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A Day in the Life of a Mental Health HCA

Recently I completed a story update which covered a day in the life of a mental health HCA/ my day at work. It wasn’t particularly eventful as our days go but it was nice to show what we do and how we handle situations and how much work we actually cover.

If you missed it or wanted a more detailed run down, here it is!

My working day starts at 7:30am for clinical handover. I’m usually at the hospital/ ward earlier so that I can get changed into my uniform and collect my keys and blick (personal alarm device).

Handover will usually be rather quick. It’s a rundown of how the patients have been recently and any significant information that the nursing team need to know. As we’ve had our patients for a while, we know a lot of the information already e.g. Legal Status, Section, Observation levels and immediate health concerns.
We would be told if anyone’s obs levels have changed e.g. from 1:1 to general observations or if they’ve been increased and why.

On a day shift, we usually hear how the patients have been over night and the days before. If you’re on a night shift, you hear how they have been during the day and the previous nights.

Handover usually takes 5-15 minutes, afterwards, the team are allocated to their observations so that the staff team who are currently on obs can swap and go home.
On a day shift, this would usually mean that the patients are all still in bed. We have patients who enjoy a lie in, it doesn’t mean that they will be asleep when you come in but it’s usually the case.
On a nightshift, patients are all awake and you can swap to begin engaging with the patients.

Observations – If a patient is asleep, their observation levels may change e.g. 2:1 when awake but only 1:1 when asleep. You sit outside their room and note their breathing, any movement or use of the toilet. Basically anything of significance. On a nightshift when everyone is asleep, you swap around and spend most of the night doing this.

During the day, we usually spend 1hr observation periods with each patient. From the point of waking, we get patients organised and assist with personal care. All of our patients get up in the morning and either shower or take a bath. They’re very independant and don’t require a lot of help other that to wash their back or help with their hair washing. We have to ensure that patients do not remove or store their own toiletries and we also dispense shampoo/ shower gel for them. It’s not uncommon for our patients to ‘tip’ their toiletries or not use them at all.

Patients are given their medication and breakfast. HCAs are responsible for ensuring patients have adequate food and fluid throughout the day – this is also monitored and uploaded to their electronic records. We use plastic plates and cups and depending on the patient, they may not have access to metal cutlery e.g. they are risk assessed as being someone who may us a knife to harm staff.

In the hour we spend with the patient, we engage in activities they may enjoy. One patient enjoys colouring and so you can easily spend an hour colouring pictures together. Another patient has a stricter schedule for his day and certain activities are care planned for certain times e.g. walk at 10:30am. The day and activities are usually based on how the patient is presenting during the day and our staffing levels to complete these activities.

We used to eat with our patients at meal times as it’s a really successful and therapeutic activity, unfortunately COVID put a stop to this and we find it quite difficult to organise who gets breaks when and around the obs schedule.

Due to the nature of our patients we due often restrain. The ward has had a significant reduction in our restraints and I can’t remember the last time I was involved in full supine, PMVA holds. We are more likely (at the moment) to have to implement arm holds to escort a patient to a room for ‘time out’ or to secure them from attempting to harm staff.

We have a variety of jobs to do around the core job of patient care:
We complete temperature/ date and stock checks daily.
I try to attend the daily reviews – we have a daily meeting at 9am which discusses our patients with our team of clinicians. Any issues are raised and we get to discuss how we may move forward.
On Friday mornings, we have an MDT for one of our patients – this involves a full team, including clinicians and social care. We discuss possible care packages/ providers and their goal of discharge. Medication reviews are done and any alterations to their care e.g. obs level and S17 leave are discussed here.
We have a cleaning rota to complete (important due to COVID).
Laundry is completed – patients are encouraged to complete their own with the supervision of staff but staff have the overall responsibility.
We have to ensure that patients have sufficient funds/cash for the week and if needed, we withdraw this from the onsite bank facilities.

If a patient has S17 leave, this can either be for ground leave or area leave. We often take our patients out for walks around the site, to visit the hospital canteen or if care planned, they can be taken to a nearby supermarket or to visit nearby family. Each patient is unique in their leave plans. We have a ward car and this is utilised for patient transport. I’m usually driving!

We spend 12.5 hours a day with our patients and it’s long. We go to work in the dark and return in the dark. Dayshift is 7:30-20:00, nightshift is 19:30-8:00.

Whilst there are obvious challenges of the job – physical aggression and violence to staff, property and environmental damage, violence and aggression to peers, verbal abuse and the risk of absconding. I have been kicked, I’ve had a patient attempt to strangle me and grab at my throat, I’ve been hit and scratched but.. we also have some really enjoyable and rewarding work with our patients. As our longest patient has been with us for 2 years (nearly 3) we can build really good relationships with them. They know your name, what you’re like as a person, ask you if you’ve had your hair done and will remember when you’re next on shift. I can remember walking on to the ward and having a patient stood right at the doors to greet me, as I entered the patient cheered. They were cheering all the staff onto the ward!

We dance with our patients, we laugh, we feel their pain and frustrations, we are their family when theirs can’t be there.

I should be sad that I’m working all of Christmas but to be honest, I feel really lucky to spend it with those that need me. I truly love my job and the personalities of those I work with. It’s not for everyone but it’s definitely for me.

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