RN(MH)

Hi We never had security in the Mental Health unit I worked in, although the general hospital and A&E Department did have. All the staff were concerned about this especially the night shift. The only security we had was our nursing colleagues. Security staff could be an advantage, but only if they fitted in with the unit, and quite often those with severe Mental Health Problems are paranoid about those in uniform, particularly the police, and the police do not always know how to handle these clients. So if the security staff had the right training in restraint and mental health issues, it could work. Funding was also another issue as always there was never enough funding for the mental health units to have security

Hi I can understand your concerns with regards to cigarettes not promoting health with regards to possible pysical problems, and agree that health promotion is supposed to be one of the roles of the nurse. I have always tried to promote health, however, I guess I look at things slightly differently, and thats one of the reasons that I chose to do Mental Health Nursing before starting my nurse training. (In the UK we have to decide what path to take before we enrol..not sure how it is in the US). I have always thought differently to many people that I have known throughout my life, and consider stress to more of a problem than smoking. It can cause both mental health and physical health to deteriorate so badly that a person cannot function and cannot cope with everyday life. I have also seen the effects that medication prescribed for stress or depression cause many problems such as the horrendous side effects and withdrawal symptoms when coming off them. These are powerful drugs which I dont feel does the body any good. Ok so they are needed in some cases, but quite often just mask problems. On many an occasion I have sat with a patient (either in the smoking room or outside) with a cigarette, and talked with them or just listened to them, and this has eased their anxiety and made them feel valued and uplifted them more so than the drugs. I have also seen people in such a panic cos they cant have a smoke and this has aggravated their problems. I have also seen this with my friends and family as well, and often I meet friends who have problems for a coffee and a smoke and a chat and this has also been done for me as well, as found this to be more effective than anything else. I think its the fact that there is someone there that does not judge them that will understand their need for a smoke and a chat, and they feel that person cares. So smoking to me is not such an important issue, yes it can cause health problems, but stress can cause so many more and does horrendous things to the body. I think that some countries are so hooked into the whole smoking issue that other issues are very much overlooked, such as stress, and also alcohol. I have seen more problems, physicaly and mentally related to alcohol than I have related to smoking, yet we are still allowed to drink alcohol on a plane for example wen it can make people roudy and aggressive and sick, yet we cannot smoke, which often calms people down. Sorry if I have offended anyone, it is not my intention to do that, but think we need to get out of having tunnel vision with regards to smoking. Yes it can cause health problems, but can also have a good effect in that in can help to relieve stress and tension. And on a positive note, if a person is less stressed then they will smoke less, and possibly give up altogether. I have heard people say that want to give up or cut down, but cannot due to the stress in their life at that time.

I dont regret doing my nurse training as the 3 years I spent at uni were brilliant. However, in many ways I do regret becoming a nurse. Its not the actual nursing that I do not like, as I love working with clients with Mental Health problems, and have met and cared for many really nice people. I have also worked with some good people. However, nurses are not valued, particularly in the private sector, although the NHS has its problems as well. Management are totally out of tune with what nurses have to cope with, and with the amount of admin that htey have to do. An admission can take up most, if not all of a shift, and at times, I have had at least 4 admissions and discharges to complete on a shift. Invariably some of the work has to be left for the next shift, which is not good for the clients being admitted. If, and this has happened many times, a nurse is the only qualified staff member on shift, they are left to do everything, meds, ward rounds, admissions, discharges, general ward work, and lets not forget actually spend time with the clients. At the end of the day, its always the nurses that seemed to get the rough end of the deal, and are made scapegoats when things go wrong. In the private sector the owners of nuring homes are driven purely by profit, and do not care about the residents wellfare.

1/ The pay and the hours that nurses are expected to work in some places. 2/ The stress that nurses suffer all the time whilst trying to do everything that needs to be done due to understaffing. 3/The cover ups that go on with regards to bad practice by some nurses (this is terrible in private nursing homes). The owners cover things up to save their homes and their profit.

I am probably risking a torrent of angry posts here, but to be quite contraversial I have to say that smoking CAN cause cancer but not does not always !! There are many other factors as well that can cause cancer and be detrimental to ones health !! There is the awful polution from car fumes that is in the air all the time, so maybe we should be stopped from driving our cars. Then there is the pesticides that is on our food, so maybe we should stop eating !! There has been on our news recently about a strong link between pesticides and cancer. Then there is the risk of using mobile phones and brain tumours, so perhaps the use of all mobile phones should be stopped. There is also the possible link of electicity pylons and cancer, so perhaps we should go back to the days of candle power. In everyday modern life there are huge risks, so me or any other nurse taking a patient out for a smoke to me is not an issue. I would take a patient (provided they were able to go outside) for a smoke. That said it doesnt mean that as a nurse or a human being that I do not care about the health of my patients, as I do. But these patients are adults, and as such have a right to make an informed decision, and to deny them this is an infringement of their human rights. There are more and more cases whereby younger people are found to have cancer, where they have never smoked, drank, they eat healthy and exercise, so every day living such as car polution and pesticides have to play a part.

Hi Certainly would take my patients out for a smoke break. Every place I have worked so far, however, have had rooms specifically for the patients to smoke in, and why not ? Working in Mental Health have found that it is necessary to allow the patients to smoke. Sometimes they may not be able to go outside (if they have been detained under the mental health act and are acutely unwell), so they can go in the smoking room on the ward. Once they are able to go out, would definately take them out. I have never worked with a nurse here that has refused to do this, even non smokers. The last thing patients need when they are unwell or suffering withdrawal symptoms is to be told they cannot have a smoke. It makes them agitated and sometimes agrressive. It can increase their paranoia and refusal to allow them to smoke does not aide their recovery. We will soon face a ban on smoking in public places over here, which I disagree with, lets hope it doesnt affect the Mental Health units. There will be a lot of stressed out acutely unwell patients, and a lot of stressed out staff. If a person wants to smoke that is their choice. There are worse things than smoking.

Self - inflicted injury? Well in a sense yes it is as we do it to ourselves. However, all of society has to in some respects take responsibility. I have also met nurses who describe it as a social problem and dont like treating these people. Self inflicted it may be but we have to look at what led to the person being addicted, and the reasons why are not always self inflicted, ie abuse in younger life,assault,domestic violence, schizophrenia,bi-polar,divorce, bereavement, and many others. If we are to consider addiction as being a self-inflicted injury, then we have to consider many other things as self-inflicted such as the person who goes rock climbing and breaks a limb. They know it can be dangerous, but still do it. At times when people are in the depths of despair, alcohol, for example can be their only way out of feeling like that, even if it is just for a short time. When they sober up, reality hits and despair again sets in and they drink again, and so it goes on, until they canot get through the day without it, and it becomes a way of escaping their problems. Not everyone is able to face their problems and deal with them positively, hence addiction being a negative coping mechanism. Unless addicts get the help needed this will always be a problem to them.

Hi Yes agree this is an interesting post. i do think that we have to be very careful though in labelling drug and alcohol addiction as just a disease though, or we run the risk of the patient not necessarily being treated in the right way for them. Over here we now use the term substance misuse, rather than drug addict or alcoholic. Agree substance misuse is initially treated with medication, maybe due to withdrawal symptoms or substance related psychosis. However, we cannot treat people with medication alone and have to take the holistic approach to treatment. A thorough assessment of the persons life history, and events leading up to their admission/addiction is the most important thing to do. Then and only then can we begin therapeutic treatments (which can include medication). This could mean counselling (ie bereavement, gambling, etc). Other therapies can be CBT,anger management, family therapy,referral to a psychologist , the list is endless. Mental health problems cannot really be labelled as such, as each person suffers in an individual way. Depression for example is so different for each person, and it is not necessarily genetic. Depression can set in for many reasons, due to a physical illness, or general life events and extreme stress. Depression can also result in substance misuse as a way of coping with it. I dont necessarily feel that medication alone is what is required in this instance. Sometimes medication is not the answer either !! If we pump people with anti depressants all sorts of problems can occur, ie side effect, feeling of worthlessness and not being able to cope unless they have their pills. Its good to have other peoples opinions though, especially from those of you who are general nurse, and those from other countries.

Hi My ex husband was a lorry driver, we were totally unsuited in every way. But the man I am with now is amazing. I am a nurse by profession, but have done loads of other things and prefer to work for myself. He is a pilot, and although he loves flying he also likes to wrok for himself. We both have the same hobbies, mainly fishing, we love to pop to our local pub, have half a lager and a smoke and spend time putting the world to rights, before either going fishing or going home and watching the tv and chatting. We both want the same things out of life, and everything we want to try in the future is the same. He is amazing.

Hi Intersting one this. Not sure I could put it under the category of being a disease though. Over here those with drug and alcohol problems are treated by the mental health services. (Although any medical complications as a result of drugs and alcohol are treated on the general side). We very often had people come in for detox. They would not go to a general hospital for detox. The community mental health team would follow up their care once discharged. Drugs and alcohol can and very often do, cause severe mental health problems, such as drug induced psychosis, alcohol induced dementia, therefore come under the category of mental health, and during the course of my work have very often found that general trained nurses do not understand this, and some of them do not wish to either, and many of those addicts are frowned upon. This is such a shame really, as it can happen to any one of us at any point in our lives. Drugs and alcohol are very often a coping mechanism, albeit a negative coping mechanism. I have seen people that once had fantastic lives reduced to wrecks through drugs and alcohol. Quite often this can relate to life events that totally threw them, and the only way they could cope was with alcohol etc. Often things creep up on people and they dont neccessarily at first realise they have a problem. And its not easy for everyone to stop the addiction.

I loved my first nursing job. I had done a couple of placements on the ward as a student, my acute placement and part of my management placement, and was recruited because of this. Didnt really have much of an interview, as I had already proved I was capable of doing the job. Was great.

I hate wearing caps/hats. Never had to when I did my nurse training, but did have to when I worked for a private nursing establishmnet. They were paper and looked and felt terrible. It also hurts when an elderly patient tries to pull it off your head. In mental health uniforms are not even worn, let alone caps. I find it a much relaxes atmosphere in that environment and so did the patients, who used first names with the nurses as well. Very important in mental healthe I think.

Hi As far as hospitals go i would say yes to most of them. The local hospital where I used to live were great, and when my son had to be transferred from there to an Intensive care bed in London, they were absolutely amazing. I could not fault them at all. He had the best possible care, and without the paramedics that first came out to him, the staff at the local hospital, the specialist team that had to travel from london to stabilise him and escort him to london, and the amazing staff in london, he would have died, so a big yes I would want my family to be treated in either of them. As far as mental health goes a yes to the one I worked in as well. Nursing homes are a different matter, I wouldnt trust very many of them at all.

Hi I wore a uniform when working originally in a private nursing home, being a dress was not very practical, and we had to wear a belt, tights and a silly paper hat, lol hated it. During my student days I had to wear a uniform for some of my placements,(that was during the early part of my training. Tights and a belt were a must, but luckily no silly paper hats lol. For the vast majority of my training though (as I chose to do Mental Health), I did not wear a uniform. Dont know how it is in the US, but over here in mental health we dont wear a uniform (except some elderly mental health wards that chose to wear one as the staff were more easily identifialble to the elderly). The acute, intensive care, rehab and community staff where mufti (there own clothes), but they have to be suitable, we do have a dress code. I found this great, and so do the patients. I dont like uniforms at all.

Hi all The first nursing ome i worked in I did nights (12 hour shifts), we could have an hours break, but it was a paid break, so you could not take yourself off somewhere quiet and relax, all the break meant was that the other staff on duty had to deal with any problems during that hour, invariably we didnt really get a break. When working on the mental health acute admission wards we were supposed to have a 20 minuts break when on a short shift, but i can say i dont remember having many of these especially if the ward was busy with ward rounds, meds rounds,office work, and lets not forget the patient care. If there a lot of admissions and discharges that shift, then forget a break. Quite often we would have at least 6 admissions and discharges on a typical shift. Then there would be the patients that were acutely unwell that needed to be taken care of. If I was on a long shift (thats 14 hours) we were supposed to get 20 mins in the am, 20 mins in the pm and an hour for lunch. The only break I used to get was a lunch break (and sometimes that was either omitted, or shortened, if we were short staffed,or had problems on the ward. Was very difficult, but worked with a great bunch of people, so didnt seem so bad at the time. At my last job in a privately run nursing home for the elderly with mental health problems was a nightmare. We were supposed to have 20 mins in the am, 20 mins in the pm and 45 mins for lunch. Very often I didint get a break until about 18.00hrs (we did 12 hour shifts). The problem there was that there would only be 1 qualified nurse on duty at a time, and the owner insisted that the qualified only answered the phones, so just as I would sit down for a break the phone would go, as would the break. I did insist in eating at lunch time, but this would always be interrupted by phone calls,or the HCAs calling me with a problem. A couple of times I attempted to let the HCAs take calls, but they would still always call me. Was a complete nightmare, and the owner had no concept of what stress this placed upon the nurse in charge of the shift. He was only interested in making money and not staff wellfare. Breaks are extremely important for everyone, and I always made sure however, that my staff had their breaks, and if I sensed they were stressed would often send them somewhere quiet for a 5 min break to have a coffee. Nursing is a bit like the aviation Industry over here, you are expected to work under extreme stress whilst still maintaining excellent patient care, be at their beck and call 24/7, and get paid very little. Our NHS is a better working environment though, than our privately owned places.