Therapeutic 24/7?

Nurse Ratched, RN · Oct 29, 2005

Correcting inappropriate behavior *is* part of being therapeutic. Setting boundaries is one of the most important things you do with the adolescent/child psych population.

We could brainstorm on the ways to redirect without saying no: "How would you feel is someone was kicking you?" "Tell me about why you believe it's OK to hit other people." Not in a smart tone, which is hard to convey here, but asked in a genuinely curious manner. Nothing slows a kid down like asking him/her to think .

I suspect you're doing just fine :).

lucianne · Oct 30, 2005

When you are working with kids who have little or no internal control, sometimes you have to exert external control until they can do it for themselves.

Since you don't have kids (and even if you did) you might find some of the books on positive discipline helpful. They will give you some ideas on how to correct unacceptable behavior without saying "No!, Stop!, Don't____" all the time, as well as ways to encourage appropriate behavior. Depending on the age/maturity of your patients, you could say things like "People are not for hitting. Do you need to go to your room until you are able to stop hitting?" (not a seclusion, just give the suggestion and they might go voluntarily). "I can see you are having a hard time keeping your hands to yourself. Let's find something to do to keep those hands busy." "I like the way you are paying attention/cooperating/sharing..."

When the milieu is agitated, sometimes it helps to have activities that engage the senses--clay, shaving cream, finger painting, water play, music, dancing, acting, etc.

No matter what you do, there will be times when things feel out of control and you feel like a prison warden. At those times, the most important goal is to keep everyone safe. Don't be afraid to use PRN meds if they are ordered. I know some people worry about "drugging" the kids into "zombies," but physical management and seclusion can be traumatizing to kids--or they can thrive on the drama and attention and learn to act out even more to get that attention. Try to keep to the minimal but effective dose unless you are dealing with a kid you know will wind up in seclusion otherwise. When kids are starting new meds or increasing doses, they may need a little extra help to keep themselves under control until they have reached a therapeutic dose.

Make sure you take care of yourself to prevent burn-out. If your facility doesn't do supervision, you could try to arrange it yourself among the staff when there has been a particularly distressing incident or if the acuity is unusually high. Communication among the staff is especially important then as kids need consistency from their caregivers.

I think working with kids is great, but if you aren't careful you can easily get overwhelmed. Good luck!

Cute_CNA, CNA · Oct 30, 2005

It's even stranger when you're redirecting people older than yourself in an adult psychiatric hospital! It can be a lot like babysitting. A LOT!

PRNMEDS · Nov 9, 2005

Your feelings are normal. I work with Adolescents, and often feel the same way you do. Just remember that many of these kids have never had anybody care enough to say no, or to try and teach them the "right" way to do things. Of course sometimes frustrated, and not the most thereapuetic - even though we are nurses we are still human (I think anyway :rotfl: ) so nothing is 24/7. Do you have a more senior nurse or therapist you can speak with when feeling extra frustrated. I know at my hospital many people feel what you described and we sometimes vent to each other. Believe me I would be shocked if you were only one there who feels that way. My advice - get a few co-workers together and go out to "Happy Hour" - feel a lot better when you return to work on Monday.