Things I wish I could tell my patients

[vintagemother]

I wish I could tell my clients at work that there is hope for a life in spite of a psychiatric diagnosis.

Sometimes they tell me they feel ostracized and left out of society because of their illness. I wish I could tell them that I struggle with mental illness, but I have found a way to survive and thrive with a mental illness.

Sometimes I see their disbelief when told they will have to continue taking meds after discharge. I wish I could tell them that there's nothing wrong with taking meds. Meds help you do the day to day activities others take for granted.

I wish I could give them tips for remembering to take meds, such as setting a phone alarm with a message only you understand that reminds you.

I wish I could tell them that a dx of anxiety or depression do not make you a bad person.

But I can't.

Well, I can. But I feel my words are hollow. Because I can't tell them that I know this because of my own personal experience with mental illness.

I don't look down on my patients. I know that, but for the grace of God, anyone could have a mental illness.

So I pray for them. I try my best to show them I care. I touch them on the arm, give them high fives and fist pumps. I sit next to them. I listen to them. It's all I can do as their nurse.

Thank you, AN.com, for giving me a place to vent.

Thank you to the others on here who tell me about their own struggle with mental illness and support and encourage me to take my meds and take care of myself.

#tears in my eyes

[albymangel]

One needs to consider disclosure ver carefully preferably with clinical supervisor

Sent from my iPad using allnurses

[poopylala, BSN, RN]

I'm starting out with my BSN right now but my goal is to become a psych nurse and later become a nurse educator. The main reason aside from mental health having always interested me is I suffer from anxiety and have family history of a number of other MI. Thank you for posting this because I like reading the discussions about what is allowed to be shared with a patient when connecting with them. Could you check any manuals at work or ask a coworker/supervisor what is allowed?

[Meraki]

I think you have to be very, very careful with self-disclosure. You can advocate for mental health and work towards decreasing stigma without self-disclosing to patients. There are lots of pitfalls in disclosing and I have rarely seen it go well in my 15 years of psych nursing. It is quite a skill and a challenge to ensure the disclosure is therapeutic. Some of the possible pitfalls are...

- patient feels unheard or invalidated, sees disclosure as you shifting the focus to being about yourself.

- patient had an emotional response to your disclosure and it impacts their mental health - for example they are worried about you, upset by what you said

- patient feels the need to support you, or wants to support you, or thinks you want their support

- patient doesn't want to bother you with more of their problems / emotions because they now see you as someone who already has enough on their plate and they don't want to burden you further.

- patient misinterprets your self-disclosure and the reasons for it (why are they telling me this?), impacts the therapeutic relationship and leads to boundary violations.

- patient now wants more detail, wants to know more, asks you about personal events in your life now that you 'opened the door'. Feels hurt if you then pull back after some disclosure.

- focus of conversation shifts to you or to you trying to get focus off of yourself

-patent does not react or respond to your disclosure as expected. Doesn't find it helpful, it doesn't give them hope, they can't relate as you though they might - again shifts dynamic of therapeutic relationship, nurse can feel hurt or rejected

-patient under no obligation to maintain confidentiality of what you tell them. They share it with other patients, families, team members and information gets modified as it moves around. You no longer have any control of the information you put out there

-the reality that the message sent (intentions) is often not the message received (outcomes)

Perhaps in a setting where you have a long term relationship with pretty stable clients, it could be beneficial but in acute care or with clients already emotionally vulnerable, it is a bit of a minefield.

I still think you can use personal experience extensively in psych without self disclosure. Use a third party - "a friend", "another patient I worked with", "something I have seen is..." Basically sure your experience and what worked without directly connecting it to you.

[ms_miyagi]

In an effort to emphasize how important it is for my patients to continue to take their medications after discharge, I advise them that their illness is just like any other run of the mill illness that requires daily medications, i.e., HTN, Diabetes, High Cholesterol, Seizure d/o etc. The majority of my patients have these co-morbidities and with the exception of a very few, they are without fail compliant with these medications. So, I play off that information and remind them that their MI is the same type of thing, if they want to get better and do better on a daily basis, so that they aren't stigmatized, they MUST take their medications as directed by their physician. I also advise, when asked, that, at least, where I live, an employer cannot ask about medications a potential employee takes on a daily basis. It is at the employees discretion to divulge that information. And, that as long as they have a prescription for drugs that appear on your average, daily drug screen, that's alright as well.

As for sharing personal experiences, if done with the appropriate tone, to instill hope, there is nothing wrong with it. I have in the past shared my struggles with grief and depression with patients in the appropriate situation. These are all teaching tools and as nurses, part of our job is to teach our patients, about their condition, coping techniques, their medications and the side effects of the medications. We must all look for teaching moments, even if the patient is deep in their psychosis, it does work. I don't know how many times I have had patients come in deep in their psychosis for days on end and I will still sit and talk to them as much as time permits, whether or not they acknowledge me and days later, after their medications have been adjusted and are working, they will come to me and tell me thank you for believing in them and taking the time to talk to them

What I have seen in my patients is they look at the staff as a bunch of people who have absolutely no clue what their struggle is, and to a large degree they are correct. I have absolutely no clue what it is like to have a/v hallucinations or they type of Hell they create, nor do I understand the paralyzing paranoia that some of my patients suffer from. All I can do is reassure them that they are in a safe environment and that nothing can hurt them there. But depression, grief, and addiction (from an enabler's perspective), these things I can talk about from personal experience and share how I made it to the other side. We do this in group, we share coping techniques, because even other patients can be teachers and share techniques that have worked for them in dealing with their issues. I can also share how my friend's have dealt with their Bipolar d/o. Believe me, when we personalize our care of our patients, we humanize ourselves to them, which go a long way in our treatment of them. When we can connect with them on a level they understand, they hear us, and at least in Acute Adult Psych, this can quite literally save your life.

[VivaLasViejas, ASN, RN]

From a patient's perspective: I think I would appreciate having a nurse who "gets it". There is no substitute for talking to someone who's been there, done that, got the battle scars to prove it. I am the administrator of a support group made up of other nurses with mood disorders, and their input has been invaluable to me over the years.

I realize that the circumstances are different; these nurses (and ex-nurses) are my peers, while a nurse in a psychiatric hospital would be an authority figure. Disclosing to me in such a setting might or might not be a good thing; I am an empath to whom a lot of people like to "confess", and I tend to take on their burdens in addition to my own. But when I'm ill, I don't have a lot of room for someone else's problems. Still, I think it could work under the right conditions, as long as the disclosure is matter-of-fact and intended to help me understand that I'm not alone. That's one of the big problems mentally ill individuals face---the feeling of being utterly alone among people who can't understand what we're going through.

Just my $0.02 worth. :)

[Meraki]

But depression, grief, and addiction (from an enabler's perspective), these things I can talk about from personal experience and share how I made it to the other side. We do this in group, we share coping techniques, because even other patients can be teachers and share techniques that have worked for them in dealing with their issues. I can also share how my friend's have dealt with their Bipolar d/o. Believe me, when we personalize our care of our patients, we humanize ourselves to them, which go a long way in our treatment of them. When we can connect with them on a level they understand, they hear us, and at least in Acute Adult Psych, this can quite literally save your life.

I find your perspective that you can only help people if you have had the same diagnosis to actually be somewhat shocking. I believe that I and the nurses on my team are able to personalize care, to humanize ourselves, and connect without self disclosure. Many of our patients are very appreciative of the support we have provided towards their recovery, without that support being self-disclosure. I would never assume that my experience is their experience and therefore sharing my experience is what they need to hear. As someone who has sought medical help for both physical and mental health care, I search for health practitioners who are knowledgeable about the illnesses, about current treatment options, and who are empathetic and respectful; and not for others who have had a similar diagnosis and want me to tell their personal story. I want them to hear my story and to provide me with their expertise and the best care possible. I couldn't' care less if they have experienced it themselves.

Would you only see an oncologist who had already survived cancer? Or only see a dentist who could tell you about his root canal? Or only an eating disorder nurse who herself had an eating disorder? There is a great deal of expertise that exists outside of personal experience.

[ksm0830]

Hi, I am currently a graduating senior nursing student at Coppin State University. Your blog really interested me because I feel the EXACT same way when talking to patients. I find it hard to maintain the boundaries sometimes because I fight with myself to not state my personal opinion even if it's just a simple "I can relate" or "I understand, because I'm dealing with the same thing". It's hard to find that balance when you want to help so many people and let them know that they are not alone.

[VivaLasViejas, ASN, RN]

I just got home after a week in a psych unit, and I'll never forget the nurse who told me that she fights depression too. She didn't elaborate on her meds or therapy (if indeed she was doing any of that) but she talked with me as if I was the most important person in her life at that moment. It made me feel less alone and let me know that she cared.

[jdewberry]

I believe that in certain cercumstances it can be extreamly benefical and therapeutic for a patient to hear about your experience and see that there is hope. While it is not appropriate in all cercumstances, not the majority in fact, I have done this as it was one of the most powerful things that helped me in my recovery. I too went into psych because I too have PTSD, anxiety, and depression (they all fall under PTSD). I was in a psych hospital myself, twice actually. I do not tell my patients this. But, the most powerful thing I ever experienced while in a psych facility was a Psych Nursing Assistant sitting down next to me at a time in my life that I was most vulnerable and scared and did not want to be here any more, and listening to her tell me that she too had once been sitting right where I sat. She too had been struggling with depression and she is better now, she is working at the very place that she once was completely broken in. She now sat one the same bench that she was at her lowest, looking at a woman and helping her become strong again. Giving her hope for a future. Letting her know that there is hope in recovery. There is now doubt in my mind that his was the most powerful thing I have ever gotten as a patient. I will forever carry this with me.

Again, as long as it is therapeutic for the patient, I believe it falls under therapeutic communication. She saved my life. You never know how much you can touch someone by showing them that you understand and how far you have come. I have gained more respect from my patients by doing this. They come to me now instead of hurting themselves. And even when I don't share my story, I know how to talk to them. I take pride in having a mental illness. I don't know how they feel but I know what it's like to be stigmatized, to be in the hell hole of a mental hospital, and to just want to be heard. It's such a powerful tool.

[elkpark]

Again, as long as it is therapeutic for the patient, I believe it falls under therapeutic communication.

Respectfully, I disagree. There are many ways we can communicate a strong message of hope, empathy, and encouragement besides disclosing personal information, and, IMO (from my education and what I've observed over decades in psychiatric nursing), it's never therapeutic. Once we start disclosing, the communication quickly becomes about us instead of the client -- and, unless you get up in morning meeting and announce to the entire client population of the unit that you have xyz psychiatric history yourself, you are "playing favorites" among the clients, establishing a seriously different relationship with that one client than you have with all the other clients, and that, too, is clearly, unquestionably nontherapeutic.

I think it's telling that the staff person who disclosed to you was a CNA and not one of the nurses; with more education, she would have known that she shouldn't be doing that, however helpful she may have thought she was being, and however powerful you may have found the experience. I think it's worth noting that, in my experience over the years, views on disclosing personal hx are directly related to education level -- techs and aides don't really see what could be wrong with just telling clients anything; a lot of staff nurses seem to waffle about it (I'm know I not really supposed to, but ...), and v. few graduate-level clinicians (psych APNs, social workers, psychologists, psychiatrists) ever even consider the possibility -- they just take it for granted that that's something you just don't do.

Also, totally apart from whether any of us, personally, feel that disclosing personal history may be helpful for clients, be aware that one is likely to get in trouble for this at work if one's superiors find out about it.

[vintagemother, BSN, CNA, LVN, RN]

I just wanted to pop on this thread and let y'all know I'm reading the replies.

I have decided to be a little more open with my patients. Not a ton of disclosure, just a little, to let them know anxiety is something "we" all work with. To let them know that side effects are to be expected, but "we" take our meds because we need symptom relief.