- Job Adverts
- Cynics Guide: Psychiatric Hotline Protocol
- Define My Madness ?
- You Don’t Have To Be Mad, But It Helps
- Better Than Butlins ?
- Stop In The Name Of My Law !
- Sectioning Detrimental To Self Esteem
- Avoiding Becoming A Patient
- Cynics Guide: Staff Retention (Part 1)
- [Cynic's Guide: How To Blog]
- Major And Minor Psychoneurotics
- Cynic’s Guide: Not Taught At University
- You know you’re an RMN when…
- A Glossary of terms
- Cynic’s Guide: How To Be An Antipsychiatrist
- The Devil’s Dictionary (Mental Nurse Edition)
- Students Guide to Acute Inpatient Wards
- ABC: A to C
- ABC: D to F
- ABC: G to I
This was going to be Mental Illness: Three: Alternative Interventions. The intended tone is closer to a Cynic’s Guide type post.
I notice in recent comments both Bloo and Zarathustra have foreshadowed what I intended. I intend to totally steal their ideas.
Intervention: Building A Therapeutic Relationship – One
Action: Ignoring Clients With Challenging Behaviour
“Just ignore him nurse, he is only banging his head off the wall to get attention”
All time classic this one. Generally used with ars people with a diagnosis of personality disorder, or just those who decide to be loudly unwell when it is time for a tea break. The theory is that time spent with nursing staff is such a wonderful experience that clients will do anything to repeat it. If they do something loud and messy (slash wrists, kick doors, take a tiny overdose) they will get time from staff. The untaught response to a client in distress, like this, is to ignore them. Otherwise they will just do it again when they want something. Ignoring them reduces the reward leading to a cessation of the disturbing behaviour. Fabulous lack of intervention. Very person centred and never ever leads to increasingly bad behaviour leading to an admission to IPCU or even more fun discharge ! If nothing else makes the nurses look like a bunch of … to the rest of the ward.
Intervention: Time Management
Action: Using “paperwork” as an entirely spurious excuse for not talking to patients (Zarathustra)
“I will be with you in five minutes just after this paragraph.”
In modern nursing there are two schools of thought. One; there is too much paperwork, preventing quality time to ignore patients. Two; there is not enough papaerwork making it difficult to avoid patients. The best time to do paperwork is just when someone is going to need a fair period of attention coming up to the end of a shift, a tea break, lunchtime or sundowning time. The best way to
do the paperwork is at a desk in the office, with the door half open. Have your side on to the door so you can comfortable give a hard stare to the side when you get disturbed. Be surrounded by piles of papers and folders, contents irrelevant. Use defensive body language, pretend you are newly in D wing and your current paperwork is your first meal. Hug it and protect it. When disturbed say you will be out in five minutes. Use this excuse three times. Then say if you do not get it done you will be in trouble, glance Heavenwards and try to look frightened. Another approach is to say:
“Can you stop hanging around the office door please”
in a suitably condescending manner. (Zarathustra)
Intervention: Looking After Your Own Health
Action: Taking Time Off Sick
“My granny died again. No, the other one this time.”
If you need to go off sick, do so. Be prepared though. Even if you come back with a brand new stoma and an amputation at least one quarter of your colleagues will think you are a malingerer. The rest will just want to feel your stump. Prepare yourself by ensuring you put the worst possible interpretation of another staff’s sick time. Point out that it was a Monday, or a Friday. Suggest they did not seem that unwell when they collapsed in a yellow heap. Nod and make hmm noises. By making others seem bigger wasters you decrease your owned perceived wasterness levels.
Intervention: Maintaining A Safe Environment For One
Action: Unobtrusive Special Observations
“No I am not following you, remember you are paranoid !”
Sometimes patients need to be kept safe. Requiring a member of staff to keep them in sight at all times. It is difficult to avoid some patient contact in this situation. You must be sneaky. Whenever the patient makes eye contact with you whistle, any tune will do, I suggest ‘Always Look On The Bright Side of Life”.
Intervention: Mentoring Student Nurses
Action: Encouraging Self Directed Study
“Why don’t you go and research that yourself, it would be a better learning experience”
Students get taught stuff in University. Often they take this book learning and ask mentors about it. Some mentors have difficulty reading the Nursing Standard without following the words with their finger and moving their lips. We get asked things we have no idea about. The secret nurses code for:
“I have no idea what you are talking about!”
is the above comment. When I did my training we got taught about models of nursing. We got taught a lot about them. I, a bright eyed young thing, asked “What model of nursing do you use on Slow Rehab ward.” did actually meet with the response of “What is a model of nursing?”. Eventually the mentors got wise and told me they used “an eclectic approach combing holistic proactive person centred theories.” I think I know what that means now. It means nothing.
[WORK IN PROGRESS - posted to allow contributions, comments will be moved into main post -Mental]
Beakie. I have not treated you with anything other than respect, though I have little respect for much of what you say.
I am not trying to patronise you. In my opinion your thinking about power and responsibility is very fuzzy and you aren’t aware of it. I was proposing a useful excercise in self-education.
I haven’t mentioned child abuse in a while. You are the one raising that again and I am unsure as to why.
You are stating your opinion about the real nature of the power dynamics of Mental Health environments. It is your opinion not a fact. The laws in hand and the situation on the ground are not the same thing. And opinions aren’t facts however strongly you express them, as I am sure you would be the first to point out to me.
I haven’t mentioned child abuse in a while. You are the one raising that again and I am unsure as to why
To offer at least part of your view my support, no other reason.
I don’t think it is my thinking about power and responsibility that is at fault here. I suspect it is a lack of a mutual understanding about terms. Please correct me if I’m wrong, but you seem to be of the view that a psychiatrist has unlimited power over the lives of his patients.
But a psychiatrist’s “power” is circumscribed by law. Even if you doubt that he is accountable to his patients, he is certainly accountable to the law, he is accountable to his professional body and he is accountable to such bodies as the Mental Health Act Commission. Not to mention his accountability to his employing Trust and its managers.
Me: Sorry Beakie that wasn’t one of my weird and whacky ideas it was the Public Accounts Committee of the House of Commons who said that. And they are right.
Beakie: They aren’t right. To start off with, the consultants I’ve worked with would balk at the idea that they have “power”. Influence, yes, but power? No. They have responsibilities granted them by law, and that’s it.
“They have responsibilities granted them by law and that’s it” ..though your later “But a psychiatrist’s “power” is circumscribed by law.” … at least admits they do have power – though you deny it… and no, we’re not just suffering a problem of linguistics here either. You originally stated they have no power – this was not and is not correct. The very law you state in defence of that statement actually DEFINES those powers.
Laws define powers and the limits of those powers. In reality though it is a complex web of written law, personal dynamics, instiututional morale and ethics and a number of other factors that limits or otherwise the power of any Psychiatrist or other doctor in any particular situation.
Psychiatry is probably, in my opinion, better regulated than most forms of medicine, by which I mean, less prone to abuse, more oversight built in, more layers of audit, more external audit and simply more laws.
However no audit regime effectively works 100% of the time.
I stand by my statement that they have no power, hence the quote marks around “power” in my previous post. Psychiatrists are just cogs in the machine, same as all of us, and the people with the real power reside in Whitehall just like they’ve always done.
Beakie
It is absurd to say that Psychiatrists have no power. For a start they sometime confine people and medicate them against their will. These actions require power. The terms in which that power is delegated and excercised are technically dictated by the law.
In practice however a number of other factors help determine the real excercise of power. What side of the bed Gordon Brown got out of has little to do with the on the ground excercise of power in Mental Health units as far as I can see.
I don’t believe you wish to maintain the proposition that Psychiatrists have no power. Even if we only confine it to the legal intention and ignore practice. Search the mental health bill for the words “power” and “authority” (synonymous in the context of the bill). You’ll have a long list.
IB
You are being an arse.
For a start they sometime confine people and medicate them against their will. These actions require power. The terms in which that power is delegated and excercised are technically dictated by the law.
Which clearly indicates that power does not lie in the hands of the psychiatrists, but in the hands of the government. The ability to detain and medicate people against their will is a responsibility handed to psychiatrists under the law, a responsibility that is boundaried by the law.
Beakie
All state power is ultimately excercised on behalf of government. Yes.
A question? On a ward is it more likely to be a) 2 Doctors b) 2 Politicians or c) 2 Ladies called Agnes, who sign the papers sectioning someone and confining them to a MH unit for observation?
Keep the answer simpe. The ones who do that (a – for anyone struggling to keep up) are excercising powers on the spot.
They may have been enshrined in laws by the politicians but you will never find a politician excercising those powers, weilding them, using them, because the law DOES NOT EMPOWER POLITICIANS to use this law. It empowers psychiatrists to use this law and these powers.
Beakie the stance you are taking is clearly absurd. If you really believe it and it is true you teach nurses I for one am worried.
Lou, by the by, you are being an arse**** … if you dont have something concrete to add and just want to flame people like that ^^^ just shut it instead?
“Lou wrote:
IB
Are you having a bad day?”
“Lou wrote:
…it’s important to have respect for eachother, and IB wasn’t doing that in his recent comments.”
“Lou wrote:
IB
You are being an arse.”
….
practice what you preach Lou.
You might not like what I say but I am not and have never resorted to personal insults as a form of argument and I was not being disrespectful to anyone. YOu have namecalled me more than onvce in this thread. I don’t appreciate it. If you have a dislike for what I write I suggest you don’t read it.;
IB – this discussion has moved away from your initial claim: that psychiatrists have power without accountability. They clearly don’t, and you seem to have shifted somewhat towards this view.
What is happening now between us is a circular discussion about the nature of power wherein I point out where the real power lies and you talk about the exercise of legally-granted and strictly circumscribed “powers”. I suggest we drop this, as it’s going nowhere. I seem to be taking a more “meta” view of power, whereas you are focussing on the particular, the “micro” view.
In terms of the relationship between a psychiatrist and his patient, then it is true to say there is an imbalance in the amount of control or influence one person has (the patient can’t detain the psychiatrist, for instance). However, the patient is not a totally powerless pawn in the psychiatrist’s hands, and nor is the psychiatrist free from being under the control of any other more powerful influences.
For instance, the fear of public inquiries means that defensive practice is often the dish of the day.
I would appreciate it if you didn’t make snide insinuations about my ability to do my job based on my contributions here. It’s unhelpful, offensive and unlikely to lead to constructive dialogue.
Beakie it was not a snide insinuation but a genuine concern stated blatantly.
I stated quite plainly that if you really believed what you were saying I was worried about the quality of education new nurses are getting. And I meant it.
Having said that, my concern is lessened somewhat by your last post in which you clearly recognises the truth is not as you have previously claimed: on the ground the Psychiatrist has powers given to him, and circumscribed, by politicians in parliament.
At the same time as changing your argument you suggest we drop the subject. I’m quite happy to drop it now you have dropped the impossible to defend line you were formerly trying to take. In fact there is no argument any more.
Except to say you were not taking a “meta” point of view, you were taking an abstract reductionist point of view that meant your arguments were absurd. I was taking a meta point of view and your attempt to confine it with your abstract reduction was always destined to fail.
I give up. You win. Happy now?
I’ll take my savaged olive branch and go home.
You already gave up. I “won” before we started. You were being silly.
I hope that makes you very content, IB, but I’m now extremely reluctant to discuss anything with you in future.
Withold your love :O —- ooh I am scared —
Next time just don’t try and hold up a piece of patent nonsense as “fact” for so long then discussing anything with me will be less problematic for you.
My intention wasn’t to scare you, IB, but to indicate that perhaps your debating style is a little oppressive and bullying. Go on – have the last word, I know you can’t resist it.
Phew is it over?
*passes Slurry a piece of shortbread*
*smiles at Lou*
Can I have a bourbon?
*Passes Beakie a bourbon* Shhh Dont tell Dr Crippen
*passes Beakie a nice cup of tea*
*passes Mental a biscuit*
P.S. I can’t comment on the live chat ????
Had that earlyer on, just refresh the page.