Dear wise psychiatric nurses - yet another case where I would be very grateful for advice...
Today and yesterday I had to be a sitter again, and this time for a young male who OD'ed a few weeks ago. Several of the experienced nurses were scared of him the first days he was there, because he had an "evil stare" and would suddenly start laughing. There used to be three people in the room with him at all times to keep him under control, but now they consider it safe with one person only. (He is still involuntarily committed)
Yesterday was ok. I sat with him at the High Dependency Unit, where the nurses are very observant and careful, i.e. emphasized the importance of him taking his meds.
He said some really weird things during my shift, but seemed to like me and we even talked about trivial stuff. He was still weak and got up with help once.
Today he was transferred back to "my" department. He did not remember me from the day before, and seemed completely different, colder and more suspicious, and didn't connect. (And he is much stronger, sits up by himself and even gets up on his feet)
I tried to tell the only available nurse (straight out of school, the "know it all" kind of person who loves to criticise) about my observations (see below), but she just said: "I do not consider him psychotic at all", and had all kinds of explanations for the examples I mentioned. I.e. him talking about missing body parts, was "probably because of the pain in his foot". I carefully tried to say that she hadn't been with him all day, and the few times she was in there, he was mostly quiet and his few answers could seem adequate enough, but no - according to her I was totally wrong and she even rolled her eyes a little.
Some examples:
- He seemed paranoid about the meals, and once stared at the meal and said: "What is the code?" (To which I replied: "The meal has no code, you can go ahead and eat"). He didn't eat at all.
- He said: "Where are my body parts?" (I said all his body parts were attached to him, and that we were taking good care of him and had everything under control.)
- He stared at his hands as if they were unreal
- He looked at me with that "evil" stare and asked if he could have a pair of scissors. (I said we didn't have any)
- In general he looked at me with this hard to describe look, it's like a mix between suspicious and calculating.
- He lied to the nurse about taking his meds, and she believed him just like that (...they were still on his tray...)
- He asked me stuff like "are we still in the same time and space?" ..... His sentences made no sense half of the time. I asked him if he felt confused, and he said yes - that he had no control over his mind now and didn't know what to think.
- He has a scary laugh. And suddenly laughs at nothing.
He is on Zyprexa (+ morphine etc), but I suspect he's good at "pretending" to swallow them (And the young nurses at my department are so relaxed about the medication, that no-one make sure he actually swallows. They show him the different pills, explain thoroughly, and ask him if he wants that pill - and given the choice, he can't decide. In the end I told him the pill would probably improve his thinking, and that if it was me, I would take it. I don't know if that's appropriate to "influence him", but frankly - since the High Dependency Unit nurses emphasized the meds, I am a little scared what can happen if he doesn't take them. (The High Dependency Unit just gave him a small plastic cup with all his pills and asked him to take them, which worked well)
It worries me that the young nurses seem very naive, and might consider him "safer" than he truly is. They seem to see this young, handsome man their own age, and rationalize every very weird thing he says into something "normal". As a student I don't really want to disagree and "go over their heads" to talk to the leading nurse, because of course they probably know more than I do and it could seem disrespectful. But I am worried. The few times I have met psychotic people, there has been the same talk about missing body parts and that "evil, calculating" expression and scary laugh (one of them were full of antisocial traits and ended up almost killing his girlfriend).
How would you consider the examples I mention above? Is it something to report to the head nurse, or should I listen to the younger nurses? (I might have to sit with him again tomorrow :/ )
(For those of you who didn't read my borderline thread: I am just a clueless med student who work as a nursing assistant in a somatic department that is short on staff. And sorry again about the lengthy text and improvable grammar 
)
