I am still quite a new psychiatric nurse (almost one year). I still get really scared and shaken during incidents of patient violence and restraints. We had a 19 year old patient. It was her psych admit and possibly first psychotic break. She has a long history of abuse and neglect and reports that she hears the devil talking to her. She had been very distant and sedated for her first few days on the unit (probably overly sedated and she had been voicing rightful distress at being "tranquilized").
Yesterday, she just flipped. She was screaming that a plane was going to crash into the hospital and we were all going to die. She had to leave to help give directions on how to land the plane. She was so afraid and truly believed that we were hurting her and preventing her from saving peoples lives. It really cut into me. She threw a chair into a window (luckily plexi-glass) and bit one of our techs. I called a code and security came running with their K-9 unit. It took 6 people to hold her down. Fortunately, 4pts were not necessary. I got the injections ready and called the doc. She managed to sleep a bit so we held on to the injections. I made sure the other patients were safe and did some debriefing. They could probably tell that I was shaken and near tears myself.
We managed to get her to her room and she slept a bit. She awoke and began screaming again. I brought the injections and I just froze up as she was begging us not to do it (we had gotten orders to involuntarily inject and petition). I handed the injections to the other nurse and she gave them. They were given in her deltoid and there was a lot of blood as they were 22 gauge 1.5in needles supposed to be used for the gluteal muscle. She was screaming. I nearly cried again. She eventually fell asleep again. Both techs were in her room so I did the q15 rounds.
We had a new admit (unfortunately this patient had come from another hospital and we had previously accepted her). I received her and got her chart stickered up and ready to go. The nurse was really angry at me for not completing the admit as she was drowning in petition paperwork she had never done before. I honestly was just paralyzed and really wanted to go home and cry. As bad as it sounds (as I was definitely not the only person frazzled), I really needed a hug and some reassurance. It was already an hour after my shift had ended and I felt in a trance. I don't know why I feel so obsessed at how disgusted and disappointed she was with me. I ended up leaving at 1am (my shift technically ended at 1130). I am having trouble shaking it.
I cried all the way home and woke up my boyfriend to cry to him for an additional hour. I could have stopped myself from crying and sucked them up, but I didn't want to. I wanted to release and I feel like the patient deserved a few tears. I took my usual sleeping med. This same nurse called me at 0630 for me to come to work because the AM nurse had called in. I was really disoriented and my eyes were swelled shut from crying. I had finally gone to bed at 0330. I refused to come in and since I was zonked on ambien, I can't remember what I said to her. I called work at 1030 to ask if I had offered to come to work or if they still needed me. Fortunately, someone else had covered. I am hoping that there will not be consequences at the workplace for my lack of team-playerness. I am afraid to go to work tomorrow. I think anyone could be shaken by that event and by the nightmare this poor girl was suffering. I am just disappointed in myself for freezing and not being the team-player everyone wanted me to be. I know that I work in a psychiatric crisis unit and this will happen sometimes, but it breaks my heart and scares me anyway. :crying2:
I'm so sorry you had this terrible experience, and I'm sending you hugs. I'm also sending them to the patient. Times like these sure shake us to our roots, don't they? I'm glad you felt you could vent your feelings here!
more hugs! >
Vent, yes, but too much information that could allow someone to pretty easily identify the patient. Gotta be careful about that.
OP, don't be so hard on yourself. You're still pretty new and the situation was quite sad and quite stressful and distressing.
Being a team player does not mean that you have to work every time they ask you to. And learn to turn your phone off and your recorder on when you don't want to be called.
I don't know that experience will make it easier. I find that I get upset every time something like that happens. I think it's actually worse with repetition. Not to discourage you. just that I'm older, maybe need to retire!
I totally agree - but I've seen it happen. Pts who don't actually require the level of intervention offered (not saying the case inthesky presented didn't) who are compliant with staff direction, given excessive levels of restriction, restraint or medication - I've seen patients walk into seclusion on staff request.
How contradictory is that?
The point about coercive medication is that it seems to be the first-response - often the only response.
Many times I've employed therapeutic control by hands-on non-restraint holding - ie linking arms or sitting close but protected; and engaging in talk down for an hour or so.
It provides a protective environment for the pt and others and is much less confrontational.
If this fails after a significant period then other options such as enforced medication are considered.
Of course this approach depends on skilled staff availability and not all places have that.
(Did that sound arrogant to refer to myself as 'skilled staff'? .. well, I am anyhow!)
It is wonderful when staff take the time and exert the energy to actually talk with the patients.
thank you for encouraging the practice of least possible intervention. I must comment, however, that your orientation and experience is yours, and does not necessarily reflect the reality others' experience. You appear to be Dutch, or north european. I would remind that America is a melting pot, peopled with those cultures of the world perhaps not considered in northern european studies.
What works with an homogeneous group of north europeans may not work with people from other parts of the globe where genetics and socialisation/education are varied...again, thanks for arguing for reduction of coercion and excessive restraint. Too often are the rights of the patient sacrificed in the interest of staff safety. Too often "staff safety" is confused wtih staff convenience/comfort. The role of the nurse should include not only caring for the patient, but also advocating for them as human beings, in a broader sense.
Its usually very disturbing to the person witnessing something like this for the first time, and you just need a little more time to observe the abnormal behaviors.
Learning the ropes of a new job is stressful in itself, and it's virtually impossible to accomplish if you aren't accustomed to the totally bizarre events that occur in the psychiatric setting on an almost daily basis.
I think employers forget about this sometimes and they rush to get you oriented and on the floor. And they wonder why nurses leave like their hair is on fire. :tinkbll:
:crying2:
Kooky Korky, BSN, RN
5,216 Posts
Vent, yes, but too much information that could allow someone to pretty easily identify the patient. Gotta be careful about that.
OP, don't be so hard on yourself. You're still pretty new and the situation was quite sad and quite stressful and distressing.
Being a team player does not mean that you have to work every time they ask you to. And learn to turn your phone off and your recorder on when you don't want to be called.
I don't know that experience will make it easier. I find that I get upset every time something like that happens. I think it's actually worse with repetition. Not to discourage you. just that I'm older, maybe need to retire!