From Geriatric to Psychiatric Nursing

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    Our little town geriatric nursing home is being turned into a psychiatric nursing facility due to the facilities social worker trying to bring up the numbers.:angryfire The nurses here are ill-equiped to handle these types of situations, and we cannot get the social worker to understand this. So my questions:
    What do you do for a bi-polar who is purposly upsetting the other, older long time residents?
    What about a schizophrenic?
    I realize that my spelling is not the best right now, and that these are probably every day questions for the more experienced, but I did not hire on as a psych nurse. I may just have to run for it.
    Any help will be greatly appreciated.
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    Will the whole facility be psychiatric? Is it going to be geropsych, adult acute psych care, chronically mentally ill or what? If there will be both geriatric and psych populations in the same facility, what provisions will be made for the safety of the elders? Will there be a "quiet room" outfitted? Will it be a locked facility? Does your community have psychiatrists who will be involved?

    There will need to be some sort of crisis prevention and physical management training. Staff will need to be trained about psych meds and adverse side effects, use of physical restraints (different than those typically used in geriatric populations), etc.

    Why is the social worker making this decision? You can't just plop a psychiatric population into a nursing home without making some changes to the facility. No glass mirrors or operable windows, no cords or tubing or sharps accessible to possibly suicidal patients, shower curtains/rods that will not support the weight of a body...

    Sorry, I know your original question was how to manage disruptive patients but I hope there is more thought and planning going into this decision than you have indicated--if the staff hasn't already been reassured about training that makes me think this idea isn't very well thought-out.

    As for managing disruptive patients, if you've been working with the geriatric population, you should already have many of the skills necessary. Kindness, firmness without being confrontational, allowing choices when possible, heading off volatile situations with use of de-escalation, distraction, or PRN meds...

    Good luck with whatever you decide to do. I love psych, but I know it isn't for everyone.


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