Tips for Psych nursing

carolmaccas66, BSN, RN · Oct 6, 2011

This question is very hard to answer. Psych nursing covers an awful lot of conditions and mental health illnesses. Some tips I can think of off the top of my head are these:

- Don't stand over patients. Always ask to sit down next to them.

- Do not react when they say things like 'I've had 17 abortions' or 'I got raped for 10 years then took a heroin overdose'. You will hear and see horrific things, but DO NOT REACT. Reacting is seen as judging.

- Listen. Do not judge (this can be very hard as humans judge each other all the time). If u can't offer any advice, don't. Touch is important, but some psych patients don't like people touching them - it sets them off - you usually have to judge this by the patient.

- Don't walk right into a room even after u have knocked. I ALWAYS say 'Can I come into your room?' or 'would you mind if I sat on the bed?' (to talk to someone etc). Let them invite you into their room. Some patients are long term and their room is their home.

- Do not care for a patient if ur getting upset by them, or vice versa. Some patients like nurses they have known for a while to care for them. If the above is the case, ask for another patient - it doesn't do anyone any good if u can't get along with ur patient/s.

- I try to get to know my patients as much as I can. You will never be friends or bond with every patient. Just try to get to know them as much as they will let you.

- Remember always that you cannot fix every problem. Sometimes, patients just want someone to vent to, or to talk to re their problems. DO NOT get sucked into every little detail - you will waste too much time talking & won't get ur other work done. I always say b4 talking to someone 'I can spend 20 minutes with you (for example), and then I must see my other patient/s'. That gives the patient ur with the expectation that u can't spend the entire night with them. If u let them talk about EVERYTHING, you will be in their room all night and they will follow you around, so you don't get any work done.

- Be firm, but positive and clear in ur instructions towards patients.

- Remember when caring for anorexic/bariatric patients - they can be highly manipulative - do not get conned into believing everything they say, ie: had an anorexic patient who told me she'd been raped & beaten for 10 years, it was all a lie, extensive investigations done & it was proved she made up fantasies to explain her eating disorder.

- Involve the patient's family as much as possible in patient's life & treatment.

- Try to sit in with the psychiatrist when u can (& if they allow) when he/she is assessing a patient, so that u have input into what they're saying to patient.

I can think of more, but it's getting late down under, so I must have my milo & go to bed! Hope this helps a little :)

HeatherPsychRN · Oct 8, 2011

Thank you! It is a big help! I would love to hear more when you have the time!

carolmaccas66, BSN, RN · Oct 9, 2011

Heather, I will post more later. I am going to have my lunch soon!

Meriwhen, ASN, BSN, MSN, RN · Oct 9, 2011

Learn how to set boundaries...then stick to them. A lot of patients can be manipulative (most intentionally), and consistently enforcing boundaries is one of the best ways you can deal with that. Also be on guard for staff splitting, which is another common patient pastime (again, usually done intentionally).

You and your staff should learn to work together as a team and when issues come up with each other, address those issues right away. But remember to present a united front to patients--save major disagreements and arguments until you're off the floor.

rn/writer, RN · Oct 9, 2011

Google "therapeutic listening" or "reflective listening. The goal with these is to lob the conversational tennis ball back to the patient. Just try not to sound too robotic and formulaic when you do it.

Patient: I *#^%&* hate this place and I hate my parents for putting me here.

You: "Yeah? What's got you bugged?"

P: All the *&*^%$ rules. Like I can't have my belt or my shoelaces. And I can't use a scissors. That's so lame. Like I'm going to stab someone.

Y: You don't have a lot of the freedom that you're used to.

P: I can't even call my girlfriend. Just my %%$#@* parents, and I don't have anything to say to them. Not anything nice, at least.

Y: Why do you think they brought you here?

P: Cause they're (*^&%$%^ jerks.

Y: Any other reasons?

P: 'Cause I threatened to throw my little sister's hamster down the toilet. I hate that %^&*(*&^ thing. It's always making these scratchy sounds that drive me *&)$%^ bonkers at night.

Y: Are you sleeping better here?

P: I was till I got my weirdo roommate. He snores like an elephant. Plus he smells.

Y: That's a challenge. Back to the hamster threat, have you said or done anything else that might have put people on edge?

P: You know I did. I know my parents told you guys all kinds of stuff, like about the knives under my pillow and taking the car out at night.

Y: They did, but I'd like to hear it from your point of view.

---------

You stay non-confrontational but your focus keeps returning to the patient. You don't get freaked out (at least you don't show it) and you take his statements at face value, even as you challenge him a little.

I used to enjoy doing one-to ones on the adolescent unit. The kids were so gut-level honest, and many of them were thrilled to have someone actually listen without "coming down" on them. That doesn't mean you don't call them on inconsistencies or push a little when you think they're trying to con you--you just do it without being mad at them.

If they get upset, you back off a little and say something like, "Let me know when you feel like talking again."

The biggest thing I will tell you is don't take things personally. And that goes for the good things as well as the bad. When they tell you you're the best nurse ever and the only one who has ever listened to them, don't be suckered in to thinking you're making a breakthrough and forging a bond. That might be true, but it's more likely you're being set up to be manipulated down the road.

Conversely, if they curse you and all your ancestors and tell you you're ugly and you need to lose a few pounds and your roots are showing (usually happens when the manipulation doesn't work), don't take that personally either.

Get your need for self esteem met away from the job and you won't have to be a hero at work. As someone else said, watch out for staff splitting. If a kid tells you, "Tony lets me stay up till ten," when you know the bedtime for this kid's level is nine-thirty, you just say, "Sorry. I'm not Tony." And say it with a gentle smile. Thanks for playing our game. We have lovely parting gifts for you.

A lot of this will come as you watch other staff members. You're not there to be liked. You are there to do the important job of helping these kids find some order in their chaotic lives.

Hope this helps. :up:

carolmaccas66, BSN, RN · Oct 9, 2011

- Remember you won't 'click' with every patient. This does not make u a failure as a RN/RPN.

- If a patient says they feel siucidal (have SI - suicidal ideation), or tell u they have just tried to commit suicide - then stop immediately whatever ur doing and just talk to them. Talking is very therapeutic & can calm most people down. Try 2 take them to a quiet place if possible. Let their Dr know ASAP.

Patients will be admitted with many, other problems like diabetes, hypertension and many psych patients have social problems. Always try 2 refer social problems to the social worker, as u can't get too involved in these. If u do, u will be seen as 'taking sides' against the patient, and you want to avoid this.

- Work with the patient's psychiatrist as much as possible.

- Always assess how medications affect patients. They may have extrapyramidal side effects (uncontrollable shaking, nervousness, parkinsonism). Suggest changes to meds and/or dosages to their Dr as necessary. The Drs rely on u to give them information re their patients, & will read ur notations or ask u for an update. Be prepared to know ur patients & their background (I use a cheat sheet cos 8-9 patients is A LOT to keep track of!)

- Always tell the Dr and NUM/shift coordinator if anything seems 'off' re your patients. Sometimes this is a 6th sense thing; and you can guage this better when u get to know ur patients better.

- Don't shout back at drunk/psychotic/angry patients. It won't achieve anything and closes the lines of communication. Stay calm - if u can't, tell someone u can't cope & get them to take over.

There's something else nagging at the back of my mind, but I can't think what it is at the mo. Maybe I'll go have another glass of wine & it might come back to me....!

HeatherPsychRN · Oct 10, 2011

Thanks for all the feedback, I can't tell you how much it helps! I have seen most of this stuff going on with other staff, but it is so much easier when you are told what is going on and then see it too. The talking to a patient with suicidal ideations right away is good advice-sometimes I just feel overwhelmed and need to remember how to prioritize care... And the references to google is great! Thanks again! This feedback is good! :idea:

xenogenetic · Oct 11, 2011

1.) Use humor as one of your tools for building rapport with and managing difficult patients. Sometimes infusing a little appropriate humor and making a patient laugh when a patient is perseverating or being negative can go a long way to helping that patient break the behavior pattern that they are currently in.

2.) Smile at psych patients, just for no reason at all.

3.) Try to talk to patients like the human beings that they are. Sometimes, because they are mentally ill, people talk down to psych patients and order and bark commands at them. First try talking to them as if they were just another person on the street outside of the psych ward.

carolmaccas66, BSN, RN · Oct 11, 2011

1.) Use humor as one of your tools for building rapport with and managing difficult patients. Sometimes infusing a little appropriate humor and making a patient laugh when a patient is perseverating or being negative can go a long way to helping that patient break the behavior pattern that they are currently in.
2.) Smile at psych patients, just for no reason at all.
3.) Try to talk to patients like the human beings that they are. Sometimes, because they are mentally ill, people talk down to psych patients and order and bark commands at them. First try talking to them as if they were just another person on the street outside of the psych ward.

What great advice! I find many of the nurses who are only psych nurses (not genreal RNs as well), get a little institutionalised too, and tend to talk down to patients, especially the ones who have been in a facility for a long time.

Yes use appropriate humour and ask patients re their day. EVERYBODY - without exception in my experience - loves talking about themselves. And if they don't want to talk to you right away, I always say come and get me or I will see you later to talk, and invariably, they always come and find you, which is great.

netanyami · Jan 18, 2015

I read an article about a nurse with bipolar. I'm wondering if that could work in a psych ward since the bipolar nurse see things on both sides.

greenbeanio · Jan 23, 2015

I read an article about a nurse with bipolar. I'm wondering if that could work in a psych ward since the bipolar nurse see things on both sides.

This is your tip for psych nursing?