celery_juice

JustKeepDriving - I found your post really helpful in understanding when it is appropriate to set limits and try other methods. Thanks so much!

He did receive the prn as ordered, I did not withhold it. I came here seeking advice on whether or not it would have been an appropriate circumstance to withhold and get into that "pissing match" you spoke of and see if maybe there were any other interventions I could have implemented. Instead of looking at me in a negative light maybe I came here for justification of not withholding it? Because I often do feel like im too "soft" with the patients in my care. From the responses, Ive gathered that I did the right thing by being cautious and giving the prn. I've said in the past that Im new to this site and I also have limited experience and little to no guidance on my unit, so when I come here and ask things it really is coming from a place of genuine interest and a desire to work with this population and do right by them. Had I been with an experienced nurse that day, I would have been able to just talk to them. But I wasnt and so I came here. Thanks for taking the time to reply to me, I do appreciate the insight

I do understand this and should have given more objective information in my original post. So to generalize, am I to go along with any behavior regardless of whether it seems genuine based on observed behavior and assessments, because to question its "genuineness" would be judgemental and subjective?

This is what we were doing to a T. In this specific instance he was being observed without knowing and while doing so he was found to have zero tremor or symptoms, was eating and drinking perfectly fine, but upon entering the room he was suddenly so tremulous he could not sit still long enough for a blood pressure check. With that being said, I do always err to the side of caution because etoh withdrawal can be dangerous, so he WAS being medicated according to Md orders.

Wondering what everyone's strategies are when dealing with manipulative behavior in a patient. I'm talking specifically about a situation I had recently where a pt was very obviously faking ETOH w/d tremors for their prescribed PRN ativan. In situations like this, do you call out the behavior? I never know how to handle it.

I took it last September and prepared in a similar way. I read the ANCC book cover-to-cover a handful of times, and researched anything I wasn't sure on more in-depth. I also purchased the additional practice questions from ANCC. I didn't use any other study materials. As other people have posted, I found it similar to NCLEX. It was challenging but you seem as if you're preparing well. Good luck!

I checked yesterday and was not accepted to the psych program. I thought I had a strong application, but maybe this wasn't in the cards for me right now. Congratulations to you and best of luck!!

I don't know why, but I never got any notifications that this thread had any comments! I just caught up, and I appreciate all of the feedback, however I just checked my portal and I was not accepted. I am disappointed. I wish they gave feedback as to what your application was lacking so I can improve it and reapply in the future. Good luck to everyone else~!

yes! this! thank you!~

Glad I found this thread. I am also awaiting a decision for Fall 2015! I have 5 yrs experience split between med/surg and psych.

""Bottom Line: "You have Two Options- One: Make a Commitment to Safety, do Nothing in Word or Gesture that could be Interpreted as a Threat of Harm to Yourself or Anyone Else, or Two: Be Restricted of Your Right to Freely Move About.""" thank you! thats more along the linea of what i was looking for.

Thank you for your response. I think I didn't articulate my question right...I know that threatening restraints is assault, so if it has gotten to the point where restraints are imminent how do you tell the patient without it becoming an ultimatum/threat/assault?

Experienced Psych Nurses.... Especially in a crisis unit, there comes a time when a patient is being a danger to themselves or others, and the need for restraint is necessary. For a psychotic person, I will typically say something like "I am going to put you in restraints right now to keep everyone safe and help you stay in control until the medicine starts working." Is this appropriate? Now, for someone who is more aware of their actions, say, a behavioral group home adolescent or a medication seeker or personality disordered patient, how do you set limits and expectations without directly threatening them? It would not be therapeutic nor appropriate (or, I'm guessing, legal) to storm in the room with security and scream "STOP THIS NONSENSE RIGHT NOW OR I'M PUTTING YOU IN RESTRAINTS" ... so, how would I say it? Always looking for ways to improve my communication skills so any input is appreciated!

When I worked med/surg and wore them, they were 30-40mm hg. While definitely snug, I did not find them to be too tight, and they did their job quite well. I know they are expensive, but if you are that concerned with them being too tight, get a lower pressure and see if they help.

Hmm. I'd be interested to hear an update if you get the position!