By Sandra Trudgen Dawson

My first job as a State Registered Nurse in mid-1980s Britain was night shift on an Acute Geriatric ward in Portsmouth. The shifts were long—eleven and a half hours—and it was hard, physical work. All sorts of strange things happen at night. At times it felt as though the ward was bewitched—sometime around midnight. Hospital patients who were perfectly sane during daylight hours became confused, frenzied and belligerent after darkness fell. Nakedness, for some reason and for some patients, became an urgent necessity as did climbing over bed rails or side tables. Zimmer frames (walking frames) and walking aids so benign on dayshift, transformed into fencing weapons at night as patients who had bottled up a lifetime of frustration finally let go. Keeping sparing patients apart can occupy nurses for hours at night. Hiding potential weapons does not always help as water jugs and cups can become flying missiles at night. Patients in Britain, unlike the United States, cannot be physically restrained in any way and so “sitting” with an agitated patient is the only action to prevent falls or the accidental maiming of another patient.