what do you remember the most about psych nursing

[soozeeq246]

:trout: I know this is strange but here goes I need qoutes from experienced nurses who have been in mental health promotion classes and know what's myth from fact and what to get hung-up about over the class. What is and what 's not even a brain teaser. Could you pleeease help me ?!!:uhoh21: This is going to go into a blog for our colleges nursing resource center's comfort zone. The nursing students need the comfort of knowing they are not going to lose it before they get throuh this class. Thanks

[rn undisclosed name]

I remember the patients the most. Duh?

I pretty much remember all the patients I was able to speak with. Yep, I don't know if I helped them much. There was one young patient (early 20's) who refused to discuss her illness. She was depressed and just wanted to talk about ordinary things. I let her. I didn't see the harm but our instructor didn't appreciate it too much. I did try to talk with her about it and she always redirected the conversation elsewhere. It was probably a control thing or maybe because she knew we were students. I had another pt who was bipolar. I never would have thought she was. She had pretty good control of it and what she though was a manic phase I didn't consider to be so manic but for her it was. It was very enlightening.

As a nurse I dread when I get a psych patient. Not only are you dealing with their acute illness but you are also having to deal with their schizophrenia and bipolar. I can deal with depression much better but when you add in the schizo and bipolar it can get to be much more of a challenge. I have also found that there is no sense in arguing with them. They have their thoughts and to them they are very real. One of them firmly believed that his whole family was after him and he was getting calls from the state pen. No amount of what I could say would sway him away from those thoughts so I would just listen. No harm done.

[loriangel14, RN]

I am a student doing my mental health rotation ( and loving it!). I have been doing admission interviews and then I get to present the patient's case to the attending psychiatrist. Very cool. The unit that I am working on treats post traumatic stress disorder sufferers and mood disorders. The thing I will always remember is how these people are deserving of the same care as anyone else and many are not that different than you and I. The patients with depression and anxiety have the same feelings we do, just not effective coping skills. I love being able to have time to talk to my patients, instead of rushing around trying to get "tasks" done. Being able to talk to someone having a bad day for as long as they need to is great.

[GingerSue]

the positive attitude of one fine psychiatrist re: patient's capability

[Ophelia78]

I haven't worked psych as an RN, but I did community mental health outreach for a few years while in nursing school. I also have 3 siblings with bipolar disorder and a father, aunt, and grandmother with schizophrenia. Some days I've felt like I have a permanent home in the Cuckoo's Nest:sofahider.

Please don't forget that mental illness is a chemical imbalance in the brain. The symptoms are behavioral. It can be hard not to take a behavioral symptom personally, but I always found it useful to view a decompensated psych patient the same as I view a patient with a raging case of c diff. The symptom can be obnoxious, annoying, and require constant intervention (or cleanup). But we don't shake our fingers and judge our patient whose uncontrollable diarrhea leaves them in a river of poo. While it's important to be firm with disruptive or harmful behavior, I believe it's our duty as professionals to take the lead in reducing stigma. The stigma of mental illness is an enormous barrier to seeking treatment. It's been more than one fellow nurse that I've heard say things like, "Oh great, I get the psycho patient!", " Crazy people make me crazy", or "Crazy people are just more easily influenced by the devil". Don't think your patient can't tell your attitude. One of the best compliments I ever got was "When I'm with you I feel like just another person, not another psycho client." It made me sick to think that this woman had probably heard herself referred to as a "psycho client" by the very professionals who were meant to help her.Try and treat your patients like just another person, and deal with their symptoms with the interventions you've learned.

When it comes to stigma, don't forget that the families of your patients are affected by it as well. Don't forget that your coworkers and fellow-students may be quietly living with the mental illness of themselves or a family member.

Working inpatient can be very disheartening because of short stays, and that is one reason why I've chosen not to do so. I know in my city, there are so few inpatient beds, people are discharged almost as soon as they've been admitted, long before compliance issues and barriers to recovery can be addressed. Working in the community was wonderful. There were many clients I worked with who had, with much help, carved out their own niche in the community and found a certain peace. This is "recovery".

When it comes to working with a decompensated patient, I say always go with your gut (like the one that told me to turn around and leave instead of passing a creepy neighbor of a client who later sexually assaulted a coworker), always have an escape route (I've been locked in a client's home twice and had to talk my way out), and learn the stages of crisis and how to defuse one before it gets to the explosion phase.

Last, don't forget to do unto others as you would have done unto you. It is only an accident of birth that you are not the one hearing voices or experiencing debilitating mood swings.

[not now, RN]

We managed to get our clinical instructor fired.

[JBudd, MSN]

Don't get sucked into the psychosis, or acting out, or verbal games. Redirect conversation back to the main point. Once a decision has been made (plan wise), don't debate it, revisit it, let the patient second guess everything. This is the plan, this is what we do. Period.

Set time limits on negotiations. This is what you have to do, do it. (ie, get undressed.) Enforce the rules. (yes, you have to take off the street clothes during the initial intake. No negotiations. We will force it if this is an involuntary admission).

[oneLoneNurse]

I don't understand how one becomes a registered psych nurse before becoming an RN, and how you were a registered nurse before you became an RN???

BC, AB, SK and MN (CA provinces) have Registered Psych Nurse credentialing. You become RPNs who are registered nurses then you may take a bridging program to become RNs.

[leosrain, BSN, RN]

I loved psych nursing.

I remember the slower pace that allows you to sit back, and really THINK about issues and plan your care. I loved sitting around with the other psych nurses and talking through a problem.

This leads to the intellectual aspect of psych nursing. You really get to think on a much more complex level than other types of nursing (in my opinion).

I remember just how fascinating some of the patient's lives were. Flipping through some of those charts was better than any novel you could buy.

I remember just the strangness of some situations. Stopping a women from killing herself with a plastic knife, or convincing a women to stop biting her fingernails off.

I remember the facinating people watching that goes on from the nursing station. The psych unit really created a "social milieu." Seeing the support the patients gave each other, or seeing the way some patients would manipulate other patients into giving them cigarettes/money/food etc. was facinating. It was a miniture society.

Anyway...I could go on and on...

[sf7126]

Thanks to everyone. This thread has been inspiring.

[jill48, ASN, RN]

Actually, my memories of psych nursing only bring back feelings of COMPLETE FEAR. I was a seventeen year old unit secretary on a teenage psych unit. I don't know how they do it now, but back then I had to do things like take the kids to the gym with the psych techs or stand guard on a suicidal patient (they called them 1:1's). Those kids were the same age as me and did not want me supervising them in any way. That was some scary stuff and I HATED that job. Worked on an adult psych unit once and had a sharp pencil held to my throat. :sofahider SCARY. Not for me. Kudo's to those of you that can handle this type of nursing.

[cisco]

I remember my clinical rotation through pysch. I was in the locked admissions ward. The ward was patroled by techs that really acted like bouncers, they would take a patient down to the floor if they acted out. I was told to NEVER go into a patients room, to stay in the main hallway where the bouncers could see me. Towards the end of this rotation the charge nurse gave us 4 students, several patients that they thought could go for a walk outside on the grounds. I was assigned a male pt. The charge wouldn't let us review any records and didn't give report. So, we started to take these pts for a walk. My pt started to walk a little faster and faster until he was fairly ahead of us, when another pt said "I wonder why they let that fellow out? He's on suicide precautions!" As soon as this was said, my pt started running fast. I ran after him, just to keep my eye on him. About 5 minutes of running after him and totally losing him, I looked up in a tree and saw a human body hanging in a tree. I mean this person hung himself and was dead!!! I knew it couldn't have been my pt, not enough time to do that. I ran back to the group and then to the ward and reported the body. Had to take the officials back to the body and report what happened with my missing pt. Got back late to the school bus and my instructors gave me a U for the day, not because my pt got away or finding a hung body, I got the U for being late for the bus...I wasn't real fond of most of my instructors...they didn't have a lot of compassion.

[Ruby Vee, BSN]

i remember being stalked by my patient. i had a second floor apartment, and one morning i woke up and looked out the window to see him sitting in a tree, staring at me. i called the police, and they didn't respond for two weeks. in the mean time, my father came to visit bearing a shot gun and a rifle. he ostentatiously sat in my bedroom, cleaning his guns and sighting out the window at the former patient who was sitting in the tree, watching. by the time dad was finished cleaning both guns, the guy was gone and i never saw him again.