A hospital ward where I used to work:
There is a male corridor and a female corridor (they link together in an L shape and men aren’t allowed down the female corridor). There are bed rooms on either side of the corridor. About 21 rooms in total and most of them are single on-suite rooms. There are seating areas in the corridor, a TV room, a canteen (open only during mealtimes), an enclosed garden, a female lounge, ward round room, clinical room, reception area and nurse office. The front doors are locked and can only be opened with a staff swipe card. Informal/voluntary patients are allowed to come and go (staff will open the door for them) and patients under section are required to stay on the ward.
7am: Arrive on the ward. Night shift staff give handover (summary of how each patient has been) to new staff and each patient is checked on before night staff leave. New staff take over duties and are assigned about 5 patients to have one-to-one sessions with and write notes on at the end of the day.
Patients are starting to wake up so the garden is unlocked for them.
8am: I’m assigned to do physical observations, which means taking blood pressure, pulse, respiration, temperature, blood glucose levels and complete urinalysis (urine testing) if necessary. If there are any abnormalities, the nurse in charge is informed. She’s usually doing medication at this point. It involves wheeling a medicine trolley down the corridor, giving each patient their medication and recording it on their chart.
9am: I’m assigned to do breakfast, which involves rounding everyone up, opening the canteen and then supervising them while they eat. Some patients are at risk of suicide or self harm so they have to be carefully observed when using glasses or cutlery. We sit and eat with them because it’s a good opportunity to engage and find out how they are. After breakfast I have to fill out food and fluid charts- they are used to monitor a patient’s intake if they are malnourished.
10am: The consultant has arrived and started ward rounds, which involves occupational therapists, doctors, nurses, etc all meeting in a room with the patient to discuss their treatment. Each consultant has a different approach- some seem to have God-complexes and give orders (which staff and patients generally hate) but others listen and genuinely care about their patients. Each patient is seen once a week. There are so many patients to see that sometimes ward rounds can last all day. Sometimes patients get discharged after ward rounds because they’re doing so much better. It’s sad to see them go but we are happy to see them well again. Another patient is usually admitted as soon as they leave- there is such a high demand for inpatient services that there are rarely empty beds.
10.30am: I’m running the community meeting, which involves getting everyone together in the TV room to give them information about occupational therapy groups available (eg Music therapy) and check if they have any feedback, requests or maintenance issues (eg broken shower). Only about 7 patients ever turn up and there’s usually one or two who are experiencing delusions or manic episodes, so they tend to be over-talkative and dominate the group. It’s my job to steer them back to the topic and give everyone a chance to talk.
11am: I’m assigned to take over close observation of a patient from another member of staff. It involves being within arms reach of the patient at all time (generally because they are at risk of suicide or self harm). Staff generally do it in 1-2hour shifts and can’t leave till someone else arrives to take over. We walk with the patient like a shadow and watch them even when they’re asleep or in the bathroom. We try to be as respectful as possible whilst ensuring that they are safe.
12noon: I’ve written up my notes from close observation on the patient’s record and now I’ve been assigned to do standard and intermittent observations. Standard observations are where you check on every service user every hour and note where they are, if they’re awake and how you know that they’re alive (eg. If asleep- chest rising). Intermittent observations are similar but they are generally done every 15 minutes for patients who are considered to be at a higher level of risk. It takes a long time because by the time you’ve checked on all 23 patients, it’s time to start the next lot of checks.
1pm: Lunchtime: Everyone is back in the canteen again. I use it as an opportunity to catch up with the patients that I’ve been assigned to today. One patient is telling me about how angels have chosen her to be the next queen and she has visions of all the people she is going to save. After lunch I write up notes about what they’ve been doing during the day, whether they ate and took their medication, how their mood was and what they told me about.
1.30pm Late shift staff arrive and the morning staff give them handover about how the patients have been.
2pm: A patient tells me that her friend (a voluntary patient from another ward) is intending on committing suicide. All other staff are in handover and the nurse in charge tells me to deal with the situation. I phone the police to circulate a description of the patient and where she is, I phone the ward to tell them what’s happening with their patient and then I phone the patient to try to calm her down. I’ve never met her before but I manage to build up a rapport and keep her talking. The police manage to reach her in time and bring her back to the ward.
3pm: Home time. Absolutely exhausted but relieved all the patients are ok. I will be up at 6am tomorrow for my next shift.
Dr Danielle Crane 