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A Lesson well learned "One size does not fit all"

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There is nothing more rewarding than Psychiatric nursing. With 16 years of experience, nothing prepared me for this eye opening encounter as did this tiny little 81 year old lady.

Specializes in psy. Has 41 years experience.

A Lesson well learned "One size does not fit all"

Working in a Geriatric Psychiatric Hospital, a lot of our patients are awake at night which requires the staff to do a lot of interactions with them to help promote sleep. This particular night, my lady was awake at the beginning of my shift, loudly talking and pacing in her room; unsafely preventing her roommate from sleeping. We questioned her as to what was wrong and what could we do for her, we were unable to pinpoint what was wrong therefore a staff member was assigned to stay with her until she calmed herself or went to sleep,

Unfortunately, this did not work. She was adamant that she wanted to walk up and down the hall. We decided that maybe this may relieve some of her anxiety. Due to her unsteady gait, we applied a gait belt as it is recommended by PT or all patients that may have unsteady gaits or difficulty transferring. The belts are applied around the patients' waist while the staff js positioned close near the patient so they are able to grasp the belt if needed as a means to provide safety for the patient.

After applying the gait belt she let out a piercing scream and began to cry...... her reaction stunned us all causing an instant pause. Tearfully she pleaded for us to take the belt off and began telling us how as a child her father would beat her with a belt then use the belt to tie her to a boiler while he played cards and drank with his friends.... it made her feel just like a dog. We immediately removed the belt and walked her to her bedroom. She continued to cry repeating over and over how she could not believe this is happening again. After assisting her to bed we sat with her for a while, looking up at us but not focusing on us, she began to say how much she loved her father but could not understand why he did this to her. She recalled her mother telling her how her fathers' drinking was the reason he did these things and he did not mean to do it.

Listening to her story saddened all of us. There was not a dry eye in the room after her revelation. She looked at each of us and proceeded to tell us how she thought she had gotten over it and really she felt she should have but when we put the belt around her it brought back those painful memories she thought she had long ago tried to forget. Noticeably calmer now, as she lay in her bed just as we about to leave her side speaking in a soft voice, she wanted us to know that it was not our fault she failed to tell anyone what had happened to her.... it was just too painful but next time please listen when someone is trying to tell you something.

Even though we were not aware of the traumatic experience she had, we should have realized that something was wrong. We must not only take the time to listen but listen with empathy and compassion using all of our senses to be able to individualize patient situations as they arise. She was referred to our Psychologist who scheduled weekly counseling sessions. All staff were alerted to the non use of a gait belt for her. This was one lesson well learned and will forever have an impact on us. As for my self, I will never forget this incident and it has encouraged me to look at my patients differently. I will from now on ask more questions, pay more attention to changes in behavior and focus on body language.

There are times that small things are overlooked when you are very busy and or dealing with difficult patients. That saying "One size fits all" when it comes to Psychiatric nursing should be "One size does not fit all".

Phyllis

A Nurse Manager from VA with 16 years of experience in Psychiatric Nursing.

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17 Comment(s)

I understand how this lady feels. I still carry the emotional scars from childhood and I thought I had dealt with years ago until my father died.

Thank you for taking the time to write this!! I wish everyone would read it.

This brought tears to my eyes! Thank You for sharing! I will always remember it.

Thank you so much for sharing, I was moved to tears and even had my husband read it. I'm a psychiatric nursing student and I would like to ask you if I can share your story with my class. We have been covering this very topic in our Therapeutic Relationships class and this is a moving and perfect example.

Sincerely,

Terri

thanks phyllis....we need more rns like you:yeah:

phdeha777456

Specializes in psy. Has 41 years experience.

That is awsome yes by all means please share this with your class and let me know their response. Psy nursing is so rewarding its experiences like this that has motivated and helped me grow over the years.

loved your story it reminds me of when my family member was in a propolol induced coma following ARDS ...you see he frantically tried to fight the intubation and as meds wore off, his arms were cutting into the wrist restraints. no one in the hospital knew he had been repeatedly tied down and raped as a child . I had to tell the nursing staff off this childhood ordeal....... and he was given around the clock care. I stayed most of the time too. I also kept telling him that he had pneumonia and the tube was in his mouth to help him breath, i also told him that his hands were being held to prevent him from touching the tube words were kept simple and safety was reassured, I'm in tears right now and will finish by adding that 2 years later he still remembers my words. you see we as nurses need all the compassion we can muster up.....you never know what turmoil your patient has suffered in the past........:cry::cry::cry::cry::cry: happy new year and bless you all dawnsternlpn

mysticalmoonray

Specializes in Orthopedic, Pain Management, Psych, Family. Has 10 years experience.

Such a nice reminder for those of us who get caught up in daily work that we 'forget' to take the time to really think about the thoughts and background a pt may have. Not realizing that when they cry, or voice distress that it may be due to something in their minds that is unresolved rather than just them 'acting up'. Thanks for the post and a nice reminder to keep our eyes and ears peeled.

how bleessful it is to be a nurse . i am new future nurse my friend . after i read you post i really think that i have made a right decision to become a nurse . thank you for sharing your experience .

I have a similar story. I was a brand new CNA and we had a patient who used to walk the wheel chair. which is clearly unsafe. The nurse and I both tried to explain to her how dangerous it was. This went on for hours and finally the nurse told me to go explain to the patient tha if she did not call for assistance to get up that we would have to put her in a vail bed, which is like a cage. The patient freaked and told anyone who would listen not to do that to her. A few more hours goes by and physical therapist comes and tells me that the patient had spent time in a Nazi concentration camp and that during her stay they had kept her in something similar. The Nazi's had also killed her baby in front of her.

When I heard that I felt so bad! The next time a nurse told me to do something like that I politely refused.

carolinapooh, BSN, RN

Has 10 years experience.

Thank you for sharing this story - what an amazing moment for you. That lady is in such good hands.

Dear Caroline,

I already know you have quiet experience in this branch of nursing,I am a freshmen in nursing,so pharmacology is giving me a very hard time,specially some drugs used in your field.Could you ,please give me a hand and answer the following question? Should we use the remainder doses of thorazine contained in a multiple vial after reconstitution, for the next doses of the patient?,thank you,Emiliano

Phyllis, thats why u r my mentor! Excellent article! I need a daily reminder as to why i stay and u just gave me the most important reason of all. OUR PATIENTS need us!!!! Thank You

tears in my eye. just goes to show you never know someone's story. I will be more open with my patient's thoughts and listen to them more carefully.

1EmergencyRN

Specializes in Emergency/Trauma. Has 2 years experience.

At the ER I work in, there are people who loose sight of the reasons why many patients may act out, there are certain personnel who repeatedly fault and blame the patients for erratic behavior indicating that it is a choice they've made to be difficult vs. remembering the need for compassion and holding the knowledge that we are and have the responsibility to be these patient's advocates. Even and often times especially for the ones that seem "difficult". Judging has no place in nursing, but caring hearts such as yours are what makes this profession so important. Thank you for sharing, I hope many more read this and are compelled to work with a little more compassion.

I just recently read the original post.

Then on my last shift, I had this little 91 yo lady who came in with R leg weakness. She had a hx of spinal cord tumor, so they were trying to r/o return of the tumor. She also had a hx or dementia/delirium, was disoriented and agitated.

Each time we took her BP, she would start screaming at the top of her lungs, asking us to stop and take it off. We ended up taking the BP on her leg and having to hold her leg still until we got the BP. Of course the more she struggled, the longer it would take to get the BP! :uhoh3: Then, in the morning, it took 3 of us to hold her still so that the lab could draw her blood, and she still managed to pull out the needle and had to be stuck again.

I don't know what else we could have done differently, but I just felt so bad, and this thread stuck in my mind making me wonder if the pt hadn't had some traumatic experience in her life. Thanks for sharing.

thank you for your story. I'm in a nurse's aide training class right now and they told us to always us a gait belt when ambulating a resident, and your story reminded me that just because it's what you're supposed to do, doesn't make it the right thing to do. I think that i'm going to recommend this site to the other people in my class. There's so much that they don't tell you in class. Things that you learn from experience, whether it be your own experience or someone else's. Thank you.