MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Mental Nurse' source. Mon, 03 Nov 2008 14:58:37 +0100 http://feeds.feedburner.com/~r/MentalNurse/~3/424639568/ testing testing one two ummm three. (Source: Mental Nurse) Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1888105 Sat, 18 Oct 2008 14:22:20 +0100 1888105 http://feeds.feedburner.com/~r/MentalNurse/~3/419733185/ Shrink got me thinking. His post on “Understanding” speaks to the role of the Consultant Psychiatrist in Aged Care. “What kind of proportion of your work is made up of patients with dementia and related conditions?” Probably about a third to a half of my work is dementia related. “What can you do for them if (as in this case) medications won’t help?” Ah, now that’s what is of interest. [...snip snip...] My stab at the simple answer of what’s done could be that, “appropriate patient centred health care and social welfare is provided with dignity and respect.” And he eloquently goes on to describe the typical process of behavioural analysis and intervention planning for those folk under his care. One example in his post: She ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1876009 Mon, 13 Oct 2008 22:17:55 +0100 1876009 http://feeds.feedburner.com/~r/MentalNurse/~3/418041669/ This week’s caption competition comes to via that bastion of reason, objectivity and non-frothing-at-the-mouth, the Daily Mail. The subject of the competition: robot nurses. This, according to the Daily Heil, is a robot nurse. With face and voice recognition technology, a robot should be able to communicate with patients and spot unauthorised visitors. It is hoped the machines will ease pressure by taking over mundane tasks such as mopping up spills so nurses can spend more time with their patients. By keeping wards clean, they could also cut infections by superbugs such as MRSA. As per usual, post your caption suggestions in the comments thread. Judge peoples’ suggestions by clicking on the thumbs-up icon by the side of each comment if you think it is WIN, and not-clicking ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1870658 Sat, 11 Oct 2008 21:00:02 +0100 1870658 http://feeds.feedburner.com/~r/MentalNurse/~3/417648116/ Wooooo! This Week in Mentalists is 50 today! And so, This Week in Mentalists is sat at home, wondering where all its dreams went, and fretting about how Global Mentalist News Roundup doesn’t seem to call or even remember birthdays much these days. The Shrink asks what can medicine do for dementia patients if medication won’t help? As a doctor, when medication won’t help, and I can’t change the underlying process at all, my role is mostly explanation and psychoeducation, with a touch of patient and carer support thrown in too. The biggest thing I do, typically, is to involve the right colleagues. When someone has dementia they need advice on a lot of things (initial assessment letters often run to over a dozen points for various folk to act on). After this, input is... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1870659 Sat, 11 Oct 2008 10:03:48 +0100 1870659 http://feeds.feedburner.com/~r/MentalNurse/~3/416678177/ What presents did you get? Made any resolutions yet? What are you having for your Mental Health Day dinner? (Source: Mental Nurse) Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1870660 Fri, 10 Oct 2008 10:42:18 +0100 1870660 http://feeds.feedburner.com/~r/MentalNurse/~3/413678367/ In the post on anorexia and coercive psychiatry, one side-topic that’s been raised in the comments thread is the use of psychopathology as a way of dismissing complaints. Remember this case? The emo kid who came to CAMHS and found himself being hectored by a consultant psychiatrist, accused of being in a cult and having his depression and self-harm dismissed as a fashion trend. Funnily enough, his mother made a complaint against the psychiatrist. The case was discussed with another psychiatrist in CAMHS, who had not met the patient or his family. Nor had he read the notes. His response to the complaint? “I guarantee you that this boy has an unstable personality disorder, and I’d be willing to bet that the mother has an unstable personality disorder too.” Psychopat... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1862713 Tue, 07 Oct 2008 10:19:20 +0100 1862713 http://feeds.feedburner.com/~r/MentalNurse/~3/412760809/ (I’m not sure if this has already been featured on MN, so apologies if you now have a strong sense of déjà vu). Whilst doing some studying (don’t look at me like that, it has been known) I came across this article (which I hope everyone can see). The authors argue that offering money in exchange for compliance with medication regimes is a “non-coercive and effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients”. In the two part study, they examined attitudes towards financial incentives displayed by assertive outreach (AO) team managers, and also offered five previously non-compliant AO patients a payment of £5-15 per single depot injection. 76% of team managers specified objections to the practice, with reasons ranging from it... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1859480 Mon, 06 Oct 2008 21:49:36 +0100 1859480 http://feeds.feedburner.com/~r/MentalNurse/~3/411196288/ Congratulations to Yorkie, who wins this week’s caption competition with “Bonus course available: A med free approach to restraints. Developing the Vulcan neck pinch.” Time now for This Week in Mentalists. Aethelred the Unread is unnerved by reading about himself in referral letters. Mr Unread is very disabled by his symptoms. I guess no one likes to read the word ‘disabled’ about themselves in an official medical document, but I can’t really argue - given that I’m quite often unable to do something as simple as read a book or watch the telly, I wouldn’t have a leg to stand on if I tried… (Apologies for sick humour.) Mr Unread is an intelligent man who rationalises and minimises his symptoms in order to feel he has some control. When I first read this it... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1852532 Sat, 04 Oct 2008 16:21:15 +0100 1852532 http://feeds.feedburner.com/~r/MentalNurse/~3/410130557/ This last two weeks is far less entertaining. But there’s a few tid-bits to ridicule review. Starting off with the reliable Tehran Times is the report of a story from Beijing of an Italian research study into the benefits of Dark Chocolate. Specifically, only 6.7 grams of chocolate per day (or 0.23 ounces) represents the ideal amount, according to results from the Moli-sani Project, one of the largest health studies ever conducted in Europe. Parent’s note - you may now put a clinically validated miniature Bounty Bar in your kids lunch box. Recent Aussie topics include the following: Finding that ADHD is diagnosable through the right nostril: The smell test was used by Melbourne researchers in a study of 88 Australian children aged six to 16 years after they discovered a link ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1852533 Fri, 03 Oct 2008 10:18:05 +0100 1852533 http://feeds.feedburner.com/~r/MentalNurse/~3/408505460/ It’s still happening far too often, according to a new report from the Children’s Commissioner for England, made in conjunction with Young Minds and Very Important Kids. Primary care trusts and mental health trusts have some way to go if they are to meet the Government’s target to ensure no children or young people are inappropriately placed on adult mental health wards by 2010, the Children’s Commissioner for England today says today. Out Of The Shadows?, a joint report from 11 MILLION, led by the Children’s Commissioner for England, YoungMinds and Very Important Kids (VIK), says that although some authorities are making good progress, others still have some way to go. The report follows on from 11 MILLION’s report of January 2007, Pushed Into The Shadows, which outlin... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1844646 Wed, 01 Oct 2008 19:00:39 +0100 1844646 http://feeds.feedburner.com/~r/MentalNurse/~3/405511038/ You know the one’s I mean - neurotic depression; ADHD - the one’s that take situations that substantially and genuinely disaffect less than 3% of a population - and they contort it to make it affect 30% or more people, then medicalise it; all about the same time as they declare - “Oh, wow. We just happen to have a pill/treatment here that will help you with that. Aren’t you lucky!” It’s impossible to tell now - are the diseases and disorders we ‘discover’ ever real anymore? Are they simply new ways for psychobabblists and Big Pharma to create personal wealth? Are they reflections of our socially demoralised, desicrated disparate or disposable society in which we still live? Or do they represent some real underlying and problematic issue that ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1837143 Sun, 28 Sep 2008 16:10:43 +0100 1837143 http://feeds.feedburner.com/~r/MentalNurse/~3/405382489/ As promised, today we have a new caption competition. This image comes from the University of Missouri’s online masters degree programme. The University of Missouri informs us that: The master of science in nursing with a clinical specialty of mental health nurse practitioner (MHNP) uniquely combines Internet course work, and community preceptors within the student’s geographic area. The program provides advanced practice nurses with the knowledge and skills necessary to conduct group therapy, social skills training, family therapy, and brief individual psychotherapy. In addition, the MHNP can diagnose and treat individuals and families experiencing psychological problems and crises, treat and case-manage individuals with persistent mental illness, and prescribe psychotropic ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1837144 Sun, 28 Sep 2008 11:54:12 +0100 1837144 http://feeds.feedburner.com/~r/MentalNurse/~3/404852203/ For those of you who have nothing to read, here’s the new edition of This Week in Mentalists. Teenage Misanthropy has been in A&E due to self-harm. The doctors were nice, though. The woman who did the whole sewing-kit deal was very friendly (being tended to by a pretty woman would be some people’s idea of heaven*), and the one-man Crisis Team who assessed me was very helpful in getting me discharged quickly. I mean, I’ve heard the horror stories about doctors’ responses to SI. Stitching up wounds without anaesthetic, berating patients, stuff like that. Thing of the past, apparently, everyone was very nice and supportive. Still not the kind of experience I fancy repeating, though. Fighting Monsters has concerns about the relationship between qualified and stude... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1834586 Sat, 27 Sep 2008 18:47:33 +0100 1834586 http://feeds.feedburner.com/~r/MentalNurse/~3/404691475/ And the winner of the caption competition, with 11 thumbs-up, is Lorna with “And this is the new antipsychotic suppository. You’re just hallucinating the sharp corners.” Tomorrow, there will be a new caption competition. And yes, I know it’s round-up day, you impatient lot. (Source: Mental Nurse) Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1834587 Sat, 27 Sep 2008 14:23:24 +0100 1834587 http://feeds.feedburner.com/~r/MentalNurse/~3/403652645/ This post is specifically directed at Ted, our occasional representative of Thomas Szasz-esque libertarianism and opponent of all forms of coercive psychiatry. So, Ted, this is from me, a jackbooted representative of evil psychiatric totalitarian bastardry, to you, brave standard-bearer of freedom and liberty. And the subject of this post is: eating disorders. Just recently I’ve been spending time on secondment to our local eating disorders unit. It’s a relief for me to get back to doing what I consider to be true psychiatry (i.e. treating severe mental illness) rather than being at the CAMHS outpatient clinic coming up with a hundred tactful ways to say, “No, your little monster does not have ADHD. Can we interest you in a parenting class?” The ED unit is a harrow... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1833164 Fri, 26 Sep 2008 19:21:42 +0100 1833164 http://feeds.feedburner.com/~r/MentalNurse/~3/403436862/ There are two main classifications of MH issues. ICD-10 and DSM-IV. ICD is a taxonomy of all health related conditions and diagnostic criteria and is varied from country to country (which kinda makes the ‘International’ nomenclature redundant). DSM is MH specific and has developed into a multi-axial tool to aide in a brief summary of clinical presentation. It is praised and criticised in equal measures. This post is about exploring the DSM and how the axes are currently used with a proposal for a new way of using the DSM in determining need for health care interventions. I may be out of sync with other places internationally that have already taken this pathway - or similar - but I’ve not seen anything thus far to lead me to think so. Let me know. Multi-axial system The D... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1829117 Fri, 26 Sep 2008 04:31:03 +0100 1829117 http://feeds.feedburner.com/~r/MentalNurse/~3/401986612/ Last week’s Nursing Times had a super-duper special ‘Student Guide’ that billed itself as “the essential survival tool for all nursing students”. I would have thought some useful survival tools may have been this, this, this and these. However, it actually covered areas such as dealing with debt (“find out if you are entitled to any benefits!”…don’t bother, you won’t be), making the most of your training (“leave yourself time for enjoyment!”…in between the three shifts you’re working this weekend to pay for printing at the uni library), and planning for your career. This last one threw up an interesting paragraph:   “Ben urges nurses not to be overambitious. As a mature student with experience of social care, he left university for a band 7 post as a regist... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1825570 Wed, 24 Sep 2008 19:26:48 +0100 1825570 http://feeds.feedburner.com/~r/MentalNurse/~3/401979835/ Here’s something a bit different from our usual output. An actual interview with a health professional rather than ranty opinion pieces and caption competitions (not that there’s anything wrong with ranty opinion pieces and caption competitions…*ahem*) The public perception of Medecins Sans Frontieres is of providing frontline medical relief in disaster zones, but they also provide a variety of mental health and psychosocial projects in over 40 countries, including Chechnya, Sudan (Darfur) and Iraq. We spoke to Kaz de Jong, who is a mental health advisor for MSF’s public health department. How did you come to work for MSF? I just walked in, and I stayed. It’s as simple and beautiful as that. I thought I wanted to do something with stress, so I applied to MSF.... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1825571 Wed, 24 Sep 2008 17:22:06 +0100 1825571 http://feeds.feedburner.com/~r/MentalNurse/~3/401890370/ NICE has produced guidelines on diagnosis and management options for ADHD. Pulse reviews the guidelines which saves me reading anything. NICE has ruled out use of antipsychotic drugs in patients with attention-deficit hyperactivity disorder, after evidence linking them with stroke, diabetes and parkinsonism. Instead, it recommends, patients should be treated with methylphenidate, atomoxetine and dexamfetamine. So NICE are still recommending drug treatment. The brief guide according to Pulse: - Determine the severity of behavioural and/or attention problems suggestive of ADHD and how they affect the child and their parents - Consider watchful waiting for up to 10 weeks, or offering referral for a formal diagnosis of ADHD - If the problems persist refer to a paediatrician, child psychiatr... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1825572 Wed, 24 Sep 2008 15:24:17 +0100 1825572 http://feeds.feedburner.com/~r/MentalNurse/~3/400610904/ We haven’t announced a winner for the caption competition yet, so let’s use this an opportunity to acquaint readers with the new way that comments can be rated on this site. As you might have noticed, next to each comment is a little icon of a raised thumb. Clicking on it enables you to give a comment a virtual “thumbs up”. Go through the thread and click on the thumbs-up graphic for each of the proposed captions that you think are actually funny. Whoever’s comment gets the most thumbs-up by Saturday will be declared the winner. Admittedly not the most scientific way of doing it, but then I don’t actually have a prize to give out, so ho hum. Currently in the lead is Lorna with “And this is the new antipsychotic suppository. You’re just hallucinatin... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1825573 Tue, 23 Sep 2008 08:49:31 +0100 1825573 http://feeds.feedburner.com/~r/MentalNurse/~3/400455629/ Don’t ask me why I’m doing this. An absence of anything to bash on about I guess. So I thought I’d peruse the global news stands and link the interesting stuff back here. I’m such a martyr for the cause, I know. Following on from Z’s discussions on Anger Management in kids; NY Times has breakthrough news on how to help kids adjust - it suggests not punishing them for bad behaviour but reward them for good behaviour. Astonishing. The problem may not be the kids so much as the way parents define discipline. Childhood health experts say many parents think discipline means meting out punishment. But often the punishments parents use end up reinforcing the bad behavior instead of correcting it. Surprisingly, the most effective discipline typically doesn’t involv... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1825574 Tue, 23 Sep 2008 04:36:07 +0100 1825574 http://feeds.feedburner.com/~r/MentalNurse/~3/399675303/ …than they were in 2004, according to a survey of 14,000 community patients by the Healthcare Commission. Six in ten (63%) of community psychiatric patients said this year they definitely had trust and confidence in their psychiatrist. This is up from 59% in 2004. One in ten (9%) of community patients said they had no trust and confidence in their psychiatrist. And 82% of community patients say their psychiatrist definitely treats them with “dignity and respect”. This is up from 79% from 2004. Only 3% said their psychiatrist did not. CPNs also fare rather well The survey reported that 86% of patients said they were definitely treated with respect and dignity by their community psychiatric nurse. Two per cent said they were not. But on issues to do with out of hours access and in... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1815281 Mon, 22 Sep 2008 16:35:18 +0100 1815281 http://feeds.feedburner.com/~r/MentalNurse/~3/399390670/ Behaviour. Is it choice or is it pre-determined? For me, I believe that people are the sum of their experiences. Good or bad - choices are made based on the knowledge we have on an issue, the understanding we apply to them and the awareness of how previous behaviour has worked in promulgating a positive or negative outcome. Genetic and environmental influences combine to create a ‘personality’ that is driven to make choices based on predictable outcomes of combined knowledge, emotion and ability. It may be, as beakie states - attempting to predict the action and outcome of one ball striking two other balls - but just because it is more complex than we can accurately predict, does not lead us to say it doesn’t happen. As such, this leads me to consider that everyone&#8217... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1812694 Mon, 22 Sep 2008 02:40:26 +0100 1812694 http://feeds.feedburner.com/~r/MentalNurse/~3/398300451/ I like dropping in the odd buzz word. Joe has consented to trial Clozapine. He has undergone all the tests, titration and monitoring is progressing without incident and is now at day 12. He’s receiving 50mg in the morning and 200mg a night and progress seems to be looking good. Friday night (it’s always Friday?) Joe tells you he doesn’t want the tablets any more so you call the duty registrar who doesn’t usually work your unit and he visits yet is also unable to persuade Joe to continue. Saturday Joe remains adamantly the same. However, on Sunday night, and after spending a long time talking with one of the Nursing Assistants, Joe presents and says he’s decided to keep taking the tablets as he doesn’t want to go back to how he was. You phone another reg... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1812695 Sat, 20 Sep 2008 18:34:21 +0100 1812695 http://feeds.feedburner.com/~r/MentalNurse/~3/397934012/ (Guest post by turboelf) 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 (Source: Mental Nurse) Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1809726 Sat, 20 Sep 2008 07:26:14 +0100 1809726 http://feeds.feedburner.com/~r/MentalNurse/~3/397636827/ You know the secret of good presentation? Timing. Anyway, it’s time for This Week in Mentalists. Crazy Nurse has been discussing the Borderline Personality Disorder label with her psychiatrist. I’ve gone on enough before about how I don’t believe it and its a load of crap, so I’ll keep it short. Seaneen over at mentallyinteresting.org says its a diagnosis they give you if you’re a women who self harms and you don’t fit any other DSM-IV for ICD 10 criteria. . . . in my case, I concur. I was never expelled from school for causing trouble, I’ve never been known to the police, I didn’t get abused as a child . . . I’m just fucked up in the head, end of. There’s no obvious reason why I feel unable to cope with life sometimes, or why I ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1809727 Fri, 19 Sep 2008 23:01:29 +0100 1809727 http://feeds.feedburner.com/~r/MentalNurse/~3/394495388/ Dunno about you, but I think this site seems to have got a bit stodgy lately. Lots of heavy discussions, and not enough CAPTION COMPETITIONS! So, here’s this grim woman from the NMC site. What do you think she’s saying as she holds up her copy of the code of conduct? I’m sure Z could rustle up a prize of some kind (virtual or perhaps even real) for the best entrant (Source: Mental Nurse) Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1802672 Tue, 16 Sep 2008 19:53:33 +0100 1802672 http://feeds.feedburner.com/~r/MentalNurse/~3/394027646/ Everyone employs moral reasoning in various situations, almost daily. To pay taxes, to not speed, to honour promises - all require a sense of moral reasoning. Some things we know intrinsically as being good simple choices - to kill is bad - to give to charity is good. But when it comes to making more complex moral decisions, such as enforced medication, declining leave or involuntary treatment - how trained are nurses in the process of moral reasoning? In a recent rant, Mr Ian (that’s me) declared on the issue: Currently I know of no guidance, training or ethical standards in psychiatry that provides this. Were the processes of moral reasoning in ethical decision making discussed as a student in your course? I’m genuinely interested to know. Kohlberg determined a process for a... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1802673 Tue, 16 Sep 2008 09:07:29 +0100 1802673 http://feeds.feedburner.com/~r/MentalNurse/~3/393495177/ So, nursing is set to become an all-graduate profession by 2015. Technically, I am a graduate; just not a nursing one (yes, I did psychology, but let’s not talk about that). Somehow I don’t think this will wash with future employers anyway. So, since I’m currently doing the diploma, I have a decision to make. At the end of my second year (assuming I can manage a 55% average mark) I will be given the chance to change to the degree course. If I do so, I will be given a means tested bursary and my income will drop by roughly half. Given that I already spend the majority of my free time doing bank shifts, I’m slightly concerned by this. Alternatively, I can hope I get a job once qualified that will put me through the degree ‘top up’ and spend yet more time i... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1798096 Mon, 15 Sep 2008 19:40:01 +0100 1798096 http://feeds.feedburner.com/~r/MentalNurse/~3/392167550/ As many as one in five young men are unhappy with their body image, according to a leading eating disorders expert, and that is leading to an increase in eating disorders among men. Dr Morgan believes that some men’s relationship with food and exercise is not recognised as disordered: - “We know that 1 in 20 young people suffer from some degree of disordered eating and that at least 15% of them are men and yet that’s a tip of an iceberg,” he said. “There are men who have problems with compulsive exercise and excessive bodybuilding who have an illness, but we haven’t defined them. Our definitions of illness have been focused on women, rather than men.” This can lead to anorexia being missed in men, as it was in George, who is quoted in the article:... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1790262 Sun, 14 Sep 2008 08:43:58 +0100 1790262 http://feeds.feedburner.com/~r/MentalNurse/~3/391576541/ That’s not to say Risk Assessment can’t have a place. After all, we accept the use of parole boards and probation services for the rehabilitation of criminal offenders. Here in my part of Oz, mentally ill offenders can only have leave approved by the MHRT. When a person breaks the law in the context of a mental illness, it’s no longer a clinical decision as to whether someone is suitable for leave and all leave conditions are determined (increased, decreased or remain the same) by the MHRT at 6 monthly meetings. Recent news has us once again reacting for our Risk Assessment calculator (that should say ‘reaching ‘ but oddly it doesn’t). Darren Harkin, a 21 year old who was resident of a low secure unit has been charged with the rape of a 14 year old girl ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1790263 Sat, 13 Sep 2008 14:29:00 +0100 1790263 http://feeds.feedburner.com/~r/MentalNurse/~3/391479280/ Joe, having managed to stay for the weekend and not get “sectioned”, is reviewed again by the treating team on Monday. Following review the registrar tends to the consultants requests to run “routine admission blood tests”. He writes out the pathology lab request form and pops it in the pending tray. When the phlebotomist arrives the next day, you collect up the forms and take them along to the clinic room. As you peruse them to see who needs what doing - you note the following tests have been ordered on Joe’s form: FBC; U+Es; Hepatitis; serum HIV* What should you do? [*: FBC = Full blood count and U+E= urea and electrolytes - which are the normal routine bloods and show generally how the body is functioning; Hepatitis and serum HIV are tests for specific chro... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1790264 Sat, 13 Sep 2008 11:29:45 +0100 1790264 http://feeds.feedburner.com/~r/MentalNurse/~3/391387861/ Ding ding! It’s round-up time. Coming at you faster than Amir Khan thudding decisively to the floor. First off, the Shrink has a patient with an “anger management” problem. He’s been assessed in 5 neighbouring hospitals with the same presentation. Euphemism : he’s problems of anger management. Truth : he batters his partner and blames it on anger that doctors haven’t cured. He feels no responsibility for this, he can be violent since, “It’s not my fault.” It’s other people, “They wind me up, play head games, do my fucking head in, doc.” So they deserve it? “Well no, but they’re kind’ve askin’ for it, really, aren’t they? Kinda got it comin’ with what they say.” Who is responsi... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1788689 Sat, 13 Sep 2008 08:23:53 +0100 1788689 http://feeds.feedburner.com/~r/MentalNurse/~3/387821772/ A slightly simpler vignette, but one that happens quite often where I work… You are a staff nurse on a locked ward. After supper, Bill the patient comes up to you, appearing agitated. He says he’s feeling stressed (or words to that effect) and needs a cigarette or he’s going to ‘kick off’. Your hospital has a policy of only allowing patients outside once an hour (escorted by staff) for cigarettes and smoke time is 40 minutes away. You have an audience of other patients all watching to see what you do and the ward is short staffed as usual. So what do you do?   (Source: Mental Nurse) Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1782620 Tue, 09 Sep 2008 16:53:58 +0100 1782620 http://feeds.feedburner.com/~r/MentalNurse/~3/387703601/ kiwipsychnurse has been asking a few questions about Seclusion and Restraint reduction. It’s a whole element of mental health nursing that has become a focus of serious attention in certain countries. I’ve got some experience of seeing seclusion used in some places at the slightest concern (”Her looks a bit odd”) and the dodgiest of reasons (”He refused to take his medication”) - and yet, also having seen it used only once in an 8 year period for one patient (until she kicked the door off and we all sat around laughing with her about it.. hmm.. surreal). Anyhoos… lately I’ve seen it reduce from sometimes 3-4 patients a week to being not used in over 9 or 10 months now. I’ve put some of the reasons I believe are responsible (and there ar... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1782621 Tue, 09 Sep 2008 14:25:25 +0100 1782621 http://feeds.feedburner.com/~r/MentalNurse/~3/386380266/ Furthering the “good news” story that appeared on MN mid-August, and the notable absence of any significant media coverage in the UK of the apparent decline in mental health related homicide, I was listening to an ABC Radio presentation here in Oz which can be downloaded in podcast from here with one (maybe more?) of the authors, of the BMJ article, Matthew Large. I first thought it was odd that such a report should get better media coverage in Oz than the country of origin - but having looked - 3 of the 4 authors are Oz/NZ based. Further resources can be found here here and the full BMJ in iPaper for - here. (Source: Mental Nurse) Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1773186 Mon, 08 Sep 2008 05:24:49 +0100 1773186 http://feeds.feedburner.com/~r/MentalNurse/~3/385271847/ As I’ve mentioned previously, the drug companies heavily target my CAMHS service with drug lunches, sponsored conferences and freebie handouts, usually for ADHD medications. Just browsing through the NMC Code of Conduct, I notice one of the obligations of a nurse is that: You must refuse any gifts, favours or hospitality that might be interpreted as an attempt to gain preferential treatment Well, I’d say that whenever a drug company provides us with lunch, gives us some free pens or post-it notes, or sponsors a conference, they’re certainly hoping to gain preferential treatment for their medication. They’re certainly not doing it because they think we look hungry or could do with a pen. Therefore, surely that means that all this big pharma schmoozing and gifting is ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1770453 Sat, 06 Sep 2008 20:29:54 +0100 1770453 http://feeds.feedburner.com/~r/MentalNurse/~3/384976229/ Rejoice! Rejoice! The weekly round-up of mental health blogs is here: Writing in the Margins of my Mind reflects on therapy. My first real foray into therapy was in late 2006, when I started at the Priory. I saw a counselling psychologist (although she was also UKCP registered as a psychotherapist), who I really got on with. I liked going to see her, and was mostly as ease talking to her about things - although admittedly, I still never got around to managing to talk about the really big things. I’m still yet to figure out quite how helpful that was… I saw her for a year, and whilst she helped me cope, I don’t know that I made any progress. Ultimately, my psychiatrist at the time decided that I was “too dependent” on her, which translated probably just means ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1770454 Sat, 06 Sep 2008 11:49:50 +0100 1770454 http://feeds.feedburner.com/~r/MentalNurse/~3/384462898/ Obviously, I don’t mean on MN, I mean my first post as a Mental Nurse (Having paid my £76 to the NMC). I will be working as a staff nurse on an acute inpatient ward later this month. I was reading a post about job adverts earlier and spotted this as my new job description: Acute Inpatient Our trust is currently recruiting for a Band 5 RMN who’s decided they don’t like talking to patients after all, and would rather just be an office monkey. Key skills include doing cool trick shots off the ward pool table, rolling a ciggie while simultaneously talking on the phone to the consultant, and the ability to say “I’ll be with you in a minute” without making it sound too much like a bare-faced lie. Our recent adoption of the Care Programme Approach will provide you with vast reams... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1768857 Fri, 05 Sep 2008 19:53:15 +0100 1768857 http://feeds.feedburner.com/~r/MentalNurse/~3/384254234/ Saturday at 2pm you arrive for your afternoon shift as nurse in charge of the acute mental health unit to be informed of a new admission. Joe (from previous vignette), was reviewed by the community consultant psychiatrist and admitted voluntarily on Friday afternoon (with some persuasion). The handover says he’s been fine, took his regular evening medication and slept through the night from about midnight. He was up at 10am, ate breakfast and a good lunch and has been sat around the unit watching a bit of TV other than when he goes for a cigarette. He’s been pleasant when approached but has appeared to prefer to keep his own company while he settles in. You read through his notes where the admitting registrar has also written the following: “25 year old male with history... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1768858 Fri, 05 Sep 2008 15:07:29 +0100 1768858 http://feeds.feedburner.com/~r/MentalNurse/~3/384214677/ My name’s Samantha Tyler. I’m a student mental health nurse. In 2008, I was knocked down on my way back from collecting two tall chocamochalattes for the qualified staff, and I woke up in 1978. Am I mentally interesting, in a coma, or back in time? Whatever’s happened, it’s like I’ve landed on a different planet. Now, maybe if I can work out the reason, I can get home… ——- The first thing I noticed was that the community mental health team where I was on placement was a branch of something called Timothy Whites. When I asked the woman at the till where the Recovery and Support team had gone, she called someone from the back office who demonstrated a truss for me. When I told him I meant the mental health community team, he looked at me blank... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1768859 Fri, 05 Sep 2008 14:16:02 +0100 1768859 http://feeds.feedburner.com/~r/MentalNurse/~3/381545643/ In Mr Ian’s last post, beakie made the comment:  “Nothing worse than blithely ripping a scab off an old wound and being subsequently unable to deal with the resultant pain”  It got me thinking about a recent assignment we had. Nothing too complicated, just a case study looking at factors that had influenced a patients current mental state. It was interesting actually, but the actual research for it made me very uncomfortable.  As well as reading their notes, we were expected to talk to the patient about their past experiences. This included covering issues such as alcoholism and drug use, domestic violence and in some cases sexual abuse. What made me uncomfortable was several things. Firstly, our common foundation training so far has only covered the basics of the therapeutic ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1754653 Tue, 02 Sep 2008 19:30:37 +0100 1754653 http://feeds.feedburner.com/~r/MentalNurse/~3/380121349/ Mental health care most often becomes ethically clouded when it interacts with the law. Jodie is a 19 year old female who is voluntarily admitted to the acute mental health unit following a suicide attempt whilst under the influence of alcohol. This is her first presentation to the service and you spend some time to get to know her the following day. During the course of conversation Jodie tells you what caused her to act as she did. “I was out with a group of my friends and I saw an old college professor who sexually assaulted me 2 years ago. I never reported it cos I thought nothing would be done and I’ve never told anyone else about it. I got really drunk and it played over in my head. I wanted to tell my friends but I couldn’t.” “I didn’t realise it... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1750080 Mon, 01 Sep 2008 08:53:48 +0100 1750080 http://feeds.feedburner.com/~r/MentalNurse/~3/380079739/ Scientists are exploring the use of psychedelic drugs such as LSD to treat a range of ailments from depression to cluster headaches and obsessive compulsive disorder. In the Swiss trial eight subjects will receive a dose of 200 microgrammes of LSD. This is enough to induce a powerful psychedelic experience and is comparable to what would be found in an “acid tab” bought from a street drug dealer. A further four subjects will receive a dose of 20 microgrammes. Every participant will know they have received some LSD, but neither the subjects nor the researchers observing them will know for certain who received the full dose. During the course of therapy researchers will assess the patients’ anxiety levels, quality of life and pain levels. I wonder what indemnity they asked... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1750081 Mon, 01 Sep 2008 01:59:04 +0100 1750081 http://feeds.feedburner.com/~r/MentalNurse/~3/379998925/ A new vision for mental health is a discussion paper from seven national mental health organisations intended to provoke a debate on the best direction for future mental health policy. The government’s ten-year plan - the National Service Framework (NSF) for Mental Health - will come to an end, signalling a new era. Important policy choices must be made to ensure both that its achievements are built upon and its shortcomings tackled. Seven leading national mental health organisations have come together as the Future Vision Coalition to outline their proposals for a substantial shift in policy during the next ten years. These organisations are: the Association of Directors of Adult Social Services; the Mental Health Foundation; Mind; Rethink; Sainsbury Centre for Mental Health; Togeth... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1750082 Sun, 31 Aug 2008 23:35:06 +0100 1750082 http://feeds.feedburner.com/~r/MentalNurse/~3/378783455/ Thank you to Cellar Door for stepping into the being-shouted-at-by-the-Shrink breach while I was away. I’m now back in the saddle. Anyways, time for This Week In Mentalists, our weekly round-up of mental heatlh blogs. Aethelred the Unread has some advice for when applying for incapacity benefit. It really is important to stress the full range of effects that a particular problem or symptom has on your day-to-day life both when filling in the form and when talking to the DWP doctor. The reason for this is that you’re not trying to convince the decision maker that you’re ill, but that your illness affects your ability to work. This can seem fairly obvious when it’s written down, but it can take some getting used to, particularly in the consultation with the DWP doctor. Seaneen ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1742712 Sat, 30 Aug 2008 08:32:56 +0100 1742712 http://feeds.feedburner.com/~r/MentalNurse/~3/377375477/ Did you all miss me? I decided to wait a couple of days after returning from the Comrade Stalin Expects Productive Diligence Recreational Facility, Scarborough before making any fresh posts. A bit of time to properly unwind from my sunny holiday and to allow the radiation poisoning to fade. Since Mr Ian is suggesting we do some case study vignettes, here’s one from me, on the subject of anger management. I notice from the previous vignette that there’s requests in the comments thread that technical jargon is kept to a minimum. I’ve attempted to do so, but where I’ve been unable to I’ve included a wikipedia link for those who aren’t familiar with some of the terms. Anger management is something that the CMHTs seem keen to give a wide berth (at least rou... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1739064 Thu, 28 Aug 2008 19:03:00 +0100 1739064 http://feeds.feedburner.com/~r/MentalNurse/~3/376154111/ As some of you may know, or not, the NMC recently conducted a consultation as part of a review of pre-registration nurse education. Organisations and individuals were asked to answer these five questions: - should the minimum academic level for pre-registration nursing in the UK be at Diploma in Higher Education level, or at degree level should the concept of the specialist ‘branch’ remain and, if so, which of the existing four branches (adult, children’s, learning disability, and mental health) should be retained? should there be a new ‘generalist’ programme for pre-registration and, if so, should it form a new branch, alongside any new or existing branches? should a specific time be set for learning in practice in the community? should there be a mandatory consolidation period ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1739065 Wed, 27 Aug 2008 12:29:01 +0100 1739065 http://feeds.feedburner.com/~r/MentalNurse/~3/374077599/ I thought I ‘d trial a new idea on the MN site based on the precept that several student (and pre-student) nurses visit this site. I’ll open up a forum discussion for feedback on the idea in general but leave this thread for responses to the vignette. The idea is to set a scenario and debate the issues it throws up - I explicitly invite “service users” to also jump in and stir the ethical stew-pot as well as our regular contributors. #1 is around confidentiality (and risk). Joe was diagnosed with schizophrenia secondary to drug use some 4 years ago. He’s been in hospital voluntarily on 3 brief occasions (4 - 8 weeks) - once as a social issue when he lost his flat and decompensated; twice for breakthrough symptom management that resulted in medication changes.... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1730650 Mon, 25 Aug 2008 08:13:07 +0100 1730650 http://feeds.feedburner.com/~r/MentalNurse/~3/372875360/ Ok, I’ve decided to have a go at this roundup lark…don’t want to disappoint The Shrink Firstly, congratulations to Suzy at Dumped By A Hallucination, for proving that being mental is no barrier to academic achievement: “But essentially, I’ve done lot of worrying for nothing. And I’ve got final, incontrovertible proof that it’s entirely possible for me to do exams in a state of psychosis and for it to still be all right on the night. I’m not entirely sure how I should feel about that…” Hannah at Coloured Minds and Scattered Thoughts has had similar success, but is struggling with the implications: “When I first found out that I was moving to Manchester I was so happy, a chance to move away, prove my sanity and escape the suffocating outreach ... Mental Nurse blogs http://www.medworm.com/rss/comments.php?id=1729348 Sun, 24 Aug 2008 09:04:12 +0100 1729348