I wake up when my alarm starts to bellow out the talking on the radio at 05:50 and think in my head

‘Dam already, feels like I only slept a few hours’

I slowly crawl my ass out of bed and head for the kitchen down stairs to make myself a coffee. Walking there my eyes feel like they are burning as if I have only had about two to three hours sleep and I also feel like I have a hangover. Even though I have had about nine hours sleep and did not drink a drop that night. Once I have made my coffee I sit feeling sorry for myself and think about breakfast but I can’t be arsed to make anything. After ten minutes of feeling sorry for myself and drinking my coffee I head for a shower and stand in the shower letting the water gush over me hoping that the day will be ok and not to tiring. Once I have this sorrowful shower I go get dressed and today I think it is going to be a green Krav Maga T-shirt and black combat trousers with black boots and I look at myself in the mirror and think

‘Sod it the shave can wait for another day’

Once I make my breakfast of eggy bread with slices of ham and burger mustard I go and wash up and think that I need a new job. You will see how busy and stressful the job is as we go through these stories. But what could I do as I don’t have the national standards of a basic C grade in maths and English. Don’t get me wrong I have worked in mental health for about twelve years and I have learnt a lot as in illness, how to deal with situations that others may feel squeamish with and how to deal with confrontations, after a while it does get to you. What I really want is a teaching post as in teaching others how to deal with situations and deescalate people, but how hard are these jobs to come by in today’s job market and without the certificates to prove your worth. Looking at my watch I see it is already 06:50 and I need to be at work for 07:15, I’ll be cutting it fine today but

‘What the hell, I’m usually the first in and one of the few last out’

As I walk onto the ward I enter the office and it looks like they have just started hand over for the previous night and one person says;

‘On time then?’

I reply to this in short term

‘Oh shut the hell up as if you ever on time’

I’m feeling so tired that I cannot be bothered with arrogant shits like him. I take a seat and the night nurse in charge carries on with the hand over. Just to let you readers know on this ward we have a patient who is nursed on a two to one enhanced observation. This means that the patient is too unsettled and for his safety or others he needs two nurses with him within arm’s reach 24/7. This particular particular patient needs two staff with him for his own safety as he has a tendency to start verbally abusing others due to a brain injury and his lack of reality.  I think to myself

‘I know where I am going to be for the shift’

At the end of hand over the nurse in charge askes Carl and myself to be on his constant. To me that’s not too bad as Carl and I can work very well together. As some as you, health care professionals are aware that you and a colleague click and don’t need to verbally communicate, it’s just a look you both give and you both know what to do. So off we both go and take over the two night staff that are sitting outside his room and park our butts on the chairs by his door. Now it is about 07:35 and the patient is still asleep for now and in about ten minutes we will have to wake him but be aware of the other patients in his vicinity, just in case they attack him due to him saying to other patients what he thinks of their behaviour. Don’t get me wrong, some of the time he is right but there is a way of saying it in the right terminology.  It comes to 07:45 and Carl walks in to the patient’s room and gently shakes him on the shoulder calling his name and saying in a soft caring voice

‘Time to wake up, its 7:45, time to get up and showered’.

The patient wakes up and tells Carl to

‘Fuck off and leave me alone’

As I am standing in the door way watching Carl’s back I laugh to myself as Carl turns to me with that Dam look on his face. As Carl walks out and gives him time to wake up, the patient slowly comes around and surprisingly apologises to Carl for swearing at him. Carl lets him know that he should not worry about it as Carl is a little grumpy shit when he wakes up. We walk the patient to the shower and spend five to ten minutes waiting outside the shower until he is done and follow him back to his room and he neatly puts his night wear away and his toiletries away. This patient is a nice bloke, don’t get me wrong but due to his injury he tends to tell people how it is in his mind which makes him very vulnerable towards others. After his shower and tidying his clothes and room it is about 08:00 and we all head down stairs to the day area for breakfast. This can be a challenging time as this particular patient does not have a lot of patience for waiting. Today must be a good day for this patient as he waits and tolerates the others taking their time. Once everyone is sitting down we stay sitting with him until he is called up for ordering his breakfast. Myself and Carl let the patient go up on his own but keeping a sharp eye on his body language and his tone of language. The patient returns and sit’s with us both and asks if we would like some of his breakfast. We both decline the offer but tell him to enjoy what he has. This in my eyes is a moment to remember. I f you work in this line of work you will understand.

The patient asks to go in to the quiet room and watch a DVD as it is a bank holiday and there is no sessions on today. In the quiet room is a three seater sofa and a TV DVD player. The patient decides to watch a film called Total Recall, which is an action film that is fairly easy watching, it’s the one with Collin Farrell in it. Carl and I sit there for about an hour and half watching this film and when it finishes, the patient wants a cup of tea. So off we go back into the day area so the patient can go and have a cup of tea. Whilst sitting there Carl notices a patient pacing nearby and looks at me and nods, this is to make me aware of the other patient pacing. I look at Carl and smile to give him the recognition that I am aware. Carl shouts out, I only assume to myself and the patient

‘MOVE’

The patient dives out the way and Carl and myself stand to attention and manage to stop this other patient getting to the patient we are looking after. Immediately another staff member steps up and covers me with the constant and I deal with the aggressive patient. We take hold of the patient using a conflict management known as PMAV and immediately relocate this patient to what is known as seclusion. Once in the seclusion room we stand there with the patient and the nurse in charge (NIC) tries to talk to the patient. The patient explains that he is sick to death of the patient saying what he says. The nurse explains that due to his injury he cannot help says what he says, it’s part of his condition.  This patient starts to put a struggle while we are holding him. We both lock our holds and move in tighter to control the situation and the patient starts swearing and trying to push us both around the room. Due to our training we both have a tight lock on our holds and with what’s coming out of the patient’s mouth we both nod at each other and the patient drops to his knees. The staff member and myself drop to our knees then down to a laying position and hold the patient on the floor face down. He is screaming and shouting

‘Get the fuck off me you bastards’

I activate the emergency alarms and we both wait for staff to respond to us. Once staff enter one staff member takes hold of the patients head and the other staff member takes hold of the patient’s legs as he is trying to kick and knee us in the back. Once we take hold the NIC tries to speak to the patient and deescalate him. All that is coming out of his mouth is swear words and threats of aggression, threats to kill the patient and anyone that gets in his way. The NIC yet again asks him to try and take some medication to help him calm him down, but yet he still refuses to take anything.  Whilst we are holding him face down the patient is beginning to become highly resistive and during this time the nurse that has the best rapport tries to speak to him, with no effect. The NIC walks off and goes to get some medication to inject into him, which will have a faster effect once it gets into his system. After about five minutes the NIC returns with a bowl that has a syringe of some sort of liquid in it and a plaster in it.  The nurse gently pulls his trouser down a little just to reveal his butt cheek and injects the needle into the muscle in his backside.  After the nurse disappears we all continue holding on to the patient and start to talk to him again after the swearing and threats have stopped. The team decide to turn him over onto his back, just so there is no pressure on his chest and he can breathe easier. This will be a well-timed and easy thing to do if you have the right people with you. Whilst he is on his back a staff member starts to talk to the patient and tries to deescalate him which has a very good effect. It has been about ten minutes since the injection has been given and with the nurse talking to the patient and the medication working we all start having a little bit of a giggle. The problem with this patient is that he suffers from paranoia and this turns out why he went for the patient is was with. The patient starts to relax a little and the nurse chatting to him asks if he wants to sit up and the person on his legs can get off.

Once sitting up myself and another staff member keep hold of his arms while the nurse that was holding his head moves round to where his is facing and continues talking to him. The patient starts to apologise to staff with tears in his eyes and asks if he could say sorry to the other patient, which to be fair seems like an ok thing at the time. After another ten minutes we decide to let go of our holds on this patient as we appear to be relaxing and deescalating him well and he goes to sit on the chair in the seclusion room with us. The patient asks if it would be ok for him to remain in this room for a while as he says he does not feel 100% safer to be on the ward but just wants time to relax. So myself and this other staff sit there chatting to him and he talks about that he was feeling paranoid this morning and while I was chatting quietly to the other patient he thought I was chatting about him and that’s why he attacked him. It’s about fifteen minutes and we all decide to go out into the day area and remain with the patient until he appears to be settled. As we walk out into the day area the patient that I was originally looking after decides to stand up and start shouting at the other patient giving him a lot of abuse. The nurse with him take hold of him and demand that he stops and sits down, surprisingly he listens and does as he is asked and sits down.

I walk with the patient that has just come out of the seclusion room and go and sit on one of the sofas. We start to watch a movie that is on the TV as there is no sessions on for today and it appears to be an action film Bourne Ultimatum, which appears to be a good action film. We sit for a while and I look round at the patient and realise that he has fallen asleep while watching the film.  I gently stand up and walk away from him and at the same time he puts his legs up on the sofa and gets comfy with his eyes closed. Once I see that he is still appears to be asleep I walk off into the nursing office and handover what has happened, it appears that the other staff member has already started to fill out the incident form for what has happened. Not bad for team work, team to restrain and one taking notes as the incident goes on. Now that’s what I call team work.

This is how a team is supposed to be working together in a job like this. We all muck in together, one leads, one takes details and the other does the notes of the patient in relation to the incident. It does not matter what position or grade you are anyone can take the lead and anyone can take notes or writes the notes. As long as you get all the details and don’t write their own personal opinions in the notes everything should work like clockwork.

Like I said these are just stories of possibilities and nothing is true fact. If you work in mental health of any sorts you will recognise situations and potential in what I write.

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