Guest Editorial
Port Arthur: From the perspective of the Mental Health Liaison Nurse
Cecily Pollard
Clinical Nurse Consultant, Liaison Psychiatry Unit, Royal Hobart Hospital, Hobart TAS
PP: 138 - 140
Article Text
For me it was a sunny Sunday afternoon- a typical Tasmanian Autumn day. The first news reports gave a sketchy picture of a shooting somewhere in the vicinity of Port Arthur, a former convict settlement in Southern Tasmania and a very popular tourist destination for overseas, mainland Australian and local Tasmanian visitors. The historic ruins and surrounding areas of tourist interest are normally thronged with visitors interested in glimpsing a picture of our colonial history. However, on this Sunday it was evident that a major disaster had occurred which equalled or perhaps exceeded anything in its infamous past.
By Monday morning, the appalling nature of the catastrophe at Port Arthur began to dawn on the Tasmanian community. The early news broadcasts were guarded but reports that a large number of people, approximately thirty, had been shot dead by a single gunman and a further number (later confirmed as eighteen) had been severely injured.
As Mental Health Liaison Nurse and a member of the Acute Care Program at the Royal Hobart Hospital, I contacted the Grief and Loss Counsellor at the chaplaincy services to confirm that the numbers of dead and injured were correct, and that a major disaster management program had been activated and all emergency services were on major alert. I was immediately registered as 'on call'.
In the events that followed, all ambulance services both aerial- and land-based were involved in transporting the injured to the Royal Hobart Hospital Emergency Department. This involved the activation of a recently established Emergency Disaster Plan. The Plan, as it has been since termed, worked perfectly and this has been proved and confirmed by accreditation procedures in the weeks following its activation. The magnitude of the disaster also called for an immediate establishment of general community counselling and a broader ongoing community recovery plan-that was April 28, 1996.
The Royal Hobart Hospital is the only major public hospital in Southern Tasmania and provides a focus for emergency medicine and has a dedicated Burns Unit. The City Morgue is also situated within the hospital complex.
On commencement of duty on Monday morning, it was obvious that my services as Mental Health Liaison Nurse for the Acute Care Program would be required but at that early stage I was not aware of the extent of that requirement. An incredible and probably unprecedented situation existed where the dead, the badly injured and the alleged perpetrator were held in the same complex.
The international media had arrived and set up camp at the hospital entrances and such was the mood of the community that threatening telephone calls, graffiti on the hospital walls and hoax bomb threats further added to the incredible nature of the situation.
My normal role as the Mental Health Liaison Nurse is to provide direct and indirect care for patients and families experiencing the psychological traumas associated with illness and hospitalisation on a daily basis. I also provide educational and management guidelines for staff caring for patients with behavioural or psychological reactions associated with their hospitalisation. I believe my position is not an optional extra but an integral part of the nursing care of patients with physical illness. With my psychiatric and general nursing background, I bring the skills and knowledge of both specialities, and the capability of promoting mental health and high standards of psychological care.
Following a meeting with the Director of the Liaison Psychiatry Unit and the liaison team which includes the Director, another consultant, a psychiatry registrar and a psychologist we agreed to remain ready for consultation. I was asked to attend a meeting on Monday afternoon of the Social Work Subplan to plan activity for the next twenty-four hours. This Subplan is a component of the Hospital's Disaster Plan and is comprised of social workers, chaplaincy services, a grief counsellor, occupational therapists and a psychiatry liaison psychologist and myself as psychiatry liaison nurse. The Subplan is designed to address the immediate emotional, informational and practical needs of the victims of an external disaster together with their families and friends, and to provide practical psychological and psychosocial care. Three areas of operation were assigned to the Subplan members, the Department of Emergency Medicine, the Visitors' Centre (where staffing included security personnel to assist with crowd control) and the Discharge Centre. I was assigned to the Discharge Centre from late on Monday to mid-morning on the Thursday.
In the meantime, I maintained my usual caseload-following up clients, liaising with the wards and responding to new referrals. The new referrals included three from the Plastics Unit who were victims of the shooting. The function of the Discharge Centre was to take all telephone calls relevant to the victims and facilitate the identification of the deceased. This required considerable flexibility as the bodies arrived at various times as they were released by the police investigators, and relatives of the deceased were arriving from overseas and interstate at irregular intervals during the day. It was necessary to conduct the identification process within the hospital environment because the City Morgue could not physically cope with the numbers involved.
In an endeavour to break the professional boundaries which appear to be set up to preserve role survival within difficult health environments, the Subplan members had met twelve months prior to the disaster to encourage trust and recognition of individual skills, facilitate cross referencing and management of mutual caseloads. We therefore knew and trusted each other and when the crunch came on April 29th, there was no conflict in terms of roles but an atmosphere of team work by a group of health professionals with different but complimentary people skills.
I was on call for one night shift and then, as I had no family commitments, I chose to work the evening shifts. This allowed me to be available in the morning to support the referred injured and attend to emergency referrals for other hospital inpatients. I was particularly pleased with this arrangement because I was available to support the injured if they chose to watch the memorial service on national television on the Wednesday morning. Only one chose to do this, and it was an extremely emotional occasion for both of us but resulted in a beautiful experience and allowed for mutual comfort. The ward staff were very protective and not entirely in favour of this viewing but, because of my frequent involvement with their unit, they trusted my clinical judgement and my ability to handle this emotionally charged occasion.
I was closely involved with three of the injured survivors but at vastly different levels. For one of them, it was at the level of brief interaction due to pain management strategies- she was transferred to her home state after five days. The other two were a married couple who had received gunshot wounds to the arms and hands and the wife had lost three fingers. I remained involved with them for three weeks before they were discharged. My involvement consisted of trauma counselling and an attempt to maintain normal activity within the ward's sterile environment. As the healing process occurred, I was able to organise hairdos, facials and a manicure for the uninjured hand. This facilitated professional counselling and allowed non-threatening conversation about the aftermath of the disaster.
Perhaps the most difficult aspect for me in this situation was knowing that each day as I left the victim's bedside I had to walk downstairs and along the corridor to the Burns Unit where the alleged gunman was being held under rigid security. Although I was not involved in any way with the prisoner, my role there was to help the Burns Unit staff prepare themselves to perform their duties in an objective and the most professional manner, which of course they did. This preparation enabled the ventilation of emotional responses and interpretation of behaviour and information in terms relevant to the caring process.
When the alleged gunman was eventually transferred to the Prison Hospital I joined the staff counsellor as co-leader of the debriefing team for the Burns Unit staff. This highly emotional debriefing was held on the morning following the transfer, and follow-up sessions were held during the period in which the unit staff were required to attend the prisoner daily in the Prison Hospital In all, thirty-two debriefing sessions were conducted within the hospital, coordinated by the staff counsellor.
During the period in which the alleged gunman was an inpatient it seemed to us that we no longer 'owned' the hospital. The international, mainland and local media on the front lawn; police and security personnel at all hospital entrances, particularly in the vicinity of the Burns Unit; and the frequency of bomb threats and crank telephone calls all added to this sense of dispossession. The chaplaincy staff conducted a special service for the staff to help reclaim our professional environment which had been so dramatically violated.
A curious phenomenon occurred during the second week-my caseload started to include referrals for inpatients who had been prominently involved in Hobart's last major disaster, the devastating fires of 1967. The Port Arthur tragedy had obviously triggered personal flashbacks.
It is now sixteen weeks since that fatal day in April and in retrospect, despite the tragic nature of the event and its immediate aftermath, I look back with considerable professional pride and with the satisfaction that the knowledge and skills I have acquired as the Mental Health Liaison Nurse enabled me to meet the enormous challenges which were presented. It also confirmed the necessity for, and highlighted the importance of, such a nursing position within the general hospital setting. The autonomy of the role is both personally and professionally fulfilling but during the first three weeks following the shooting there were several periods of loneliness. However, the support received by mail, fax and telephone from colleagues within and outside Australia was of tremendous comfort.
The knowledge that the three victims with whom I was most closely concerned are now physically and psychologically adapting to the life changes necessitated by their injuries, and that I was able to be of help at an early stage in their ongoing healing, is immensely rewarding.
In conclusion, I must acknowledge the support of my colleagues within the divisions of Medicine, Surgery, Health Professionals and the OHS unit for accepting and meeting magnificently the professional and personal challenges presented by this unprecedented emergency.
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