NURSING

item, this then requires physical
interventions to secure their arms
while we remove the ligature
using the ligature knife.
The young person requires
further support following this. We
take her physical observations
and start to discuss how best to
manage this new risk.
We decide that removal of
risk items and an increase
in enhanced observations is
appropriate. Following this, the
young person is offered a debrief
to discuss the incident.
At 11am I return to the office
to document this incident. This
is a sometimes frustrating but
necessary part of my role.
Typically an incident like this takes
around an hour to document.
At 12pm I have a one-to-one
with one of the young people for
whom I act as ‘primary nurse’.
We are doing some work around
stress vulnerability.
Engaging a young person
requires some creativity at times,
and we conduct this session
whilst playing basketball.
It’s not the most
straightforward session but
successful nonetheless. We make
a plan to continue this next week.
At 1pm I have a meeting
scheduled at another ward to
discuss how to reduce restrictive
practice within child and
adolescent mental health service.
I represent our ward at these
meetings and we are hopeful of
making some significant changes
to how the ward operates, in
terms of restrictive practices.
This will hopefully reduce the
frequency of incidents of violence
and aggression. I plan to get
young people’s perspectives on
this before the next meeting.
I arrive back on the ward at
2.30pm. Just as I am scheduled
to take my break the alarms
are raised again. This time a
young person has self-harmed
using a piece of glass secreted
from home leave. The cuts are
superficial and are cleaned and
dressed.
I have a one-to-one with
this young person after to
discuss how best to keep them
safe. Along with the ward
consultant, we develop a plan of
enhanced support to keep this
young person safe, and I then
contact the parents, who are
understandably upset by this.
At 3.15pm I document this
incident. Again, this takes roughly
an hour.
After this, as part of my role I
facilitate clinical supervision for
support workers. I meet with one
of my supervisees for around
30 minutes to discuss current
concerns and issues.
At 5.15pm I have another oneto-one
session, this time with a
different young person for whom
I act as ‘primary nurse’. This
session focuses on distraction
techniques for preventing selfharm.
At 6.15pm I have just enough
time for a quick game of pool with
one of the young people.
At 6.45pm I start to prepare
for the handover to the next shift.
Again this is a time-consuming
exercise, requiring documenting
the same points repeatedly.
We generally find that just
before handover time is when the
ward is most unsettled. I can’t
help but think that my skills could
be put to better use at this point.
At 7.15pm I have the handover
meeting with the night staff.
This takes roughly half an hour,
depending on when the night staff
were last in work.
My shift ends at 7.45pm. My
drive home is my reflection time
because we don’t have time for
reflection at the end of the shift
as everyone needs to go home.
Any challenging shift can be
stressful given the responsibility
and accountability involved, and
I reflect on how I could have
managed situations differently.
I am fortunate to be able to
leave work in the car and when
I arrive home I can concentrate
on my personal and family
responsibilities for the rest of
the evening, as I am back there
tomorrow. MHN
Name:
Simon Hall
Role/setting:
Senior lecturer in
mental health nursing, Bristol
‘‘
We go into
nursing
to witness
and share
moments of
courage and
compassion
’’
I am actually on leave from
academic work but I still try and
support the football group that we
set up in 2009 whenever I can.
It also acts as a peer and
family support group and a place
we just think about having fun.
We also use some of the
service users from this group at
the university where I work to help
coproduce a programme that is
suitable and relevant for mental
health nursing education.
At 12.45pm I am helping
with pickups, and as Wiltshire
is such a rural county with poor
public transport, the start of the
group (and sometimes the most
important element) is the drive to
the sports centre to pick up the
lads and find out two important
questions – how they are and
what are their expectations of
today?
Everyone seems happy and we
spend our time catching up and
discussing the few past months.
At 2pm everyone is changed
into their kits and we have the
perfect numbers for a six-a-side
game.
There are two new faces and I
introduce myself. They observe
the other players’ actions to
meeting me and I reflect that it
must be hard meeting so many
new people in circumstances that
you wouldn’t choose.
I also reflect it is clear that
one is recovering from an acute
episode of psychosis and the
other appears more confident.
It proves to be a close game
and I have a period in goal in
which I feel like a magnet or a
target in a video game, so I am
pleased to hear the half-time
whistle.
During the break I have a chat
with a one of the guys who I
recently supported at his asylum
hearing and we are just waiting
for the outcome.
The anxiety is shared with the
whole group, but the support and
care provided by all is truly heroic
especially those recovering from
an acute phase of their illness.
It is why we go into nursing – to
witness and share moments of
courage and compassion when
faced with adversity.
The result of our football game
is always irrelevant, but the match
remains competitive to the end.
Then everyone shakes hands and
everyone heads off for a shower
15