In the book “Loudspeaker in the head. About psychiatric treatment in Poland”, which will be published on February 9 by Wydawnictwo Czarne, Aneta Pawłowska-Kać talks with patients and their families, with psychiatrists, nurses and nurses, and paints a picture of Polish psychiatry, unfortunately in dark colors . Patients are hospitalized too late, stay in hospitals for too long, lack adequate support and care, are stuffed with drugs and released from wards without guidance on how to proceed. But it’s hard to blame the hospital and clinic staff – they’re so small and overburdened that they simply can’t give their patients the attention they need.
Is there a way out of this situation? The author examines the solutions adopted in other countries and analyzes the reform of psychiatry, which is now hardly being implemented. And although you can see a light in the tunnel, it is impossible to say whether it is an exit or a speeding train that is approaching us and it is too late to avoid a collision.
Aneta Pawłowska-Kranie “Speaker in the head. About psychiatric treatment in Poland” – excerpt:
For years, the nursing community has been calling for the introduction of employment standards in terms of the number of patients. More staff means greater patient and staff safety, higher standard of work, more time for patients. But the introduction of these standards is constantly postponed. There are several reasons for this, but the most important is the lack of staff that hospitals could hire. Fewer and fewer nurses and midwives enter the profession than are gaining pension rights. For at least ten years, there are fewer of the former than the latter (for the last time, the bar showing the number of persons acquiring the right to practice an occupation was higher than that representing persons acquiring the right to retirement pension in 2009, by 941), and for the last six years by almost a half. For example: in 2019, 5,969 nurses and midwives entered the profession, while 10,702 pension rights gained. A year later – 5,693 compared to 10,314. with a lack of staff. To prevent this from happening, “people who have reached retirement age are encouraged to remain in the profession” – Arkadiusz Szcześniak from the Central Register of Nurses and Midwives writes to me in an e-mail. It was he who sent me the above data. Therefore, the average age of nurses is also increasing higher: in 2014 it was forty-eight years, in 2020 – fifty-three.
The problem is growing and it is expected to continue to do so.
The case was also complicated by the coronavirus, because additional labor was needed in temporary hospitals and covid wards. Staff was vulnerable to disease, so some of the cast were necessarily quarantined, in home isolation, or on sick leave. In addition, nurses were referred by voivodes to other institutions. Introducing employment standards at such a time would result in the closure of entire departments – because there would be no one to fulfill these standards. Nurses and (a few) nurses have an impact on the quality of care, are responsible for safety, but also for the atmosphere in the ward. […]
Romek is a nurse. He has been working in geriatrics for a month, previously he was in the adult psychiatry ward for four years. As he changed his place of employment, he began to see the shadows of work in a psychiatric hospital more clearly. Through the change, he gained a different perspective.
– This is not a good place to work, I was coming back mentally tired of patients screaming for twelve hours. Such people are most often placed near the nurses’ station. If someone has a day, he listens to it 24 hours a day. After returning home, I did not turn on the radio or TV. I was left in silence.
There was a need to increase employment in the ward, but they did not give us nurses, but rescuers. Only the rescuers do not have the same powers. They can’t order a patient to be secured, take a patient. Why did they hire them? Because there were no nurses. They do not want to work in such a department. In my college year, only I worked in psychiatry. I am not surprised because it is a harder job than anywhere else. It happens, for example, that a patient attacks a nurse. One of my friends had a broken nose after such an incident. The patient’s family was there, just watching. On the other hand, the patient bit off a finger. Someone else got kicked, spit on. It is not a grateful job, because alcoholics and drug addicts, of whom there are many among patients, have demanding attitudes.
Nor is it that only psychotic patients can be dangerous. We know when there is psychosis. But patients are just mischievous. It is not surprising that they are often forced to stay in the hospital. After such acceptance, the court must approve it. While I was working on the ward, the judge never decided that the admission was unfounded. He almost always comes with a policeman. He will only welcome the patient, he will rarely talk to him longer.
Once a friend told me that she was giving the patient medication, and he said to her: “Give me the drugs, whore”, to which she said, “Here you are, dick”. From the side, it may look bad, but when we spend a lot of time with our patients, we see it differently. Sometimes a man can’t stand it either.
There is one psychologist out of fifty-two patients in the ward. Three psychiatrists. Residents save the situation. At night, for the entire hospital, four hundred patients, there is one doctor plus one in the room, from which he does not leave.
I believe that the time in the ward should be organized differently. The occupational therapist is till two-thirty. Patients get bored all afternoon. This time can be filled by a nurse. But he must want to. There would be time, especially when there aren’t many patients who need to be taken care of.
I had a rather good contact with the patients, but it did not necessarily make me sympathetic among the staff. Once, I talked for twenty minutes with a schizophrenic patient. She was a doctor of philology, an English teacher. Then my friend asked me why I hadn’t come back for so long. I said I spoke to the patient. “Are you the one talking to the patients?” I heard. Many nurses think they are there to do what they have to do: give drugs, put in a drip, fill out paperwork. Talking to patients goes beyond these responsibilities. I have noticed that the relationship with patients is rather shared by older nurses.
In nursing studies, they teach that it is important to talk to the patient. Especially in paediatrics, geriatrics and psychiatry. But how many nurses remember this later?
In the afternoons, if I had time, I gave the patients drawing or painting supplies and asked the topic. Beautiful works were coming out. Very interesting. Then we talked about them. Do I especially mention any of the patients? There was such a lady, also in philology. She came from the States. When she became ill, her husband divorced her. She had a severe psychosis, was not good for us, for the staff. She could spit, bite. But I liked her anyway, probably because she came to the duty room and started dancing hula. It made me laugh a lot. After her psychosis was over, we had a good conversation.
I chose to work in psychiatry because I used to be a patient myself, I thought that I would be able to change something. I saw what it was like for a doctor to talk to a patient once for the entire stay. I saw the lack of commitment, passivity of the staff. I was a child then. Few of the staff gave me the attention I needed. On the other hand, teachers from the hospital school were very involved. I keep in touch with some of them to this day.
Since I knew what it looked like from the patient’s side, as a nurse, I wanted to do more. Pay more attention to patients, talk to them, organize their time. Already at the beginning of my work, I faced reality, for example, I went for a walk with the patient and he escaped from me. I didn’t know that working on the other side was so strenuous. But the reality of the ward also seemed to me that way. I was disappointed because I thought I would change the world.
Nursing seemed good and noble to me. Noble all the more that the salary in this profession is disproportionate to the salary of the doctor. After a year of nursing, I got into medicine, but quit after a short time. The studies were far from home, several hundred people a year. I was disturbed by anonymity. When I left, I was saying goodbye to my teachers. The woman who teaches anatomy is a nurse. As a farewell, she told me that it was a profession filled with the smell of feces, urine and suffering and if I am a Master of Nursing, I will always be ONLY a Master of Nursing. Do I regret quitting then? Yes. Today I can see that she was right. There is urine, faeces and patient suffering, but also a lack of respect for this profession. Both on the part of patients and doctors. And finances. I still remember the amount of my first salary. It was – for three quarters of a full-time job – one thousand two hundred and thirty zlotys plus two hundred zlotys for nights and holidays worked. It didn’t bother me at first, but after the third salary, I looked at the voucher from the strip and thought, “How is it possible that such a responsible job and only so much money?” Now, after a few years, I get more, along with nights and holidays, about three and a half thousand per hand.
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