Any good books/literature on how to deal with psych pts on a medical floor?

[tbbtpeach]

Does anyone have any good books or literature that they would recommend concerning dealing with psych patients on the medical floor? I try to rely on my therapeutic communication skills when I have a psych patient, but I feel so woefully incompetent and always feel like I agitate them more by the time I leave the room. As a new nurse it can be so frustrating to finally be nailing down some common nursing practice, but feel like such a failure when I have a patient with psych issues. I work on a fairly large medical floor and I typically will get 3-4 psych patients a month (mostly chemical dependency, but also bipolar, schizophrenia and personality disorders). I tried to do some research and got mostly textbook chapters outlining generic psych nursing "communication" techniques. Anyway, thanks for any help :)

[VivaLasViejas, ASN, RN]

I wish I were able to help with references for your question, but I've been out of practice for a few years and am woefully out of date. But I can give you a piece of advice which will serve you well in any future dealings with psych patients: treat them as you would any other patient, and don't regard them as just their mental illness. That happens too often. I've been a med/surg patient a few times, and on one occasion I overheard a nurse outside my room talking to another nurse about "the bipolar in 201". I wasn't there for psychiatric care, nor was I exhibiting symptoms. But such is the stigma that still surrounds mental illness, even among professionals who should know better. Don't be a part of it!

[hppygr8ful, ASN, RN, EMT-I]

Try looking for Psych Notes: Clinical Pocket reference

It's available at most bookstores and a used copy can be purchased online for under $10.00

Still Viva gave you great advice.

Hppy

[ruby_jane, BSN, RN]

I can give you a piece of advice which will serve you well in any future dealings with psych patients: treat them as you would any other patient, and don't regard them as just their mental illness. That happens too often. I've been a med/surg patient a few times, and on one occasion I overheard a nurse outside my room talking to another nurse about "the bipolar in 201". I wasn't there for psychiatric care, nor was I exhibiting symptoms. But such is the stigma that still surrounds mental illness, even among professionals who should know better. Don't be a part of it!

SHEESH. I am truly sorry that happened, Viva.

OP - why is the pt on your floor? Psych or medical reasons? Are you invited/requested to do anything with the psych dx? Is the patient actively suicidal or hallucinating? No? OK. Yes? You need more help than just good communication skills. Also - people with personality disorders will very likely make you feel inadequate, and that has nothing to do with you or your skills.

Being in a hospital is boring. Patients with psych diagnoses may be bored just like anyone else. Is this an issue of attention-getting behavior/statements? There's usually a reason behind any behavior, whether the person has a psych dx or not.

[FolksBtrippin, BSN, RN]

I would not categorize chemical dependency as a psych diagnosis. Chemical dependency is when a person exhibits withdrawal symptoms when taken off a substance. Chemical dependency is treated by managing symptoms while weaning a person off the substance. Addiction is much more complex and can be reasonably grouped with psych diagnosis. Addiction involves a pattern of maladaptive coping which leads to severe impairment of the addict's life. Many addicts are chemically dependent, some are not. Many chemically dependent people are not addicts. As a nurse on a medical floor, chemical dependency is really important for you to understand. So I would start there.

Get a good grasp on the difference between chemical dependency and addiction. This is highly misunderstood. And the terms are often flip flopped, but you need a good grasp of the concepts to respond appropriately to your patients.

I don't think I'm allowed to post a link, but if you google NAABT addiction vs. Physical dependence you will get a really good article on the difference.

Now for psych:

It's hard to know exactly what is going on because you have not given examples.

Viva gave you good general advice. Do you think of these patients as psych first and medical second?

You could be having a problem because of stigma. You could be expecting agitation and then seeing what you expect. You could be unconsciously drawing out negative behaviors in your patients in order to make them more predictable. If any of these ia going on, noticing it in yourself is more than half the solution.

One other thing to be aware of, is that your patient with a psych hx may have more psych symptoms from the stress of being in the hospital, off routine, in pain, etc. He or she may need a prn for anxiety, agitation or psychosis. Make sure you have at least one on board, and ask the patient what helps them cope with stress and what prns have helped in the past. Be willing to ask for an order for a med you don't usually use (like thorazine, vistaril, etc) if the pt says it is what helps him.

If you give examples, I think I could help more.