17th December, 1971Vol. 1. No. 28.


This week we publish letters regarding the standard of Winwick and an article on discipline.

The Editors believe that the two are quite closely interwoven. Following one of our favourite pastimes, delving into the dictionary, we think our opinion confirmed by one definition of "standard" - "of enduring value", and one on discipline - "training or mode of life according. to rules."

Social Therapy Review

This has been one of our quieter weeks, sportswise. We have had neither net-ball nor foot-ball matches which needless to say have been missed by both teams.

As you are all by now aware we have begun a more integrated programme of entertainments for our patients. The socials during the evenings continue to be successful. However, if anyone has any bright ideas on how to make them just a little different, occasionally, I'm sure both patients and staff will gain more enjoyment. After all, I know that I would soon tire of doing the same thing every evening as I'm sure you would as I'm equally sure some of our patients do.

During the day we have tried integration in the fullest sense of the word and have found it very successful. We have mixed P.T. sessions in the gym, mixed venues on the wards and our staff play an integral part in working on both male and female wards. I'm sure all of the patients concerned benefit to some extent for there is nothing more natural than the mixing of the sexes, is there?

As we have only one week to December, 25th I think it's safe to wish everyone a very Merry Xmas. It's a special time of year. Special to everyone, including our patients. The one's I have spoken to are looking forward to their respective ward parties, Christmas dinners and presents. I know that everyone of us will enter into the true spirit of Christmas when helping our patients to enjoy this happy time.

K. Appleton.


On Sunday, 12th December, Winwick played British Rail, St. Helens.

Newly signed S. Leyland (Staff Nurse at Rainhill Hospital) was in fine form, scoring 5 goals in our hospital's 8 - O win.

Next week's match promises to be a good one, as we play Tetley Walker Transport, from Division 1, in the last eight of the J. White Cup.

Winwick play at home, and kick-off is at 2.00 p.m., so come along and support our team.

L. Smith

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Re. J. Shaw's letter headed 'Recreation Hall,' I can only say 'What a cheek!' Why should anyone receive public praise for doing their jobs and why should it be such a pleasant surprise that it is well done?

If the management thought of giving the nursing staff an Olde Englishe Dinner for MANY jobs well done I think they would have been more than satisfied.

E Hodge, Day Hospital.
Re: What is the Standard of Winwick. This may have been written purely to stimulate one or two people who have not yet contributed to the Hospital Magazine. It has without question stimulated myself into putting pen to paper. There is among some S.E.N.'s at Winwick a "feeling of unworthiness" and I think this is quite true of last weeks article writer. As most staff know there is a positive and essential part for every nurse to play regardless of status, and if J. L. Simpson is feeling insecure with the knowledge she has acquired in training, there is nothing to stop her from furthering her studies at home. As for your sentence, "You can only learn how best to look after the patients by being taught by Qualified Tutors," this seems to me to be a dig at the tutorial staff, which is quite unnecessary, as their results speak for themselves. As for S.E.N.'s who have not had any training, this is indeed unfortunate, but why try to discourage new pupil nurses from entering training school, as this is what your letter implies. I also think that the conclusion to your letter should have read "several qualified Female S.E.N.'s as this has obviously been submitted by a female.

A. Ravenscroft.
There would not be enough space in the Standard to reply to J. L. Simpson's smouldering letter in No. 27 issue.

So cutting things short J.L., why don't you read paragraph two, page one, same issue, and get on with your vital work, as others are doing, trained or untrained, and maybe we will make our hospital a better place for all concerned.

As for the books, you so grudgingly seem to have bought for your training, get them out occasionally, as they should repay in reference for now and years to come. Mine have.

Bitterness and prejudice play no part in our Nursing behaviour and etiquette, not in my books anyway, and I hope never will. Hard work! Well, Maid to Matron must work hard, and enjoy doing so, if the hospital is to maintain a high standard. Hard work is not just done in training, but in all spheres.

A. Fedyk S.E.N. (proud untrained)


Last week's letter to the Standard from (School Trained) J. L. Simpson, to my mind caused a lot of ill-feeling amongst our Unit Staff, and, I assume, many others.

The question of the deterioration in the standards of nursing at Winwick has been brought up many times, but if S.E.N.'s either through service or School training could come together and work as a team, as the text-books tell us, standards would automatically improve.

The majority of S.E.N.'s (service or school-trained) are very good, although there are those who are not too good either, theoretically or practically. I have seen service S.E.N.'s working successfully in areas where Training School nurses have made a real mess of the job, creating little more than confusion. If S.E.N.'s became less status-concious, got on with their job, and realise that team-work requires harmony (and the letter from J. L. Simpson created a tremendous amount of dis-harmony among nurses), then the Hospital would be far better off.

As for the badges of qualified nurses being two-a-penny, is there not some feeling of achievement or pride in gaining one? To those for whom this is not true, might I suggest they form their own 'Selective Nursing Council' and issue badges on approval only.

T. Dunn


Most people, I think, beginning work in a disturbed situation find it difficult to accept the fact that discipline in the ordinary sense of the word has no proper place in the treatment of the disturbed or aggressive patient. The grounds against the use of discipline in a disturbed situation contain both moral and therapeutic elements.

Let us take the moral constituents first: The enforcement of discipline implies the use of sanctions and sanctions in the context of the psychiatric patient, in the already deprived closed ward situation, must be of a crude and simple nature if they are to be effective.

They must, at the least, involve a restriction of personal freedom of movement, i.e. confinement to a room or to a closed ward. Such a restriction of liberty constitutes a deprivation of a basic human right and, in my opinion, no doctor or nurse has a moral right to deprive a patient of a basic human right. If such action is taken primarily or solely for punitive or corrective reasons.

If a patients freedom of movement has to be limited because of his mental state the purposes of such restrictions must be entirely therapeutic.

Cheekiness to staff, disobedience or unwillingness to work or to take part in ward activities do not in themselves constitute valid grounds for restricting a patients personal liberty. To use them as such is as immoral as to steal the patients property or to deprive him of food.

The Therapeutic Grounds.

Discipline of this type is also "antitherapeutic." The patients dignity as a human being - which good Nursing strives to preserve - is entirely dependent on the enjoyment and exercise of his rights as a human being. Curtailment of these rights leads to an erosion of the patients human dignity. The end result of this erosive process is the ultimate degradation of the patient to a status which is something less than human.

The chronic wards of our mental hospital are overflowing with human beings who have suffered this devolution from human to sub-human state of existence.

Agency of Fear.

My opposition to a punitive element in the control of psychiatric behaviour is not on the grounds that it is ineffectual. Except possibly where consciousness has been artificially clouded by drugs or toxics the psychotic mind can be very effectively influenced through the agency of fear. But fear is always malign in this context and its use is morally permissible only in the rare circumstances where life or limb is placed in jeopardy.

Apart from these very rare occasions a compassionate acceptance of disturbed or abnormal behaviour is the most productive basis upon which to build dynamic and positive treatment policies.

Two Alternative Approaches.

There are, it seems to me, two visible approaches upon which to base management policies in the disturbed situation.

One is the "quick result" approach in which madness is confused with badness and in which crude repressive methods are employed with emphasis on "getting the better" of the patient rather than getting the patient better. The end result of this approach is a passive withdrawn patient whose spirit has been completely broken by the processes of the "treatment".

The alternative approach is based on the unconditional acceptance of the patient as a human being. The methods of treatment of this approach are based on interaction forms of therapy, the success of which is largely dependent on the emotional maturity and personal integrity of the nursing staff. The behaviour changes achieved through this approach take longer but the patients independence and dignity as a human being remain intact at the conclusion of treatment.

Where this latter permissive and compassionate approach embraces a whole hospital the need for closed door nursing policies becomes less. In contrast, where a repressive reproach is used throughout a hospital the need for closed door custodial care increases.

This contrast can be figuratively represented as two circles - one "benign" the other vicious.

The vicious circle, unfortunately, does not break easily, if ever.


Royal College of Nursing
Student Nurses Section Xmas Draw

The organisers of the above wish to express their sincere appreciation to all those who contributed to its success by donating the prizes, selling the tickets and buying the tickets. A donation of 60.00 has been made to the Hospital Swimming Pool Fund.

A full list of prize-winners will be published next week.



Mr. I. HibbertPre Student
Mrs N. O'NeilNursing Assistant

Congratulations to the following:

On passing Final Examinations in Mental Nursing:

J. Hunt
E. Molloy
R.O. Amponfi

On passing the Assessment in Mental Nursing:

T. Allen
F. Cox
T. M. Healy
E. Kenwright
H. Marsh
V. J. Patterson
L. M. Peers
M. Vanes

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Will Staff on all wards look to see if they have any stainless steel lids from Food Trollies.

Thank you. Kitchen Staff