Psychiatric Home Care Nursing

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    I am about to start a new job as an RN Mental Health Home Care Case Manager. I will be doing intakes, home visits and the 60 day re-certs. (I am not sure if re-certs is the correct term-I have been out of the field for 13 years!)

    I have psych. nursing experience, including home care, but that was eons ago,in nursing terms. To me, OASIS is a nice place in the desert where you can get water, and the camels can rest.

    This will be a challenge in another way, as most of my psych. experience was inpatient care. I have done psych home care years ago, but it was with a small number of clients and I never had any major problems arise that were a challenge to manage.

    Any advice would be appreciated. Stories of challenges that you went through, or patients that taught you new things... I want to be prepared to do my best. Thanks!

    Pooksmom
    Last edit by Pooksmom1996 on Jul 2, '09
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  4. 2
    oasistraining.org

    This website will help you.

    I loved the psych patients.

    You will be fine.

    The documentation will come easier as you do the assessments and learn
    what the question is asking and how to answer it according to government
    standards............

    My favorite accomplishment was using light therapy (my own idea and okayed
    by the doctor) on a patient with seasonal affective disorder............she was
    not willing to take medications and had problems all year round, not just
    in winter. It worked and her family and she was very grateful!

    The patients who do what is asked of them in the one to one talk therapy
    are the ones who do the best.................and it is very rewarding to see
    them progress.
    Smitty08 and Pooksmom1996 like this.
  5. 0
    I currently am doing Med/Surg Home Care and am curious about Psych nursing Home Care. Would you feel safe doing psych nursing home care? Rarely I feel unsafe but I don't ever have to go to home if I ever feel safe. It might be different for psych patients.
  6. 0
    I am a little confused by your post.
    Home Health does not do nursing home care.
    There are psych nursing homes.
    I have been director of one. No, I was not scared.
    Your experience prevents that.
    Not understanding the patients and their behaviors when you are new
    to the psych world is what scares people.
  7. 0
    Quote from bargainhound
    I am a little confused by your post.
    Home Health does not do nursing home care.
    There are psych nursing homes.
    I have been director of one. No, I was not scared.
    Your experience prevents that.
    Not understanding the patients and their behaviors when you are new
    to the psych world is what scares people.
    I'm sorry I misread your post. It now makes sense.
  8. 1
    Quote from Nurse4life09
    I currently am doing Med/Surg Home Care and am curious about Psych nursing Home Care. Would you feel safe doing psych nursing home care? Rarely I feel unsafe but I don't ever have to go to home if I ever feel safe. It might be different for psych patients.
    I rarely felt unsafe when I visited psych. patients at home in my previous home care job. Usually the clients view the nurse as a support person. They are often socially isolated and welcome the company, and the security of knowing that a caring person is checking in and making sure that they are OK. Home visits are voluntary-the client has a choice to accept visits or not, and if a client is becoming very paranoid, they usually will not open the door if they feel that the nurse is a threat.

    In my experience, working on a locked psych unit is much more dangerous, because clients mostly tend to lash out when they feel trapped in a situation. Also, if I visited a client and felt that I was unsafe, I could leave the clients home, tell my supervisor, and another plan could be made. Perhaps the client needs to be hospitalized, or a visit by two nurses could be arranged. I don't remember ever having to do this. I am lucky in that I work for a great company (same one I worked for in the past)and I believe that they take safety very seriously.
    Thunderwolf likes this.
  9. 0
    Agreed w. above that I rarely felt unsafe in doing psych. home care. It was at times a little strange going into peoples homes for assessments, I would often have the medical nurses request an eval. to see if there was a psych. dx. I was a new APRN at the time. I think its great to have some psych. inpt. experience to do psych. home care, as you will see the whole gamut!
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    Im really curious, what sorts of things does psych home care involve? What sorts of patients do you see (disorders, levels of acuity etc), what sorts of things do you do with them (just chat, dispense meds, assess safety etc) and what sorts of other supports do your pts have?
  11. 0
    Quote from rachelgeorgina
    Im really curious, what sorts of things does psych home care involve? What sorts of patients do you see (disorders, levels of acuity etc), what sorts of things do you do with them (just chat, dispense meds, assess safety etc) and what sorts of other supports do your pts have?
    Many of the clients have schizophrenia or bipolar disorder or schizoaffective disorder. They usually are non-compliant with their meds if they dont have help in this area. They need help from a homecare nurse who can bring the meds from the pharmacy and make sure that the meds are set up for the week. If possible, the client sets up the meds while we supervise. Some clients take injections such as Risperdal but are not able to reliably go to the clinic every couple of weeks to get the shot. so, we come to the home and give them the injection.

    Med teaching and monitoring of the clients' condition are all very important pieces also. We are the eyes and ears of the docs (and social workers) in many ways. Also, we can help clients with support and strategies if they are going through some kind of crisis.

    Quite a few patients need a PCA or Home Health Aide part time to help them, as they cannot manage independent living without that support. Supervising the aides is part of what we do.

    Many clients have physical things going on such as diabetes or impaired mobility and we help them manage those as well, in the same way that any home health care nurse would. At my company, the psych case managers do not take clients with ventilators or highly complex medical care-those clients are followed by the medical case manager nurses.

    In my area there are day treatment programs where the clients can go and attend groups and socialize with other people. I believe that social workers often help with hooking patients up with these-I dont know much about that piece yet.

    Hope this helps! Psych case management is a rewarding field-we help keep patients out of the hospital and are an important part of their support.


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