Contents -

Editorial

Attitude Survey III

Social Therapy

Round the N.H.S.

Social Club News

Miscellany

Letter to the Editors

Nursing News

EDITORIAL

The distribution of The Standard has caused quite a bit of comment recently - some people don't have the easy access to it which we had thought was hospital-wide.

Basically we use the Telephone List, and assume that everyone who works on a particular ward, or in a certain Dept., will have access to the copies sent there.

If you know of any area where this is not the case please tell us.

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PSYCHIATRIC HOSPITALS VIEWED BY THEIR PATIENTS -
Report of an Attitude Survey by W Raphael & V Peers

PART 3

Relative Satisfaction with Different Topics

The preliminary survey at the first three hospitals suggested 19 topics that seemed most relevant to patients' views on their hospital, and a direct question was asked on each of these. Eight were on the physical environment, four on patient care and treatment, and seven on the patients' life in hospital, including meals, clothing, activities and relations with other patients.

The results for the whole group show comparatively little criticism about the ward itself, nurses' care, work and occupational therapy. The main criticism, each coming from about a third of the patients, referred to noise, boredom and the fact that the patients did not see the doctors sufficiently often or receive enough information from them.

It is interesting to compare the relative views of the short-stay patients and the long-stay patients (the latter including the medium-stay). On the whole, the order is similar but the short-stay patients tend to be far more critical on all topics (except occupational therapy and the amount of space in the ward) - sometimes twice as high a proportion complained. Since physical conditions for short-stay patients are often better than for long-stay, it appears that after a time patients get used to a situation and notice disadvantages less - what is sometimes described as 'institutionalised'. Indeed, some of the long-stay patients had been so many years in hospital that they may have found it difficult to remember standards for comparison. And, again, there is the fact that more of the short-stay patients were young people, and in hospital surveys the young are generally far more critical than their elders.

Patients were invited to give explanations and suggestions to supplement their answers. Typical comments are quoted in the next section and are an important aid to interpreting bare statistics.

The eight direct questions on the physical environment were all concerned with the ward. Sometimes comments were offered on other environmental factors, especially the grounds.

It became apparent that most patients are satisfied with both their dormitories and their day rooms but have many complaints about the lack of privacy, the poor storage accommodation and, above all, the noise. The sanitary annexes received far less criticism than in comparable surveys in general hospitals. Most of the hospitals had lovely gardens and grounds and they were often a great source of pleasure - indeed, they were frequently given in answer to the question, "What do you like best about the hospital?" The rather grim exterior of some of the hospitals, the long corridors and the wide-spread buildings were seldom mentioned nor was the distance from home or from shops and pubs that might have been counted a difficulty in some hospitals.

Space

Percentage critical: whole group 14
short-stay 15
long-stay 16

The patients did not seem to consider overcrowding a serious problem except in a few wards but in these it was much disliked. One said about a day room, "There is barely room for everyone to sit down". Other patients found the dining area too small especially where men and women shared the same room.

Overcrowding of the dormitories, though only mentioned in a few wards, was heavily criticised. "The beds are too close together." "Can touch the next person." "I get oppressed if others are close." People disliked beds down the middle of the ward without the feeling of protection of a wall at their heads. One or two elderly long-stay patients said they hesitated to report that the dormitory was overcrowded, "for fear I might be the one to get sent home."

Many patients said, "We have plenty of space", or, "'The ward is not too full." A few people referred to the fact that the number of patients in their ward had recently been reduced: "more room than before, now alright."

Quiet

Percentage critical: whole group 28
short-stay 37
long-stay 19

There was more criticism about noise than about any other factor in the physical environment especially from the short-stay patients. Over a quarter of the whole group of patients complained about it. Its incidence was closely linked to the layout of the ward, for noise was worse when there way just one day room or a room partitioned by dividers, "If there was second room then noisy can go to a quiet room", "There is another room available for reading or writing."

Most wards had television on all evening, some during the afternoon as well, and many had a radio or record player on before that. "Ward life is governed by TV or radio"', one patient said. Another said, "'the TV's on loud enough to accommodate the hard of hearing."

It is true that most of the patients appreciated this form of entertainment, but those who did not suffered considerably. They said that they could not "read, write or even snooze". Since there is such a diversity of views here, the only solution is to have a quiet room away from the music.

Noise from other patients is a particular problem in some acute wards. "The patients walk up and down." "There are a few rowdies". At night, a few patients shout out and make disturbances, and some people also mentioned "footsteps" and "creaking doors when others go to the lavatories". A group of nursing assistants who chattered at night was a cause of much distress in one ward of sick old men. Obviously, the amount of noise at night depended on the size of the dormitories and also whether they were divided into sections.

A few patients, especially the young ones, said, "The noise doesn't bother me". Others expressed gratitude for having "the refuge of a quiet room" or a bedroom to themselves.

(TO BE CONT)

PC

SOCIAL THERAPY

A RATIONAL MULTI-DISCIPLINARY APPROACH TO THE PROBLEM OF RE-SOCIALISATION AND REMOTIVATION IN A LARGE, LONG-STAY PSYCHIATRIC HOSPITAL.

(The author is indebted to Dr B. Ward, Medical Superintendent, Winwick Hospital, for his encouragement and support)

This paper has been submitted for publication in the Nursing Times, and we are grateful to Mr Jolley for his permission to serialise it in The Standard.

Part 1

Social Therapy is still a relatively new technique in the field of psychiatric patient treatment. This essay is an attempt to explain the concepts and give some idea of the many functions involved.

It was prompted by an increasing awareness of how far the reality came to exceed the expectation leading to a lack of general understanding and recognition even in a hospital where social therapy began in name in 1968, and has existed in fact since 1969.

It should be noted here that the Social Therapy Officer has lectured to every P.T.S. for four years; that the Department has provided programmes for the involvement of pre-nursing Students; and that in March, 1972, the Department was recognized by the G.N.C. as a suitable area for Student Nurse training).

THE SETTING UP AND HISTORY OF THE DEPARTMENT

In August, 1968 the Rehabilitation Services Committee of the then Winwick and Newchurch Hospital Management Committee, recommended that the report of Winwick's Medical Superintendent on the policy regarding the entertainment and recreation of patients be accepted in principle. This report recommended that:-

a)	The nursing establishment be increased by -    1 Assistant Chief Male Nurse    1 Charge Nurse    1 Ward Sister
b)	The Assistant Chief Male Nurse appointed be designated Social Therapy Officer and be responsible for the supervision of therapeutic activities.
c)	A Steering Committee be formed consisting of the Medical Superintendent, the Group Secretary and the Chairman of the Medical Advisory Board. (This Committee met once only, in March, 1969.)

At this time efforts were directed solely at the enlargement and organisation of the existing policy with regard to entertainment, recreation and general social facilities.

The Social Therapy Officer began work in December 1968 with an inherited staff of two, a female P.T.I. and a part-time Nursing Assistant, whose duties had hitherto been concerned solely with PT and sports.

During the three month period from December 1968 to February 1969 a complete survey of the existing facilities was carried out, followed by an assessment of the entire patient population's requirements in terms of social and recreational needs.

It was soon apparent that only small percentage took part in any regular social activities and that approximately 80% had practically no social involvement, either within the ward situation or in central activities.

Even at this early date it was recognized that in this important, if as yet undeveloped, area of life in the hospital lay the ideal media required to facilitate patient integration, which was long overdue, particularly in the area of recreation/entertainment soon to be known as Social Therapy. The events of the following four years proved this judgement to be correct and subsequent developments were successful beyond all original expectations.

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ROUND THE NHS

EX-CHAIRMAN DIES

Mr Fred Banner, who was chairman of Warrington and District Hospital Management Committee for four years and a member of Winwick and Newchurch HMC, died at his home in Warrington recently.

Mr Banner, a retired engine driver, was associated with hospital work in Warrington for over fifty years.

PC

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NO INCREASE IN PAY-BEDS AT WRIGHTINGTON

Wrightington Hospital, near Wigan, has been refused permission to provide two extra beds for private patients by Manchester Regional Hospital Board.

At present, eight of the hospital's 360 beds are reserved for private patients.

Mr Percy Bibby, Secretary of Wrightington HMC, said that this was because more people are in private health insurance schemes.

The hospital has a l2-month waiting-list for private beds.

A spokesman for the Manchester RHB said the request had been refused because of the high level of demand for beds from the NHS patients.

He added that alternative suggestions in connection with the use of accommodation to be made to the Hospital Management Committee.

P.C.

SOCIAL CLUB NEWS

As from this coming Saturday sandwiches will be available in the Club. These will be made to order. At the moment this applies only to Saturdays, but if demand warrants it the service will be extended to Sunday as well.

McKENDRICK'S MOONSHINERS

Music in the Social Club - Folk and Country and Western, each Sunday commencing 9 00 pm. There is no entry fee, and members and their guests are all welcome.

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MISCELLANY

We are glad to see both Stan Jones and Mr Wright well and back at work, but sorry to hear that Ronnie Ireland is leaving. Quite apart from his professional skills he'll be missed on the sporting scene - we wish him all the best at his new job.

On a much happier note, we hear that Tony Haughey has just won a Scholarship to the International Nurses' Conference, to be held in Mexico in May of this year. Congratulations.

P.C.

VALENTINES NIGHT DANCE

(Run by the Warrington Fund for Cancer Research)

At Rylands Recreation Club, Gorsey Lane, Wednesday l4th February, 8 p.m. until 12.00 p.m. Licensed bar, Spot prizes and Tombola stall. Disco by Dave Warwick, Tickets 40p available from Mr Dave Hamilton D/C M 8M.

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LETTERS

WORK STUDY

With reference to the two questions raised by Mr E Bromley in The Standard Vol. 2 No. 32.

It is impossible to understand the issues involved in productivity deals and related forms of payment simply by studying technically the productivity deals themselves. This technical aspect is important, but secondary. We must start with basic principles.

This system of society we live under is capitalism. That is to say that the vast majority of wealth, the means of production, distribution and exchange are private property owned by private individuals who operate them not at all to fulfill the needs of society, but purely and simply for profit. The moment profit is no longer forthcoming, irrespective of the degree of need which may exist, production ceases.

It is, therefore, necessary for Trade Unions to play their part in negotiating fair productivity deals, to prevent exploitation of their members and to ensure that they get the benefits from Work Study, for besides making sure that the increased earnings are related to the increased effort involved, Trade Unions could see that Work Study is used to ease the load of the worker, to remove all drudgery from his work, to shorten the working day, to eliminate accidents and to bring about huge increases in the productivity of labour within an easy and interesting working environment. The degree of success achieved by Trade Unions when negotiating productivity deals will depend largely on shop floor strength.

J. Shaw

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NURSING NEWS

On Monday 12th February five Post-enrolment Student Nurses from Warrington General Hospital will be commencing a period of 12 weeks secondment to Winwick Hospital. We look forward to these nurses joining our staff and hope that they will be the first of many others to come from General Hospitals. During their stay with us they will spend six weeks on Acute Admission Wards and six weeks on Long Stay wards.

N. Coppack H. O. N. S.

On Thursday 15th February the Professional Hour (Dr Briggs) will be held in the In-Service Training Room at 2.30 p.m.

Warrington Infirmary Pupil Nurses will be visiting the hospital on Tuesday, 13th February at 2.00 p.m.

Welcome to

	Miss K. Robinson	N/A
	Mr J.C. Stewart	TN/A
	Mrs M. Porter	TN/A N.D.
	Mrs T.N. Lacey	T/SEN N.D.

Farewell to

	Mrs S. Conroy	TN/A
	Mr S. Lunn	SEN
	Mrs A. Hardman	N/A
	Mrs G. Alcock	N/A

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