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greenbeanio has 3 years experience and specializes in mental health.

greenbeanio's Latest Activity

  1. greenbeanio

    Question to all nurses who work in Psych

    VegGal, Can't speak for all inpatient settings but in the 3 that I have worked in, "med passes, initial assessments, ongoing assessments, monitoring clients and documentation" just about sums it up, in addition to admissions, discharges, and going back and forth with the doctors reminding them of what the patients need etc. And of course de-escalation and calming patients down and behavioral codes on occasion. And I like to do a lot of patient ed whenever possible. Occasionally I can squeeze in a group but its hard, time wise. No IVs, caths etc, - at least, not under normal circumstances. (I remember just one patient with an IV, and one that I had to help straight cath - although if a med sure nurse hadn't happened to be a float that day, I would have asked for a med surg nurse to come help out). Some wound dressings, though. And sometimes baths and incontinence care. As for a reasonable patient load - hah! That depends on just how superficial your patient care is expected to be. And on acuity. On my unit 6 patients is routine and although we are technically able to go up to 8, we never do - the charge nurse takes the extra patients. So much depends on acuity though - recently one of our teams had only 4 patients on it and it was way more work than my team with 6.
  2. greenbeanio

    Psych Nurse Report Sheet

    I got a blank page when I opened it?
  3. greenbeanio

    Is specialized training required?

    Do yourself a favor and get this book and read through it cover to cover: Inpatient Psychiatric Nursing: Clinical Strategies & Practical Interventions: 9780826109712: Medicine & Health Science Books @ Amazon.com It is the best "training" you could get in inpatient psych that is in a book. The rest of the training will be on the job, learning through experience. And the best way to get that right now is to look for a job as a mental health counselor or psych tech (different names, same thing) at your local hospital. Because nursing school takes a lot of time and you could be getting invaluable experience in the meantime.
  4. greenbeanio

    scheduled meds with prns

    So much depends on the individual patient, and what their body can handle. Some of them can have enough antipsychotics to slay a horse and still be walking around quite calmly. Some of them need it to stay in control. And then again, some are med-seekers and totally dependent on popping pills. What you do depends on who you have. Here's how I would proceed: 1) Like Jules A said, ask the patient to give the previous meds a chance to start working, and offer support/distraction in the meantime. 2) If it's a patient well known to the unit, check with the other nurses who have been there longer to see if they know this patient's pattern. 3) Like Elkpark said, check with the doctor who wrote the orders, if they are available. 4) If that MD is not available, check with the on-call doctor. 5) If there is some reason you can't reach the on-call doctor, then like ThymeRN said, check with pharmacy. 6) If all else fails, check with the Nursing Supervisor. 7) If nothing else works, and you have checked with everyone available, you can give the medication as ordered. After all, it is ordered and the attending doc is the one responsible for being aware of the patients meds including PRNs and it is up to them to write in clear parameters. OR If you have a strong gut instinct about it and your nursing judgment says not to give it, then don't give it and start preparing for a code. (Which may not happen but its good for the unit to have a heads up.) 8) Document everything, including everyone consulted and rationale for your decision to medicate or not medicate.
  5. greenbeanio

    I handled this poorly. What would you do?

    As someone said, hindsight is 20-20. So in the situation I would probably have said "This is completely inappropriate, and frankly pathetic and ridiculous. What exactly are you hoping to get out of this?" Then I would have reported it to the supervisor and to security. But given the fact that I am not in the situation, I can afford to have 20-20 foresight and so I would call the police and file charges. Because I refuse to be sexually harassed by anyone, anywhere, at any time. And the fact that he did it to one of your coworkers as well shows that he is a habitual offender and deserves to get the message loud and clear. Where's Lorena Bobbitt when you need her?
  6. Like this stuff: https://en.wikipedia.org/wiki/Psychiatric_and_mental_health_nursing#Therapeutic_relationship_aspects_of_psychiatric_nursing
  7. That's what I've been hearing recently. That it's unrealistic for patients on acute inpatient units to expect a one-to-one check in with staff each shift, or individual patient education. That these days its all done in groups. And the depression/anxiety/SI/HI/AH/VH/paranoia assessments that we are required to chart on can be done briefly at the med room window. That inpatient psych nurses cannot realistically do the interventions listed in the literature and the textbooks, and that at this point, on account of increased patient numbers, acuity, and liability (leading to increased documentation requirements), all we can hope to complete in a shift is passing meds, brief assessments, charting and de-escalation/crisis response as needed. That building trust and establishing therapeutic relationships and providing patient-centered individualized care is no longer possible except on the fly, maybe squeezed in as a luxury only after the essentials (the "tasks", the charting) are completed. And that all the therapeutic work of healing has to happen in groups, "in the milieu" and outpatient, after discharge. Not one on one with nurses any more. Is this true? Is this a nationwide trend? Is this how we all have to work these days? Or do any of you work in places where you can still have meaningful contact with your patients?
  8. greenbeanio

    Innovative Mental Health Care

    OMG! Where is this wonderful unit you speak of? Sounds great!
  9. greenbeanio

    Good books on psychiatric nursing?

    Here's one I think is very good - very practical and geared towards real life inpatient psych. Its called... Wait for it... Inpatient Psyhiatric Nursing! By Linda Damon et al. If you get only one book for inpatient psych, this should be it! Inpatient Psychiatric Nursing: Clinical Strategies & Practical Interventions: 9780826109712: Medicine & Health Science Books @ Amazon.com
  10. greenbeanio

    NEED ADVICE Male Borderline!!!

    We use a behavior plan, refer all questions and concerns to their contact person who sets a time to meet with the pt for a finite length of time that is not extended. And encourage the pt to write down all of their concerns so that they can be addressed within the time allotted.
  11. greenbeanio

    long nails as "sharps"?

    If you had a patient with a personality disorder who is not psychotic but has an aversion to rules of any kind and of limits being set .... and if this patient had assaulted staff 3 times in one week, scratching them with long nails and drawing blood every time ... would it be expected that their nails would be clipped and filed for the safety of staff and possibly other patients? Even if they had to be restrained in order to do it, if they refused to let their nails be clipped voluntarily? Or would you have to let this patient keep their long, jagged and filthy nails? Even though they are not allowed to keep any other weapons or sharps with them. I'm sure the laws regarding this kind of thing vary from state to state. Although I am not sure that there are laws specific to nails, which are the only part of the human body that can be removed without pain and which grow back (other than hair, which cannot be used as a weapon). So I am not asking about the laws of your state, so much as the common sense/ethical perspective on this.
  12. greenbeanio

    non-religious overseas medical work

    Children's charity for cleft lip and cleft palate surgeries - Operation Smile Partners In Health Healthcare Volunteer Abroad- Medical, Dental, Nursing Volunteering worldwide with United Planet Mammoth Medical Missions | Routine Medical Missions Just look on google for secular medical missions and you'll find them. Good luck! And thank you for doing what I can't do right now!
  13. greenbeanio

    alternative to trauma shears?

    Found it! Here it is: S-CUT - The Emergency Cutting Tool for Rescue Services It's called the S-cut. "S-CUT replaces scissors, knifes and similar tools. Ordinary fabrics as well as leather belts, zippers and heavy outerwear can be easily cut. All you need is a free edge of the clothes where you can start the cut."
  14. greenbeanio

    Patient on patient abuse?

    All residents have the right to be safe and free from harassment. To say that this is baseline and do nothing about it is negligence on the part of the management towards the "non-bully" residents. I feel that there should be consequences to bullying behavior such as being restricted to their room for a certain length of time or a loss of social privileges. Not necessarily as behavior modification since they may be beyond learning anything much at this point, but just as a way to have some peace and safety for even a little while. And who knows - the behavior mod might just have some effect.
  15. greenbeanio

    Are bras contraband?

    I know of a patient who hung herself with a sweater. You can't take everything away. Especially things like bras which affect a patient's dignity so much. The best protective factor is connection.
  16. Read this book, and really use it: The Depression Workbook: A Guide for Living with Depression and Manic Depression, Second Edition: Mary Ellen Copeland, Matthew McKay: 9781572242685: Amazon.com: Books Exercise, eat right, sleep well. Start with the basics.