web of manipulation?

Specialties Psychiatric

Published

Hi,

I'm a student doing my psych rotation and I really like it.

Im, however, confused: a pt w/o insurance was admitted and started to ramble in the day room, in front of others of how no one was seeing him or giving meds and that no one was helping him and worse, he'll get evicted from home and has no job, blah blah. I know the nurses were getting VERY annoyed, esp. b/c he was admitted regardless of his lack of insurance, was actually seen by an MD and was given three meds...only not the ones he was seeking. Well, I asked him how he managed previously to get his prescribed meds and he said sometimes he had to go w/o paying bills and also buy them on the street. Well, that was when the RN popped in, heard only the part about buying benzos on the street and accused him of glorifying drug use, which was not the case. She asked me to back her accusation up and I had to be honest and say that I did not think he was glorifying drug use. She got mad at me saying that now she's the bad guy and that I just did what he manipulated me to do. I know he was drug seeking and upset and ungrateful for what they did to him and an annoyance and disruption at the unit. Well...I just could not in good conscience affirm that he was glorifying drugs when he was not doing that at all.

What do you all think about this?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Did you look through and read all the assessment information on this patient in his chart? Is it possible that the nurses and doctor knew information about him that you didn't? Was he admitted before? Did they know him from previous admissions?

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Good questions, thank you. At the incident I had not looked at his info b/c I had a different patient assigned.

What I want to know is: should I had sided with the nurse or tell that he was not glorifying drugs, even though he was being an ass and all?

pe

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When in doubt, always consult with your clinical instructor for guidance. :) As a student, it's best to avoid getting into situations that involve taking anyone's "side." As Daytonite notes, students typically don't know much about a client's history and preferred defenses and communication patterns (positive or negative), and certainly don't know how much familiarity and "history" the staff have with a particular client.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

why is it important to side with anyone at all? you are a student, right? you are supposed to be learning about the nursing process, right? the nursing process is all about making decisions. step 1, do a thorough assessment:

  • a physical assessment of the patient
  • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with their disease
  • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
  • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.

you never make a decision until you are satisfied that you have all the facts. even then, there is usually something that can get overlooked--my years as a nurse taught me that! a thorough assessment to obtain all the facts comes from many resources. you only talked to the patient in the day room and in your second post even stated that you had not "looked at his info". do you think you did a thorough enough assessment to make any kind of decision about this patient? i sure wouldn't want to make a care plan based on what you knew.

you need to get over this idea of "siding" with people. this isn't a street corner where you are vying for one-upmanship and leadership. be professional. we all have opinions, but we base our opinions on logical and knowledge.

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Specializes in critical care; community health; psych.

I believe what happened was not in the patient's best interest. It really shouldn't have come down to that though. The RN should have thought ahead. It's not about us and what we think. We can only guide. Besides, you are the student.

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I agree with everything I read but would just like to add that Psych rotations can be pretty intense and I think it was a bad idea of the nurse to put you in that situation. He or she probably would not have appreciated it had the tables been turned. I found that some nurses were a little burnt out (understandably) and often overreacted, but as students, how are we to really know where our boundaries lie. Just better to not be put on the spot, I guess. Anyway, hope you made it thru.

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Specializes in Med-Surg, Psych.

Since you're a student, I suggest being careful when talking with psych patients that are not your assigned patient. Psych patients can be very manipulative.

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why is it important to side with anyone at all? you are a student, right? you are supposed to be learning about the nursing process, right? the nursing process is all about making decisions. step 1, do a thorough assessment:

  • a physical assessment of the patient
  • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with their disease
  • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
  • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.

you never make a decision until you are satisfied that you have all the facts. even then, there is usually something that can get overlooked--my years as a nurse taught me that! a thorough assessment to obtain all the facts comes from many resources. you only talked to the patient in the day room and in your second post even stated that you had not "looked at his info". do you think you did a thorough enough assessment to make any kind of decision about this patient? i sure wouldn't want to make a care plan based on what you knew.

you need to get over this idea of "siding" with people. this isn't a street corner where you are vying for one-upmanship and leadership. be professional. we all have opinions, but we base our opinions on logical and knowledge.

in an ideal world, we don't have to take sides. in the real world, it's another story. certainly the student is entitled to her own view. however, for speaking her view, she angered the staff nurse. how badly? i hope not very and i hope not forever.

op: don't get sucked into the whirlpool of the patients' stories. the part about him buying his meds on the street is a warning flag. i think he probably could get his meds through a clinic, for free, if he wanted to and if he was capable of being organized enough to keep appointments and the like. try to stay above the fracas. it wouldn't have really hurt you to grunt some sort of non-committal acknowledgement when that nurse asked you. like "ummpp" while shaking your head despairingly, slowly, side to side. :chuckle wish i could show you and have audio here so you'd know exactly what i'm talking about.

the nurse needs to get a grip, too.

best wishes to you in school and after.

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Specializes in telemetry, med-surg, home health, psych.

oh the borderline, what a wonderful pt. to be talking to, especially as a student.....I still must be so careful when dealing with them....they can be SO utterly manipulative and are so good at staff splitting.....

We had one on the unit that literally got as many as 11 other pts. on her side and they were about ready to revolt!!! complaints, imaginary things happening to her, etc, etc....we finally had to dischare a few of them it got so bad....These pts. are so cunning....

But in your situation, (sorry, got off track), do not get so involved that you are put in that situation to side with anyone while a student....

Watch, listen and learn............good luck, happy psych nursing....

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Specializes in psych, addictions, hospice, education.

I'm thinking that if the nurse got angry because she was considered the "bad guy", it's because she WAS the bad guy and might have felt somewhat guilty about her behavior.

I wonder what the patient's diagnosis was--if he was schizophrenic, he's likely to be paranoid, and that could account for his belief that no one was helping him.

I'm glad you stated what happened and didn't just agree because it seemed to be expected and/or would have been the easier thing to do. You were a patient advocate and that's one of our basic roles. Sometimes it's not at all easy. Yes patients manipulate, but we don't know if that's the case in this situation. You stated the facts, as anyone would do. By the way, I've been a psych clinical instructor for over 10 years and I would have backed you up in all of this. I think you did a very positive thing. :yeah:

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Good questions, thank you. At the incident I had not looked at his info b/c I had a different patient assigned.

What I want to know is: should I had sided with the nurse or tell that he was not glorifying drugs, even though he was being an ass and all?

pe

NO! State facts.....it's your license.....

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