Tag: Anxiety

What happened on my mental health nursing placement

My first morning as a student nurse on a mental health placement

Anxiety and stress can affect anyone.
My first experience of mental health placements terrified me

So, what happened on my mental health nursing placement? I mainly remember how my anxiety levels went through the roof even before my first day. I’d almost forgotten the sickening thud of palpitations that indicated the onset of a panic attack. Breathe Nancy, breathe…..

It all started after coming across the Scary security guard who let me into the acute inpatient mental health unit. If he was anything to go by, now I really was afraid! However, I followed his scant instructions to my allocated ward… and I breathed my way through the anxiety.

Beyond the ward door, people were milling about in all states of undress. One lady baring her breasts, as she had a hospital gown on backwards and the ties were undone at the front. Fortunately, she had knickers on, albeit they were large white paper ones, which covered her modesty.

Others had on what looked like hospital-issue pyjamas, tho’ some male patients were bare-chested, and barefoot. While some had their own dressing gowns, clothing and footwear on.

The ward on the first of my mental health placements

Staff photo board on my first
mental health placement

More dusky-coloured walls lined the long narrow ward corridor. The old artwork that adorned the wall on the left was curling at the edges and hanging precariously with tattered tape.

A large perspex-covered board with photographs of unsmiley people (staff) wearing nametags hung on the right. Maybe someone had had a fallout because they’d scribbled over one particular nurse’s face.

Alongside the board was a wonky shelf with “Welcome” leaflets and other ward-related information. Some were ripped or scrunched up, and others were way past their sell-by-date. To one side grubby windows were bare, the lino looked like a dried sanwich curling at the edges and a lone dining chair sat against a long wall.

Which one is the nurse

Nurse sauntering lazily
Nurse sauntering lazily — Image from Shutterstock

Heart still pounding, I pressed the buzzer and watched as this man-mountain sauntered lazily towards the door. He unlocked it with a key from a large bunch and nodded me in, smiling. As I entered, he locked the door behind me.

Other than those in pyjamas, it was difficult to identify who was a patient and who was staff. Man-mountain was wearing jeans, a sweatshirt and trainers and could have been anyone, but for the keys and lanyard round his neck. The staff badge itself was concealed within his clothing. He introduced himself as Adeola and nodded me toward the nursing office, a small room surrounded by perspex windows.

The door to the office was locked so I tapped lightly on the perspex and waited. I stood for some 30 seconds, hoping one of the three people in there would let me in. And quickly, as a small crowd was beginning to gather round the ‘new nurse’, some leering and making rude gestures. One had his hands down his pyjamas and was grunting unpleasantly. However, a few patients smiled at me and asked whether I was a nurse or a student. My anxiety levels began to stabilise.

The nursing office

No uniforms in mental health nursing

Yay! The door opened and a young man with a bald head and geeky but cute round glassed bounded towards me. “Hello. You must be Nancy, our new student. Come in now, come sit. Moreblessings get up and give this wee lady a seat now, will ye?” This young Northern Irish guy also in jeans, with a t-shirt and trainers raced on “I’m Derry, that’s Moreblessings and there’s Abimbola, Nancy.”

Without coming up for air “Would ye like a wee cuppa tea Nancy, would ye? Give us a wee minute and Moreblessing will get ye one, eh?” I loved him already and despite some humphs and tuts together with eye-rolling from Moreblessings, I knew I was going to like it here.

Moreblessings was dressed in a neat flowery jumper, a calf-length polka dot skirt with thick black tights and flat black shoes. The poor thing huffed and puffed her bulk out of the chair in the far corner, between the filing cabinets, to give up her seat. Derry slid into her empty chair, leaving his for me.

As I sat I took in the rickety desk with some stacked filing trays, a telephone, and some office paraphernalia on it. Two battered-looking four-drawer filing cabinets stood opposite each other, crammed into the corners. An ill-fitting formica top stretched along one side of the office and held a fax machine, the photocopier, and few loose files. Above that was a couple of flimsy shelves holding lots of precariously balanced lever-arched files and some nursing books.

Start of early shift

Just at that, the office door burst open and in bungled two others, out of breath and laughing as they attempted to get their coats off in the tiny space. “Yer late again Alison, Fadhil. Come on now. Hurry up,” shouted Derry pleasantly above the din.

“Keep your hair on, I’ll just grab some coffee.” giggled Alison as she winked at me.
“You’ll just not. Come on. Some of these folks want to go home this morning.” said Derry. “Anyway, this is Nancy, our new student,” he added. Alison smiled and Fadhil nodded at me.

Morning handover on mental health wards

The heat from the six of us soon steamed up the office window and I was getting a whiff of body odour, badly covered up with strong but not unpleasant cologne. Alison sat her neat bum on the table edge closest to me and her sweet, floral scent helped mask the icky smell. She too was wearing faded jeans with a striped t-shirt and trainers. Fadhil wore white jeans, a red shirt with an unusually ornamental tie and shiny black mock-croc shoes.

Derry looked towards Abimbola who started to read out names from a large whiteboard on the wall. “Helen, slept all night, no problems. Peter, he’s okay, just waiting to go home. Isaac, restless and sat in the day area most of the night.”  Abimbola went on, discussing the twenty patients on the ward that morning. This was called handover and it happened at the beginning of each shift. It was brief and didn’t give me too much information. However it was enough to begin with as I also had to memorise staff names.

Finished, Abimbola snatched up his coat and heaved his large frame through everyone and left the office, waving wearily as he went. The other two night staff also made a mad dash for the front door.

“Coffee Nancy?” Derry asked over his shoulder as he went next door to the kitchen, so I followed, and said yes. A toaster, cereal bowls, plates and coffee mugs clattered onto the stainless steel worktop as staff began preparing breakfast for the patients. As they worked, they helped themselves to hot toast dripping with yellow axle grease (aka, cheap margarine) and runny jam.

Smoking rooms on acute in-patient mental health wards

Derry made two coffees and handed me one asking “Do you smoke Nancy?” As I nodded he made cheeky eyes at me to follow him and we crossed the narrow hall to the smoking room. As we walked in, clouds of yellow fog surrounded us and the pungent smell of too many lit cigarretes  hung in the air. Two filthy windows were open by half an inch so the smoke had nowhere to go.

Several pairs of lifeless eyes turned towards us, others stared blankly at nothing in particular.

The floor was littered with fag ends, empty crisp packets, screwed up plastic cups and old cola tins. Derry sat on one of the chairs, inviting me to sit next to him. As I did I noted the  stains, the cigarette burns and other unidentifiable debris so perched myself lightly towards the front end of the chair. Smiling nervously I offered my introduction “Hi, I’m Nancy and I’m a new student on the ward.”

“Alright Nance. I’m Pete” one guy mumbled flatly,  “I like students,” and I sighed in relief, then “You got a spare fag Nance?”

Derry interrupted, “Pete, the wee lass just started today. Leave her alone.”

“No it’s okay.”  and I offered the pack to Pete, who took two!  Then I watched as others eyed the box, willing me to offer them one too. I didn’t feel I had a choice, so I was five ciggies down already, and it was just gone eight a.m. However, I could see that ciggies were going to be great currency for getting patients to engage with me.

Breakfast and Medication on a mental health ward

At that, there was a loud rattling of the kitchen hatch going up and Moreblessings yelled out, “Breakfast time, breakfast……” as she loped along the hallway.

“Time to move,” said Derry. “I’m your mentor for this placement Nancy, but bear with me and I’ll catch you up in a wee bit. I’m coordinating the shift today. Have a wee seat, chat to a few patients and see how you get on, eh?”

Moreblessings was still yelling and now Fadhili had joined in, “Medication,” he sang and I watched as he went down the hall, knocking on bedroom doors “Medication…… Break……fast…….. Med…i….cation………”

Patients trickled out from rooms, heading in various directions. Some shuffled to the hatch between the kitchen and dining room for breakfast and others towards the queue for medication. One or two just flopped on chairs in the living area and gazed vacantly at the blank t.v. screen.

I thought I’d be best in the kitchen helping with breakfast, as there wasn’t much I could offer on the medication side, being a new student. But to be honest, I was glad of the counter between the kitchen and the dining room. It put a barrier between me and a slightly aggressive young female who was eyeing me up and down, glaring. However, it didn’t protect me from the stale morning breath and rancid bodies of one or two who hadn’t seen a shower for weeks. I retched when I saw ingrained dirt under one patient’s fingernails as she scrambled to pick up toast.

I was out of my comfort zone

There was no queue as such and patients just leant over each other to reach for cereal, milk and sugar or the unevenly toasted bread. Green plastic cups of hot water were being handed out so that patients could add either tea or coffee.

Drinks and cereal sloshed around as patients shuffled to small tables in the dining area, leaving sticky puddles everywhere. Afterwards, vacated tables were dotted with crumbs, slops and spills, so I went round the other side of my barrier to wipe them down.

I practically flew back when Mandy screamed, “Fucking lesbian. Stop fucking staring. You fucking ugly white bitch.” This was the young lady who’d had her nightgown on back to front.

“Oh, ignore Mandy. She harmless really.” said Mrs Wilson, this tiny, sweet domestic lady in her Jamaican twang “She just having a bad morning.” Which didn’t do anything to abate the dry mouth and dizziness my anxiety was causing.

Supernumerary on mental health placement

Breakfast was almost over and the last of the dawdlers stood heads down in the queue for medication. I popped into the office to see that Derry had allocated patients to the four staff on duty; two qualified mental health nurses being Derry and Alison, while Moreblessings and Fadhili were the two nursing assistants.

I had Supernumerary status which means that student nurses are additional to the clinical workforce and undertake a placement in clinical practice to learn, not to be used as members of staff.*

Feeling like a spare part and quite out of my depth, what with Mandy following me, I asked Derry what I could do to help.  He said to just shadow one of the staff and not to worry about Mandy; she’ll be fine after her medication. Alright for you to say, I thought as I bumped into Mandy when I backed out of the office. I turned with a wobbly smile to say “Hi, I’m Nancy, a new student here. Is there anything I can I do to help you this morning Mandy?”

Patients love student nurses on mental health placements

“Ah, you’re a student, I thought you was one of the Doctors, I fuckin’ ‘ate Doctors. Ask if I can have leave, will ya? It ain’t ward round today and that’s the only time you get to ask for leave, but I ain’t fucking waiting ’til Wednesday. I need some clothes, look at me in this fucking dirty ‘ospital gear.” she ranted. And while she ranted, I relaxed — a little.

I asked where her clothes were, what did she come in with and whether we could perhaps find them together. “They ain’t here. Someone nicked them in the night. Jealousy, that’s what it is. Jealous cos I’m a model and I get given good gear to wear. And that’s why they nick it. Fucking poofs and lesbian, all of them. And the staff, they’re at it too. All of ’em,” she rambled.

I didn’t know what to think so I offered to help find her clothes but she wandered off, still cursing and muttering. Quieter now though.

“Go and have a wee break Nancy, you deserve it.” Derry grinned. Not a bad introduction to my first mental health placement.

Over to you

Have you ever been on or visited a mental health ward? What’s you’re experience of mental health wards. How does your experience differ from mine? Maybe you’re a student nursing and wondering what it’s like on mental health placements?

*Nursing & Midwifery Council, 2015

We need to talk about anxiety in men

Do you think we need to talk about anxiety in men?

Are you about to explode? You may suffer from anxiety.
Anxiety in men is real — Image from Irishtimes.com

An article by Madeline R. Vann, MPH caught my eye recently. She wrote: “Anxiety disorder in men is real and treatable through therapy and medication.” She’d written about a young man who, although aware he’d had anxiety since childhood, he never actually tackled it until well into his twenties. I just thought, what a long time to suffer. This, and the fact that it’s Men’s Mental Health Week, is why I think we need to talk about anxiety in men.

So what is anxiety?

Are you aware of the effect stress has on your body, mind and spirit?
What do you know about anxiety?

Anxiety is a type of fear usually associated with the thought of a threat or something going wrong in the future, but can also arise from something happening right now.

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe, according to the NHS. Everyone has feelings of anxiety at some point in their life. For example, you may feel anxious about sitting an exam or a job interview. During times like these, feeling anxious can be perfectly normal but some people find it harder to control their anxieties. Their anxiety is more constant and can often affect their daily lives.

Anxiety is a feeling that lets us know when we might be in danger, at risk or under threat. However, anxiety disorders occur when our fears and perceptions of danger are greater than they need to be.

The following information from the NHS is about one specific condition called generalised anxiety disorder (GAD). GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.

Symptoms of generalised anxiety disorder (GAD) in men

GAD can cause both psychological and physical symptoms. These can also occur in other anxiety disorders but for brevity, we’ll just talk about GAD. These symptoms vary from person to person, but can include:

This guy is about to have a nervous breakdown
Symptoms of generalised anxiety disorder
  • feeling restless or worried
  • having lots of negative thoughts, feeling guilty, angry or shame
  • having trouble concentrating or sleeping
  • dizziness or heart palpitations
  • feeling like you’re having a heart attack – if you suspect heart attack, seek urgent help
  • sweating, sticky palms
  • shaking
  • fidgeting or pacing
  • feeling faint
  • feeling like you can’t breather, choking
  • fingers or toes tingling (this happens when the blood runs from your extremities to your heart and muscles, where it’s needed to prepare for fight or flight

What causes anxiety disorder in men?

The jury’s out on this one. The exact cause is not fully understood, tho’ it’s likely that a combination of several factors plays a role. Research has suggested that these may include:

When stressed out your brain activity increases
Does over-activity in the brain cause anxiety
  • over-activity in areas of the brain involved in emotions and behaviour
  • an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
  • hereditary – you’re more likely to develop an anxiety disorder if you have a close blood relative with the condition
  • having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
  • a painful long-term health condition, such as arthritis
  • having a history of drug or alcohol abuse
  • but many people develop anxiety disorders for no apparent reason.

Who is affected by anxiety?

Absolutely anyone. You might’ve noticed someone constantly drumming their fingers or tapping their foot annoyingly? Maybe you’ve seen that irritating colleague who constantly fidgets during meetings or spits out the nails she’s chewed for the last half hour?

Anxiety in me

Swimming helps reduce anxiety in men
Anxiety in men — image by featurepics.com

I’ve experienced mental health problems, including anxiety and I know how horrendous it feels (you can read it here). The dread when going to watch my sons swimming because of the steep seating area. I hated all those stairs looking over the pool and had a terrible fear of tumbling down them all. I’d start to sweat in fear, and my heart would be pounding through my heart and in my ears. It was the same in the cinema, those damn stairs, and in the dark!

Tube stations soon became a problem too, the further down the escalator went, the more anxious I got. (Hence my love of driving and the famous London black taxis.)

Vicious circle of stress and anxiety
Vicious circle of anxiety

See, the thing with an anxiety disorder is that once you’ve had a panic attack, you get anxious about being anxious. You only have to think about, let’s say, the tube station, and your anxiety levels shoot through the roof. And then it becomes a vicious circle of thoughts, feelings, behaviours.

Take a look at the diagram. You might have the thought “I’m dreading the tube station,” and you begin to feel anxious, so you avoid the tube (behaviour). After this, you might think “I’m so weak,” and feel sad, alone, angry…….. and so on…….

Anxiety in men close to home

Black belt anxiety management
Black belts can have anxiety – Image by jahir-martinez-unsplash

My two adult sons experienced anxiety and panic attacks in the past. They’re both black belts in Karate, they’re club swimmers and play football each week.

So, although they both claim to be geeky in a science-type way, they’re not weedy or wussie; nor do they come across as lads who’d have anxiety.

Some family and friends have been shocked, like “Wow, I didn’t think they’d have mental health problems.” and “Never? I’m really surprised.”

Several younger male family members were encouraged by this and sought support themselves, with some having gone into talking therapy. They’ve all said they’re so glad they did.

So, what I’m really saying here guys is, it doesn’t mean you’re a weak person, anyone can experience anxiety. It doesn’t care where you’re from, what class, faith, creed, race, gender you belong to or what job you do.

Anxiety statistics

Biting nails can be a sign of anxiety
The anxious and pacing nail biter
  • In 2013, there were 8.2 million cases of anxiety in the UK.
  • In England women are almost twice as likely to be diagnosed with anxiety disorders as men.
  • the condition is more common in people from the ages of 35 to 59.
  • 5.9% of people suffer with a generalised anxiety disorder.
  • mixed anxiety & depression is the most common mental disorder in Britain, with 7.8% of people meeting criteria for diagnosis.
  • 7.2% of people aged 5 – 19 have been diagnosed with an anxiety disorder
  • In 2017 13.1% of people aged 17 – 19 had an anxiety disorder

As you’ll have noticed, anxiety and depression are closely linked so if you have one, you’re more likely to be experiencing the other. You might also find that some form of agoraphobia, a fear of doing certain things, or going to certain places quite often occurs with anxiety.

How is anxiety disorder treated in men?

Anxiety disorders can have a significant effect on your daily life, but several different treatments are available that can ease your symptoms. These include:

Colour image of scrabble saying recovery
Recovery from anxiety — image from Psychcentral.com

With treatment, many people are able to control their anxiety levels and lead normal lives. But some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.

Self help for generalised anxiety disorder (GAD)

Regular exercise can keep anxiety at a distance
Exercise for anxiety – Image by Pexels at Pixabay.com

There are also many things you can do yourself to help reduce your anxiety, such as: 

  • reading a previous post 19 free mental health apps just for you here
  • or Tips to help with your anxiety and panic attacks here
  • attending a self-help course in person or online
  • exercising regularly
  • stopping smoking
  • cutting down on the amount of alcohol and caffeine you drink
  • trying 1 of the mental health apps and tools in the NHS Apps Library

Over to you

What do you think?
Clipart.com

When it comes to talking about mental health problems, do you think it’s necessary to separate the men from the women? Or should we just be inclusive and talk about mental illness as a whole? What about the men; should they just man up? I look forward to your thoughts and comments, and of course, I’ll answer any questions.

Related: A look at mental health during men’s health week (1). 8 symptoms of anxiety in men (2). Men and anxiety (3).

If anxiety was a person I’d punch it right in the face

My journey through anxiety and more – Part XI

dark skinned lady with white wrap covering her most of her face, tears in her eyes
Anxiety and panic attacks
broke me

This is the 11th in a series of “My journey through Anxiety, panic attacks, depression and psychosis. Please click here for Parts I, II, III, IV, V , VI, VII, VIII, IX, and X if you wish to read the backstory (It might make more sense).

For those of you who don’t know, I started writing about my journey six months ago and only ever intended to write it in four posts. However, it’s become clear that my journey through mental illness was a lot longer and more painful than I remembered. That’s made it difficult to get the words down on paper at times. I’ve taken many breaks and written lots of other posts in between, giving me time to reflect and bounce back a bit stronger each time.

I’d had enough!

……….. I told him to pack his things and leave before I got home from night shift in the morning.

Night shift on a mental health ward

Lady in red dress and white sandals hanging from a rope around her neck
Shocked? You should be! Female patient strangled herself

After our patients had had their night medication, the support nurse went to complete the half hourly observations. This meant checking each bedroom or cubicle to ensure everyone was accounted for and alive.

I was in the office when a roar from the end of the corridor alerted me and I raced towards noise. Oh, Jesus! A female patient had strangled herself with the belt from her robe. Her face was a horrible shade of purple and she appeared not to be breathing. My anxiety levels just shot through the roof and I felt the colour drain from my face.

I helped untangle the belt from round her neck and felt for a pulse, but there was nothing. Jesus, I’d only been a mental health nurse for two months and I was near paralysed with fear. “Get the crash trolley,” I yelled down the ward to Maria the third nurse on duty. Sarah was a favourite of mine and there was no way I’d let her die, not on my watch.

Cardiopulmonary Resuscitation (CPR) on a mental health ward

Down on my knees now, I fumbled, trying to find the right place to press (the breastbone is pushed down firmly and smoothly, so that the chest is pressed down between 5–6 cm) then started CPR (at a rate of 100 to 120 chest compressions per minute – that’s around 2 per second, British Heart Foundation).

I could feel the sweat dripping down my back and the trembling in my arms as I continued 1.2.34.5……… 30, for what felt like a lifetime. All the while, I was trying to keep calm, as this was no place for my impending panic attack. Concentrate, concentrate Caz, you can do this, concentrate. Finally Maria arrived with the crash trolley and I asked her to take over while I ran to call the Crash Team.

Crying with relief

I turned to sprint back to the office but stumbled and fell forward with a thud and landing awkwardly. I immediately felt searing pain in my right shoulder. Still, I got up as quickly as I fell and dashed to put a call out “Cardiac arrest on Violet Ward.” This relays a crackly radio message to the Cardiac and Rapid Response Teams. When they get that message, they race from the general side to the Mental Health, side pretty damn quick.

Four doctors dressed in scrubs, running down a corridor
Emergency Crash Team running to
an emergency

I’d all but forgotten my own burning pain as I ran back see what was happening. On my way, I guided any inquizitive patients back to bed and tried to reassure them all was well.

I took over the CPR and rather stupidly, wept with relief when Sarah started showing signs of regaining consciousness. Her eyes were flickering and she was trying to catch her breathe. She now had a pulse, albeit a weak one. Just then, the Crash Team arrived and took control.

Caught wearing a tired grey bra

Male Doctor, white scrubs and stethoscope
Duty Doctor —Image from Freepik

Sarah had survived, but was still taken over to the general side to be observed overnight. The Duty Senior Nurse was in our office making sure we were all okay when someone let on that I’d fallen. The cute young Duty Doctor came to see me and all I could think was “What bra have I got on” when he asked me to undress to assess any damage. Only I could be wearing a comfortable but tatty old bra that looked like I’d washed the floor with it! The shame.

Despite the agony, I didn’t complain too much so the Doctor suggested I go home and return to A&E tomorrow if the pain got worse. It was just past eleven p.m. and I called to let the boys know I’d be on my way home. Only it was Ian who answered, drunk and stoned, so I hung up and got a taxi home.

He should have been gone. Aaarrgghhh……. I sure as hell was in no mood for more of his spiteful crap. Once home, I ignored him and went straight up to our bedroom when I got home. I managed to sleep with some pillows propping up my right arm and woke at dawn, in agony.

A slap in the face

Lady with right arm in a sling
Broken collar bone — Image from Amazon UK

Back to the hospital, where they confirmed that I’d broken my collarbone and torn my rotator cuff tendons (muscles and tendons that attach the arm to shoulder blade). I was put in a sling, given strong painkillers and sent home to rest up. But before I left, I went to see how Sarah was. I got a slap in the face, albeit a light one, cos she was mad that we’d saved her. Of course, I told her, I’d do it again.

My painkillers were starting to kick in and I was feeling kinda woozy so any anxiety I’d had about facing Ian all but disappeared. For f*ck sake! The whiff of beer and cannabis about knocked me out as I opened the front door. It was just two in the afternoon, for crying out loud.

Still, I was delighted to see all his boxes stacked in the hall, “Wakey, wakey, time to go,” I sang cheerfully.

The drunk driver and a mad man

Ladies face with tears of pain
Crying in pain

“Can I borrow the car?” slurred Ian as he staggered towards me, hand out for the keys. It would have been funny if he hadn’t been so serious. “Nope! Get a taxi,” I smiled. With that, he lunged at me and grabbed my wrist viciously. “Aaarrgghhh!” I screeched in pain and anger, hanging onto my arm and cursing under my breath.

At that, I heard “Mama,” and Nic was hurtling down the stairs behind me, “What did he do, did he hurt you Mama?” I hadn’t realised he was home from school. Ian shot out the front door and Nic was charging round the kitchen like a madman, cursing furiously. He yanked the front door open and threw out every one of Ian’s carefully packed boxes. Ian looked on helplessly as glassware, cd cases and electronic equipment crashed down onto the road.

The neighbours were out, wide-eyed at the the scene unfolding and I don’t know what was funniest. Ian’s look of helplessness or Nik holding every last piece of luggage high above his head before throwing it as far as he could. The door thudded shut! Nic was trembling and pale with anger, he turned to me tearfully, whispering “I’m sorry Mama.”

We hugged and cried, but this time we cried with laughter. Ian was calling across the road “Can you get us a taxi?”

Over to you

Big red question mark with little white character leaning against it, pondering
Clipart.com

I’ll end here for now and hope you’ll stay with me for the next part. In the meantime, I’d love to hear your thoughts and please feel free to ask any questions.

Spoiler – find out what happens on Mental Rehabilitation Wards

Early shift

memesmonkey.com

As I parked up my first morning, even above Slade’s Noddy Holder screaming “It’s Chriiiiiistmass”, I could hear a female screeching “Medication. I want my medication. Where’s my medication? I need my medication.” The poor neighbours either side of the building must have been well p’d off. It was six forty-five, pitch black outside and the streets were eerily quiet — other than the high pitched screeching coming from the Mental Health Rehab Unit piercing the air.

Someone in the office by the front door pressed a button to let me in and I was greeted by this tiny little lady who grabbed both my hands and panted “Help me. Help me please. I need my medication. You’re new. Are you an Agency Nurse?” Will you help me? Please?”

I spoke calmly but firmly, “Listen to me, I can’t help you right now…” I was trying to placate her enough so that she could hear me and take in what I was saying. At the same time I was trying to get her to take a breath as she was panicking and was as white as a sheet. I really felt for her.

“Please, please. I’m begging you,” she continued to screech, now in my face, as I tried to disentangle myself from the tight grip she had on my wrists. The office door opened and a nurse yelled “Cindy, stop it, leave her alone. Cindy!” I’d now managed to get myself free but Cindy had grabbed the nurse and was pulling on her cardigan, all the while screeching “You’re a bitch. You’re a fucking bitch! Get my medication you fucking black bitch.”

The nurse eventually pushed me into the office and she followed, turning to slam the door in Cindy’s face with a kiss of her teeth “Oh Lordy Lord. That Cindy. She will be the death of me. I am Ayo. Who are you?”

I breathed a sigh of relief and introduced myself as the Student Nurse. “I don’t know. See how it is here. I pray to God for her sins,” humphed Ayo. “Hmmm. Take a seat. Ah! Here come the staff.” and I turned to see two females and one male puffing away outside, the ciggie smoke belching through the office window. “Tsk, Tut. I don’t know. Smokers, heh!” moaned Ayo as she reached to slam the offending window shut.

Seven o’clock on the dot the three members of staff traipsed in, throwing their coats on top of a filing cabinet. Lisa was first to introduce herself as the RMN, the shift coordinator and my supervisor, and said “That’s Lorna, she’s a qualified (RMN) and that’s Graham the NA (Nursing Assistant).” Where’s the fourth member of staff? I thought to myself.

Morning handover

“Okay.” started Ayo, above Cindy’s screeching. “The lady herself. Cindy, she slept and now she has been shouting before six thirty. Lord help me! Everybody still in bed. Only Sasha, she awakes all night but she stay in her room. Somebody needs to clear her room. I saw the mouse there.” My feet moved on their own, up off the floor as I sat on a desk, and I shuddered involuntarily when I was looking around for the said mouse.

Ayo continued and ended with “Moses needs to see a Doctor and his toenails need to be cut. It’s in the diary for this morning. Now I’m going home. Goodbye!” She pulled off her slippers and put them in her bag then huffed and puffed as she bent down to put her shoes on. She grabbed a large woollen blanket and shuffled out of the door.

Lisa went through the diary, handed out tasks to the other two and said she was doing medication and that I should shadow her. Lorna went off to wake up the other nine patients that lived in the ten bedded unit and Graham wandered off to the kitchen to prepare for breakfast.

Medication

With our coffee, Lisa and I went to the medication room, we were met with Cindy who was still gulping in great lumps of air, wringing her hands and saying “Thank you Lisa.” and “Thank you nurse.” to me. Yes, I could get quite used to being called Nurse.

“Right Cindy. You know we start titrating down your Diazepam today.”

“No, please Lisa. Not today. I can’t cope. I can’t cope!” Cindy screamed.

“Nought point five milligrams Mandy. You won’t even notice it.” Lisa tutted and turned to me. “She’s been on thirty milligrams three times a day for years and you can see it doesn’t reduce her anxiety. So we’re going to try titrating down while she’s in Rehab.” Cindy lived in a one bedroom flat and had apparently relapsed over a period of six months prior to admission to an acute ward. Once stabilised she was transferred to rehab.

Cindy had generalised anxiety disorder (GAD) which is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. 

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue. Titration looked like it would go on forever, reducing her Diazepam by nought point five mg three times a day. However, Cindy eventually accepted the reduced dose and greedily swallowed down all her medication, followed by gulps of water, then scurried off to the dining room.

Breakfast

We continued until each patient had had their medication then joined everyone for breakfast in the dining room because, on rehab, we were encouraged to eat with the patients each mealtime. Lisa waffled something about nurses having a responsibility to role model table manners and eating with the patients was supposed to encourage healthy eating. I wasn’t sure that this was an evidence-based intervention but I went along with it anyway.

Coffee and toast with jam was just what I needed but as I sat to eat I was immediately struck by an offensive odour. One older lady to my left had obviously not washed or brushed her teeth, yet there was another disgusting smell.

Graham screwed his nose up and said “She’s just sat there and shit herself and carried on eating!” to nobody in particular. “That’s Elsa.” he whispered with an Aberdonian accent. “She normally goes to the toilet but she uses her clothes to wipe herself and then hides them down the back of the toilets, eh Elsa?” he now boomed. “Elsa, say hello to Nancy, she’s our new student.” Elsa’s face was buried in the huge breakfast she was picking up with her teeth. She raised her head and gave me a toothless grin.

None of the staff got up to help Elsa so I offered, but Graham told me “No. Wait til after breakfast!” And this is rehab? I wondered — does it really work?

Around the table, there was belching, farting and one young chap was trying to snort back the snot that was threatening to hit his top lip. He eventually gave up and wiped a huge glob on the sleeve of his t-shirt leaving a silvery snail-like trail.

Coffee finished and my toast in the bin, I helped clear the table and took my time in the kitchen. I was hoping someone would deal with Elsa, as I was already feeling queasy. Fortunately, she’d gone by the time it took me to do the dishes but she’d left wet poop dribbling down the chair legs. Gloves and apron on and ten minutes later the chair was scrubbed and left outside in the back garden to dry.

Activities of daily living

To the bedrooms on the first floor now where I tried encouraging patients to wash and dress before attending any appointments or activities. Oh my word! I’d knocked and opened the door to Sasha’s room and was aghast at the cereal boxes piled as high as the ceiling. At a guess I’d say there must have been over two hundred boxes and the only other floor space was filled by her bed and two or three black sacks.

“Get out of my room.” stormed Sasha as she pushed me and slammed the door. I stood for a few seconds, stunned, then knocked and called out “I’m a student nurse Sasha. Is there anything I can do? Would you like me to help you clean your room.”

“Get lost.” Sasha muttered. I went to find Lisa and asked what I could do to help Sasha. “Not a lot,” Lisa laughed. “Her room’s been like that forever. She won’t let us in.” That can’t be right. Surely we have a duty of care? I went to the office to look through Sasha’s file and her painstakingly completed but outdated care plans to see if I could find ways to engage her.

I read that she was single, had no children and had been in care since the age of eleven when her mother couldn’t cope with her chaotic behaviour. She was thirty one and was diagnosed with Schizophrenia at eighteen. Sasha heard voices and was often heard talking back to them when alone in her bedroom. Apparently Sasha had no insight and didn’t believe she had a mental health problem. She’d been on the unit for six months and was awaiting housing but it was proving difficult to find a place that would meet her needs.

I decided then that I’d be really firm with Sasha right from the start, telling her that we have a duty of care to ensure that her environment is habitable. If she wouldn’t clean it herself, then we would have to do it! It annoyed me that staff had let her live like this for months. Even if Sasha had refused to let them clean it, surely the staff could have come up with a plan between them.

It was exhausting and often thankless, but I worked hard with Sasha for the next twelve weeks, updating her care plans and engaging her in meaningful activities; things that would both interest and help her rather drum banging or painting by numbers. I appreciate that one of her care plans previously stated ‘Engage Sasha in activities.’ But, while these particular activities may help with dexterity and fine finger/hand movement, I wasn’t sure they would support her development. It was clear that certain staff had intermittently tried to push Sasha into any activities and wrote in her notes ‘Declined to attend.’ I wondered why!

I’d eventually learned more about Sasha, along with the other patients on the unit, and had managed to form a professional bond with each of them. As I got to know them better, often by engaging them in friendly banter, I was better informed about their likes and dislikes. It was easy to see they weren’t interested in particular activities and that they had their own ideas about how to spend their time.

Mark liked football so I’d have a kickabout with him in the gardens – he was quite good – so encouraged him to attend the local leisure centre where he could access different types of exercise and look out for a local football team to join.

Jenny loved knitting so we bought her knitting needles, a few patterns for baby clothes (that she requested), and some wool. She wasn’t great, dropping more than a few stitches, but that wasn’t the point. She enjoyed it. Other staff who could knit helped her unpick and start again. Eventually, with the help of staff, she started her own small weekly knitting group on the unit.

We also got a group of patients to go swimming once a week, with a member of the team. We also went to the local pub once a week so that some of the young lads could have half a pint and a game of pool. They’d never felt comfortable going into a pub previously, because they were worried about what other people thought. We quite often did get some odd looks but as a rule, the regulars were great – helping the lads with their game and showing them trick shots.

At the end of my placement I loved seeing Sasha and the others laughing, smiling, engaging and growing in self-confidence and once again, I was sad to leave.

I would later bump into some these patients in various settings i.e. in the community or on the wards and I was either saddened by their relapse or delighted by their continued improvement.

Note to self: “Public service must be more than doing a job efficiently and honestly. It must be a complete dedication to the people and to the nation.” Margaret Chase Smith.

Verified by MonsterInsights