Tag Archives: nursing

“Safe” staffing on mental health wards

5 Feb

Some thoughts on “safe” staffing and what this mean on psychiatric inpatient wards.

 

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Forced medication: resistance is futile

19 Mar
Pacific Northwest Ballet principal dancer Carrie Imler, with corps de ballet dancers William Lin-Yee and Andrew Bartee in Jiri Kylian’s Sechs Tänze (Six Dances). Photo © Angela Sterling.

Pacific Northwest Ballet principal dancer Carrie Imler, with corps de ballet dancers William Lin-Yee and Andrew Bartee in Jiri Kylian’s Sechs Tänze (Six Dances). Photo © Angela Sterling.

Someone found my blog today by searching “how to get out of the restraint that psychiatric wards use”. That lead to these tweets on my experience of forced medication on a psychiatric ward (set out below, slightly edited).

I discovered that nothing I did or said made any difference to the use of restraint on me: they were going to carry on and do it, no matter what. It made no difference to them what I said or did. All I could do was try to make a difference to me.

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Someone found my blog today by searching “how to get out of the restraint that psychiatric wards use”. Yeah, no chance there: it’s six to one. I discovered that nothing I did or said made any difference to the use of restraint on me: they were going to carry on and do it, no matter what.

In my experience of restraint, once there’s a tick on the chart saying “forced medication”, it’s going to be done to you, no matter what. Once there’s a tick in the box saying “forced medication”, it doesn’t matter where you are or what you’re doing, you’re getting it.

It made no difference that I’d never been asked whether I’d like pills or an injection. The forced med squad just turned up and did it to me. It made no difference that I’d never been asked which drug I’d prefer to take. They just climbed on top, pinned me down and stuck it in me. It made no difference that I’d never had a discussion about symptoms or potential diagnoses or treatments. They just carried out orders.

It made no difference that I was sitting on my bed, reading quietly, minding my own business. They’d turn up mob-handed & do their business. It made no difference that I’d stepped out of a meeting with the IMHA to get a letter from my bedroom she’d asked to see. They came in as I sat on the floor, document wallet in hand, surrounded by papers. They did it to me there, then walked off chatting, leaving me to wander back to the IMHA, disheveled and dazed.

It made no difference when I pleaded with them to explain what they were doing, what was in the syringe (or syringes – it varied), what effect it would have on me. None. It made no difference when I talked calmly to them, speaking to each by name, asking them to explain why they were injecting me. None. It made no difference when I repeatedly called out a friend’s name, calling to mind someone who cared for me, who heard my words. None.

It made no difference whether it was night or day. They could turn up any time, stick it in me, roll off, leave me lying in dirty sheets. It made no difference when (realising nurses wouldn’t speak to me) I wrote notes and handed them to the nurses. The notes asked the nurses to explain what drugs they were injecting, what the effects were, what they were for and what the plan was going forwards. No response. They just handed each note back to me later, unopened.

It even made no difference when I was first in the drugs queue so I could take the pills instead: they still came for me again. I had a double dose that day.

The staff weren’t monsters. Far from it. They’d chat away to each other, coordinating between themselves who was going to take which limb; who was doing what when; and then when to let go as one.

They’d chat away to each other as if the person beneath them was not a person who spoke their language but a wild and senseless beast. They’d leave behind a bed pushed out from the wall, sheets trampled under their boots, empty swab wrappers on the floor, lumps and bruises on my arms and legs. They’d leave behind a person who didn’t know what had just been done to them, or why, or when it would happen again, or how to make it stop.

I learned that, when they come for you, there is no escape. You are locked in and cornered. It is going to happen. It makes no difference what you say or do.

I learned that, when they come for you, there is no escape. You are locked in and cornered. It is going to happen. It makes no difference what you say or do. You can’t reason with people who won’t listen to you. You can’t persuade people who don’t hear you. You can’t resist them when it’s six to one, even if (unlike me) you knew how. You can’t reason with people who are just carrying out orders. You can’t persuade people who don’t think you’re worth asking.

It’s like being in a science fiction novel. Resistance is futile. Your life as it has been is over. Comply, cooperate and engage. Resistance just prolongs the process. The quickest way to get out is to comply, cooperate & engage.

I found that there was nothing I could say or do to stop them using restraint on me. But things I said and did helped me cling on to me. Little things I did and said as they did their business on me helped me to cling to my sense of being a person, a human being not an animal.

It made no difference to them what I said or did. All I could do was try to make a difference to me.

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Trust, respect and coercion in mental health services

12 Feb

Trust dancers

Trust, respect and coercion: Can people who use mental health services ever really trust staff when coercion is always an option?

Some thoughts of mine on the subject.

Some responses of the lovely twitter people.

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But we’re not all like that …

16 Aug

Blue Toyota toy car

“But we’re not all like that!” We’ve all said it, haven’t we? Read or heard something that seems to criticise a group we belong to or feel part of and said, “But we’re not all like that!” I know I have. It’s instinctive. Especially so for those working in social care or the NHS, perhaps even more so for those working in mental health which seems to get criticism from every angle. There are many committed, hard-working, professional, compassionate staff who do the best they can in difficult circumstances, make a  positive difference to people’s lives and do a really good job.

So when a dedicated  GP or mental health occupational therapist hears a story on the news about terrible care in a service elsewhere, he might say, “But not all of us are like that!” A compassionate doctor or psychiatric nurse will read a story about a patient abused in another hospital and say, “We don’t all do that!” A social worker will see a story on a soap about a child being taken from its mother and say, “Not all social workers!” A psychiatrist or mental health healthcare assistant will read a patient describing their experience of poor care and tweet back, “But we’re not all like that!” It’s true: we’re not. But … And there is a but.

What happens when someone – such as a patient who’s had a brutal experience of mental health care or been badly let down by the NHS when she needed help – describes their experience and gets the response, “But we’re not all like that!”? What happens? The conversation stops being about the person who’s describing their own difficult experience and becomes … all about the person who’s interrupted. It becomes all about the interrupter talking about me,  me, me.

Now that’s understandable … to an extent. We all have our own experiences and perspectives. We all have our own hot buttons or soft spots. Many working in the mental health field have, I’ve come to learn through twitter, their own personal experience of mental health problems – whether directly or through family members. It really isn’t them and us.

It’s always easiest to see our own perspective. But … there is a time and a place for raising it. When someone is describing their own experience of pain, abuse or neglect it may, I’d suggest, not be the time to butt in defensively and talk about yourself. Sometimes, a sense of perspective is needed. This is well illustrated, it seems to me, with this simple anecdote:

Me: Someone driving a blue Toyota just hit and killed my four year old child.

You: I drive a blue Toyota. Not everyone who drives a blue Toyota hits four year old children.

What does this do? I was talking about having been recently bereaved: you turn the conversation around to … you being a good driver. No doubt that’s true or, if not, you sincerely believe it to be the case, are a conscientious driver and are genuinely offended at any suggestion you might not be. Perhaps there have even recently been stories in the press about bad drivers. But … was I criticising drivers of blue Toyotas? No. Was I criticising drivers? No. Was I criticising you? No. I was talking about the painful personal experience of bereavement.

Or, as mental health researcher Dr Sarah Knowles tweeted:

“I broke my leg :(” “Okay, but not all legs are broken. Why do you generalise? For example my leg is intact.” “I … what?!”

Put like that, it should, I hope, be obvious why the response, “But we’re not like that!” is inappropriate. And how responding or butting in with, “But we’re not all like that!” derails the conversation and belittles the experience of the person describing it.

It’s not about you.

Why do I raise this now? Because the “But we’re not all like that!” argument was raised earlier this evening in a twitter conversation. The conversation did – as these sorts of things so often do on twitter – broaden out to include many other tweeps and move on to other debating gambits, such as victim blaming, “if you can’t stand the heat, stay out of the kitchen” and the “them and us” culture. Read on for some fascinating insights and well-made points.

As Charlotte Walker (twitter @BipolarBlogger) tweeted:

“If someone has a terrible experience, I am going to honour that experience. There is no point in saying to someone who’s waited 18 months for CBT, ‘Oh don’t be harsh, in other Trusts it’s better.’ No use at all.”

And as NHS doctor Elin Roddy (twitter: @elinlowri) tweeted:

“I always remember you saying – just because you don’t work in a bad service doesn’t mean they don’t exist … It stuck with me and stops me getting too defensive (I hope) when people criticise health care.”

Next time you’re tempted to butt in and say, “But we’re not all like that!”, take a breath, pause and think … Maybe it’s not the right time to interrupt and hijack the conversation. Maybe  it’s time, instead, to listen.  Maybe it’s not about you. And, next time someone tries to stop you in your tracks with a “But we’re not all like that!”, maybe send them a link to this blog!

Not all drivers

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Let’s talk about poo! It’s tweet chat time …

28 Jul

Keep calm and poo with pride

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Update

 

Here’s the transcript & fab wordcloud from the tweet chat on 1st August – patients & nurses all talking about poo!

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This Thursday 1st August at 8pm, We Nurses will be hosting a tweet chat about constipation problems, at my suggestion. Here’s my earlier blog on constipation induced by psychiatric medication, including 25 tips you can try for yourself. It is my most read blog piece ever. I guess that makes me some sort of Poo Queen. Hmm …

However, if it gets people talking about an important but often overlooked or covered up topic, that’s all to the good. Let’s break the taboo about poo and make a date in our diaries for this Thursday’s poo chat!

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Background reading:

The Bristol stool tart cake!

The Bristol stool tart cake!

 

Additional information on constipation:

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Restraint – 10 ways it harms psychiatric patients

19 Jun
Greer Garson, Lauarence Olivier, Maureen O'Sullivan & Bruce Lester in Pride and Prejudice

Greer Garson, Laurence Olivier, Maureen O’Sullivan & Bruce Lester in Pride and Prejudice

 

Restraint. It’s such a polite word. What does it mean to you? Genteel Victorian ladies in romance novels? Bondage in Fifty Shades of Grey? Artistic photographs from the Held exhibition? Or perhaps the word conjures up the grotesque inhumanity of the face-down restraint and forced medication that take place on psychiatric wards up and down the country every day of the week and which are the subject of mental heath charity Mind’s new campaign. (See below for links to Mind’s campaign, press coverage, commentary and resources.)

The word restraint is reminiscent of Victorian novels of manners such as Jane Austen’s Pride and Prejudice. Of elegant ladies and gentlemen, like the renowned actors pictured above, exercising self restraint to stay within the confines of the social norms of the day. Rather than going “at it like knives on battered settees” (to quote a humorous song), characters manoevre to form genteel and restrained attachments.

Restraint also has connotations of the erotic kind. That’s especially so since the Fifty Shades mommy porn phenomenon brought bondage to the mainstream. By now there’s a Fifty Shades of Grey official pleasure collection, which includes a bed restraint kit, “approved by author” E L James. There’s even a parody novel incorporating Pride and Prejudice, called Fifty Shades of Mr Darcy.

A photograph from the held exhibition by Jane Fradgley

A photograph from the held exhibition by Jane Fradgley

Some think of restraint in mental health settings as an interesting topic for art, fashion, photography and academic discussion. Photographer and fashion designer Jane Fradgley’s exhibition Held (see here and here) has a related symposium on restraint. Her photographs are inspired by the historical collection of “strong clothing” at the Bethlem Royal Hospital Archive & Museum and explore her impressions of restraining garments as facilitating dignity, comfort and protection. That’s straight jackets..

When I hear the word restraint, however, the first thing that springs to mind isn’t Victorian ladies, saucy pleasures or artistic photos. It’s the brutal reality I’ve experienced of being pinned face down by teams of six as a vulnerable psychiatric inpatient. It was done to me repeatedly, to administer medication. There was never a justification. It was done to me without warning. It was done to me without explanation. It was done to me without any shred of compassion. It was done to me routinely, on a schedule I was not told about. It was done to me as a first resort.

It’s too traumatic for me to write about again. However, if you want to know more, read this blog, Treated Like an Animal, where I describe one incidence of face down restraint step by step.

Late yesterday, when I checked twitter,  my feed was filled with references to restraint. It was not good for me: here‘s my reaction. Hours later, after the flashbacks and tears had subsided, I was still sick to my stomach, heart pumping, unable to sleep.

Why had there been so many tweets on my feed about restraint? Because mental health charity Mind was publicising the launch of its campaign around the use of physical restraint in mental health care using the hashtag #crisiscare. As Mind says:

“When people’s lives come crashing down in a crisis, they need help not harm. We’re calling for national standards on the use of restraint, accredited training and an end to face down restraint. Excellent crisis care exists. It can save lives. And that’s why we need it available for everyone.”

It’s an important campaign, and one which must succeed so that the harms like those that were inflicted on me when I was at my most fragile aren’t allowed to be imposed on others in the same way. Here’s my personal experience of the harm done by physical restraint in a mental health setting:

  1. It destroyed any chance of developing a therapeutic relationship with ward staff. Staff became my jailers and tormenters, wielding arbitrary power, casually chatting over me to each other as they did their business. All I was interested in while on ward was discharge, not healing: get out, get away from staff and make sure they never came after me again. Fear of psychiatric staff affects me to this day.
  2. Mentally I was pushed to a place I would never have gone to had I received care rather than violence. At my most vulnerable, I was brutalised. Like smashing down a sledge hammer again and again on a tender broken wrist instead of enveloping it in a protective plaster cast, these restraints made me much, much worse than I ever needed to be.
  3. Each time it was done to me, I was reduced to the state of a cornered animal, running on stress hormones, on fear and instinct. My dignity and humanity were removed. (One time I was carried face down and shoeless through wards and corridors and past men playing snooker, with no explanation. I was so terrified I wet myself and was left in my own urine, watched through a porthole at 15 minute intervals. After some time, I was carried back the same way.)
  4. These physical restraints caused distress to other patients, who would hear me crying out in fear as I was manhandled, or see me being taken through the ward face down.
  5. I was physically injured by being yanked, pinned down, knelt on and injected. My buttocks were bruised meaning I was unable to sit. I was covered in lumps and great purple and green bruises and finger marks. Although the severe bruising and lumps have healed, two years later I still carry two physical injuries (one serious and for which I still receive treatment). (None of these injuries will be recorded in hospital records.)
  6. Two years later, simply hearing or seeing the word “restraint” can bring on overwhelming flashbacks and deep physical responses. Two years later, I can’t even can’t watch light-hearted TV programmes with traffic police in them because, sooner or later, there will be a big scrum when officers pin down a suspect. Just seeing that can trigger the flashbacks too. I can’t even lie on my tummy without it reminding me of being brutally pinned down.
  7. Two years post-discharge, the symptoms I still struggle with – and spend a lot of time managing – relate to my treatment on ward (flashbacks and physical symptoms), not what brought me onto the ward in the first place.
  8. I have been diagnosed with Post-Traumatic Stress Disorder as a direct result of my ward experiences (I am on a waiting list for treatment).
  9. Friends and family are horrified at the barbarism of what was done to me, putting them off seeking psychiatric help themselves.
  10. Having experienced what can go on behind closed doors when no-one is looking, I will never go back into a psychiatric ward, no matter what.

Since discharge, I’ve learned that restraint is a physically risky process in which people can die, so my fears were justified. Recently I bumped into a woman called Cheryl Prax. I spent 90 minutes listening to her describe her experience of having her arm broken in two places when she was restrained by psychiatric staff (see her speak about it here).

Why am I giving all this personal detail? Because staff may believe that using physical restraint helps them to manage the ward environment in the short term. But perhaps, as caring professionals, they will reflect on the long-term implications, both physical and mental, for those on the receiving end. And perhaps they’ll reflect that some mental health trusts have already banned the use of face-down restraint without losing control of the wards.

And now it’s not just me who’s saying they have had bad experiences being pinned down by psychiatric staff. Now there’s a national campaign from Mind to get rid of this barbaric practice once and for all. See the links below to see what you can do to help. Please help. Because this monstrous practice must stop.

There are numerous links below.

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My thoughts on restraint:

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Material related to Mind’s crisis care campaign on the use of restraint:

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Commentary & additional material:

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Press coverage of the story:

Nationals:

Locals:

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The saucy side of restraint, plus art:

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Confiscating patient phones on psychiatric wards

4 Jun
My photograph of an Olympic Park telephone box, July 2012

My photograph of an Olympic Park telephone box, July 2012

Some thoughts on the confiscation of patients’ phones on psychiatric wards, prompted by the fact someone found my blog yesterday by searching the term, “If you are in a psychiatric ward do they confiscate cell phones or computers”.

I’ll work the twitter conversation up into a proper blog post when I have time, and then publicise it. In the meantime, it’s here as a repository for some thoughts of mine and thought-provoking responses of others.

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Constipation: embarrassment, discomfort … and Poo Pride!

14 Apr
Alternative Bristol stool form chart from rewarm.co.uk

Alternative Bristol stool form chart from rewarm.co.uk

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On Thursday 1st August at 8pm, the #PooPride tweet chat with We Nurses took place – woo Update smallhoo!

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Having been on twitter for a little over a year, I’ve seen lots of topics discussed. Bowel problems aren’t one of them. Which is odd, given the effect many psychiatric medications have on your digestive system. My hints on twitter about my debilitating bowel problems seemed to go unnoticed. However, since there are a lot of people taking psychiatric medications, and for long periods, there must be a lot of people out there with constipation and other bowel problems who are suffering in silence.

At Easter, Charlotte Walker (@BipolarBlogger) blogged about a weekend away and how medication and bowel problems had affected her. I recognised the juggling act and stress of taking medications and planning toilet breaks. Then, yesterday evening, I spotted a tweet by Charlotte about constipation, to which I responded. When Charlotte asked me if I had any recommendations, it turned out that, after years of managing my own bowel problems, I could come up with 20 off the top of my head! (See below.)

That started up a spontaneous tweet chat. (All the tweets are linked below.) Then, because the issue is much wider than our personal experiences, because people were suggesting medications and treatments to try, and because constipation can cause serious complications, I decided to see if we could have an organised tweet chat involving medical professionals too. Watch this space!

Here’s the tweet of Charlotte’s that caught my eye:

“Dear antipsychotics, love what you’re doing on the bipolar, great stuff. Just concerned my bowel may RUPTURE, ease off a bit there, maybe?”

Charlotte explained that she was experiencing antipsychotic-induced chronic constipation which had flared up into faecal impaction. Not fun. Not fun at all.

Problems with your digestive system – whether it’s too much movement, or too little, or both; whether it’s frequency, consistency or volume; or colour, smell, blood or mucus; or some other charming symptom – can be a blush-making topic. I know, because I’ve blushed those blushes.

The first time I plucked up courage to mention to a medical professional the bowel problems I was experiencing, I received a reaction I hadn’t anticipated: laughter. As a result, I didn’t raise the issue again till an Atos medical. Through bodily sobs and streaming tears caused by shame, I forced myself to describe my symptoms. This time, the reaction was disbelief: zero points. Laughter; then disbelief. After that, through trial and error, a keen  memory for toilet locations and a well-stocked handbag, I gradually found ways to manage my bowel problems myself.

That was no longer possible, however, when I was detained in hospital. The combination of enforced inactivity, a diet devoid of fibre and the side effects of psychiatric medications meant my bowels came to a halt. There was one fortnight when I passed just one motion. Thank goodness for stretchy trousers that could accommodate my massive and growing belly, taut as a drum, as I waddled round the ward in pain, unheeded and untreated except for senna.

Since then, through my own efforts and working with my GP and the specialists she’s referred me to, I’ve found a way to manage the problems. And I can talk to pretty much any health professionals without embarrassment now so I know that, if problems come up in future, I’ll be able to talk about them and, hopefully, get the help I need.

You know you’ve got constipation when your digestive system has slowed down so you pass motions less often than you want to or when your stools are hard and difficult to pass. You may also have indigestion. It’s uncomfortable. It’s embarrassing. It’s even potentially dangerous. It’s an important topic.

Normally, constipation is a short-term problem which responds well to lifestyle changes and, if necessary, treatment. However, if constipation is drug-induced and there isn’t an alternative, you may be looking at a multi-pronged approach in order to successfully keep on top of constipation. So, for those of us taking medication, it’s a topic of even more importance.

Below, as a starting point for discussion, as food for thought, are the twenty tips I came up with off the top of my head for Charlotte to try out, plus a few more I thought of later. They are things that have helped me personally (or people I know) to manage the impact of drug-induced constipation. They’re aimed at someone who’s otherwise physically healthy. They’re tips you could use as a springboard for discussion. They’re common sense, not rocket science. They’re not comprehensive. For medical advice, take a look at the NHS website or ask your medical practitioner. Maybe they’re worth a try. We’re all different, after all.

As Charlotte tweeted later that evening:

 “Goodness! What a lot of people have followed me since @Sectioned_ and I started talking about constipation! #goodtoshare

And, as Phil Dore (@thus_spake_z) tweeted:

“Poo Pride! :D”

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Bristol stool form scale

My personal tips on dealing with drug-induced constipation:

1. Keep a poo diary

If you keep a record of the motions you pass, you may start to see a (monthly or other) pattern. Women in particular can find their bowel movements are affected by their monthly cycle. Maybe it’s not a relapse or a remission; it’s just your monthly cycle. If you get to know the effect (if any) that your monthly cycle has on your bowels, you’ll be better able to distinguish what works and what doesn’t for your constipation. And improving constipation involves trial and error.

What to include in the poo diary? Time of day you pass (each) motion, what you were doing at the time (eg had you just smoked a cigarette). You’ll need to keep a record of what you eat and and your fluid intake, to see what effect that has too.

Also, include your Bristol stool scale number. It classifies stools into 7 different types. The ideal is around around a 3 or 4. The official Bristol stool form chart is above.

Bear in mind when looking at the chart above that your poo may not be the same as the colour shown: stools vary in colour depending on what you’ve eaten. I’ve pooed red after beetroot juice and green after spinach. Taking an iron supplement can (I’m told) blacken stools (and harden them). If there’s blood or mucus in your poo though, that’s not a good sign. Mention it to your medical practitioner.

Such a detailed diary won’t be necessary forever, but it’s a useful tool to see where you are now, and to identify any patterns emerging. Try to keep one for at least 2 weeks (men) or two cycles (women).

2.Eat or drink something

Stimulating one end of the alimentary canal (the long tube that runs from your mouth to your bum) can stimulate the other. Therefore, when you want to poop, first eat or drink something. I find that, if it’s going to work, it does so within around half an hour. So if I need to leave the house by 10am, I’ll eat drink or something (however light) at 9am to give it a chance to work its magic.

3. Try a stool softener

An effect of some psychiatric medications is to reduce the fluid content of foods. A stool softener (or osmotic laxative) is a medication that draws water into the stools, making them softer and therefore easier to pass. Lactulose is the stool softener I’ve tried and it’s worked for me. Brilliantly. Movicol is another one, though I haven’t tried that.

A downside is its taste: exceptionally sweet. But hey, just clean your teeth afterwards. Especially as another side effect of some psychiatric medications is dry mouth, or rather reduced saliva – and hence reduced protection for the teeth.

4. Use a jug

If your problem is hard stools, it’s water that will soften them; so you’ll need to take in sufficient fluids during the day. To ensure I push through enough fluids, I fill a jug with water on rising and fill my glass from it throughout the day. That gives me a goal to work through during the day.

Don’t drown yourself in fluids late in the day and end up wetting the bed. And yes, I have done this too: the meds I take knock me out so I sleep like the dead and wake up in a puddle. The way round that is to spread my fluid intake throughout the day so it’s not gulped down in a rush towards bedtime.

5. Prunes

Fluids rock. As do prunes. Drinking prune juice helps me too. And it’s super yummy. As are prunes with custard. I’ll take any excuse to eat prunes.

Beware though: don’t take too many. Once, before I knew the laxative effect of prune juice, I drank a whole litre in one go. That’s how I know it works. Now, I just drink a glass.

6. “Doing a Paula”

If you’re just not going, your bowels may be sluggish. Your digestive transit time (the time it takes from something going in your mouth to it coming out the other end) may have been slowed – whether caused by medications, or enforced inactivity if on ward, or lack of motivation to get active (a side effect of some drugs). If you want to know your transit time, you can do the sweetcorn test (eat some sweetcorn and see how long it takes to spot it in your stool – transit time should be around 24 hours).

One way to get the bowels moving is high impact exercise, which can stimulate the bowel to open. If I’m indoors, I’ll fire up my trampet and bounce along for a song. Jogging works too. Just be sure you know those toilet locations or have a handy pack of tissues in your bum bag.

Incidentally, if you normally have healthy bowels but find yourself almost or actually involuntarily evacuating your bowels during a run (pooing yourself), that may not necessarily mean you have a bowel problem. It can happen to normal, healthy runners the world over. It’s an occasional downside of the pastime. After all, the phrase “Doing a Paula” derives from the reason Olympic athlete Paula Radcliffe had to retire from the Athens marathon. Don’t panic. Just plan ahead. And learn the technique that enables you to delay passing a motion.

7. Vitamin C

Heard of the vitamin C “bowel tolerance dose”? Taking over 1g vit C gives me the trots. Everyone’s dose is different. I know the trots aren’t ideal, but sometimes you just need to pass a motion.

Incidentally, if you’ve recently changed your diet to include a high dose vitamin C supplement and find your stools are loose, the vitamin C could be the problem. Don’t automatically assume you’ve caught a bug or got IBS (irritable bowel syndrome). Experiment with the dose till you find the one that works for you.

8. A bathroom step

Essential bathroom kit is a little step (about 8” high), so that, when you sit to poo, your knees are a little above your bum. Sitting in this position relaxes your lower body and places your bowel in the correct position to pass a motion easily. It reduces the need to strain (which risks causing haemorrhoids/piles). And, bonus, it also means you can rest your reading material on a flat surface!

They’re cheap as chips (mine cost £2). Once you’ve used one of these, you’ll never want to poop any other way. If you’re visiting, you can usually find something to stick  under your feet – eg a couple of thick books, a pack of loo rolls – so your knees are at the right height. Simples.

9. Try training/routine

This is a controversial point because some bowel specialists I’ve seen say it’s impossible to train the bowel and others say the opposite.

The idea is that, at the same time each day – eg half an hour after breakfast (when you’ve stimulated the bowel by drinking or eating something) – you go into the bathroom whether or not you want to pass a motion. A sort of potty training for adults. You sit on the toilet, hang out there for 5 minutes, then leave. If you pass a motion good; if not, no problem. Maybe next time.

10. Latex gloves

This comes from a little trick I recall my mother showed me as a child. To get newborn kittens to poop for the first few weeks, rub their little bottoms. It worked. Why wouldn’t it work for humans too?

The idea is to very gently circle the anus with a gloved finger to relax it and, hopefully, give it that little extra  nudge it needs to stimulate the passing of a motion. Use lubrication of some sort (eg vaseline).

11. Smoking

Seriously. There’s a reason people smoke after a meal! I nearly took it up  in hospital again because I was so blocked. (Also because only the smokers were allowed into the garden.) Before I became a non-smoker, smoking a cigarette was a guaranteed way to bring on what I believe the Girl Guides call the “daily clear out” (though I suspect they don’t get the little girls to smoke).

12. Coffee

Again, there’s a reason people drink coffee after a meal. If you don’t like the taste, think of it as medicine: it may not taste good but, if it does the job, that’s what matters.

13. Stimulant laxatives

Senna is a laxative that works by stimulating the muscles of the gut to push your poo towards the anus (a stimulant laxative). Maybe this is just what you need. Bear in mind though that that senna is aimed at relatively short term use because it can, over time, make your bowels lazy.

Personally, senna was not good for me. When the nurses offered me various medications on ward, I made the mistake of thinking that, because it is a natural product, it would be the best choice. Wrong.

In fact it’s what caused me to blow up like one of the sheep in Far From the Madding Crowd: I wanted someone to spike me in the guts to relieve me of the terrible pain. I felt like I was going to die. In one fortnight, I only passed one motion.  I didn’t know what was causing the problem. I thought I’d be even worse without the senna. Luckily I was able to speak to a hospital pharmacist for an hour, and he helped me to work out what the problem was and what would help. If in doubt, seek medical advice.

Bulk-forming laxatives such as Fybogel are a third type, which help stools retain fluids.

14. Fibre

It’s a key recommendation for the prevention and management of constipation to have sufficient dietary fibre. Most adults don’t eat enough, and constipation is your clue that that means you.  You can increase your fibre intake by eating more fruit, vegetables, wholegrain rice, wholewheat pasta, wholemeal bread, seeds, nuts and oats. Eating more fibre helps keep bowel movements regular by helping food pass through your digestive tract more easily. High fibre foods can also make you feel fuller for longer, in case you’re struggling with cravings (another side effect of psychiatric drugs which contributes towards weight gain).

If you decide to increase your fibre intake, however, do so gradually: a sudden increase may make you feel bloated, produce more flatulance and give you stomach cramps. Eek!

15. There may be no magic bullet

Bear in mind that, though the hard stools and slow transit may be caused by psychiatric drugs, they may not be fixed just with drugs. It may take a package of measures to bring constipation under control. But finding the right drug/combination can surely go a long way to helping.

And be prepared for the fact that you may end up taking more drugs to deal with side effects (like constipation) than the number of drugs you take for your primary psychiatric symptoms. That’s just the way it is. Just as every surgery causes scars, so every drug has side effects. It’s just a question of finding the side effects profile you’re prepared to live with.

16.Experiment

You could try each of these suggestions to see which ones work for you. Perhaps put them together into a morning routine, tweaking as you go to work out the right combination for you: we’re all different.  However, it’s hard to tell what’s working when you’re doing lots of different things at the same time. You could consider doing them all at the same time and then gradually cutting each one out, one by one, to see what works; or stopping everything then adding them back in one by one.

17.Input and output

Reducing food intake (a little) can help. I wouldn’t have got quite so bunged up if I hadn’t eaten quite so much! Obviously we all vary and some people are under-weight or need to follow a special diet. On the whole, however, many of us would benefit from cutting down a little on what we eat. And, the less you put in, the less there is to get stuck inside!

18.Wet food

If the problem is constipation & hard stools, eating “wetter food” (eg soups, stews, curries) can also help a little. If you live on crisps, you’re asking for trouble.

19.We can all learn

Even clued up healthy eaters who think they know a lot about diet and lifestyle may benefit from a food diary & having their diet tweaked by a dietician. I’ve learned new stuff from the professionals I’ve seen. Even if we’re doing everything we know 100% spot on, science might have moved on since then. There are lots of fad diets and food myths we might have fallen prone to without noticing, so reviewing a food diary or having a professional do so can lead to improvements – even small tweaks – being found. And, with constipation, it’s these little things that add up.

We might even learn that things we thought were healthy options were actually contributing to bowel problems. For instance, taking supplements is always good, right? Wrong. For instance, taking too much vitamin C can cause loose stools, whilst taking iron tablets can harden stools. Fibre is always a good thing, right? Wrong. For some, a high fibre diet can irritate the bowel and lead to bloating and frequent loose stools. What you may think is IBS may resolve entirely on a lower fibre diet. Exercise is always good for you, right? Wrong. For some, high impact exercise can lead to involuntary bowel evacuations (“Doing a Paula”). If so, stick to gentler exercise. Or practice bowel control techniques.

20.Try it

Even if you’ve tried something before, it may be worthwhile trying it again. Bowels can be contrary beasties. “I’ve tried everything already” may mean you miss out on doing something that now works.

21. Tummy massage

Another way to stimulate the bowels to start moving is with tummy massage. Use the heel of your hand to make a big circle in a clockwise direction (the direction the bowels go in). Alternatively, lie on a hard surface face down and roll around. Or lie on your back with your legs in the air and cycle, to get the tummy muscles moving. All very elegant!

22. A hot bath

As Sylvia Plath wrote in her novel The Bell Jar, “There must be quite a few things a hot bath won’t cure, but I don’t know many of them.” A hot bath is another great way to get the bowels moving.

23.Specialist help

Ask your GP for a referral to a specialist clinic. If at first they say there isn’t one (my otherwise excellent GP did), do your research so you know the right terminology to use when asking for the service. For instance, I’ve had referals to a community dietician; a colposcopy clinic; a continence clinic; a bowel education group; a colonoscopy consultant; and a hospital consultant for anatomical investigations.

24. A tricky balance

Once you start taking steps to actively treat constipation, you might push your bowels the other way. Oh joy! Your bowels become as unpredictable as climate change. You might swing back and forth between the two before getting it right. Ho hum. You’ll get there. And in the meantime, be prepared.

25. The pitfalls of syndromes

If, along your constipation journey, someone mentions IBS, be careful how you use the diagnosis. With family and friends it may provide a label that helpfully enables you to side-step that awkward conversation about symptoms. However, if you’re going for medical treatment and you mention IBS, you’ll most likely see the doctor’s eyes glaze over. In essence, a syndrome is the medical profession’s way of saying they don’t know what’s wrong with you. It’s saying you’ve got a collection of symptoms they don’t know how to treat. It is a label that says to a medical professional, “Nothing you do will make the patient better. Next!” Use with care.

If you have any tips for easing constipation that you’d like to share, please feel free to comment below. Happy pooing!

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web links 5

.Bristol stool chart NOV 2013

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Treated like an animal

24 Mar

Project Nim 2

Today I shared some of my experiences of forced medication, restraint and seclusion from my recent (2011) stay on a psychiatric ward. Hopefully it will be my only stay on a psychiatric ward, because, as you’ll see from these tweets (see the links below), it wasn’t a healing experience. In fact, I’m undergoing treatment for post-traumatic stress disorder as a result of my hospital stay.

The photo above is taken from the documentary, Project Nim, that prompted me to start tweeting this morning. Nim Chimpsky was a chimpanzee taught to sign then sold for medical research. When I watch documentaries with captive animals, it reminds me how ward staff treated me like a creature to be observed, not a person. That’s what happened this morning.

I was tweeting a flood of consciousness, as the images came to my mind. I was sharing what was, for me, a very powerful experience. Holding those images in my mind, tweeting about them, wasn’t easy. I’d never tweeted in that much detail before. I felt sick when I sent these tweets. Bringing back these memories brought back some of the trauma. I was shaking. I was crying. It took me over an hour to send the first tweets.

I wasn’t engaging in a light hearted conversation, garnering opinions, having a chit chat. I wasn’t looking for banter and interaction. I just kept tweeting through the tears.

When I’d finished, I went back and checked the responses of others. I’ve included those in the Storify story as the voices of so many tweeps both mirror and challenge some of my experiences. There isn’t much interaction, because I was too upset.

At the end of the Storify story are comments from two tweeps who say they are psychiatric nurses (I don’t know them). Their comments, sadly, demonstrate one of the reasons my stay on psychiatric ward was so horrible: lack of empathy, lack of understanding and lack of compassion from ward staff. It was a reminder that, for some psychiatric staff, people’s emotional distress is just a day job.

I know there are more compassionate psychiatric staff out there, because I have seen excellent psychiatric care in practice. I’ve just not received it myself.

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web links 5

*** UPDATE *** [23 October 2018] Tweets now saved on Wakelet > Treated like an animal

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Mental health nurse & patient tweet chat: what do newbies need to know?

11 Feb

Psychiatric Nurse - Garrison - Book cover

Update small..

The tweet chat took place on Thursday 20th February 2014 with We Nurses – catch up with the discussion by taking a look at the full transcript!

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I’m planning my first one hour tweet chat in a couple of weeks (date to be announced). (Check out my quick guide to tweet chats for more on what they are – this and other helpful links are below). Here’s what I have in mind, for an inpatient mental health nursing tweet chat:

  • Patients: Are you a patient who’s experienced inpatient mental health nursing? What would you like the newbies to know – the student nurses about to start a placement or the newly qualified mental health nurse. What things that nurses did – good or bad – made a difference to your experience on ward?
  • Students: Are you about to qualify as a mental health nurse? Are you a student nurse about to start your mental health placement?  What is the balance between fear and excitement? What would you like to know? What practical concerns do you have? What do you want help with to make your first days on ward a success?
  • Nurses: Are you a qualified mental health nurse? Are you a student nurse who has completed your mental health placement? What tips would you like to pass on to newbies about to qualify or about to undertake a placement? What are those little insider tips that really helped? What would you have liked to know when you were a newbie?

I’d like to be able to share some really useful tips to help new mental health nurses and nursing students make their best start on ward, because that benefits both staff and patients. Here are some example questions I’ve thought up that students might want to know the answer to:

“How can I prepare for my placement so I get the most from it?”

How can I put the knowledge I’ve learned at university into practice on the ward?”

“How can I settle in as quickly as possible so I fit in with my nursing team and ward life?”

“How can I switch off after a shift?”

“What should I do if I see another nurse doing treating a patient unkindly?”

Here are some examples of useful tips to pass on:

The Bic 4-colour pens are really useful for filling in your paperwork.”

“Remember to always respect the patient as an individual and see past the diagnosis.”

“Don’t make assumptions or have preconceived ideas based on what you’ve been told before. Remain open-minded and make your own judgments based on your own personal experiences.”

As I’m not a nurse and haven’t run a tweet chat before, I’ve invited @MHnursechat – associated with the awesome We Nurses website and tweet chats – to run a joint tweet chat with me. We’re going to be discussing how this will work and, hopefully, setting a date. Very exciting!

In preparation for the tweet chat, I’m asking you to please share your tips and questions. That will help set the agenda to be followed and the areas we’ll focus on in the tweet chat – so it covers the most burning questions and drills down to the most useful tips. It may be that there will be more than one tweet chat on this topic – perhaps one covering what nurses need to know in their first few days, and another for when they’ve been there a few weeks. We’ll see. A tweet chat needs to have enough of a focus to engage people without overwhelming them, but at the same time enough breadth so it doesn’t peter out prematurely! If there are other topics you think would be good for tweet chats then please let me know!

You can comment below or tweet me (please don’t try to pack more than one query or tip into each tweet ) @Sectioned_ (please remember the underscore). It’s helpful if you could say whether you’re offering your comment from your experience as a patient, nurse or student. Look forward to hearing from you!

Why a tweet chat? I’m often interested in discovering what other tweeps think about topics and then sharing those insights. So, quite a few times, I’ve tweeted questions then collated the responses into a Storify story which I’ve sometimes turned into a blog. (I was rather excited to learn that this is called “crowd sourcing” and “curating the chat”.) This time I thought I’d try making it a bit more organised & involve more people: I’m beginning to learn just how valuable Twitter is as a way to bring together groups of people to share views openly in a way they might not otherwise do. (I’m told this is called “disruption” – disrupting the natural order of things and mixing it up, like mental health peeps and staff learning together.) (Thanks to Victoria Betton for all the cool jargon!)

Why this topic? After all, I’m not a nurse. As a child, however, I remember being taken to one of the big long-stay psychiatric hospitals of the sort portrayed in the film One Flew Over the Cuckoo’s Nest. I remember the high ceilings, big windows and long corridors. Happily I wasn’t being booked in myself. I was visiting family friends who worked there as psychiatric nurses. Members of my family also worked on psychiatric wards and in nursing.  When I was sectioned a couple of years ago, my inpatient experience fell far short of the care I would hope all psychiatric nurses aim to deliver. You could say that everything that could go wrong did go wrong. But, as I’ve been around nurses my whole life, I know that the image and practice of mental health nursing has come a very long way since the fearsomely controlling figure portrayed by Nurse Ratched. For me, nurses are (or should be) an essential part of the team that helps get me well. So I’m all for sharing tips and best practice to help nurses be their best. I’m hoping this tweet chat will be one small way to do that.

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web links 5

  • Guide to tweet chats – all you need to know to join in your first tweet chat or get more from them
  • Mental health jargon buster and acronym buster – please send yours in! We’ll try to avoid jargon during the tweet chat itself, but if the jargon’s in the jargon buster, I can just tweet a copy of that by way of explanation

For the nurses and student nurses amongst you, here’s some nurse-focussed content:

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