Contents -

Editorial
Attitude Survey VII
Around the Hospital
Round the N.H.S.
In the Group
Letters to the Editors
Nursing News

EDITORIAL

The time schedule for this year's J.C.S.C. Elections is as follows:

Nomination forms* to be completed and returned by 2nd April. Ballot papers and boxes will be distributed as required, and the vote-count will take place in the Recreation Hall on 10th April.

*Obtainable. from
General Office
Engineering Dept.
Staff representatives
The Library

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

PART 7

Nurses' Care

Percentage Critical: Whole group 12
short-stay 15
long-stay  8

Most of the patients were very happy about the nursing staff, from the most senior - 'Matron and assistant matron will go out of their way to spend time with you over what may appear to be trivial things' - to the most junior, but especially about the sisters and charge nurses. 'Sister worth her weight in gold.' 'Two of the best charge nurses in the world.' The nurses were appreciated both for their kindness and for their efficiency. 'Nurses very friendly and kind.' 'They would do anything for us.' 'Wonderful people.' 'Very nice both white and coloured.' 'Co-operative, efficient and patient.' Such remarks were legion.

One aspect of the relationship noted by the patients with particular satisfaction was that the nurses treated them courteously. 'They give me respect.' 'See patients as adults on equal terms, not as pathological cases or children.' 'I feel wanted'. They spoke of the support given by the nurses and the important part this plays in well-being and recovery. 'When you get fears sister reassures you.' 'They help us with our problems.' 'Staff are always ready to listen and help.' 'Comradeship, reliability and understanding of the male nurses,'

Far more praise than criticism was given about the nurses but there were some adverse comments about poor relationships with patients, excessive discipline and regimentation and shortage of nurses.

Comments describing poor relationships included, 'they shout at us'. 'Not sympathetic about insomnia.' 'The nurses are sometimes cross with me but one needs reassurance when one is in a panic'. 'The way they treat old people'. 'The difficulty of having two charge nurses of different personality.'.

There was very little reference to any bullying by nurses except for one ward in one hospital, where it was said, 'Use too such violence in restraining patients', 'Knock new patients about'. 'Hit in face because I refused tranquilliser'. This was brought to the notice of the hospital which immediately acted upon the information.

Typical complaints about the discipline exerted by the nurses were, 'Treated like children', 'Not democratic enough', 'Staff sometimes despise patients', 'Too much care', 'Treated as insane and not as if I were a human being', 'Punish patients by stopping vouchers and sending us to bed.'

A number of patients expressed sympathy about the staff shortage. 'Sisters have to do all the work with very little help.' 'Not enough staff to help with disturbed patients.' ' Old people wander about due to lack of supervision'. 'Nurses overworked'. 'No time to take us for a walk'. However, criticism of any kind about the nurses was rare and, including the comments on staff shortage, was only expressed by 12% of the patients.

Comments about social workers were very occasionally included, both favourable - 'The social workers are very helpful', and critical - 'The social workers should have closer contact', and 'Too autocratic.'

Feel Free

Percentage critical Whole group 17
Short stay 23
Long stay 11

There is a frequent misconception by the general public that most patients feel imprisoned in psychiatric hospitals. This is, perhaps, a hangover from the days when all hospitals had closed gates, many locked wards and padded cells. All the hospitals studied were typical in that there was free access for the great majority of patients to go as they liked in and out of the hospital. They were free to visit local shops and pubs and many went home from time to time. All the wards were unlocked in one of the hospitals; in the others there were two or sometimes four locked security wards and two locked wards at each were included in the survey. These wards were for people who needed protection from hurting either themselves or other people and included those admitted on order from the courts. Some of the other wards were locked at night to prevent outsiders from entering, disturbing the inmates or stealing their possessions, or to stop old, confused people from wandering out when there was little supervision.

Naturally, there was a much more critical response to this question from patients in the locked wards, though even some of these said they felt reasonably free. A few people, including potential suicides, said they had asked to go to a locked ward, but more resented being in them. 'Locked doors terrify me and make me feel like a criminal'.

'Hate jangling off keys'. 'Kept here against my will'. 'In prison one is told when one will be free but not here.' 'Locked wards are still unpleasant even if you have parole to go in the grounds'. 'Patients in locked wards should go out every day.'

From the rest of the wards, the most frequent comments were, 'You are free', or 'As free as can be', 'Can walk out at anytime'. 'Can get leave till 11 pm', 'Given sensible latitude but some patients have to be looked after and doors locked'.

Views on permissiveness varied. Some liked it, 'No set rules'. 'Can go to bed when I like.' 'Under no compulsion to do anything'. Others complained that they would like a more permissive atmosphere. 'Too many rules and regulations'. 'Have to do as you are told.' 'Can't even make a cup of tea on your own initiative'. Such comments came far more from the short-stay patients. Presumably the long-stay patients had come to accept conditions as reasonable or had become institutionalised. But still different views were expressed by some patients who liked a measure of control and the regularity of life at the hospital. 'I feel safe here'.

Some wards had a studied policy of permissiveness. These were generally wards for young, short-stay patients, or wards where patients were being rehabilitated as a preparation for leaving. Patients in the rehabilitation wards appreciated the easy atmosphere but some of the young in the short-stay wards were critical of it, 'Too free and permissive need to keep terrific control of yourself.' 'Patients try to stay in hospital because of the emotional relationships they have made with the male patients'.

It can be seen that an immense variety of views were expressed about freedom and control. Some liked full freedom, some felt they needed a measure of control, and in both groups some were satisfied and some dissatisfied with what they were experiencing. This is not surprising, for in this respect patients vary as much as, or more than those of us outside the hospital gates.

PC

(To be cont.)

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AROUND THE HOSPITAL

BOWLS SECTION

G R A N D  A N N U A L  D A N C E

to be held in the Ballroom, Winwick Hospital

On Friday 27th April 1973
Dancing 8.00 p.m. - 1 00 a.m.
With the Norman Keeley Orchestra in attendance and Supporting Group.

Refreshments; Bar; Good Spot Prizes; Star Prize

Tickets £1.15 available from:

W. Hampson (Gardens)
G. Poulson (Cobbler)
T. Pilling (Wd. 44)

GIFT SUGGESTION INVITED

Last week ward staff were asked to make suggestions for a useful gift for the hospital.

The request came from Leigh Ladies' Inner Circle, who intend to provide an item which will be of benefit to Winwick patients.

PC

WELCOME BACK

We hear that John Lowe has returned to us after several weeks' illness. John, who works in the CSSD dept., assures us that it is untrue he needed the rest to develop a moustache.

Welcome back also to Anne Smythe, now happily recovered from her recent illness.

Still on the sick list with a broken ankle is Ian Mitchell, from ward 15.

Also in dock is Jean Buckley (Night Nurse) who is at present a patient in the Infirmary ward.

We wish them a quick recovery.

PC

EXTENSION OF IN-SERVICE TRAINING

The In-service training programme is now to be extended to include deputy ward sisters and deputy charge nurses.

A programme of lectures has been circulated to all wards. Speakers - mostly members of Winwick staff - include Miss N. Coppack, Miss M. Downey, Mr. H. Stokes, Mr. H. Taberner and Mrs. M.D. Leach.

The first talk - on "Work Study" - will be given by Mr. P. Holman, from the LRHB Organisation and Method Study Team, and is planned for 5.4.73.

PC

SPECIAL DIETS

Due to staffing difficulties in the Catering Dept. wards have been asked to review the number of special diets needed by patients.

This follows a considerable rise in the number of special diets requested, despite a similar request last year.

APRIL BOUTIQUE

"Direct Fashion Services" are arranging a boutique of ladies' and mens' wear in the Rec. Hall commencing on Monday, April 2nd.

The boutique will run for five days, and will be open from 10.00 a.m. to 4.00 p,m. The usual bank facilities will be available.

It is hoped to follow this up with a visit later in the month by a firm specialising in footwear.

Because of the boutique. the Area meetings for April have been cancelled.

PC

MEDICINE ROUND

After a review of annual expenditure wards are to be. visited with a view to effecting economies in the use of drugs and medical supplies.

Among the first items affected is the disinfectant "PRINTOL-D" which will no longer be supplied. Wards are being asked to use "Izal" instead. In another area, a small surplus will allow for 100 beds to be stove enamelled.

JOINT CONSULTATIVE STAFFS COMMITTEE

Up to the time of the meeting of the Publication Committee there has been no news of a fresh date being set for the March JCSC meeting.

Accordingly, no progress has yet been made in the elections of next year's Staff Side.

PC

DRO AT PROFESSIONAL HOUR

Mr. Dayus, Disablement Resettlement Officer for the Warrington Area, was the speaker at the monthly Professional Hour for ward sisters and charge nurses held in the in-service training room on Thursday, March 15.

Introduced by Miss E. Pennington, co-organiser of the monthly meetings, Mr. Dyas spoke of the work of the DRO and outlined the provisions of the Disabled Person's Act 1944. He said that while firms employing more than 20 people had an obligation to have disabled people as 3% of their labour force, and certain legal requirements under the Act, the DRO relied upon gaining the co-operation of the employers. 50% of local firms did have their full quota of disabled people, while the remainder mostly required only one or two such employees to reach their quota.

Mr. Dyas went on to talk of the industrial Rehabilitation Units. Government Training Centres and the 'Re-employ' factories at St. Helens and Wigan. Despite these facilities, there were 250 - 300 disabled people unemployed in the Warrington area, but 60 - 70% of these were over 55, and age was a great handicap in itself.

He said that he was a member of Winwick Hospital's Rehabilitation Committee, and that ex-psychiatric patients were forming an increasing proportion of disabled people in the area. Due to their history and often poor employment record, long-stay psychiatric patients were difficult to place in employment, Of 150 ex-patients seen in 1972, only 30 found employment, and selection appeared to be the critical factor. Also in 1972 15 ex-patients attended Industrial Rehabilitation Units and 2 went to Government Training Centres.

At the conclusion of Mr. Dyas' talk, there was a considerable amount of discussion from the floor on the importance of careful selection of patients for rehabilitation, and the need for a realistic assessment of patients' capabilities.

Without an internal rehabilitation programme which included an industrial department making employment demands upon the patient comparable to those which would be experienced in the community, the feeling was that rehabilitation within the hospital would meet with little success.

PC

FOR SALE
Vintage 12" Qualcast lawnmower.
Excellent working order. £2.00
Box No, 4.

WANTED
Fish tank.
Details to Box No. 5

FAREWELL TO
Mr. Jimmy Buckley-Mellor, who is retiring after working at Winwick, latterly as a slater, since early 1937.
Best wishes for your retirement.

WELCOME TO
Last week we unaccountably welcomed Linda Lewis to the O.T. Dept. The name should have been Linda Shaw. Sorry - and welcome.

INFORMATION TO STAFF ABOUT THEIR CONDITIONS OF SERVICE

Following a letter received from the Dept. on the 5th March, 1973, copies of handbooks and circulars governing the various Whitley Councils are being obtained from the Dept.

These will be issued to the relevant staff organisations who should make them available for staff to peruse. Nevertheless, Heads of Depts. have always been issued with Whitley Council handbooks in order that staff might study them if they so desired.

To date an ASC and GC Handbook have been received and have been issued to Union Representatives this week,

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ROUND THE NHS

MEDICAL CENTRE FOR WHISTON

Work has started on a medical centre at Whiston Hospital.

The £68,000 Post Graduate Centre will be equipped with a comprehensive library., seminars lecture and medical rooms. It will cater for the whole of the St, Helens district for all sections of medical and health services.

The Centre is expected to be completed in eight or nine months time.

PC

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IN THE GROUP
APPOINTMENT

Dr. D.B. Mossman, Pathologist and Control of Infection Officer for the Warrington General Hospital, has now had his duties extended to include the whole of the Warrington Hospitals Group.

PC

LETTERS TO THE EDITORS

Ward 28
On behalf of my patients and staff, I would like to thank the catering department for the lovely birthday cake and extra provided on the occasion of Mrs. E. Brookson's 93rd birthday and Mrs. R. Barrow's 83rd birthday on 17.3.73. I would also like to thank Mrs. J. Devine, Mrs. P. Farrimond and Mrs. A. Jones for giving up their valuable off-duty time to entertain my patients; also Shirley, Ann, Pam, Kath and Clare. Everyone thoroughly enjoyed every minute of it, the entertainment putting the finishing touch to a birthday party which was a great success. Once again, thank you all very much.

Sister A. Rigby

During the course of a really excellent night out at Blighty's Night Club, in Farnworth, Marie Bailey (my thanks to Marie and her friends for the invitation) went backstage to the Entertainments Manager and obtained an offer to patients and staff here of complimentary tickets to some future show. The Bachelors were on that night, giving a fine show, and this offer, and the initiative which gave rise to it, is worth a little publicity.

Yours sincerely
D.J. Devine.

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NURSING NEWS

On Wednesday 28th March 20 Pre-Nursing girls from Newton-le-Willows Technical College will be visiting the hospital.

Welcome to

Mr. S. Mathes T/NA (Holiday Employment)

Technical Nursing Library

'The Manufacture of Madness' - T.S. Szasz

'A Textbook of Psychiatry' - Henderson & Gillespie

'Psychiatric Illness in General Practice' - Shepherd, Cooper, Brown & Kalton

'Psychological Medicine' - Curran & Partridge

Nurse Teaching Dept.

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