nursing students and behavioral health units

DesertKat · Mar 12, 2009

----Off topic rant----

The anthropologist in me shudders each time nurses talk about culture because, frankly, few have a real clue. Few nurses have the training and the experience to step out of their own culture to address the true cultural needs of their patients. Mainly because the majority of their patients have the exact same religious and cultural needs as they do. Cultural awareness exceeds simply knowing that those who are of Jewish descent might not appreciate a slab of bacon beside their pancakes. Its learning to assess the fact that people of different cultures have entirely different ways of processing thoughts and feelings then, say, most Americans. America is clueless about culture because of the myth of multiculturalism.

Ok, off rant. Annnnd back to our originally scheduled programing....

Anyway, the fact is you have to assess patients for why they are in the hospital in the first place. As you said, talking to the light fixture is weird (of if you are wealthy and from the South, eccentric) but not in and off itself criteria for hospitalization. Where delusions really have to be addressed, as you have stated, is when it radically interferes with their ability to live day to day life or they become a danger to themselves or others.

Is turning off the lights for this patient appropriate? I would say, yes. And for this reason. If the patient is so fixated upon this delusion that you cannot bring their attention away from it and it interferes with treatment, then it might be the only solution as harsh as it may seem. Even in my short amount of experience, I have seen patients fight medication and treatment to maintain their delusions and when they have a trigger, say another patient that is feeding into the same sort of religious delusions as themselves, it becomes that much harder to break the psychosis. Once the psychosis is treated, then it is appropriate to help that patient develop a healthier expression of spirituality- even if it is still directed towards the light socket. Its basically a question of Maslow's hierarchy. Treat the most basic needs first then address the needs of spirituality.

jujube · Mar 12, 2009

What you mention is true...sad but true. There was a pt of middle-eastern descent who kept splashing water on his feet (and the water inevitably got all over the floor) during certain hour of the day. He did not speak English and he was written up as delusional by all the staff. Once he was sent to seclusion after throwing water at the doctor and a nurse when they wouldn't let him bring water into his room anymore. Turns out that he was washing his feet as part of his religious ritual and all of us nurses were culturally ignorant of this fact. (A Muslim friend finally told me why this pt engaged in this foot washing).

Mr Ian · Mar 13, 2009

ut I have a patient who uses the light fixtures to talk to God (which light=God is a very common connection I get that) and God talks back... Still all great and wonderful except that because of this time with God the patient is unable to keep up with his ADLs or interract much with the rest of the world. While I want to help him engage in the world and care for himself I also want to be careful not to be too unaccomodating with his religious experience. Other staff simply turn off all his lights to redirect and this seems a little harsh... but maybe it isnt. Any thoughts????

Why does he have to engage in the world?

DesertKat · Mar 13, 2009

In short, he doesn't.

But he does have to engage himself. A man living on his own and not interacting with the world looses out, but that in and of itself does not need intervention. If he is so involved with his psychosis that he no longer eats, sleeps or cleans himself or his environment, then that requires intervention.

Mr Ian · Mar 13, 2009

In short, he doesn't.
But he does have to engage himself. A man living on his own and not interacting with the world looses out, but that in and of itself does not need intervention. If he is so involved with his psychosis that he no longer eats, sleeps or cleans himself or his environment, then that requires intervention.

In short.. and in long... he doesn't.

So involved with his psychosis is indeed unusual.

If he was so involved with his muscle car or his Xbox - would he warrant the same intervention?

DesertKat · Mar 13, 2009

It isn't the object of his psychosis that matters, its the result. There are plenty of people who are delusional, actively hallucinating or are extremely paranoid that still function relatively well. If the psychosis develops to the point in which it interferes with his ability to function on a basic level, then it is acute enough for intervention. And that's pretty much the long and short of it.

So yes, if someone is obsessed about cars to the point at which they are no longer eating, bathing, walking into streets or any number of actions that can harm themselves then they would meet criteria for acute intervention and stabilization.

So, no- the mere presence of psychosis does not require acute intervention. But it *might* require out patient intervention if, and only if, the patient themselves feels that their illness interferes with aspects of their lives. But to have that much insight, they would have a MUCH higher GAF then those who spend time with me as an inpatient.

Mr Ian · Mar 14, 2009

So yes, if someone is obsessed about cars to the point at which they are no longer eating, bathing, walking into streets or any number of actions that can harm themselves then they would meet criteria for acute intervention and stabilization.

Nice answer.

Interventions to re-establish functioning should be least restrictive and person-centered.

So to SweetLemon -

If staff are removing the focus of his delusional behaviour (ie turning off the light) has anyone talked to him about it and how he feels about the light being turned off? What are his reactions; both behavioural and cognitive? Is there a consistent approach and routine to the intervention?

v8grrl · Sep 23, 2009

I am doing my Psych clinicals as I write, I'm on a break...I just asked my RN a questions and she said she didn't have time to "deal with a student" I am an RN student hoping to go into the Behavioral Health field. I am so irritated right now. I am here to learn, help, interact...i would love to chart, watch charting, pass a med or 2? but I got nothing. I have less than a week here and she won't help me with anything. it's a true bummer.

v8grrl

DesertKat · Sep 23, 2009

Yeah well, remember the phrase "nurses eat their young"? Sadly its often true.

I can't advise you more then saying that you are going to have to be your own best advocate. Unfortunately in nursing you only seem to get what you demand.

inthesky · Oct 7, 2009

You can be the nurse who is different!

It is a bummer. I knew that I wanted to work psych after doing behavioral health tech work, not after nursing school rotations. I did BHT PRN for an agency. I'm not sure what is up with psych and students.

wonderbee, BSN, RN · Oct 7, 2009

Nowhere else in the medical community is confidentiality stressed more than in psych. I believe many nurses feel uncomfortable sharing information on the MAR. Other members of the treatment team reinforce the belief that nursing students are outsiders and therefore not privy. It's like someone posted a sign "no trespassing" and the nurses are the messengers. Nursing instructors are sensitive to the subtle and not so subtle signals that are sent

As for myself, I invite students. I know they are bound by the same rules of confidentiality as am I. When students come onto the unit, the temperature of the unit comes down. Patients are better served. Charge nurses have mixed feelings about students being on the unit and in the nurses station. I'm happy to have them and they are free to view charts. How else will they learn?

Students however are not allowed to pass meds. They may watch but that's it. Those are the rules. I don't make them. But they are the rules just the same.