Crossing Over to Psych Nursing...advice please

Blackcat99 · Apr 6, 2005

While I have not been employed by a state hospital, I did teach psych clinical for a few years at a nearby state hospital, and I have worked in psych at a VA and in a few "cushy" community hospital psych units. I have not observed one setting to be safer or more dangerous than another. I believe it depends more upon the staff, and their attitudes and training, than the type of setting.
A word of caution about "self defense" techniques -- in my state, and probably plenty of others, the state dept. of mental health mandates that only behavior control techniques reviewed and approved by them can be used in psych settings. Your new employer will provide training in the de-escalation and physical behavior control techniques they want you to use. In my state, it is state mental health regs that all staff must be trained and certified in an approved behavior control program before they provide any direct client care. If you find yourself in a physical confrontation with a client and use any kind of physical interventions or techniques other than the hospital's approved program, even to defend yourself, you could be fired and even open to criminal charges. Please stick with the hospital policies/procedures!
Best wishes with your new job -- I hope you will enjoy it! :)

I don't work in state psych hospitals anymore. I worked at the state hospitals years ago when they were severly understaffed on a regular basis. I never had to use my own self-defense tactics. However, if I would have had to I would have. I'm not going to stand there and be permanently maimed for life because I might get fired for defending myself. The way I see it I have a right to defend myself period. Yes I might have gotten fired but who cares? I can always find another job or another line of work.

StuPer · Apr 8, 2005

The issue of violence and aggression in mental health is to say the least a touchy subject. While it is true that mental health workers, along with ED staff face more Ag & Vi than most other settings, it is nothing like as high as many people in non-psych settings believe.

One of my roles is teaching staff both physical and non-physical interventions and strategies for dealing with violence and aggression, physical restraint is always used as a last resort and only then used if there is an immediate risk to the patient or others. So if someone is acting out and not hurting anyone else, we will not get involved simply observe, of course if they are acutely psychotic then thats different. The physical interventions we teach do not inflict any physical pain on the patient at all, in the hope that post-restraint we can mantain a therapeutic relationship.

So what elkpark mentioned was good advice, but I would add that if you had'nt been taught the appropriate skills by your facility and you were put in a situation of violence then in Australia it would be the facility liable for any consequences not you. If when confronted with a aggressive patient and you have been unable to use de-escalation skills, as the person is unresponsive, then exit the situation asap. Failing that and you believe your life is in danger then of course you must use whatever means available to defend yourself. At no point in any career except the military or the police, should you be expected to face violence and injury and just accept it as part of the job... it is not.

regards StuPer

Blackcat99 · Apr 8, 2005

Yes you and Elkpark have some very good advice. I am referring to those totally unexpected attacks when a patient attacks for no apparent reason. My friend said "Hi" to one of her psych patients and she got attacked right then and there. I would not want any nurse to think that if attacked that they have to stand there and be beaten to a pulp and perhaps end up being permanently disabled as a result.

elkpark · Apr 8, 2005

I would certainly not want that, either, and that's not what I was suggesting. In my state, psych facilities are required to provide extensive training to new staff (and refresher courses on an annual basis) in a comprehensive program of de-escalation techniques and physical restraint techniques (if needed as a last resort, as StuPer notes) that protect the staff without injuring the client.
As far as I know, most "general purpose" self defense classes offered to the public outside of psych settings are not concerned with the safety and well-being of the person assaulting you, only your own safety. My caution was only in regard to using techniques other than the facility's approved policies/procedures. I've worked in psych in three different states over the years, and none of them allowed you to just haul off and do whatever you felt like doing (to protect yourself) to a psych client; you are only protected from criminal assault and abuse charges if you use approved therapeutic techniques in accordance with facility policy. I was not advocating that anyone just stand there and allow someone else to assault you!

Blackcat99 · Apr 8, 2005

Hi elkpark my friend :) No I did not think you were suggesting that either. I guess I just worry too much. I was afraid that a new nurse might panic and do nothing because of worrying about losing their job. :crying2:

Whistleblower · Apr 9, 2005

i have been a nurse for a loooooong time. i have spent most of my years in geriatrics/acute care and now have accepted a position at the state hospital here. i worked at a state hospital years ago and have had psych experience (in a hospital based unit and private hosptal) but it has been so long ago that i would appreciate any advice from you more experienced psych nurses. what can i do to be more prepared for this position? it is on a chronic/long term ward. any offerings would be appreciated.

thought you might want to read a perspective from a mental patient. as a psychiatric nurse for over thirty years i find this piece disturbing and yet i see a lot of truth in what mr unzicker writes.

warm regards

tom

www.antipsychiatry.org

to be a mental patient

by rae unzicker

(1948-2001)

to be a mental patient is to be stigmatized, ostracized, socialized, patronized, psychiatrized.

to be a mental patient is to have everyone controlling your life but you. you're watched by your shrink, your social worker, your friends, your family. and then you're diagnosed as paranoid.

to be a mental patient is to live with the constant threat and possibility of being locked up at any time, for almost any reason.

to be a mental patient is to live on $82 a month in food stamps, which won't let you buy kleenex to dry your tears. and to watch your shrink come back to his office from lunch, driving a mercedes benz.

to be a mental patient is to take drugs that dull your mind, deaden your senses, make you jitter and drool and then you take more drugs to lessen the "side effects."

to be a mental patient is to apply for jobs and lie about the last few months or years, because you've been in the hospital, and then you don't get the job anyway because you're a mental patient. to be a mental patient is not to matter.

to be a mental patient is never to be taken seriously.

to be a mental patient is to be a resident of a ghetto, surrounded by other mental patients who are as scared and hungry and bored and broke as you are.

to be a mental patient is to watch tv and see how violent and dangerous and dumb and incompetent and crazy you are.

to be a mental patient is to be a statistic.

to be a mental patient is to wear a label, and that label never goes away, a label that says little about what you are and even less about who you are.

to be a mental patient is to never to say what you mean, but to sound like you mean what you say.

to be a mental patient is to tell your psychiatrist he's helping you, even if he is not.

to be a mental patient is to act glad when you're sad and calm when you're mad, and to always be "appropriate."

to be a mental patient is to participate in stupid groups that call themselves therapy. music isn't music, its therapy

;

volleyball isn't sport, it's therapy

;

sewing is therapy

;

washing dishes is therapy. even the air you breathe is therapy and that's called "the milieu."

to be a mental patient is not to die, even if you want to -- and not cry, and not hurt, and not be scared, and not be angry, and not be vulnerable, and not to laugh too loud -- because, if you do, you only prove that you are a mental patient even if you are not.

and so you become a no-thing, in a no-world, and you are not.

[

main page | next article: "does mental illness exist?" ]

elkpark · Apr 9, 2005

To Be a Mental Patient
by Rae Unzicker (1948-2001)
To be a mental patient is to be stigmatized, ostracized, socialized, patronized, psychiatrized ... And so you become a no-thing, in a no-world, and you are not.

All too true ... I've read a lot of the antipsychiatry movement literature over the years, and have found it to be v. helpful in maintaining what I hope is a healthy perspective on what I do as a psych nurse and psychotherapist (CS). I went into nursing at the close of the "golden age" of psych nursing in the '60s and '70s, when the ideal was not to be able to tell the staff from the clients by looking, and we were all aware that (as we used to say at the time) the only real difference between us and them was that we had keys (to the unit, that is). You must remember that, too, Whistleblower.

I really miss those days ... I'm v. unhappy that the pendulum has swung so far over on the all-hallowed "medical model" side of things. (However, the antipsychiatry people are never going to convince me that mental illness doesn't really exist! :) )

Whistleblower · Apr 9, 2005

All too true ... I've read a lot of the antipsychiatry movement literature over the years, and have found it to be v. helpful in maintaining what I hope is a healthy perspective on what I do as a psych nurse and psychotherapist (CS). I went into nursing at the close of the "golden age" of psych nursing in the '60s and '70s, when the ideal was not to be able to tell the staff from the clients by looking, and we were all aware that (as we used to say at the time) the only real difference between us and them was that we had keys (to the unit, that is). You must remember that, too, Whistleblower.
I really miss those days ... I'm v. unhappy that the pendulum has swung so far over on the all-hallowed "medical model" side of things. (However, the antipsychiatry people are never going to convince me that mental illness doesn't really exist! :) )

I know exactly what your talking about when you speak of 'the golden age of psych nursing' it was then we treated our patients with dignity and respect and viewed our pataints as having a functional illness not organic or medical model as it is called today. Many of us used medication on our patients not so much to treat a disease or control their behavior but to help them alleviate whatever mental anguish they were going through at the time. Some patients saw the medication effective but many others did not.

Oddly the antipsychiatry people are largely composed of former psychiatric survivors who have empowered themselves to tell the world of the horror stories they have to endure as psychiatric patients. Many of them speak of the medications they are given as being spiritually deadingning. Many say they have been harmed by ECT. lobotomies and the like.

The few dissenting psychiatrists are simply telling us that mental illness does not exist in a disease state inside the brain. Hard as they try the American Psychiatric Association and years of pseudoscience research have yet to demonstate any true genetic marker or any thing else that might prove mental illness is a disease of the brain.

The pendulum has swung to the "medical model side of thing" by the drug companies who used the American Psychiatry Association to make phenomenal profits out of the pains and suffering of the mentally anguished

Upon observations over the years I have found that people suffer from mental illness not because of some disease process but primarily because they have experienced some kind of real or imagined personal crisis or abuse in their lives and because they suffer from a moral delemma. Take for example the women who drowned her children to prevent them from growing up in this evil world of ours. In her mind she drowned them to save their innocents and to permitt them to go directly to heaven. Consider countless so called Borderlines who may inflict harm on themselves for the guilt they feel for having been raped by their sibling or relative. Counsider countless schizophenics who either God or the Devil is talking to them. Who are they going to listen to? Us nurses who are mere motals or these supreme beings?

Ever heard of the Moral Treatment of Care for the mentally ill? It was highly successful years ago and could easily be applied today.

Warm regards,

Thomas M Fraser RN

elkpark · Apr 9, 2005

Oddly the antipsychiatry people are largely composed of former psychiatric survivors who have empowered themselves to tell the world of the horror stories they have to endure as psychiatric patients. Many of them speak of the medications they are given as being spiritually deadingning. Many say they have been harmed by ECT. lobotomies and the like.
The few dissenting psychiatrists are simply telling us that mental illness does not exist in a disease state inside the brain. Hard as they try the American Psychiatric Association and years of pseudoscience research have yet to demonstate any true genetic marker or any thing else that might prove mental illness is a disease of the brain.
The pendulum has swung to the "medical model side of thing" by the drug companies who used the American Psychiatry Association to make phenomenal profits out of the pains and suffering of the mentally anguished
Upon observations over the years I have found that people suffer from mental illness not because of some disease process but primarily because they have experienced some kind of real or imagined personal crisis or abuse in their lives and because they suffer from a moral delemma.

I completely agree with everything you're saying -- I was referring only to some of the antipsychiatry folks (Laing immediately springs to mind) who have insisted over the years that schizophrenia is not an illness, but just a different, wonderfully creative way of looking at the world that should be celebrated, not "cured." I would love to believe that myself -- it's so much more pleasant an image than the illness -- and, if I had ever in my life met a schizophrenic who seemed to be having a good time, I'd be happy to agree with them ... But, since every schizophrenic I've ever encountered was deeply miserable and suffering greatly, it seems to me the least we can do is try to help them in whatever way we can. :)

Don't forget, also, the role of the insurance companies and managed care companies -- who want to make the biggest profits they can, and the pills are so much cheaper than actually helping people work through their issues ... They have marched in lockstep with Big Pharm to sell the "medical model."

It's such a treat to encounter another "old throwback" like myself, from the good ol' days (before the sole focus of psychiatry became which pill to give. Best wishes --

Whistleblower · Apr 10, 2005

I completely agree with everything you're saying -- I was referring only to some of the antipsychiatry folks (Laing immediately springs to mind) who have insisted over the years that schizophrenia is not an illness, but just a different, wonderfully creative way of looking at the world that should be celebrated, not "cured." I would love to believe that myself -- it's so much more pleasant an image than the illness -- and, if I had ever in my life met a schizophrenic who seemed to be having a good time, I'd be happy to agree with them ... But, since every schizophrenic I've ever encountered was deeply miserable and suffering greatly, it seems to me the least we can do is try to help them in whatever way we can. :)
Don't forget, also, the role of the insurance companies and managed care companies -- who want to make the biggest profits they can, and the pills are so much cheaper than actually helping people work through their issues ... They have marched in lockstep with Big Pharm to sell the "medical model."
It's such a treat to encounter another "old throwback" like myself, from the good ol' days (before the sole focus of psychiatry became which pill to give. Best wishes --

And, if I had ever in my life met a schizoprenic who seem to be having a good time, I'd be happy to agree with him...Of course you have! What about the shizophenics who only hears the "good voices" saying nice thing to them and complimenting them. You can tell they are in a happy frame of mind because you see them laughing seemingly at nothing and with no one . The voices they are hearing are pleasant and agreeable to them. Do they seem miserable or are they suffering greatly then? Do you encourage these patients to accept medication in order to stop these good voices in their tract . Will they even take the medication willingly? Is hearing the good voices currently a threat to themselves or others? These are questions you may have ask youself at one time or another. I bet when you saw this happening to one of your patient's you stopped him/her in his/her tract, distracted him/her, and offered youself as a real person he or she could talk to. You may have offered him/her a PRN but you never forced it on him/her. Am I right?

I think the point is we should work with one another and celebrate all of our lives. Setting schizophenics apart from the rest of us, fearing them and isolating them in state hospitals or jails does not celebrate their lives and has only hurts humanity at large.

I too have enjoyed our conversations.

Warmest regards,

Tom

StuPer · Apr 11, 2005

I too agree with the philosophy of treatment via therapy and talking, and that it is all too easy to prescribe a drug for a personal crisis, when in fact some good counselling/therapy will resolve things much quicker.

However as regards to schizophrenia, I have only ever met 2 clients who had pleasant auditory hallucinations. One hardly came to the attention of services at all, because she managed quite well in the community. However the other lady, despite being happy with the voices (she saw/heard and played with fairies) her personal situation deteriorated due to being completely absorbed with the phenomena.

regards StuPer

debRN0417 · Apr 18, 2005

Thanks to all for your advice/responses. I appreciate your input. I start my new adventure the 25th....wish me luck!