what interferes with counseling

Whispera, MSN, RN · Feb 24, 2015

Counseling isn't something RNs do, unless they're advanced practice. RNs listen and encourage patients to tell their stories and work through their problems. Maybe I'm picking at words, but want to make sure you know that counseling is outside scope of practice for an RN.

Now...things that keep me from engaging in a therapeutic conversation...when the person is objectionable...nasty, stinky, mean, history of hurting others, and other negative characteristics. It's also difficult to be effective with someone who reminds me of someone in my own life...it's hard to be objective then.

I'm also hindered when I'm tired, I'll, or have too many other things that need to be done.

elkpark · Feb 24, 2015

Counseling isn't something RNs do, unless they're advanced practice. RNs listen and encourage patients to tell their stories and work through their problems. Maybe I'm picking at words, but want to make sure you know that counseling is outside scope of practice for an RN.

The OP's user name, studyingRPN, suggests to me that s/he may be outside the US, since RPN is not a title or degree we have here, so I would not assume that the scope of practice is the same as it is in the US.

studyingRPN · Feb 24, 2015

Hi elkpark,

You are right. I live in Canada and am working towards becoming a Registered Psychiatric Nurse.

studyingRPN · Feb 24, 2015

Hi Whispera,

thank you you for replying to me. I am in the middle of studying for becoming an RPN, which in Canada stands for Registered Psychiatric Nurse (sorry for the confusion, I thought that I posted to the Psychiatric Nursing section).

That said, I would say that all nurses do make use of the therapeutic relationship when possible, so it is good to hear what circumstances interfere with this.

As RPN's we are expected to provide mental health assessments and Counselling.

Whispera, MSN, RN · Feb 24, 2015

I appreciate the clarification.

cayenne06, MSN, CNM · Feb 24, 2015

One of the biggest barriers to therapeutic communication is our own preconceived ideas and prejudices, conscious or unconscious, about our patients. And while it is easy in theory to say that you will put aside your own biases, it becomes a little more tricky in practice, when you have a patient in front of you who has, say, been convicted of child abuse, or has been in and out of the unit 100 times already and isn't willing/able to do the work needed to help themselves, or who you find out has been lying to you, cheeking their drugs, etc.

You can acknowledge that someone's actions are unacceptable while still reserving judgment on their character. But it's not always easy, and requires a lot of self reflection on our part. I come up across this a lot in my line of work (LDRP)... like a few months ago when I had a mom present to the ED, in full blown active labor, no prenatal care, drunk as a skunk, a tox screen full of everything imaginable and 5 other kids that she doesn't have custody of. That paints quite a terrible picture, but if you are able to develop a trusting relationship with her, maybe you will find out that she has been running from her abuser (who is also the father of her kids), is addicted to pain killers from an MVA 5 years ago, and has tried to get clean countless times but doesn't have insurance or transportation to access services. Or, maybe you will come to round on her and find out that she has snuck off the unit with her heplock in place, and you never see her again. Sigh. (details changed dramatically for pt privacy)

greenbeanio · Mar 1, 2015

What gets in the way?

Tasks. Tasks get in the way.

Charting, charting and more charting. Charting that nobody looks at.

Little things that pts need - supervising pt's getting #s out of their phones, $ out of their wallets, other items out of contraband.

Doing checks.

Doing 1:1 Constant Obs.

Admissions.

Sorting out problems with meds - meds not ordered, ordered wrong, not working and pt wants something else, etc.

Sorting out problems with things like pt did not get meal ordered, pt's visitor smells like marijuana/alcohol, pt's visitor is underage

Dealing with pts with chronic pain

Dealing with med refusals

Dealing with pts who need to be toileted, dressed or otherwise assisted with ADLs

De-escalating agitated patients

The list goes on. But I'd say charting, checks and admissions take the most time.

vintagemother, BSN, CNA, LVN, RN · Mar 5, 2015

I agree with Whispera. I too worked as a psych nurse in the US, so there is likely a difference in scope/practice between the us and canada.

That being said, we tend to be so busy with other nursing tasks, which disables our ability to do counseling.

At one position, my job was to be the "helper" nurse. I had administrative duties more than med administration, and I did have some time to counsel and talk with clients. This time was extremely beneficial to me, as a nurse, because it helped me to understand my clients symptoms better. It also helped the clients because I could better advocate for the their needs.

Davey Do · Mar 7, 2015

Good discussion/replies...

Subjectivity and VoluminousTedious and sometimes Superfluously Redundant Doumentation and Other Duties can be a Hindrance to Therapeutic Interactions with Patients.

Focusing on Judgemental Feelings toward Patients, all too often Patients are Sujectively Treated by Nurses who believe they need to act as the Judge, Jury, and Executioner. For Example, sometimes the Nurse's Subjective beliefs are passed on as Information in Shift Reports. Or sometimes Prescribed PRN Medications are not given due to the Patient being labelled a "Med Seeker". This can Result in Animosity between Staff ans Patients, which can of course, interfere with Situational Homeostasis and require other so-called Therapeutic Interventions like De-escalation.

A Nurse's Inability to Interact with and Administer Care in an Objective Manner are Major Stumbling Blocks to a Therapeutic Treatment Regimen.