The other day on a neighboring psych unit, I heard a pt tell his nurse "I lost my dog and I'm going to kill myself if I don't find him! I need you to search for him online!" I wondered what I would have said to him if I was his nurse. Also because I have been preparing for an RN interview, I have been thinking about the question, "Tell of a time when you went above and beyond for a patient."
My thought is that we really need to distinguish between appropriate and inappropriate requests. If we can do that, then it will be much easier to say no to the inappropriate requests, because we are saying yes to something better - keeping the patients safe and helping with appropriate requests.
In my opinion, the pt's request was not reasonable not only because nurses don't have time to do that, but because he is taking no responsibility for his own life, he's putting it all on his nurse. I thought about a response like "Have you considered calling a friend or family member to do the search for you?" Then I thought about what I would answer if the person said "I have no friends." I thought about saying "How did that happen?" but that didn't seem optimal. So I thought I would call on you trusty psych nurses, like Davey Do, to give me your thoughts on these type of situations. What are some good things to say to people who don't take responsibility for themselves? Also, any tips you have for responding to typical requests/comments would be helpful.
I had one situation recently when my response seemed to work. The pt stayed back from lunch, then asked to be taken to the cafeteria. We were lacking staff to do so, so I told him that I would try to find someone. He said "It seems like you don't care." I responded "It may seem that way, but that's not really how it is."
At our free standing psych facility we actually house the dogs of our homeless patients. If they have no one to care for them. Our boss even went and got one out of the pound that would have been euthanized before the patient could have been discharged.
That is fabulous!
The thing with psych patients is their disease process often prevents them from being able to take responsibility for themselves and they often literally have no one they would consider a friend. Often their dog is their only friend in the world. The large majority of psych patients don't choose to be sick anymore than cancer patients do. While I agree that a nurse would not have time to do an on-line search I find your proposed answers to be unnecessarily unkind.
Actually, I agree that my answers were bad, that is why I was asking for feedback. Later in the thread I clarified the situation to explain that the pt didn't seem distraught, but instead seemed demanding by his demeanor, body language, etc. which was one reason that I was struggling to come up with an empathetic response. I really do appreciate your feedback.
I actively engage a patient to help them identify solutions for lots of everyday problems that we normies find routine. As psych patient cannot focus on getting well if they are burdened by excessive worries.
Great points!
In the case of the cafeteria guy did you actually see if you could find someone to take him to the cafeteria
Yes, I did find someone to take him to the cafeteria.
For some patients, I find it much easier to provide an empathetic response than with others. Maybe some of them trigger something in me. I have tried to work on past hurts so that I don't have vulnerabilities, but am still a work in progress. I do want to grow as a psych nurse so that I can be more therapeutic for all of my patients.
Specializes in Psych, Addictions, SOL (Student of Life).
For some patients, I find it much easier to provide an empathetic response than with others. Maybe some of them trigger something in me. I have tried to work on past hurts so that I don't have vulnerabilities, but am still a work in progress. I do want to grow as a psych nurse so that I can be more therapeutic for all of my patients.
My worsttrigger is mean old ladies - I have a lot of "Mommy Dearest" issues. We all do have our days.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
It's hard to know exactly what was going on with the man with the dog. But I think it's really important to understand that even among psychiatrically healthy people you will see vastly different behaviors when people are distressed. Because people process things in all sorts of ways. For example, when I am nervous I tend to laugh. Most people have no idea how nervous I am when I do this.
For psychotic patients there is often a discrepancy between mood and situation or belief. It's called incongruence. A patient could be telling you that their house burned down and you have hard evidence that their house actually burned down and yet they are laughing at the same time. That's incongruence. It happens when people are manic too.
It is possible your patient was extremely distraught about his dog, and presented as demanding. That's how some people are when they are distraught.
Whether his dog was lost, the pt was manipulating, or the pt was delusional I try to help pts help themselves. So I would get the number for the local animal shelter and coach the pt to report the dog lost and get advice from animal control on what to do next.
Whenever possible, let your pts know what to expect based on the rules or customs of your unit. For example, mealtimes are at 8, 12 and 5. We encourage you to go to the cafeteria at that time. You will not be permitted to go outside of that time frame. If that's your rule of course. I don't know how your unit works.
For some psych pts, being in a room full of people is unbearable. But they may want to select their meals. Help them verbalize their needs and accommodate as much as possible.
Be as clear in your communication as possible. I always tell pts I care. Because I do. Examples: I care and I won't break this rule for you. I care and I know you can do this yourself. I care and I will help you do this yourself.
Specializes in Psych (25 years), Medical (15 years).
Wow - you have a lot of power - in my facility it practically takes an act of congress to get 1:1 supervision on a person who is verbalizing without otherwise acting out.
I'm impressed - maybe I should look into Wrongway?
Hppy
Wrongway hires any RN who undergoes spontaneous respirations, Hppy, so they'd strike up the band and roll out the red carpet for you.
A patient can be laughing and joking and say they're suicidal, refuse to commit to safety, and be put on a 1:1 status at Wrongway.
Having had a few "successful" suicides here, they take any threat seriously.
And if a non-treatment compliant IDDM patient admitted with suicidal ideations after abusing coke and meth cries "chest pain" they get an ER eval and shipped over to medical.
However, if a patient has an altered mental status, a critically low H&H, signs of dehydration, high BUN and creatinine, they can stay on geriatric psych.
But what if the dog is killed by animal control/shelter in the meantime?
Answering my own question...
I guess it provides an opportunity to teach on putting a collar on with an ID, microchipping, etc. (I think they have programs to make those things affordable). A pack of cigarettes is about $8 in my state, and one of the most popular activities on our adult psych units are smoke breaks. Yes, our hospital has smoke breaks in order to increase our census and it works! (Shaking my head as a nurse). People are not logical...
Some hospitals still have smoke breaks for whatever lame reason they give. I don't fight it anymore. I'm just grateful that my hospital is not one of those facilities that allows that. It would make me ill.
My approach with patients is that we deal with "what's happening right here, right now, in front of us." Dogs, cats, goats, pigs, cows, wives, children, teachers, bosses...none of them are here in front of our face to deal with right in this minute.
All of those things will be waiting (or not) after discharge. Patients must get to a point where they can at least handle walking out the door of the facility, and then face those issues. We don't fix issues in an acute facility, we just learn how we are going to take the steps to face all of the difficult parts of life after discharge. The team puts all the parts in motion - medical, therapy, primary care, case management, housing assistance, IOP, PHP - whatever it takes to make the patient have the most success once discharged.
The dog? Sorry, I stand by my original answer. It is not an acute problem that will be solved while in my facility.
Specializes in Psych, Addictions, SOL (Student of Life).
I can only comment as a casual observer.
My response would be "you can look for your dog once you are discharged."
I just believe that this is somewhat uncaring. One can express appropriate concern and provide resources for the patient to make phone calls. The average shelter/pound will only hold a dog for 48 to 72 hours before euthanizing. This, (while not something we can prevent) can constitute a genuine tragedy to a patient and set back their recovery.
As a nurse on a very busy acute psych unit - there is only so much I can do in these situations but being kind and showing concern are always within my scope.
Specializes in taking a break from inpatient psychiatric nursing.
How about asking the patient, "What kind of dog do you have? When did you last see your dog? Have you lost your dog before?"
Listening to the patient answer questions like these questions might inform you about the patient's orientation to reality. If their answers make sense, you will also have more information to give to the social worker if they can follow up.
Specializes in Hospice, corrections, psychiatry, rehab, LTC.
But in the case of the "lost dog" story, I was wondering what I would have said. I'm not sure "I don't believe you" is appropriate even thought that's what I'm thinking.
I wouldn't have blatantly said that I didn't believe the story, but I might have explored it by asking questions about the dog (color, breed, size, how long the patient had had it, how long ago it ran away, etc.). Patients who fabricate stories can seldom provide such details, or if they try, they take more time than should be necessary thinking about their responses before deciding what to say. That could have been revealing. If it was clear that the patient was fabricating (which I believe that it already is), I might have then asked, "What is really bothering you?"
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elizabethgrad09
51 Posts
That is fabulous!
Actually, I agree that my answers were bad, that is why I was asking for feedback. Later in the thread I clarified the situation to explain that the pt didn't seem distraught, but instead seemed demanding by his demeanor, body language, etc. which was one reason that I was struggling to come up with an empathetic response. I really do appreciate your feedback.
Great points!
Yes, I did find someone to take him to the cafeteria.
For some patients, I find it much easier to provide an empathetic response than with others. Maybe some of them trigger something in me. I have tried to work on past hurts so that I don't have vulnerabilities, but am still a work in progress. I do want to grow as a psych nurse so that I can be more therapeutic for all of my patients.