CITIZENSHIP - OR CLASS DISTINCTION.

I presume them equals patients, us equals staff. (All staff from management level?) I am surprised, to put it mildly, that Mr. Jolley should feel that he has to describe the situation in these terms; perhaps I am presuming wrongly and that, the intention was to equate them = staff, us = patients, after all patients, are the prime factor involved.

Posing the question, "Do we feel deep down, that a great majority of our patient population are just 2nd class citizens?", is too easy, for (in this context), how are we to define 2nd class citizens. Is it meant that, anyone entering a psychiatric hospital is looked upon as a 2nd rate person, in the eyes of the community at large, or are staff to be singled out as being of this opinion; is it meant that, 2nd class citizens are such, because they are unable to cope in .. the community, because they are unfortunate enough to be mentally ill: is it meant that, certain patients, have mental illness to a more severe degree than others, and if so are they not 3rd or 4th class citizens? Or perhaps we should rest the criterion on length of stay; I wonder if patients who are discharged, automatically become 1st class citizens again.

I could go on in this vein; however I am merely illustrating that, simple statements and questions, sometimes promote a deal of thought, (and this I think would be Mr. Jolley's objective) and sometimes research, to answer. Mr. Jolley was probably generalising and describing a situation as he sees it; but generalisations are never satisfactory.

Personally, I don't believe that, "them and us" (what a derisory and incomplete description, of a most important facet of psychiatric nursing ), describes the attitude of staff towards patients! There is an understanding now, that emanates from staff towards patients, which not too many years ago, did not exist. I think this attitude is reciprocated by patients to staff, except when the nature of a patient's illness, deprives him/her of this advantage; to anyone with enough years of experience to compare, it is evident, that on most wards, the atmosphere is more relaxed, than it has been in the past; this present state of affairs, surely indicating that, progress has been made in staff/patient acceptance of each other's roles; unfortunately (I can comment only on the male division, as at present, and hope that integration will resolve this problem to a certain extent), there are not enough staff to bring about a more complete understanding between patients and staff, more could be achieved in this direction if more staff were available.

Staff are professionals, with a vocational interest in their job; the foregoing being a most important aspect of their work, However as professionals, staff must guard against becoming too deeply, emotionally involved and should therefore, balance their emotional involvements, against their own ability to withstand stress and tension that may emanate from a patient in an acute phase of illness; the role of a psychiatric nurse can be sometimes difficult; and as the term role appears more and acre frequently in professional jargon it nay be helpful to quote notes by writers in the field of psychiatry.

Stanton and Schwartz define "role" as an "organisation, of human behaviour", they also stress the important point, that roles are not isolated, but must be related to counter-roles.

Hindesnith and Straus put down the process of role enactment as:-

There could be a great deal more to be said about "them and us"; however to summarise, I would contend that we are moving towards a more enlightened state of affairs in Winwick Hospital. Ultimately it is the individual that counts, in the nature of the development of attitudes and relationships; in the knowledge that we nurses are in a profession second to none, given inspired leadership, and encouragement from informed management, we could more efficiently benefit our patients, short, medium, or long stay.

T. N. HUGHES

A NIGHT NURSE'S LOT

L. FRYER.

At Winwick we are striving to form a therapeutic community for the ultimate benefit of the patients. There is no doubt that the environment within which we work and live affects us all - staff and patients.

Can anyone explain to me how we intend to make such a society work within the framework of a tyrannical, hierarchical system? I wonder if we are all waiting for a modern Phillipe Pinel to come along and free psychiatric nurses from their chains.

Here is a little story.

A, B, C, D. are all nurses above the level of Staff Nurse. And we have one Nurse, below the level of Staff Nurse, who is within the normal limits of emotional stability.

There comes a day in our Nurse's life when she needs to change her shift. She enquires politely of Officer B if this can be arranged. "Yes" says Officer B. (Nurse feels satisfied.) Officer A. hears of this. "No, No, it can't be done". (Nurse feels insecure.)

A few weeks roll by, and our Insecure Nurse needs to change her holidays. She approaches Officer B. "Under no circumstances can you change your holidays." Insecure Nurse: "But I only want to know how to apply for a change in my holidays. Other people are allowed at least to apply." Officer B. " They shouldn't have been allowed." Our Insecure Nurse develops an Anxiety state.

Our Nurse, who hasn't been away for a holiday for X years because she couldn't arrange then at the sane time as her husband, stays at hone and cleans behind the stove, and under the eaves of the house - due to either her anxiety state or sheer boredom.

Our Nurse moves to another ward, and changes her shift. Her day off gets lost in the process. Officer C tells her in no uncertain manner that it doesn't natter if she has worked eight days without a day off. "What you lose on the swings, you gain on the roundabout." Roundabout? Our Nurse feels dizzy. Words like Magna Carta, Fair Play, Democracy and Factories Act, spin madly around in her head.

Our Nurse develops a severe neurosis.

Officer D to Patient (she was our Nurse, until she developed this severe neurotic reaction.) "We'll soon get you well and back to work."

Patient suffers an immediate relapse.

Officer A visits. "Stay in bed this morning, get up after lunch". Our Nurse/Patient thinks - "She's given me an afternoon instead of a morning." Officer B happens to pass. She smiles at our Patient. "A good holiday will do you good." Patient is sick-noticed.

A few weeks go by. There is a distinct improvement in our Nurse/Patient. She is working on the ward. "Now, now," smiles Officer C, "don't go doing too much." Patient develops a severe psychosis.

She has now lost interest in Democracy, Liberty and Equality. Such things as Therapeutic Communities and every man's right to freedom of speech are like birds flying off to

What money they do receive goes some way to giving them more independence, e.g. being able to buy their own clothes. The work gives them an outside interest, a wider range of people to meet and pride in their work. It gives then some hope for the future. These benefits cannot be measured in money alone. Independence and Pride in self is the greatest gift in all the world.

P.W. McManus.

I. Turner. P.N.

P.N. Walsh.

Dear Sirs,

While as a publication "The Standard" is still in its infancy - can it really achieve its true potential if over 25% of its space is devoted to editorial conmments? For an editorial column to be effective it should be short, sharp and to the point! Perhaps the staff on "The Standard" should review their second issue which was by far the best issue to date.

Sincerely Yours,

M.C. Wyatt.

------

Nine staff contributions this week.

Co-Editors.

------

Sirs,

No doubt a lot of foresight and imagination goes into the planning of the daily menu, but surely what is also needed is a little more insight as to the patients' needs. For instance a ward like M.8D., where the "B" diets outnumber the "A" diets by nearly three to one, and the majority of the patients are mostly sick and feeble old men, surely something light and tempting and equally nutritious could be served perhaps as an alternative! Far be it that I a mere nurse should tell the dieticians and cooks what is nutritious and sufficient for old people's diets, we only serve it and brave the looks of disgust.

As the saying goes the proof of the pudding is in the eating and the state of the swill buckets on this ward at least, is proof enough.

J. Mort.

Co-Editors.

-----

For this is the time that we realise our work as a psychiatric nurse is just beginning. This is our great chance to put into practice all that we are taught in the teaching department.

I was fortunate in that I was allowed a great deal of freedom in putting ideas forward. I never did this before discussion had taken place first.

At times frustration creeps in and we wonder whether we are wasting our time, this we must bear and overcome

. The added responsibility helps the student to realise the importance of trained staff on a ward.

Once the exam is passed, the student finds that she is often still treated as the student. Once a request is made that does not suit, the remark of "she's gone in blue now, who does she think she is?" This does not happen frequently and has not happened to me.

This situation may be helped if the student was moved to another ward as a staff nurse. Also to gain experience qualified staff particularly newly qualified be moved away 6 or 9 months so they become acquainted with all spheres of psychiatric nursing, so being able to where their devotion lies.

M. McKendrick.