New to psychiatric nursing and would love any and all advice/suggestions!

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    I am brand new to the world of psychiatric nursing and am finding it VERY interesting. I have had several years experience in trauma ICU, then about 6 months of dialysis. So obviously, my knowledge base is very limited when it comes to psych. I have just started a new job with the state in an outpatient medication clinic. I will be seeing patients who are somewhat stable (when on their meds) but would eventually like to move over into the inpatient hospital down the road. We deal with a lot of CD when it's co-occuring with a mental illness but I am getting the impression that the main focus of this facility is with the mental illness. I have a pretty good foundation with the CD/recovery but none with things like schizophrenia, severe depression, personality disorders, etc.

    I would love to hear from those who have experience in this fascinating area of nursing and especially advice on how to survive! And if anyone has suggestions on good books to read, websites, etc., I would love those as well. Also, I would like to hear some personal stories of how to handle agitated/aggressive patients and how you de-escalated the situation. I'm very nervous about not handling that kind of situation correctly and putting myself in more danger than is necessary. I took a class today on Crisis Prevention and Response Training where we learned how to deal with the more heated situations but I would like to hear from those who have been in those situations and how they handled them.

    I already know I'm going to love this job and it's a type of nursing I've never done before. Very interesting, never boring, and I love the feeling that I'm truly helping these patients. I never thought I'd end up in psychiatric nursing but I'm very glad I'm here! Thanks in advance for any responses!

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  2. 14 Comments...

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    Congrats on your new employ. Please review what we have here in the psych forum already to help familarize yourself to this new area of focus. Lots of stuff have already been covered. You can also do a "search" on topics in this forum to help you. You'll enjoy this new field...and your past experience will certainly come in handy. If you run across questions as you work, please post'll get some great feedback.

    My very best to you,

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    I think it would help you to do some reading of books written by people who have psychiatric disorders. It will help you see their illnesses as they see them, plus they're quite interesting. Dr. Kay Jamison wrote An Unquiet Mind. Both Patty Duke and Carrie Fisher have written books. There are oodles out there. Try checking the National Alliance for the Mentally Ill (NAMI) website.

    As for how to handle crises, it's important to stay as calm as you can (or at least ACT calm if you don't feel calm). It's important not to let YOUR behavior escalate because you're stressed, and important not to let your voice get louder and louder or more and more pushy. Be direct and simple in what you say. Get help. The people who have been there longer than you should be good models on what to do. Ask them what they do in such-and-such a situation, and when there is a situation, talk about what happened afterwards. You'll learn alot by doing and observing.

    This is a huge topic and hard to answer in a couple of paragraphs. Do you have more specific questions?
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    Thank you for your responses. I don't have anything really specific; I thought maybe there might be some good advice from seasoned psych RN's about things they have seen and heard over the years. I'm also looking for some suggestions on good books to read that may give me some insight on the psychiatric world. I just finished my Crisis Prevention Training today and learned a LOT of helpful information in dealing with clients. It also made me realize just how unpredictable psych patients can be.
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    When I was first a psych nurse, I'd go to the big book stores and look in their nursing/psychology/self help aisles. There are hundreds of books there! It's fun to sit down in one of their handy chairs and just flip through the books to see if there's something worth buying...
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    hi LIG1973 I have been a Psych Nurse for the past 36 years and yes it can be very interesting and yes it can be frustrating, scary ,threatening etc. The things you should know about the profession you have entered, it can be rewarding and it can be demoralizing depends on how your ego is. In saying that remember how you would like to be treated, if you were ill is how you should treat the ill yourself, with empathy. I also urge you to be aware gain the peoples trust through a good rapport with them and inform them when you first shake their hands that you want to shake their hands as they go out the door they have just come in and you will work with them to do that as quickly as possible. all the best robails1
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    Hopefully your unit will send you to some sort of crisis intervention training. My unit used the Mandt System. Mandt teaches you restraint techniques, but it also teaches you crisis response so that hopefully the situation won't get that far.

    As far as deescalation techniques - tone of voice is very important. If the escalating patient senses that you are also losing control, it is very scary for him/her. Speaking calmly and slowly and keeping your statements in small, easily-digestible bytes (the escalated patient isn't concentrating very well) helps, too.

    It may also help to allow another staff person to take the point if that person has a good rapport with the patient. Check your ego at the door, and realize that just because you are the charge nurse doesn't mean that you are always the best choice to handle every situation. For instance, I had a female patient on my unit who was suffering from PTSD after a rape, and she began to escalate. According to the patient (who explained after the situation was over), I physically resembled the man who raped her, and she was afraid of me when I entered the room. I quickly left the room and sent in one of the female staff who she had spent a lot of time talking with to handle the situation.
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    hi orca & anyone I have lectured on Critical incidence and techniques to combat aggression as well have been to Prevention and management of violence and aggression courses over the years and still in a split second when someone is in your face and ready to belt the be jesus out of you. You tend not to think of what you learnt but anxiety and fear of a threat even perceived threat can cause adrenaline to rush and the consequences can be damaging. The end result is you learn from it and you start again and yes assess the situations before you put yourself in them or act or do something which could be detrimental to your patients or your career or self.
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    Whenever we had a restraint situation, we always had a debriefing immediately afterward. We discussed what we did well, what we didn't and what we could take away from that particular situation. I found it very helpful.
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    I always find it helpful to talk to the people who work with particular patients a lot, and find out more about the patient...for example, what behaviors do they display when they are decompensating? Some patients have a predictable pattern of behavior that indicates they are decompensating. I work outpatient county mental health and I LOVE it!! Psych is the only reason I went to nursing school, and aside from a brief stint on a med/surg unit, it's the only thing I've done or will do!! Welcome to 'the dark side'!! lol

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