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Discussion

HELP ME

OK you guys.  I work in a SNF with SO MANY psych patients.  The dementia unit is more psych than dementia.  I'm talking incessant screaming damn near my entire shift with little to no relief from the go to PRN trazodone.  Facility reluctant to medicate them because of the red tape and the probability of getting tagged even though they absolutely qualify.   It breaks my heart because its clear to me they are suffering, but CMS makes it so hard to medicate them because of all the patients who get chemically restrained.  How do I advocate for them in a way where I'm being respectful of the facilitys view point but also getting results.  We had the psych NP recommend zyprexa for one lady, somehow administration got the house doc to say no. So they are trying depakote.  No difference.  Its so bad that I changed my schedule around so I'll almost never have to float up there.  I can't handle it.   This is my first issue. 

 

Secondly, and more affecting my daily work life:

Then I have a few of my long term patients on my sub acute floor that are SO BEHAVIORAL. Some nurses say "oh they're just psych" 

What does that mean?  

I'm having a hard time with the behaviors, especially.  If a patient has dementia I can totally handle everything about them.  But when they don't have dementia and they just seem to be badly behaved, attention seeking drama queens I have no idea what to do.   (I don't say that lightly, im not that kind of nurse. I give everyone the benefit of the doubt)

I've ended up forming pretty good professional relationships with them, but I'm making my co workers irritated because they aren't as patient or warm and they get the brunt of the behaviors. 

Personally I think they just want love and attention, and thats its.  

But there are a couple who I know are "misbehaving" just because its fun (or just because they can?)   Bullying other patients, causing a scene to get the attention off of someone else (who really needs much more care than them) 

How can I better understand and deal with this behavior?  

I had a totally A&O patient who is completely independent and inappropriate for this setting ( but won't leave - long story) cause an absolute SCENE the other night and cause me to spend over an hour on her and her alone.  Threatening to elope, etc.  (This took away the window of time I had intended on spending on her roomate, who is paralyzed - I was going to help her set up her phone to use via her voice).

Prior to now I thought she just wanted to know someone cared, but I think she may have done it because her roommate was getting too much attention from me. 

Is this a thing?  Please help, I really am no equipped for this kind of nursing. 

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    • Featured Replies

    I'm sorry you're having a hard time. Did you have to go through any type of training prior to starting this position? Psych can be challenging however, you either love it or you hate it.

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    • Author

    Just nursing school.  Its not a psych facility.  I have a lot of dementia training but this is nothing like it.  Just happen to have patients with a lot of psych issues. 

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    9 hours ago, Straight No Chaser said:

    Then I have a few of my long term patients on my sub acute floor that are SO BEHAVIORAL. Some nurses say "oh they're just psych" 

    What does that mean?  

    It means that they want to dismiss the problem without medicating for it.

    Years ago, I was the charge nurse for mental health for my region of the state with the Department of Corrections. We had a psychiatrist who we were convinced was performing some kind of study, because every management problem in the facility was "just behavioral", and he would not medicate for it. My DON and I had desperate custody supervisors from his facility calling us, begging us to intervene. We tried many times, but ultimately it was up to him to either issue an order or not.

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    Too bad soooo many don't recognize 'psychic PAIN' as real as they do 'physical pain'. Like who runs around measuring psychic pain/distress 'on a scale of 1 - 10 ...'

    I believe the dementias, Alzheimers, other psych dx, even the behavioral ones, are in some type of psychic pain. And you're right, they are difficult to manage even when medications are being used.

    Sounds like you're burning out on your unit. Not meant in any disrespecting manner. Any way to take a breather off to another unit to recharge YOUR psyche?

    It's sad when facilities take the tack to avoid psychoactive medications because of some great 'fear' of 'big, bad' CMS. Yeah, they are a terror, but if all the documentation, family support, monitoring and interdisciplinary care-planning is in place, pts might be helped. It is an effort worth the try.

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    • Author

    I just can't look away. I want to help, I want to make it better.  I can elevate someones legs when their feet are swollen, I can ask for pain meds when their in pain but this issue I can't fix because I don't' know whats causing it.  

    I don't feel like I need a break, I just feel like I wish I could help them.  I don't really mind dealing with it but I don't understand it and I want to. 

    I guess I'm trying to figure out if patients can be manipulative and mean spirited, which obviously I know the answer to because they are people.  I just see so much of it.  I think its worse lately because of COVID and the lack of activities/social interaction. 

     

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    OP - you said it all in your last paragraph!

    Take a deep breath and hang in there.

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    Have u tried given her a warm shower, getting her something to eat.  We used to let our hardcore patients play cards or put puzzles together.Our psych docs told us that their sleep/wake cycle had became impaired and were not able to adjust.

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