Is this nurse in the wrong?

[Novo]

My brother was admitted into a psych unit this week and when I visited him today I walked in on him arguing with the nurse. He was asking why he was there - which he has done since the first day he arrived We tell him because he's not well but the nurse today told him EXACTLY why. She basically read of the chart to him and said it was because he was delusional, schizo, may cause harm to others and mentally unstable. At this point I could see my brother clenching his fists and as shocked as I was to hear her say this to him I kept my composure for his sake. She also noticed his agitated state and I saw her reach down and try to press the security call button. I told her we were going for a walk and escorted him away from the front desk. Moments later she followed us with meds and insisted that he take them. After he swallowed them - he started going off again on how he wasn't crazy and AGAIN she started arguing with him and this time even louder and more condescending than the first time. Again I walked him away from her and we came back 15mins later when he calmed down for him to do some paper work.

I'm only a student by why on earth would you argue with a psych patient. I mean I've tried to convince him that his delusions arent real but he just gets agitated and very defensive - whatever he's seeing must be real to him so I just let it be. But I felt this nurse today was agitating him on purpose. When he aks any other nurse they either nod and tell him you;re not feeling well. Furthermore, she was speaking to him like he was in some kind of prison in such a condescending tone - not therapeutic.

I didn't react to her attitude because I knew that my brother would feed off of it and it would cause him to have freak out. What can I do now though? Can I have her taken off my brothers case or even file a complaint against her? I'm pretty sure she was the charge nurse. Did she do anything wrong - again not sure If I'm over reacting since I have a personal stake in this.

[fasnv]

I never been in nursing field, but I think that was wrong.

[SinikRN101]

I wouldn't wait too long to speak with either the nurse or a supervisor, I think the sooner addressed the better. I agree that she was in the wrong with the above people who posted I just wanted to say Kudos to you for showing the critical thinking to not bring it up in front of your brother to cause things to escalate.

[Orca, ADN, ASN, RN]

The textbook approach is to reorient the delusional patient to reality. However, experience has taught me that you sometimes have to temper that a bit. You can unnecessarily escalate a patient by being too frank or blunt, and sometimes a softer, more tactful approach is required. Some patients want to know what their diagnosis is and can handle that information, while others cannot. You have to know your patients. Experience and interaction are key.

The nurse arguing with the patient in question served no useful purpose. If a patient asked for his/her diagnosis and then started to argue when it was presented, I would explain to him/her what the diagnosis means (if he/she seems unaware) and refer the patient to the physician for further explanation if necessary. I would also explain that this was the doctor's professional opinion besed upon what he/she knew about the issue.

[sharpeimom]

I feel the nurse's attitude was out of line (as you described it) but sometimes we don't realize quite how we sound when we speak to patients. I have a soft voice and sometimes have to strain to make myself heard in a noisy area, which results in my voice sounding different than I would wish it to sound. I'm not making excuses for the nurse, I'm just thinking aloud.

It can be quite difficult to answer a psych patient's questions when:

a. the family doesn't want him to know what the diagnosis/es are.

b. when the patient himself absolutely does NOT want to accept any diagnosis at all and not just the one he's

been given.

It must be done privately, somewhere nonthreatening to the patient, and many many times, if that's what it

takes for him to understand and come to terms with his diagnosis. He must accept taking pills for the rest of his life even if he does feel good and doesn't think he need them.

All of this will take time, but it is your brother's right to know what's wrong with him.

[Kooky Korky, BSN, RN]

I think you might want to personally, privately talk with the nurse and tell her what you saw. As the sister of the patient, being familiar with his situation for years, you are a very valuable source ofinformation. She should be glad you are involved.

That all being said, you might not want to have high expectations for her being receptive to you. If she gets upset with you or if you feel she is discounting you or is just not good at working with your brother, be prepared to discuss this with her supervisor and be willing to go all the way up the chain of command.

Be willing to speak with your brother's doctors, too, although you might get rebuffed/excluded if you are not the guardian or if they (or the nurses) believe you are not authorized to be included in care plan meetings/treatment team meetings. This could be remedied easily enough, I think, by having your brother give his permission for you to be included.

I think the mental health system has some rough edges, as does any man-made system, but it's all we've got for now.

If this particular nurse is in need of some further training and education, make sure her bosses know. We don't want her to get hurt or to be upsetting the patients - you could start off this way.

If they are unresponsive, go to the state Board or to hospital Board of Trustees or other higher-up's in the hospital. Maybe your brother will have to avoid this hospital totally.

I hope your brother does well and that this nurse gets better at her job.

[Kooky Korky, BSN, RN]

I'm glad you are giving it some thought. This may not be your situation...I am merging my experience as a nurse and family member here. Sometimes family members are angry at the situation (rightfully so), & they misdirect their anger toward the provider of care. The provider of care can't really do anything right, as the angry family member of the patient will pick them apart in an effort to make right what is wrong with their loved one.

It might be better for her to learn that she can just tell the patient that his doctor will talk with him about that because she's not sure. Or she can say that his doctor wanted him to be in the hospital for a while.

[canned_bread]

Arguing with someone with delusions, whether they have dementia or schizophrenia psychosis, NEVER works. They are convinced. I have said in the past "you are here for a break. You don't have to work, your meals are provided, have a break!" And treat it as a holiday. Then I redirect the comment to another topic. It takes a lot of patience, but agitating a patient is what must be avoided because it's not fair on them when they don't understand. When the medication starts taking effect then they will understand and education can begin. It's hard, and takes a lot of practice and experience to get it right. Some nurses have it, some don't.

My thoughts are with your brother and family.

[tristessa]

You say "why on earth would you argue with a psych patient" well why would you argue with any patient?? Nurses are professionals and arguing with anyone in your work environment is not professional. From what you have said, that nurses arguing only seems to have agitated your brother even more. Your brother needs to be told the truth about why he is there - he has the legal right to know....He may not agree with this information....but arguing with him does not help the situation. The nurse involved sounds very unprofessional and needs to be reported. What she has allegedly done is not therapeutic...

[K os]

by the way lovingtheunloved, it's not very "therepeutic" to refer to the OP's sibling as "crazy". It is no longer correct to use the "R" word, make jokes about short busses or gay people, but somehow it's still acceptable to marginalize people who are overweight and people who suffer with mental illness.

Are you thinking about a career change?