BPD View

Thunderwolf, MSN, RN · Mar 8, 2008

Thanks for the post.

You are correct, folks with BPD often fight against the very thing they need most...structure and boundaries. Once a person begins seeing this as a basic human need that we all need, the "Aha" light sort of goes on...and then he/she finally sort of gets it. Structure and boundaries make it safe for everyone.

In this light, BPD actually becomes a much easier diagnosis to understand and work with.

My best to you.

angelchick · Mar 10, 2008

Thanks Thunderwolf, yes I think humanbeings in general often fight against what they truely need the most, but definitely those that endure BPD.

IMustBeCrazy · Mar 14, 2008

I have been dx with BPD/PSTD for the last 20years, my husband was told that I would not live to 30years of age, today I am 36 and a 2nd year nursing student, wanting a career in mental health, wanting to advocate and make a difference in this arena

First of all, I think the strongest advocates for any disease can be the survivors themselves, so yours is a noble goal. I would, however advise extreme caution and urge you to be super careful that your symptoms are managed at all times.

The *last* thing that is needed on a behavioral health unit is a nurse with their own semi-controlled mental health issues trying to provide care to another behavioral health pt. I've been in several situations where the knowledge of the nurse's diagnosis was like the elephant in the room that no one talked about, and the pts suffered dearly for it. The staff, including psychiatrists, were none too pleased.

I agree, it goes without saying how important it is for any pt to be referred to as "Mr. Smith" rather than "the Borderline in room 8" or the "CABG in room 4."

You are right on the money about about boundaries. It sounds like a great idea to "listen to their story." In practice, however, it is most often counter-therapeutic to sit with a BPD pt for an extended length of time while they dominate conversation while in their uncontrolled BPD state. The goal of any mental health treatment is to start with the pt where they are AT THIS TIME and challenge them to live in the present and future, not the past.

I hope you are able to objectively assess your own situation in order to be positive this is a specialty that would be the best therapeutic fit for the pts you'd serve. I would encourage you to speak to friends that know you very well to get their thoughts on your proposal. Sometimes what we perceive about ourselves is not what others perceive.

angelchick · Mar 15, 2008

Thank you for your input. Im not sure I agree about the "patient's" suffering if the nurse is trying to control or battle her/his own symptoms. In any speciality nurses are human beings and have issues, a nurse that can say they have "no" issues probably has the biggest issues of all. As a professional I leave my personal issues at home and do not bring them to the work place, I am lucky that I am aware when I am becomming stressed and take certain measures to regain my strength.

I think your concerns are very valid though, my husband, mother, don't want me to go in mental health, they believe it will drag me down too much, I respect their opinions and realise I have a lot to consider. Thank you for being so up front with your thoughts.

Kind regards,

Lisa.

IMustBeCrazy · Mar 17, 2008

Im not sure I agree about the "patient's" suffering if the nurse is trying to control or battle her/his own symptoms. In any speciality nurses are human beings and have issues, a nurse that can say they have "no" issues probably has the biggest issues of all. As a professional I leave my personal issues at home and do not bring them to the work place, I am lucky that I am aware when I am becomming stressed and take certain measures to regain my strength.

The suffering that I refer to is the change in the therapeutic milieu that occurs for the patient when it is obvious that the nurse is also having problems with mental health issues.

This is completely different than, say, a nurse with cardiac issues that works on a cardiac unit. General medical units are more "task-based", so as long as he/she is proficient and can monitor rhythms, hang cardiac drips, assess pt, monitor labs, etc., there is little impact on the nursing or patient milieu there unless he/she is unpleasant, which is a different thread altogether.

Behavioral Health units are very different. Patients generally are "walking and talking" to themselves and others :wink2:. On a medical floor, the only time you will generally see patients out of their room is when they are ambulating in the hall, etc. In most medical units, pts don't usually talk amongst themselves, and other than their assigned nurse, the other nurses on that unit probably do not have any idea of who that pt is. Medical units don't have 'activity group', 'community meeting' or 'group therapy' designed to bring patients together and learn to cope and function within a small group/society.

The reason mental health pts go to the hospital is to be surrounded by a solid, supportive therapeutic milieu *in addition to* getting the help with general medical problems/medications that they may need. Maybe it's one of those things that you need to observe for yourself as a staff member to understand the importance, because it is tricky to explain. One of the problems I observed firsthand was a willingness for the nurse with their own mental health issues to form some type of alliance (whether knowingly or unwittingly) with the patient that allowed that nurse to be more easily manipulated by the patient. In my opinion, there should never be a reason for a patient to know a staff member's mental health or medical diagnoses or for that matter *any* personal information - 99% of the time it turns into a problem. I can't tell you how many of our patients, especially the returning pts, are able to staff split very effectively in this way. And that is only one example.

Generally, the reason BH pts decompensate and require hospitalization is due to stressors in their lives. Running an effective BH unit is full of stressors for staff as well. How will you feel when you need to be involved in putting your pt in 4-point restraints? How will you feel when a pt attempts to hit/kick/bite you? How will you feel when your patient brings harmful contraband that could potentially hurt other pts or staff members onto the unit? How will you feel when a pt calls you repeated foul names just for doing your job? How will you handle 2 or more pts that have made it clear that they do not like each other and *will* physically confront each other? How will you handle families that come to the unit reeking of alcohol/marijuana and demand visiting time? How will you deal with family members that are even more profoundly mentally ill (but not generally diagnosed) than the pt that is in your care? How will you feel when you find out that a pt has blatantly lied to you about their health history i.e. being abused as a child for example, just to elicit sympathy from you? These are just some of the things that are very difficult to deal with, and make it necessary to bring your "A Game" to work every day. And, more importantly to keep that "A Game" going when things get rough on the unit - there is no time to counsel a staff member as well.

Do I believe the nurses on my unit are perfect? Not at all. But I have no doubt that any or all of them will "have my back" and not hesitate to jump in if things get rough. More importantly, I trust each and every one to "de-escalate" a situation before it becomes a problem. And many times, that "de-escalating" process means being able to understand and comprehend their role in the situation and how they contribute to it.

I wish you the best on whatever career path you choose!

angelchick · Mar 17, 2008

Thank you for your words of wisdom, I hear what you are saying, truely I do. And I understand your concerns, I too, have concerns about whether I will make a good Mental health nurse, but I am also nervous about whatever first job I take on. I have been involved with mental illness for some time, and been cut with a razor in ER by a friend, helped restrain a young girl, I have also witnessed suicides and whilst working on the ambulance witnessed attempted suicides, so I know that side of things wont shock me, BUT I do know that I need to get harder, (for lack of better word), and I hope with guidance and awesome staff members like you I will endeavour to do an excellent job. I am trying not to be blind going into this, I just really feel like I can make a difference (last final words huh)! LOL

Anyway thank you for taking the time to write!

Gentle Blessings

Lisa.

batgirl23 · Mar 19, 2008

I think you should follow your heart, angelchick, and work in psych if you choose. I think your experience and insights will be invaluable to the pts you will care for. You are obviously person-centred in your approach and you truly understand the idea that recovery is possible - that there is always hope. Frankly, after 20+ years working in psych (currently as a clinical nurse educator), those are 2 of the most important traits I want to see in new nurses coming to work with me! :nurse:

Good luck to you!

angelchick · Mar 21, 2008

Batgirl, THANKYOU! for the first real positive view on my understanding of mental health. It's encouraged me to stop doubting myself and my passion for it and allowing me to listen to others comments but not necessarily take all the negative ones on board. Thanks for the encouragement!:heartbeat

wonderbee, BSN, RN · Mar 21, 2008

It's no secret that MH attracts practitioners with their own issues. It's a shame that more of us can't be more up front about them with each other. Valuable insight can be gained. I carry the keys to the unit today, but who knows if I was once on the other side of the locked doors.

We treat the person. Unless their physical suffering is relieved, we won't be able to touch the psyche. I think patients are often misdiagnosed BPD. Take a patient I had on a recent shift. Patient presented with pain in his hand. No one asked him anything about the pain and blew him off. He came back several times to the nurses station which bought him a working diagnosis of BPD. Last night this guy was lucky enough to have a new nurse who wasn't burnt out yet and took him seriously. She asked me to look at his hand and sure enough, it was swollen and warm to the touch. I asked him the questions that should have been asked on admission. What did you take for it at home, how long have you had it, etc. The guy asked for Darvocet, not dilaudid or fentanyl. Just one lousy darvocet. The charge nurse for the unit felt in her clinical judgment it was a matter for the tx team, and the patient should sit on his pain till the morning. The new nurse wasn't comfortable with that and called the resident on call for the darvocet. Good for her. She had the courage of her convictions. Now maybe this guy is borderline and maybe not. He's still entitled to relief from pain and treatment of physical complaints based on an ongoing clinical assessment.

I come from a strong med-surg background. I'm the only nurse on my unit who has a med-surg background. I see from different eyes than my fellow nurses. Our patients present with a lot of physical complaints and conditions. It's just assumed that they are borderline. I find it upsetting.

angelchick · Mar 23, 2008

What a great post! It warms me to know there ARE in fact Nurses out there like yourself, looking beyond....

You ROCK!!

IMustBeCrazy · Mar 27, 2008

We treat the person. Unless their physical suffering is relieved, we won't be able to touch the psyche. I think patients are often misdiagnosed BPD. Take a patient I had on a recent shift. Patient presented with pain in his hand. No one asked him anything about the pain and blew him off. He came back several times to the nurses station which bought him a working diagnosis of BPD. Last night this guy was lucky enough to have a new nurse who wasn't burnt out yet and took him seriously. She asked me to look at his hand and sure enough, it was swollen and warm to the touch. I asked him the questions that should have been asked on admission. What did you take for it at home, how long have you had it, etc. The guy asked for Darvocet, not dilaudid or fentanyl. Just one lousy darvocet. The charge nurse for the unit felt in her clinical judgment it was a matter for the tx team, and the patient should sit on his pain till the morning. The new nurse wasn't comfortable with that and called the resident on call for the darvocet. Good for her. She had the courage of her convictions. Now maybe this guy is borderline and maybe not. He's still entitled to relief from pain and treatment of physical complaints based on an ongoing clinical assessment.
I come from a strong med-surg background. I'm the only nurse on my unit who has a med-surg background. I see from different eyes than my fellow nurses. Our patients present with a lot of physical complaints and conditions. It's just assumed that they are borderline. I find it upsetting.

Amen!!! I agree 150%! I have said it before and I will say it again, psych nurses need to have EXCELLENT assessment skills AND the fortitude to advocate for their patients, no matter what their diagnosis is.

The often thought but extremely incorrect sentiment of "You don't have to be a REAL nurse to be in psych" is a complete joke. If anything, you need to be even more on your game and be willing to be outspoken for the patients that are not able to do so on their own.