Pt from Psych unit knew everyone in my community!

[2126]

I had a situation happen to me awhile back and I just wanted your thoughts on it.

I was doing my psych rotation and was on a unit where I would never expect to see a person of the same religion as me (due to the location I was in). For this clinical, all we did was sit and talk to patients, so after group I approached him because I thought it would be a good ice breaker. There are only a few communities with this particular religion and he started naming everyone he knew from mine!! I was trying to be very nonchalant as to not disclose which community I was from. He started telling me that I'm welcome to ask these people about him because they all know him! He then preceded to ask me out on a date after our conversation (I replied that I'm here to maintain a professional relationship with him, which is what our instructor told us to say if anyone were to ask us such a question.)....I was very thankful my last name was covered on my name tag!!!

So my questions to you...

I obviously did not tell anyone his name or any identifying information about him, but would you have if he gave you permission to do so? He was A&Ox3 and we had a pretty long conversation.

Secondly, since this was my first experience on a psych unit and I'm a nursing student, I wasn't completely sure how to approach this situation. How would you have approached the conversation?

Thanks! I'm interested in what you have to say!:)

[ImThatGuy, BSN, RN]

He recognized you or was observant enough to ascertain who/what you were and where you were from.

I can't even stand people knowing my name so I wouldn't agree with him, but it's nothing to worry about. If you're ok with the guy knowing about you then use it as conversational. The familiarity might do him good.

[2126]

Through conversation he knew about these communities because of the high population of people living there with the same religion. He did not know me personally, just everyone around me! I know the same people because it's a close knit community.

Thanks for your input!

[mentalhealthRN]

No reason to discuss him with anyone you know, permission or not. This is a toucy situation. He doesn't need to know that the people he is mentioning are people you also know. The best you can do is try to keep conversations general and not bring your personal stuff into it. The more you get into psych and nursing in general the better you will get at changing the subject promptly when you seem to be heading into an area that seems to be getting gray.

As far as a patient asking you out--this is common is psych I have found.

I think it happens because when people have a mental illness so often there is a stigma and these people so often are treated not so nice or differently and when they have people who are kind to them and seem to really care about them they mistake this attention for more then it is. I just explain to them that I am flattered--as they often have fragile egos and you don't want to make them feel too rejected--but that I appologize if they have mistaken my kindness and concern for their well being for something more. That I am there for support and that though I truly want to help and want to see them get better I am there as a professional. As far as connections in the community I find it best to try to tactfully re-focus on the treatment plan. With this a general referral as to how it is really good to have support systems in place and how this can help in his/her wellness. But no I would not get into the--oh yeah hey I know those people too.....and I would explain that there is no reason for you to dicuss any of your patients outside of the workplace.

[TanyaBRN]

I think from a professional standpoint I would have found a polite way to end the conversation and found a different patient to talk to. People dealing with mental illness often become overly attached to their caregivers, and I would be concerned that he would seek you out in your faith community and possibly continue to pursue a date with you. I encourage you to bring this up with your professor also. Unless you have a signed HIPPA release form with the names of everyone in your community on it, don't talk to them about your patient. He gave you verbal permission but if you don't have it in writing it doesn't matter, he could have a change of heart and you could get in big trouble if he claims that he never gave you that permission.

[2126]

I told him that this community is a great place to stay connected to because of the support. I tried to keep it at that. I also just kind of smiled and nodded when he mentioned the people I knew. I was just really thrown off by the whole situation because I don't have any experience with it.

[2126]

I think from a professional standpoint I would have found a polite way to end the conversation and found a different patient to talk to. People dealing with mental illness often become overly attached to their caregivers, and I would be concerned that he would seek you out in your faith community and possibly continue to pursue a date with you. I encourage you to bring this up with your professor also. Unless you have a signed HIPPA release form with the names of everyone in your community on it, don't talk to them about your patient. He gave you verbal permission but if you don't have it in writing it doesn't matter, he could have a change of heart and you could get in big trouble if he claims that he never gave you that permission.

I did bring it up to the professor. She just reinforced that I not speak about him in a identifying way outside of clinical, which I obviously agreed. She didn't give me much more input beyond that unfortunately, which is why I'm asking here. I just want to get out as much as I can from this situation.

[April, RN, BSN, RN]

2126, can you clarify your questions a little bit? When you say "this situation", are you referring to the fact that he knows many people from your community, or that he asked you out on a date? Why would you need to tell anyone his name or identifying info? Are you concerned for your safety?

Personally, when I find myself in awkward conversations that I don't feel comfortable with, I try to divert the attention away by changing the subject or by excusing myself to tend to something work-related. I might say I have to call an MD before he leaves his office or something just to get myself away. I think your response to being asked out on a date was just fine.

I like to chat with patients and family members but I've learned from experiences like yours to keep them very basic and am careful not to give out any personal details.

[2126]

2126, can you clarify your questions a little bit? When you say "this situation", are you referring to the fact that he knows many people from your community, or that he asked you out on a date? Why would you need to tell anyone his name or identifying info? Are you concerned for your safety?

Personally, when I find myself in awkward conversations that I don't feel comfortable with, I try to divert the attention away by changing the subject or by excusing myself to tend to something work-related. I might say I have to call an MD before he leaves his office or something just to get myself away. I think your response to being asked out on a date was just fine.

I like to chat with patients and family members but I've learned from experiences like yours to keep them very basic and am careful not to give out any personal details.

It was more that he knew so many of the same people as me. Yes, I was a little concerned after that conversation and was thinking to maybe get more information from my community leader because he has hosted him at his house for a meal. I was thinking of getting his input on whether I should be concerned. I'm not so concerned anymore -- this happened awhile back and it hasn't come up as a problem, thank Gd. I just wanted to hear what you would have done in the situation.

I'll know from now on to switch the topic or to avoid such a conversation altogether.

[Sniper RN]

I think what you are asking is if you should talk about him.

I think to CYA you should not discuss him with anyone outside of your clinical group. All he has to say is, "I never said that." and you just violated a HIPPA law.

Also consider where you are at. Psych clinicals. They are not in their right mind or they would not be there. You can't hold them to anything they say there. During my clinicals at psych I got a kick out of how fascinated the other students were at 'Who their Pt's were."

"My patient owns the Krispy Kream donuts. He said when he gets out to come see him and he will hook me up." followed by a big smile. :) I said, "Where are you?" (She never got any free donuts)

"I don't know why my patient is in here. He is normal. I was talking to him and he said that his parents had him locked-up in here to deem him insane so they can take all of his money. He is a millionaire." I said, "Oh let's go look at the chart."....."Homeless, schizophrenic, pick-up by police officers while standing in the road naked screaming."

I don't think saying, "He said I could" will fly. I would just avoid the situation.

[JeanettePNP, MSN, RN, NP]

I had this experience in my first psych clinical as well. There was a patient there from my community, and although I don't know him personally I do know his wife and many of his relatives. I was not assigned to him and if I had been I would have asked for a different patient because I think it would have been hard for me to maintain that professional distance. But if I had no choice but to deal with him I'd have done like the others said -- try to steer the conversation away from the people you know in common and back onto his issues or concerns. Use the same comments to redirect that they teach you in psych: "We're here to discuss you and your concerns." And, of course, do not mention to anyone that you met him or under which circumstances.

[JeanettePNP, MSN, RN, NP]

I would like to add that I wouldn't freak out because you happened to know people in common. Psych patients are people too, they have their lives and their social circles and their relationships too, and it's a bit naive to expect that their life will never intersect with yours. I don't know why it would be necessary to discuss his status with a religious leader just because he happened to host him for a meal.