I'm a new LPN. I've been working in LTC for the past few months. Some of my residents are elderly people with illnesses or physcal limitations who require care. Some of them are dementia patiens who can't care for themselves. Some of them are elderly people with mental illnesses which may include some kind of psychosis as well as dementia.
The third type of patient doesn't mix well with the first two. The patients with no cognitive symptoms and the pleasantly demented are usually a joy to be around. We have a few disturbed individuals on our unit, however, who scream, curse, act out, and disrupt the environment for the other patients.
I'm bothered by this for two reasons. The first is that I think sick, elderly, disabled or dying people deserve the dignity of a calm, peaceful environment. The psych patients in the mix make my unit a very unpleasant place to be. I feel awful for everyone, especially the cancer patients who have come there to spend their final days. No one should have to listen to shrieking and swearing as they are dying.
The second reason is the psych patients themselves. Their agitation looks like sufferring to me. We try to reduce their medications because the meds are seen as chemical restraints. But don't psych meds take the patient's pain away to an extent? I watch these people through my shift and they are clearly sufferring.
What happens in my area is this: A geriatric person is found disheveld bt family members. They go into the hospital on a 72 hour psych hold. In the hospital they are stabilized, cleaned up, and medicated. Then they are shipped out to a nursing home, and the meds are D/Ced. As soon as the meds are gone they become aggittated and/or violent. I can't blame them for that. I would do the same if removed from my home against my will.
I think this is a lousy model, and doesn't really address the needs of the patients. They are not being treated for mental illness. They are not encouraged to thrive to the extent that they are able. They are just being warehoused. Do other parts of the country do things differently?
I've been working in a psych hospital for over 6 years, and I used to be an LNA on a ten-bed geri psych unit located in a community hospital while stumbling through nursing school. These demented patients DO suffer. And we who care for them are often at great risk. I'm not quite sure what evidence evidence-based-practice is looking for, but someday folks will look back at this period of time and think our policies of undermedicating angry, hostile patients made no sense at all. It doesn't preserve their quality of life, their dignity, or their loved ones from suffering more, longer. I'm convinced that if most of these folks were in their right mind, they would beg to take the med that helped them sleep instead of wail and scream in the hallway. If I ever get there, please spare me. Give me the pills.
Last edit by Imarisk2 on Jan 3, '13
: Reason: mistyped word.