St. Edelweiss Staff Manual
Introduction
Welcome to St. Edelweiss Institution for the Insane. As an employee, you share the responsibility for one of the most renowned asylums in Europe.
You may have difficulties finding your bearings at this large workplace to begin with, divided as it is into many sub-organisations such as the security, the medical staff 1, laboratories, and technical and administrative units who will all support you in accordance with their best skills and the facility's interests.
The size of the institution offers advantages, as well as disadvantages. Among the advantages, you will find that as a member of staff it will be possible to take on a broad range of different tasks, and gain an insight into the many different aspects of the work carried out at one of the country’s most exciting and heterogeneous workplaces. Among the disadvantages, you may find that the long distances make it difficult to form a general view of and conceive of the institution as a whole.
The task of any member of staff is to share the aim of ensuring the institution's status among Europe's large, first-rate asylums. It is the privilege of the institution to manage and renew the professional traditions and results established and achieved during its long history.
The contribution of each staff member towards preserving a high standard of quality - whether this be in reality to research, teaching, collaboration with other sectors, or technical and administrative fields - is absolutely necessary for the institution's long-term, international status as a place of research and healing. In return, the institution tries to motivate and engage its staff in the development of our common goals by involving you and your colleagues in our intriguing fields of research and through the pursuit of an active medical and scientific interest.
1 From here on referred to as the doctors and nurses respectively, with additionally mention of the doctors' assistants; for more detailed information, refer to Section 3.1.
Introduction from the Superintendent
We welcome you as a new colleague to our common place of work. This Staff Manual will provide answers to many of the questions that may occur to you during your daily work. It also contains many references to sources of further information. Consequently, we invite you to make use of the introduction and any further assistance which your fellow staff members are prepared to give you.
The institution is committed to the following values:
· lifelong learning
· equitable access
· intellectual freedom
· confidentiality of access and records
· communication and cooperation
· continuous improvement
At our workplace a serious effort is made to ensure that asylum policy towards medical and technical workers is followed duly. But irrespective of this, situations and problems may arise, which are most appropriately handled through the respective staff representatives and the senior staff members. Consequently, it will be to your advantage to make use of this possibility, as you begin your new job.
The purpose of this manual is to assist our capable staff by providing:
· Guidelines for the management of patients with conditions that require immediate attention
· Reminders to help them in their daily work
· Detailed instructions for performing routine procedures
I would like to thank our staff at St. Edelweiss for the care and attention they have taken in preparing the current revision.
Finally, as the institution's supervisor, I would like to encourage you to engage yourself in the development of our common place of work, which you may henceforth help to make an even better and more welcoming establishment.
Switzerland, Winter 1891/92; The Superintendent
Table of Contents
Section 1: Procedures
1.1 Medication
1.2 Psychotherapy
1.3 Research Projects & Reports
Section 2: General Care
2.1 Daily Schedule
2.2 Responsibilities On Duty
2.3 Communication & Requests
Section 3: The Staff
3.1 Organization & Hierarchy
3.2 Terms of Cooperation
3.3 General Guidelines
3.4 Disputes & Penalties
Section 4: Concluding Notice
Section 1: Procedures
Since ancient times, diseases of the mind have been considered a supernatural phenomenon, the presumed causes ranging from possession by evil spirits to divine intervention. These views have accompanied mankind through the past centuries: for instance in the form of psykhosis, once considered "animation" or the "principle of life" by Greek thinkers such as Hippokrátes, to whom we owe a vast amount of the roots of our modern research. Once treated with crude and barbaric methods such as exorcism, the treatment of the unrest of the mind is St. Edelweiss' focus and mission. We have abandoned such ancient and unscientific methods. Patients at St. Edelweiss are treated with modern equipment and the best experimental medication available. For this reason, the following chapters are essential guidelines in the treatment of the troubled minds of our patients and the experiments required for scientific advance.
1.1 Medication
Most of the severe mental distortions treated at our institution require medication for their management and resolution. The correct dosage is essential not only for the prolonged survival of the patient, but also for the accuracy of observation and the success of research. Following experience, it is highly advised that all and any kinds of medication to be taken orally are added into the test subject's meals. The nurses and kitchen staff are to be informed of any changes in a subject's prescription immediately. In special cases, on a doctor's wish, the medication may be administered separately from the food. This is possible especially but not exclusively in order to test the medicine's effect independently from other substances, in case of prescribed fasting, or in order to rule out allergies to particular substances.
Amounts of standard medicine sufficient for average weekly dosages are available in every office for doctors as well as nurses and the security unit. Additional supplies or specific, customised substances can be requested and obtained at the infirmary pharmacy.
If so required, attending nurses have authority to change prescriptions until further notice. Should a decision such as this be made, the responsible nurse is required to inform St. Edelweiss' physicians of the nature and reason for any changes made. The physicians alone have authority to overrule such a decision.
1.2 Psychotherapy
A multitude of treatments is offered in the institution's therapy rooms. In accordance with the nature of a subject's disorder, various regular treatments such as electroconvulsive therapy, group therapy sessions, environmental modification, or treatment in the pain room1 will be ordered.2 The regular and responsible execution of the prescribed treatments is essential to the success of the research in question. Any staff member on duty who fails to perform as expected will be held responsible for the effects on the project's schedule as well as the subject's condition of mind and body.
Independent of those particular treatments, regular meetings between staff and individual test subject for the purpose of problem analysis and extended experimentation are absolutely necessary. Attending staff members are free to decide in which manner or at which time during the day treatments and experiments are to be carried out. The presence of one doctor, possibly accompanied by one or two assistants3, is recommended; however, the nurses have authorization to carry out treatments on their own or in small groups of two to three, should this be necessary. Especially in case of the more aggressive subjects, it is recommended that nursing staff request assistance in escorting and controlling the subject from the security unit.
1 For further information on the purposes and use of the equipment in question, refer to the manuals available in our staff offices.
2 See the respective subject's dossier.
3 It remains the attending physician's choice whether to let a nurse assist or to be accompanied by his personal assistant or that of another doctor; the latter, however, requires the approval of the assistant's own supervisor.
1.3 Research Projects & Reports
While the exact procedure of the daily treatments is left to the medical staff, all such sessions are required to relate to the specific symptoms the research subject exhibits and must leave the subject in a physical condition that does not impair his or her worth to the institution's research as a whole. Should this occur, the leading staff participant will be held responsible for any damage done and will be subjected to penalties appropriate for the situation. Should death of the subject or any lasting damage occur, the situation will be investigated by the head secretaries. The staff members present during the incident are required to hand in their reports of the experiment by midnight of the same day or, at latest, twelve hours after the time of the incident.
All members of the institution's staff are obliged to hand in the records of their projects, progress, and general activity in regular intervals, approximately every four days. Failure to conform to these requirements, except when excused by official and confirmed leave, will result in according penalties within one day.1
1 For details on penalties for different offences, refer to Section 3.4.
Section 2: General Care
2.1 Daily Schedule
A tightly controlled and strictly followed daily schedule allows the clearest results for medical research, as the test subjects have the possibility to live in a well-organised environment without unnecessary stress that might have an effect on the institution's psychiatric research.
7:00 AM - 8:00 AM: Breakfast, served in the cells and dining hall. Cells are locked during this time.
8:00 AM - 10:00 AM: Unlocking of the cells. Scheduled time for showers and grooming.
10:00 AM - 12:00 PM: First Recreational Block. Various kinds of occupational therapy offered. Outside of these, test subjects are free to spend their free time according to personal preferences
12:00 PM - 1:00 PM Lunch, served in the cells and dining hall. Cells are locked during this time.
01:00 PM - 06:00 PM: Recreational block continued.
06:00 PM - 06:30 PM: Dinner, served in the cells and dining hall. Cells are locked during this time.
06:30 PM - 09:00 PM: Second Recreational Block. Various kinds of occupational therapy offered. Outside of these, test subjects are free to spend their free time according to personal preferences.
09:00 PM: Evening Lock-Up. Patients are expected to keep the peace at night. Experiments may be carried out at any point between 09:00 PM and 09:00 AM of the next morning
2.2 Responsibilities On Duty
Above all, the staff's responsibility is to ensure the efficient and smooth process of research and treatment. As the subjects you are dealing with suffer from severe mental abnormalities and, in some cases, a high risk of aggression and violence, a determined, responsible approach is vital in the interaction and treatment of patients.
While there is no time and no need to quench every dispute between patients, potential threats to the asylum environment are to be treated with immediate attention and boldness, to ensure the continued safety of the research project. Subjects acting violently or posing a danger to the research itself, the collective, or the staff, need to be moved to isolation and paid immediate attention, remaining in isolation until their behavioral problems are under control again. For the protection of the staff and patients, physicians may use whatever means necessary to achieve this. If necessary, restraints can be applied in the Control Room to guarantee the attending staff members' security.
On duty, the staff is permitted and encouraged to be available for patients' support, should they suffer from bouts of confusion1 or insecurity, administering additional medication or, if necessary, impromptu therapeutic sessions. This applies especially but not exclusively to paranoid delusions directed against fellow subjects2, in order to prevent a mass panic or irrational individual actions on account of the delusional subject, and any plans, intention or plots, individual or communal, hinted at or explicitly stated, to violate the institution's rules3. Occurrances such as these are critical signs of potential violent outbreaks in our tight, close-knit community. The slightest hint of a potential unrest are to be taken absolutely seriously and dealt with accordingly.
In accordance with these points, all of the medical staff and security unit are required to perform with flawless concentration in the best interest of the institution and its research. Failure, intentional or negligent, will lead to the responsible member of staff being held fully and personally responsible.
1 A common occurrence in many of the conditions treated at St. Edelweiss.
2 The target of such delusion may as well be a staff member or the entirety of the institution, which is no less severe.
3 In particular plans to leave the permitted areas, or the institution altogether.
2.3 Communication & Requests
The communication between staff and test subjects is a critical and sensitive issue, considering the condition a dominant part of the subjects is in. It is suggested that you address any kind of issue with the patient in person, in the presence of a physician. This is especially true in the case of necessary chastisement for violation of rules.
Under no circumstance should the staff include the patient in discussions about the details of their treatment, the nature of their medication, or the institution's experiments. In the troubled state the subject is in, this will only add to his confusion and induce inappropriate fear. Failure to follow this rule, or inappropriately exaggerated concern for the subject to the point of downplaying the severity of their disorder will be handled as a major offence. Questioning of the active physicians' ability, reliability, competence or decisions in the presence of any patient, as well as either questioning or detailing the research and experiments under the same condition, will be handled likewise.
The staff is authorized but not required to accept requests from the subjects such as the need for particular objects that pose no risk to the physical or mental condition of the subjects themselves or the staff or group1. Should the patient's request require very specific details, permission should be sought from a physician.
1 For instance books (for a list of available and acceptable reading material refer to the library), cigarettes, any food or drink that is non-alcoholic and does not interfere with the subject's medication and diet, maximally one additional blanket.
Section 3: The Staff
3.1 Organization & Hierarchy
The medical staff at St. Edelweiss is split into the three groups of physicians, nurses, and assistants. The close communication of all these groups, internally and externally to the group itself, is a requirement for the success of the research.
The nurses make up the central part of the medical staff, responsible for everyday care, medication, and the regular, direct communication with patients. Our training ensures that the nurses on staff are prepared to perform the difficult task of organizing the accommodation and care of patients as well as supporting the doctors during and outside of therapy sessions. If required, the nurses are authorized to make changes in patients' medication and rooming conditions as well as to carry out experiments and treatments alone. Our nurses are expected to perform their duties precisely and on schedule. They must be able to deal with the mentally disturbed in a professional way and combine medical attention with a talent for organization and flawless reliability. Close communication with the doctors is a vital requirement, and while the nurses have authorization to make quick and professional decisions in accordance with the institution's best interest, they must be willing to communicate issues with the attending physicians and accept their authority in case of disagreements.
The doctors take a leading role in overseeing and leading treatments as well as taking on larger research projects. This position requires a high degree of medical or scientific ability and absolute responsibility for one's actions and orders. The doctors have authority over the entire remaining staff and are required to fill in detailed reports on both the experiments and staff-intern issues on a regular basis. Each of our doctors is assigned a private office and laboratory to be used for his research, and, at request, an assistant for support in this matter, whom the doctor is required to supervise, educate, and, at his own discretion, penalize. It is within the physicians' authority to diagnose disorders and to order treatments as well as chastisement of patients, if so required. The doctors on staff are the leading elite available and are expected to perform in accordance with the trust placed in them by the asylum. The Superintendent and his supporting secretaries will personally ensure that the doctors are provided with all and any substances, support and equipment they require, should it be available in any way.
Supporting the medical staff is the security unit, with guards responsible for restraining and controlling the test subjects if needed, during and outside of experiments and therapy. It is furthermore their responsibility to prevent outbreaks and uprisings as well as to step in before either can occur. While technically not medical staff, cooperation requires their submission to the doctors' orders, should conflict endanger the research. It is their responsibility and theirs alone to issue physical chastisement and restraint or sedation to patients. While regular reports are required, the guards will not be held responsible for the progress of the research but for the state of security within the institution. The nature of this position demands high physical abilities and endurance as well as the capacity to act quickly and with self-assurance.
Under no circumstances may any staff group take over duties they are not explicitly authorized to perform.
3.2 Terms of Cooperation
As a member on staff of St. Edelweiss, your contract extends for a year, after which you will be permitted to leave our service at your discretion. During your time here, you will find a great deal of useful and modern equipment at your perusal during experiments, as well as receive training in your respective field in one of Europe's most prominent asylums.
You will be assigned a room and, in accordance with your position, are authorized to request and receive support, additional means to follow your own research and experiments of your interest1, and supplies for personal use, professional or private. The respective request forms can be found in all nurse, security, and doctor offices and will be processed as quickly as possible, depending on the nature of the request. Food and shelter will be provided in return for your work, and you will be provided with a small allowance for personal use outside the asylum. Leaving the institution without prior notice is, however, discouraged
1 As long as they are in accordance with the institution's mission and purpose.
3.3 General Guidelines
All members on staff are expected to perform their duties to their best ability and to take an active interest in the institution's research as well as the development of its patients. They are encouraged to engage in personal research in order to contribute to the mission of furthering the understanding of biological, chemical, psychological and sociological relationships of groups and individuals, mental and physical abnormalities, and their sources, manipulation and prevention.
The institution's mission is of utmost and absolute importance and may under no circumstances, by action, word, or thought, be endangered. All treatments, experiments, and duties must be carried out in accordance with the aforementioned guidelines and rules. Failure is highly discouraged and will be met with strict repercussions.
3.4 Disputes & Penalties
Cooperation and communication are of inestimable importance to the success of your own working performance. Should issues within staff arise, they will easily cause unrest among patients. We encourage the staff to handle internal disputes independently. Should the staff prove incapable of taking control over internal issues or disputes in an appropriate and effective manner, the administration will intervene as necesarry.
Depending on your position, you may face varying consequences for inappropriate or unsatisfying performance and behavior. Failure to fulfill your duties on schedule and with satisfying results will result in demotion. We understand that under stressful and demanding conditions such as these, failure usually roots in emotional and mental burnout. These will be treated in our own institution, should this become necessary. In the same manner, it is possible that after recovery from said conditions, a former or temporary subject may be moved into a staff position.
For obvious reasons, the higher-ranking staff members are required to act as examples and capable leaders in this environment, and failure to perform appropriately and deliver satisfying results will, in the interest of the staff itself, be handled with strict repercussions. Nurses as well as guards are expected to receive penalization by either colleagues or, specifically in the case of nurses, the active physicians. The doctors are furthermore expected to assure that their personal assistants act and perform appropriately, and in case of failure are encouraged to order or carry out penalisation personally. Should your colleagues be incapable of correcting worrisome tendencies, the administration will issue penalties including but not limited to demotion, temporary suspension, and lessons in regards to authority according to the nature and the severity of the violation of rules or guidelines. This applies to any and all groups and individuals on staff.
One should note that, in an institution of this nature and purpose, staff/patient relations are highly discouraged, and action will be taken should such a relationship affect one's duty and loyalty to the institution.
Section 4: Concluding Notice
This manual in its current revision is the general guideline to life and work at St. Edelweiss Institution for the Insane and is permanently and in its entirety valid until revised by the Superintendent. We wish our new staff members a successful and pleasant time in our service, as part of our revolutionary and intriguing research. For further questions and clarification, staff is encouraged to address the available doctors, who have authorisation to contact the administration if necessary. It has to be noted, however, that due to the elaborate and expensive research and connected administrative work, which is to ensure the smooth and efficient progress of experiments and research, only questions of importance can be dealt with as of now. Pointless and inappropriate questioning will be met with repercussions.