Technorati href="http://www.technorProfile Thinking Nurse: February 2005

Thinking Nurse

This blog will reflect my interests in learning disabilities, nursing, nursing theory, philosophy and politics and my general interests in the arts and literature. (Nursing is an art as well as a science!) Philosophy and nursing have been intrinsically linked since the days of Socrates, his mother was a midwife, and taught him everything he knew!

Monday, February 28, 2005

Healthcare Discrimination and People With Learning Disabilities

Discrimination in healthcare against people with Learning Disabilities

I have posted before about some of the shocking ways in which people with learning disabilities or mental health problems suffer serious discrimination from health services – discrimination that actually shortens life expectancy and reduces quality of life:

There can be little doubt that if a racial or religious minority suffered this kind of discrimination, it would be a national political scandal, but because it is people with disabilities who are suffering, their voices are hardly heard at all.

A document produced by MENCAP ‘Treat Me Right!’ (Available from ) is full of frightening examples of discrimination, going on in the UK today, and it’s painful and deadly consequences for people with learning disabilities.

True stories from this document include the tale of ‘Max, who broke his hip at 30, suffered immense pain, having fits, moaning and punching himself in the face. It was too late when doctors finally realised he had blood poisoning because of kidney problems. Max died.

Other people, like ‘Sarah’, found that regular, generic services were unwilling to treat her, instead referring her back to the learning disability team.

‘Ibrahim’ found that GPs never spent the necessary time to let him explain what was wrong with him, or to explain the treatment so that Ibrahim could understand it.

‘Cathy’, a girl with Down’s syndrome had her ear damaged by a doctor who did not know that people with Down’s syndrome have smaller ear canals, he pushed an instrument to deeply into her ear, and irreparably damaged her hearing.

‘Anthony’s’ parents had to stay with him 12 hours a day, during his stay in hospital, because otherwise nobody bothered to feed him.

One mother heard a doctor remark about her daughter “That’s not coming in my room, it will destroy the equipment’.

People who work in learning disability services can furnish many stories of health professionals who have acted in a discriminatory way – operations that have been refused using the learning disability as a reason, post mortems that have cited ‘learning disability’ as a cause of death, doctors who have remarked ‘I need to have the skills of a vet with this person’. Mental Health services that flatly refuse to accept referrals of people with learning disabilities who also have mental health problems.

Opening up health services to people with learning disabilities so that they get the same quality of healthcare as everyone else is not necessarily that difficult – it simply requires a little thought and effort, a readiness to be flexible, to listen to the person and their carers, and to respect their expertise on the individual. Parents and carers who have worked with a person for years, are the best people, for example, to recognise when a person who cannot talk is in pain, far more than a doctor who has seen the person for five minutes.

Taking a little extra time, to explain things more slowly, and in simpler terms is very worthwhile, producing patient leaflets with pictures, larger text and easy words opens up healthcare not just to people with learning disabilities, but to a whole layer of the population.

Discrimination against people with learning disabilities in healthcare is not acceptable. They have the same human right to live a full and satisfying life as everyone else. Professionals in health services need to start thinking about, and examining their practice now - if we are not part of the solution the we are part of the problem. If we can combat this discrimination, it will mean better lives for hundreds of thousands of people.

Nurses' Network Revamp

Bluegnu and Clodagh over at Nurses Network: have been busy revamping this excellent nurses' website.

Basically Clodagh had done a huge amount of research and written a whole array of articles useful to nurses, but they were kept separately from the discussion boards, which were the most heavily used part of the site.

Now these articles have been combined cleverly into the discussion boards themselves, making them much easier to find, and considerably improving the whole 'feel' of the site.

I have been a moderator on the Nurses' Network Student Nurses discussion boards for nearly 3 years now - so maybe I am a little biased, but I feel that Nurses Network is a useful asset to the nursing profession, and especially to students. Through the network, many students have been able to support each other, get advice and help from qualified nurses, and grope our way through the confusing maze that is modern healthcare.

New Humanist

The 'New Humanist' has listed 'Thinking Nurse' as one of it's 'blogging friends'.

This post is to repay the compliment. The New Humanist site is packed full of interesting articles, debates, news, and other interesting bits and pieces. Here it is:

Saturday, February 26, 2005

Willy Mason - Talent and Truth From the Heart

It is rarer that you are touched by music when you reach my age.

It is partly physical - as a teenager, your senses are keener, your emotions quicker to leap at a note or a chord, and of course the world seems new, you are the first person to feel alone, the first to feel rage, the first to love and to revel in cold night air and damp streets. Then when you hear music you realise that other people feel like you too, that you are conncected in strange ways to millions of people around you, that you share a secret.

When you are older, you have seen all the kids with guitars a million times.

They all sound like cheaper versions of the heroes of your youth, and with the corruption and decay of the music industry being so manifest, you suspect strongly that indeed they are.

Then, tonight I heard Willy Mason sing 'Oxygen'. He spoke about being young, about freedom and about hope for the future. The hair literally stood up on the back of my neck.

He said
"I wanna see through all the lies of society
To the reality,
happiness is at stake I wanna hold up my head with dignity
Proud of a life where to give means more than to take
I wan't to live beyond the modern mentality
Where paper is all that you're really taught to create"

Then the cynical side of me fought to get back to the surface. Come on it said, this guy is part of the 70's revival, just like everyone is wearing suede coats with fur collars, and little Chinese hats, they need an ersatz Bob Dylan, a Jack Kerouac to go with all the cowboy boots and ponchos.

I cant make my mind up whether this is true, heartfelt, youthful, rebellious poetry, or just more product placement and manipulation by the record industry - will Willy Mason be picking up an OBE in a few years time like so-called 'streetfighting man' Mick Jagger?

Perhaps it is a bit of both.
Willy Mason is clearly a poetm and a talented singer, and I can see that he writes and speaks from his heart, and so what if he has been placed by some cunning record executive - the words he speaks are truths:
"it's easy to see that something here isn't right
I know the future looks dark
But it's there that the kids of today must carry the light."

I intend to enjoy this talent and this truth, at least while it lasts.

A Victory For US Anti-War School Students

I was very encouraged to read this report about a small group of school students who stood up for their right to free speech, against undemocratic attempts to suppress them by the school authorities:

"High School students win free speech victory

Solidarity appeal forces authorities to drop ban against anti-Iraq war activists

Brandon Madsen, Senior at Kennedy, Youth Against War and Racism, and Ty Moore, Socialist Alternative (cwi US)

In just over 24 hours, authorities at Kennedy High School, Minnesota, reversed a ban stopping Youth Against War and Racism student activists running an information stall in the school. This swift U-turn is the result of an immediate solidarity campaign by student activists, who appealed to students, school workers, the local community, and to anti-war activists internationally.

Student activist, Brandon Madsen, reports on what happened in his college on 23 February:

Under pressure from the American Legion, the Bloomington(Minnesota) Public Schools Superintendent, Gary Prest, banned Kennedy student anti-war activists from setting up a counter-recruitment table on 23 February, while allowing military recruiters unfettered access to our fellow students.

We responded with a solidarity appeal, urging people to call the Bloomington Superintendent, Gary Prest, and the Principal of Kennedy, Ronald Simmons, and
urge them to respect our right to free speech, and our right to set up an anti-war information table when the military recruiters come to our school.

Background information

Weeks ahead, we planned to set up an anti-war information table on 23 February, when the military recruiters were scheduled to table at Kennedy High. We had obtained permission and reserved a table. But on the morning of 22 February our Principal got a visit to his office by representatives from the American Legion.

They told him that unless he stopped us from tabling, they would stop donating money to Bloomington Public Schools. Our principal also got a call from the District Superintendent, who had also met with the American Legion, and the District Superintendent also instructed him to shut down our club, Youth Against War and Racism.

This repression of our rights follows months of negotiations with our Principal to get the right to set up a table. Last December, the Bloomington School District lawyer finally gave his opinion that we had the right to set
up a counter-recruitment information table when military recruiters came to Kennedy. On 8 December, the recruiters came, and our counter-recruitment tabling met with huge success. Over 230 students signed our petition against military recruiters being allowed into Kennedy High in the following days.

Our Superintendent and Principal allowed themselves to be blackmailed by the American Legion. We immediately decided to fight this suppression of our First Amendment rights.


Socialist Alternative member, Ty Moore, describes how the Kennedy students' solidarity appeal forced the authorities to back down:

On the evening of 23 February, about 14 Kennedy students gathered to discuss how to fight back against this attack, and decided, among other things, to defy the order and set up a table anyway, whatever the consequences.

On the morning of 24 February, they gave out 300 flyers, explaining the issue to their fellow students, demanding their free speech rights, and urging students to join them at the lunch table to show support. Also, the flyer advertised an after-school teach-in/protest, and urged students to have their parents call in to the Principal and Superintendent to complain.

Also that morning, thousands of Minnesotans woke up to find in their email inboxes an appeal for solidarity, urging them to call the Principal and Superintendent. A press release was sent out, as well, explaining the attacks on students? rights, and calling an after-school press conference.

At lunch, shortly after the students set up their table, the Principal and other administrators approached the students threatening three days suspension if they didn't leave. When the students refused to leave, the administrators physically grabbed all their literature and told them the afternoon teach-in (in the school cafeteria) was cancelled.

The Principal demanded they stop asking people to call his office to protest.
"It?s been overwhelming," he said.

The students packed up and went to the Superintendents office across town, and had a meeting with him. By this time, it seems the Superintendent had also received many protest phone calls. He realised the students would not back down quietly, and that they were capable of mobilising community support. So, when the students talked to the Superintendent, he tried to play the whole thing down, as a big misunderstanding. He said that from now on they would have permission to run information tables when army recruiters came.

So the teach-in protest after-school turned into a teach-in/victory meeting, with around 30 students and 10 community supporters in attendance.

Alongside three speakers (Vets for Peace, Palestinian activists, and Ty Moore, from Socialist Alternative), Brandon Madsen gave a general summary of the previous two days of events, with a clear analysis of why the students had won. Many of the other students got up and said their piece as well, describing the days? events. The main Minneapolis newspaper, two radio stations, and the Bloomington newspaper all sent reporters."

It is small victories like this, that will build up into a massive movement against the war in Iraq, and for social justice in the US, Britain and across
the world, so this is a message from 'Thinking Nurse' saying well done to Ty and Brandon, and all their comrades in Youth against War and Racism and at Kennedy High School.

Thursday, February 24, 2005

You can now Email Thinking Nurse

I have set up an email address so that people who wish to make suggestions, comments, or even complaints about the Thinking Nurse blog and it's content can now send an email to me.

I dont want to get overrun by spam from spiders and other automated crawling web devices, so I am putting some extra characters in the address - take out the 'x's and 'z's and you have the email (alternatively just click on the 'email' button at my profile.

Here is the address for your comments and feedback:

Nursing Blog Roundup

I have previously posted on the need for more nursing blogs, and I hope to use this blog to encourage the development of a community of nurse bloggers.
To this end, this roundup will look at highlights of some of the best, and newest of the nursing blogs I have found so far.
This is by no means an exhaustive list - there are millions of bloggers out there, and a fair number of them must be nurses - the more we post, search, and link with each other, the more we can draw together - so if you are a nurse who likes to blog, please post below.

One nursing blog that has made a big impression on me is 'Baskets of Blessings', by 'Barbara' particularly her post 'True Story': True Story where her living experience burns through the screen: "The abuse began again. My husband had drank when we first got married and for awhile after. He was a bit rough with Matt. He would spank him and leave whelps. He would spank him for such stupid reaching for things in the store. What child less than two years of age doesn't?? Then it got better for awhile. He quit drinking and we were much better off for a year or two. I hadn't been beaten in awhile...or abused much. He would punch me in the head with his fist so that no one could see that he hit me. Sometimes he'd keep me up all night for several nights denying me sleep until I was delirious. He smashed things against the walls....threw phones through windows...broke things that meant a lot to me...force me to have sex against my will....etc. Then he had started this back. This time though, he was chasing Matthew through the house like a madman, spanking him and telling him that he'd get it worse if he told me when I got home from work (I didn't find out for awhile), throw things at us, smash things on the wall over his head for the scare affect, throw him across the room onto the couch or a bed, ask him to answer questions that he couldn't possibly answer and make his punishment worse when he didn't...and on and on."

We like to think of nurses as cool professionals, but we are also human beings, with real experiences who need to name our worlds and share them, there are many people, including many nurses who will have shared similar experiences to Barbara, she has done them all a service by daring to write about them so honestly.

This post from 'Third Degree Nurse' describes some of the real fear felt by Nursing Students, even mature experienced adults with existing academic qualifications ; What Is This Fear?

"I keep thinking if I could name this fear it will dissipate. It is not real and I won't let it consume me.

However, I do recognize that my stomach has been upside down and, quite unlike me, I have not been able to sleep.

It's been this way since I got accepted into the nursing program.

Maybe I read too many nursing blogs. There are a lot of horror stories out there, people. Some are as bad as some of the things I remember from the state school (although that was often more comic than tragic) or corrections.

And now my math phobia has resurfaced."

I have been in a class of nursing students attempting to work out dosages, and it is a real eye-opener!

In this post 'Head Nurse' describes the single downside of nursing: Downside of Nursing "There is, near as I can tell, only one real downside to nursing as a profession.

I'm not joking, people. The hours are long and the pay can be miserable, but there's always another (possibly better) job out there. Physically, it's hard work--but there's always another (possibly better) job out there. Patients and coworkers do share bugs with you now and again, but you get better. Mostly. Even the caffeine addiction can be broken, with time and careful medical management.

No, friends, the downside of which I speak is Not Being Able To Dress Oneself Any Longer."

Tomv32 in his brand new blog, posts on his experience of the problems experienced by relatives with strong religious beliefs: Prayer
"The problem is not the people feel better if they pray. The problem is that people count on God to do some thing that is just not going to happen. The more religiously conservative a person is the more likely they are to believe that God will actually help them. I an a nurse and have seen several people die. The more religious a person is the harder the death of the loved one is because they have asked God to heal their family member."

Nurses can write poetry too - as Heidi proves in 'Tales of an Aspiring Nightingale" Tales of Aspiring Nightingale here is an extract from her most recent:
How I nearly plunged into ecstasy
when I pulled you over
my hips
and fastened you
just below my waist
your softness caressing every inch
of my legs
The image of you and me
as one
showed me
how you fit me like a glove
how you held my thighs perfectly
how you molded my backside
into two perfect orbs"

(It is an ode to a pair of jeans!)

Finally, this post from the excellent 'Seyms Nurse in Training Blog' Seyms argues convincingly for more nurse involvement in the drafting of National Institute of Clinical Excellence Guidelines (very relevant as NICE issued new guidance on managing violence in Mental Health care environments yesterday), and for nurses to advocate more clearly for their profession:

"I am suddenly more aware of the need rather desperately for nurses to advocate more vocally for their role and perspective which, after all, is forged uniquely in 24hr hands-on-care of clients. In order to do this it may even be needful for some to get over the "identity crisis" I sense in Psychiatric Nursing. "What should we be doing and how should we be doing it?" is highlighted, too in the article by Phil and Poppy. I have seen mental health nurses in the community fight tooth and nail to distinguish themselves from social workers and other MDT members but we need something a great deal more positive than "we have a different training" and something a bit deeper than "they do sections and we do depots.""

I think these few extracts demonstrate the vast creative and thinking energy that exists out there among the nurse bloggers - so lets nurture this!

If you know of a good nursing blog, why not leave a link to their best post below!

Wednesday, February 23, 2005

Holocaust Memorial Wreath Incident Sparks Stupid Prosecution

Martin Gleeson, secretary of the Oldham branch of the Trade Union AMICUS was arrested on holocaust memorial day, for placing his Trade Union's wreath on top of that of an unauthorised wreath placed by the notorious fascist group the British National Party. He was immediately arrested and charged with criminal damage to the BNP wreath, which cost £20!

The BNP leadership have a history of racism and of denying that the holocaust even happened. Was their attendance at this memorial day an organised attempt at provocation?

Martin Gleeson has had hundreds of messages of support from Trade Unionists, Socialists and Anti-Fascists. To add to this flood of outrage at this needless and expensive prosecution, visit

(for the BBC report on this, click on the title of this post)

Tuesday, February 22, 2005

Thinking Nurse Highlights

The acceleration in readership of this site is continuing - I am aware that many people come to this site, and will read the post at the top of the pile, and maybe miss out on reading some of the articles which I consider to be most worth reading.

This post will list some of the articles which I have had the best feedback about, or which have created the most discussion:

One of my first posts at this blog is 'A charter for human caring in nursing' where I point out some of the difficulties of offering full human solidarity and human caring with our patients/clients in modern society, I think this post 'set the tone' for the rest of my blogging.

The next big post would be The Twisted History Of Margaret Sanger, Woman, Rebel, Nurse, Oppressor where I evaluate the strange political and ethical journey taken by this radical nurse, from socially conscious anarchism to the clutches of the eugenics movement.

This post on the 'Gassing of Aloisia V; Hitler's Mentally Ill Relative' goes further into the question of eugenics, and the culpability of healthcare professionals, including nurses in the so-called 'euthanasia' of hundreds of thousands of people with mental illnesses, and physical and mental disabilities that was the first part of the holocaust.

This post: More on Raskin and Rogers - Nursing, the Humane Interface explores the role of the nurse as a 'humane interface' between the person and the health system, using Jef Raskin's graphical interface with computers as an analogy for this role.

This book review Tregaskis, Constructions of Disability highlights a brilliant piece of experiential qualitative research that I think is highly useful to learning disability nurses, and other people working with people with learning disabilities.

This post:Theistic and Humanistic Nursing is the one that has caused the most discussion, but I am surprised that I have not had more comments on my attack on the Harvard Referencing System: .
Harvard Referencing System - A Bizarre Academic Ritual where I turn the techniques of evidence based critical thinking nursing onto the practices of the academics who taught us them!

Here is an interesting article on the new internet phenomenon known as Blog Therapy

Back to the subject that concerns my work most directly - this is an important post on the continuing 'discrimination suffered by people with learning disabilities in their access to healthcare'. It is time for health professionals to make that little extra bit of effort to make their services accessible to ALL their users.

Finally this post on the banning of hunting with dogs: Hunting Ban - Will it work? is at least worth a look, just to find out the weekend habits of some members of the British establishment!

I hope most readers who come here have been enjoying their experience, and getting something out of it - I am always open to suggestions...

Monday, February 21, 2005

Carnival of The Godless

The fourth 'Carnival of the Godless' is now online, at this site: Philosophy Etc.
I would have posted about the existence of this carnival at it's inception, but only learned of it's existence in the last few days. I immediately posted my article on 'Theistic and Humanistic Nursing' to it's administrator, and am pleased that they accepted it for the carnival.

The idea of a 'carnival' is a great way of encouraging quality blogging. Basically a blog author announces a carnival and calls for articles on a certain topic, bloggers then post in their best work on that topic, the carnival host then makes a post containing links to all the best articles - a great way for bloggers to get together, exchange opinions and ideas.

Perhaps some of the Nurses and other Health Professionals who blog (plus other people with opinions on health - health belongs to everyone after all) could think about starting a 'Carnival of Health'. Anyone who would be enthusiastic about such an idea should post below, as it takes a few enthusiasts, and a few excellent articles to get anything like this off the ground.

Defend the Iranian Bloggers

This is an emergency alert to all bloggers.

Visit this blogsite now:

The reason for the emergency: two bloggers have been detained by the Iranian authorities; they are Mojtaba Saminejad and Arash Sigarchi here are the links to their stories:
Please visit the Committee to Protect Bloggers Site and take the suggested action - if all bloggers act together, we can show our collective strength and perhaps help the cause of Freedom of Speech.

(I had to take the pictures out of this post as it was bloggering up the way my blog displayed!)

'Choice', Smoking and Health Promotion

I got rather animated, even "abrasive" in a recent discussion on the International Council of Nurses Student Nurses Discussion Boards here:

It was a discussion about smoking and whether Student Nurses who smoke can give health promotion advice. I felt that a lot of the posters were thinking in terms of 'individual choice', either in the argument 'it is someones choice to do it, so we should respect that choice' or the other argument 'it is their choice to do it, so they deserve everything they get'. I disagree (at least partially) with both these arguments, and feel we need to think a lot more deeply about how we go about promoting health - to find out why, read on....

I think 'choice' is one of the most misused words in the dictionary - particularly in the modern world.
I had a 'choice' of whether I shop at the local greengrocer, butcher and baker, or whether I go to the big multinational superstore that opened up out of town - until those shops went out of business because the superstore was there. Now my elderly neighbours who dont have cars have to eat convenience food out of packets bought from the local newsagent (the only source of food within walking distance) - so much for their ability to make healthy choices...

We are told that smoking is a 'choice'. But of course once you're hooked, it isn't a choice any more, if it ever really was in the first place - how many smokers out there ever made a conscious decision 'I am going to be a smoker' - most people get into smoking by having the occassional cigarette with friends at school - they dont think about it any more deeply than that, until they are on 20 a day...

Then the health fascists (I.e. nurses!) tell them that they should give up smoking, otherwise they will not be entitled to certain treatments, and The insurance companies jack up their premiums.

Noone looks at the amount of tax smokers are paying on their habit, (far more than the total cost of smoking to the health service), or at the fact that because smokers die earlier, they save the state and pension companies a fortune in pension payments, and noone says 'perhaps these people are just as entitled to health services as the rest of us?' because their behaviour is 'self-inflicted' and they deserve everything they get - dont they?

Smoking is an addictive behaviour, so is drug taking (illicit or prescription), alcoholism, overeating, dieting, getting tattooed, gambling, self harm, marathon running, extreme sports, cult membership, church membership, surfing the web and writing blogs.

Some of these behaviours are more harmful to a person's health than others, but once you get into them, it is very very difficult to get out.

People who have no knowledge of you, or the things you are dealing with by using these behaviours, are not helping when they judge you for them.

Such people are very, very unlikely to succeed in ever persuading you to change these behaviours - and when they do, chances are you will replace them with something else far worse, unless they can come up with something better that fills the same function as the original addictive behaviour.

As for nurses - we indulge in all the behaviours listed above, and many more - even though we know slightly more than the general population about the harm these things can do. We do them because we are human beings in a stressful job, and stressful situations, and we use them to cope, just like the rest of the population.

Time to get real - if we want to promote healthy behaviour, and healthy lifestyles, we are going to have to get into things a bit more deeply than simply preaching the gospel of fresh fruit and vegetables, exercise and non-smoking. Nobody listens when they are preached at. They have heard the same message a million times, and it hasn't worked. Perhaps instead we can share information, and explore together with real people ways of making our lifestyles better, in ways that fit in with real lives and circumstances?

And perhaps we can also explore some of the social and economic reasons for unhealthy behaviour - such as the demise of local greengrocers and the rise of supermarkets and multinational fast food chains. Such as the brewing and gambling industries funding political parties so they can get more liberal licensing laws. Such as the long working hours culture that leads to high levels of stress - stress being THE major factor in inducing people to behave in ways that are harmful to their health. Such as POVERTY, the biggest single factor in ill-health by a mile, and at the root of so many other problems.

If we want to really promote healthy lifestyles, we are really going to have to think at a deeper level about why our society seems to be promoting precisely the opposite?

One place to start: The film 'Supersize me'.

Saturday, February 19, 2005

Hunting Ban - Will It Work?

Today was the first day that it became illegal to kill live quarry with dogs. But there were probably more people out 'riding to hounds' than at any time in the last 30 years. They are attempting to exploit the loosely written nature of the anti-hunting law, by pretending they are following aniseed trails and suchlike, and if the hounds catch the trail of a fox and follow their 'natural killer instincts' and tear the fox to pieces, why that would just be an unfortunate and unintended accident, entirely unforeseeable that such a thing might happen...

I dont usually get that animated about 'animal rights' issues - they are well down the scale of importance for me compared to the many abuses of human rights that happen every day, and I am prepared to put my neck on the line and defend the use of animals for medical experimentation, simply because of the many human lives that have been saved by the discoveries that these experiments have supported, however I do find the idea of watching animals getting torn to pieces by dogs a rather distasteful way of gaining pleasure in the 21st Century.

Now that it is illegal to hunt, I was wondering whether all the anarchists who used to follow hunts in order to disrupt them would be out trying to support them in their law-breaking, and defend them from the oppression of state forces. Actually of course, the anarchists, in a quite bizarre role-reversal are now acting as civilian law enforcers, videoing the hunts to try and prove that they are indeed acting illegally, and to goad the police into taking action (which I think they are very unlikely to do, given the class backgrounds of the people who participate in hunting).

Making the hunt illegal could actually make it far more popular: - the savage pleasure of watching a wild animal being slaughtered by a pack of dogs, will now be seasoned with the additional spice of knowing that you are doing something illegal, and getting away with it. Banning things has a very poor success rate for making people stop doing them.

The magistrates, justices of the peace, town councillors and police superintendants who still enjoy their bit of hunting every weekend, will be going back to work on monday and coming down hard on working class youth from the local council estates, handing out ASBOs, curfews and electronic tags, for breaches of the law that some might consider less violent, aggressive and illegal than what they themselves had been up to the day before. So much for the 'classless society'....

Friday, February 18, 2005

NHS Pension Robbery

I was standing in the cold and rain outside a hospital today, with about 50 other UNISON members, to protest about the government and management plans to change our pension rights.

Basically there are two threats - one is to raise the retirement age for all NHS workers to 65 - this seems madness - are they expecting 64 year olds to staff orthopaedic wards? The consequence of such a policy will simply be to raise the number of nurses and other staff 'on the sick', as backs and morale give way.

The other is to get rid of the final salary pension scheme, and bring one in based on career average salary. If this is such a great option, why havent MPs and top managers chosen it?

Now is a good time for public sector workers to be protesting about these things, showing Tony Blair for what he is, as there is a general election on the way.

The other thing that really annoys me, is the way our union, UNISON, is funding the Labour Party, despite all the attacks the Labour Party carries out on public services - PFI, Foundation Hospitals, and now this dipping in to our pensions. We are literally 'feeding the hand that bites us' as Roger Bannister put it.

It's time for our unions to stop giving money to Mr Blair and the Labour Party to help them attack our public services, and our public service workers, and instead start to use it for campaigns to defend the membership and the services we deliver.

Thursday, February 17, 2005

Religion and Patient Care

My recent post on the differences between theistic and humanistic nursing has generated considerable discussion, the vast majority at an excellent level of reflection and argument.

Some though think that I should not be bringing the issue of religion into it at all :quote:
The RELIGIOUS groups that you speak about that are terrorizing the world have nothing to do with the care of patients.

Unfortunately of course, they do; through the promotion of beliefs such as the division of the human being into two parts - body and soul, religions have had a huge impact on human health, particularly as religion emphasises the primacy of the soul over the body, allowing religious people to 'mortify' their bodies for the benefit of their souls, and to participate in violence against other people's bodies - where this is believed to be in line with 'Gods will' (I.e. the tortures of the Spanish Inquisition, or the infamous crusade against a town where many 'heretics' lived, where the instruction was 'slay them all, the lord will know his own', as well as the oppression of the female body through institutions such as purdah, hijab and 'female circumcision' - in reality genital mutilation). On top of all this comes the denial and suppression of human sexuality, leading to mental anguish, and worse.

A full assessment of the impact of religion on human health could well be the subject for another 'Thinking Nurse' post, as I dont have time to cover it all today - I do recognise that there can be positive effects too, particularly those associated with 'belonging' and sociability.

Religous groups do participate in health care provision - particularly where there is no, or minimal state provision, and they do so in a way that is affected by their religious dogmas, certainly they are strongly influenced by teachings about 'charity' and by the opportunity for proselytising, while I would regard health as a 'human right' rather than something to be given to 'the deserving' and held back from the 'undeserving', and the delivery of healthcare as a form of 'human solidarity', due to everyone regardless of religious orientation, ethnicity, gender, disability, sexuality or perceived morality.

Patient care is affected when religious groups attack family planning clinics and the nurses and doctors who staff them, or when AIDS awareness programmes are interfered with, or when people are taught that illness is a product of 'sin', that disability is the product of bad karma from a previous life, or a punishment for the sins of that person's parents, or that mental illness is due to possession by demons, or when creationism is taught in schools as 'fact' disrupting the scientific education of the new generation of human carers.

None of these attitudes encourage people to seek help for their problems, instead they encourage shame, guilt, ignorance and stigmatisation. This is a type of 'spirituality' that our patients and clients do not need.

I therefore make no apology for raising this issue. It is one that nurses at least need to think about, even if they do not agree with everything I have said.

People with strong religious beliefs have a right to have their beliefs and customs respected - I feel that atheist and humanist nurses can respect the beliefs of others, where people with strong, but different religious beliefs can find it difficult.

Personally I have been involved with taking my clients to churches of many denominations to participate in worship - I feel this accords perfectly with my own atheism, as I am enabling my client to express their own spirituality, and participate in the wider community, though often I have cringed at what is being spouted from the pulpit!

Harvard Referencing System - A Bizarre Academic Ritual

Every Student Nurse, in the UK at least, will know the misery created by the Harvard Referencing System, the method our tutors, and presumably the NMC, the Department of Health and the Quality Assurance Agency think that student nurses should use to reference their work.

As a consequence, students spend hours torturing little blocks of text, agonising over whether to italicise the Journal Title or the Article Title, scanning through textbooks to find their year of publication and the city where they were published.

Of course we are being taught to be 'critical thinking nurses' - to examine and scrutinise our practice, to seek out and destroy 'nursing rituals' that are there for no apparent reason, apart from 'thats the way it has always been done'. Practice must be justified with evidence that it is actually of some use.

Perhaps it is time to apply this method to the bizarre academic ritual that is the Harvard Referencing System. Here are a few questions we could use to interrogate the practice of using it.

What use is it to patients that their nurse knows how to reference an article?

Does use of the Harvard Referencing System provide any evidence of either a nurses' practical skills or of their ability to think?

Does use of the Harvard Referencing System make a student nurses essay any easier to read, or their message any clearer?

Does the Harvard Referencing system provide any more useful information than a simple bibliography at the end of an essay?

Should a nurse fail their course because they cannot get their head round how to reference correctly?

Of course the answer to these questions is NO! Patients and clients do not care one jot about the Harvard Referencing System, or whether their nurse knows when to use bold text in a reference.

Using the Harvard referencing system is a mindless rote exercise - it demonstrates a student's ability to unquestioningly obey arcane rules - precisely the kind of thinking that is meant to be discouraged by the modern nursing 'critical thinking' curriculum.

Articles written using the Harvard Referencing System are difficult to read - the flow of an argument is constantly interrupted by irrelevant names, dates and page numbers. We need to be trained how to present clear, easily accessible information to our clients, instead we are being trained to make our essays into headache-inducing mazes of references.

I can understand the need to use references correctly when writing for a peer-reviewed journal - here the provenance of ideas and facts becomes an important issue - but is it really neccessary for student nurses at undergraduate level? At this level, a simple bibliography should suffice - tutors would in reality be just as able to detect plagiarism, poor thinking and invented facts using this system as with Harvard.

The fact is that some student nurses do fail because they lose marks for referencing (and conversely, perhaps some pass because they can reference, even if they are not good at much else?) Should this process really be part of how we select who should become a nurse?

Perhaps there are legions of fans of the Harvard referencing system out there, who can explain why it is so vital that nurses should be able to reference a parliamentary paper correctly - if there are, I hope they will post here and explain it to the rest of us!

Tuesday, February 15, 2005

Theistic and Humanistic Nursing

Theistic and Humanistic Nursing

As an atheist, and a humanist, my view of nursing differs fundamentally from those (perhaps the majority of nurses worldwide) who approach nursing from a theistic perspective. Bringing God into nursing however leads to huge logical and practical problems for nursing thought.

One theistic nurse, for example, writes: “I believe all humans are created in the image of God. For me this provides a rational basis for loving and caring for one another that is stronger than humanism's strongest (which still befuddles me)”

The theistic justification for caring for human beings is thus that they are made in the image of God, and God is more important than anything (including human beings).

The humanistic justification for caring for human beings is that they are human beings – and being human is what ultimately matters.

Theistic nursing is serving God, a spiritual quest expressed through the medium of the people who present as patients. Humanistic nursing is showing solidarity in a human way with other human beings

Putting a divine being above the human race, and arguing that the divine, the spirit, the soul, is higher than the human being has immense dangers. How many wars, massacres, genocides have been justified by claiming that these are spiritual ‘crusades’, with the backing of the divine? This is one consequence of placing the spiritual above the human.

Another danger is this question of the ‘ideal man’ – if we are made in the image of God, and we are all so different, some of us must be closer to the image of God than others. Traditionally religions have argued that men are closer to the image of God than women – one reason why they have resisted the idea of women priests. Presumably they also imagine that non-disabled men are closer to this image than men with disabilities, mentally stable men closer than people suffering from psychosis.

My theistic friend falls into this trap “ Even the mentally ill or deformed are still made in his image”, the words ‘even’, ‘still’ and ‘deformed’ speaking volumes about the theistic attitude to humanity.

A Humanistic view of nursing avoids this pitfall. For humanists, there is no ‘ideal’ human being. Humanity, in all it’s wonderful diversity, is a material fact that we accept. ‘Nothing human is alien to me’ was Terence’s humanistic, accepting and tolerant concept, expressed in 154 BC. If humanity had followed such sentiments think of the wars, witchunts and persecutions that might have been avoided over the last 2000 years, the human beings that might have been accepted instead of being shunned, or actively hunted down, by the theistic majority.

For humanists, nursing at it’s best, is an activity conducted by one human being, in a human way, with another human being. The nurse is attempting to open dialogue with the person in front of them, find a way to connect, as one subjective human being with another. This is all. There is no ‘hidden agenda’ of seeking to find the divine in another human being, or to serve God through that human being – the agenda is simply to find, and be with that person, for who they are. This makes humanistic nursing achievable, realistic, rooted in the material rather than seeking to ask nurses or their clients/patients to rise above or reject their humanity.

Of course this humanistic nursing is frequently not achieved. It is difficult to be human and behave in a human way, it is difficult to reject our programming and accept people rather than judging them, it is difficult to ‘be with’ rather than ‘do to’ in understaffed, bureaucratic, undervalued environments and to reject the social prejudices that divide humanity – even so, it is vital that we struggle toward it, for otherwise we become part of the system of prejudices, theologies, bureaucracies that exclude and oppress so many of the people that nursing serves.

Thursday, February 10, 2005

Need for More Blogs By Nurses

There is a definite need for more blogs by Nurses. According to Seyms' Nurse in Training Blog, there are currently only 6 (including Thinking Nurse and Seyms - if you know of any more, please let me know!).

Why is it useful for nurses to blog?

Nursing is an incredibly diverse and exciting sphere of activity. Nursing penetrates into every aspect of life, every social sphere. We see and experience things the rest of society likes to pretend are not there. We go to places that the rest of society would prefer not to go. We interact with people who exist on the margins of conventional society and learn things that society collectively ignores. This means that nurses have (many) unique perspectives that should be expressed and shared: - Shared with each other, because we are often dispersed and atomised, constrained within hierarchies and bureaucracies, and shared with society, because our messages, once expressed, debated and digested can enhance the physical, mental and social health of whole communities.

This article explains a lot of the benefits of the web-based knowledge log: . Blogging is a method that nurses can use to reflect and communicate, to speak about and name their worlds. Blogging can foster an "unsettling (to the powers that be) critical consciousness that is within the goals of an increasingly democratized culture"

By blogging, we are adding to nursing's collective knowledge, spreading ideas and questions, gaining support and strength from each other, providing a new interface between nurses and their clients.

How can nurses blog?

Practically, it is actually very easy. For example, it took me approximately an hour to start off this blog. I do not know how to write computer code - and I have not needed to write any.

Everything I needed, including the basic template was provided free. Once the template is set up, it is as easy to post to a blog as it is to send an email. This blog does not cost me a penny to run, and can be updated during a lunch hour, from anywhere that has internet access.

What should go into a nursing blog?

The blog belongs to the person (or people) who are writing it. It's content is therefore 100% determined by them. Basic nursing ethics, such as patient confidentiality should be observed, beyond that I feel nurses should be free to use their blogs to express ideas, ask questions, tell stories, write poetry, share practice, debate, boast, complain, laugh and cry.


If you try to set up a blog, you will be offered the opportunity to put advertising on your blog. I have resisted this pressure, as I want this blog to be entirely independent of the drug companies and other big multinationals that see healthcare as a vastly lucrative market. (Now supplemented by the companies involved in PFI and PPP).
The Nursing magazines that depend on these companies for advertising cannot, by definition, ever be fully independent, and 'bite the hand that feeds them'. I would strongly advise writers of other nursing blogs to resist the temptation of what in actual fact is likely to be a few pennies, and not allow their blogs to become points of support for these companies.

If you are a thinking nurse, it is time to get blogging!

Sunday, February 06, 2005

Parenting With a Learning Disability

The other day I was privileged to listen to three mothers with learning disabilities talk about their experiences of bringing up children.

It was inspiring to see how these women had managed, despite all the attitudes and prejudices against them, to bring up children, and to gain the courage to speak about their lives.

I am a firm believer that all should have a voice, because we need to name our worlds in order to change them. These women had been involved in a self-helping support group, for only eight months, and were now going to conferences and speaking publicly, while still managing to get home in time to pick up their kids from school.

They spoke in particular about their difficult relationship with services. In order to succeed as parents, they needed a network of support - which included family, friends and professional input, particularly in times of crisis. However they lived in constant fear that their children might be taken away from them, often making them reluctant to ask for help when they really needed it.

Research by people like Booth and Booth (available from ) found that 14 out of 20 parents with learning disabilities had one or more of their children placed in short-term or permanent care. Can we be confident that in all these cases, everything had been done to give the parents the chance to care for their own children? Services tend to look at parents with learning disabilities with a 'presumption of incompetence', and often have conflicting responsiblities, reacting to crises rather than putting in training in parenting skills (it has been proven that parenting skills of people with learning disabilities can be improved through training) and long term background support - there to be called on when needed - evidence shows that adequate social supports can protect against parenting breakdown.

Such social supports include support from family and professionals, but could also be adequate benefits, decent housing and proper access to health services.

Despite this Cross and Marks (1995) found that 13 children from 18 pregnancies of women with learning disabilities were subject to child protection procedures 7 of these started within 1 week of birth, 6 of those 7 starting at birth itself.

A single minded concern by services with parental inadequacies can lead to self-fulfilling prophecies.

There is clearly a need, if we are to take the principle of 'ordinary lives in the community' seriously, for attitudes to change, and for services to use an enabling approach, that creates opportunities for parents to develop and demonstrate their competence, and that seeks ways to give parents a sense of control over their own, and their childrens' lives.

I asked the women "If you were approached by someone with a learning disability who wanted to have a baby and start a family, what advice would you give them?"

The reply was a unanimous "Go for it, and fight for the right to keep your child".

Tuesday, February 01, 2005

Star Rating System of NHS Acute Hospitals

This press release from the Royal Society of Medicine describes a study that illustrates what many of us have believed about the NHS star rating system since it's inception, that it is a fairly arbitrary process, riddled with problems, that often does not mean very much and can lead to 'misrepresentation of data' (a phrase that translates into English as 'telling lies') and other practices that are not in the interests of patients ('unintended and dysfunctional side effects'). The big problem is that such ratings can influence major funding decisions which can drastically affect local healthcare services:

"The problem with NHS star ratings
Since 2001, the star rating system of NHS acute hospital trusts have given the public the ability to compare one hospital from another using a standard evaluation process. What are the consequences of the results, and is this enhancing patients’ experience in NHS hospitals? Dr Russell Mannion and colleagues at the Centre for Health Economics, University of York present new research in the current issue of the Journal of Health Services Research and Policy, published by the Royal Society of Medicine Press.

The ‘importance’ of star ratings
Although the star ratings system is not the only process in place to measure the performance of NHS acute hospital trusts, the ratings system and its results gain broad media exposure and is therefore scrutinised by the public. They are also viewed as a benchmark for internal processes. ‘In addition to facilitating accountability to patients and the public, they also serve as an important tool for concentrating management attention on key strategic priorities and national targets,’ Dr Mannion writes.

Are star ratings a ‘balanced scorecard?’
Staff members at some of the hospitals surveyed thought that star ratings ‘did not represent a rounded or balanced scorecard of their own organisation’s performance.’ One of the inconsistencies of the NHS star ratings system are the sometimes conflicting results of similar, commercially-funded surveys, the author says. These differences are ‘assumed to be due to the increased weight accorded to clinical indicators in the methodology used’ by other organisations, the article states. Other complaints from staff included that they did not take into consideration ‘local contingencies’ and specific ‘mitigating factors that might help explain variations in the measure performance of hospitals.’ Many of these unique conditions are beyond the hospital’s control and it is therefore viewed as unfair that this would not be taken into consideration when the rating is calculated.

Inaccurate data is ‘not in the patients’ best interest’
This study also highlighted the ‘widespread belief that the data used to calculate the star rating were often incomplete and inaccurate,’ Dr Mannion says, to the extent that the staff at one highly-rated hospital admitted to ‘purposefully manipulating and misrepresenting data in order to improve their rating.’ Some of the tactics used included scheduling cancellations at a time to avoid unfavourable data and re-classifying trolleys as beds. One hospital with a low rating thought this was a result of the accuracy of their data, and another expressed concern that this practice was ‘not in the patients’ best interests.’

Responses to star ratings
In addition to the data and methodology of the star ratings system being evaluated, the internal effects is also relevant in determining its integrity. There were many positive hospital responses to the star ratings, including the alignment of ‘internal performance management and reporting systems with key national targets.’ The communication between central government and hospitals was improved and ‘dysfunctional senior management’ was identified that otherwise may have stayed hidden within the hospital, Dr Mannion asserts. The negative responses included ‘evidence of tunnel vision and a distortion of clinical priorities,’ reduced staff morale and public trust, and ‘bullying and intimidation.’

‘Gaps in knowledge’ and ‘dysfunctional consequences’
The authors conclude that ‘this study highlights some important gaps in knowledge and failings in current policy and practice. That star ratings may be used for good or ill makes it imperative that the Healthcare Commission monitors the impact of these data, not only in terms of the degree to which they lever beneficial change, but also in terms of any unintended and dysfunctional side-effects they generate for patients and staff.’


Nursing and Sex Role Stereotypes

Nursing is typecast as a feminine profession, but as this rather excellent website demonstrates male nurses have played a key role in nursing since the earliest times.

The first nursing school was set up in India in 250bc it would train men,

"of good behavior, distinguished for purity, possessed of cleverness and skill, imbued with kindness, skilled in every service a patient may require, competent to cook food, skilled in bathing and washing the patient, rubbing and massaging the limbs, lifting and assisting him to walk about, well skilled in making and cleansing of beds, readying the patient and skillful in waiting upon one that is ailing and never unwilling to do anything that may be ordered."
The Charaka (Vol I, Section xv)

There have been many male orders of nursing, including ‘The Parabolani’, the Benedictine Nursing Order, the Alexian Brothers, the Knights Hospitalers, the Teutonic Knights, the Tertiaries, the Knights of St Lazarus, The Order of the Holy Spirit and the Hospital Brothers of St Anthony. Some of these were monks, some soldiers, some both. There is a tendency to describe men who are actually carrying out nursing tasks as 'healers' or 'witch doctors', so the existence of male nurses has been edited out of a lot of history.

Male nurses are much more common in learning disabilities and mental health nursing than in general adult nursing, though the numbers are growing in every branch of nursing, as sex role stereotypes begin to break down.

However, some things do not change – male nurses tend to rise through the ranks more quickly and end up in management positions more easily than female nurses, reflecting the fact that sexism is still a powerful force, even in professions where women outnumber men.
It is in the interests of all nurses to challenge the sexual stereotyping of nurses, and the assumptions that give male nurses an easy ride into management positions.

Cost of the War in Iraq
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