Sunday, 22 November 2009

Decisions, distances, dementia and Damsons

I have been told that last weeks posting was a little obscure in places, particularly at the beginning. Apologies, it was a simple message. I think a professoriate should be made up only of professors. For me, anything else defeats the point of having a professoriate. There, story re-told.

Two colleagues have, during this week, had to come face to face with the realties and consequences of having to make decisions about providing care for their elderly parents. This is something many of us of a certain age have to face. Often these decisions are made more difficult because of the geographical distances involved in where we might live in relation to our parents and other family members. Trying to make arrangements for the care and accommodation of parents at a distance is always going to be difficult.

Likewise, entrusting our loved ones into the care of others is also not an easy decision. Stories such as those around the neglect of many older people do not help either. For example, this week I was drawn back to the story that reported on how many people with dementia have been receiving anti-psychotic medication in order to keep them quiet and ‘controlled’. This is a distressing story of abuse of our older people. Especially as this is abuse said to be carried out by those responsible for providing un-conditional care and treatment of the highest order. Abuse of the vulnerable in society is typically hidden, and as well as being hidden in the hospitals and care services of society, much abuse is often hidden within the family. For example, the NSPCC have recently reported that:

• 7% of children suffered serious physical abuse.

• 6% of children suffered serious neglect.

• 6% suffered emotional abuse.

•11% suffered sexual abuse from an unrelated but known person; 4% suffered sexual abuse within the family.

Child abuse causes 1-2 deaths per week in England - possibly more.

Ironically, perhaps, there was also a report this week from US researchers that made the tenuous connection, but a connection nevertheless between childhood emotional and physical abuse and the premature aging of the body. This premature aging brought with it a range of physical problems including cardiovascular and cancer illnesses. I don’t know if these problems also include mental health problems, but I suspect they probably do. My colleague Sue McAndrew and I have, for many years, been looking at the relationship between childhood abuse and mental health problems in adulthood. As part of this work we produced the first structured review of the literature that identified the large number of nurses who were unprepared to work with those who had been abused as children. This lack of preparedness was both from a knowledge perspective as well as from an attitudinal point of view.

So I was also a little concerned this week to read the story about nurses clamoring for further education and training to enable them to provide better care to patients with dementia. That the story came out at the same time as the chemical straight jacket story noted above was one level of concern. Another concern was in thinking about what it was these nurses wanted in terms of further training and education in order to be able to care for these people. Being with a other, establishing relationships and helping others with their daily activities of living where they cannot help themselves, are and should always be fundamental aspects of good nursing care.

Thanks, I think, to Sue MacDonald (Royal College of Midwives), for her support on nursing becoming an all graduate profession. Midwifery, which has had an all degree entry only since September 2008, embraced this approach to ensure the continuing development and high standards of midwifery. Sue MacDonald’s comment was to welcome this approach as it would improve nursing care and the status of nursing.

Last night ended with a glass or two of home made Damson Vodka. It was many years old and had matured to a fine drink, which inspired introspection and philosophical debate amongst the dinner party. Given, what might happen to us in childhood and older age, much of this debate seemed to revolve around whether life was, in fact too short to remove the stones from Damsons when cooking with them or not. Although of course, I always follow the drink aware code of practice, this morning I cannot recall what the outcome of the debate was. So answers please, on a postcard or as a comment to this blog would be more than welcomed.