Help/Advice - Inpatient Ward

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prospsych
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Help/Advice - Inpatient Ward

Post by prospsych » Tue Jul 24, 2012 8:08 pm

Hi Everyone,

I've recently been offered a post as a support worker which i'm really pleased about :) ! Its my first relevant job after graduating and i'm basically looking for some advice or information about what i'm likely to face, from people who have experience working on these wards.

I will either be based at a male (adult working age) Acute Inpatient Ward or a male (adult working age) Psychiatric Intensive Care Unit. I've done quite a thorough search and found some relevant and helpful threads (e.g. viewtopic.php?f=19&t=1919&p=118219&hili ... ay#p118219). However, i'm just looking for any other information that may prepare me and ease my nerves, particularly in relation to the questions below:

1) Firstly, am I correct in thinking that the key difference between an acute ward and PICU, is that there will be a higher number of staff in relation to patients on the PICU, with more observations and monitoring taking place? For individuals who are, for example, more likely to self-harm?

2) What are the main mental health issues that individuals on these wards will be experiencing? I'd expect that it would mainly be psychosis?

3) How often are individuals likely to become aggressive toward each other and staff? I would hope that this wouldn't be too often as the position is not based in forensic services. Am I being naive in thinking this?

4) Finally, how much personal care is likely to be involved when working with individuals in these services? Again, I would expect that it wouldn't be as much as within other services such as older adults. Am I being naive again in thinking this?

Any help/advice that people can help would be much appreciated!

Prospsych

Ruthie
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Re: Help/Advice - Inpatient Ward

Post by Ruthie » Wed Jul 25, 2012 12:24 am

Congratulations on your new job!
1) Firstly, am I correct in thinking that the key difference between an acute ward and PICU, is that there will be a higher number of staff in relation to patients on the PICU, with more observations and monitoring taking place? For individuals who are, for example, more likely to self-harm?
Yes - but we are talking severe and life threatening self-harm here and also risk to others. That doesn't mean you should be frightened - PICUs are often the quietest and most settled wards in the hospital because they have a higher staff to patient ratio to ensure monitoring and also provision of meaningful structured activities. I've known a few psychology graduate HCAs who have worked on both acute and PICUs and most of them would prefer the PICU given the chance as it is more structured and there are more opportunities for therapeutic engagement.
2) What are the main mental health issues that individuals on these wards will be experiencing? I'd expect that it would mainly be psychosis?
Psychosis and personality disorders. People will probably meet diagnostic criteria for about half the DSM or more. But what you can be sure if is that they will have complex and often traumatic histories and very complex difficulties both in managing their own emotional states and experiences as well as their relationships with others. In many ways, I think this is where a psychological formulation can be so helpful in unpicking the nature of the problems and suggesting potentially fruitful avenues for intervention. If there is a CP on the ward you are working on hopefully they will be supporting this kind of thinking within the team.
3) How often are individuals likely to become aggressive toward each other and staff? I would hope that this wouldn't be too often as the position is not based in forensic services. Am I being naive in thinking this?
It varies hugely between wards and how well they are run and how staff manage clients and how well supported they are with this. What I would say is these anxieties are VERY normal and you should expect to be given guidance and support with this. it is ok to be intimidated, frightened or disturbed by peoples' behaviours. If peoples' difficulties are of a severity that warrants inpatient treatment then they will have some very disturbing and challenging difficulties. You will get training in managing aggression and violence as part of your induction. In general, you should be aware of peoples' emotional state and possible triggers. Obviously if you feel threatened in any way you should never hesitate to withdraw from the situation and ask your colleagues for support. All in all - you can get a long way just by treating people respectfully, being interested in what they have to say and being reasonable and transparent in your approach to them.
4) Finally, how much personal care is likely to be involved when working with individuals in these services? Again, I would expect that it wouldn't be as much as within other services such as older adults. Am I being naive again in thinking this?
No - that is very true - it should be minimal, if at all.

But overall - expect to be disturbed by some of this - I have worked with people with complex mental health difficulties who have been in and out of inpatient wards for several years as a qualified CP and I can still be unnerved. I think this is human and normal - indeed, it would be more concerning if someone was unphased by it. If you are uncertain seek support and help from other staff. There will always be other people around and it is important for ward staff to work very closely as a team. It will be a great opportunity for you to see a wide range of people with different difficulties - some may be on the wards for a few days and others may be there a few months or even longer so you are going to learn a lot from that. You'll also meet lots of different colleagues and will be working as part of a team so there will be lots of opportunities to see what different professionals do. So really good luck with it and I hope it's a great start for you!

Ruthie
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

prospsych
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Re: Help/Advice - Inpatient Ward

Post by prospsych » Wed Jul 25, 2012 9:59 am

Thanks for your reply Ruthie, it was really helpful, particularly in helping me realise that my concerns are normal!

Any other information/examples of experiences that people can provide would be much appreciated!

Prospsych

Goldy85
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Re: Help/Advice - Inpatient Ward

Post by Goldy85 » Wed Jul 25, 2012 10:33 am

That is a comprehensive post from Ruthie. I can't add much more than that. I currently work on a Female Acute Inpatient ward and the experience has been invaluable in terms of developing my communication skills and understanding the role of different services within the NHS.

In terms of dealing with aggression and violence you will be trained to desculate situations through communication or by the use of restraint (team approach) as a last resort measure . If you fear for your safety at any stage then activate your alarm to alert your colleagues. From my experience, incidents of physical violence toward staff are rare, but you do need to be aware of the risk assessments in relation to the service users on the ward. If you treat people with respect, dignity and engage with them then these incidents are less likely to occur . Given that you will be a Support Worker, you will often be the service users first port of contact, attending to immediate needs and feeding back information to the qualified members of staff.

When I have been involved in increased levels of observations, I try engage the service users as much as possible. This might involve various activities, such as playing cards, board games, etc or just in conversation. Also, I try to establish personal boundaries, which we can work around, such as personal space and sensitive topics. PICU will have a higher number of staff to service user ratios, but increased levels of observations are also possible on Acute wards.

Good luck with the position. I am sure you will find the post rewarding, especially, when you see people making a recovery and returning to their lives in the community.

If you have any other questions feel free to PM me.

prospsych
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Re: Help/Advice - Inpatient Ward

Post by prospsych » Wed Jul 25, 2012 3:52 pm

Thanks for the information Goldy!

I was also wondering whether its common for individuals to be in possession of illegal drugs on these wards? An article I recently read (although it was written in 2007) by the guardian said that this was common?

Ruthie
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Re: Help/Advice - Inpatient Ward

Post by Ruthie » Wed Jul 25, 2012 6:38 pm

I have come across it more than once. Substance abuse is not an uncommon issue in this population so it stands to reason that substances will make their way on to the wards, but it has to be monitored and addressed very proactively by ward staff.Supplying drugs is criminal and should be reported to the police as well so imho that should be taken extremely seriously.
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

prospsych
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Re: Help/Advice - Inpatient Ward

Post by prospsych » Wed Jul 25, 2012 8:24 pm

Thanks Ruthie. I'm aware that many of the individuals on the ward may use drugs, but I suppose i'd never thought of them actually being used on the ward before!

This is the (old) article that I found the information if anybody's interested: - http://www.guardian.co.uk/society/2007/ ... eandhealth

And heres the quote from the ward matron about drug use "The worst problem we have is the use and supply of illegal drugs on the wards. Patients regularly bring anything from crack cocaine to cannabis. Some actively deal drugs to other patients, while others have their drug dealers come in to visit."

Reading it made me more worried than I was in the first place to be honest. Particularly quotes such as this from a mental health nurse! "Every morning, we brace ourselves for mayhem: I could start my day witnessing an attack on another member of staff or a patient, or even be attacked myself."

Back to my opening post - my questions have definitely been answered, but if anybody has any other information about these kinds of wards that they think would help myself, or future forum searchers, then feel free to post :) .

Prospsych.

ILikeBrains
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Re: Help/Advice - Inpatient Ward

Post by ILikeBrains » Wed Jul 25, 2012 11:03 pm

Hi, congratulations on the job! I worked within an acute inpatient unit for a while and wrote an article based upon my experiences, please free to pm me for a pdf if you like (I find it quite interesting to read back now and then as I would probably have used very different language these days!). I regularly had to attend searches and learnt to be mindful of the effect upon the therapeutic alliance that searching someone's property has. Working on an acute ward had it's challenges, but I met some amazing people (both staff and clients) if you can approach your work with an open mind, I'm sure you will find it rewarding :)

Chessie269
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Re: Help/Advice - Inpatient Ward

Post by Chessie269 » Mon Jul 30, 2012 10:14 pm

I work on the nursing bank and have a lot of shifts in male inpatient acute and PICU. Ruthie's post was very accurate! Just an aside - in my hospital in the PICU there is an LSU (low stimulus unit) with an adjoining seclusion room. It is one of two seclusion LSU/seclusion rooms in the hospital and is used by the all the other wards (very) occasionally. Seclusion policy states that there must always be 2 members of staff outside the seclusion room, and one of these staff members is from the PICU. So you may be involved in that too :) but that's not something to worry about - you would never open a seclusion room without a team there, you would just observe.

ps. Congrats on the job!

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