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Psych, med surg
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pandora44 specializes in Psych, med surg.

pandora44's Latest Activity

  1. pandora44

    XL Humane blanket?

    When I posted my original comments I was quite frustrated and tired and simply needed a few sentences to vent. I neither expected nor asked for responses about acuity. The implication that the nursing staff is responsible for patients acting out and that management was lax in their responsibilities is misplaced considering I offered no information about the clinical situation of the patients involved, or the unit's policies or procedures (other than that we use restraints), or management's response to the situation. I would hope that a fellow nurse would respect the clinical judgment of experienced psychiatric nurses who actually knew the situation. For the record, and as I originally stated, multiple codes in a night is not normal for my unit. We frequently go weeks without any codes at all. Additionally, calling a code does not mean that a patient is going to be restrained. It simply means that the RN wants extra staff members available and, if possible, we call codes before a patient loses control. We do assess for patient triggers and coping skills that work for them on admission to the unit. We do care plan that. We do strive to provide consist limits for patients. We are not ignorant of the fact that patients do up the ante, as it were. Nor do we think of ourselves, or act, as the Behavioral SWAT team. And incidentally, management closed four beds for us and provided extra staff, all without prompting from staff, while our acuity was high. Since my original post, we've had no codes at all. What we do as psychiatric nurses is so challenging and difficult. It is also terribly misunderstood by the general public and misrepresented by the media. We have so few avenues to talk freely among ourselves about the more difficult aspects of our work, i.e. restraints, seclusions, ECT, ect. I had hoped that the psychiatric nursing specialty pages of allnurses could be a space for us to communicate freely without the need to defend what we do and how we do it. I am truly sorry that has turned out not to be the case.
  2. pandora44

    reporting abuse

    Yes, this should be reported. It is not up to us as mandatory reporters to decide if there is or is not abuse or neglect. We have to report anything we suspect. When you call it in, just say what you know. Do not extrapolate. If they ask something you don't know, say so. I would have asked the patient more information about the situation. How often does he hit the child? Is he alone with the child? Most importantly, where is the child now? Does the pt feel safe with her husband? Gather as much info as you can. The first time I asked a patient these questions knowing I was going to call a report into DHS I felt awkward but remember, you are protecting someone who is unable to protect themselves. File a report as soon as possible.
  3. pandora44

    XL Humane blanket?

    When I first wrote this post I assumed that the Humane blanket was much more widely known that it obviously is. Among the staff, the humane blanket is known as the "Burrito" and that image helps explain how it is used. The blanket is a large piece of heavy duty canvas with velcro that is used to safely transport an out of control patient. It cannot be used to restrain a patient, only to move them. There are two extra pieces of canvas about ten inches wide and pretty long. One of these goes around the pt's legs at the knees and the other around the pt's torso at the elbow. Both are secured with velcro. The pt's arms have to be inside this canvas strip. Once the two canvas strips are on the pt, it's fairly easy-ish to roll the pt into the blanket and secure them by wrapping it around them. There are six handles on the blanket to carry the pt. As I mentioned in my first post, this works pretty well if the pt is of average size. With an obese pt, nothing fits. We spent 45 minutes the other night trying to move a pt through two doors and ten feet to get her to a bed to be restrained. We sort of got her in the humane blanket but she was too big for it to fit properly. She was also kicking, clawing, bitting, punching, and causing as much havoc as possible. This is an interesting discussion and I am curious to hear about other's experience of restraints. We heard earlier this year that our hospital system is considering doing away with restraints completely but even our director said that was not likely to happen. I, too, never like to restrain patients. However, I think that it is sometimes necessary and I feel confident that in my facility restraints are only used when a patient is a clear danger to self or others.
  4. pandora44

    Reserved Personality Type in Demanding Career

    Hi there. I happen to be a INTJ, so I know about being quiet and reserved. My natural inclination is as a loner and outsider. I'm not good with snap decisions or interacting with large numbers of people. Still, I am a successful and happy nurse, even though I worried in school about all the things that concern you. However, it seems like you have two different issues going on. Its one thing to be shy and have poor communication skills. You can work on your communication skills and get better at them. You may always be shy in your personal life, as I am, but as a nurse you learn to put on your "nurse face" and take charge of the situation Again, you learn it with experience. Your comments about second guessing yourself and being too hard on yourself are different than just being shy and socially unsure. It sounds like you have some serious self-confidence issues. The good news is that it should not keep you from becoming a great nurse if that is what you decide to do. The bad news is that you will definitely want to work on those issues before starting nursing school. Nursing school is really difficult and for people with perfectionist tendencies, it's brutal. I know, I am one. Bottom line: don't let you fears dictate you life.
  5. pandora44

    Going into psych after 15 yrs of hospital nursing

    There are lots and lots of greats posts on the psych pages for nurses new to the field. Spend some time reading through the posts. Here is what I wish I'd known: You will become strangely close to many of your patients as you work with them over the months and sometimes years. You will see them at their worst, and daily hear intimate details of pain and heartache. This creates a bond that is difficult to describe but none the less real. I think of it as a cross between an older sibling and a distant cousin. Your patients will make poor decisions. Not always, but frequently, and sometimes fatally. However much you may lament their choices, you must always remember that they are still responsible for them. Keep your boundaries firm, but never lose your compassion. Know yourself. I cannot stress this enough. Being a good psych nurse requires a strong sense of self. What types of manipulation are you especially susceptilbe to? Most psych patients are master manipulators and some like to split staff. Watch out for phrases like, "No one understands me like you do" and "You're the best nurse here." Leaning to set appropriate limits on patient behavior can be daunting. I think it is one of the least addressed aspects of the job but one of the most important. You must address inappropriate behavior in a timely manor. Sometimes that means addressing it immediately, such as a when a patient is harming themselves or others, and sometimes it can wait until you sit down with the patient to have your 1:1. On the other hand, pick your battles. The mental health care system will make you want to bash your head against the wall. Lack of services, extremely long waiting lists for every type of assistance, and the almost daily loss of mental health beds mean more frequent hospitalizations for everyone. Despite all I've said above, psych nursing is actually fun. I spend every day engaged in my job, challenged intellectually and emotionally. I love what I do, and I have the time to make a difference in the lives of my patients.
  6. Hmm... This is a tricky situation. Good for you for recognizing your issues and seeking help. I know a number of staff nurses on my psych unit who sought mental health services and I think that is all for the good. But I would be very, very cautious about joining a DBT group. Just too many blurred boundaries and you are bound to run into former patients. And I wonder at the impact on a DBT group if one of the members is a pscyh nurse. Is your therapist willing to do DBT with you individually or can he/she recommend a therapist that would do so? Good luck.
  7. pandora44

    XL Humane blanket?

    So what do you do when the pt is assaulting staff by bitting, kicking, punching, rushing, etc.? Those are the only times we use the humane blanket, when we can't get the patient safely to the quiet room otherwise.
  8. pandora44

    XL Humane blanket?

    It's been a very bad couple of weeks lately and our unit has had a very high number of code greens. We're averaging 4-5 a night. It's been bad. This is not normal for us. We just have a very difficult patient population at this time. My question is about our humane blanket, which is used to restrain and transport patients who are out of control. It works pretty well, provided the patient is of average size. However, the patients who have been causing the code greens are all very obese. The humane blanket doesn't fit around them very well, or, in some cases, at all. This is dangerous for the patient and the staff. I looked online to see if there was a blanket that was bigger but it seems like we have the largest one. Some staff said we used to have walking restraints that worked well but they had to have a key, and we can't use any locking restraints. Have any other units had this problem? Any ideas?
  9. pandora44

    What references do you you use?

    I understand why they want you to save your texts, but honestly, I wouldn't bother. You'll be able to find anything you need on the internet quicker than you can find it in the textbook. After I graduated, I never look an my textbooks again. I wish I gotten rid of them years ago. Also, if they want you to buy a medical dictionary, I'd pass. It's heavy and expensive and you can find it all online.
  10. pandora44

    If you love your job, what is your speciality?

    I work and love psych. :redpinkhe I worked a year of med-surg and hated it. Psych is intense and interesting and challenging. I've been two years now in psych and don't think I'll leave it any time soon.
  11. pandora44

    Newbie psych nurse seeking feedback (long)

    [quote= My own Rule of Thumb is to titrate my Expenditure of Energy according to the particular Patient's Resolve to help themselves. I fulfill my responsibilities as a Professional to all Patients. For those Patients willing to better themselves or their situation, I will go to the Ends of the Earth in assisting them in their Therapeutic Endeavor. I will not cast my Pearls before Swine but I will take a Bullet for a Few. Dave - what a lovely and delicate way of phrasing that sentiment. On my unit, we short hand it to "don't work harder than your patient." I hope no one blasts me for that, as I believe that's the credo of every good psych nurse. I have spent hours and hours of my time with patients and their families who are terrified, motivated, and desperately looking for answers and guidance. On the other hand, I've lost track of the number of patients who have told me that it's my job to "fix them" when I ask what they are doing to speed their recovery. This always leads to a discussion about their responsibility to themselves to get well and do what they need to do to stay well. Then there are patients who are in no way willing or ready to make any changes in their lives. Sometimes a patient is just not in a place mentally to respond appropriately to challenges from staff to work on their issues. Of course, these are not discrete categories but a continuum of motivation and desire to change. Patients move back and forth on this continuum all the time. As a psych nurse, being able to recognize where a patient falls on that continuum on any given day will save you a lot of energy and time.
  12. pandora44

    Newbie psych nurse seeking feedback (long)

    I've been a psych nurse about two years, after moving over from medical. I well remember where you are right now. It takes awhile to learn to deal with challenging patients! When I've had a patient who is obviously "faking it" but suddenly appears much improved, I don't focus on it. I might say something like, "I'm glad you are feeling better" then move on to other things. I will call a patient on their behavior if their symptoms just suddenly appeared when I know they were fine a few minutes prior. For example, a patient recently told me she couldn't get out of her bed, even though she had been up walking in the lounge a few minutes before. Nope, I told her, you can get up. You were just in the lounge. She got up. Chest pain and S/S of other major medical issues are tricky. I would always report chest pain, c/o seizures, overwhelming pain, etc. Just because they have mental illness doesn't mean that they might not have a heart attack. And yes, I know, 99% of these complaints are requests for attention and/or medication. But is it really worth your license to not report it? I work in a medical hospital with multiple psych units. CP gets reported to the psychiatrist, who almost always consults our medical residents, who of course order an EKG at the minimum and usually labs. Calling pts on obvious BS stories? Generally I wouldn't, at least until I had developed a good relationship with them. But in most cases it's probably not therapeutic unless their stories and/or behavior is outrageous. Calling pts on excessive use of pain and/or anxiety meds? Maybe, depending on the patient. Again, I would have to have a good working relationship with them. If it's someone with some insight into their issues, I usually mention it and suggest that they cut back. And yes, when a patient shows some insight is exactly the right time to bring these things up. For a pt who calls herself a princess, I might say, "Well, yes, you are a bit of a princess," with a little smile to take the sting out of my words. I might add, "Let's talk about that in our 1:1 after supper. Right now I need to check on my other patients and check my paperwork." Setting appropriate limits on demanding patients can be a real challenge. On our unit we will sometimes do hourly requests with these patients. Works pretty well. I think it's also appropriate to say to a demanding patient that you need to check on your other patients and it will be 45 minutes (or whatever time) until you can get to their latest request. Hope this is helpful.
  13. We don't use any specific tool for suicidal ideation at our hospital. If a patient comes into the ER and says they are suicidal, they are admitted to our ER Access Center. The Access Center is staffed with experienced psych RNs and social workers who do an assessment to determine the lethality of the pt's suicidal thoughts. Just because someone says they are suicidal doesn't necessarily mean they will be admitted. The following questions are all explored with the pt: -Do they have a specific plan? Is the plan viable? The more specific the plan, the more details, the greater the lethality. Someone with a plan to jump off a bridge but without transportation to the bridge is probably ok. On the other hand, if someone is planing to shoot themselves and there is a gun in the house...much higher lethality. -Have they put the plan in action? Have they started gathering any supplies they would need? Made arrangements to get loved ones out of the house? Buying pills, stockpiling pills, hiding a knife, buying bullets, figuring out train schedules, learning to tie a noose, searching the internet for ways to kill themselves, etc. are all very serious signs. -Any history of self harm behavior, previous suicide attempts, or a family history of suicide? Any of these increase the chance that a person will take their life. The more serious and recent, the higher the lethality. -What type of support do they have? If the pt is not admitted to the psych unit, do they have supportive friends or family they could call on if needed? Is someone available to stay with the pt, 24/7 in need be, until the pt can be seen by their psychiatrist or therapist? Someone without significant social support is more likely to take their life. -What happened to cause the current crisis? Something acute - pt got fired today, wife just left, first grandbaby died unexpectedly - is more likely to warrant an admission to the unit. -Finally, what does the pt think? Do they feel they would be safe if they left the hospital? Can they contract for safety if they leave, promising to return if they feel they can't be safe? How likely are they to follow up with their psychiatrist or therapist? In these crisis situations, most offices will see pts ASAP the following day. The above assessment is used in the ER but it is also the same information we explore with the pt on a daily basis in 1:1. Hope its helpful.
  14. pandora44

    Nursing and sexual orientation

    I my experience, it depends on the area of the country you are in and the type of nursing you do. Many people on this tread have said you just shouldn't say anything about your sexuality and then no one will bother you about it. I find this very insulting since if you never say anything about your sexuality everyone will assume you are straight. If that doesn't bother you, then hey, no problem. But I have found that there eventually comes a time when you have to make a choice about outing yourself, at least a little bit. Usually it comes when you eventually get tired of all the snide and homophobic comments that some straight people make on a regular basis. For example, using the phrase, "That's so gay!" as an insult. Or using air quotes when talking about a female patient's legal "wife," as a colleague of mind does. I find this behavior unacceptable and will tell someone so. I take pains to make it tactful but it doesn't take a genius to figure out that I'm not straight. Frankly, I couldn't care less what my co-workers think of my sexuality. I would much rather they know that I'm bisexual than let comments like those above go by unchallenged. Actually, I think they were more horrified that I'm an atheist.
  15. I was at my doctor's office with a UTI. I had peed in the cup and put the lid back on. Then I was looking around for gloves to carry my own urine sample. Cracked me up when I realized what I was doing. When I'm bored or anxious I count my own radial pulse. I usually use military time. When texting I use "et" instead of and and "c" instead of with. It confused my friends at first but they're used to it now. I always check out people's veins, frequently diagnose strangers, and sign my checks with RN after my name. I also work a second job in retail. I have to concentrate very hard to give the right greeting when I answer the phone. I also tend to call customers "patients."
  16. pandora44

    Suggested Videos / Movies About Mental Health

    I started watching a little known movie called Manic with Joseph Gordon Levitt that I got from Nexflix. Its about a teenager with bipolar, I think. Its actually set in an adolescent psych unit. I didn't watch the whole thing because it was my day off from work and watching it was just like being at work. Very realistic.