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Medication aide on Psych Floor

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Hello all. I am seeking advice on how to handle, respond and work with patients that are schyzophrenic and psychosis. I was recently hired at a LTC facility. During the interview I was advised they the patients wondered not that they scream, curse, fight and other things. I have been working there a month and it seems each week it gets more hectic. It's very different for me. Any suggestions would greatly be appreciated.

verene, MSN

Specializes in mental health / psychiatic nursing.

I've found in working LTC mental health, that my behavior goes a long way towards setting the tone for my residents. If I can be calm and comfortable in my environment and my interactions with them, it helps to keep them calm and comfortable. Other areas: respect - it doesn't matter how "out there" or belligerent one of them get, I still need to be the bigger person, not take the situation personally, and treat the individual as another adult deserving and capable of earning and having my respect. Active listening goes a long way to establishing that respect, as does following through on promises and following up on concerns. If I tell someone I will help them with whatever after dinner, I need to show up after dinner and take the time to help them. If I can't, stopping by in advance and saying "hey X came up and I won't be able to help you with Y right after dinner. Is it okay if we wait until 7pm?" goes a long way towards keeping them feeling respected and lowers anxiety and paranoia levels, because I've made it clear that I haven't forgotten about them.

Screaming, fighting, and cursing are all issues that take some experience to become adept at handling. The biggest thing is to make sure in addressing them, that you don't escalate that situation. Staying calm and non-confrontational, but authoritative helps. I have one individual I work with who screams all the time, everything needs to be yelled at the top of her lungs. One day she was yelling at me while standing a few feet a way, and I just looked at her and said "C, I can't have a conversation with you unless you use your inside voice." Her volume dropped immediately, and I've found that when she gets loud simply reminding her "We are inside, I'm right here, lower you voice" usually (though not always) works to lower volume. If she won't lower her voice, I redirect her to her room (or other quiet area) to calm down, and to come to me when she is capable to talking to me in indoor tones.

Same with cursing, I've made it clear that I have no problem with what language they use in their rooms (so long as roommate is okay with it) but in public areas certain language is not allowed. I'll politely ask once to not use profanity, and if they continue ask that they redirect to their room, or leave facility and go to the park across the street if they want to continue using that kind of language in their conversation.

Fights are trickier, but usually pulling each party aside, listening to their side of the story, coming to a compromise, and keeping both parties away from each other until deescalated is the basic goal.

I also recommend asking more experienced staff for advice. I personally have found the book "Grace Under Fire: Skills to Deescalate Aggressive and Mentally Ill Individuals" by Ellis Amdur a great resource to have on hand.

Not an easy task at all, but try to have a routine as much as humanly possible. Sometimes have activities for them to look forwards to that allows them to zone in on something fun and enjoyable for them.

I always watch how I say things so I font seem to be arguing with them. They can get agitated if they don't feel you are trying to be too bossy or are not listening to their viewpoints.

The PP gave great advise.

Hope things go well for you

Been a psych tech, counselor, cna, mental heath worker so many different titles for close to five year's. I am burnt out you see a lot of BS from medical staff l, question decisions, and get yelled at by other floors or other floors hindering your care.

You might be hit been hit a few times. Spit at poop thrown at you cut, rarely. Blood will be thrown around at times. Be yelled at cursed at made fun of.

You will see a never ending revolving door of the same patients who make it.

However, the teamwork is amazing tight group. The patients who do succeed it's a great feeling.

However, it's bringing up past issues of bipolar and depression. Being on a rotating variable schedule and low pay thinking of running away.

Best of luck to you.

I work with behavioral health patients quite a bit. First, look to see if your agency offers any training such as CPI. It's basic training for what to do to protect yourself if a patient is combative or violent. By being trained you'll probably be calmer on the floor, which helps because patients can pick up on uncertainty and fear and that can make them more combative.

I personally find talking with the patient and telling them everything that is going to happen helps, even if they are unresponsive or not listening. I'll approach them from the front, so they can see me and introduce myself and just explain what needs to happen: "We need to go to your room because you are disrupting other patients." etc. I ask permission before I touch, but if they give permission I make sure to gently touch their shoulder or arm.

If the patient is yelling or screaming but not harming anyone, tell them they can yell and scream in their room, which is a safe space. As long as they are not physically hurting someone or themselves let them use that tactic to exercise their feelings.

Big one--if you ever feel unsafe, leave the situation. Tell the patient that you need to go get another person and back away so you are always facing them.