EDITORIAL COMMENT

Mr. Beck's article on The Stepping Stone. Club last week spotlighted an area which will, and rightly so, receive greater attention in the future. We look forward to bringing you news of a venture which, if successful will be something of a feather in this Hospital's cap.

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Social Therapy Review

This week, the accent has been on sport. On Tuesday evening, a visiting, five-a-side football team came to play Winwick in a mini-knockout competition. The visitors were from the youth club of Warrington Silver Band under the supervision of Mr. Harvey. The evening was a great success with everyone thoroughly enjoying themselves. There were two teams from Winwick, indicative of the enthusiasm which surrounds sport just lately.

Thursday saw the first of the '72 season's fixtures which was a netball and football match played away at Prestwich Hospital. Unfortunately, the football match had to be cancelled due to the waterlogged state of the pitch. However, the netball team played their match indoors with the men as spectators. The match was of a very high standard indeed and resulted in our girls winning by 38 points to 13. It was fantastic to watch the courage and determination shown by both teams and if this is any indication of the standard for future matches we shall have a hard but undoubtedly successful season.

As I mentioned in last week's 'Standard' we are trying to organise staff netball fixtures. Anyone who would like to be considered for the team, including students, pupils, cadets and nursing staff, should attend the practices which have now been arranged for every following Tuesday evening between 6.00 and 7.00 p.m. Everyone is welcome.

K. Appleton.

The Science of Behaviour

I feel compelled to write in answer to the article "Discipline in a Disturbed Ward", which appeared in "The Standard" number 28.

The crude moral basis of this article is incompatible with any attempt to provide a reasoned solution to the problems of nursing the disturbed patient. What the author is overlooking is the fact that there is a science of behaviour which provides us with a model for the treatment of all types of behaviour which we construe as undesirable. Emotive words such as, 'discipline', 'immoral', 'deprive' and 'fear' should not be used when we are looking for a solution to such a serious problem.

Whilst admitting that violence is always unacceptable, it is naive to assume that "interaction forms of therapy" are the only alternative. Such forms of treatment, based loosely on the psychodynamic model are virtually worthless in terms of acute behavioural disorder. Whilst it is commendable to think of the patient at all times in terms of personal dignity, this becomes a worthless statement in terms of practical solutions to practical problems. Acute behavioural disorders exist, and it is of great dis-service to patient and staff alike to pretend that they do not.

The science of behaviour, founded upon well tested principles, gives us the following hypotheses.

1. Behaviour may be weakened by not rewarding it.
2. Behaviour may be strengthened by following it up with reward.
3. Reinforcers may be described as those consequences of a behaviour which strengthen or weaken it as they are presented or withdrawn.

Let us now analyse a piece of disturbed behaviour in terms of this model.

The patient will emit a piece of undesirable behaviour, for example, hitting a member of staff. In order to stop the patient repeating this action the staff must ensure that it is not rewarded in any way. This is not the same as punishment.

Let us now see what would happen if this piece of behaviour were treated by the 'interaction forms of therapy' as suggested. This form of treatment will be highly rewarding to the patient as it involves a great deal of attention. Thus one is rewarding undesirable behaviour by giving attention. One is teaching the patient how to gain attention by emitting behaviour which is obviously undesirable. This illustrates the fallacy of treating acute disturbance in this manner.

In order to reduce disturbed behaviour, one must ensure that no reward follows it. The simplest method would be the removal of the patient to a side room. This involves no punishment, nor any loss of human dignity. What it does do, is ensure that there is nothing rewarding in the emission of undesirable behaviour.

This simple model gives a guide to the practical and effective treatment of patients in a disturbed ward. It involves no hysterics; no accusations; and no blame. It is a sound and practical solution. Let us hope that this rational approach will be adopted.

F.C. Mort

There appears to be a rumour circulating through the hospital to the effect that the Hospital Advisory Service is to re-visit the Hospital on 28th March.

Is the rumour correct?

If so, it would no doubt help to allay possible staff anxieties if we were told what the purpose of the visit is to be.

E. Bromley

Editors Note:

Mr. Bromley's query and suggestion anticipated correspondence just received to inform us that the Hospital Advisory Service are at the present time in the Liverpool Region and plan to make a follow up visitation to the Winwick & Newchurch Group from Wednesday 29th March to Friday 7th April, 1972. Details of the visit are not yet finalised but as soon as these are to hand they will be made known through the medium of the Standard. It is understood that the personnel of the team has changed to the extent that of the original members who visited Winwick only Mr. Baldwin, the Chief Nursing Officer remains. We shall look forward with pleasure to meeting him again.

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Mr. Evans, Chief Fire Officer, presented the film "They Called it Fireproof" on F.6 Up on Tuesday 25th and Wednesday 26th. Many members of staff attended also Unit Officers, several patients from various wards even from outside our unit attended. The film was indeed very interesting and appreciated by all. Since the showing it has been a regular topic of conversation on F.6 Up and I'm sure it has made many of our patients more aware of fire precautions.

K. Lythgoe

Re. Social Therapy Review, over the past few weeks we have had the benefits of social therapy brought to our notice. Indeed the assets of such therapy are many, and it would be impracticable for me to list here the benefits of such treatment.

However, are we not forgetting the many other therapies equally as beneficial to our patients?

Let me make an even bolder statement (if I dare). Are there not patients in our hospital to whom socials may hinder their return to the community, rather than help?

Does the patient admitted with marital problems benefit? Does such socialising not threaten their marriage further? Should we not concern ourselves with the wife or husband left to cope at home? Does this not lead to ill feelings, even resentment and jealousy?

What of the inadequate personality, does too frequent socialising not offer a means of escape, to shirk everyday responsibilities? Would it not be more beneficial to the patient if we concentrated on more educational classes, housecraft, and home management?

Do short stay patients need such constant socialising? Surely their visitors offer adequate male company for their short period of hospitalisation? It is doubtful that they will forget or become unaccustomed to socialising as on their return to the community outside, they will probably continue their previous social life.

To summarise, the need for our patients to mix socially is undeniable but we should not overlook the many other forms of therapy, nor should we neglect the possibility, that in certain cases emphasis would be better placed on other forms of therapy.

E. Molloy.

COMPOUND GLYCERIN OF THYMOL MOUTHWASH

Published in the 'Lancet' in January was a letter written by a M.H. Hughes of the public health laboratory, Royal Hampshire County Hospital.

He says that "undiluted glycerin of thymol in the maker's container was found to be contaminated with sporing bacilli and, when artificially inoculated, Ps. aeruginosa was maintained in a viable state; the use of the stuff therefore, carries a risk of cross-infection should pathogens gain access to the ward stock bottle. It is likely that tap water would be a safer and cheaper fluid for mouth toilet."

The preparation issued by the Winwick pharmacy contains an additional antiseptic (Phenol 0-5%). Nevertheless tests on our product are being conducted in and by the courtesy of the Path. Laboratory, results of which we hope to give eventually.

Meanwhile, in the interests of safety it would be prudent to cease use of this preparation pending completion of the investigations.

Alternative preparations are stocked by the pharmacy, and the information is available to any inquiring member of the medical or nursing staff.

STOP PRESS

The Compound Glycerin of Thymol tested in the Laboratory did not support the growth of micro-organisms even when artificially inoculated with Pseudomonas aeruginosa. Staff will be glad to know that it is still safe to use this preparation as a mouth-wash or gargle, - providing that it is not diluted until required for use.

Laboratory staff are thanked for their cooperation and for the speed with which they obtained and communicated the results of their efforts.

H. Taberner

The Standard Vol. 1 No. 34.

I would consider it is the prerogative of the Heads of Departments and their recommendations to the Hospital Management Committee to make the decisions as to the capability and usefulness re. the Maximum retirement age of individual staff members.

W. Lane

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Regarding that marvellous feat of engineering The centre piece at the Staff Dances - CINDERELLA'S COACH, which I am told is destroyed after the festive season.

May I suggest an alternative fate? Why not display the above mentioned at the local walking days and carnivals, and then present the coach to a children's home, where it would bring endless hours of pleasure?

The publicity derived from this gesture would be most welcome in an age when psychiatric hospitals are being criticised for ill treatment and brutality.

G. Moon.

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May I thank the kind person who sent me the address of a charity which requires old "Christmas Greeting " cards. We will be collecting these in future.

J.A. Jolly.

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Will the nurse who wants a "Textbook of Surgery" please contact Social Therapy Dept.

J.A. Jolley.

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We are sorry to hear of the illness of Mr. Lewis, the Head of the Psychology Department who has been "off sick" for some time.

We wish him a speedy recovery and hope he is soon back amongst us.

Publications Committee

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During recent months much publicity has been given to staff ill-treating patients and long drawn investigations have been carried out. However, recently, when a patient attacked a Male Nurse and this action resulted in the death of the Nurse the publicity only warranted a meagre four lines in an obscure column of the daily press. It looks as if this is just one of those things that staff have to accept.

K. Lythgoe.

Editors: Not at this Hospital.

A number of spare staff locker keys are available on Female 1 Down; the numbers are:

944, 111, 1013, 865, 53, 1259, 9663, 988.

If anyone has key no. 101 and 856 spare, they would be welcome.

D. McKendrick.

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Does anyone know of a furnished flat suitable for a single nurse? if so, please contact D/S Rynn, F. 1 Down.

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