I’ll list one or two more unnecessary and time-wasting demands before I move on.
1. ‘Risk must be reviewed hourly’ – not too onerous, you might think, except – ‘it must be documented.’ And they want your name on it. More time wasting for anyone who’s not that hot with words. This policy’s ‘owner’ (that’s how they write it) is the Director of Quality.
2. Here’s another which any reasonable person recognises the true meaning of, i.e. ‘Here’s yet another policy we’ll catch you out missing. Even if you followed all the biggies, you’ll forget this one. And we’ll get you.’
Strong clothing and bedding. The qualified has to sign out strong clothing. And write several reams justifying its use. There is no justifiable reason for this. Worse, if the patient refuses to accept it (*) the NIC has to phone the on-call consultant (and don’t believe the managers when they say that it only wastes two minutes of your shift) and get permission. The only purpose for this is so the managers can bleat to the CQC and whoever polices that policy that ‘we are trying to reduce the coercive use of strong clothing.’
*) In old school days, if the nurse-in-charge decided strong clothing was needed, you stripped the patient and left them the strong clothing behind when you exited. It’s not that easy to strip an uncooperative patient but it is impossible to dress them.
It just occurred to me, not everyone will know why strong clothing and bedding is needed to start with. It’s to stop a secluded patient tearing their clothes (or bedding) into strips and tying their neck up with it. Usually, you already know if the patient has a history of self-ligating. Normally, shoes – and shoelaces – come off and anything with a cord, like a dressing gown, has the cord cut off. But you should leave their clothes on. It’s very bad practice to seclude a naked patient. It doesn’t matter what they did, you must treat them like a human being. That’s what you want them to act like, eventually, even if it doesn’t seem likely at the time. We have to remember that the nurses have all the power (*) and the patient has precious little. It gives patients confidence and trust – sometimes – when they see we have lines we will not cross.. So, for those patients, you give them strong clothing which is ‘impossible’ to rip into strips. I have seen it ripped but only once and the patient wasn’t doing it to make a ligature, just to show how strong he was.
Bedtime reading. An extreme example but take a look at this impossible patient and her efforts to self-harm with anything to hand.
*) Correction – we used to, but policies and those who police them have overthrown us.
Continues in Seclusion Pt 3
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