source (except medicine). Generally not worth the paper it is written on.
NHS (National Health Service) – What you get if you can’t afford BUPA

O
Organised labour - what New/Old Labour used to be interested in.

P
Patient centred – (nurse education): “we can’t be bothered to look after them; so perhaps they’ll do it themselves”.
Post-modern – (modern French ‘philosophy): literature claiming that no account of events can be trusted. ‘Texts’ must be ‘deconstructed’ for their hidden meanings - except those by post-modernists, to be taken at face value. (See nursing theory, religion)
Procedure - (management) see policy
Progressive - describes ideas generally thought up around 40 years ago – that still don’t work.
Policy - (management), everything you didn’t need to know about anything but could never previously be bothered to ask. See procedure
Policy Wonk – (management) person of diminished stature who spends all of their time chained to a desk in a windowless basement room in Trust headquarters (aka Gnome central) denied food and water, regularly abused and forced to churn out endless policies on everything from, “How to dispose of rubber gloves” to “How to find your nipples without using a Sat Nav”. (See management wonk)

Q
Quality- (NHS policy) opposite of what it usually means

R
Registrar – (medical). Fully house trained doctor (the one who does all the work).
Relevant – (nurse education): something badly written, with no relevant references whatsoever.
Religion - An irrational, dangerous belief that material things may not be the principal motive behind human behaviour.
RCN - (Royal College of Nursing)-. All policies have to be “in line” with “best practice” as defined by the RCN
Root causes – (academia, NHS policy): Usually need to be ‘examined’. Belief in ‘root causes’ reflects a dogged nurse academic’s habit of trying to see “issues” through the prism of ‘nursing theory”.

S
Secretary of State for Health – (government). The poor sap who has to explain why despite being hosed down with billions of our tax pounds, the socialised system of health care we have in this country is still not fit for purpose. (aka Lying mendacious bastard)
Senior House Officers – (medical) Semi House trained Doctor.
Skills-based - (nurse education): teach student nurses all about nursing theory or something else they don’t actually need to know anything about while ignoring anything practical that they might actually find useful.
Social exclusion - Where bad people, behaving badly, somehow became our fault.
Social Worker – See God
Stereotype - any attempt to describe the general characteristics of a group favoured by Guardian reading social worker types.
Stigmatise - what we do to anti-social people if we ask them to stop.
Subsidised art - art no one would buy.
Subsidised health care – health care no one would buy.

T
Take forward - use instead of ‘do’.
Targets – Arbitrary set of meaningless requirements set by Management wonks (see policy wonks) to be “delivered” on time and under budget. (See bench marking).
Transgressive - A term of approval for anything ‘challenging established values’ - but generally puerile, annoying and dumb.

U
Unilateral - media, used to describe any act by any state in furtherance of its national interest.
Unprofessional – (nursing) The most heinous crime for any “health professional” on a par with buggering the pope if you are Catholic

V
Victim - See ‘gender issues’, ‘race issues’ and ‘social exclusion’.

W
Workers - A notional ‘class’ of people that New/Old Labour once claimed to represent. Now replaced by college lecturers, human rights lawyers, pressure group employees, civil servants with ‘liaise’ in their job title Nurse consultants, or any one you would probably not want over for supper.
Working Party- (NHS policy) – the repository of all moral authority whose words and motives may never be questioned.

Since I’m not too expert on Section 25 myself…over to you guys.

Dear Mental,

An issue has arisen in my professional work that you might like to air on
mental nurse.

I have limited experience of section 25 but my understanding is that it
allows three main things to happen.

1. The client has to reside at a particular location
2. The client has to allow MH professionals access
3. The client has to comply with an agreed care plan, which can include
accepting medication as well as abstinence from illicit drugs.

The sanction that can in theory be applied if these conditions are not met
is that the client can be “conveyed to a place of safety” and then
assessed by the RMO and readmitted to hospital (under section) if this is
felt to be necessary.

The issue that this raises is the element of compulsion and all that this
implies. Is it legitimate to use section 25 to ensure compliance? I had a
long conversation with an ASW who argued that if the client was not in full
agreement with being placed on a section 25 then this was somehow an
impediment to applying for it. I was and am comfortable with using sec 25
in this way; indeed I would argue that the central function of the mental
health act is to ensure compliance with a care plan where informed consent
is not freely given. If we can be reasonably certain of a clients
continued compliance with his or her care plan, particularly compliance
with medication and abstinence from drugs then we would not have no need to
have recourse to the MHA including sec 25.

Many of my colleagues dance around this issue seeking to avoid it by
calling it “concordance” but the issue is the same, how do you get some
one to do something to do that is in their interest but that they would not
willingly choose to do? Fannying around and fudging the issue by calling
it “concordance” does not really help. What do you think????

I can’t decide if I want to work in traditional medicine or as a mental health nurse. Here’s my vital statistics:

• I am 22 years old
• I write this blog: http://thesecretlifeofmanicdepressive.wordpress.com
• I live in London
• I am currently unemployed and trying to claim Income Support
• I have bipolar 1 disorder and am taking medication. I’m under the care of the Community Mental Health team. Does this bar me from being a nurse?
• I have 7 GCSEs (I dropped out of college due to mental illness). They’re good GCSEs, all As and A*s.

Do they let skint, mentally ill, unemployed college drop outs become nurses? Can I claim benefits and receive funding? Do you know anywhere to study and how I would go about applying?

Thanks in advance for your help.

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

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?!