Having patience with patients

There are no starched uniforms. There are no clanging doors. The sun is streaming in. The pace is relaxed

There are no starched uniforms. There are no clanging doors. The sun is streaming in. The pace is relaxed. Frank Cronin is having a chat with one of the men under his care. Cronin's work as a psychiatric nurse is all about being patient. Encouraging someone to have a wash or a shave can be an important part of his morning's work.

"Even simple things are a start when someone is very ill," says Cronin, who is a staff nurse in St Brendan's Hospital, Grangegorman, a psychiatric hospital on the north side of Dublin.

A psychiatric nurse has "more interaction with a patient. Over time, you have a deeper relationship with each one. Over the years, you have long-term patients who tend to be readmitted and you get to know them very well. For those that are being re-admitted the trauma of coming back is blunted for them when they recognise us, and their faces brighten up when they know someone."

He describes taking a patient to the dentist, and weather permitting, how they might stroll back and perhaps stop en route for a cup of coffee. Every year, the nursing staff takes all the patients on a holiday.

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"The job is never dull or boring. No one day is the same. There are so many different areas you could be working in as a staff nurse. It's an inner-city hospital so it's at the cutting edge of society."

Working at St Brendan's for the past 18 years, he's found that "the older you get, the more compassion you feel. As you go through your own milestones in life, life experiences help you empathise more."

The job is rewarding and always interesting, he says. "Most of the patients are almost friends. They are that familiar to you and over the years, getting to know so many, you know what to expect and you know what makes him feel secure."

Over the years he has largely worked with male patients, though not exclusively. "Most patients respond to kindness and compassion. We remind them that our main role is to get them back to their families and routine."

"You tend to get involved the more you get to know a person. You get to know their needs. In psychiatry, the emphasis is on getting the person to do as much for himself as possible. You point him in the right direction."

"It's not like the traditional hospital. It's not regimented. We try to make it as homely as possible. Many tend to be long-stay, or longer than in a traditional hospital." The last thing a person who is depressed needs is somebody coming in bustling about, making beds and upsetting a calm, peaceful atmosphere, he explains.

"The approach is that bit more relaxed. You're professional in your approach but even in the medication round, it's not rushed. You chat to the patient. Whether it's in the morning in the bathroom and you're encouraging him to shave or trying to get him to change his clothes, you're chatting in between to get to know him. It's all part and parcel of their treatment.

"You get to know them very well. A patient may have illusions, which are very well hidden, but bit by bit you find out the things that he really believes and you discover what his attitude to his treatment is, and whether he wants to take his medication or whether he is complying with a regimen of treatment.

"The hand-over in the morning is an important part of the day. It's important for us to know every patient: who slept well and who didn't, who is restless and hyperactive, who is awake since 4 a.m. - that could be a clinical sign of depression and we may need to get the doctor to change his medication. A patient may have confided something to the nurse during the night which may need looking at - we discuss all those things. A little thing may lead the nurses to observe some patients more closely during the day in a discreet way."

Cronin, who went to school in Ballinskelligs and second-level in Caherciveen in Co Kerry, studied general nursing in Cork's Regional Hospital (now Cork University Hospital), graduating in 1982. The four men in his class of around 50 went on to study psychiatry, he recalls. The others largely went on to study mid-wifery. Cronin sat his finals in 1983 and was awarded the year's gold medal by the hospital.

"The traditional stereotypical picture bears no resemblance to the reality of a psychiatric hospital," he says. "We plan a pretty hectic schedule for everyone, according to their needs. We keep a tight eye on the level of sedation. It's quite a full day."