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Discussion

Hello from Scotland

Hi folks

As is my wont, I'd been aimlessly surfing cyberspace when I stumbled across allnurses and made a beeline for this subforum. After reading the first 4 pages I was so excited/entertained/curious that I just had to register.

I'm a Registered Mental Nurse (RMN) working for Britain's National Health Service (NHS), with a peach (sometimes a ******) of a job in a small psychiatric department in the Western Isles of Scotland.

From the posts I have read it seems that some themes are international constants: funding cuts compromising care and treatment; staff shortages; quality of nurses ranging from excellent to abominable, enthusiastic to burned-out-years-ago.....

Some of the terminology and acronyms used here sound a bit foreign to me, and the career structure seems odd. And what, exactly, are these "restraints" people mention?

Like most RMNs, I like the sound of my own voice when I get the chance to sound off and I have an opinion on everything (including things I haven't even heard of). So, hopefully, I'll be able to contribute something of value to this forum as well as take some inspiration from you all.

Regards

Mickey

(That's a ruthless censoring tool.....and I thought I was being very mild in my use of language: you should hear me talking about the Head of Mental Health Services here.)

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    • Featured Replies

    • Expert

    Hi Mickey,

    Welcome! Restraints are something used to prevent a patient from moving about such as tying the patient to the bed. It has been my experience that here in the US many facilities are trying to move away from them especially in Peds.

    Jules

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    • Author
    Hi Mickey,

    Welcome! Restraints are something used to prevent a patient from moving about such as tying the patient to the bed. It has been my experience that here in the US many facilities are trying to move away from them especially in Peds.

    Jules

    Hi Jules, thanks for the welcome :up:

    Tying patients to the bed........us folks in the Old World usually look at the US for guidance about the best way to do things in every aspect of life, but this seems seriously backward and antiquated and counter-therapeutic.

    We go down the chemical route.....if someone needs serious tranquilisation we first try (oral) 5mg haloperidol and 2mg lorazepam. Of course, this is usually refused, even after explaining what the next step will be. The next step is haloperidol and lorazepam I/M with a bit of manual control and restraint.

    If that doesn't calm things down and the guy/gal is still bouncing off the walls and causing mayhem, we up the ante and jump in with clopixol acuphase. The drawback with this is that you can't give any other neuroleptics for 3 days - so if he's a big guy and you didn't jab him with enough to knock him out.....it's time to phone in sick (it seldom happens).

    My experience with acuphase is that the patient is much, much calmer (may sleep for a day) afterwards, with fewer psychotic symptoms and chaotic behaviour.

    Of course, there are militant objections from the extreme fringes of the service user movement and the anti-psychiatry "drugs are bad" crowd. Firkem - my job is to minimise distress and suffering.

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    • Expert

    Well! Welcome to AN.com and to the Psychiatric Nursing forum, Mickey!

    You have already met one of your goals- to contribute. I have been in Psych Nursing for 28 years now and had never heard of clopixol acuphase. Your Post inspired me to look it up. It's a thioanthene, a neuroleptic dopamine antagonistic antipsychotic that's been around for over ten years. Hmmmm!

    Allow me to clarify the restraint thing- In the Facility that I work at, for example, use restraints are only after every other intervention to prevent a Patient from harming him/herself has been utilized.

    In the Admitting Process I inform the Patient that restraints are a last alternative obtion because, "We will insure the safety of everyone."

    The use of restraints is not taken lightly; it is a loss of a Right, and a Legal Process. We, as Professionals, have to jump through bureacratic hoops in order to apply restraints, which include a mountain of paperwork, notification of legal next-of-kin, Doctor's Orders, etc.

    I also wanted to let you know that I liked your words on how you see your responsibility: "my job is to minimize distress and suffering".

    Amen, Brother.

    Well, the best to you, Mickey. I hope to "see" you around the forums. (BTW: check out AN-central.com. There's a lt of fun People and topics over there.)

    Dave

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    • Author

    Thanks for the welcome, Dave.

    Acuphase is a godsend. I'll take your word about it being a thioanthenethingy: I'm a prescriber, but the chemistry and psychopharmacology of things is beyond me...... After you've given it, you can't give any neuroleptics for 3 days - so if you haven't given enough, you're screwed for options. Before acuphase we used paraldehyde - effective, but a bit vicious. :nuke:

    AN-central looks like fun - insouciant and irreverent, just my style :) Not as clinical/professional/serious as here.

    Physical restraints are anathema in the UK. Although the UK doesn't go in for the bondage gear popular across The Pond, we do have Seclusion Rooms, low-stimulus environments with no windows and containing just a plastic p!sspot and a mattress. Putting someone in there requires paperwork +++, so it's also not taken lightly......

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    Hiya.

    I am a RN with a BSN, and am nearly 2 units getting through my Graduate Diploma in Psych Nursing!

    We aren't allowed in Oz to chemically restrain people, as they have rights (even dementia patients), however I have seen this done when some dementia patients gets physically violent in extreme cases. This is only justified if they are trying to hurt others, or themselves.

    Is it hard getting work over there? I have worked in psych, med/surg, oncology, day surgery, ED and many other places. I have 3 years experience, how would I go about getting a job over there next year? I was born in Prestwick & still have to organise a passport (came over on parents when I was 4).

    Cheers.

  • Quote
    • Expert

    Some of the terminology and acronyms used here sound a bit foreign to me, and the career structure seems odd. And what, exactly, are these "restraints" people mention?

    Hi Mickey!

    Restraints are either physical or chemical means of controlling a patient's behavior. They are the last resort to be used if all other alternatives have failed and the patient continues to be a danger to themselves and/or other people.

    In my facility, we usually try medications first before resorting to physical methods of restraint. If I am offering a patient a scheduled or PRN sedative/antipsychotic and they accept it, I don't see that as being chemical restraint even though the Haldol/Ativan/Cogentin combo may knock them out for a few hours (and effectively restrain their behavior).

    I consider it crossing over to chemical restraint if I'm giving the medication against their will, or if I don't tell them what I am giving them. Sometimes it has to be done with the truly psychotic or dangerous patient that has caused or will cause harm. I don't like whenever it comes down to that, but the main goal is always the patient's safety.

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    • Author

    Is it hard getting work over there? I have worked in psych, med/surg, oncology, day surgery, ED and many other places. I have 3 years experience, how would I go about getting a job over there next year? I was born in Prestwick & still have to organise a passport (came over on parents when I was 4).

    Cheers.

    Hi Carol

    Here's a link to NHS Sotland's recruitment page.

    http://www.jobs.scot.nhs.uk/list.aspx

    Currently only 74 vacancies for nurses of all specialties and levels throughout Scotland. Not very encouraging, I'm sorry to say. I know people who qualified 2 years ago who still don't have jobs as registered nurses. Even in the private sector it's hard to find a job as a qualifed nurse.

    Anyway.....why on Earth would you want to exchange Australia for Prestwick???? It rains here every day......

    How about if we do a jobswap?

    Best wishes

    Mick

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    Hi Carol

    Here's a link to NHS Sotland's recruitment page.

    http://www.jobs.scot.nhs.uk/list.aspx

    Currently only 74 vacancies for nurses of all specialties and levels throughout Scotland. Not very encouraging, I'm sorry to say. I know people who qualified 2 years ago who still don't have jobs as registered nurses. Even in the private sector it's hard to find a job as a qualifed nurse.

    Anyway.....why on Earth would you want to exchange Australia for Prestwick???? It rains here every day......

    How about if we do a jobswap?

    Best wishes

    Mick

    Thanks Mick.

    I was born in Prestwick & have always wanted to go back & see the house I was born in. All I know is there's (or used to be) an airport there!

    I would definitely come in the summer anyway, can't stand the cold, lol! It's actually cold here today, but a few days ago was humid & hot.

    Do u think the lack of jobs is cos of the global economy, or has Scotland struggled to get people in employment? We didn't really have a recession down under, my phone pretty much rings off the hook most days.

    Do you think it will pick up?

    What is Prestwick like (apart from the rain), ie: accommodation wise, gyms, etc?

    Cheers.

    Caz

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