There are many things in nursing and health care that seem to happen because 'we have always done it that way'
Sometimes that's good-after all Florence Nightingale said that having a clean hospital would keep people healthier-it turns out that handwashing works.
Sometimes I don't know the purpose of it. Why do psychiatric patients sometimes have to wear pyjamas? After all the nurses are wearing street clothes-why don't the patients?
Not all psychiatric patients do, but some have to, and I actually don't know the reason why.
I suppose it is because of the risk of people running off-part of some illnesses includes lack of insight-meaning people don't realize that they have a mental illness-so people would rather not be in hospital because they don't see the need for it. Another part would be safety-having people in pyjamas gives an opportunity to examine clothes and make sure there is nothing harmful in pockets etc. And I would think another advantage would be that if someone has been neglecting their hygiene due to another sign of illness-lack of self care-clean pyjamas is an improvement.
So, there are some good reasons for it. But there are also some problems with it. Wearing pyjamas singles you out as a psych patient-not just another patient in the hospital-but the only patients who wear the pj's.
Another issue is that it is not good to wear pj's all day. 'Normal' people don't do that-and a sign of getting better when you are sick is wearing clothes.
A large issue is that people feel embarrassed wearing them-no underwear, just pj's, for women this is quite embarrassing-no bra, especially when you consider that substantial numbers of women in in patient settings have had violence -up to 70% have experienced physical and sexual abuse. Having to wear clothes that leave people feeling vulnerable and exposed could create harm.
Which is the better way?
I need to do research on this...
Sunday, July 25, 2010
Saturday, June 26, 2010
Caring
We had a 1 day education inservice (thank you big pharmaceutical for providing unrestricted educational grant) and one of the topics was on caring.
We spent a lot of time on this topic when I was in school-what exactly is it, how do nurses do it, and what happens when it is not being done?
It is central to nursing-and I find it a fascinating topic. The presentation was based on the presenter's research on how nurses care while in stressful situations. Her research showed that caring is a choice that people consciously choose and that though environment plays a part, that it does come down to the individual's decision. Her thought and I would agree, is that nurses who are able to engage in this are happier and can provide quality care despite various circumstances.
I was discussion this a colleague, who is a social worker, he said that though he enjoyed the presentation, that his perspective tended to be more on the environment and how that impacted care. Makes sense when you also consider that nursing tends towards individualized interactions, whereas social work tends towards looking more at systems. Both of course frequently move in and out of those frames of reference.
Naturally both play a role, but I do think that it does come down to more of a conscious choice in the particular workplace I am in. It is easy to get caught up in the idea that we don't have enough money, there is not enough time, there are too many patients. But when compared to most health care systems in the rest of the world, we are far and away able to offer superior care. So why does it seem that it is not enough?
What would be enough?
Yes, I would like to be able to ensure that more people with mental illness have access to timely, prevention focused care, and I agree that we are often stretched to do this, but I can't say that I go home at night feeling that people have not received good care-and honestly when I do, it is more likely to be as a result of what I see as uncaring nursing. On an individual basis.
I never really thought of myself as being someone who sees things as more individual responsibility, with my patients, I encourage people to act within their ability to change, but also strongly believe that societal systems have hugely impacted the onset of mental illness and ability to manage mental illness.
But it seems with nurses working, that I do see their behaviour and actions in terms of individual choice. What is the difference for me then?
I suppose because though nurses have in the past (before the 1980's?) been a devalued group, now they are not. They wield a great deal of power within the healthcare system-without nursing, healthcare does not function. we are paid well-I would venture to say, very well. We are professionals-well educated, and self regulating. Generally we are well respected-depending upon which study you look at, nursing is at the top or near the top of the lists ranking professionals who are trusted.
Why are we still acting in ways that seem to take the stance that the system works against us, that we don't have control, that we are not respected then? I think that this sometimes victim focused mentality leads to uncaring nursing. Because if I am a victim too, why should I have to put so much effort into doing a caring act? How can I gather enough energy to care for others if I am being trampled on?
I think that we need to recognize and acknowledge that we have power within the health care system and that we need to be using that power respectfully-whether interacting with the health authority, each other, and above all with patients. Would that help?
We spent a lot of time on this topic when I was in school-what exactly is it, how do nurses do it, and what happens when it is not being done?
It is central to nursing-and I find it a fascinating topic. The presentation was based on the presenter's research on how nurses care while in stressful situations. Her research showed that caring is a choice that people consciously choose and that though environment plays a part, that it does come down to the individual's decision. Her thought and I would agree, is that nurses who are able to engage in this are happier and can provide quality care despite various circumstances.
I was discussion this a colleague, who is a social worker, he said that though he enjoyed the presentation, that his perspective tended to be more on the environment and how that impacted care. Makes sense when you also consider that nursing tends towards individualized interactions, whereas social work tends towards looking more at systems. Both of course frequently move in and out of those frames of reference.
Naturally both play a role, but I do think that it does come down to more of a conscious choice in the particular workplace I am in. It is easy to get caught up in the idea that we don't have enough money, there is not enough time, there are too many patients. But when compared to most health care systems in the rest of the world, we are far and away able to offer superior care. So why does it seem that it is not enough?
What would be enough?
Yes, I would like to be able to ensure that more people with mental illness have access to timely, prevention focused care, and I agree that we are often stretched to do this, but I can't say that I go home at night feeling that people have not received good care-and honestly when I do, it is more likely to be as a result of what I see as uncaring nursing. On an individual basis.
I never really thought of myself as being someone who sees things as more individual responsibility, with my patients, I encourage people to act within their ability to change, but also strongly believe that societal systems have hugely impacted the onset of mental illness and ability to manage mental illness.
But it seems with nurses working, that I do see their behaviour and actions in terms of individual choice. What is the difference for me then?
I suppose because though nurses have in the past (before the 1980's?) been a devalued group, now they are not. They wield a great deal of power within the healthcare system-without nursing, healthcare does not function. we are paid well-I would venture to say, very well. We are professionals-well educated, and self regulating. Generally we are well respected-depending upon which study you look at, nursing is at the top or near the top of the lists ranking professionals who are trusted.
Why are we still acting in ways that seem to take the stance that the system works against us, that we don't have control, that we are not respected then? I think that this sometimes victim focused mentality leads to uncaring nursing. Because if I am a victim too, why should I have to put so much effort into doing a caring act? How can I gather enough energy to care for others if I am being trampled on?
I think that we need to recognize and acknowledge that we have power within the health care system and that we need to be using that power respectfully-whether interacting with the health authority, each other, and above all with patients. Would that help?
Friday, May 21, 2010
Medicare
The idea of extraordinary drug coverage seemed like a good one to me when the Romanow Report came out, but didn't really think about it as I haven't known anyone personally or professionally needing that kind of coverage as BC has pretty good pharmacare.
As with most things, once you know someone affected, this changes perspective. As in a family member needing a super expensive medication costing about $20,000-$24,000/year and the province they are in has a terrible pharmaceutical program.
How this can be when it makes so much money off of industry is beyond me-but I guess they don't have a debt do they? As if that matters when you are sick.
The arbitrariness of this kills me. For a related disease, drug is covered, though I noted when looking through the special coverage form that you pretty much have to be at the end of the line treatment wise before they will consider covering. This seems to be true of most of the drugs I saw on the document.
Yes, because multiple hospital stays are so much cheaper aren't they?
In relation to psychiatry, I saw that a drug we pretty much routinely give here, is not covered there, unless you get special authority, and that is after you have developed nasty side effects from older drugs.
This is not to say that I think newer drugs necessarily are the cat's meow-after all pharmaceutical companies like to make a lot of money and new drugs do this for them. But if we know that a drug is effective, why wouldn't we cover it (as in we-the government and taxpayers) rather than spend the money on repeated hospitalizations, ineffective medications, and the like?
As with most things, once you know someone affected, this changes perspective. As in a family member needing a super expensive medication costing about $20,000-$24,000/year and the province they are in has a terrible pharmaceutical program.
How this can be when it makes so much money off of industry is beyond me-but I guess they don't have a debt do they? As if that matters when you are sick.
The arbitrariness of this kills me. For a related disease, drug is covered, though I noted when looking through the special coverage form that you pretty much have to be at the end of the line treatment wise before they will consider covering. This seems to be true of most of the drugs I saw on the document.
Yes, because multiple hospital stays are so much cheaper aren't they?
In relation to psychiatry, I saw that a drug we pretty much routinely give here, is not covered there, unless you get special authority, and that is after you have developed nasty side effects from older drugs.
This is not to say that I think newer drugs necessarily are the cat's meow-after all pharmaceutical companies like to make a lot of money and new drugs do this for them. But if we know that a drug is effective, why wouldn't we cover it (as in we-the government and taxpayers) rather than spend the money on repeated hospitalizations, ineffective medications, and the like?
Friday, April 9, 2010
Friday
How is it that a 4 day workweek feels more like 7?
Actually, it doesn't.
Rather today just seemed long and I believe it had to do with hormones. Though being irritable does not help when dealing with narcissistic people.
I am reading a book called The Sociopath Next Door, about the sociopath next door.
Interesting and the rate of sociopaths is about 4%, schizophrenia and bipolar disorder are about 1% each, which means there are way more sociopaths around than one would think. I think that rate in the book may be a little high-antisocial personality disorder (which sociopathy is a subset of)is about 2-3% if I remember correctly.
It discusses the concept of conscience which I find interesting and uses the example of the Milgram experiment-where Milgram told people that during the study, the subjects were to administer an electric current to other participants if they got a wrong answer. The subjects never actually delivered an electric current, but thought they did and Milgram kept pretending to increase the voltage-with the people pretending to get the current would act as if they were. The current would be increased to life threatening levels and the subjects kept going along with it-something like 90+% went along with it. Interesting on many different levels, though of course his experiment has a lot of ethical issues-like how did those people feel administering the current? Anyhow, when the person telling the subjects to increase the current wore a lab coat and was a doctor, people were more likely to go along with it. If the experimenter was presented as a working class citizen, people were less likely to continue shocking.
Authority plays a big part in what we are willing to believe and influences what we think is the right thing to do.
This reinforces to me the importance of understanding and carefully considering what I think and considering how my actions as an authority figure (ie nurse) may impact patients etc. And also to consider how it is important to develop and stand by my beliefs, after a lot of reflection, and not just blindly follow.
The book sort of boils down conscience to the ability to love/care for others, and that by considering how our actions impacts others leads in part to our conscience.
All very interesting and I would write more, but have to go nap.
Actually, it doesn't.
Rather today just seemed long and I believe it had to do with hormones. Though being irritable does not help when dealing with narcissistic people.
I am reading a book called The Sociopath Next Door, about the sociopath next door.
Interesting and the rate of sociopaths is about 4%, schizophrenia and bipolar disorder are about 1% each, which means there are way more sociopaths around than one would think. I think that rate in the book may be a little high-antisocial personality disorder (which sociopathy is a subset of)is about 2-3% if I remember correctly.
It discusses the concept of conscience which I find interesting and uses the example of the Milgram experiment-where Milgram told people that during the study, the subjects were to administer an electric current to other participants if they got a wrong answer. The subjects never actually delivered an electric current, but thought they did and Milgram kept pretending to increase the voltage-with the people pretending to get the current would act as if they were. The current would be increased to life threatening levels and the subjects kept going along with it-something like 90+% went along with it. Interesting on many different levels, though of course his experiment has a lot of ethical issues-like how did those people feel administering the current? Anyhow, when the person telling the subjects to increase the current wore a lab coat and was a doctor, people were more likely to go along with it. If the experimenter was presented as a working class citizen, people were less likely to continue shocking.
Authority plays a big part in what we are willing to believe and influences what we think is the right thing to do.
This reinforces to me the importance of understanding and carefully considering what I think and considering how my actions as an authority figure (ie nurse) may impact patients etc. And also to consider how it is important to develop and stand by my beliefs, after a lot of reflection, and not just blindly follow.
The book sort of boils down conscience to the ability to love/care for others, and that by considering how our actions impacts others leads in part to our conscience.
All very interesting and I would write more, but have to go nap.
Friday, March 26, 2010
Put On Your Big Girl Panties
OK, vacations are good, but then I have to catch up on all this stuff when I get back.
Not that it was even too much, but week was exhausting. Mostly because I had to listen to people complain without any solution.
Like, did you think nursing was going to be easy and calm? please. Find another career if you can't handle stress. Suck it up buttercup.
I put the magnet that Anne gave me-Put on your big girl panties and deal with it-on my file cabinet. I would put up the cross stitch that Laura gave me too, but perhaps that is too much, given that patients might see it and I don't mean them.
Why as nurses do we always think that we need to control everything? Everytime something unusual/challenging happens, our immediate response is 'we need more rules' For the love of Pete, let it go! Not that I'm all loosey goosey, I like to be as bossy as the next nurse, but why freak out about everything? Yes, we work with people who have poor boundaries, are impulsive, poor communicators, and disrespectful-but they are my coworkers and I have to put up with them.
ha ha
Anyhow, if you are working in psychiatry-did you think it was going to be with only the pleasantly mentally ill? Oh yes, sure this woman is mentally ill, but her delusion is that I'm God and she must do everything I tell her?
OK, must stop whinging-I do love my job, but occasionally feel exhausted. Alternative is to plod along and do basics without advocating for change, which is not an acceptable alternative...
Not that it was even too much, but week was exhausting. Mostly because I had to listen to people complain without any solution.
Like, did you think nursing was going to be easy and calm? please. Find another career if you can't handle stress. Suck it up buttercup.
I put the magnet that Anne gave me-Put on your big girl panties and deal with it-on my file cabinet. I would put up the cross stitch that Laura gave me too, but perhaps that is too much, given that patients might see it and I don't mean them.
Why as nurses do we always think that we need to control everything? Everytime something unusual/challenging happens, our immediate response is 'we need more rules' For the love of Pete, let it go! Not that I'm all loosey goosey, I like to be as bossy as the next nurse, but why freak out about everything? Yes, we work with people who have poor boundaries, are impulsive, poor communicators, and disrespectful-but they are my coworkers and I have to put up with them.
ha ha
Anyhow, if you are working in psychiatry-did you think it was going to be with only the pleasantly mentally ill? Oh yes, sure this woman is mentally ill, but her delusion is that I'm God and she must do everything I tell her?
OK, must stop whinging-I do love my job, but occasionally feel exhausted. Alternative is to plod along and do basics without advocating for change, which is not an acceptable alternative...
Saturday, March 13, 2010
Advocacy
As nurses, we are supposed to be advocating for our patients everyday and should be considering how to promote health and well being. This in some way makes me think of nursing, considering customer satisfaction-if the customer is not satisfied with their service-then they leave, taking their business elsewhere. Really, though I certainly am not an advocate of for-profit health care, I think we should always be considering how we increase 'customer satisfaction' I read a letter to the editor of the Canadian Nursing Association magazine, by a nursing student who believed that by referring to patients as clients that we are stepping towards acceptance of the for-profit system and eroding public health care. This was not something that I had ever thought of. I actually think of client as being perhaps, a more empowering term than patient. But I have no idea why I would even think this-other than from working with people with disabilities, we tried to discourage any kind of labelling-rather than seeing people as patients, residents or even clients, see people as people!
So, it is interesting that sometimes, nurses start to resent patients, and start seeing them as not deserving of our care and seeing them as 'drains on the system.' And if we consider a customer satisfaction kind of approach-the issue with hospital care is that people don't have a choice, especially people requiring psychiatric care, who don't have money and have been an oppressed group. Again, I am not in no way advocating a for-profit system, or a 2 tier system in any way. But I do wonder if we consider how we should be viewing our patients, clients, system users, whatever you want to call it. I don't think that we need a competing system-ie HMO, to address these issues, but I do think we need to consider the satisfaction people receive out of this system. Instead of believing that people should be happy with whatever care they get, shouldn't we be thinking of how to improve our care delivery?
I see also, when nurses start to see themselves as victims of patients! I think this might happen more in psychiatry, where we can be dealing sometimes (though much less than people think) with aggressive people. And in some cases, nurses may be on the receiving end of a violent patient, resulting in injuries, which certainly meets the standard of being a victim. I think though, it is important to consider that as noted by CRNBC, that as a nurse, we have more power, and must always be considering how that impacts our care.
This is a challenge sometimes in psychiatry. We deal with a disempowered group, as nurses we hold much more power. It is only relatively recently that mental illness has begun to be seen as illnesses that are blameless. Or rather, as a society, we have just recently started to see mental illness as perhaps not the person's fault-sometimes. Health care still sees people with mental illness as less worthy of care than someone with a physical problem. And nurses working in psychiatry often perpetuate that idea-'oh, I'm not a real nurse, I work in psychiatry' I hate that! Give your head a shake! If you don't see yourself as a real nurse, leave, and let nurses who see themselves and their patients as deserving of real nursing care provide advocacy and care to patients who are entitled to professional, supportive nursing interventions!
So, it is interesting that sometimes, nurses start to resent patients, and start seeing them as not deserving of our care and seeing them as 'drains on the system.' And if we consider a customer satisfaction kind of approach-the issue with hospital care is that people don't have a choice, especially people requiring psychiatric care, who don't have money and have been an oppressed group. Again, I am not in no way advocating a for-profit system, or a 2 tier system in any way. But I do wonder if we consider how we should be viewing our patients, clients, system users, whatever you want to call it. I don't think that we need a competing system-ie HMO, to address these issues, but I do think we need to consider the satisfaction people receive out of this system. Instead of believing that people should be happy with whatever care they get, shouldn't we be thinking of how to improve our care delivery?
I see also, when nurses start to see themselves as victims of patients! I think this might happen more in psychiatry, where we can be dealing sometimes (though much less than people think) with aggressive people. And in some cases, nurses may be on the receiving end of a violent patient, resulting in injuries, which certainly meets the standard of being a victim. I think though, it is important to consider that as noted by CRNBC, that as a nurse, we have more power, and must always be considering how that impacts our care.
This is a challenge sometimes in psychiatry. We deal with a disempowered group, as nurses we hold much more power. It is only relatively recently that mental illness has begun to be seen as illnesses that are blameless. Or rather, as a society, we have just recently started to see mental illness as perhaps not the person's fault-sometimes. Health care still sees people with mental illness as less worthy of care than someone with a physical problem. And nurses working in psychiatry often perpetuate that idea-'oh, I'm not a real nurse, I work in psychiatry' I hate that! Give your head a shake! If you don't see yourself as a real nurse, leave, and let nurses who see themselves and their patients as deserving of real nursing care provide advocacy and care to patients who are entitled to professional, supportive nursing interventions!
Sunday, February 7, 2010
Dealing with Awfulness
There are some things that people should never get exposed to, yet they do happen. People who nurse see things that just should not be seen and have to manage things that are not supposed to happen. This is not limited to healthcare providers naturally, but they are the ones I am thinking about now. How do we cope with this?
This is something I have been trying to process since there was a terrible thing at work last week. Interesting, since I work in psychiatry and know all the signs and symptoms of critical incident stress, and yet when going through it, though I know theoretically that all the signs and reactions are normal it is the continuing feeling that my responses are abnormal. That I should not in fact, even react to things that are traumatic. I became really irritable, tired, detached, angry, and even had a flashback.
Thankfully, today I woke up and felt much better. Though I will watch myself to make sure that it isn't just momentarily repressed and also that I give myself time to continue to deal with it.
The other thing I think about is, after going through terrible events, how do we not detach, blame, become reactionary, in short-not think through things rationally? After all, that is naturally how people cope with these types of things-yet these reactions are not necessarily beneficial to ourselves or our patients. I can see the allure of doing this stuff too. After all, I left work Friday, found I had a parking ticket and my reaction was, 'How could I get ticketed after all, I just went through a terrible thing? I don't deserve this!' My deciding consciously, a long time ago, to park in 2 hour parking areas, despite the risk of tickets is why it happened. It is totally unrelated to anything to do with my week or the fact that I am a nurse. Yet, I felt that the bylaw officer should be doing me a favour and just know that I had a bad week.
I see this kind of reaction in other forms by the people I work with. 'If only this situation had been present, then this wouldn't have happened'. I got really pissed off by this, because in actual fact, the things they mentioned, would have had no bearing and would not have stopped it from happening. I though, 'Are you stupid? Don't you think things through?' This reaction was in part, due to my displaced emotion, but also came from the fact that I pride myself on being logical and become irritated when people are not.
Which also means that I get angry with myself when after a critical incident, that I react emotionally and without being totally rational.
This is something I have been trying to process since there was a terrible thing at work last week. Interesting, since I work in psychiatry and know all the signs and symptoms of critical incident stress, and yet when going through it, though I know theoretically that all the signs and reactions are normal it is the continuing feeling that my responses are abnormal. That I should not in fact, even react to things that are traumatic. I became really irritable, tired, detached, angry, and even had a flashback.
Thankfully, today I woke up and felt much better. Though I will watch myself to make sure that it isn't just momentarily repressed and also that I give myself time to continue to deal with it.
The other thing I think about is, after going through terrible events, how do we not detach, blame, become reactionary, in short-not think through things rationally? After all, that is naturally how people cope with these types of things-yet these reactions are not necessarily beneficial to ourselves or our patients. I can see the allure of doing this stuff too. After all, I left work Friday, found I had a parking ticket and my reaction was, 'How could I get ticketed after all, I just went through a terrible thing? I don't deserve this!' My deciding consciously, a long time ago, to park in 2 hour parking areas, despite the risk of tickets is why it happened. It is totally unrelated to anything to do with my week or the fact that I am a nurse. Yet, I felt that the bylaw officer should be doing me a favour and just know that I had a bad week.
I see this kind of reaction in other forms by the people I work with. 'If only this situation had been present, then this wouldn't have happened'. I got really pissed off by this, because in actual fact, the things they mentioned, would have had no bearing and would not have stopped it from happening. I though, 'Are you stupid? Don't you think things through?' This reaction was in part, due to my displaced emotion, but also came from the fact that I pride myself on being logical and become irritated when people are not.
Which also means that I get angry with myself when after a critical incident, that I react emotionally and without being totally rational.
Saturday, January 16, 2010
Change
Though health care is always changing, people who work in it seem to find the process difficult. Not that I think health care providers are alone in finding change a challenge, but it is interesting that people working in these areas continue to work in them, sometimes feeling a lot of anxiety about change knowing that change is inevitable and will be on-going. It's not like say, working as a philosopher, where change might be a little less frequent.
I am in a new position again at work as educator, which is a good change, but of course comes with its' own stress adjusting to a new position, trying to learn a whole new set of skills, changing to non-shift work life (which is more difficult for me than shift work-I like longer shifts with more time off). Happily, this week after 2 weeks in my new role, I thought, 'I like this job!' This may be a new record for me as it takes me a long time to adapt to new things and I stress a lot about having to do new things perfectly. Nevermind that this is impossible.
So, how have I managed to enjoy it when usually I feel a lot more stress at this point in changing work roles/jobs?
I think I have forced myself to do different things even though they stress me out. I have worked on seeing mistakes as learning opportunities-clichéd, but necessary if I am to live with my errors. I have to tried to also admit, recognize when I have screwed up. I really hate doing this, it is terribly uncomfortable for me. Medication helps. Another big part of it is enjoying my area of work-working in the hospital in psychiatry is where I want to be, so switching roles within that environment, still means I am in a field of work that I love. I feel valued with the work I do and I feel that I can promote change, and I can see the change I am promoting! Though it is not without its' struggles, I do see it as benefiting patients in a meaningful way, which really makes me feel pleased.
On that note, a policy change which a group I am a part of, looks like it will be implemented within the whole health region-not just our little corner of it! I feel a huge sense of satisfaction with this-because even though implementing this policy has been stressful at times, it seems that others see it as a useful and patient centred approach!
I am in a new position again at work as educator, which is a good change, but of course comes with its' own stress adjusting to a new position, trying to learn a whole new set of skills, changing to non-shift work life (which is more difficult for me than shift work-I like longer shifts with more time off). Happily, this week after 2 weeks in my new role, I thought, 'I like this job!' This may be a new record for me as it takes me a long time to adapt to new things and I stress a lot about having to do new things perfectly. Nevermind that this is impossible.
So, how have I managed to enjoy it when usually I feel a lot more stress at this point in changing work roles/jobs?
I think I have forced myself to do different things even though they stress me out. I have worked on seeing mistakes as learning opportunities-clichéd, but necessary if I am to live with my errors. I have to tried to also admit, recognize when I have screwed up. I really hate doing this, it is terribly uncomfortable for me. Medication helps. Another big part of it is enjoying my area of work-working in the hospital in psychiatry is where I want to be, so switching roles within that environment, still means I am in a field of work that I love. I feel valued with the work I do and I feel that I can promote change, and I can see the change I am promoting! Though it is not without its' struggles, I do see it as benefiting patients in a meaningful way, which really makes me feel pleased.
On that note, a policy change which a group I am a part of, looks like it will be implemented within the whole health region-not just our little corner of it! I feel a huge sense of satisfaction with this-because even though implementing this policy has been stressful at times, it seems that others see it as a useful and patient centred approach!
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