More on my point that it isn’t just patient violence – per se – that ruins the job. There are heaps of ‘things’ (*a) that some patients do that are dangerous, but short of violence. Things that we nurses have to stop them from doing, usually coercively. Well, I suppose I must concede we used to do that, once upon a time, in a galaxy far, far away, when nurses kept the wards peaceful (mostly) and therapeutic, places where patients got better.
Some of those actions?
Direct and veiled threats, posturing and squaring up in a fighting stance, demanding with menaces, intimidation and verbal bullying, insulting and threatening language are a few examples you must immediately address and terminate IF the ward is to remain a peaceful, safe, therapeutic place for everybody. (Everybody means patients, nurses and HCAs, visitors and relatives, visiting or sessional professionals like psychiatrists, pharmacists, therapists, domestics and kitchens staff delivering the food trolley. Allowing simmering threats and pre-violence to go unchallenged means the ward can’t function because its not safe for visitors.
*a) no, Wikipedia readers and SJWs, something doesn’t become a ‘thing’, i.e. real and definable with a border where it begins and ends, just because a social scientist or journalist named it. Even schizophrenia, though pretty woolly and elastic, is real, a definable thing with edges . There are plenty patients who are obviously NOT schizophrenic. E.g. if they have no negative sx, can speak as clearly and emotionally as they did when first diagnosed, if their sx resolve after a weekend in the bin then they’re not schizophrenic and something else is the problem and antipsychotics won’t help them.
A social scientist cannot deistically give something existence just by giving it a name. Minstrelsy (*b) does not exist. Ebonics is not a language and the Bechdel test isn’t a real test i.e. it doesn’t differentiate one real thing from a different real thing.
‘Transgender’ is another good example. An elasticated word which can be stretched to include anyone the user wishes it to. Therefore men who become sexually excited when they imagine themselves as women (*c) are described by the same word as a girl who considers she is a boy trapped in a woman’s body or a homosexual young man who isn’t ready to acknowledge he is homosexual. (Or a homosexual young snowflake who doesn’t think being gay is sufficiently special and wants extra social currency.)
*b) https://www.bbc.co.uk/sounds/play/m000vx3k Thinking Allowed Radio 4
*c) That’s called Autogynephilia. It’s a paraphilia, a perversion. Those men are perverts, but special perverts who our courageous ministers gave licence to be perverts.
Anyway, enough on that. Look at David Attenborough documentaries to see how this works in nature. Look at our own British rut, at elephant seals among their harems, at buffalo or antelope bulls competing to impregnate the herd’s females, or lions taking a carcass from leopards or hyenas – there is far more threat, growling, posturing, in birds fluffing up their feathers, and sparring than actual fighting. Much more. That is what’s going on. That is how working class men, drunk men, cons and men disinhibited by mental illness settle places on the dominance hierarchy ladder. But you can’t allow it in mental hospital because a) mad people’s brakes don’t work, b) it frightens the others and c) we, the nurses, are the alphas and we have to keep it that way.
Dominant cons and mental patients don’t always have to thud someone to be cock of the walk. I remember seeing a couple of times where the two hardest patients teamed up and dominated the other twelve or eighteen. They didn’t have to fight each other. Masterstroke.
An example. There was this fairly disinhibited, not fully psychotic but getting there, patient who kept on walking into the dining room when patients were eating (cutlery and plates are out) taking off his top, standing on a chair and making threats to everyone and insulting their mothers. Then he started targeting (this is a good way of judging just how psychotic they really are – or not) a particular patient who could have dropped him in one. This bigger pt didn’t want to react, not that he was peaceful, he just knew it would cost him, but he (and this is true for every other male pt, especially cons), could and would only take so much. I had to lock the provoker up before he started fighting or, obviously, got thudded by the harder guy he was baiting. Managers and regulators and anti-seclusion crusaders don’t care that you prevented at least two people, the two patients, from getting injuries, (*d) they only care that you naughtily intervened before there was actual violence. Injuries from two patients swapping a punch aren’t necessarily serious ones, most of the time they’re minor but you can never know how it will go down. If they don’t stop by themselves when you tell them too, you have to take charge.
By the way, it doesn’t matter a fig whether he was bonkers as a box of budgies or not. That’s completely irrelevant. That patient is acutely dangerous to staff and other patients and has to be managed safely. You can look at medication and symptoms later when things are calmer.
*d) Staff also get injured in moving fights. Most of us aren’t Jean-Claude Van Damme, just normal men.
Once upon a time, (I haven’t seen it recently) when the patient was not ill (i.e. they were pretending, malingering or a PD) but still provoking the bear, we would let the bear give them half a good hiding before moving in. A lot of good is accomplished by doing that. The PD gets a life lesson that he can’t do to patients what we have to let him do to us. He is incentivised to manage his own behaviour with stronger incentives than psychologists could ever dream up if they dared. The insulted patient (who is only a victim in a psychologist’s imagination – explore Transactional Analysis to learn more) gets to defend his mother’s honour. And we don’t get into bother because we did break it up, if only a little late. Nowadays, that technique doesn’t work properly because the wretch who gets the tune up also gets a nice jolly trip out to A&E and with it, bragging rights over the other patients.
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