psych nurses....Please HELP!!? - page 2
as some of you may already know i work on an adolescent unit in a psych hospital. as with any job in psych it can get very frustrating... not to mention depressing. well the staff and i are dealing... Read More
Apr 14, '03It's funny that you said that she would most likely be pushing hospitalization, she has bullied her way into having him elsewhere currently. He is in another acute care hosp. as I write this. On the psych unit of coarse, as he is physically healthy. And as for approval from staff, she has all her co-workers that she gets approval from, who also work in the ER with her. She doesn't want our approval, because according to her, we are clueless. So, in a way she does qualify. I don't know... I just know it's nice not having her call me every night, and taking the verbal abuse on a daily basis from her. I don't need that, and neither does the rest of the staff, we are there to help these patients, and sometimes I feel like we just get kicked in the teeth.
Apr 14, '03It makes me wonder if she has history of mental illness in her family history and this is her way of denying that he has anything wrong with him. If she has a history of this in her past family history, she is scared of being blamed for him having it.
Apr 14, '03Yes,... she of coarse blames everything on her ex husband though. I admit he's really concrete in his thinking, and doesn't appear to be overly bright, but he does not have a mental illness, that has ever been diagnosed. She has told people that he has schizophrenia..... isn't that almost laughable.
Apr 26, '03It sounds to me like both parties in this situation are at an impasse and at the root of it seems to be each party's implicit 'model' of mental distress.
The staff see this boy as clearly suffering from schizophrenia - a disorder that they believe is genetic in origin, related to abnormalities in his brain and which will respond to treatment with anti-psychotics. They see the purpose of the psych unit as providing that treatment for this boy. They are unable to see the mother's side in this and view her as obstructive, in denial, possibly mentally ill herself - all of which militates against collaborative working.
The mother, it would appear, believes that there may be another cause for her son's distress, and rejects the bio-medical explanation of schizophrenia. This is understandable - who would want to see their child receive a diagnostic label as loaded and stigmatizing as schizophrenia? She possibly sees the psych unit as a place where her son is unjustly detained and sees it's staff as clueless, unhelpful, oppressive and acts accordingly. This, too, militates against any notion of collaborative working.
So, you have two sides locked in battle, with no apparent hope of rapprochement. What it seems to me is needed is a third party, an impartial person who would be able to speak to both sides in this situation, who wouldn't necessarily be committed to any implicit model, who could speak for either party to the other.
The staff certainly do not have to endure her verbal abuse over the phone or in person - this is unacceptable. However, I do wonder whether this woman feels she has no ally in this situation, feels somewhat cornered and isolated and thus lashes out as a result. Having someone she perceives as independent to talk to might help. Over here in the UK, an advocacy service might help out - do you have anything equivalent in the States? We also have groups and voluntary organisations for family members, informal caregivers and so on, who also might be able to help - again, is there an equivalent over there?
What is needed is mediation.
Apr 27, '03We do have an advocacy for patients and families, and refuses to talk to them, accusing them of siding with us. I know that this woman feels trapped, and possibly hopeless. This is a very heavy diagnosis, and she can see her son deteriorating, I really wish, someone could sit down and talk to her rationally about the situation, however it appears that she only sees him as "normal" and THAT to her, IS rational. Anyone or anything that deviates from that, is not. As much as she has torn me apart, I really do feel compassion for this woman, and I know that I would struggle if put in the same circumstance. Is it possible that all she has ever dealt with is illness/injury that is tangible, obvious to the naked eyes, and something that she could "fix" in a matter of speaking? This illness, one she cannot measure the magnitude of with lab tests, or X-rays is just too foreign to her that she rejects it?????
Apr 27, '03One of the crosses we bear in mental health is a comparison to other medical specialties, in which the problems are more visible and obvious, and the solutions faster. Pain medications work in 30 minutes to an hour. Antidepressants take 7-10 days to show any progress, and 4-6 weeks for full therapeutic effect. Also, it is much easier to know what to do after a surgery than it is to determine a treatment for the broken mind.
Mental health is as much art as science. Therapies take longer to help, and the wait is frustrating, especially if the first (or second, or third) regimen is ineffective. The medications we give can also have some heavy side effects. It is for these reasons that compliance after inpatient treatment is such a problem, and why there are so many relapses.
If I had a neatly-canned solution to this, I could sell it for millions and never work again.
Apr 28, '03Hello Everyone,
Sorry to come back to this so late, but a few things occur to me. Firstly, is there a possibility of the clinical team noting the specifics of his delusional content in order to ask mom if this is a reasonable supposition? giving her the oppportunity to gain insight ... secondly a good line is to ask mom how she (in the context of the psych ward) would like to participate in his care and what she would like to see done to aid her son. By engaging her you may gain some trust and then be able to offer opinions that are'nt rejected out of hand.... of course it may have gone to far for this now...
Now of course I am unfamiliar with the US system of treatment and the legality of such, but in this scenario here in Australia, or in the UK it is likely a depot medication would be prescibed and given against the patients & families wishes.... in Australia he would likely be discharged (eventually) on a CTO (community treament order) which ensures any non-compliance re: treatment results in imediate re-admission, and enforced treatment.
At the end of the day, the client is the priority, if his mother is demonstratabley interfering with his treatment, it should'nt be to hard to remove her form the scene until he is better?... (clueless re: US legal issue) having said that, most psychiatrists I've met are reluctant to alienate the family of a client... even to the point of allowing a patient to suffer, rather than confront the family.
Apr 28, '03In the begining, about 12 months ago, she WAS consulted, along with the father, but it didn't work, despite the team's many attempts. She was, and still is angry with the father for bringing him to us.
Apr 29, '03A complicated and taxing situation indeed. I suspect that without individual psychological treatment for mom herself - as in totally outside this setting, and perhaps under the guise of stress management for herself - not much progress will be made. I agree with previously noted concerns about the meaning the son's illness has for mom.
Clearly in this situation it is also important to recognize one's personal and professional boundaries and limits concerning both patients and families. One of the things I sometimes have to say to clients is that when I became a nurse, and later a psychologist, I didn't give up my rights to respectful treatment. Being very clear in teaching people how they can and cannot interact with you is a useful, and therapeutic skill. Perhaps some behavioral management, limit setting, careful documentiation, and a deliberate plan for staff-directed (with a view to specific areas for her input under appropriate conditions) may help. Good luck.
May 1, '03I've seen some very good input to the problem. Now days you deal so much more with behavior disorders that a real psychotic patient can be difficult to deal with. I prefer them to the behavior disorders. Every one is trying to make sense out of the situation and deal with it in a sensible matter. Remember Psychosis=Crazy. Crazy don't make sense, that's why its crazy. That being the case, what can be done about it, how can family and patient get invested in treatment. Sure Mom may have guilt issues. Unfortunately not every problem can be fixed. When the person is ready, the instructor appears.
May 10, '03Hmmmmm! Just wondering --- Any possiblity that this kid is the "Identified Patient" in this very complex and dysfunctional clinical picture????
I worked Child/Adolescent psych. for a number of years, the parents and the potential return of the kids to those parents was one of the reasons I think I quit working Child/Adolescent.
Apples don't fall very far.........you know the rest!!!!!!!!!!
May 27, '03You said this particular pt does not like taking medications. What about street drugs, marijuana, xanax, pcp, ectacy ect? This could be very important in his treatment. What about a treatment team meeting. All disciplines meet and discuss strategy. This meeting should at some point include the parents and the resident so, that whatever treatment plan is decided on everyone is on the same page. Good luck
Jun 13, '03Keep up the good work in trying to get advise for this unfortunate boy (and family). It is so hard to treat schizophrenics and the mom does sound very confused about the son's diagnosis, possibly guilt for some reason, Munchausens shouldn't be ruled out either, keep an eye on what she's feeding him. This family needs plenty of therapy and soon. Best of luck.