How Do I Approach This? - page 2

We really do have good nurses on our unit, but I do not like hearing, in report, them say stuff like 'she's psycho' or that one is a whack-job' and the whole borderline borderline borderline thing... Read More

  1. by   anichols
    i'm usually assigned to the borderline unit and yes, it's stressful. sometimes it's hard as heck not to give negative/sarcastic reports when when everyone in the room knows the latest "emergency" is just a head game. but whenever it gets to me i just remind myself i like my borderlines much better than any other unit, even the "baby borderlines" (teen girls)...other than the constant mind games, they really are more "normal" than most and it's easier for me to see why they act out (as opposed to a voice in their head suddenly decided it didn't like you) and take it more in stride....
    also, comments during report are often not just giving info to the next shift but a good way to judge just how "fun" the previous shift was and what to gear up for, plus it helps de-stress the staff by venting. not that it's good, but maybe staff isn't trying to be mean.
  2. by   kadokin
    Quote from anichols
    i'm usually assigned to the borderline unit and yes, it's stressful. sometimes it's hard as heck not to give negative/sarcastic reports when when everyone in the room knows the latest "emergency" is just a head game. but whenever it gets to me i just remind myself i like my borderlines much better than any other unit, even the "baby borderlines" (teen girls)...other than the constant mind games, they really are more "normal" than most and it's easier for me to see why they act out (as opposed to a voice in their head suddenly decided it didn't like you) and take it more in stride....
    also, comments during report are often not just giving info to the next shift but a good way to judge just how "fun" the previous shift was and what to gear up for, plus it helps de-stress the staff by venting. not that it's good, but maybe staff isn't trying to be mean.
    You have an entire unit of borderlines? And you enjoy it??? God bless your ever-lovin soul! You are well-placed. I don't think that I could stand it. I would MUCH prefer someone hearing vox to someone screaming 2 inches from my face that they were going to slit my throat b/c they DISAGREED w/me. You are a credit to your profession. If you possibly can, stick w/this area of speciality. These people SO need someone who is a sympathetic advocate. There are not many who can tolerate this sort of thing. More power to you.!:wink2:
  3. by   sanctuary
    Lots of insightful comments. Makes me glad to be a psych nurse (42 years and still doing it). I have found that working in psych,even though well intentioned, people often reflect the attitude of society in their work. I have come to depend on the newbies to help us see our callousness. While many would argue that attitudes shared only in the staff break room, or office are a healthy way to discharge negativity, I find it gets dragged onto the floor and into conversations with the subjects of the "black humor." While staff are careful not to use the same words, the tone, attutude and content of interaction gets stained.
    There is an attitude I call "sane-ism", akin to sexism, racism, et. People with a diagnosis automatically become less that whole, less than adult. The concepts of the Recovery Model would ask us to be honest and gentle share with the person (pt) what their behavior makes us feel. Instructing others not to have symptoms rarely is effective. Remembering that in every case, they are doing the best that they can in the moment helps tolerate things we find troublesome. Reminding our co-workers that positive energy heals, or that patients are very sensative to unspoken intention might help. Marsha Linehan's work with BPDs is a good start to creating a healing enviornment.
    Her work is called Dialectical Behavioral Therapy, and is the only therapy scientifically proven to be effective with BPD. Not surprising, it starts with respect for the person and acknowledging that they are responding to pain in the way that seemed to work for them at one time. The work the Sandra Bloom has done on the Sanctuary Model is also helpful. Together they make a powerful model of coaching .
    Re-training attitudes of staff is the hardest job in psych nursing. I wish you well.
  4. by   Balder_LPN
    Quote from Thunderwolf
    Excellent input everyone. We are blessed, you know, to have a very fine bunch of psych and ex-psych nurses here. I just needed to say this. I feel blessed as a Moderator.

    Thank you all.
    I know that I am really learning alot about my future specialty.
  5. by   mona b RN
    Quote from Balder
    I know that I am really learning alot about my future specialty.
    Me too Balder Very interesting posts and I enjoyed reading about all of your experiences.
  6. by   danu3
    Quote from sanctuary
    Re-training attitudes of staff is the hardest job in psych nursing. I wish you well.
    There is the "Professional Provider Family Education Course" that might help. It is offered by NAMI. It is an interesting multi-week course as it is taught be 5 instructors. 2 instructors have a serious mental illnes themselves and they are stable. 2 instructors are family members of a person who has a serious mental illness. 1 instructor is a mental health provider (psychiatrist, psychologist, psych nurses, social worker) who has a family member with a serious mental illness. One of the objective to to model how these 3 parties can work together for the good of everyone. It is a major attitude change kind of class.

    Unfortunately this is only offer like in 20 some states only right now.

    Here are some abstracts in pubmed about this class:

    http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
    http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
    http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
  7. by   StuPer
    I have to add my tuppence here as well and say that DBT which is a 'talking therapy' does show effectiveness in BPD, in fact it is the only thing that does. However there remains a shortage of trained nurses/psychologists, but I can say categorically that some of the BPD clients I've known for sometime, no longer access services due to the effect of DBT. It isnt a panacea, and it doesnt work for all (some clients give up because 'its too hard'). But generally when someone has come to the point of realising their behaviour is destroying them, they are receptive to it.
    regards StuPer
    P.S Most of the clients I know where it has worked have also either reduced or ceased any Mx as well.

    Ooops posted this at the bottom of the 1st page, sorry to repeat what Sanctuary has already said....
    Last edit by StuPer on Jan 18, '06
  8. by   kadokin
    Regarding DBT: Does anyone know if it is appropriate for short-stay acute settings and does the training require a Master's Degree? Can a BSN qualify to be trained for it? Where is a good place to go to find out about training? Just a few questions.
  9. by   Thunderwolf
    Due to the sophistication of this type of therapy, a psych internship (pre-doctoral/doctoral) may be required. Do a google search.
  10. by   CharlieRN
    Re DBT: It is my understanding that it is a good framework for the staff to be working within when they have to deal with Borderlines. That is, even if your unit is very short term ,you should know what it is and how to support the therapy that may be going on in out patient groups etc. At the very least you should be modeling appropriate behaviors and problem solving techniques. This means you should have someone on staff who really knows what they are doing and can teach you all.

    Re Borderlines: The most helpful thing I can suggest is to keep yourself safe. These folks are rarely a physical danger to others but they need to pull people into their belief system and make them play roles that confirm that belief system. They have had lots of practice and are good at what they do. This can be highly destructive to your relations with your peers, your peace of mind and your professional status. They can cost you your job! Possibly your license.
    What to do? Read your employer's policy manual and keep it firmly at your back. Do not exceed your role. Never expect a borderline to keep a confidence. These are folks you can't trust with a sharp object, don't trust them with hurtful information either. Think about what your relationship to the patient really is. You are not their friend. Absolutly not their lover. You are not an angel of mercy. You are a professional doing a job. If you don't let the compliments make you feel good, it is easier not to let the insults make you feel bad. Remember that both are just information about what the patient's internal world is doing. Also remember that if you work with them long enough you will get burned. It happens.
    Last edit by CharlieRN on Jan 22, '06
  11. by   Thunderwolf
    most excellent, charliern

    what to do? read your employer's policy manual and keep it firmly at your back. do not exceed your role. never expect a borderline to keep a confidence. these are folks you can't trust with a sharp object, don't trust them with hurtful information either. think about what your relationship to the patient really is. you are not their friend. absolutly not their lover. you are not an angel of mercy. you are a professional doing a job. if you don't let the compliments make you feel good, it is easier not to let the insults make you feel bad.
    the highlighted areas in the quote are quite often the reasons why nurses slip up (they forget or get enmeshed) and get burned...and burned bad.
    Last edit by Thunderwolf on Jan 20, '06

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