TamIam

I am interested to hear what others think about this situation. A male patient is admitted after an impulsive OD ingestion of an antidepressant, following what he percieved as rejection from his physician. The patient has a history of being admitted several times in the past. He claims to have a neurogenic bladder, and this may be true, as he is reported to self-cath at home. He was admitted with a diagnosis of Suicidal Ideation, and has been diagnosed in the past with Personality Disorder. At the time admission, the patient acted out, throwing his belongings at staff or nearby. He calmed down and was admitted, slept well, and had a calm day. He was offered a catheter several times during the day, but said he was fine, that he didn't need it. When the Psych Dr. came that evening, the patient demanded to be discharged, sit ting down in the nurses station and refusing to move until he did. He was not discharged, however. He then began demanding a catheter, which was supplied. However, he is accustomed to using a rigid straight cath, and was provided with a flexible rubber catheter. He became angered, saying he couldn't use this one. His bladder was palpated, and was not distended. (The nurse did not provide the patient with a firm catheter because, during a previous admission, he had inserted a firm female catheter [which he had impulsively grabbed from the nurses hands] in so far it had to be surgically removed. He also had a past history of pulling an indwelling cath out when he was angry.)The patient yelled that he would "piss all over the furniture" and was encouraged to use the bathroom. He then voided in the bathroom and provided a urine specimen. He then went to sleep. The next morning, he awoke and met with the doctor, who discharged him. The patient said he was "Fine. Ready to go." There were no complaints at that time about urinary discomfort. After discharge, the patient called the facility and reported that his nurse had a bad attitude, refused to discuss the rules of the unit during his admission, and failed to supply him with the materials he needed for his condition. The Unit Director has questioned the staff RN in this case, and feels that the nurse should have arranged for the patient to be cath'd. It was clarified that the rules of the unit had been reviewed at the time of admission. The staff RN feels that the patient was being manipulative and was not in true crisis, as did not have a distended bladder and was able to void immediately after the event in question. The RN also feels that the patient is splitting and transfering, being pathological in his behaviors, concurrent with his diagnosis of Personality Disorder. The Unit Director requested that Axis II no longer be considered in treatment, because "it leads to judgement." What do you think?

First Year, I don't often respond, but thought this worthy of a couple words. I have worked psych for several years. Long ago, when I graduated, I was told to get some med-surg experience first, and I have been ever-so grateful that I did! It has been an incredible resource that just can't be replaced. Actuallyl, I wish I would have worked ICU, because the decision-making level of a critical care nurse is so amazing---they really think through how the systems work!! Too, I have worked with several others who went straight into psych, and they just don't seem to grasp the medical side of the patient as well---they just don't get enough exposure on the psych floor. Geriatric psychiatry may be a different story, because most of the elderly are affected in some way or another, but the intensity still isn't the same as on a medical floor. You just don't get the skills of doing dressings at lightning speed AND sterile when you only have to do them once in a while. Too, after working a medical floor, you get a 'feel' for conditions, or the 'picture', that is almost intuitive--and it doesn't go away. Actually, some of the psych patients present so differently than the average Joe, there are times you have to look at subtle signs and symptoms--and labs---because the patient is not going to be of any help. My vote: hone your medical skills first, then do psych. Of course, my first suggestion is this: listen to your own heart. What do you feel is right for you? Best of luck.

I have to put in a plug for Crocs. Innexpensive, washable and durable, and they massage your feet all day. They're lightweight---nearly like going barefoot. A friend of mine has them because of the neuropathy she has in her feet---she doesn't feel pain when she wears these! (She has 6 pairs !) As a matter of fact, she says PayLess Shoes makes a brand (Airwalk) that mimmics Crocs, and is just as good, for $10 less.

Of course, they're "Real Nurses"! But, then I am one. I just don't listen to others' comments, because I know what I do. Like the time a woman came in w/ the c/o extreme anxiety and aggitation: we discovered she was having hypoglycemic episodes. And there was depressed woman who had an MI. Or the schizophrenic man with a staph infection. There's LOTS of diabetes and drug-enduced conditions that truly require a skilled profession NURSE to recognize, treat, and educate. Furthermore, we usually work w/ a population that has difficutly communicating, has limited insight and/or ability to comprehend the extent of their condition, so the ability to pick up on subtle clues is absolutely essential. Furthermore, we detox drug/alcohol patients, and if that's not medical, I don't know what is! I should add, I've been a med-surg nurse. Others I work with have worked ICU, CCU, Obstetrics, and Emergency prior to coming to our unit. Real Nurses? You bet we are!!!

RealNurseWitch, I sit on the fence with this one. I agree with the administrator, that the hospital should not be spending money on this. Health care costs are already rocketing beyond affordability. Too, it's my opinion that it's not appropriate for the facility's website. However, I think employee moral is important, and games are fun. (I don't like gambling, personally.) What's to say that the ones who want to play pitch in, and the pot is divided in an agreeable way. You could get, say, UK hats, scarves, or something of the sort, for the winners, and the remaining funds donated to a local charity. That's more of a win-win solution for all. Good luck.

:) I love to meditate. It's my favorite thing to do! I have practiced for 14 years, doing Sahaj Marg (Raja Yoga). More info on this can be found at www.srcm.org. As for relaxation techniques, I have been a psych RN for years, and find that asking the pt to listen to his/her breathing is very effective. With some guided imagry, the in/out of respiration can be likened to the in/out of waves on the beach. Now, that's peaceful! The mind can be so tormenting for some people. I encourage them to re-focus on their respiration whenever their thoughts intrude. I can't tell you the times a client would come to me the next morning, bright-eyed and bushy-tailed, saying, "Wow! That really helped!" And it's free. :) And they can take it home w/o a perscription.:) Can't beat it. I'd be interested to hear what's worked for others.

I am curious to know what others' experiences are in their practice. Where I am employed is currently changing from a Primary Nursing Care approach (RN's doing most of the care/assessment/etc) to a Team Nursing Care approach (One RN to 13 pts, with LPN and PCT assistance). My understanding is that the RN is 100% accountable for the work done by the LPN and PCT. Has anyone had experience with this? What are the pros/cons that you have seen/encountered?

NPR radio recently said that Dayton, OH has the largest shortage in the US. Where they got their info, I don't know.