Patient Rituals

Published

Specializes in Psych (25 years), Medical (15 years).

One of the behavior assessments on we do every shift in psych has a box which reads, "Preoccupation with... rituals". A ritual is defined as "...solemn ceremony consisting of a series of actions performed according to a prescribed order".

During med pass the other evening a patient I learned the ritual of a patient on the geriatric psych unit when she said,

"The other nurses give me a damp paper towel to wipe the coating off of my levetiracetam because I'm allergic to the coating."

Then, " The other nurses break open my gabapentin and sprinkle it on applesauce."

And finally, as she bites into her colace gel tab and sucks out the juice, "Do you have something sweet to drink because that tastes bitter?!"

Got any patient ritual stories?

2
Up Vote Up Vote ×

I handed my older male patient a cup of 12 pills plus 30cc of MOM plus a cup of water and he dumps the water out and says,"Oh no, honey, I take my pills like this at home," then proceeds to dump the pills into the MOM before I could stop him. Nearly choked to death right in front of me!

6
Up Vote Up Vote ×
Specializes in Mental health, substance abuse, geriatrics, PCU.

Not a patient ritual but a ritual of a nurse I used to work with. She was a very strange lady, heart of gold though, I only worked briefly with her before she retired. Anyway, every time she would pull up an IV med when she was finished she'd lick the top of the vial, didn't matter if it was solu-medrol, lasix, or morphine. It was very... odd.

Another former co-worker would join in conversations by grabbing the trash can and straddle it while talking instead of pulling up a chair it was ALWAYS a trash can and the way she straddled was more rated R versus PG. Once again, very odd.

Have had several patients over the years that everytime they went to the bathroom after finishing they'd grab some toilet paper and start digging around to see if they had any more stool "up there", and the clincher is that I'd have to remind them to wash their nasty hands afterwards ?

6
Up Vote Up Vote ×

Most of the patient rituals that come to mind are about medication.

"Rub the blue color off I don't like it because it makes me sad"

"Arrange my medication from smallest to largest in a line, then give me one from each end alternating"

"I only take my medications in the chocolate pudding because I choke on the vanilla (as she is eating a stable choco chip cookie)"

Patient that when you'd take his blood sugar would snatch his finger back, lick it then rub the bloody mess onto his shirt because he was anticoagulated. Of course, sugars ordered four times daily.

1
Up Vote Up Vote ×
Specializes in retired LTC.

Personally, I understand medication rituals. Early this year, I was in the hosp/rehab/NH. A medical diagnosis made me distrustful, suspicious, even paranoid at times. And it was no surprise when some new meds had physiological side effects affecting my senses of TASTE and smell.

I am dead serious when I say this, but I thought they were trying to poison me. (esp when after one night, I saw 2 coffins standing against the opposite wall and a sarcophagus on the ceiling!!!). And I was hallucinatory at times. Seriously!

To make matters worse, with just about EVERY med pass, I found TRUE errors being made. This was NOT an imaginary issue - as a nurse I did know what I was supposed to be getting (WHEN they told me) and then what I received.

Underdosed, overdosed, omitted doses, new? doses of ?. So I started to lay out all my pills on the table to identify them. One by one I counted them to check them. I also found I needed applesauce as I started to gag on even small pills. Hey, I was still thinking they might still be trying to poison me since everything tasted so bad!

I've been home 6 months or so and I STILL LAY OUT MY PILLS. Even though I, myself, set up my pills in a pillbox, I HAVE TO CHECK THEM. I do swallow them better, though.

I just finished taking my meds before I read this post. And yes, I laid them out to check them, after I separate them into little clusters.

Yes, I am my own pt and I have ritual about my meds.

6
Up Vote Up Vote ×
Specializes in Psych (25 years), Medical (15 years).
20 hours ago, Davey Do said:

"The other nurses give me a damp paper towel to wipe the coating off of my levetiracetam because I'm allergic to the coating."

10 hours ago, CharleeFoxtrot said:

"Rub the blue color off I don't like it because it makes me sad"

The levetiracetam 250 mg had a blue coating on it too!

Perhaps the pharmaceutical companies need to put a warning on blue pills:

"CAUTION: The coating on these pills has been known to cause allergic reactions and depression."

3
Up Vote Up Vote ×
Specializes in Psych (25 years), Medical (15 years).
5 hours ago, TheMoonisMyLantern said:

Have had several patients over the years that every time they went to the bathroom after finishing they'd grab some toilet paper and start digging around to see if they had any more stool "up there"

Like Mom always said, "A clean rectal vault is a happy rectal vault"!

2
Up Vote Up Vote ×
Specializes in Psych (25 years), Medical (15 years).
4 hours ago, amoLucia said:

Personally, I understand medication rituals.

Of course, amoLucia.

Rituals give us a sense of security and power. It's one of our most basic needs, ranking second only to our basic physiological needs. We all have some sort of idiosyncratic ritual in our lives we go through in order to feel like we are safe and have control over a situation.

I just find some rituals interesting and amusing, like the way a cat will knead its bed before it lies down.

4
Up Vote Up Vote ×

I had a patient who needed assistance to ambulate. She would do the usual count "1,2,3" then stand. But every trip to the bathroom continued with her counting aloud "4,5,6,7...". She would reach the toilet on 14 then plop down.

2
Up Vote Up Vote ×
Specializes in Psych (25 years), Medical (15 years).
3 hours ago, Pax_Ramona said:

every trip to the bathroom continued with her counting aloud "4,5,6,7...". She would reach the toilet on 14 then plop down.

"Houston, the Eagle has landed."

4
Up Vote Up Vote ×
Specializes in retired LTC.
3 hours ago, Davey Do said:

Of course, amoLucia.

Rituals give us a sense of security and power. It's one of our most basic needs, ranking second only to our basic physiological needs. We all have some sort of idiosyncratic ritual in our lives we go through in order to feel like we are safe and have control over a situation.

I just find some rituals interesting and amusing, like the way a cat will knead its bed before it lies down.

And the cats circle & circle & circle the litter box before doing business. ?

I'm appreciative that you mention ritualization as a second basic need. Maslow, I think?

I can see where my med pill checking & rechecking relieves my concerns re being mis-medicated. Kind of gives new meaning to the term 'hooked on meds'. ***

When I orig posted I was thinking maybe I borderlined OCD as I've other quirky collecting habits.

*** Off the track but anybody else remember when 'Hooked on Classics" was popular music in the '70s -'80s? ? Wayback machine time!

1
Up Vote Up Vote ×
Specializes in Psych (25 years), Medical (15 years).

Ritualization, in and of itself, is merely an action which results in meeting Maslow's second level of the need hierarchy, safety and security. Installing a baby monitor or carrying a handgun and other multiple actions across the spectrum are also actions which serve to meet that need.

I have the "Hooked on Classics" album both on vinyl and CD. Listening to it relaxes me and allows me to feel safe and secure both in my home or automobile.

4
Up Vote Up Vote ×
+ Join the Discussion