An Interview with Ian Wilson – Mental Health Lecturer

word-cloud-ianIan Wilson, Honourary Teaching Fellow in the Mental Health Field has given us an early christmas present in the form of this amazing, honest interview about his specialist field – Mental Health, specifically discussing his work in the community with dually diagnosed service users (those with mental health and substance misuse diagnoses). This is a truly insightful piece with some wonderful tips and advice for all fields of Nursing.

ENJOY!!…

 

What do you enjoy most about working in the community?

I enjoy the autonomy of community work. I enjoy being truly collaborative with my service users and colleagues. I enjoy the flexibility and responsiveness that community work offers workers and their clients. I enjoy the equalization of the ‘power balance’ between professionals and service users that community work offers.

What do you enjoy most about working with the university?

Regular contact with students is undoubtedly the most rewarding part of my university job. I welcome the enthusiasm, creativity, professionalism and dedication to mental health nursing that I see students frequently displaying. Because of this student contact I am reassured about the future of my profession and reassured about the future of mental health services.

What do you think is the biggest challenge facing Mental Health Nurses today?

I believe that we MUST maintain and nurture our own professional identity as mental health nurses. We have a unique perspective and a unique therapeutic trust. Both of these things are a huge privilege. We must ensure that this is not diluted.

Even as Student Nurses we can sometimes neglect our own mental health, especially with dissertations looming, what advice would you give students struggling with university stress?

I manage my own stress through regular exercise. I also have a group of friends who I can trust. Some of them are nurses, most of them aren’t. I have different groups of friends for different aspects of my life; my ‘football’ friends; my ‘music’ friends; my ‘work’ friends; friends I’ve known for 40 years or more, friends who have only recently entered my life. I rely on them all for support and encouragement.

How has your role as a Mental health Nurse changed since you registered?

I commenced my career as an inpatient staff nurse (two years). I then moved into community mental health nursing and I’ve done that for 20 + years. During that time my roles have changed and my responsibilities have increased. However, my core values have changed surprisingly little. I would still recognize myself from 25 years ago!

What qualities make a great Mental Health Nurse?

Empathy, unconditional positive regard, honesty, therapeutic optimism, positivity, self-reflection, a genuine interest in other people’s lives, open mindedness, a sense of humour, resilience, resourcefulness, self-reliance.

What made you choose to work with those suffering from drug and alcohol misuse?

I have both personal and professional reasons for working with dually-diagnosed (both mental health & substance misuse) service users. Additionally, I find service users with ‘dual’ problems resourceful, resilient, insightful and challenging. This keeps me going!

f3766f876d143ea85bd35fb7b63cabaf731c5493-3-1.jpgWhat piece of advice would you give Mental Health Student Nurses today?

Take every opportunity that comes your way to promote non-stigmatising attitudes towards mental health service users. Promote acceptance and respect among your colleagues. Use evidence based practice wherever possible. Have confidence to stand up against poor practice whenever you encounter it. Always push to improve services and your own skills and knowledge as a nurse.

From your experience working with service users who smoke cannabis, have you seen a therapeutic effect from taking it as a method of self-medicating and not just for recreational use?

Yes. For instance, a man with bi-polar illness has been using cannabis to regulate his mood. He has been actively attempting to reduce his cannabis use but as soon as he starts to reduce, he experiences a relapse into distressing elevated mood. His answer to this currently is to attempt to grow his own cannabis, which, he hopes, will be high in cannabidiols (anti-psychotic and sedating) rather than high in THC (very psychosis inducing). He is proving to be partially successful. However, in my experience this is unusual. Most of the service users I’ve worked with for many years do not get a good therapeutic effect from cannabis. Quite the opposite in fact. For almost all service users with psychotic illnesses cannabis can be a disaster for their mental health prognosis.

What impact do you think there would be on mental health services if cannabis was to be decriminalised or legalised in the UK?

Taking cannabis misuse out of the legal system and into the healthcare system would enable those people who have problems with cannabis misuse to seek appropriate help and treatment. It would also remove it from the control of organized crime.

From your experience what role does excessive alcohol consumption play in the development of mental health disorders?

This is a complex and multi-dimensional issue. Demographically, 50% of people entering alcohol treatment services have a severe depressive illness. 20% of people have a psychotic disorder (Weaver et al 2003). Whether this is a consequence of drinking excessively, or whether drinking excessively is a causative factor in the development of illnesses is, of course, usually too complex to fully determine.

legalhighs_2130872a

Legal Highs come in all sorts of forms and can be bought on the high street

With the rise of “legal highs” and previously uncommon substances of abuse (such as ketamine) in Greater Manchester, has their been a notable shift in conditions patients suffer with as the popular drugs of choice have changed?

I believe that there is now no doubt that many of the newer substances, such as synthetic cannabinoids and highly potent stimulants such as PMA and methadrone are potentially far more dangerous to both physical and mental health. Synthetic cannabinoids, especially, appear to be very dangerous and unpredictable. However, their use, among mental health service users and people in general seems to be increasing year by year.

If you could give child/adult field nurses a few key points to convey to patients they may encounter that they believe might be struggling with drug or alcohol abuse what would they be?

  • Be honest but non-judgmental about peoples’ lifestyle choices
  • Encourage service users to discuss issues of substance misuse in an open and honest manner
  • Listen to what they tell you and find ways of reflecting back what they’ve said
  • Express empathy about their situation in relation to substance misuse. Be especially empathic about the difficulty their substance misuse is causing them and how it may be preventing them to achieve their goals
  • Seek permission to offer information which is neutral, up-to-date, and presented in an accessible form. Check out carefully what they make of this information
  • If they don’t want to change their current patterns of substance misuse, carry on discussing the issue in an open and honest manner, avoid arguing or persuading; offer harm reduction tips
  • Keep the door open to possible intervention in the future

Raising Concerns

Whilst in practice, unfortunately, sometimes we can witness bad practice. It’s not a situation I would wish upon any student nurse or registered nurse for that matter as it immediately puts you in a very difficult position.

Yes, in the perfect world, there would be no internal conflict, you would identify the issue, escalate it to your manager or mentor and trust that it will be dealt with appropriately and with discretion and professionalism. However I know in my circumstance, I was/am struggling to trust that sharing my concerns will not impact upon my learning and education within this ward. This isn’t based upon anything other than my own fear of self-preservation, which makes it harder.whistleblowing

You’re faced with a decision, to voice your concerns and risk an uncomfortable and strained time in practice or say nothing and risk patient safety/dignity/pride. It really isn’t a toss up in my opinion.

The process is intended to be as pain-free as possible. Speak to the relevant individual, be it PEF, Ward Manager, Academic Advisor or Mentor and your concern should be dealt with in a professional and serious manner befitting the circumstance.

I have to say that as soon as I raised my concerns I felt an immediate sense of relief and confidence. Confidence that I had done the right thing for my patient, patient’s to come. I had 3 weeks remaining in my practice area and this was rather terrifying as I thought I would be identified somehow and treated poorly for raising concerns in practice, this I am very happy to report WAS NOT THE CASE. I wasn’t treated any differently whatsoever, I felt supported, trusted and above all I felt like the University was proud of me speaking up when I did.

This feeling was reinforced on Monday when placement allocations came out. A very close friend of mine has been allocated the same placement in which I experienced poor practice. I could have easily ignored the issues in the ward. Easily put them to the back of my mind and they would have continued and other Students would have struggled and felt as conflicted as me but because I spoke out – those issues have been resolved.handshake

I was able to say to my friend in confidence that any obstacles I encountered in practice have been resolved. No placement is perfect but if each student that encounters issues keeps quiet – they will never be perfect.

It can be very easy for student nurses to lay the blame for poor practice areas at their mentor’s feet but we have our part to play as well. Be honest in your placement evaluation and be honest with your mentor throughout your training – if they know what works well and what doesn’t that can only lead to improvements in how they teach and how you learn. So BE BOLD and SPEAK UP, who knows the number of people that will benefit from your honesty in the future.

PEF contact details can be found via this link:

http://sites.bmh.manchester.ac.uk/nursing-mentors/contacts

Healthy Eating-YES you can!

Since starting Nursing I feel I have been unintentionally gaining unwanted weight and with each academic year I promise myself this year will be different. And we all know how New Year resolutions turns out (sad, but true). I use to be great at meal prepping and avoiding junk food. After my night shifts and the ridiculous long hours I started to feel tired, stressed and would skip meals or ate whatever was easiest at the time (most of the time it was junk food *sigh*). I stopped cooking (which I love to do), I did not stick to my usual routine of eating (big breakfast, medium lunch and smaller dinner), instead I would skip all meals and eat one large meal when I got home at 9PM (yes, very unhealthy eating at that time) and that meal could sometimes be just toast (once i ate 8 pieces of toast within a 24 hour period *ashamed*). Then in the morning I would be so HANGRY (hungry & angry) because I want to eat but don’t have time to eat. At times I would come home from a long day, knowing I have a 04:30am start the next day I would make a decision: to eat, to shower, to sleep? and most of the time it was to sleep.

But this September I decided enough was enough and did something about it. These are my five tips to eating healthy/better and working a 12 hour shift (night shifts are the worst for eating properly- its so easy to eat nonsense, especially when staff bring in quick food to munch on).

#1 MAKE LUNCH: During first year I use to cook lovely delicious healthy meals and bring in nutritious snacks and occasionally a cheeky chocolate bar. I bought a new lunch box, wrote out a meal plan for the week and stuck to it. (most of my time is spent thinking about what to eat). Plus I get to use my half hour (if that) to actually sit and eat properly rather then going to a shop to get a sandwich (that I do not want) and eat quickly in ten minutes.

#2 ALWAYS MAKE LUNCH THE NIGHT BEFORE: you will never wake up early (earlier rather) to make your lunch. I have lied to my self more than I can count, I’d rather sleep then eat (as we have already established :-p). You are always to tired before work to cook anyway. I suppose for night shifts it is a little easier.

#3 DRINK WATER: I keep a 1 litre of water with me all the time. I am continuously drinking. This not only keeps you hydrated but also stops you from snacking on biscuits/chocolates.  To be honest, water is my answer to everything! It reduces my headaches, my cravings and keeps me focused. Not to mention how great water is for your skin. It keeps you less stressed through the day as you are hydrated and makes you feel full (so you don’t get HANGRY).

#4  NEVER SKIP MEALS: As I have mentioned I have a huge tendency to do that. It is easy to skip meals when you are in a busy working environment. Make time to eat, you owe that to yourself. If you can not got for a lunch break, keep fruits, granola bars with you and munch on them as you write your nursing notes. If you skip meals, you go home hungry and feel you can eat your whole fridge.

#5 AVOID JUNK: Easier said than done, I know. But if you remove junk from your household and do not buy them when you are out then you will avoid the excess sugar and fat. I’ve started to buy lots of fresh fruit and veg, from continuously eating such food you can change your cravings and habits. I really believe that the more your eat healthy the more your body wants healthy food. Once I was addicted to carrots and hummus, I would keep a bag of carrot sticks and a pot of hummus with me all the time because I craved it.

Bottom line. You can eat healthy whilst being a nurse. Bring healthy snacks with you to munch throughout the day. Try to have your lunch halfway through your shift (I know that can be difficult). When patients give the staff chocolates to say thank you, be careful with your hand because it will have a mind of its own and you will end up eating one to many! I truly believe that a healthy nurse is an efficient nurse, it will allow you to be always on your ‘A game’ and you will feel great!

Please share any tips you have to eating better on a 12 hour shift.

 

A Day in a life of a Hospice Nurse

Today I am delighted to bring you a guest blog post from a Hospice Nurse.

After qualifying as a children’s nurse about 2 years ago I worked on a neonatal intensive care ward. Although palliative care was an integral part of the role, I felt that I wasn’t using my specialist paediatric skills so decided to apply for a nursing role at Haven House.

I was lucky enough to be successful and a few months later, I can honestly say I love my job. The encouragement from staff and the hands-on-experience has already helped me progress and develop as a nurse.

The work here varies on a day-to-day basis which makes my job really interesting. At the start of a shift all staff receive a handover from the nurses on the previous care shift. We discuss all aspects of individual care and then a lead nurse allocates each child to a nurse and one of our fantastic health care support workers. This ensures continuity of care and gives everyone a sense of security throughout the day.

Depending on the care plan we bath or shower each child in our luxurious sensory bath that has lights and music. Most of our children attend school, so if it is a weekday we ensure they are dressed, fed and ready for school by 8am. This can sometimes be a challenge but good team work and staff management helps ensure we are usually on time. Haven House has fantastic complementary therapies for children and families to benefit from such as therapeutic yoga and music therapy. When children attend these sessions we usually have the pleasure of providing day care to them as well as attending the therapy session. We also have paperwork, care plans, documentation, audits, research and meetings to attend so it soon comes round to 3:45pm again. The beeping sound of a vehicle in reverse informs us that the school bus has arrived! Each child’s detailed care plan informs staff on shift how, when and exactly what to feed them. After a snack or feed its playtime. Many of our children can’t eat solid foods so are fed through a tube in their stomach.

Next, the children have some down time. Haven House has a sensory room with an interactive floor and walls. Music and lights, sensory toys and games and books for all ages are available in the activity room. Our lovely play co-ordinator ensures there are always activities and crafts set for children to immerse themselves into, whatever the weather. We often spend time in our wonderful grounds or our cinema room – the children love this as it often gives them a feel of family time and time to develop interpersonal relationships with staff and other children. Breaks in play time have to be had when children need changing, medicines or a feed.

Dinner time can’t come soon enough and we either have food ordered in or we whip up a healthy meal ourselves for the children who can eat. After dinner we have a good tidy up and then take the children to their bedrooms to get them prepared for the evening. It’s bath time or showers for those who require them according to their care plan or based on how actively engrossed they were with their messy play and crafts during playtime! Medications are given throughout the day at specific times to each child based on their individual prescriptions.

Once the children are washed, they are dressed in their pyjamas, teeth brushed and settled into their rooms. It’s either story time or a bedtime programme to help children wind down. At 9:45pm the handover process begins again with a fresh team of staff ready for the night shift. I can honestly say it’s a complete privilege to do my job every day. Our children have complex and rare life-limiting conditions and require a great deal of care and attention. I draw my strength from the knowledge that parents and carers look after them on a daily basis without any complaints. Their strength becomes our strength and this translates into brilliant care for each child at Haven House.

Despite the long hours, intensive work and heavy case-loads; I wouldn’t exchange the job satisfaction that nursing gives me for anything else in the world.

Muryum Khan, Pediatric Nurse.