Did you care for a psych patient today?

Cute_CNA, CNA · Nov 10, 2005

I'm a little tired, but here's a stab at it:

I work in a psych hospital. I think that laughing at patients or poking fun at them or ignoring their illness is usually either a way to cope, or because the person doesn't understand mental disorders, or both. I admit that on more than one occasion, I have laughed at the behaviors of some of the people who come here, often because it is so strange and unusual. I haven't met a staff member who hasn't laughed at something a patient did unintentionally (or possibly, intentionally). You need a sense of humor to work in a psych hospital. No, we aren't constantly pointing out the "funny" things and humiliating the patient. Every once in a while, they just do something that's.... well.... funny. Like patients in other kinds of hospitals.

These issues need to be addressed, because mental health can affect a person's overall wellbeing. Perhaps your hospital could use some more psychiatrists, since it sounds like your MDs don't seem to specialize in this area?

What about mental illness don't you understand? I'm not being a smart aleck, it's a serious question. I know there are lots of things about mental illness that I still don't understand or know about.

Tweety, BSN, RN · Nov 10, 2005

Pysch issues are largely ignored in med-surg. where I work too. We don't even have Pyschiatrists that are willing to take priviledges at our hospital. Sad.

Indy, LPN, LVN · Nov 10, 2005

I've had two schizophrenic patients since graduating. One was pleasant, scared of her procedure, watched kids cartoons on TV and had a hard time explaining her use of nicotine to treat her mental condition to the cardiologist. (There's some study I heard of that apparently concluded that nicotine improves cognition in schizophrenics. She smokes more if she feels worse, less if life is good.) She also got funny looks when, instead of saying she was disabled, she said she walks all over town. She does, I've seen her, usually with this goofy smile on her face too. She was a joy to have as a patient.

The other one had aphasia so communication was very limited and I do not know how in the heck a diagnosis of schizophrenia could have been slapped onto this guy when it's nearly impossible to get an idea of his thought processes. I just felt sorry for him.

We do see our share of meth and crack users in CHF who are my age or younger, some of them really ought to go straight to detox once they leave my unit. We try not to ignore the psych issues but the ABC's come first.

onconurseRT · Nov 10, 2005

To respond to CNA... I actually do understand a great deal about mental illness, because my heart goes out to these individuals because it is so difficult to understand and to treat. What I was referring to is that I don't understand why the patients that present with a mental illness get less care, no care or are treated negatively like they are a "side show." I don't understand why it is that when I request a mental health consult from a general MD for a patient that obviously needs it, they look at me like I am, for a lack of better words, CRAZY! I understand that there are priorities in care and so on. I guess my point is that I feel that a uncontrolled/ non-monitored mental health crisis should have the same urgency as anything else.

Crystle_clear · Nov 10, 2005

I work in a psych facility too. The thing that makes me so mad is the poor treatment that our patient recieve when at the emergency room. We are a free standing facility, so we have no access to medical supplies or diagnostic equipment. When we have a client with a medical concern like chest pains or shortness of breath we have to take them to the ER to be evaluated. I've accompanied these patients on several occassions and they are treated so poorly. These are humans and their bodies break down just like everyone elses. I don't care if you don't like psych patients and you have no desire to learn about their mental illness, please please please at least give them the physcial care that they need.

A few months ago we had a gentlemen with severe heart problems on our unit. After sending him twice to the ER in one shift, the ER doc called and informed us he would not be seeing this man again. This doc felt his chest pains were "psychosomatic". Three hours that he was in CHF and died long before the ambulance got there. It was tragic and senseless. Psych patients get sick too, please help everyone remember that.

Columnist · Nov 10, 2005

I find this thread at once heartbreaking and hopeful.

My mother is schizophrenic, and I can assure you she's experienced all of the negative things noted so far (having bona fide physical complaints dismissed out of hand, being made fun of by medical staff), yet she's also experienced the positive people (caring nurses) who helped her through some very rocky times.

I want to differentiate between holding patients up to ridicule and laughing privately at their aberrations. Believe me, my sister and I would never be able to cope with our mother if we weren't able to occasionally share in private a laugh over some bizarre behavior she'd exhibited. It's only human nature.

But calling another person to go and observe a psych patient's aberrant behavior in order to have a laugh -- this behavior borders on "mocking," to me, and I think that's inappropriate. And there is no excuse for doctors' dismissing psych patients' very real medical complaints simply because "they're crazy." Just because a person suffers from diminished mental capacity doesn't mean they don't have physical ailments or that their complaints aren't real.

I often ponder why it is, in the 21st century, that mental patients remain ostracized, mocked, and belittled. It saddens me.

I thank all of you nurses who take a compassionate attitude toward caring for the mentally ill. It means a lot to me, my mother, and all of my family members.

veronica butterfly, ADN, RN · Nov 11, 2005

I am in the LPN to RN mobility program and doing my clinicals at a level 1 trauma county hospital this semester. We just finished 8 weeks on med/surg where there were a fair number of homeless, drug abusers, and/or people with mental illness. Today was our first day on a locked psych unit. I can't tell you what a positive experience this has been and how much I have enjoyed and learned from these patients. It really has not been scarey or even that frustrating. I have learned that a mental illness is a diagnosis just as a total hip or whatever. I know this sounds simplistic but I really was surprised that it hasn't been all that hard to care for this more complicated people. I hope when I go on to get a "real job" next spring, I can do some teaching by example and by sharing my experiences of the respect these folks deserve. I do think many nurses are just afraid of what may happen and use humor or making fun of them to make themselves feel more at ease. Maybe we should all rotate through psych a couple days a year to get more comfortable...

Kelly_the_Great · Nov 11, 2005

I just finished a reading a really interesting article from the Journal of Advanced Nursing from 2002, addressing nursing staff's perceptions of persons suffering from mania and how those perceptions affect patient care.

It addressed issues of seeing mania as a phenomenon but also as disease suffering.

To me this is really key to understanding why it is so many of us, while perhaps well-educated in the phenomena itself, i.e. the prevelance of its occurence, risk factors, symptoms and manifestations, treatment, etc., still do not perceive it as disease suffering. I think our unwillingness/inability to see it as such is rooted sociologically in fear and ignorance (lack of knowledge).

But this is just my opinion. Love hearing everyone else's. And thanks, onconurseRT, for bringing the subject up. :) I agree with semisweetchick's assertion that this thread is both "heartbreaking and hopeful." Open discussion is the best way to break down these barriers I think.

P.S. While I mentioned mania, this misunderstanding (IMO) could be applied to almost all psych disorder behavioral manifestions

kadokin, ASN, RN · Nov 11, 2005

Psych nurse here

Keep it up folks, this is a useful thread.

-Please understand this-Psych pt's are human beings. Sounds simple enough. But, sometimes, easy to forget. THEY DO Suffer from physical ailments. Granted, some psych pt's are somatically preoccupied. This does not mean they are immune to physical difficulties. It can be VERY difficult to distinguish between a delusional physical complaint and a real one. Or, sometimes, very easy. Lucky us, we live in an age of blood tests that can rule out pregnancies, etc.

-A word of wisdom from an experienced psychiatrist that I work with: People who suffer from severe mental illness often feel things in a magnified way. A minor inconvenience of a headache to one person can be a debilitating disability to another.

-Still, we need to LISTEN to our pts and take a good HISTORY if possible. To give an example, as a newly-minted RN, a (psych) patient I cared for c/o no urination for > 12 hours. He stated he suffered from CP and sometimes needed to be catheterized. I didn't know what to do and asked my charge RN (more of a medical nurse) what to do. She advised me not to make a big deal about it. I ignored her advice and shared my concerns w/the primary (a psychiatrist). He ordered a straight catheter and a urology consult. Pt relieved.

-To paraphrase a giant whose shoulders we are standing on, "Pain is exactly what the person who is suffering from it says it is". 'Nuff said.

- Yes, we sometimes laugh (discretely), at our pt's behavior. Show me a health care professional that doesn't, from ER to ICU, we've all done it. People are funny, psych diagnoses or not.

-See thread "Things pt's have taught me not to do".

Siouxz2 · Nov 11, 2005

I just got done at a rotation at a State mental facility. Sure, sometimes the nurses jokingly made note of their patients' odd behaviors, but the care and concern they had for them came through at all times. They way they acted didn't seem offensive to me at all. I have also been on med/surg where the nurses (my instructors included!) mocked psych patients. I must admit that I joined in on occasion.

But since starting my psych rotation, I am seeing how tortured these poor souls with mental illness are, and I am so ashamed for my previous behavior. As if they would choose to be the way they are! Health professionals should know better. I especially am disgusted with my instructors, who are condoning this behavior when they are in a position to change the next generation of nurses to be more caring and understanding.

LoriAlabamaRN · Nov 11, 2005

Since I work at an LTC facility, we have many residents who suffer from dementia or other psych disorders. Sometimes you gotta laugh- I had one elderly gentleman block me in my office to tell me he was protecting me from "the coloreds" until the governor- his "best friend"- could get there to airlift us out. Turned out he'd been cheeking his meds. It's not a cruelty issue, nurses are human and some things are amusing. The thing that does bother me is that I think some physical complaints made by our known psych problem residents are attributed to the mental problems and not taken as seriously. I actually created and held an inservice with my staff on this very thing a few weeks ago.