Comment on: Support for US nurse criticised over hair colour
Equating ‘other’ with lack of professionalism is a slippery slope. I love the diversity that is modern Britain. Diversity has nothing to do with whether or not you are a professional i.e. someone whose practice is evidence-based and embedded in an ethical and moral framework.
To paraphrase Martin Luther King, we should lead by example, judging people by the content of their character, not the colour of their skin, or their tattoos, or their ear-rings, or their LGBT status. A workforce in touch with the communities it serves should reflect those communities in all their diverse pomp, and not try to be some conformist, hideously white, vanilla profession, circa 1949. Nursing is diverse but has a problem with diversity. It’s time it loosened up man :-)
1. Please don't 'go on a diet’, they’re snake oil. Like political careers, all diets end in failure. You will gain weight long term if you 'go on a diet'. The question is 'what happens at the end of the diet?' (the answer is: 'you gain even more weight' because when you mess with your metabolism's homeostatic mechanisms, you either slow down your metabolic rate (and feel lousy) to preserve calories, or eat voraciously to return to your personal caloric status quo. Diets may win you beauty contests but have nothing to do with health (20% of the obese pop. have perfectly healthy biomarkers and will live a long, healthy life; 40% of the BMI-normal population are insulin resistant, 20% are likely to be carrying visceral fat and will either die early or suffer multiple long term conditions in later life (but the NHS will do a grand, unaffordable job in keeping them alive to savour their illnesses for years).
2. A 'calorie is a calorie' is arrant nonsense. Adopt a paradigm of permanent, good nutrition: eliminate lethal calories: sugar and refined carbs from your eating habits ( 8g fibre per 100g of carbs). Eat whole fruit, not juices or smoothies which mechanically destroy the fibre, causing it to lose its utility. This is important because it’s the fibre that speeds the movement of food through the gut to the small intestine, where it triggers the satiety signal. Also, without the coating fibre provides around the stomach lining during digestion, we get a large hit of glucose and fructose. The glucose will cause a large hit of insulin, leading to fat retention, insulin resistance, diabetes and heart disease. The fructose flies under the insulin's radar, causes a disruption of the body's satiety mechanism and you fail to 'register' the calories, so inadvertently you eat more than you need. And sugar is addictive, great for Big Food and its profits, not good for you. Rx: whole grain rice, whole wheat spaghetti, bread made from 100% stoneground wholewheat flour (sorry, potatoes are refined carbs, they’re used for fattening pigs and they’re completely out, well maybe once a year). Be prepared to fart a lot (we fart about 15 times a day anyway, we’re nurses, who cares? You’ll live, literally.)
3. Avoid low-fat diets like the plague. If you are eating food with its fibre, fats won't make you fat and they won't make you ill (now that we've eliminated industrial trans fats). The Masai live exclusively on fatty meat, milk and blood. The Inuit eat nothing but meat groaning in fats: seal and whale, complete with lots if blubber. Both populations have infinitely better biomarkers than us, and virtually none of the metabolic syndrome diseases of the West. The low-fat diet is the confidence trick of the age. Guess what got put into processed foods to replace the fat in order to make crap seem palatable? Low fat diets are particularly lethal for women, because their HDL goes down.
4. The NHS is a toxic nutritional wasteland so avoid any food that is sold at work (and whatever you do, don't eat the patients' food, as if you would - it's particularly cheap, nasty and lethal). Avoid any food sold in public places unless you really know its provenance, because it is likely to be groaning in sugar (metabolic syndrome) and salt (stroke, gastric cancer) and will kill you. There really is no such thing as a free lunch: buy and prepare your own food according to sound nutritional principles; make your own lunch and bring it to work.
5. Alcohol (ethanol) is a problem. Unlike carbs, the liver can’t store ethanol as harmless glycogen (liver starch). What the liver can’t send to the mitochondria for energy, it turns into liver fat. Long term ethanol use can cause fatty liver disease, cardiomyopathy, oh the joy is endless. Remember it is visceral fat that makes you sick, not subcutaneous fat. Recent work suggests that the public health advice out there about drinking limits may be overdosing us and that even light to moderate drinking is a risky behaviour. As well as being addictive, it’s culturally problematic to eliminate drinking if it is already part of your social life, so do what you can.
6. Exercising at the amounts prescribed by public health peeps will cause you to merely lose a couple of pounds, so for obese people it is fairly irrelevant to weight loss but relevant to general health in ways I don’t need to rehearse here (cancer, dementia etc etc). It may help with weight stabilisation, in that we consume most calories through our resting metabolic rate, and exercise raises it. Do exercise but don’t expect to lose appreciable amounts of weight by doing so. If you want to develop a targeted OCD around spending several hours a day in the gym, you might get to lose 4 pounds. Fill your boots.
7. Stay strong and don’t listen to pig-ignorant comments about there being some direct relationship between calories in and calories out, or accusations of gluttony and sloth. These comments usually come from smug people with normal BMIs who have no idea that they may be carrying visceral fat and that they are eating in ways which will make them sick in later life. Did an entire generation suddenly decide to eat to obesity? Why are so many poor people overweight?
8. Remember obesity has a genetic component and that the luck-of-the-DNA-draw dictates your body-type. If you eat to sound nutritional principles, and let go of calorie reduction (and if you don’t, naivety will meet the complex awesomeness of the endocrine system, and lose) you will shed the visceral fat that will eventually make you sick, and you will feel great. You will also feel happy because your life does not revolve around the misery of stupid calorie reduction. You may or may not lose weight. You are loved for the content of your character by family, friends and your current squeeze, not the content of your fat cells.
9. Be prepared to seem a bit weird to your family, friends and colleagues. This will be the biggest challenge of all (‘go on, have a chip/another glass of wine/doughnut, it’s a treat, just one’). We live in a toxic wasteland and the current zeitgeist operates from an erroneous paradigm of gluttony versus calorie control and sloth versus treadmill purgatory. It is our responsibility apparently to navigate it, nothing to do with government or reining in Big Food and its tawdry adulteration of food.
So, anyway, I’ve no idea how you lose weight :-)
So, I managed to locate and read the paper. I'm surprised that there is no mention in the analysis of the role of neuroleptics in metabolic syndrome (i.e. obesity, high blood lipids, high glucose) or of lack of exercise and poor nutrition. These are deadly enough in the general population, positively lethal if you are on neuroleptics.
My most dispiriting experiences have been seeing how little encouragement is given to promoting exercise and good nutrition on the wards (chips, spuds, puddings groaning in sugar and other refined carbs, biscuits, fruit juice, crap). No effort at controlling tobacco use, apart from restricted hours leading to binge smoking. I dispensed neuroleptics with one hand and smoking materials with the other - appalling.
If you omit to dispense someone's meds, you're in trouble. Feed them nutritional poisons, tobacco and a sedentary lifestyle and no-one notices. Our practice of 'care' is what is truly insane in mental health.
No full reference, then you send us to a web page listing 12 years worth of journals and no search facility? Seriously NT?
Comment on: Is compassion possible in a market-led NHS?
I've read the Francis Report, which concludes that there was a whole system problem and no individual could be singled out as culpable. He ranged far and wide: senior management focus on cost rather than care and compassion, a climate of intimidation, confusion arising from the RCN's dual role, political pressure on the DH, a split between the regulation of finance and care, task interference from fatigue, low morale, excessive workload, distracted managers, and on and on.
I've an inkling that Robert Francis might have seen Philip Zimbardo's excellent TED talk http://www.ted.com/talks/philip_zimbardo_on_the_psychology_of_evil.html
Mr. Zimbardo was the director of the Stanford Prison Experiment in which we saw good people turn bad. His central thesis is that evil is the exercise of power, and that we should examine not the bad apples, but 'the bad barrel', the situational forces in context. In my paragraph above, it is plain that the power did not reside with the nurses. The last time I looked, I didn't see any nurse selection criteria for 'psychopathic tendencies'. It is highly likely that what we have is good people turned bad by the bad barrel. When we ascribe predicates like 'compassionlessness' to individuals, in order to start an industry called 'compassion training', not only do we traduce an entire profession, we are doomed to repeat the mistakes of recent (notorious) history. I find myself asking 'who benefits?'.
Compassion training seems to me a crass idea which lets powerful people off the hook, won't address the compassionless system in which this awful affair took place, and demeans the nursing profession. Who benefits? 'It's politics Jim, but not as we know it.'
There is one final confound in the compassion training concept. I vaguely recall that Peter Carter (for it is he) many years ago, pointed out that we can teach people whatever we like in college, but us students model ourselves on those in clinical practice, not on teachers. If clinical practice is struggling to find its way in a bad barrel, it will offer poor role models to the seed corn (apple seed?) of the NHS.
I'm just sayin'