Technorati href="http://www.technorProfile Thinking Nurse: April 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!

Friday, April 29, 2005

Nursing Moments: Last Call For Submissions

'Nursing Moments' is going to be the first nursing blog carnival in history!

You can be part of this historic moment, a major step into the information age for the entire nursing profession, but only if you submit your article before the deadline!

The deadline for submission of articles is 2nd May 2005.
Nursing Moments #1 will be published on or before 4th May 2005.

We still need a logo.

We need volunteers to host future editions, which will hopefully be published monthly, July is already taken, but June and August are still free.

Rush your contributions now to thinkingnurse AT coolgoose DOT com to be there at the start of something BIG!

General Election 2005 - The Most Stinking Election In Living Memory

On May 5th 2005, British voters will go to the polls, or more accurately, some British voters will go to the polls. The majority who do make it to the ballot box will be pinching their noses tightly with expressions of disgust as they mark their papers. Why? Because this must be the most stinking election in living memory - and we are faced with a choice between some of the lowest, vilest examples of the ways that the lust for office can distort human values.

I have been trying to avoid watching the election coverage. I knew it would make me angry. I didnt realise how much it would make me seeth with anger at the depths to which British politics have sunk.

The first thing I would like to do, is to ban politicians altogether from NHS premises (unless obviously they are using their services!). The sight of Michael Howard walking round hospitals, no doubt spreading vile bugs as he shook hands with patients without washing in between was bad enough, but the knowledge that the politicians, both Labour and Tory who enter these hospitals know full well that their parties plan to continue the creeping privatisation of the NHS, with more dodgy PFI schemes and more Foundation hospitals, and to raise the age at which health workers can retire, all the time that they are grinning and saying 'the NHS is safe in our hands' is even worse.

You can be sure of one thing - when a politician says 'the NHS is safe in our hands' you can be sure that very soon, there will be big business hands in the NHS safe.

The Tory election campaign has attempted to benefit from deep racial fears, targetting asylum seekers, immigration and Roma/travellers. This is unprecedented in a British General election, in the past politicians have been decent enough in general to avoid playing 'the race card'. This time round neither of the parties has felt such inhibitions as they vy to prove that they are the 'toughest' on immigration, without considering the major benefits that immigration brings to this country, the reality of the dangers that asylum seekers are fleeing from and the dark forces that their racist rhetoric could unleash.

The publication of the Attorney General's guidance on the legality of the Iraq war has led to clear evidence of the way that Blair, just like Thatcher, treats his own cabinet with contempt, using them as a 'rubber stamp' for his decisions (or more accurately the decisions that GW Bush has made for him). Michael Howard pretends he would have acted differently - we dont remember him questioning Thatcher's dictatorial approach to cabinet government. He accuses Tony Blair of being a 'liar' with perfect justification, but is just as vulnerable to the charge himself.

I have friends who are going to vote liberal democrat, but in the councils where they hold office or share power, they have enthusiastically implemented the same cuts and attacks on their workforces as the Labour and Tory administrations.

Other friends say 'I know Tony Blair is a liar and is privatising the NHS and attacking our pensions, but Howard will be worse'. This seems to be the main theme of Labour's election campaign 'we are not the Tories', 'Vote for anyone else, and you will let the Tories in'.

The reality for the NHS (and other public services), is that whatever the result of the general election, there are dark days ahead: Privatisation via PFI and Foundation Hospitals, will be stepped up. Workers will face further casualisation and attacks on their conditions, such as retirement age and pensions.

The future of our public services depends not on which dishonest bunch of politicians comes to power, but on the determination of public service workers, and the British people to defend them from these politicians, and the big business interests they serve.

Tuesday, April 26, 2005

International Nurses Day 12th May

May 12th will be 'International Nurses Day'.
The International Council of Nurses honour this day by raising issues that are important to nurses across the world.

This year they are highlighting the scourge of counterfeit medicines.
You can download their 'ICN International Nurses Day Kit' (a pdf file) here.

Last years kit featured their campaign against poverty. I think it is worth having another look at the excellent pack they produced then: Working With The Poor Against Poverty (ICN 2004)

As I have said before, issues like poverty are vital to health, but often swept under the carpet, as it does not suit those in power to highlight the awful health consequences of the economic systems they defend.

Monday, April 25, 2005

Nursing Shortage - RCN

This article on the flight of nurses from the health service suggests that recruitment of Nursing Students needs to DOUBLE to 66,000 a year if present numbers are to be maintained.

It strikes me that if you are pouring water into a bucket with a hole in the bottom, there are two ways to keep the water level adequate - either increase the rate at which you pour water in, or make the hole in the bottom of the bucket smaller! Rather than focussing on the need to recruit more nursing students, surely it would make more sense to try to address some of the reasons why nurses are leaving in the first place?

There are hundreds of reasons why nurses are leaving the profession. It is a tremendous waste of training, knowledge and experience. In the current general election, I have not heard the politicians speak a single word about this issue.

Health policies have clearly not considered adequately the needs of health staff, particularly where they contradict the needs of PFI companies.

The health service's most valuable resource is it's people - perhaps the government and the commissioners of healthcare need to start thinking about this, unless they plan to waste £millions more on training students who also end up burning out and leaving the profession early...

Thinking Nurse Share Prices Soar

I dont own any shares myself, and dont go in much for share trading (I have always questioned the value priorities of a society that rewards it's stockbrokers vastly more than it's care staff!).

Nevertheless, I have found it hard to resist taking a sneaky peak at the 'blogshares' rating of this blog. Perhaps this is a sign that to paraphrase Marx, 'in any society, the ideas of the ruling class are the ruling ideas of that society'. Here I have been assessing the success of my blog, not by the quality of writing, or it's contribution of ideas to the blogosphere, but by it's success on a virtual stockmarket. Cultural hegemony has arrived at 'Thinking Nurse'.

Despite all this left-leaning hand wringing, I cannot deny the pleasure I felt when I realised that someone had felt it worthwhile to take a gamble on the future success of this blog, and even more delighted when I saw it was HypnoKitten who had bought them, a person whose speculation has netted her a 600,772,271,679.81% increase in her share values in ONE MONTH. Makes you wonder if she thinks Thinking Nurse is capable of a growth in value of such proportions! Perhaps, like George Soros, anything she invests in will attract a wave of 'copycat' investments, making her choice of shares a 'self-fulfilling prophecy'...

On the other hand, perhaps she plans a takeover bid, then to sack half the workforce, get the other half onto casual contracts, then split up the blog and sell the bits on at vast rates of profit...

Lucky for me that Blogshares is just a 'piece of fun' that mimics the capitalist system, without any of it's nastier consequences.

In the meantime 'Thinking Nurse' will remain entirely independent of any shareholders or advertisers, and continue to put out content totally free from any commercial considerations. By the way, I find GloopCo Chocolate bars a satisfying meal on their own, and enjoy two or three every lunchime. Every nurse should have one in her bag, next to the big diary with a massive elastic band and a giant paper clip...

Friday, April 22, 2005

"Naming Is Not A Simple Act"

Bob Gates very recently changed the name of the 'Journal of Learning Disabilities' to the 'Journal of Intellectual Disabilities', and he reflects on why he did this in the editorial of the March edition of that publication.

People do not like to be labelled. Labelling people leads to all kinds of ramifications, and the disability movement has the slogan 'label jars not people'. People with learning disabilities have been, and still are, given the label 'mentally handicapped', 'retarded' 'subnormal' 'low grade' etc etc, but they themselves argue that they simply want to be referred to as 'people', like anybody else.

Rob Greig takes this approach in his Valuing People Support Team Report to the Valuing People Review Throughout the text, he refers to people with learning disabilities as 'people', which is of course, exactly what they are.

Nevertheless, people with intellectual/learning disabilities do have particular needs. Professionals who work with these people do need particular skills. In today's society, in order to get the support they need, people have to show that they meet certain criteria, and join the community of people with the label of 'disabled'.

Publishing a journal that is read by the professionals who work with people with Intellectual Disabilties is hugely important. The name of a journal can 'set the tone' for the attitudes we express toward the people we work with. Gates is aware of this

changing the name of this journal has been fraught with a degree of hesitancy on my part. This is because I wished the journal to have a title that had international meaning, but did not wish to further marginalise people with learning disability by adopting a title that might be seen by some as inappropriate, or even negative, nor be seen to further disempower people with learning disabilities. (Gates 2005)

I have thought for a while that the term 'learning disabilities' is confusing. It is very similar to the term 'learning difficulties' an educational term used to describe children with dyslexia and other problems that affect their learning. The confusion has affected some of the services I work at, with inappropriate referrals coming from people who have only a vague idea of what a 'learning disability' actually means, (including some professionals who you might expect to know better).

Perhaps Gate's use of the term 'Intellectual Disability' will catch on, and all the services will change their names to 'Intellectual Disability Service', and LDN's will describe themselves as 'Intellectual Disability Nurses', we will have to wait and see! (I can see tens of thousands of pounds from tight budgets being reallocated for new letterheads as we speak...)

The idea of an 'Intellectual Disability Nurse' is actually quite close to the pseudonym I chose to write this blog: 'Thinking Nurse'.

I chose this 'nym' for a variety of reasons:
* I am a nurse who likes to think.
* My blog 'thinks' about nursing.
* I work with people whose 'Thinking' is different from the mainstream, I am someone who supports and facilitates people in their thinking, making me literally a 'Thinking Nurse'.

"Nursing Moments" - Publication Date Announcement

The launch of Nursing Moments has created a buzz around some of the various nursing blogs.

I hope it will be a way that nurse bloggers can begin to draw together as an online community, sharing ideas, supporting each other, promoting the wonderful writing about nursing that is appearing every day in the blogosphere, and making sure that the best articles dont get lost like precious needles in the online haystack.

I hope it will also generate discussion and debate, and get people THINKING about nursing.

Nursing Moments #1 will be posted on or before May 4th 2005

The DEADLINE for receipt of your contributions is May 2nd 2005. send them to thinkingnurse AT coolgoose DOT com.

You dont even need to be a nurse to contribute! As long as the article relates to nursing and healthcare, it will be considered for publication. Poetry is just as welcome as prose.


We still need a logo - so budding artists out there get your pens and brushes out!

We need publicity - I dont want people to miss the chance to promote excellent pieces of blogging, just because they never heard of this carnival! Mention it on your own blog, get the word out!

We also need volunteers to host future editions of Nursing Moments. I think we should aim to publish it monthly, at least to start with. Hosting a carnival is not just a service to the nurse blogging community, but also a way of promoting your own blog, and generating lots of extra hits!

Think carefully - what have you written in your blog, that the rest of the world badly needs to see?

How To Pass Your Driving Test, And All Your Nursing Exams

Exams and tests are tough. They are highly demanding on the body, as well as the mind!

I tend to rationalise the sweat and misery they cause with the thought that if they were easy, they would not be worth doing.

I had a mock exam on Wednesday, and a driving test on Thursday morning. The good news is that I have finally passed my driving! I have failed this test twice before, last time with a total nervous 'shed collapse'. I think the examiner was as relieved as I was when we finally got back to the test centre.

Yesterday however, although I was nervous, I managed to control it, keeping the ride largely smooth and calm, though I was a jelly when I finished.

Is there a secret to passing exams and tests?

I dont really think there is. There are things you can do, like planning, revising, preparing yourself.

I find with exams that it helps a lot to actually be interested in the subjects that you are studying - if you are interested in something, you tend to remember the facts and ideas you will need to pass.

The other side I suppose is just not giving up. Nobody passes every time, and when you dont pass, you have to deal with the awful feelings that creates, then get back on your feet and do it all again.

The good news is that the more tests and exams you do, the better you get at them, so even an exam where you dont pass is not wasted effort.

Every so often, I try and think of a better, fairer way for nurses, or people who want to drive on the roads to demonstrate their abilities than at least partly in a test or exam. I really wish I could think of one!

Friday, April 15, 2005

Nursing Moments #1 A Nursing Blog Carnival is Launched

My suggestion that there should be a carnival for nursing blogs met with a surprisingly strong and positive response.

I have therefore decided to launch it.

It will be called Nursing Moments, being a title that can embrace all branches of the nursing profession.

If you are not a nurse, you can still post to it, if your post is related to nursing, nurses or experiences of the nursing profession (good or bad).

DEADLINE for receipt of links to your articles is 2nd May - send me them NOW!

I also need a nice logo for the carnival - if anyone is good at this kind of thing and willing to work for the glory of having their logo displayed on my page, and no money, please send me a link to your efforts (you will need to host your image too!).

As a newly launched carnival, it will also need publicity - please big it up on your own blogs, so that everyone in the 'nursey' part of the blogosphere gets to hear about it!


What has Learning Disability Nursing Got To Do With It?

This is another report from the 'positive choices' conference, continuing from the reports I made here: Bob Gates and Jason Grundy and here:PCP in Northern Ireland.

This time I am writing about Ruth Northway's speech 'But What Has Learning Disability Nursing Got to Do With It?'

Ruth Northway is editor of the RCN publication 'Learning Disability Practice'.
Like Bob Gates, she looked at learning disability nursing from the perspectives of past, present and future. Learning Disability Professionals, she said, became almost 'accidentally' part of the nursing profession, and the existence of learning disability nursing has been continually challenged, for example in publications like the Jay and Briggs reports.

This was a symptom perhaps of a lack of understanding of the role of the learning disability nurse.

LD Nurses have a position that is influenced by the views, wishes and needs of clients, by the views wishes and needs of families, by a changing professional context, by changing social policies and by changing models of service provision. Against such a background, one of the key attributes of the profession has been flexibility, indeed, according to Mitchell (2003) the survival of learning disability nursing 'depends on the profession's continued ability to change in line with government policy.' creativity and flexibility are part of the identity of the learning disabilty nurse (Turnbull 2004)

What is important however, is that LD Nurses should also be drivers of change, as well as simply responding to it. We need to be looking to the changing needs of the community of people with learning disabilities, for example the growing number of young people with profound and multiple disabilities, and the rise in the number of elderly clients, with even more elderly carers.

She pointed out there was a need for the development of practice, education and research to reflect such changing needs, in partnership with people with learning disabilities at individual, group and population levels.

She cited Kim (2005), Learning Disability Nurses need 'VIP' - Vision, Integrity and Passion.

Tuesday, April 12, 2005

One Year of 'The Unlikely RN'

'The Unlikely RN', a nursing student blog of genuine quality has reached it's first blog birthday. Join the celebrations here!

Congratulations to EmJC, the prolific author of 'The Unlikely RN'.

One thing is for sure, the nursing blogger community is growing in breadth, depth experience and entertainment value. It is equally certain that 'The Unlikely RN' is one of the shiniest jewels in that growing treasure hoard.

Cranial Nerve Mnemonic

I dont have to remember the names of the 12 cranial nerves, but if I did, I am sure I would remember them easily thanks to this rather splendid Cranial Nerve Mnemonic posted on the 'Journal of Genki' by Steve from the Shameless Antagonist blog.

The names of the 12 cranial nerves are:
olfactory, optic, ocolomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal.

The unforgettable mnemonic: "Only One Object Transcends Time and Foams Vivaciously: Glorious Vagina! All Hail!"

Anyone want to suggest a similarly memorable mnemonic for the titles of the 11 objectives of 'Valuing People' (2001), the British Government's White Paper that aims to improve the quality of life of people with learning disabilities by promoting Rights, Independence, Choice and Inclusion?

These are:
1. Disabled Children and Young People
2. Transition into Adult Life
3. More Choice and Control
4. Supporting Carers
5. Good Health
6. Housing
7. Fulfilling Lives
8. Moving into Employment
9. Quality
10. Workforce and Planning
11. Partnership Working

A good mnemonic will be of immense use to me, as one of my exam questions is on the implementation of Valuing People: so post your suggestions below!

Thursday, April 07, 2005

A Carnival For Nursing Blogs? - Who Wants One?

I have been thinking more about starting a Nursing Blog Carnival. Basically the definition of a blog carnival is where a group of bloggers each sends their best posts (or nominates other peoples best posts) to a central blogger, who collates them, then presents them as a 'carnival'. This is done on a regular basis, and the person who hosts the carnival can alternate. It is a great way of getting your blog more widely known, and of finding out about some of the excellent writing that is going on.


Why a nursing blog carnival I hear you ask - are there not already very excellent carnivals in existence, like the wonderful and popular 'GRAND ROUNDS'.

Yes indeed there are - and nurses have posted some excellent bits of writing there, (even I have put a couple of my own efforts up) but isnt it time we nurses as a profession came out of the shadow of the biomedical establishment, and expressed our own collective reflective voice?

After all we come from a rather different perspective from many of the other medical professions - a unique 24 hour/lifetime professional relationship with the people we care for. So we have unique things to say, which we have every right to express in an independent way.


I'm not sure yet, but I have thought of two alternatives: 'Nursing Moments' (Inspired by the idea of the 'Nursing Moment', that therapeutic instant of connectedness between nurse and client), or 'Head and Heart and Hands' - (Inspired by the true tools of nursing; our abilities to think, feel and act). I am open for suggestions if people can think of a better name, and for indications about which alternative is preferable.


I am willing to host the first carnival, if there is a call for it. - But it means that YOU will have to post your best articles to me via my email: thinkingnurse AT coolgoose DOT com. If you are up for such a carnival, and willing to play your part, please post a comment below. If you think that nurses should not have a blog carnival of their own, or are not capable of sustaining one, please post below too!

Wednesday, April 06, 2005

Orac And The Tangled Bank

Orac is hosting a blog carnival today called 'Tangled Bank'. It's like Grand Rounds, but devoted to posts about science (both medical, biological, physical or any other science). Orac is a fellow medblogger (and past host of Grand Rounds). The permalink is here:

Tuesday, April 05, 2005

Positive Choices Conference - Student Presentations: Person Centred Planning in Northern Ireland

The Positive Choices conference kicked off with an inspiring contribution by Bob Gates, which is covered here: Bob Gates and Jason Grundy
I will now write a little about the excellent presentations made by the students who attended the conference. In the difficult first spot were Orla MacAllister and Johnathon Pollock, of Queens University Belfast reporting on the work that had made them 'RCN Student Nurses of the Year 2004' (Well done!).

The two intrepid students had brought Person Centred Planning from off the pages of the idealistic textbook, and into a Nursing Home that housed people with learning disabilities who had complex health needs. They engaged with staff attitudes to PCP in a straightforward and honest way, offering training to the whole staff team, and dealing frankly with the various attitudes and beliefs about PCP that exist in every care setting where this is introduced as a new concept.

The scepticism of some staff was expressed in the statement "I dont think that the person is capable of participating meaningfully in a PCP" - Jonathon Pollock felt that often the people who made this kind of statement were actually projecting their own fear that they were themselves incapable of doing PCP onto the person with Learning Disabilities.

They did not win everyone over in the Nursing Home to Valuing People's bright vision of Person Centred Planning - this would have been impossible - instead they followed up with the 'propaganda of the deed' - they carried out a Person Centred Plan, involving people at every level from the client's circle of support. The best way to prove that something can be done, after all, is to do it.

The plan they organised was for 'Mary' (a pseudonym), ensuring that she was at the centre of the process by asking questions of all the members of the circle of support like "What is it that would really add quality to Mary's life? If Mary had a dream, what would it be?".

I am still waiting for full details of MacAllister and Pollock's presentation to be posted on the Positive Choices website - keep checking, it is worth a read particularly because of the objective way they have reported staff opinions of PCP. No starry eyed idealism here, but gritty realism, and a determination to make it work.

Coming Soon: More reviews of student presentations.

Monday, April 04, 2005

Tips For Nurses and Health Professionals On How To Work With Someone With A Learning Disability

People with learning disabilities are not getting proper treatment from health services. They are not getting accessible information, staff are not spending the time to explain things. Many staff are scared of people with learning disabilities, avoid them, or treat them disrespectfully.

Here is a great video to watch, made by another student learning disability nurse, and two people with learning disabilities, giving some handy tips so that medical staff can avoid some of the pitfalls that so often crop up when people with learning disabilities try to access mainstream services, but instead find themselves being dealt with in a way that fails to meet their needs:


You need broadband to see the video, otherwise, you still get audio. Check out the rest of the site too - one of the best I have seen for a long, long time.

The Disability Discrimination Bill aims to make it a statutory duty on all public authorities to promote disability equality - so if you work for any public organisation, you need start thinking about how you can make your practice accessible for people with learning disabilities!

Positive Choices Conference Report - Jason Grundy and Bob Gates

For the first time ever, a national conference of student learning disability nurses brought together hundreds of students at the University of Nottingham.

The conference was the brainchild of Jason Grundy, who, incidentally, holds the world speed record for rowing around the Isle of Wight. Unfortunately for Jason, he also gained the world speed record for descending a flight of stairs, the night before the conference, so he was unable to open the proceedings, spending the morning at casualty instead! (He was there for the afternoon - giving an impressive speech. I made a note on my pad: "Jason Grundy - a name I will hear again".

First speech at the conference was by the eminent Professor Bob Gates on the theme "Choosing to be different", it was also a tour of the past, present and future of learning disability nursing, conducted, thanks to the wonders of 'Powerpoint' via a working model of Dr Who's Tardis.

He described his own 'Choice to be Different' when he made the decision to become a learning disability nurse, much to the chagrin of his father. He cut a rather remarkable figure in his role at the local 'Mental Subnormality Hospital' with his buttock-length hair, tie-dye T Shirt and purple velvet loons.

He pointed out, that while many people make the choice to be different, some people have no choice, and that the dearest wish of some people with learning disabilities is to be accepted as 'ordinary people'.

People with learning disabilities, he stated are the most socially marginalised group in society. When they access mainstream health services, they are faced with a disproportionate risk of ill health, limited health education, poor screening, hostile environments and segregation.

Gates briefly covered the main aims of the government White Paper 'Valuing People', and described some of the research he had been involved in, about people with learning disabilities and mental health problems experiences of accessing mainstream mental health services.

People with learning disabilities who used such mental health facilities had a simple list of wishes and dreams, such as 'more support to go out more often' 'getting a good explanation of my medicine' 'more workshops and training for staff on awareness of mental health and learning disability'. (Bob's presentation on this issue will be posted soon on the
Positive Choices Conference website.

The major experience of people with learning disabilities and mental health issues, is that it is not enough just to 'get in' to these services - when they do they are pushed to the margins and treated differently - real access means staff becoming aware of the needs of these people, and respecting them.

The experience of people with learning disabilities of accessing mainstream services that cater for physical health are very similar. The Disability Rights Commission are launching an enquiry into the major health inequalities that lead to people with learning disabilities having a mortality rate up to 4 times higher than the general population.

Bob asserted that Learning Disability Nursing has 'a wonderful future' - our role will be as 'Agents of Social Inclusion', battling against the 'fear and misunderstanding' of people with learning disabilities that exists in mainstream health services, including among nurses:

"Some people need help to achieve ordinariness, extraordinary people are needed to help with this". Learning Disability Nurses are ideally placed to be these people, they are the only current social care practioners who spend 2 of their 3 years preparation for practice specifically in the field of learning disabilities. Our task as agents of social inclusion lies in bringing the needs and wishes of people with learning disabilities to the fore in mainstream services.

(More on this conference to come - including reports of Ruth Northway's presentation, and most importantly, the excellent presentations made by the student Learning disability Nurses.)

Blogitus Interruptus

Just a note to say I'm sorry to have been away for so long.

Had a pile of work to be handed in today - so blogging took a back seat while I rushed to write up my coursework (at the last minute as usual).

I Have both mocks and real exams coming up too, so my blogging will be reduced in frequency, but hopefully not in quality.

The next item I blog will be the report that I promised from the 'Positive Choices' conference that took place in Nottingham last Friday. I managed to drag myself away from the monstrous heap of paper that surrounds my workstation to get to this extremely successful and enjoyable conference. This report will be posted here VERY SOON.

Cost of the War in Iraq
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