Biomedical subjects
Publications and source records attributed to P Tarbuck.
While it is largely accepted that smoking is injurious to physical health, there is no general consensus on the value, or otherwise, of mental health nurses smoking in the company of their patients in the creation and maintenance of therapeutic relationships. This survey of key opinion-formers within medium- and high-security mental health-care facilities was designed to ascertain whether a consensus exists.
The recent report of the inquiry into complaints at Ashworth Hospital (1) recommended that control and restraint techniques, used to contain violent conduct, should be used as a last resort, 'and should be subject to careful scrutiny to determine system failures'. This article, which points out that nurses in many areas are victims of increased levels of violence, defines control and restraint techniques, who should use them and in which situations their use may be sanctioned. The author concludes that although preservation of the patient's rights and dignity is paramount, nurses who have undergone control and restraint training are more confident practitioners when they are confronted with violent situations. In a second article next month, Tarbuck will look at issues of ethics and the human rights of patients.
Nurses' uniforms have been the subject of ongoing debate in many areas. Following the Ashworth Hospital inquiry, two wards at the hospital piloted the wearing of casual clothes by nurses. Patients and nurses in these wards completed questionnaires to evaluate the effects of the change. The results showed that the patients felt casual clothes helped remove a 'them and us' distinction and enhanced nurse/patient relationships. Nurses found casual clothes to be more comfortable and practical. Although concern was expressed that, without uniform, nurses might not be readily identifiable in an emergency situation, the change to casual clothing was generally viewed positively by both patients and nurses.
Behavioural disorders present extreme problems for clients and careers. In this article, the authors discuss a definition of challenging behaviour. Types of behaviour classified as 'challenging' and possible responses to them, are also considered. Some of the points are illustrated with short case studies.
In an earlier article in Nursing Standard (1), the author discussed the use of control and restraint techniques when dealing with violent or potentially violent situations. Here, he offers a nurse's perspective on the ethical and human rights issues which confront staff who are trying to cope with the challenging behaviours of their patients and who, as a last resort, may have to use physical restraint to prevent injury occurring. In intervening physically, nurses, he argues, must be aware of the legal and ethical boundaries of their practice.
In August 1992 a damning report was published on the mental health services provided at Ashworth Special Hospital in Merseyside. It described a brutalising and damaging regime in which nurses were singled out for the strongest criticism. In November 1994 the Health Advisory Service (HAS), which has a watchdog role, spent three weeks at Ashworth reviewing developments in the wake of the inquiry report. The HAS report, published last March, praised the hospital for undergoing tremendous change and recovery. Areas of exemplary practice were evident and major dehumanising practices had been eliminated. This paper attempts to analyse some of the difficulties confronting nurses at the hospital during the years of change between the public inquiry and the HAS visit, and identifies recent major achievements and areas for further work.