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Unsure of what I am suppose to be doing as a Psychaitric nurse?

Psychiatric   (927 Views 5 Comments)
by fworkentin fworkentin (New Member) New Member

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Greetings,

I need some information. What are you doing when you are on the floor with your patients? I work in a acute psychiatric facility. I do the admission process. Ask how they are, sleep, any problems with meds, goals for discharge. I am assessing them i.e. mood, thought etc but I feel like I am missing the boat. I don't really feel like I am "helping" them. Its like this intangible thing that I'm not meeting. My background has been hospital for 17 year so psych is so different. Ive been doing this acute now for a little over 1 1/2 years. Does anyone have insight or suggestions/experience to share? I would appreciate  it,

alwayslearning

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verene specializes in mental health / psychiatic nursing.

1,523 Posts; 9,729 Profile Views

Part of going on the floor and interacting with patients is to figure out where each patient is at, and what they might need – yes, much of it is assessment – are they improving, not improving? How are they sleeping? Food/water intake? Overall mood? Changes in affect and hygiene? Medical needs?

But it is more than that – you can weave building of coping skills, education on illness, medication, and community supports into the conversation. I try to elicit patient identified strengths and weakness, to build on what strengths and resources a patient already has just as much as shoring up weak skill areas.

I think it is also import to have nursing staff treat patients as humans – sometimes my conversation is around the latest basketball game, their favorite band, or their mom’s recipe for brownies! Mental illness is still stigmatized in many circles and it is important to reinforce that they are more than just their diagnosis and the medications they take – they are still their unique human selves with their own stories and interests – the need to care for their mental health is just one aspect of who they are, so I like to help build/reinforce the other aspects of their identity as well. Never under estimate the power of restoring and building hope in an individual. 

All of this information can feed into goal planning, assessment information, and recommendations to providers and other treatment team members – which in turn can lead to more individualized care and increased progress towards treatment (and patient!) goals.

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Verene,

Thank you so much for replying. It made me realize that I am doing more than I thought I was. It also is helping me to see some area's that I need to be aware of and that I can improve. I am copying this down and taking it to work with me so I can keep it in the forefront of my mind as I work with clients. 

Again, thank you for replying and sharing your expertise.

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On 7/21/2019 at 7:10 PM, fworkentin said:

Greetings,

I need some information. What are you doing when you are on the floor with your patients? I work in a acute psychiatric facility. I do the admission process. Ask how they are, sleep, any problems with meds, goals for discharge. I am assessing them i.e. mood, thought etc but I feel like I am missing the boat. I don't really feel like I am "helping" them. Its like this intangible thing that I'm not meeting. My background has been hospital for 17 year so psych is so different. Ive been doing this acute now for a little over 1 1/2 years. Does anyone have insight or suggestions/experience to share? I would appreciate  it,

alwayslearning

Aside from assessing their mood, suicidal ideation, hallucinations etc which all help to determine if medication is being effective and a generalized medical including vitals etc. Take the time to learn exactly what led to them ending up there with you. Off meds? Why? You may can help with resources to fix that issue while you encourage them not to wait so long before doing something about it so as not to see you again. Most psych patients are repeats and instantly feel better when coming in because you are there and already know a lot about their mental health hx, family, living conditions, coping skills, substance abuse etc. So in a way it’s like ongoing therapy. A chance to reassess if the patient is implementing the skills taught while in your facility before. You have the opportunity to reenforce teachings and find out if they are still working on same goals or making new ones. Need assistance on HOW to accomplish a goal. And on a personal level how is the loved one diagnosed with an illness before last admission? How’s the daughter they got to see? Whatever information you got from them before? Most of all you are building a Report based on trust. And you saved their life more times than you know because you care & in the darkest moments they remember what you said, did, gave them to read to help so instead of harming themselves or others they returned to you. 

P.S Be careful about the way you ask when a patient is ready to discharge. Few are really ever ready. I had a patient that had eaten jagged tin in a state hospital with cameras & staff all around. I wondered why, and also wanted to make sure he didn’t try anything similar in my facility so I ask him, why? What made you do that at that moment? ANSWER: Because, all they kept asking me was “When do you think you will be ready to go home? What is it we need to work on to get you back home? What else do you need to be ready for d/c? “  Not once did they ask me how I was really feeling other than how my meds were affecting me. Not once did one staff member talk to me without mentioning “When I was going to be leaving “.  ...  Home if there is one isn’t always such a good place to go back to. Back to what triggered them in the 1st place. Back to emotional, physical or sexual abuse. Multiple people in the home & no room of their own, drug and alcohol use which it’s hard to say no to your mama or abusive father that’s supplying it. Or looking at the person That assaulted you no one else knows about because you can’t bring yourself to tell. No home isn’t what most patients are looking forward to. Somehow you have to give them the encouragement & compliment each tiny improvement you recognize each day so that they believe they have the strength to go back home...until another day comes..

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