Psych patients on medical floors

[rn undisclosed name]

I will start off by saying I don't like dealing with psych patients. If I like it I would work in psych. It's just not my cup of tea. In my experience psych nurses don't like dealing with medical issues.

So, my question is how to deal with these patients. Depending on how bad the patient is I don't think it is proper to tell them the psychiatrist has to come and evaluate them. The psychiatrists don't appreciate that but I don't think it is my place to say anything because that can just agitate them more if they know a psychiatrist is going to see them. If the psychiatrist determines they should be admitted for psyiatric evaluation I think they should tell the patient and not leave it to the other staff. I am wondering how others deal with this situation.

[floridanurse1983]

With staffing the way it is now, it is not possible to have psych pts in med/surg units who are actively psychotic. I have no problem taking care of psych pts. My problem is when people have 7 pts and all the aides on the floor are doing 1-1. Who has time to take care all the other pts not getting care.

[Crazed]

I love the idea of a Psychiatric Medical Surgical type unit and while they do exist in small numbers it's unfortunately unrealistic to hope for such combination units in all nursing specialties so I don't think we'll be seeing any psych-OB, psych-rehab, psych-oncology etc. It would be great if we had more nurses who are experienced both in the medical aspects of patient illness as well as psychiatric aspects. I think alot of medical minded nurses are uncomfortable with acute psychiatric issues and I understand that. For a non psych nurse I think treating mental illness is quite a challenge. We can't measure mental illness and target a certain number and aim for that as we can with BPs and glucose levels. We can give medications but that's not always really treating the problem. We can be unsure how to communicate with a patient who is acutely psychiatrically ill. I don't think those nurses who are uncomfortable with psychiatric care are talking about a patient whose psych illness is currently well controlled; they aren't trying to cast all patients with mental illness off to an island so they can be avoided. I liken it to placing a patient with an acute cardiac problem on an oncology floor - those onco nurses likely would not be comfortable because it's an acute problem which they are not familliar with caring for. I see acute psych problems in the same way. It is NOT a good idea to keep a psychiatric diagnosis from your treating physician as that disease process or any medications that one may be on to treat it are important pieces of information and can effect current medical treatment or even easily explain a problem that the patient is currently having. I sincerely hope the previous poster will keep in mind that while there may be few colleagues of ours who unfortunately may still stigmatize mental illness most will not allow that to effect the care they give and may actually be able to give BETTER care based on that knowledge. We need to advocate for ourselves in all nursing disciplines to ensure that we get adequate training in all aspects of care that would should be expected to provide and some psychiatric training is certainly something that we and our patients would benefit from us recieving. Perhaps offering a shift of shadowing in a psychiatric unit would do a world of good!

If my lamictal dose made a bit of difference for a fractured metatarsal I'd speak up but it doesn't.

The reason why this thread scares me so much is because with meds when I am perfectly even, medical staff with little to no understanding of bi-polar disorder super impose every bi-polar horror patient they've had onto my face. I become Charlie Sheen on a meth binge when all I want is to be evaluated just like everyone else.

But you see this thread proves I can't be.

It proves it because the horror story doesn't exist as the exception but as the rule.

You know the look that people give me when I say, "The entire reason I decided to go to nursing school was because I met a psych nurse that loved his patients," is usually somewhere between a puzzled glare to responses like, "Oh you don't want to do that."

You see, I have the ability to see things others don't and that makes me unique. (Like a self injuring patient can do this with anything from the cap of a stick pen to removal of the spring in the toilet paper roll)

I honestly cringe when I see my NP and he asks me, "So how's the bi-polar going?" because it's not like I'm constructing a sand castle or reading a romance novel.

The only time I was inpatient for psych was when a doc totally switched my meds with no winding down which sent me in a depressive state. While I was inpatient I met a man with some form of a mood disorder who disagreed with the diagnosis he had been given but since he was there on a commit he couldn't refuse meds. They blanket wrapped him and forcibly gave him his meds and afterwards he looked at me and said, "Not only did they break my watch but they were rude too. Had they told me they were going to do that I would have just taken them."

I'd never see anyone look so sad and beaten down until that moment. It was as if the one thing that he had left, his one measure of control had been stripped away without even a second thought.

You see to "normal" people medical care can be invasive but tolerable. There is a measure of trust in the people providing that care. To an actively psychotic psych patient who isn't even sure where they are, if what they are seeing is real or not, it's a struggle to control the things they know they have some say over.

[xtxrn, ASN, RN]

Lamictal is an anticonvulsant- what prejudice are you getting from that? :) I know I've had horrible ED care when epilepsy is even brought up.....but I have to tell them my meds. It's unsafe otherwise. I don't like the ridicule- but I'd hate a drug interaction worse. :)

I'm also epileptic, and have had a ton of nurses tell me I'm a "wasted bed" in the ED, cram ammonia inhalants under my nose and HOLD THEM THERE while I gasp, tell me "no epileptic is compliant and they never see their primary doctors" (uh, not true), and , among other things, had an MD try to intubate me without checking my LOC- I had just woken up and figured out where I was (ceiling tiles- no call light ever left near me). He came in alone- and started cramming the laryngoscope down my throat, triggering the gag reflex (no nurse with him to suction), so I had to turn my head to let the puke out- turning caused the scope to scrape my tonsil, so it started bleeding like crazy; I was trying to get the scope out of my mouth- and they tied me down. All he had to do was take the scope out and let me turn my head and spit out the blood. FINALLY, Dr. Genius takes the scope out (obviously I wasn't having trouble with gagging), and asks me "Did you OD?"- I was bewildered (didn't even remember being sent there) and said "no"....he got huffy and said "that's all you had to say".... Well, buddy- that's all you had to ASK...