evil.. just so evil...

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I'm pretty heart broken right now seeing the type of care given at my facility. I work at an acute psych facility.. and i feel for the patients who has a hold, reised status, conserved.. a lot of times, these patient's basic rights are taken away. The other day i had a patient who was reised.. and complained that her med was giving her severe constipation- that is affecting her entire GI system, making her nauseated, extreme pressure. naturally, she refused the med and said "this med is giving me such a strong SE". I wasn't sure how to handle this situation since she is reised. She pleaded to me and said, "i know you nurses will shoot me with an injection if i dont take my oral pills.. please don't.. please, you're killing me".

When i contacted my charge nurse, she said just GIVE IT! these patients are psychotic, dont care about what they say! they are doing everything to manipulate you into thinking they don't have to take the meds. just give her the IM backup and get it over with!

So i decided to call the MD to see if we can change to another med (since the pt agreed to take another similar one). the MD disregarded the case. . the nurses yelled at me for picking up the phone =/ and said "i'm too new to know how manipulative these ppl are.. If you going to bother the Dr. about constipation, just wait to get your head chewed out. I know you're a new grad and you like to follow the book, but its NOT like that here. just freaking give the IM already!".

i was so heart broken.. i feel for the poor patients. this is not how i imagined being a nurse.. I struggle between the fine line of listening to someone's real concerns vs disregarding them because they are just manipulative and psychotic and "reised".

sometimes i hate my job. evil is another word to describe it.. nurse ratched anyone ? :idea:

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Specializes in Tele, ICU, ED, Nurse Instructor,.

Just in my opinion Psyche nurses are either lazy or crazy. In this case its crazy. The nurse dont understand Constipation is Medical Diagnose, this would cause more problems than good. This patient can become medically unstable. I can believe this going on. Where I work, the psyche nurse drug the patient up so much then the patient not responding and they come down on the a tele unit to be monitored and this could have been prevented. The nurse on the Psych unit dont want to be bothered with the patients. It beats me.

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Specializes in home health, dialysis, others.

What is 'reised'?

Not everyone is familiar with terminology from every specialty.

And it is very hard to determine what is real, and when you are being manipulated. It was the same when I worked in a jail. Some of the inmates were master manipulators.

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reised means their rights to refuse medication is taken away. so they have to take it, or we have to give them an injection.. against their will.-- as ordered by a judge if the feel the patient is always refusing their meds but at the same time they are too mentally ill to make that decision..

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Specializes in Occupational health, Corrections, PACU.

Simply approach it as you would a s/e in any other M/S unit....ask the doctor for orders of Colace and laxative if the Colace fails. If she is telling the truth, then she could potentially get a bowel obstruction and perforate. Take care of the medical problem before it turns into a bigger one.

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Specializes in Research & Critical Care.

If the patient has been court ordered to receive a medication because of prior history of refusing meds, then I'd be suspicious they're manipulating you.

But there's still the possibility that they're telling the truth. You did the right thing IMO by contacting their doctor. Document everything. If it ends up that the patient was telling the truth and a failure to act causes complications, it should be known that you did make an attempt to correct the situation.

Sorry to hear about it. I can't imagine being in a similar situation; not caring about your patient basically defeats the purpose of being a nurse..

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I was working in psych not long ago, and some patients were handed over as being very manipulative. But if the patient agreed to another similar med, why do they think she was being manipulative?

But continued constipation is a serious diagnosis, as straining can cause strokes, leads to haemorrhoids, damages the bowel, etc. The Dr and nurses should know this! (and wait till you have done a manual evacuation; that's really fun!)

It's hard when you are new being your patient advocate but you did the right thing. Nurses are pretty much stressed I think - I just did another post recently about what mistakes (or supposed mistakes) we make due to all the pressure & responsibility we have. Keep plugging away; maybe you will change their minds one day. It's hard because you have to also do what is legally right for your patient; you can't leave her constipated just because the others say she is a psych patient. Quite often patients come in with multiple medical problems that have to be treated, despite their primary diagnosis. So yeah you are right.

Next time complain to someone senior on the shift & get them to sort it out. I know you were worried re your patient, but a senior person should be sorting this out if you don't get any action.

Just make sure you document everything - and I mean everything, ie: conversations, what the patient actuall said (quote it) to cover yourself ALWAYS.

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Specializes in Psych.

I know of a state psych hospital in my area where a young female patient died because of complications from constipation. It can get really serious... Don't let it go on! Ask for a stool softener or something.

It's terrible that you and your patients have to go thru this, but I think you are doing a great job by fighting for what is right.

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Specializes in Pediatrics, ER.
Just in my opinion Psyche nurses are either lazy or crazy.

For someone who can barely type the English language you sure don't have a problem using it offensively. Lazy or crazy, huh? I've worked per diem in pediatric psychiatry for two years and find the work interesting and gratifying. Compared to the extremely ill children I care for on a daily basis, caring for children with mental illness is a welcome break and based on our low readmission rate, we appear to make some sort of impact on them. It is unfortunate that the OP's work is such a toxic and undereducated environment, and I hope she will report them to the JC for investigation. It is true that some psych nurses have less experience in the medical component, but there are measures that can be taken to improve patient care, such as nursing care plans for constipation or side effects. At my hospital we have standing orders for certain side effects and medical conditions, and the physicians welcome input from nursing because their medical experience as psychiatrists is somewhat limited as well. We work as a team to give our patients quality care, and both nursing staff and the mental health counselors work very hard to help our patients get better. We have an extremely dedicated staff and I couldn't be more proud of them.

I'm not sure if you're careless with words or just plain ignorant, but I suggest you think about using such severe words before posting on a forum dedicated to all walks of nursing. Watch what you say, what goes around comes around, and you never know, perhaps someday you or one of your loved ones might be in need of us "lazy crazy nurses."

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Wow.....Lazy or crazy??? I'd hate to see what you would say about LTC nurses.

If they need to take the med for psych reasons and there are side effects to the meds...call the doc to get something for the constipation or GI issues until they get on track with them.

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A nurse is always right to call the doctor when she has a gut feeling she needs to.

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Specializes in ICU.
I know of a state psych hospital in my area where a young female patient died because of complications from constipation. It can get really serious... Don't let it go on! Ask for a stool softener or something.

It's terrible that you and your patients have to go thru this, but I think you are doing a great job by fighting for what is right.

I will second this scenario. I took care of a pt last year, on multiple psych meds, who developed megacolon, then perforated his bowel. Per the surgeon, he had LITERS of stool in his gut when then opened him up. He became very septic (of course) and spent weeks on my unit. He ultimately made it, but it was *very* touch and go for a while.

OP: you did the right thing. Try again, for colace and/or dulcolax at least.

:paw:

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