Cumberland Hospital

COVID-19 weighs heavily on psychiatric nurses

December 2, 2021 by Madeline Lucre Leave a Comment

Cumberland mental health nurses knew COVID-19 would eventually reach their understaffed and ill-prepared hospital, but their warnings went unheeded.

When the Delta outbreak took the life of a Cumberland Hospital mental health patient in August, nurses and medical staff took up a collection for their family.

“We were very upset by their death,” said Nick Howson, the hospital’s NSWNMA delegate and branch president.

“In mental health, you can have years-long relationships with some of your patients, and this patient was extremely well known to us.

“We felt we had let them and their family down because we failed to stop the infection getting into the unit, despite taking every precaution provided to us.”

Staff suspect the initial patient contracted the virus in the emergency department, where they returned a negative COVID-19 test result in the ED prior to coming to the unit.

“Our patient developed symptoms a couple of days after admission and by then it was too late to stop the infection spreading through the closed environment of the unit,” Nick said.

“We were policing distances between patients and doing our utmost to get them to wear masks, and it still wasn’t enough to stop the infection spreading.”

A total of 11 patients were reported to have been infected in that outbreak at Cumberland Hospital, which is Western Sydney’s main psychiatric hospital.

Delta also spread through Nepean, Campbelltown, and other Sydney mental health units.

A struggle to get PPE and staff

Nick, who is also the health and safety representative for his work group, said nurses knew that COVID-19 would eventually reach the hospital, which was understaffed and ill-prepared.

“There were COVID-19 plans on paper, but no-one really knew what to do in a practical sense and we hadn’t had any drills. It was all based on prevention – not what to do when the virus got in.

“Our PPE stocks were locked away apart from a few kits and very few of our patients were vaccinated.

“We were understaffed, and we knew it would be an absolute nightmare when Delta got here, but management ignored our warnings.

“We have always had to fight to get staff shortages covered.

“In the first week of the outbreak in August, there was an endless struggle to get the PPE we needed and the staff we needed. We were told there was enough, yet we constantly had to chase up supplies.

“On the first day there were only five of us on shift to start with and seven after staff deployments. We should have had ten.”

Nick points out that mental health patients are less likely than most to follow guidelines and requests.

“Before Delta got here, only about 20 per cent of patients would wear masks regularly and some would flat out refuse to wear them.

“We get people who spit and become violent if you try to tell them what to do. Even if it’s in the interest of their own safety.

“On the first day of the outbreak I called all patients into the lounge before breakfast and told them a patient had COVID-19 and every-one had to wear masks. Anyone who refused would be kept in their room with a staff member stationed outside.

“Most patients immediately got a mask and went outdoors to put a bit of space between them and others.”

Higher rates of burnout

Getting enough staff in mental health has always been difficult and COVID-19 has added to the strain on nurses.

Nurses who escort patients to outside appointments face the challenge of ensuring the patient wears a mask and takes other precautions against contracting the virus.

Mental health nurses are also required to do more medical work now than they did before COVID-19.

“Having to learn how to do more advanced observations for respiratory, cardiac and other issues related to COVID-19 was a stressful experience for everyone in our unit – nursing and allied health as well as the consultant psychiatrists,” Nick said.

“The extra time and effort involved in donning and doffing PPE makes you more uncomfortable and tired than normal and erodes a lot of break time.

“It takes an extra 10 minutes to get in and out of your gear every time you need to change. By the time everybody has had their breaks, that is the equivalent of taking one person off the floor for six of the eight hours.

“People were postponing toilet breaks because they were approaching the end of the shift and didn’t want to waste time dealing with PPE.

“At the start we had 14 permanent staff put in isolation, which obviously made the workload even more horrific for the rest of us.

“On top of all that, we had to swab every patient every day of the first week.”

Under these circumstances, nurses were only able to do perfunctory mental health assessments.

“The quality of mental health care we were able to provide was well below any anything that any of us were comfortable with,” Nick said.

“COVID-19 has led to a higher rate of burnout among staff who need a break from the acute environment.

“People are resigning, taking maternity leave and long service leave earlier than planned, or shifting to rehab work.

“I’ll be very surprised if the profession as a whole doesn’t come out with some sort of collective PTSD from this.”

Don’t forget! April is Sexual Assault Awareness Month

April 12, 2021 by Rayan Calimlim Leave a Comment

Cumberland Branch NSWNMA member and Willow Sexual Safety Champion Marcela Scarpenti wrote to The Lamp to remind our community about Sexual Assault Awareness Month this April.

Meet Marcela Scarpenti, Benjamin Clarke, Dorota Rodzen and Goran Otomancek. Together we are here to remind our consumers in Willow Rehabilitation Unit and everyone reading this article that April is Sexual Assault awareness month. Sexual Assault is the legal term given to describe a collective range of sexual offences committed against a person without their consent, making them feel uncomfortable and/or afraid.

Sexual Assault is most often reported as being committed by men against women. However, we need to remember that men too can be the victims of sexual offenders, as are lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) persons in our communities.

Trauma of sexual assault is a strong predictor of Post-Traumatic Stress Disorder (PTSD) and has been associated with increased rates of other mental health disorders including depression, anxiety, substance dependence and suicide. This gives high importance to the need for Domestic Violence screening and Sexual Assault History on admission to facilities. It is important to be aware sometimes, a consumer in a mental health facility may not know how to make a complaint about sexual assault, and in some cases, may not fully understand what constitutes sexual assault.

Through increased knowledge, staff are able to provide gender sensitive and evidence-based practice, confidently implementing sexual safety policy and procedures in the prevention and management of sexual assault.

You can find out more about sexual assault awareness and our work here.

Help create a safer space for consumers and staff.

Acknowledgements

This piece has drawn on existing policies and procedures from Australia, in particular the NSW and QLD Sexual Safety Guidelines and VIC Chief Psychiatrist’s guidelines.

When seclusion is the only option

July 31, 2017 by Rayan Calimlim

Policies and procedures governing seclusion are “very stringent” and staff already do their best to avoid the practice, says delegate, Luke Muller.

Luke Muller works in Cumberland Hospital’s acute mental health ward and on the admission desk where he triages presentations. He has 15 years’ experience in mental health nursing.

“There are strict criteria – you can’t just throw a patient into seclusion for a minor reason, such as yelling at someone or threatening to harm someone,” he says.

“Seclusion is almost always reserved for patients whose behaviour poses a real threat to the safety of other patients and staff.

“Sometimes the only way you can safely manage certain patients is to isolate them from other people while they are at the height of their psychotic episode or whatever it is they are experiencing.

“However, putting someone who is suicidal into a seclusion room might put them at even greater risk of self-harm.

“In such cases it is far better to increase the level of observation, sit with them and engage with them and use other strategies to manage their behaviour.”

Luke says the number of patients put in a seclusion room after admission is relatively low.

“Most seclusions are for people taken directly from the street into a seclusion room.

“Often they have been detained by police who are unable to use the strategies and techniques we have to calm people down and prevent them from harming others.

“They come to us at crisis point. The medication they are using – if any – is not helping and seclusion is the safest place to be.

“They are not yet in a state that allows us to have a cup of tea and a chat with them and get them talking about their problems.”

Banning seclusion would create problems

Luke says a ban on the use of seclusion would result in worse outcomes for both patients and nurses.

“Any open and broad review into how we can do things better is welcome so long as it’s not designed to reach a predetermined result such as closing seclusion down.”

He says patients are not secluded in order to make life easier for staff.

Strict monitoring requirements for secluded patients only add to nurse workloads, he points out.

“The requirements for documentation mean that a lot of your clinical time is spent making notes and ticking charts, which means less time available to engage with patients.

“We are always stretched for staff. If we had more staff on the wards we could spend more time building rapport with patients.

“One positive result would be that patients would be less likely to escalate to the point where they had to be put into seclusion.”

Insufficient staffing also cuts the time available to mentor new graduate nurses.

“A lot of our staff are retiring after working at the hospital for decades. They have a lot of knowledge and have built a lot of rapport with our patients, many of whom are in and out due to the revolving door syndrome.

“We are getting an influx of new staff, which is great to see but they get a short orientation package before being thrown in at the deep end.”

Observation demands can be ‘unachievable’

The NSWNMA wants the mental health review to consider how better staffing and use of new technology could improve restraint and observation of patients.

Failure to accurately observe patients correctly has had fatal consequences, says the NSWNMA submission to the review into mental health services.

“The association strongly advocates that all staff comply with state and local policy at all times to ensure best possible client outcomes,” it says.

“The Association acknowledges there have been situations where failure to accurately observe patients correctly has resulted in poor and on different occasions, fatal consequences.”

It says nurses have warned that due to the number of patients requiring observation and the physical layout and design of some units, the required frequency of observations (every 10 or 15 minutes) is “unrealistic and in some cases unachievable”.

On the issue of restraint, the submission says a sufficient number of restraint-trained nurses are required to be able to implement a restraint procedure safely.

“Mental health units have minimum staffing overnight and need to rely on trained staff to come from other areas before a minimum complement for restraint is available.

“This can impact on the feeling of vulnerability that staff feel when managing a high-risk client.”

The submission says staff try not to wake clients due to the detrimental effects of poor sleep on clients’ mental state.

They also are reluctant to disturb clients at night when nursing numbers are lowest, “due to the fear of aggression and violence that could result”.

The Association suggests the review look at the use of technology to help monitor clients overnight.

This could include instruments to measure breathing and movement and electronic wristbands that monitor pulse.