Diary of a Psychiatric Nurse – The Inspectors

I organised some tea and coffee for the inspectors, not so much out of courtesy, as a wish to buy some time while I planned my escape. Care plans were always written using ‘defensive documentation’ techniques to ensure that officialdom couldn’t scapegoat the staff without a struggle, so I felt reasonably confident that my paperwork was watertight; but I’d still rather have been on Mars. Sadly, much more effort went into meeting the needs of our financial planners, legal experts, managers and auditors than into meeting the needs of the community as a whole, otherwise we would have certainly thrown off the bureaucratic fetters by now and used a ‘rehabilitation’ model which actually worked in some way. But alternative ideas were virtually outlawed, ‘opinion’ was a dirty word and care plan entries had to revolve around factual descriptions of what was already happening. This was simply a formula for clinical inertia, so I sensed that I should probably keep out of the inspectors’ way in case my exasperation boiled over at P45 expense. Besides, the two Trust managers were about to be hung, drawn and quartered, and I’d rather not distract the executioner with a flasher’s side-show.

So for half an hour I moved around the unit like a commando, concealed within dust clouds, tying shoelaces behind armchairs, inspecting far off bedrooms, and visiting the lavatory with octogenarian frequency. Running out of ideas, I finally seized the menu sheets while the office was empty, and slowly toured the unit asking patients what they would like for their evening meal. Some patients gave entirely rational answers, while those with more serious cognitive damage often struggled terribly with the simplest enquiry. I had just reached the most challenged patient of all, when I sensed one of the inspectors sliding silently towards me like a tobacco-stained boa constrictor on the look out for easy meat. Rather than short circuit my enquiries by simply completing the sheet in accordance with my observations of the patient’s previous preferences, I now had to put on my politically correct and untouchable hat on, so the inspector would be impressed. This meant going right through the menu sheet, item by item, so that the patient was exercising ‘free choice’:
“ Now then sir, would you like chicken soup at tea time?
“Aye” (so far so good)
“Would you like shepherds’ pie….”
“Or cheese omelette?”
“Or a salad, or an egg sandwich?
“How about your sweet. Would you like apple pie…
“Or jelly and ice cream, or cheese and crackers, or a banana?
I felt the boa constrictor coiling and about to strike, but instead, with an empathic smile, the inspector said:
“He’s got a very good appetite, hasn’t he?”
He then rejoined the main group, and I couldn’t help noticing that Richard looked a little disappointed as they all turned away. Moving like a squad of monosyllabic minders guarding two beaten boxers on their way back to the dressing room, the inspectors and the managers quitted the unit for ‘further discussions’…….www.windowsofmadness.co.uk


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