Psychiatric Nursing Differences?!

[medsurgrnco, BSN, RN]

I just started my new psych RN position, and am surprised at some of the differences from med/surg. Seems none of the nurses actually assess the patients (other than a few questions) and no one uses double-checks to make sure they are giving the medications to the correct patients (who do not wear namebands or allergy bands). I think I'll really like psych, but am pretty appalled at the laxness of other nurses. Is this typical of psych?

[Wildwood Flower]

First, please don't be so quick to judge what an assessment is; most of our pts are "walkie/talkies"and have no medical issues that would require a full body assessment. I'm assessing my pts every time I interact with them, from introducing myself at start of shift, thru med pass{can't beleive no id check for med pass} . You can glean a lot of info from casual interaction which is also a lot less intrusive, threatening feeling to pts with paranoia etc.I have worked many areas of nsg and each is different but the same. You assess, listen and act on that assessment. Instead of a neurovascular check {for med-surg etc}psych nurses are assessing mental capacity. Hope this isn't too long or rambling !

[medsurgrnco, BSN, RN]

Yes, I understand that psych nurses are primarily interested in psych type issues. But they are also charting that they have done physical assessments, which they do not appear to be doing.

[Wildwood Flower]

Yes, I understand that psych nurses are primarily interested in psych type issues. But they are also charting that they have done physical assessments, which they do not appear to be doing.

Let me back up a minute; if there is any medical issues then they certainly should be assessed, addressed,but if the pt is there only because of psych issues, then during normal casual interaction, I am able to note orientation, and do the ABC's of assessment. address pain issues etc without taking valuable time to assess a perfectly healthy pt{physically},:uhoh21: which in turn gives me time to establish a trusting relationship with my pts so hopefully their psych issues are addressed.Am I making sense/lol:wink2:

[wonderbee, BSN, RN]

Yes, we do chart a physical assessment. But a physical assessment on a psych unit is not a head to toe assessment. I'm looking for cogwheel rigidity r/t psych meds, staggering gait, slurred speech, skin alterations, hygiene issues, stable vital signs, tremoring, sweating, etc. The physical assessment is focused on the presenting problem. A patient detoxing from ETOH is going to get a targeted assessment different from a patient with a mood disorder.

These patients are mostly walkie-talkies. If they report or display somatic symptoms, we check them out. Every time a patient comes up for meds, I'm using all of my senses. I'm eyeballing and listening. I don't need a stethoscope for that.

[StuPer]

Apart from the ongoing issues which rotate primarily around medication side-effects, most psych facilities only complete a physical assessment of a client on admission, and that is to rule out a physical cause/contributor to the actual psych presentation.

However an ongoing psych assessment is very much the bread and butter of psych nursing, MSE, social history, changing symtomatology in response to treatment. All of this can be obtained via informal and formal questioning.

Ask yourself this, if you were in a state of severe mental distress, how readily would you respond to the nurse who breezed up sat you down and said 'tell me how your feeling today' while holding a clipboard and notepaper.

Just because you have observed nurses behaving diferently to your previous clinical experience, does not mean they are lax or failing to meet patient need..

StuPer

[aloevera]

In my facility a new admit is assessed first by the nurse in needs assessment then again by the nurse on the unit he is assigned. A complete medical history along with psych is done twice. Head to toe may not be as thorough as you are used to in med-surg but within 24 hrs. pt. is seen by MD and given a complete physical. So that is 3 physical and mental assessments given to each pt. Our pts. all wear namebands.....we have pictures of them on the MAR so that helps with the ID for the med nurse, also.

[medsurgrnco, BSN, RN]

The above responses have been informative. Yet, if nurses are documenting breath sounds & abd sounds, etc. on assessment forms, then I think nurses should be assessing them. And I also think that nurses should be taking measures to be sure they are giving meds to the correct patients.

[aloevera]

we are not documenting any breath/abdom. sounds unless there is medical reason to check this....that is not included in our assessment...there is a difference in psych physical assessments and med-surg....I agree, that this should not be documented if not done...Yes, if this is being done in your facility something is not right..Our assessment deals with the presenting problem/situation....if a pt. is coughing/resp. diff. then we would listen to br. sds. otherwise this is all done, as I said, a complete physical by the MD after admission......Don't your med nurses have pictures of pt. on their MAR and use wrist bands??

[medsurgrnco, BSN, RN]

Most of our patients do not wear name bands or allergy bands. We have pictures of patients with the MARS, but patients can look similar to others, and some nurses do not take the MARS with them when giving meds to multiple patients. They just mark the med cups with the patient names.

Our assessments have some physical items on them, but some nurses are not assessing those areas. I don't know if they leave those items blank or not.

Anyway, I was just wondering if this stuff is typical of psych units. By the way, I'm loving working in psych compared to med/surg!

[sarmedic70]

Hey everybody:jester:...............good posts ...............

We are ALWAYS assessing our patients..........it is just not the "M/S" variation of assessing. Weekly, we do our full range of vitals on each patient (each patient has a day that they get their weekly vitals) then the monthly requirements on all patients.........all other times, we are always, through our interactions with the patients, watching them (and also, they are not afraid to tell you if they are not feeling well).....................

With regards to Pt ID during med pass: if this is not being done they are in violation of JACHO requirements/rules, and this is not good nursing practice as well. ALWAYS the two-patient identifier is used.................the picture that is on the Med trays and also in the MAR as well as (1) ask the patient or (2) have a core staff member at the med window for "med watch".......

As with anything else in nursing, given a situation may not be the "norm" as a result of that situation................When you have patients who are in facilities long-term, it is truly unnecessary to go through the type of assessments every day that one would do for a patient who is short-term in an acute-care facility; however, you do keep constant vigile at all times on the patients, and especially since mental illness can truly mask (or contribute to) physical illnesses........................then once the physical illness is suspected, then a thorough assessment would be warranted..........

I hope this makes sense?

Enjoy your time in psych :redpinkhe.................it's challenging but also so very rewarding.......it truly does take a very special person to do this job...................(oops! It truly is NOT a job!...................for me, it's a passion!!! :redbeathe)

Cheers!

C

[medsurgrnco, BSN, RN]

Now our patients are wearing name bands. As far as assessments go, I've been under the assumption that if the assessment form lists an item then they expect me to assess it. Apparently others only assess medical areas if there is a reason to do so.