I came across something today that really made me stand back and think about the history of nursing and how badly in the past we treated those with learning disabilities as well as mental health problems. Even until15 years ago there was in the UK the presence of long stay hospitals and asylums for people with mental health problems and people with learning disabilities.This has led some ex patients to have extremely institutionalised behaviour and even after all these abuses from the past are still labelled as being clients with challenging behaviour.
Today when taking a client out we bought a drink from a local shop, after taking a few sips I offered to put the lid back on for the client. This caused a massive agitated reaction where the client started self harming and shouting in the middle of the street. I caught on pretty quickly that the client was scared that I was going to take the drink off them. So I calmly explained to the client that I wasn't going to take their drink, and was only offering as I thought they might like to keep some for later. The client drank their whole drink, and this made me wonder why there was a fear surrounding drinks, and I wondered about institutionalised behaviours.
When returning to the home I consulted with other staff who have worked in this area for far longer than I have and they explained that a few of the clients had spent many years in a local long stay hospital. Where under staffing, under training and abuse were often the order of the day. The client I worked with today is largely non verbal in communication although the client does make some sounds and two very definable words. In these institutions food and drink were often stolen and that might explain why when receiving food and drink these clients will gulp them down often without taking time to breathe. What a legacy to be left with, clients so afraid of not being allowed to finish their food/drinks that they will gulp them down risking choking.
It suddenly started to make sense to me the differences between some of the clients I work with those who stayed at home and had access to freedom of choice and those who were raised or lived in long stay hospitals. Some of the service users are so compliant with everything that it is difficult to gauge whether they want to do something or not. Asking particular clients if they want a walk or a bath they will immediately get up and go towards the bath/or to their coat. I always assumed maybe wrongly that this was because they would like to undertake a particular activity, however maybe this is institutionalised behaviour. Other clients when asked if they would like to do a particular activity will make it clear in whatever form that they do not wish to do something. Effectively in being able to communicate no the client can express their individuality.
Other staff today confirmed that there has been an improvement in the institutionalised behaviours since the clients from long stay hospitals have been within the trust. Some are now communicating in their own ways how and when they would like a drink, refusing to eat food they don't actually like and refusing to engage in some activities. In the past they would have waited to be given a drink, eat everything they were given and generally comply with anything that was asked of them. I think this shows how far we have come from the days of the institution however there is still a way to go. How do we go about supporting these clients develop their individuality and self esteem to the point they can live their lives as they would wish rather than the ways imposed on them by the institution. That is the million dollar question!
Today when taking a client out we bought a drink from a local shop, after taking a few sips I offered to put the lid back on for the client. This caused a massive agitated reaction where the client started self harming and shouting in the middle of the street. I caught on pretty quickly that the client was scared that I was going to take the drink off them. So I calmly explained to the client that I wasn't going to take their drink, and was only offering as I thought they might like to keep some for later. The client drank their whole drink, and this made me wonder why there was a fear surrounding drinks, and I wondered about institutionalised behaviours.
When returning to the home I consulted with other staff who have worked in this area for far longer than I have and they explained that a few of the clients had spent many years in a local long stay hospital. Where under staffing, under training and abuse were often the order of the day. The client I worked with today is largely non verbal in communication although the client does make some sounds and two very definable words. In these institutions food and drink were often stolen and that might explain why when receiving food and drink these clients will gulp them down often without taking time to breathe. What a legacy to be left with, clients so afraid of not being allowed to finish their food/drinks that they will gulp them down risking choking.
It suddenly started to make sense to me the differences between some of the clients I work with those who stayed at home and had access to freedom of choice and those who were raised or lived in long stay hospitals. Some of the service users are so compliant with everything that it is difficult to gauge whether they want to do something or not. Asking particular clients if they want a walk or a bath they will immediately get up and go towards the bath/or to their coat. I always assumed maybe wrongly that this was because they would like to undertake a particular activity, however maybe this is institutionalised behaviour. Other clients when asked if they would like to do a particular activity will make it clear in whatever form that they do not wish to do something. Effectively in being able to communicate no the client can express their individuality.
Other staff today confirmed that there has been an improvement in the institutionalised behaviours since the clients from long stay hospitals have been within the trust. Some are now communicating in their own ways how and when they would like a drink, refusing to eat food they don't actually like and refusing to engage in some activities. In the past they would have waited to be given a drink, eat everything they were given and generally comply with anything that was asked of them. I think this shows how far we have come from the days of the institution however there is still a way to go. How do we go about supporting these clients develop their individuality and self esteem to the point they can live their lives as they would wish rather than the ways imposed on them by the institution. That is the million dollar question!
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