Tag: nurse

Exercise without returning to extremes

WARNING – this post discusses weight loss and eating disorders

I saw the nurse today as I had to have an ECG. I’ve had a lot of chest pain lately which is thought to be costocondritis but the GP wanted to check my ECG again. I’ve also been potentially diagnosed with another condition but that’s a story for another time.

Whilst I was there, the nurse took my weight and height and we decided I’m going to try the exercise referral scheme again (to a different gym this time), to have support to try very gentle swimming or at least exercises in the water.

It is time for me to do something about the fact that I am really upset at how much weight I have gained in the last 2 years, through poor diet and through my medications and being very sedentary as I often can’t walk more than a very little way unaided. The weight is increasing my hate of myself and my body. Not succeeding in losing it by my familiar means over the last few months has increased this hate even more. I know this isn’t a healthy thought pattern and I know many of my “familiar means” are eating disorder behaviors. At the same time, I am now slightly overweight according to BMI recommendations, so I need to lose weight for my physical health; also I need to care for my body’s needs by eating healthful meals rather than oscillating between starving and junk food, as has become my habit through lack of money and depression. I need to try to do some kind of exercise to improve my physical strength to manage the pain from my chronic conditions better.

So I have to figure out how can I manage my situation now and the changes I need to make without plunging deeper into eating disorder thoughts? How do I start an exercise programme without using it to punish my body? How can I keep track of my weight and control my diet without returning to my totally addicted state and the ever-present revulsion at my body tipping back over into self-harm and purging?

Does anyone have any thoughts about how to lose weight and change your eating to get back to a healthy weight range, when you have a history of binge-eating and bulimia? Are there any particular resources on this topic? I know that somehow I need to address the pervasive disgust I feel towards my body and ideally I’d do that first, but it has been present most of my life and I can’t allow my weight to grow to an even more unhealthy level. Most of my life since age 3 when my abuser started to use weighing me and controlling my food as one way of punishing and shaming me, I’ve been overweight, severely underweight or plummeting or ballooning between the two. I have lost all concept of normal food intake and normal appetite.

Ginny xxx

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Slipping through our fingers

There have been several cases in the news recently, in particular two this week, of children suffering unfathomable cruelty at the hands of their parents / caregivers. Much has and will be made of the failings on the part of social services and social workers. How could the horrors and suffering go unnoticed and why were concerns not followed up, staff nor taking a more joined up approach, so the children could slip through the net?

I don’t doubt that there certainly were failings in the services. I’m not denying that. I can’t imagine the guilt the workers involved in those two cases are feeling right now. I’ve suffered myself and so did my mother and so have several other people I care about, because of failings in the organisations that should give support and protection, which let us fall through the net without intervention in times of crisis and without promised follow up or communication across different services. Sometimes the services involved have seem totally unaware of the harm this causes and unwilling to take responsibility. That hurts even more. Fortunately I have never suffered anything approaching what the children in this week’s cases did.

I’m not trying to deny that there were failings and I don’t want to hurt anyone who has been through similar experiences. However I think the somewhat understandable jump to publicise the blame attributed to the social workers and agencies masks some important points.

First, the perpetrators of the terrible abuse the children suffered were their mothers, father’s and family members. That’s the greatest horror. It is terrifying that as humans we are capable of inflicting such suffering on another, let alone on one of our own family or our own child. It’s particularly horrific that a mother can do this to her own child. It so negates every good and nurturing thing a mother is. It means no relationship and no home is immune to evil actions and absence of love.

Secondly, that is such a frightening fact and we want to know why. How and why can a person do that? What does that mean about what’s possible? About our human race? That sounds like an overly broad concept really. But I think it shakes us. Can we conceive that our world is one where what should be the safest and most protective relationship, mother and child,  is used to inflict fear and hurt and pain?  We don’t want to. We at least need some explanation. It’s easier to label the failing of a particular social worker or agency, because that we can understand. That we can name. What brought the abusers to use their own children that way, we can’t.

Thirdly – and this is something that’s hard to explain but significant to me as a survivor of childhood abuse – these horrific abuses can and do happen in secret and undetected. Trying to come to terms with what happened to me and questioning over and over whether the things I can remember done to me are true, I’ve often doubted myself and told myself it must have been my fault or I must be mad and inventing it all, because at the time nobody else realised what was going on and nobody intervened and people thought my family was normal (er okay maybe not but they didn’t often suspect the full truth). These two tragic cases in this week’s news show the awful fact that abuse much worse than what I suffered can indeed continue in secret. Therein lies the abuser’s power to control, manipulate and deny.

Fourthly, no more resources are coming for social workers and care and protection teams at the moment. The little glimpses I’ve seen from my work in hospitals, psychiatric services, care teams and so on has shown me loud and clear that there simply are not enough hours in the day and not enough people on the ground to have the contact and communication and time to spend directly with children, families, patients in need,  as well as following the ever more extensive proformas and completing paperwork that is required to meet the rules and regulations (which are supposed to ensure good care is happening but at the same time take you away from doing it).

This is no new or ground breaking feeling. I think most people in nursing or caring services have been saying this for years. But it’s still frighteningly swept under the carpet and denied by those in power. When I worked in a service that supported teenagers and young adults with mental health needs and social support needs, I would take the minutes of clinical team meetings. In one such meeting, changes to documentation for care planning and recording were being introduced, which would require nursing staff to (a) spend much longer away from patients, sitting at computers completing databases and reports and (b) in many cases require nursing staff to spend already limited professional development time on training in IT packages, not in patient care.  Of course, the aim of all these whizz new care planning systems was supposed to be a magical improvement in compliance with regulations about good care. However, nobody could answer who was going to be delivering the care during the time that the already over stretched nurses were completing the compliance paperwork. I wonder whether there’s a box in the risk assessment screen to record the increased risk caused by the fact the nurses and carers are filling in the [expletive deleted] risk screen instead of assessing the patients? 😉 Time and time again there was no answer to this impossibility. In that meeting, one or two nurses directly asked, how in the same shift with the same staff,  were they to fit in their work with their patients, as well as completing the new compliance activities being introduced. How could they do both? Which was to go when the time ran out? In my eyes the response was appalling. The nurses were told that was an unacceptable attitude to display and there was simply no choice and the compliance work was to be done. This came from a senior clinician who I had greatly respected and her response was totally at odds with her usual very reflective approach. Of course I don’t know the history with that particular member of staff who asked the questions and perhaps there was more to it than that, but there seemed a forced denial of the impossibility of continuing to provide good care and the level of presence on the ground with those we are caring for,  which is so important if we are to prevent tragedies like the children who slip through the net where abuse and suffering goes undetected.

I left the service I mentioned because more and more changes were taking clinicians, and support staff like myself, away from being able to maintain the personal contact with patients.  (I’ve since regretted leaving, I’ll admit.) Clinicians left too, at least in part due to stress and sadness around similar issues. They were a great loss to their patients, in my opinion.

A little later I worked a temp cover role as a secretary for the legal team that supported my local county council’s child protection services. Round about this time I thought about training as a social worker. I didn’t in the end. I thought I’d find far too many situations where my hands were tied and too many times bureaucracy stopped me doing the good that was needed.

….

I cry for the children that suffered and for those who so want to be present on the ground to help those at risk but who are taken away and whose voices are silenced when they highlight the lack of resources and impossibility of meeting the demands of keeping children safe in the field, and complying with everything that’s supposed to be ensuring children’s safety. One thing is sure and that’s that it is far too easy to be silenced – again both in the case of the victims and the carers pointing out the shortage of resources to help them. Let’s keep on speaking out.

Ginny xxx