Question for the Psych nurses and others.

Nurses General Nursing

Published

From my personal experiences and also from my general opinion, I feel that the many varying degrees of mental illness in a psych ward can be extremely harmful and interfere with the treatment of patients and also have negative effects on doctors, nurses, staff, etc.

For example, you have a person who is in for suicidal thoughts but is not violent at all and might not be too good at defending himself and then you have a person who has a history of extreme violence and severe mental illness, hallucinations, etc. that could potentially be a danger to the latter patient and this also has effect on the hospital staff as I think it can create a situation where the hospital staff has to keep a keen eye on the severely mentally ill patient while at the same time trying to not allow it to effect the care of the overall ward and it's patients.

I have heard nurses say and experienced for myself that on the same ward, you can have patients who you have no problem being with alone, no problem allowing them to give you a hug when you come back from vacation, no problem taking that person out to eat with just you and that person alone and then you have patients who you don't want to be on the same ward with without what you feel is adequate backup available in case they are needed.

I am bringing up this issue knowing that resources are nowhere remotely close to what would be needed to modify this situation ideally and I do not have any specific solution to suggest but I was wondering what people's thoughts and maybe experiences were with this issue.

Sorry if this is too long of a post!

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Specializes in chemical dependency detox/psych.

I haven't found it to be a huge issue--basically assess the patient and respond accordingly. Just as there are patients that are of higher acuity in other units, the same will occur in psych.

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Specializes in Medical Surgical Orthopedic.

I wonder about that too. In one instance, I was talking to a young, severely abused, non-violent patient who had just turned 18 and transferred to an adult ward. Another patient, with a more violent past and aggressive personality, approached us and started talking about "raping and strangling children until they're dead". The younger patient winced while he tried to distance himself from the older one. It just seemed wrong that the two of them were sharing a common area in a locked ward.

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I haven't found it to be a huge issue--basically assess the patient and respond accordingly. Just as there are patients that are of higher acuity in other units, the same will occur in psych.

I see your point, just think that in the other areas, you don't have to be concerned with the way patients act and what they do to each other like in a Psych setting.

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I wonder about that too. In one instance, I was talking to a young, severely abused, non-violent patient who had just turned 18 and transferred to an adult ward. Another patient, with a more violent past and aggressive personality, approached us and started talking about "raping and strangling children until they're dead". The younger patient winced while he tried to distance himself from the older one. It just seemed wrong that the two of them were sharing a common area in a locked ward.

Yeah, that is really scary to say the very, very, least and I agree totally with the rest of your post.

I just think that situations like these have the potential to have devastating effects and at the very least, can lower the level of care on the ward because of the attention needed to be given to the situation.

What would scare me is if someone was really determined to hurt someone, they might find a way to do it and even if they don't, knowing a person wants to hurt you is not easy to deal with for a person not dealing with any issues in their life, much less a person who is dealing with issues.

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Specializes in (Nursing Support) Psych and rehab.

I sort of understand your concern. Lets say a bipolar pt comes in for lithium detox. (after a while, high lithium can be toxic) and they are not hyper manic.... Yet there is another pt who is hyper manic... There is a chance that they can encourage manic behaviors in pt 1. Sadly, unless a pt is rich, isolated care is almost impossible. The fact that they have been admitted shows that they do need the medical/increased therapy that is offered in psyciatric units. My unit is a voluntary unit, so most of our pts check themselves in. We get a variety of pts, but there is one goal that covers all patients: get back to being a productive member of society. This includes modifying maladaptive thoughts and behaviors, taking meds as prescribed, etc. This approach goes for the schizophrenic as well as for the person who came in for drug/alcohol detox. Yes, at times extra eyes/ears are needed because there are pts who have to be monitored more closely than others, but usually these pts actually help others want to get better quicker lol. At the same time, if a pt does get out of hand, we send them elsewhere. We don't take any pt that is on a 1013 (brought in against their will) because that already shows that they will pose a threat of danger. The sneaky thing that is done is that sometimes the 1013 is released right before they get upstairs. I think that these dangerous pts should be sent to where there are pts with common features, but unfortunately that isn't the case. Its a complicated issue because the hospitals and facilities would lose money if they only accepted the harmless pt or put all the semi dangerous pts in one place.

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I'm a charge nurse on a hospital based acute psych unit. You are exactly correct in your concern. I see it all the time. Fortunately, my hospital has addressed this concern to some degree. We have two floors now. One floor is seperated into depression/geriatric psych...the other floor is general acute psych with all of the acutely psychotic patients, violent behaviors, etc. I work both floors routinely. The problem is that when you seperate the population, you end up with an entire floor of acting out psychotic patients which isn't safe for anyone either. With money issues the way that they are, I don't see this problem getting fixed anytime soon.

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I sort of understand your concern. Lets say a bipolar pt comes in for lithium detox. (after a while, high lithium can be toxic) and they are not hyper manic.... Yet there is another pt who is hyper manic... There is a chance that they can encourage manic behaviors in pt 1. Sadly, unless a pt is rich, isolated care is almost impossible. The fact that they have been admitted shows that they do need the medical/increased therapy that is offered in psyciatric units. My unit is a voluntary unit, so most of our pts check themselves in. We get a variety of pts, but there is one goal that covers all patients: get back to being a productive member of society. This includes modifying maladaptive thoughts and behaviors, taking meds as prescribed, etc. This approach goes for the schizophrenic as well as for the person who came in for drug/alcohol detox. Yes, at times extra eyes/ears are needed because there are pts who have to be monitored more closely than others, but usually these pts actually help others want to get better quicker lol. At the same time, if a pt does get out of hand, we send them elsewhere. We don't take any pt that is on a 1013 (brought in against their will) because that already shows that they will pose a threat of danger. The sneaky thing that is done is that sometimes the 1013 is released right before they get upstairs. I think that these dangerous pts should be sent to where there are pts with common features, but unfortunately that isn't the case. Its a complicated issue because the hospitals and facilities would lose money if they only accepted the harmless pt or put all the semi dangerous pts in one place.

Good post.

I agree about the more severe patients actually helping others to want to get better faster, lol. Although I think they can also deter others from seeking help knowing of the environment they could be heading into.

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I'm a charge nurse on a hospital based acute psych unit. You are exactly correct in your concern. I see it all the time. Fortunately, my hospital has addressed this concern to some degree. We have two floors now. One floor is seperated into depression/geriatric psych...the other floor is general acute psych with all of the acutely psychotic patients, violent behaviors, etc. I work both floors routinely. The problem is that when you seperate the population, you end up with an entire floor of acting out psychotic patients which isn't safe for anyone either. With money issues the way that they are, I don't see this problem getting fixed anytime soon.

I am glad to hear that your hospital made an effort to address the issue and I agree about now having an entire floor of acting out psychotic patients which obviously isn't safe for anyone either, certainly a case of give and take.

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Hi Ya Mr. Mikey :)

I am not a Nurse, I am a Nurse's daughter - My Mom is a RN.

Long story shorter - I was looking around to find some fun printables for my Ma cause she doesn't have a comp. I have only found Nurse word searches & cross words, still looking for other fun ones for her! - I came across Your post! - I joined cause I seen Ya didn't have any reply to this post - well, it took awhile to get regi 4 me. but Ya got some replies :D

I still will like to tell Ya what I was going to write!

My Mom is a RN & has worked at Psych Nurse for most of her life. This really isn't going to answer a question 4 Ya, Please keep in mind 2 things - I am a Nurses daughter & this is more than 20 yrs ago when i was a lil kid. I would go with my Ma to pick up her paychecks & stuff like that. I was SO used to being around people of various special needs. There were a few people I would talk to, even though I was little I could tell some of them were Child-like & I would ask my Ma if i could please stay awhile & play with them, but my Mom always had stuff to do & we couldn't stay long, I told them maybe next time I could stay longer. There were People there who could leave the wards & some who could weekend passes or be able to be just on the hosp. grounds. There was a vending machine in the lobby, the items in it were only 5 cents. I had asked my Mom if I please get one once, she had told me that if I did, then that would be one less treat for the people that lived there. I sadly said Yes i understand. So, I asked my Mom to hold my hand when we went past the vendo, so I could close my eyes when we went past it so, I wouldn't be able to see the treats! - Hey, i was lil, I thought that was a good idea?? LOL. One time My GrandMa was there with us when I was 4 yrs old ( she lived far away ) , I guess she never been around people with special needs cause when one really Sweet older Lady asked her if she had a nickle she could borrow for the vendo, my GrandMa ran out of the building. I was able to catch up to her on the steps/stairs, begged her to stop for a second, I also begged her for a nickle & I told her a would do a chore for her or my Ma so, she would give me one - She gave me one, but she said she was going to the car & locking the door. I said ok & I would give the Lady the 5 cents & find my Ma. I went back in & the Sweet Lady was, right there at the glass door looking out ( I think she wasn't allowed to leave the building ) - I gave her the nickle & she asked me the lady's name ( my Gram ) - so she could pay here back & cause she didn't know how to use the vendo. I told her it was a gift & I would help her with the vendo & Sorry after I needed to find my Mom cause I was only 4. I helped her pick out what she wanted & went to find my Mom in the office, my Mom was just about ready, I told her why I wasn't with my Gram, she wasn't happy about it - but she did giggle about how scared Gram was & she told me she was pround of helping the Lady & finding her. We walked out a few mins later & the only person in the lobby was the Sweet Lady I helped - She didn't see my Mom & me, She was busy enjoying her treat she picked out! I will never forget the look of JOY on her face!! :) - I know it seems all too silly to whoever is reading this but it was one of the more important times in my life - Also, I could walk past that vendo with my eyes open from then on! Over the next few yrs that my Mom worked in THAT building ( she was still a Psych Nurse there ) - When I had a nickle I would leave it in the coin return tray/part for someone to find & be able to get a treat.

Ok, Mikey & all who took the time to read this long story - I live in Alaska now, ( YES ALASKA ) so although I am not a nurse - If Ya got a question for me about Alaska, I will do my best to give Ya an answer - THANKS a Bunch!

Please Everyone give a LOVED one a HUG & tell them THANKS!!

Big HUGS 2 ALL! Please Take CARE!!

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Hi ya Tookie! :) Thank you for your post, I really enjoyed it!

I think your story is a great example of not needing to do a whole lot at all to put a smile on someone's face and make their life better! All it takes is a little effort!

You are my go to person if I ever have questions about Alaska!

Big HUGS 2 YOU TOO AND you please take CARE TOO!!

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I've worked on "mixed" psych units for decades, and it seems like a "draw" to me -- there are some advantages and some disadvantages. I've never seen another client get actually physically assaulted or injured by a client (thanks to staff vigilance) -- only staff. Plenty of people have had to share a unit with somewhat scary people, but all of us have to associate with people we would prefer not to have to associate with -- that's called life.

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