EDITORIAL COMMENT

Nearly five hundred copies of this magazine are run off every week. At an average of ten pages, each with two sides, this comes out at around 10,000 printed sides.

Fortunately we have a machine in Hollins House which is built for this sort of work.

Fortunately? I saw it in action last week. Like the buttered toast which falls face downward this machine has a nasty mind of its own. Spare a thought for whoever has to hold its hand.

** ** ** ** ** ** ** **

Social Therapy Review

For the past three to four months, the department has been primarily concerned with the geriatric population of the hospital. The interest has taken the form of what we call 'assessment groups' which until now have taken place during four mornings of the week. On entering the gym anyone might be forgiven for mistaking the session for a games morning, however, on closer observation one can see that the patients have been split into rough groups according to their capabilities. Just now we are working on the fruits of our observations by trying to help our patients understand more thoroughly what they do know and to learn what they don't know, for example, personal hygiene, how to play cards and dominoes, therefore understanding numbers, the new decimal currency; not new to us but absolutely alien to those of our patients who do not handle money. However, on several occasions I have been surprised by the number of staff who continue to think that our people are still coming down to the gym purely for P.E. Admittedly we usually spend the last half hour dancing or doing something active as a light relief and certainly as a passive form of exercise. Perhaps we have been at fault for not explaining the new sessions to each member of staff but it's as easy for one member per ward to come down and observe for their own, and their colleagues benefit.

K. Appleton.

We regret that Dr. Gulland is leaving this Hospital soon. His forward-looking attitudes and drive will be sadly missed.

Publications Committee.

** ** ** ** ** ** **

How long must we wait for a swimming pool? While we are waiting can we press for our own coach? I am sure that the money saved from the hire of coaches for summer outings and games fixtures would go a long way to pay for this coach.

D. J. Devine

** ** ** ** ** ** **

Swimming Pool

Finance Committee 8th June, 1971

Minute No. 99

Agreed that the first priority for endowment monies at Winwick Hospital be the provision of a patients and staff swimming pool.

** ** ** ** ** ** **

Cacti and Succulents

"Succulents": There's such a colossal range of succulents. Even 'Cacti' are succulents but this week, the subject is "Succulents other than Cacti".

There are several types of succulents from thin to thick leafy types, small to tall growing types. called by the fanatical collectors "T.C.P.'s" (Turnips, carrots and potatoes), and some that are stemless types.

In each of the types mentioned above, there are hundreds of different and in each genera plenty of different species.

One of the most common genera is called "Haworthia". These plants have very short stems and beautifully patterned leaves, anything from 1/4" to 6" long, and they flower every year from being two-year-old plants. The flower stems are usually about 18" long, with flowers shaped like little bottles, which are red at the base changing to bright green at the tips.

These plants are not really grown for the flowers because these take a long time to form and fall off within hours of opening. But the formations and patterns on the leaves make the plant worth having.

Now, along with "Haworthias" there are "Alues", "Agaves" and "Gasterias", grown also for the leaves only because the flowers are very much all the same. All of these genera come from Africa, in the grassy plains, hence the flowers being so tall in comparison with the plant.

Some other succulents are known as "Stapelias"; these plants are not very attractive in body, but the flowers are beautifully harked and shaped like a starfish, brightly coloured in red, yellow, green, and purple. But this type has one main drawback, the flowers make an evil odour.

Another favourite are the "Crassulas" these are small growing plants in various shapes. The flowers are very small and some are heavily scented.

There are also the stemless types of plant which come under the heading of "Mesembryanthemaceae". This family alone contains a very large number of genera, some of which are named, "Conophytum", "Ophthalmophylum" and "Lithops." "Lithops" are commonly called "Living stones", and in their natural habitat they look very much like pebbles, and cannot be found very easily until they flower. Another tyre of stemless plant is called "Fenesteria". These live most of their life buried under the sandy plains but for the very tip of the plant, which is transparent so that the sun can get into the plant to keep it alive. (Commonly known as window plants).

Another type of succulent that comes from Ethiopia is known as "Euphorbia". These are weird plants, with an extremely snail waxy-like flower. If these plants are fractured in any way they bleed a white residue that looks like milk, and if at any time you ever get any of this milk on your fingers do NOT lick it off, because it is very nasty to taste and has a paralysing effect.

Now we come to the "T.C.P.'s.". I have left these plants till last because .I know very little about them. To me they don't look like plants at all, but like rotting pieces of tree stumps, but most collectors go out of their way to try and acquire them. I don't knows why, maybe it's because they are rare and hard to keep. I know they need a high temperature all the year round or they will die.

I have now come to the end of these articles on and "Cacti and other Succulents", and have only touched a fraction on this subject. I hope I have been able to answer some of the questions you had in mind.

I have somewhere in the region of about 2,000 different plants in my collection, and my greenhouse is only 32' long. To house every different succulent under the sun, one would need a greenhouse about a mile square, there must be about three or four hundred thousand.

If you want to know more about "Cacti and other Succulents" you can always go along to your local public library and get books on the subject or join a club. There are about ninety-five clubs up and down the country, and the address to write to is:

Membership Secretary, N.C.S.S.,
Miss W.E. Dunn,
43 Dewar Drive, Sheffield S7 2GR.
Phone 074-2-3616149

You are always welcome to come along and see my collection any evening at any time.

Bert Green,
17 All Saints Drive,
Thelwall,
Warrington. Phone War. 65626

The Sherbourne Tragedy

In Winfrith ward at the 350-bed Coldharbour Hospital, Sherbourne, Dorset, 30 mentally handicapped patients died in a fire which broke out in the early hours of July 5th. Only 7 of the 36 patients in the ward were rescued, and one died shortly afterwards.

The fire was described as "A nightmare come true", and within 24 hours a committee of enquiry was set up. Its terms of reference: "To enquire into the cause of the fire and the action taken, including the adequacy of fire prevention arrangements.

The committee has met, evidence has been taken, and a full report will be published shortly.

Many theories have been put forward on the cause of the fire. If press reports are to be believed, it is thought probable that the fire was caused by a patient setting something alight in the dormitory, whilst the person supervising the dormitory was elsewhere within the building.

This sort of situation has all the ingredients for disaster. Patients, cigarettes, matches, flammable bedding and minimal supervision, and is by no means confined to the Hospital at Sherbourne.

Apart from patient supervision, or the lack of it, let us consider one fire prevention measure which could be taken and would not involve hospital authorities in considerable expense. Control of Cigarette smokers.

It is said that cigarette smokers stand a fifteen times greater chance than non-smokers of dying from emphysema, thirteen tines greater chance of dying of lung cancer and a twelve times greater chance of dying of bronchitis. Cigarette smokers also account for most of the fires that occur in mental hospitals.

Smokers may risk their own health, but what is objectionable is the smoker setting fire to his bedding, killing himself and others in the process.

There is no doubt that cigarettes are killers both in the medical and physical sense, and it is incomprehensible that institutions dedicated to restoring human beings to full health, will at the same time permit those same persons to impair health and to create a hazard to others.

Common sense dictates that smoking should be controlled in hospitals, and where one has to contend with pathological puffers among staff and patients, special areas should be set aside: but outside these areas a 'No Smoking' should be rigidly enforced.

C.P. Evans.

** ** ** ** ** ** **

Self Financing Lead in Payments Ballot Results

	For	Against
Butchers & Catering	30	6
Farm & Gardens	16	14
Portering Staff	25	8
Wardmaids	20	126
Drivers	--	2

A monk, a nun and a novice went out on a lake to fish. The monk found he had forgotten his rod, got out of the boat and walked over the water to the shore and brought the rod back. The novice was astounded. Later the nun decided to have some tea, she got out of the boat, walked over the water and back again with the tea.

The novice was again astounded.

Later the novice felt hungry .and offered to get some food, his offer was accepted. With considerable trepidation, the novice got out of the ,boat, and, not surprisingly, sank. Coming up for the third time he heard the nun say to the monk, "Do you think we should have told him about the Stepping Stones?"

** ** ** ** ** **

Our ex-patient club, The Stepping Stones is now in Ashton Hall in Warrington, every Thursday night at 8.00 p.m. Why not come along, and not only enjoy the evening out but also to help to fulfill a worthwhile need which is sadly lacking in our community. Everybody is welcome and any help given will be appreciated.

J. Beck

** ** ** ** ** **

The Proprietorial Pronoun

In 99 instances out of a hundred an enquiry made, at random, to any sister or charge nurse in any psychiatric hospital in Britain about the number and type of patients in their care would elicit, I feel sure, a response couched in terms such as the following: MY ward contains X no. of patients. MY patients in the main suffer from chronic schizophrenia. The possessive adjectives are in capitals because I would like to devote this letter to a few speculations on the degree of ownership which is intended to be conveyed in such contexts.

The usage of proprietary expressions of this sort is not confined, of course, to the world of nursing. Doctors shop-talk about THEIR patients. Vicars will refer to THEIR curates. An army officer will express pride in HIS troops. Headteachers will tell jokes about THEIR pupils or THEIR school caretaker.

I have often wondered if these persons, consciously or subconciously, wish to convey the same degree of ownership as the farmer who boasts about the price he got for his pigs, or the gold cup won by his prize bull at the county agricultural show. If they do, their factual accuracy - to say the least - is questionable. Ownership of this degree and kind was made illegal many, many moons ago. Indeed, where I came from, it was an anachronism when Brian Boru won the battle of Clontarf in 1014, A.D.

It must be conceded, however, that the words MY, HIS, and HERS have different connotations depending on their context. For instance, the phrases, "my boss" or "his mother-in-law" denote a much weaker proprietary relationship than the phrases, "my car" or "her dowry".

But our topic is concerned with human relationships and not semantics and in the present instance, with the degree of ownership which doctors and nurses in psychiatric hospitals imply when they use the phrase, "my patient".

A clearer insight is to be gained in this matter, I think, if we briefly consider some aspects of the nurse/patient and doctor/patient relationships in a fresh, if unusual, light. See them, let us say, through the eyes of a visitor from Mars who knows nothing about psychiatric orthodoxies or mental nursing theories.

One of the first observations our visitor might make, on entering a disturbed male ward, would be that a small number of the inhabitants wore white coats while the reminder wore ordinary clothing.

After some time he would notice that at regular intervals during the week the white coated ones knocked some of the others unconscious by connecting them to an electrical circuit.

At other times he would observe the people in white coats sticking needles into the buttocks of some of the others, sometimes against the wishes of the victims, and then forcing then into darkened rooms where they were kept in isolation for indefinite periods.

He would notice, too, that the whitecoated ones strictly controlled the freedom of movement of the other, deciding such matters as when they got up in the morning, when they ate, when they bathed and when they retired at night.

If our man from Mars had enough curiosity - and courage - to ask one of the men in white coats who and what the other inhabitants were, and why they were being so treated, he might be answered, "Don't interfere. They are MY patients."

What meaning I wonder, would our Martian have given to the word, MY, in that context?

If later our visitor made a tour of the rest of the hospital, spending a day in each Department, he would become more puzzled about the word 'my'.

On Monday, the long-haired chap in the Psychology Department introduces patient x as "MY patient". On Tuesday, the claimant to patient X is the clever-looking Education Officer. On Wednesday, it is the Social Therapist who claims patient X. On Thursday, Patient X is to be found on the Psychiatrist's couch being given aversion therapy by a very proprietorial behaviour therapist. On Friday, the claimant is the busy O.T. girl, who has as little doubt about her proprietary rights as had any of the others. Is it unreasonable to assure that on Saturday our Martian would go shopping for a dictionary to discover the meaning of the word MY?

In conclusion, as for as the present writer is concerned, the above speculations are completely open ended. But I must add that during the course of my nursing career I have heard professional people using the impersonal pronoun, it, when speaking of individual patients. In your journals, The Nursing Times, even, such terms as epileptics, alcoholics, schizophrenics etc., are often used in articles about mental illness. This trend toward the depersonalisation of the patient, in my view, is to be deplored because it subtracts the element of human dignity from the nurse/patient relationship. The nurse's usage of the proprietorial adjective may be another component in this depersonalisation process. No doubt, not always, but often enough, I think, to make it suspect.

C. Breslin.

Industrial Relations - Code of Practice

Part VI Communication and Consultation

1. Communication and consultation axe essential in all establishments. They are necessary to promote operational efficiency and mutual understanding as well as the individual employee's sense of satisfaction and involvement in his job. Management employee representatives and trade unions should co-operate in ensuring that effective communication and consultations take place.

2. Communication and consultation are particularly important in times of change. The achievement of change is a joint concern of management and employees and should be carried out in a way which pays regard both to the efficiency of the undertakings and to the interests of employees. Major changes in working arrangements should not be made by management without prior discussion with employees or their representatives.

Communication

3. In its day-to day conduct of business management needs both to give information to employees and to receive information from them. Effective arrangements should be made to facilitate this two-way flow.

4. The most important method of communication is by word of mouth through personal contact between each Manager and his immediate work group or individual employees and between managers and employee representatives.

5. Personal contact should be supplemented as necessary by:

a) Written information provided through, for example, notice boards, house journals and handbooks.

b) Training, particularly induction courses for new employees;

c) Meetings arranged for special purposes.

6. Subject to the limitations on disclosure of information (see later), management should regularly provide employees with information about:

a) the performance and plans of the establishment, and, so far as they affect it, of the undertaking.

b) organisational and management changes which affect employees.

7. Management should ensure that:

a) Managers, including supervisors, regard it as one of their principal duties to explain management's policies and intentions to those responsible to them and have the information needed to do so;

b) work instructions are conveyed clearly.

8. Management in co-operation with employee representatives should:

a) provide opportunities for employees to discuss matters affecting their jobs with those to whom they are responsible;

b) ensure that managers are kept informed of the views of employees and of the problems which they may face in meeting management's objectives.

9. The Contracts of Employment Act, as amended in Schedule 2 of the Industrial Relations Act, entitles every employee, other than those in certain categories specified in the Act, to be notified in writing within thirteen weeks of starting a job, about:

a) his main terms and conditions of employment;

b) his rights under Section 5 of the. Industrial Relations Act in respect of Trade Union membership;

c) How he can seek redress for a grievance.

10. The written statement should be as comprehensive and easy to understand as possible, where it refers the employee to another document, the Act requires that he must have reasonable opportunities of reading that document in the course of his employment or that it must be made reasonably accessible to him in some other way. He should be told clearly in the written statement, where he can see the document.

11. Apart from the statutory requirements, management should ensure that each employee is given information about:

a) the requirements of his job and to whom he is directly responsible;

b) disciplinary rules and procedures and the type of circumstances which can lead to suspension or dismissal;

c) trade union arrangements;

d) opportunities for promotion and any training necessary to achieve it;

e) social or welfare facilities;

f) fire prevention and safety and health rules.

g) any suggestion schemes.

12. Employee representatives and trade unions should:

a) ensure that they have the means to communicate effectively with those whom they represent;

b) recognise that management has a responsibility for communicating directly with its employees.

13. Management, employee representatives and unions should co-operate in keeping employees informed of the conclusions reached through negotiation and consultation.

Consultation

14. Consultation means jointly examining and discussing problems of concern to both management and employees. It involves seeking mutually acceptable solutions through a genuine exchange of views and information.

15. Consultation between management and employees or their representatives about operational and other day-to-day matters is necessary in all establishments whatever their size. Establishments with more than 250 employees should have systematic arrangements for management and employee representatives to meet regularly.

16. Management should take the initiative in setting up and maintaining consultative arrangements best suited to the circumstances of the establishment in co-operation with employee representatives or trade unions concerned. The arrangements should not be used to by-pass or discourage trade unions.

17. In setting up the consultative arrangements, management should ensure that:

a) the arrangements provide opportunities for employees to express their views on proposed changes which affect them and encourage discussion at whatever level is most appropriate, of matters closely associated with the work situation;

b) employee representatives have all the information they require to enable then to participate effectively in discussions;

c) Senior managers take an active part in consultation;

d) the arrangements include effective means of reporting back to employees.

18. Where committees are set up management and employee representatives should agree on:

a) the composition, objectives and functions of the committee and of any sectional or functional sub-committees;

b) the arrangements for the election or nomination of representatives;

c) the rules of procedure;

d) the range of subjects to be discussed.

19. Consultation and negotiations are closely related but distinct processes.

Management and employee representatives should consider carefully how to link the two. It may often be advantageous for the same committee to cover both. Where there are separate bodies, systematic communication between those involved in the two processes is essential.

Publications Committee.

Next week - Employee Representation at the Place of Work.

(This series is taken from HMSO booklet: Industrial Relations - Code of Practice)

** ** ** ** ** **

WELCOME TO:

Mrs. G. M.. Clarke, S.E.N.
Mr. K. Hallsworth, Pre Student
Mr. G. Griffiths Nursing Assistant
Miss A. Burke Pre pupil
Miss E. Hutchinson, Cadet
Miss K. Edwards, Cadet
Miss G. Cawley, Cadet
Miss K. Lagar, Cadet
Mr. G. Lee, Cadet.

FAREWELL TO:

P. Cox, Nursing Assistant
R. Kelly, Pupil Nurse
B. Hayes, Staff Nurse
S.E.N. Stringfellow.

************************************