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nurse lala BSN, RN

Psych. Violence & Suicide prevention.

Behavioral health RN III at LBVA.

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nurse lala has 42 years experience as a BSN, RN and specializes in Psych. Violence & Suicide prevention..

A humanitarian by birth, a mental nurse by the grace of world forces. I was born and raised in Orange County, Ca. My dear husband and I bought the house I grew up in. We share it with our teenager who challenges our sanity regularly. I learned early about the strength of words. I now use these super powers for good. Usually.

nurse lala's Latest Activity

  1. nurse lala

    PC RN appt is with a health tech!?

    I am gobsmacked by something that happened today. I had an intake with a new primary care provider at a local UC hospital. I received recombinant zoster from the heath tech who directed me to call to schedule a follow up injection and to request a nurse appointment. I asked if the clinic at this very prestigious teaching hospital had nurses? No, just one LVN. The Inj will be with her, the health tech. She reassured me of her qualifications. I have no qualms receiving the injection from a HT. but, labeling an appointment as being with an RN, when the clinic has no RN seems fraudulent to me. I value your thoughts on this.

    “I believe in everything until it's disproved. So I believe in fairies, the myths, dragons. It all exists, even if it's in your mind. Who's to say that dreams and nightmares aren't as real as the here and now?” 
    ― John Lennon

  3. nurse lala

    Self harmers

    Short of a staff member holding each hand, you cannot keep this person safe. Wouldn't shackles be indicated for such high risk?
  4. nurse lala

    Psych nurse. Questioning if psych is for me.

    No that doesn't feel good. You are not alone itsbekah. I think many new psych nurses experience the self doubt that you are feeling. I know I did. What worked for me may work for you. Think about the different professionals you work with. Some have strengths de-escalating, others are great helping process issues, someone else may be best at redirecting inappropriate behavior. When a situation occurs when you need a skill set that you do not have, consider pretending you are that nurse or SW or MD with the skills that you need. I wasmthe charge nurse of a locked adolescent unit in the 80s. I was a brand-new grad and pretty clueless to mental health, a subject I almost flunked in nursing school. I just pretended I was Nathan who was so capable with agitated or aggressive teenagers. Nathan was the most capable of avoiding a take down, by soothing and educating and redirecting. I learned the importance of staying calm from him. I became very proficient at adopting and adapting the strengthes I observed daily in Others. In time you will have an arsenal of skills learned from other professionals. Haldol for sleep is not appropriate unless the practioner wrote in the order to give for sleep. Please request a sleeper is ordered. From what you have shared it sounds like your being bullied. It's important you learn how and when to set limits on other people. Patients, MDs (carefully) and fellow nurses. It's okay to stand up for yourself and expected. Sometimes you have to show muster to get respect. I've learned that standing up to bullies, for example, make them back down. I have witnessed a fellow RN (she couldn't weigh more then 80#) stand up tall at 4" to patients and staff twice her size. And she controlled them because she expected them to comply. Reflected in her body language, words, tone of voice. I learned lots from that pipsqueek including how to be stern in a caring manner. Over time most nurses find comfort in the milieu. While I no longer work the locked units I visit as a consultant regularly. I still feel safer there then anywhere else in the hospital. its funny how frightened I was in the beginning. Good luck.
  5. nurse lala

    Disturbing lack of info on Self Injury(Ligaturing)

    Quite frankly, I'm curious. I do know about ligature points and suicide risk. But I suspect you're asking about another kind of ligature.
  6. nurse lala

    Disturbing lack of info on Self Injury(Ligaturing)

    May we have a clinical presentation?
  7. nurse lala

    Personality Disorders and Recovery

    Whispera is spot on. The client has serious mental illness. The hallmark of a person with Borderline PD is dissatisfying interpersonal relationships, unstable mood and unpredictable behavior. In your case WINTERLILAC, you have substance abuse as well. This is a dual diagnosis patient which means a complicated patient meriting specialized care. The person with BPD is often miserable and everyone near them is miserable as well. We have a responsibility to educate them about the disease process and treatment options. When the patient comments on their poor relationships or any other characteristic of BPD, I ask if they are familiar with their diagnosis? I pull up the criteria. And review with them. Not once has anyone denied meeting the diagnostic criteria. By talking about the disease we can help the client understand that the behaviors they learned as a child to survive their upbringing no longer serves them. Most people are relieved to know it is treatable with CBT or DBT. There are great books and websites on CBT. When working with the BPD you must have boundaries. Set limits on the time spent. Set limits on what you will listen to; QUALITY and Quantity. I refuse to engage in time that is not purposeful and goal directed. I make it clear we are not going to review all their complaints in the world. I refuse to entertain their fantasies. I ask that they identify what is the most important 1-3 issues they want to address. I will practice supportive and active listening for About 15 minutes. Much longer if we have a true crisis/dysregulation. Then we can process. We come up with a plan of action. I ask how likely they will act on their plan of action. I validate their readiness or lack thereof. I make it clear it is their decision. I make it clear that the only person really being hurt by their failures are their self. (No apologies to me dudette. It's your health. Apologize to yourself). I either reinforce decisions or suggest they consider doing things differently later. I refocus on the plan of care if they want to perseverate on fantasies or feel the need to keep talking about what we just finished talking about. I refocus on the goal of treatment and redirect the patient elsewhere. I never spend more than an hour. One of two things will occur. They usually want and respond to consistent and strong boundaries and keep coming back; or find someone else that will entertain their disease.
  8. Your son is responsible for himself ever since he became an adult. He has done well until he didn't and apparently stopped trying. He can blame his problems on you all he wants but you don't have to agree. He damaged your home and property all the while blaming his behavior on you because he doesn't like your husband? You are living your own life and have the right to live happily ever after, safely with your husband, if that is what you want. It is your decision as to whether or not you will allow your boy to come back home. You can choose to meet with the treatment team to discuss your concerns. You can develop a behavioral contract as conditions for his return. Or you can suggest he explore other housing options if he is less than cooperative. Take care LTCNS.
  9. What you did was timely and indicated. Your son needed immediate attention. You did it in a reasonable manner to minimize the drama. What you did took courage and selflessness. Knowing he may not forgive. You placed your sons needs before your own. No, he probably won't want to talk to you at first, anyway. But he may see things differently in time. Most people do. You will be hearing from him when he wants something. Maybe to come home. What you did was what a good mom does. Hang in there baby.
  10. nurse lala

    I need some input...

    Wow. My spider senses are tingling. But this feels too much like Pandora's box for this cautious chick. I sure hope you found some help you need(ed). I would encourage you to call the National Crisis Line at 1-800-273-8255 if things get worse or too hot to handle. Take care.
  11. nurse lala

    new grad with a psych degree, but no experience

    My experience reflects the sound advice posted by my colleagues. As a new grad, way back in 1986, every hospital wanted RNs with a years' experience. I worked as a CNA through the registry while I waited for that first RN job offer. I wanted to work in Spinal Cord Injury or a cardiac unit. I had no mental health experience and in fact found MH to be the most difficult rotation in my studies and I barely passed. One of the hospitals that always needed a CNA was the psych hospital. I worked on the locked adolescent unit for several weeks. It was pretty intimidating back in the day. We had two restraint rooms that were rarely empty on a 12 bed unit. The facility hired me when they learned I had an RN degree. And put me in charge. The facility invested in me because they saw my strengths despite my lack of experience. You have an edge with the degree in psychology. Now apply for the jobs and be confident you will make this yours.
  12. nurse lala

    TPA when drunk

    I would like to see GLU level.
  13. nurse lala

    Is it illegal to place a towel over a patient's face?

    illegal? No, I don't think so. The thing with spitting is the client has a right to do it. But the patients rights stop where and when the safety of others becomes an issue. Spitting is an assault, at least it is in California. It is vile behavior, usually perpetrated by antisocial personalities. We are allowed to protect ourselves in a reasonable manner. In an emergency situation, psych nurses will use what we can. A towel has been known to work well. So does a beanie, pulled over the face. They are both relatively light and air permeable. I would not likely question the pillow-to-face maneuver of a police officer. They are well educated in working with antisocial behavior and are quite effective in diminishing inappropriate behavior.
  14. nurse lala

    Pyschiatric nursing intervetnion help nursing student

    A psychiatric nurse would not give a medication for anxiety. We teach self calming measures. Coach to focus on breathing is an easy lesson.
  15. nurse lala

    Nursing diagnosis and intervention

  16. nurse lala

    How do you help your suicidal patients?

    What a great question. Talking about suicide is important because by discussing painful feelings will usually lighten the emotional load. The RN builds rapport and can help process the issues contributing to their circumstances. Suicidal thoughts can be distressful or a source of twisted delight. In either case, an assessment is always warranted. Ask these questions: How long have you had the thoughts? What triggered them? Do you have a plan? intent? Have you found a means? Do you have something to hurt yourself? Have you already done something to hurt yourself? Have you practiced? What has kept you from acting on your thoughts? Then use this opportunity to process what triggered the thoughts. Help problem solve. Educate. Reinforce good choices, such as reporting the SI. Validate and normalize the experience. Come up with a plan to avoid the trigger to the suicidal thoughts. We need to reinforce strengths and this is an easy one. Implement safety measures. Communicate to key people. Document.