My junior doctor started last week and, today, starts on his placement.
What's he been up to over the last 7 days, then? He's been indoctrinated or inducted or instructed or something in to the Trust. Finally he's arrived, bright eyed and bushy tailed, ready to learn something about mental health work with older adults.
What did he do yesterday? Why, he did his Managing Violence and Aggression (MVA) training. What was this? He said it was mostly about running away but then there was lots of tustling around with holds and stuff that he's already forgotten as it all got quite confusing.
Medics tend to have a more cavalier attitude to this since, in truth, it's not common for patients to assult us. Fair or not, the last 2 occasions I know of when a patient seriously assaulted a psychiatrist they both ended up detained in a high security forensic hospital for the long haul . . .
. . . it's rather the opposite with in-patient nursing colleagues, sadly, since they are assaulted more often. Our incident forms show it's rare for community nurses in our corner to be assaulted. In-patient staff are open to assault when delivering personal care. Although not acceptable it is understandable - helping a confused patient undress for a bath when the patient can't appreciate why amounts to them experiencing someone tearing their clothes off them, thus they react to fend this off. Good dementia care means repeated reality orientation (speaking to the patient throughout the process rather than just explaining before care's undertaken and assuming 90 seconds later they're still retaining that) and de-escalation of risk.
So in fairness a good organic assessment ward for older adults will have patients who can be challenging to nurse if it's not care planned for and resourced adequately. I'd see this as key - high staffing levels of qualified mental health nurses are key to managing Behavioural and Psychological Symptoms of Dementia (BPSD) and reducing risk to staff and other patients.
At present none of my in-patients are on an antipsychotic at all, not even prn. It's been tried but hasn't been successful so was stopped. The management is wholly about skilled nursing care. In the last year, several patients have been admitted from EMI nursing homes as unmanageable through violence. Medication changes were tried in the community. All have been placed from the ward back into the community after admission and receipt of this skilled nursing care.
For nurses to generate stability and reduce risk without use of oodles of medication, in my corner, necessitates good staffing ratios and the right environment. Without this, the evidence shows nurses get battered.
It's frustrating. Done well, with lots of staff, units are successful with excellent patient care, turning folk from unsettled/unmanageable to content/manageable. Done badly, with poor staffing levels, units are unsuccessful, don't effect change, staff turnover is high and assaults are commonplace.
Now if only I could persuade the local acute Trust to buy in to this, so their staff aren't getting battered all the time whilst trying to care for delirious and demented folk with medical needs . . .