42gameover

Hey there RNfinally: Very happy to pass it on; figure on me having the info this weekend. I'm not sure if you'll find it useful for peds but may as well take a look, right?

We (ie, the psych division) invented the Falls Risk Assessment tool we use. It evaluates gait and balance. There are several "measurements," such as: patient can arise from chair without use of arms or assistance, can maintain balance when given a little push -- eyes open and then eyes closed, can maintain balance when turned in a 360 degree circle -- eyes open and eyes closed -- does all this sound like what you've already got? I really don't know if it would be useful for a pediatric population, but if you think it might be of use I can give you the whole thing.

Wish I'd been there. Go you!

That's very true, and most psych facilities are simply not made for pts like that (even though the ER will still send them). We are not allowed to use medical beds on my unit, we are not allowed to have grab bars or handheld sprayers in showers, we have no specialized rooms for pts with contagious illnesses, we are not allowed to have any medical equipment which must be plugged in -- on the rare occasions when this is temporarily essential, that pt is placed on constant observation for as long as such equipment is required. I leave one or two hours late every shift as it is, sometimes more -- and I don't think I'm alone in that. We carefully address what medical issues we have (ie, impaired kidney function, diabetes, HIV, broken limbs) but if every patient required a physical every day -- eek, I would never have time to do that for 15 (or 17 or 19) patients. If RNs find that they're fudging paperwork because this is the expectation, then they need to sit down with their managers and alert them that these expectations are out of line. We have no such paperwork and JCAHO has never given us a problem.

This makes sense to me. If a thorough admission assessment is done, and you follow up daily with inquiries regarding pain/distress (we try to do this religiously) and evaluate/ask about side effects -- well, combine all this with your own observations and interactions with the pt and you should be able to pick up any real problems.* Remember, too, that many psych pts are wary of being touched -- a big difference from med/surg. But I'm wondering if you're communicating your concerns to your own colleagues? They'd be the best ones to advise you. (I'd love to have you working with me; Nursing Ed's not always available for our medical questions.) *On my own unit we do VS daily or more often, but we're an acute care unit; no doubt long-term facilities would not do VS as frequently.

We've had dozens of pts on abilify; some did benefit but most ended up being switched to another med. Since we're speaking anecdotally, I will say I've seen it help a few young adults with bipolar disorder (who were given the abilify to get psychotic sx under control, along with their other mood stabilizer/s), but as far as pure psychotic illness, it hasn't been overly impressive.

Glad I'm not the only one. I do think some of us are more susceptible to this sort of thing, and for those of us who do have that tendency, Psych is probably not going to help. Every time I hear a loud noise I'm afraid a pt's just thrown a chair through a window (or thrown a peer through a window, heaven forbid). The positive aspect is that I'm always the first one to race to the source of the noise. The negative is that I jump ten feet in the air every time the fire bell goes off, and if I'm ever giving an injection while that occurs things could get ugly. In regard to the original poster, I've worked in an acute-care psych unit for 17 years and it has taken a toll -- but I really feel any branch of nursing could do the same. Again, it's partly a matter of our own particular frailties, but whether you're tough or a bit fragile, nursing is damned stressful. I addressed the burn-out by giving up a head nurse position and taking a part-time staff RN job. That said, I would just add that a nurse who can work effectively and compassionately in the field of psych is doing something special in this world, and if you think your skills lie that way, go for it.