EDITORIAL COMMENT

Elsewhere in our column attention is drawn to those personal qualities which tend to build up good nurse-patient relationship. In parallel similar comment could be made about staff-visitor relationship. It is most heartening that in an organisation of the size of Winwick Hospital so very few of the comments from visitors are of a disparaging or critical tone, it speaks much for the good sense, the courtesy and the friendly receptions accorded by staff to visitors that such a situation obtains. On the other hand we must not blind ourselves to the importance of the odd person who leaves the hospital feeling aggrieved, cursorily or even rudely dealt with, because these are they who always take the trouble to write in about it, these form the hard core of complainants, and however unjustified may be their complaints, whatever may be the volume of unmentioned mitigating circumstances, they do damage to the Hospital's image and reputation.

"The customer is always right" is a maxim well worth remembering when exposed to excessive pressures or provocation.

The Service of the Future

After a lapse of two weeks we can once again don our spectacles and take a further look at the proposals which are likely to form the basis of the legislative structure of the Health Service for some years to come.

We have already examined the proposed roles of the Central Department and the Regional Health Authorities.

The Area Health Authorities of which there are to be circa 80 collectively form the fulcrum around which a unified Health Service will revolve. They are the operational part of the whole organisation responsible for, planning organisation and administering a comprehensive service to meet the needs or their areas.

A foretaste of their exacting role can be obtained by glancing down the skeleton descriptions of the facets, of their overall responsibilities from which also can be formulated an assessment of the tremendous task which faces them.

The responsibility for administering the following service will fall upon the Area Health Authorities:

the existing hospital and specialist services; the existing family practitioner services; the following services at present provided by local health authorities: ambulances, epidemiological work (general surveillance of the health of the community), family planning, health centres, health visiting, home nursing and midwifery, maternity and child health care, prevention of illness, care and after care, through medical, nursing and allied services (including chiropody, health education - other than its place in the school curriculum and screening),

residential accommodation for those needing continuing medical supervision and not ready to live in the community,

vaccination and immunisation; the school health service.

A list as extensive and comprehensive as this will make tremendous demands upon the planning and executive skills of personnel from all sections of the service as well as from advisory bodies, which from sometime privileged positions have been able to observe and to calculate with remarkable degrees of accuracy the effect both of decision and innovation in a service which already has become pre-eminent when judged by world-wide comparatives.

We shall have more to say on how it is hoped that Area Health Authorities will tackle their problems.

Nursing News

Induction Courses for Nursing Staff

With effect from September 1st 1971, all new nursing assistants and State Enrolled Nurses who have gained this qualification by virtue of experience elsewhere will spend their first month at Winwick Hospital undertaking an induction course under the direction of Sister I. Hankey.

The first day on duty will be for general orientation of the hospital and include fire drill. Following this the nurses will have instruction and experience on the following wards and in the following order:

Week 1	Female 1 Down	Geriatrics
Week 2	Female 6 Up	Long Stay
Week 3	Male & Female Infirmary	Physically Sick
Week 4	Male & Female Upper Delph	Acute

Formal lecture periods will also be arranged during this period.

In order to gain experience of the whole range of a patients day the nurse will work the usual shift system with occasional modification to accommodate lecture periods.

It is hoped to start a 'crash' in-service training programme for nursing assistants already employed but not having undertaken such a course, on October 4th 1971, details of which will be published later.

N. Coppack

NURSE-PATIENT RELATIONSHIP

The many changes and improvements which have taken place in the nursing care of the mentally ill, have been brought about, in the main by dedicated nursing staff past and present, and in no small measure has the ever improving nurse-patient relationship, (particularly since the 1959 Mental Health Act) played its part in obtaining the high standard of nursing care the mentally sick receive today.

In consequence of the importance of nurse-patient relationship I wish to point out a few things that may help new nursing staff in establishing a successful nurse-patient relationship.

In nursing generally it is necessary that you know your job and can do it efficiently. In psychiatric nursing in particular, the nurse-patient relationship based on confidence is fundamental to all psychiatric nurses. The nurse becomes a model in some ways for the patient's own behaviour. Patients are watching you and assessing you all the time. 'It is impossible to form successful relationship in a short space of time. It is a full time job. Furthermore a successful maturing relationship nay be broken by a few ill-advised words or a thoughtless action.

Things that may Help

a) Addressing: The patient is a friend and courteous manner by name (never by surname alone)
b) Friendly physical contact (e.g. a hand shake or a hand on patients shoulder)
c) Avoidance of moral judgement.
d) A cheerful smile (except where inappropriate of course)
e) Learn to recognise concealed aggression in oneself towards a difficult patient, and to understand its causes.
f) Try to avoid giving orders.

The list of do's and don'ts can be endless and not all that helpful. The basic attitude and approach is the all-important factor. If every patient in every circumstance is treated in the way you would treat a close friend or loved relative, you will come very close to being the ideal psychiatric nurse.

E. Wright

Swimming Pool Fund

I would like to thank very much the staff of the Infirmary Unit for the donation of £13.00 to the above fund from their effort on Saturday 7th August, also Miss Coppack has received a donation of £5.00 from the Warrington Soroptomist Society. I hope in the very near future to be able to give you the target we shall be aiming for.

The total amount in the fund at present is £236.70.

A. Kennerley

FIRE HAZARDS IN THE HOME 4

WHAT TO DO IN CASE OF FIRE

A plan of action should be prepared so that every member of the family knows what to do.

Bring everyone in the house to the ground floor where they can leave the building safely.

See that the FIRE BRIGADE are called at once: don't just think that someone else has already done so. All members of the family should know the position of the nearest fire alarm or telephone and know how to call the fire brigade.

THE SERVICES OF THE FIRE BRIGADE ARE FREE

All children, invalids, and old persons should leave the house immediately and under no circumstances should they be allowed to go back until the fire is extinguished. Make sure everyone is safe.

Do everything to reduce draughts which may fan the fire. Close all doors, windows and other air vents.

Pending the arrival of the Fire Brigade efforts should be made to check the spread of fire by use of extinguishers, buckets of water, or whatever other means may be at hand.

Do not put yourself at risk.

IF CUT OFF BY FIRE

Close the door of the room and any fanlight, and block up all apertures.

Go to the window and try to attract attention.

If the room fills with smoke, lean out of the window, unless prevented by smoke and flame from a room below or nearby. If you cannot lean out of the window, lie close to the floor where the air is clearer until you hear the fire brigade.

If escape has to be made before the brigade has arrived and no other method is available, make a rope by knotting together sheets or similar materials and tie it to a bed or other heavy piece of furniture.

If you cannot make a rope and the situation becomes intolerable, drop cushions or bedding from the window to break your fall. Get through the window FEET first, lower yourself to the full extent of your arms, and drop.

If possible drop from a position above soft earth. If above first floor drop only as a last resort.

LETTERS TO THE EDITOR

(In reply to Mr. Nunn's letter in Standard 10)

The patient's of F. 4. Up are encouraged every week by the staff to attend the Church services.

We have approximately 7 patients who attend the Roman Catholic service; but not one who will attend the Church of England service. When encouraged, we are told that they would sooner:

a) attend coffee mornings
b) watch the service on the television
c) plain and simply No.

None of our staff has ever refused to take a patient to church, as we acknowledge this as a nursing duty; but we respect our patients' wishes and prefer them to make their own choice.

Perhaps if Mr. Nunn spent more time with the patients and stimulated their spiritual needs and his sermon themes, then more patients might want to attend Church.

Congratulations To:

W. Robinson S. Harwood

On passing the City and Guilds examination in Catering.