Mental health nurses face attacks

Started to comment but was rambling and going off topic (tangientiality, derailment, loss of goal?) so added thoughts to what I was saying here.

And I agree, I don’t see doooom at all. Done right, all is good

46% of mental health nurses say they have been attacked? That is a large proportion isn’t it? Could I ask who did this survey? I ask because I am always sceptical of,well, anything really.

I was attacked by another patient when in acute care. I was disgusted with the attitudes of staff, who kind of poo poo’d it. On reflection I could have made a formal complaint. Asked for the police to get involved but actually I wasn’t so much angry with the other patient. I had been in hospital with them before and they were kind to me but when they get ill, they are aggressive. I didn’t feel it was personal. The attack but I do think the way it was handled was atrocious.

In the old days…when resources were available and staff didn’t spend most of their time in the office and faffing about with paperwork…..if someone got violent on the ward…or seemed to be heading that way, they were taken off to a secure unit for a few days and didn’t come back on to the acute ward until they were calmer and less inclined to get violent. So what went wrong and where? Because acute units are now alot more aggressive than they were.

On the ocassion of the other patient trying to strangle me they were taken to their room and given sedation and I was advised to keep away from them. Advise which was about as useful as a perforated condom. Obviously, I did my best but in a chicken run, the chances of keeping away from other chickens is rather low.

I reckon the reason for so much aggression on wards now is the rise in drug addiction and acute units being used for detox, sneaking of drugs into wards and behaviours that go with that (stealing also takes place), too confined spaces with not enough room to get useful exercise in and not enough attention provided to patients. And maybe people are getting more aggressive anyway but that is another tale of cause and effect.

I did lose my temper once on a ward when being treated by staff with utter contempt. I threw a table across the corridor. That is not normally my nature. I am usually the friendly one who talks to everyone but after a savage week and being treated like a dog I had had enough. After another couple of days of neglect I ran away, in desperation and only after a phone call from my named nurse apologising for not giving me any time and agreeing to slot allocated times into the day did I return. But really, if things have to hit crunch point before a nurse acknowledges that they are not giving patients enough time, something is fundamentally wrong.

Blimey, I have rambled on. But what the heck. I speak from my experiences and it is important for people, with experiences, to be able to share them and not just in ’service user’ environments Well, I think so.

P.S. In light of the new Mental Nurse slogan I am going to call myself an expert in evidence based personal experience.

I worked on an assessment ward for people with organic conditions, and most of the people there were in their sixties and seventies. I did notice quite a lot of ownership issues around possessions such as zimmer frames and walking sticks which occasionally resulted in someone being `thwacked` around the ankles if they had the temerity to try and nick one. I had to work hard at building up trusting relationships with the people on the ward as many of them needed assistance washing, shaving, going to the loo etc. and it was not infrequently that individuals would become agitated and upset with nurses who did not know them and who might be hurrying them along to get dressed for example. I vividly recall going onto the ward one morning and thinking that everyone looked slightly `different`. I couldn`t figure it out, it took me ages and then I finally realised that several people had been swapping their dentures around and putting their usual facial expressions, which I had come to know and be extremely fond of, slightly out of kilt…. like slipping into a parallel universe. In the 2 and a half years I worked on the ward, we only had one incidence of a person attacking a student nurse. Enid was a really large and powerful lady with chronic diabetes and an irrepressible urge to eat anything at all. The student nurse found Enid with about fifteen sandwiches stuffed down her jumper, nicked from the kitchen while no-one was looking. Enid reminds me, retrospectively, of Anne out of Little Britain, a natural food kleptomaniac and the young student just didn`t have the experience to handle the situation in an `Enid` sort of a way. Other than that I have to reflect that on the ward worked, relationships between patients and staff were mutually very affectionate and nurturing and in fact, if i was dementing and needed assessing, I`d be quite happy to be on that ward.

I do believe that some aggresion arises out of fear and confusion and if you add in to the equasion, staff with little experience of handling aggression then things will get out of hand. Give everyone more training and opportunities to work in lots of different environments and that will help staff to find the niche that suits them best and gives the service user a far better deal.

Helen.

That`s equation….. speling!

I just wanted to add that having read the recent post regarding issues relating to young people in the mental health system, and violence and aggression, it would be interesting to conduct some research and see how this might correlate to increasing incidences of aggression towards MH nurses, if indeed the increase can be properly evidenced?

MLA, (can I call you that? It’s easier to type!!) thanks for sharing, you’re right, we need more “user” involvement, and not just in focus groups and consultations.

I have seen several causes/reasons for aggression, including the patient being frustrated at the crap attitude of [one] nurse, by way of approach. Generally speaking, yelling at someone to “turn the stereo down now” is not helpful! Thankfully on the most part, the nurses I have worked with are a bit more considerate and thoughtful.

I’ve been assaulted several times, mostly by people with dementia or an acquired brain injury. Fortunately never seriously though.

Hey Beakie

I know all about NIMHE’s Experts by Experience. I used to be one. And what did my experience count for?…stuff all. That place is full of tea party chats that go nowhere.

The notion that a group of say 10-12 people can sit there and make decisions or more so pretend to make decisions for other people is ludicrous….particularly as there are zilch consultations that go into the pot. NIMHE..their slogan should be “To Listen and then Ignore”!

I am an expert in my experience but nobody else’s and I will never again join anything that claims to be representative without actually being fully consultative as well as acting on the outcomes of them. That would be novel wouldn’t it?

This post has made me break my vow of monastic silence. I discussed my draft job description a long time ago. I recently managed to get a copy of the final job description just to see if they had made any significant changes. Generally much the same.

The last section covers Physical, Mental and Environmental Demands of the Job. It includes:

Prepare and administer medication.

A standard part of the job.

Frequently pushing wheelchairs.

Yep. Normal enough.

Regularly involved in the physical restraint of patients.

Regularly? Physical restraint is actually mentioned twice in this section.

And my favourite, unchanged, item.

Exposure to verbal and physical aggression from patients and their relatives and/or carers.

I ranted about this last time. I still feel the same.

We should not complain about being exposed to verbal and physical aggression. Plainly it is just as accepted and normal a part of the job as giving medications and pushing people around in night shift wheelchair races.

My trust is still very proud of it’s Zero Tolerance to violence policy.

I am back off to the Monastery. Thanks for letting me break into your comments section Beakie.

You work in a mental health monastery mental?!

Nice to hear from you anyway.

Mandy, you are not alone, I have just been reading this story on the BBC website:

http://news.bbc.co.uk/1/hi/health/7241306.stm

That’s scary. I haven’t heard stories this extreme before.

Even working in the field, I’m surprised the figures for staff assault are so high and I certainly don’t recall it being that bad when I was working in the UK. In 10 years I was directly assaulted only once. Since then I’ve experienced more staff assault working in another country (in the same clinical environment) and have found myself a victim on at least half a dozen occasions in 3 years. My understanding of the difference rests in the staff training and experience - where I work now they are all generic “RN’s” who just shift across from Surgical or Operating Room to work in Secure Mental Health. Things are improving as more staff develop a wider repertoire of skills and a greater understanding and ability of dynamic situational management.

As for the patients - I find it appalling that those such as Mandy who are placed in a ’safe’ environment under the ‘care’ of others are actually placed in an environment of seriously increased risk and actualisation of violence. On an acute unit this is seriously not-good, for example; the depressed person who resides in a milieu of a drug-detoxifying anti-social personality.

I believe acute units need a PICU and a sub-acute area also to allow for the safety of the already vulnerable and to keep patient mix numbers at a minimum. Optimally I also believe a Personality Disorder unit is indicated. Such moves would also support the therapeutic quality of the lesser intensive areas whilst reducing the number of available (& likely) victims from the (likely) perpetrators.

That would bring a lot of understanding to the current situation. Thx.

I’m guessing ‘risk assessment’/litigation for the rise in admissions & meeting govt targets for primary care in the community for the fall in resources?

The inferrence of your comment :
“the number of younger people coming in increased. The things they came in with changed also - far more complex problems, involving substance use and criminality.”
highlights some of the issues I’ve raised previously on the mixing of criminality with mental illness and how to deal with it.
The service seems to have gone thru a natural (?market forced) progression ever since the Dangerous and Severe Personality Disorder label came into accepted existence within the MHA and has either been left unchecked or with lots of blind eyes being turned.