Pysch nurses, how often do you do these things?

Sour Lemon · Feb 7, 2018

This will vary a lot depending on the type of unit each nurse works on. On my unit, there are no wounds beyond minor, healing abrasions. There's no suctioning, either.

A lot of our patients are incontinent and near total cares when it comes to ADLs, though. And even the ones who do ok during the day often have bed wetting problems at night due to the heavy meds they take. There are lots of bed baths and assisted showers.

perfectbluebuildings, BSN, RN · Feb 7, 2018

I do a lot of physical and mental health assessment, and as the only nurse in the facility on my shift, there is a lot of autonomy in the job as far as monitoring physical symptoms and providing nursing care, and figuring out when a resident needs to go for outside care, as well as trying to figure out when the issue is more psychological than physical. Many of our residents are incontinent and do require help and reminders for showers and basic ADLs, but it is mostly the direct-care staff who provide those needs.

I do basic wound care and assessment, very minor injuries most of the time, and monitor for more serious issues before they get worse, i.e. a resident who got a concussion from self-injurious behavior of repeated head-banging, convincing the doctor they needed to be treated and trying to porifice which symptoms were from the head injury and which were more "attention-seeking"/psychosomatic in nature. I use a lot of psychiatric/behavioral interventions and communication skills.

We do not have anyone with trachs or G-tubes or any other "complex" medical equipment, as the setting is not safe for that type of patient (behavior issues, peer-to-peer aggression, etc.)

I use my assessment skills quite often and in a very different way than when I worked in the hospital, and I enjoy it. I do not use a lot of the technical skills of typical acute care nursing i.e. IVs or other things I was used to doing. But I like being the advocate for these residents, that just because they have a mental health diagnosis does not mean there is not something else physical going on (beyond "attention-seeking" that some of the staff think is going on), and figuring out when a nonverbal patient is just upset or whether they are actually having a physical issue/illness, and deciphering what that issue may be.

I don't know if that rambling response helped answer any of your questions or not; I apologize if not. I just wanted to give you a clearer picture of the nurse's role in this type of setting and how the skill set you use differs from acute med-surg care.

B52, ADN, BSN, MSN, RN · Feb 7, 2018

Most of the wound care we do is minor, i.e., scrapes and bruises, superficial self-injurious behavior, stage 1 pressure ulcers. However, we have had at least one self-inflicted gunshot wound. We don't administer IV meds. We have a geriatric unit on our floor and many of those patients are incontinent. If they are ambulatory, we walk them to the bathroom. If they are capable of making their needs known, we assist with a bed pan. We measure urine for all patients who have a catheter. We help bathe all patients who are unsteady and we assist with ADLs. In my two years at this hospital, I recall only one patient who had a trach, and just a handful of patients who had G tubes.

deza, MSN, NP · Feb 7, 2018

Hardly ever any wound care. Where I work most of the wound care has been spraying wound cleanser, clean with gauze. Then apply fresh gauze and wrap with coflex. Sometimes we have pt's that have been incontinent. Some choose to not get up and use the toilet. Rarely do we chart I and Os. Sometimes we document intake on patients that are not eating much or have a pt that is on fluid restriction due to low Na+. For IV medications our pt's only get those if sent to the ED. Though when I worked at a geropsych private facility there was more wound care and ADLs. Usually some wheel chair pt's in gero would have a pressure ulcer on their buttocks.

As far as physically sick goes we send pt's to ED for delirium. We usually don't have pt's that are physically sick, most of the time. Every now and then one has intestinal blockage or an impaction. Enemas are rare, usually we do mag citrate.

This is at a large urban psych facility.

3peas · Feb 7, 2018

On my unit no, no, no, no. Are our pt's physically sick? Yes, but our pt's are too acute for lines, drains, or other appendages. Basic wound care, yes, but no wound vac. If the pt cannot ambulate on their own or perform independent ADL's they are not suited for our unit. There are many different unit's in psych with many different populations.

Meriwhen, ASN, BSN, MSN, RN · Feb 8, 2018

Depends on what unit I'm working in. If I'm on psych-med, yes, I do a lot of these things. Well, wound vacs would be the wound nurse's responsibility, but I'd still have to change dressings.

Psych-med is a hybrid of a psych unit and a low to moderate acuity med-surg floor. We get patients that require more medical care than a basic psych unit offers, but who also need more psychiatric care than a med-surg floor offers. We don't get ICU, step-down, tele, or fresh post-op patients, as we're not equipped to handle them. But we get lots of med-surg and LTAC patients and provide all the care needed.

As far as incontinence goes, that could be on any unit, though most of them are found on the psych-med unit. But if my patient is incontinent, it doesn't matter what unit they're on--I'm in there to help get them cleaned up.

ProperlySeasoned · Feb 8, 2018

When I worked in adolescent psych I did a little would care, a bit of measuring for the ED kids, and I gave a shot of birth control once. In 5 years. If a teenager had a self harm/suicide attempt that required care physical care, all this was done on a medical unit prior to transfer. Our patients had to be medically stable. Over on the child pscyh side, there was a fair amount of pee/poo to deal with, especially for the MRDD kids.

I agree that it really depends on the age and population you are working with.

kingvonnBSN2017, BSN · Feb 8, 2018

Hi!
I have so much respect for pysch nurses, who often go under appreciated for all the amazing, life saving work they do.
Im just wondering, for all the pysch nurses out there, how often do you: do wound care (and are they simple dressings or wound vacs and beyond?), care for patients who are incontinent (does your unit/facility admit incontinent pts?), walk patients to the bathroom, measure/examine pts urine, feces, and vomit, bathe or help to bathe patients, change pts clothes/briefs/diapers, suction pts, ect.
How physically sick are your patients on average? Do many pts recieve IV medications and/or enemas?
Thanks so much in advance!

I'm in acute adult psych. I do wound care, but they're usually simple dressings. I deal with incontinent patients often, have to assist patients with ambulation (or a sitter/tech), check I/O's, trach care, ostomy care. I actually like it though.

squishyfish · Feb 8, 2018

I currently work on an inpatient psych unit in a hospital. We admit adults, both voluntary and involuntary. My answers to your questions are below in bold.

how often do you: do wound care (and are they simple dressings or wound vacs and beyond?),
We do basic wound care fairly often, usually there is one or two patients with dressing changes QDAY. This is usually from self-harm, such as cutting. We also have abscesses (from IV drug use) that require cleaning and dressing. We do not do wound vacs or anything like that
care for patients who are incontinent (does your unit/facility admit incontinent pts?) Very rarely we will have a patient with stress incontinence who wears depends or adult briefs, however they must be able to change themselves. We can't take Geripsych
walk patients to the bathroom
Sometimes, if they are unsteady on their feet
measure/examine pts urine, feces, and vomit
We collect urine samples for U/A, HCG, and drug screenings. Ideally this will be completed in the ED but that's not always the case. I inspect the urine for color, clarity, etc. If patients c/o diarrhea or vomiting, we want to assess it.
bathe or help to bathe patients
We've had some developmentally disabled or very confused patients who may need help getting the shower started or getting set up, but we don't usually have to bathe them.
change pts clothes/briefs/diapers, suction pts, ect.
I have never suctioned a patient on the psych unit, that wouldn't be appropriate for our unit. I have assisted patients with getting dressed in hospital gowns/paper gowns)
How physically sick are your patients on average? Do many pts recieve IV medications and/or enemas?
Our alcohol/opiate withdrawal patients can be pretty ill, we've had to transfer some to the medical unit because they were too sick. We've had some flu/GI bug cases recently which wasn't fun at all. Of course, we have diabetics who get sliding scale insulin, hypertension, COPD, asthma, but they must be stable. We have a medical provider assess them and order the correct meds. Occasionally a fleet enema or IV fluids will be ordered.

Hope this helps!

allnurses Guide · Feb 9, 2018

I do a fair amount of wound care. Everything from dressing changes on cuts and other self harm actions (simple dressings) to packing PU's in heels and buttocks of our homeless patients. We don't admit patients with wound vacs.

We also see some incontinence - we don't admit patients with Foley's but we see a fair number who due to psychosis don't like to keep cloths on and will urinate/defecate where they happen to be standing. All our pt's are supposed to be ambulatory but occasionally someone who is a high fall risk gets past our screener and then they get a 1:1 staff.

Patients will vomit to get Phenergan and yes we are required to see it as part of our assessment.

We are a general acute psych so we don't see patients who are super sick medically but we get a fair number of diabetics and hypertensives.

Hppy

Heylove, BSN, RN, EMT-B · Feb 9, 2018

Im just wondering, for all the pysch nurses out there, how often do you: do wound care (and are they simple dressings or wound vacs and beyond?), care for patients who are incontinent (does your unit/facility admit incontinent pts?), walk patients to the bathroom, measure/examine pts urine, feces, and vomit, bathe or help to bathe patients, change pts clothes/briefs/diapers, suction pts, ect.
How physically sick are your patients on average? Do many pts recieve IV medications and/or enemas?

I work adolescent psych. We have a moderate amount of of sutures and simple dressings for self inflicted cuts and abrasions.

We have very few incontinent patients. There may be some bowel issues, usually constipation due to the stress of hospitalization. Very little assistance is required with ADLs. They are able to bathe, toilet, dress and feed themselves. There are no IVs on the unit because of the risk of self harm, and patients are sent to the ER if fluids or IV meds are needed. IVs are used on the senior unit, however. No enemas.

In addition, this patient population doesn't usually depend on medication therapy related to diabetes, hypertension, chronic pain, etc... that the adults typically use.