Response to Molly from psych nurse!

[Bjo]

Hi Molly,

I am a psychiatric nurse with specialty certification through the ANCC. I will try to answer some of your questions because I absolutely love my job! I work as a nurse manager in a psychiatric hospital for children and adolescents. I have been at the same facility for 8 years.

My most effective ways to de-escalate angry situations are to most importantly, treat each situation individually. When the kids are admitted we complete a questionaire about such situations. We ask the kids if they have ever escalated to the point of losing control, what methods have worked for them to calm down and if there are any types of medication they have found to be useful. We keep these questionaires in a binder and utilize them throughout the patient's stay. A 'normal' stay is usually about 5-7 days. I stress to my employees that communication is of utmost importance. Many situations can be handled by listening and problem solving. It is helpful to have keen observation skills in regard to body language as well as being aware of why the kids are there in the first place.

As far as compassion, I sometimes become very frustrated with the repeaters. I try to always keep in perspective that these kids and their families need help and it is our responsibility to provide the tools for them to get better. It is hard to accept sometimes but not everybody wants to get better!

Chemical dependency in teens is definitely a contributing factor to emotional problems. Getting to the core of the problem is helpful. When the precipitating factors are identified regarding the need to use, it is easier to help the families problem solve the situation and develop more effective coping skills. You have to find the problem to come up with a solution and drug use is an indicator of emotional instability in itself.

Our LOS is very short. The purpose of our unit is to stabilize the patients and return them to a lessor level of care. We ensure a plan of action for follow up care but we can't guarantee the families will follow through. That takes us back to the compassion for repeaters! Our job is to merely offer the help but we can't carry it through for them. We try to stress to them that their place is in the community with their friends but some kids still feel more comfortable being institutionalized than being 'out there'.

Five things I would tell parents about their teen:

1. Don't feel guilty because you hear a sob story about how unfair the rules are.

2. Always let your teen know you love them even if they don't believe you.

3. Put the responsibility for the teens behavior back on them and make them suffer the consequences even if it hurts you. Be sure the teen knows the consequences of his actions and let him decide what to do. Just follow through, follow through, follow through, on whatever you have told him.

4. Being a teen ager is tough. You are the parent, they are the child. You have more experience and they need your guidance as an adult.

5. You can't force change. If they don't want to do it, they won't do it.

Hope this was helpful!

Bobbi Jo

[ChristyM]

I work in a short term private hospital in children/adolecent unit also. The number of repeat visits is very high. We do as much as humanly possible for our "kids", then we send them home to the same environment, where no one else has changed, their stay with us has no lasting effect (how can it). Medication alone can only work so much. There are no magic pills. Our facility stresses the importance of family involment, but there are many who only show up for admission and discharge. A few months later(sometimes less) the child returns and and the parents don't understand why!!!! I have seen some of our patients grow up. I feel as if they I am part of their family. This frustrates me terribly

Bobbi Jo the rules at the end of your post are fantastic!!!!! Now maybe we can find a way to make familes follow them