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marydc 4,679 Views

Joined: Apr 2, '12; Posts: 58 (69% Liked) ; Likes: 214
Specialty: Psychiatry

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  • Jun 24 '15


    Welcome back. Glad you're feeling better.

    And, uh, the board's been a little weird lately.....

  • Jun 22 '15

    I believe when we as professionals start delegating tasks out based on gender and the belief that it will make the patient uncomfortable then we ourselves continue this circle.

    Do male OB/GYN's have their female partner perform the examination because it is a woman? Of course not so why should a male nurse do the same for a female patient or vice versa. Most of us have a second person there for help anyway so what is truly the problem? It may be your own bias or fear of performing such an intimate and often times frightening (for the patient) procedure.

    I have never had a female patient refuse a catherization from me, I tell them matter of factly that they are retaining urine and list the consequences and inform them that the doctor and I believe a foley/straight catheter would alleviate the issue and BAM they say okay. I call over my Pod Mate (ICU speak) and we get the job done.

    Also, I never ever ask the patient if it is okay if I perform the procedure, it instills doubt in their mind and may weaken the nurse-patient relationship.

  • Jun 13 '15

    We require a code word that the pt comes up with.

    Just yesterday, I asked a caller "do you have a code?".
    The caller replied, "No. I think it's just allergies."
    It took me a second...

  • Jun 10 '15

    After a vaginal delivery in which she tore a little bit, the physician was getting ready to repair her perineum. He was about to give her a shot of lidocaine, and as he's standing between her legs, I said "Okay, you're going to feel a little prick in your vagina." I remember the look he gave me as I realized what just came out of my mouth.

  • Jun 10 '15

    I was walking my blind resident to the dining room. When we bumped into a chair. I said " well if this isn't like the blind leading the blind"

  • Jun 10 '15

    Patient: I'm sorry. I'm not a very good patient.
    Me: That's okay, I'm not a very good nurse!

    (The shut down valve from brain to mouth appears to be nada.)

  • May 30 '15

    "I just wanted to tell you thank you, I can tell you really care." Anonymous, 2015

    So often I have heard this statement from my clients. Not to toot my own horn, but I began to wonder personally how much my empathy for the mental ill population promoted my competency in providing optimal care. So I began to analyze the fundamental components of my work as a psychiatric registered nurse that are conducive to promoting my psychiatric clients' stability.

    The fundamental foundation in initiating competent skills as a psychiatric nurse is similar to any specialty in nursing. We must implement the necessary processes of providing the standard of care by using the method known as the nursing process. The nursing process includes the following steps:

    Assessment, Diagnosis, Planning, Intervention, and Evaluation.

    In saying such I would like to rephrase these steps into the perspective of a mental health nurse. In similar order of the nursing process assessment is viewed as "I need to know what you are experiencing so I can help you", diagnosis as "I listened and acknowledged your needs", planning as "This is what we can implement to meet your needs", interventions as "let's apply these individualized strategies and alleviate your acute circumstances", and evaluation as "How did this work for you? ".

    Each stage conveys the primary idea of client - focus care; centering around the client's individuality. However, with clients experiencing severe depression, paranoia, and/or psychosis establishing rapport is essential in obtaining accurate data to promote stability (Decety & Fotopoulou, 2015). This requires implementation of the vital principal of Jean Watson's Theory of Human Caring which is to promote the client to achieve HIS/HER optimal being of holistic health (Suliman, Welmann, Omer, & Thomas, 2009). For the psychiatric nurse this requires empathy that encompasses finding understanding of the client's current stressors, perceptual, and actual needs through genuine interest that encompasses calculated verbal and non-verbal communication (Derksen, Bensing, & Largo-Janssen, 2012).

    Finally, the "light bulb" illuminated for me on the reason why my clients felt potentially more considered than their peers. It was a simple math equation of caring by distinguishing individuality, building rapport through sincere, calculated, verbal/nonverbal communication that resulted in accurate empathic understanding of my clients. Thus, a healthy nurse-client relationship is established providing a platform for a conducive and productive recovery from acute mental illness. The following were communicative actions implemented:

    "I need to know, so I can help you":

    1. Establish rapport/ building trust, by active listening, respecting individuality, giving time, maintaining individuality actions throughout each stage
    2. Nonverbal communication i.e. body movement, facial expression
    3. Removing overwhelming stimuli
    4. Discussing more than reason for admission but general topics of conversation; "implementation of "soft concepts of empathy with hard science" (Derksen, Bensing, & Largo-Janssen, 2012, p. 2).

    "I listened and acknowledged your needs": (Decety & Fotopoulou, 2015)
    1. You have noted the external symptoms of this patient
    2. The patient has shared, their internal symptoms experienced
    3. You have noted the congruency or non-congruent behaviors/symptoms in their diagnosis

    "This is what we can implement to meet your needs":
    1. Active participation in planning with client to meet his/ her needs; promoting compliance
    2. Confirmation of short and long term goals; the steps in which client desires to reach these goals
    3. Suggestions offered and multidisciplinary, familial, and outpatient supports established

    "Let's apply these strategies according to your circumstances":
    1. Implementation begins, support measures positioned to encourage
    2. Consensus of specific supportive mechanisms implemented by multidisciplinary team, and family
    3. Flexibility provided to the client's circumstances

    "How did this work for you?":
    1. The noted growth, stagnant, or regression of results reviewed
    2. Challenges acknowledged, barriers noted
    3. Suggestions on interventions that may promote his/her desired outcomes

    To successfully implement these steps it is necessary to seek understanding of the clients' individuality which takes effort, establishment of rapport, and time. Empathy is an essential factor to obtain accurate data, individualize interventions, and best outcomes addressing the clients' uniqueness. As a psychiatric nurse one noted that empathy plays a significant role in providing competent care and optimizing positive outcomes for my acute mentally ill clients. (Decety & Fotopoulou, 2015). Empathy allowed me to care for the client's individuality by grasping an understanding of their personal strengths, struggles, and journey to mental stability. Likewise, empathy is the foundation for competent psychiatric care.


    Decety, J., & Fotopoulou, A. (2015, January 14). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Why empathy has a beneficial impact on others in medicine: unifying theories

    Derksen, F., Bensing, J., & Largo-Janssen, A. (2012, December 19). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Effectiveness of empathy in general practice: a systematic review

    Suliman, W., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson's Nursing Theory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment. Journal of Nursing Research, 293-299.

  • May 30 '15

    Regardless of whether you were actually right or wrong, it would be best to find another case, now, while you have a say in the matter.

  • Apr 12 '15

    It sounds like you have issue with her personality in addition to her prescribing so it sounds like a decent idea to find another job and possibly consider mentioning your complaints when you resign. If your PA and NP are bothered by this I would hope they will say something to change it or get another job. I have never worked at a place where anyone told me what to prescribe or I had to ask permission before writing an order but then again I have always made it a point to work with providers who had a similar prescribing philosophy to my own.

    On both of the inpatient psych units where I work we are rather stingy with benzodiazepines especially for people with addictions issues however I am generous with them for the person who presents in alcohol withdrawal for obvious reasons. With regard to those who come in on them from an outside provider it is a case by case basis and yes we will also do a fairly brief taper for people who have either been abusing them or are using illicit substances especially alcohol. I do it in a safe manner and make no apologies for it. I personally think the unofficial extremely conservative recommendations for tapering benzos that are found online were clearly written by someone who was attempting to work over their prescriber to keep the gravy train rolling as long as possible.

    Exactly how small of a dose of Zyprexa? Was there anything else available to go with it like Benadryl or Vistaril? Although I'm a huge fan of a B52 IM when needed I think there are some units where psych RNs rely too heavily on benzodiazepines prn when an antipsychotic with benadryl would be more effective for agitation especially if there is psychosis involved.

  • Apr 12 '15

    I do not work in such a place. And while I'm not a big fan of benzos I do acknowledge their medical and/or psychiatric necessity...

    To be honest, your facility sounds frightening.

  • Feb 22 '15

    I'm trying to imagine the next job interview when they ask why you left your last job...

  • Feb 21 '15

    I think you should remember that people who write here are writing, oftentimes, about their stressors. People write about the negatives more than the positives, sometimes, because the negatives tend to stand out in their minds more intensely. You might not be getting a totally realistic picture from the negatives you read here. The same is true from what you see on the units. People experiencing work stress tend to be more vocal than those that are happy.

    A common misconception is that there are never tubes, drains, or body fluids on psych. That isn't true, especially if you work med/psych. Also, believing psych will be a place where you get breaks and lunchtime isn't necessarily an accurate belief. I almost never got a lunch break when I worked psych. I'd eat bites as I flew by the table where my food was sitting, but I seldom got to sit down to eat. I got more lunchbreaks on med/surg than on psych, and that's not saying much because my med/surg experience was very intense and time-consuming too.

    I've never been hit by a psych patient. I've had patients show extreme anger, and we worked through it. Most psych patients would much rather hurt themselves than hurt anyone else. I've never been peed or pooped on by one either. They aren't out to get you!

    The stress on psych comes from the intense emotions the patients feel, as well as from experiencing their bizarro world, from their point of view, sometimes. It can be emotionally draining. Emotional draining is very physically tiring. I think I came home more tired from a usual day on psych than I would experience during the usual day on med/surg. Then, when a day on psych included managing the extremes, there were times I could hardly make it to my car, I was so exhausted. I'd also worry about the safety of the patients I had left when I went home. Would they ever feel better? Would the world ever decide to provide enough services to mentally ill people so they can get well and stay well?

    The good parts:

    Psych caregivers often become a well-oiled team that will pitch in to help each other and the patients in any circumstance. They don't even need to be asked to help. They just know what's needed and jump in. They stand up for each other.

    You can make a difference. That one patient you spent time with may believe someone cares, or that he or she matters, because you spent time with him. You can see people get very-obviously better.

    You can develop an intense belief in the power of the human spirit.

  • Feb 21 '15

    I don't know why they don't just dc the etoh wd order. My nurses wouldn't allow me to get away with that. I like to document the actual withdrawal process clearly for my notes also so I wouldn't leave it as if the patient was continuing to get meds for wd. Then again my patients with substance abuse rarely get benzodiazepines from me unless they are being treated for withdrawal from alcohol or benzodiazepines so the Ativan would be long gone.

  • Jan 3 '15

    ROFL, gotta love auto spell correct. I got a text the other night that read:

    Pt escalated again given porn calm now

  • Sep 16 '14

    I think one way of counteracting the stigma of mental illness is for those that have it to come forward and talk about it. Everyone has times of mental distress, if not illness. If we can be open about it, our experiences can help others going through similar things. Sharing will also show we are not ashamed. We should not be ashamed of being ill or hurting emotionally. We should be able to talk about such things as we search for better.