I'm better at dying

[mi_dreamin, BSN]

I've posted a few times before, not often, but it's apparent from my posts that part of my job includes inpatient hospice. I am really good at this part of my job. The palliative care providers like me (the way I do my job), the families like me, and I keep my patients comfortable (they usually aren't alert enough to know whether or not they like me).

That being said I am NOT a psych nurse. A little agitation here or there, depression, your run-of-the-mill anxiety, all this I can handle.

What I cannot (or don't want) to handle is acute psychosis, especially when it involves pulling scissors out of my pocket and asking for the "son-of-a-***** who put these orders in" and pushing the sitter, and punching the staff who came to see what all the screaming was about.

I especially don't like it when the acutely psychotic screaming patient comes out to the nurses station and rips her IV tubing in half and threatens to bite anyone who tries to take her back to her room but strokes Mr. Security 1/3 and says that she wants to take him home.

I do, however, find some amusement when the doctor opens the door to the dictation room, quietly says, "I'll put some orders in" and then gently closes it back, remaining there for the duration of the excitement.

I do not, however find it amusing when security guards 1-2 stand there uselessly while the patient calls me a sneaky ***** and insists that they keep me away from her.

I also don't like it when we have to bring her bed into the front of the unit and prompt security guards 2-3 to lift her onto it and hold her down while we restrain her and give her a magical injection that I'm pretty sure is made out of the same dust that's on those poppies in The Wizard of Oz.

I espcially don't like documenting on 4-point restraints every hour while also trying to get the med rec done for my admission that came in hours ago while keeping"high fall risk and I just learned I can stand today" from falling and also making sure Mr. CallLight doesn't purposefully set his bed alarm off again because he's been waiting "too long" and also contacting the surgeon so I can give Mr. Vascular surgery today his meds.

I don't mind not taking a lunch though, it's not that bad when you don't have time to think about it ?

[beekee]

3 hours ago, mi_dreamin said:

I do, however, find some amusement when the doctor opens the door to the dictation room, quietly says, "I'll put some orders in" and then gently closes it back, remaining there for the duration of the excitement.

At least you get orders! ?

[Davey Do]

6 hours ago, mi_dreamin said:

That being said I am NOT a psych nurse. A little agitation here or there, depression, your run-of-the-mill anxiety, all this I can handle.

What I cannot (or don't want) to handle is acute psychosis

Welcome to My World, mi_dreamin.

It is a truth that we learn to deal with problems by experiencing problems and receiving the gifts of solutions.

It is very important that we first identify our subjective perspective toward the symptom of a disease, e.g. psychosis, and realize that subjective perspective needs to be objectified. We need to strive to learn to deal with psychosis as we would any other symptom of any other disease and intervene accordingly.

Easier said than done, I know. However, once we free ourselves from our subjective perspective, we open up our minds to more logical, objective approaches. It is extremely difficult not to take aspersions upon our character personally, but it can be done. I could not go back every weekend and deal with psychotic patients who act out if it were not so.

We first need to become okay with who we are. We need to know "My happiness is not a result of what others say or do or what goes on around me. My happiness is a result of being at peace with myself". Once we have institutionalised that belief that -all in all- we are okay with who we are, we can better suffer "the slings and arrows of outrageous fortune".

Your post may just be a catharsis, a healthy method in order to deal with your feelings and thoughts, but I wanted to share some of my philosophy on the subject of dealing with psychotic patients with you.

The best to you, mi_dreamin!

[mi_dreamin, BSN]

Thanks @Davey Do. And to clarify, I wasn't angry, or really even upset by any of this, I simply didn't feel I had the skill set to manage it.

I knew I was not strong enough to hold her down myself and useless security guards stood there for an hour before we finally brought her bed out.

I just like it better when I know ehat to do and feel capable of doing it ?

[mi_dreamin, BSN]

6 hours ago, beekee said:

At least you get orders! ?

Exactly! Lol

[Davey Do]

10 hours ago, mi_dreamin said:

I've posted a few times before, not often, but it's apparent from my posts that part of my job includes inpatient hospice. I am really good at this part of my job.

41 minutes ago, mi_dreamin said:

I just like it better when I know what to do and feel capable of doing it ?

"It's not if you win or lose. It's how you look playing the game."

For example, we need to look "professional".

[MSO4foru, ADN]

Aaarrrggghhhh.... am assuming this is inpatient hospice. Obviously there should have been a sitter. And yes, med orders. Am so sorry for this situation, but unless we get some Major health care reform, this will happen. Peace to you.

[MSO4foru, ADN]

Ok so just scrolled up..... this pt should have not been admitted to Inpt Hospice. I have had similar scenarios in the past. It wasn't fun.

[mi_dreamin, BSN]

1 hour ago, MSO4foru said:

Ok so just scrolled up..... this pt should have not been admitted to Inpt Hospice. I have had similar scenarios in the past. It wasn't fun.

I should have clarified - this wasn't a hospice patient and she did have a sitter. We do palliative care in addition to tele/renal/dialysis on our floor (some ICU stepdown as well).

Honestly it wasn't so bad except the not knowing what to do nobody doing anything part.

Probably the worst of it was sitting down at 1700 to enter the meds of my 80-year old admission whose only request all day had been to get his home meds and whose BP was now 184/85. For some reason sitting down in that moment I felt defeated, exacerbated of course by the (different doc) who I couldn't get to put orders in on him but apparently had had time to wait on hold for 30 minutes earlier in the day....I never did mind the little things ?

[Jedrnurse, BSN, RN]

You may reconsider the title of your post. I love dark humor with the best of them, but...

[mi_dreamin, BSN]

2 hours ago, Jedrnurse said:

You may reconsider the title of your post. I love dark humor with the best of them, but...

Thanks for the feedback. In daylight with sleep, food, and rational thought onboard I agree.

[verene, MSN]

I found the title of this post amusing - and as some one who has worked in both inpatient hospice/palliative care and acute psych settings am frustrated as well be being system that can't deal with patients who have both needs. Hospice and palliative care in my experience are well versed in depression, anxiety, grief, confusion, and existential emotional pain, but not always well trained or set up for aggression and psychosis. Unfortunately most acute psych units have the inverse problem in that they are well equipped and trained to manage acute psychosis and aggression, but not so good at the hospice and palliative care pieces.

The patient you were working with should have had a sitter and/or another nurse should have taken over your "calmer" patients if sitter wasn't available. Did the team figure out the underlying cause of agitation with this individual? Agitation usually results from being unable to have needs met another way - what is agitating this patient? Are they in pain, cold, hungry, confused, delirious, or do they have an underlying psychotic disorder that has de-compensated with end of life physiologic changes? Aside from liking the security guard anything that helps calm them down?