Inpatient Treatment

De-glamourising inpatient (Part IV)

Slowly but surely making my way through my list!

18. Adjusting to life post discharge- Particularly when I’m down, I can find the ‘bubble’ that hospital provides quite comforting, and I’ve met a LOT of people who felt the same- that the ward was ‘safe’. While in some ways it’s positive that the hospital environment can feel like a safe place to heal, it can also be damaging. Getting leave from the ward can be unsettling at first with the ‘real world’ seeming busy and stressful and overwhelming compared to the slow pace of life on the ward. Keeping someone contained in a small space and isolated form the community can have that effect, and after discharge, there is always an adjustment period to life back home.

In hospital there’s a fixed routine- being woken each day at handover, fixed mealtimes, fixed medication times, (on some wards) fixed smoke times, fixed visiting times, fixed ward round times, groups or occupational therapy or school (on adolescent wards) at the same time each day and bed before midnight. If you’re there long enough, you’ll get used to seeing someone bringing the food trolley in every day at 11.45 and 16.45, the man that delivers bread every other day, the times the staff have their tea break, the weekly clean out of the medication trolley, the hospital chaplain coming in every Sunday at 1pm. You’ll fall into a routine of This Morning  before Occupational Therapy and Tipping Point before dinner and Family Guy before bed. You’ll learn which nurses give out night meds at 10pm, and which ones hold off til 11pm. Your whole day is structured around these little things, and once discharged, that structure disappears and you can fall into the trap of having too much spare time.

Another challenge is taking responsibility for your illness/recovery. In hospital there’s a team of people (staff and patients) that are there to support and encourage you. Back at home, you’re once again responsible for taking your medication/maintaining your intake or weight/self care/attending appointments and therapy/sleeping/filling your day with activities/keeping yourself safe. The switch from 24/7 care to an appointment once or twice a week can be hugely unsettling. Psychiatric hospitalisation can wrap you up in cotton wool and then send you home, blinking like a rabbit in headlights as you go it alone

19. Competition between patients- kinda similar to ‘triggering patients’ mentioned in Part II, and again, more likely on adolescent or eating disorder wards. One thing I found was that if there were a lot of younger people on the ward, things got pretty competitive- and pretty toxic- pretty quickly. There was a lot of ‘one upmanship’, under the guise of ‘relating’ to each other; “One time I did X”. “Well one time I did X, and Y happened!” “One time I did X, Y and Z!” Honestly I found it hard to listen to, as it kind of came across as people showing off about the shitty things they did or that had happened to them, and the result was, patients just bounced off each other. For some people, mental illnesses can have an element of wanting to be the ‘sickest’ or feeling a need to ‘prove’ you’re unwell, which led to the ‘boasting’ about symptoms/behaviours/experiences. This type of competition could also be dangerous as if one person was upset or had an incident, it could trigger their ~friend to have one too. A lot of people that have been on adolescent wards have said competition between patients was something that they found difficult, with several patients kicking off or having incidents after someone else had

malpractice

20. Malpractice and unprofessionalism- this can range from relatively minor things to things that result in huge lawsuits. As a patient I’ve overheard bank staff bitching about the ward, regular staff bitching about patients and on one occasion, a nurse bitching about me/another nurse/the consultant. I witnessed a patient being taken off 1-1 observations and subsequently fall and severely injure themselves, I’ve heard nurses and doctors say things to people that they probably shouldn’t have, I’ve been given my dixie cup with medications missing on several occasions and once or twice they forgot to give me my meds altogether.  As a student nurse I witnessed two nurses book a holiday instead of doing, er, their job, witnessed a nurse write someone down as refusing their medication without asking them if they wanted it, witnessed a support worker lying back with their feet up on the sofa watching TV and witnessed a woman with limited mobility and english being left alone in her room all day, every day. Things not being written up in your notes, having details of your care hidden from you, observations not being carried out (and self harm incidents as a result!!), medications not being available, the wrong medication or dose being administrated, being refused PRN, changes being made to your medication/treatment without being informed, having no say/not being able to voice your opinions, not being asked for consent, breach of confidentiality, delay in carrying out procedures (or carrying them out incorrectly), favouritism expressed for particular patients. There’s lots of little examples of unprofessionalism or malpractice, both accidental and deliberate, experienced by patients, and they’re the kind of things that really chip away at you when you’re already in a bad place. Ultimately, malpractice in the most extreme form can result in death while a patient in hospital

21. Picking up behaviours- again, more common in adolescent or eating disorder wards, but still very much an issue on general adult wards. It’s kinda like that saying ‘you leave an alcoholic in a bar, sooner or later he’ll drink’. If you’re sick and surrounded by sick people, sooner or later you’ll start to pick up new things. There was one occasion when a patient was talking about how she’d attempted suicide in the past, and she mentioned something and I remember thinking “oh I’ve never thought of that”. On another occasion, a patient had found out I’d taken a paracetamol overdose in the past and was telling me how dangerous that was, and another patient overheard and later told a nurse (within my earshot) she now knew “how to do it properly the next time” (I still feel horrendously guilty over that one, but it highlights how damaging casual chat can be in an inpatient setting). Mimicking symptoms is also an issue- whether it be subconscious or deliberate. I was once in hospital with someone who admitted that she didn’t know if she was “actually manic” (she had no bipolar diagnosis) or was just “bouncing off [me]”. It’s not uncommon for people to go into hospital and come out with new symptoms or new behaviours because you’re suddenly intimately exposed to a host of different illnesses, presentations, and ways other people have hurt themselves- things you mightn’t have thought about or heard of before. It can be easy to look at other patients and think “X behaviour works for them, I wonder if it’ll work for me” or relate to someone’s experiences and kind of ‘take on’ their symptoms? If that makes sense?

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