Vent about psych admit of 12 yo boy

[elizabeth8503RN]

***VENT*** ***Kind of long***

I work in an equivilant to a pysch ER, we do assessments, then reccommend the patient to the correct level of care (therapist, psyciatrist, in-patient, ect...)

Anyways.... I did an assessment on a 12 yr old boy, accompanied by his bio mom and her boyfriend. The boy was making threats to hurt himself, cut his throat, ect. Very defiant, rude, obnoxious, continued to deny that he was ever suicidal, not very cooperative.

After the assessment I called our on call doctor (per protocal) and it was reccommended that this boy go to either day program (if parents felt safe taking him home), or in-patient on our unit.

I go back to the assessment room to inform the boy and his mother of the decision. I basically say "Ok...I talked with our doctor on call, and we have two options. 1. (talking to the boy) You can go to day hospital, or 2, you can go in-patient."

The immediate response from the boy was "My mom has a third option. She can just take me home. I am not ever coming back here. I don't have to!"

I inform mom that yes, that is an option, but we also have a fourth option, mom and mom's bf could file for commitment. The three of them begin to discuss this, and it became heated. I opted to leave the room so that the three of them could discuss the options.

While I was waiting, I noticed the boy attemting to leave the premisis, with mom yelling at him to come back. Luckily he did go back to the room, and our security guard had to stand by to help monitor him. I go back to the room and mom tells me that she wants me to start filing for court committal.

I go back to the nurses station to page our doctor yet again. Not five minutes pass, and I am called back into the room, yet again. Mom has decided that she will take him home, AMA. I let her know that before we can go that route, the doctor must be informed.

Get a hold of the doctor, and the doctor reluctantly agrees to do this. Go back to the room, have them sign AMA. They leave.

NEXT DAY

I get a frantic call from the same mom about the same boy. He went to school and made threats that he wanted to die. She was headed over to the school to pick him up and bring him there. I inform her that if she wants to bring him in, and he was unwilling to come voluentarily, that they (mom and mom's bf) needed to go to the clerk of courts office and have him committed.

Few hours later they stroll in with the court committment papers... and he is promptly admitted (be me).

The entire time the boy is abrasive, rude, and continues to deny any suicidal ideations, he claims that what he said at school was "This (who knows what "this" means) is what makes me feel like killing myself."

Anyways, he is admitted to the unit, and mom still isn't sure that she wants him there. (AFTER obtaning the court order)

Some days I just don't understand people.

[leslie :-D]

I am confused why your MD on call did not come in to evaluate him directly...

this is my question, too.

when one of my sons was around 15, he got a butcher knife from the kitchen and threatened to kill himself, if we (mom/dad) went through with our punishment to him.

i froze in place when i saw him press that knife against his throat.

i had to talk him down and told him i was going to bring him to the hospital.

he refused to go.

i called 911, and they took him.

he got a psych eval, and the dr deemed him safe for discharge, sev'l hours later.

i 'allowed' him to come home, no further threats as we weren't going let him dictate to us, what he wanted or not.

when kids are unstable, it's very true that ambivalence can escalate the situation quickly.

that said, and until you have children, it's much easier said than done, on what you would do IF you were a parent.

you will never, ever know until the situation arises...i can promise you that.

leslie

[Spidey's mom, ADN, BSN, RN]

My first thoughts we not on the process but on the boy.

How did he get like this?

"Mom and boyfriend" . . that bothers me. What right does the boyfriend have in any of this?

Bio-dad not in picture or not much in picture? That bothers me too.

This kid went through either a divorce (if parents were married) or separation - his family may have been disruptive prior. It may have gotten worse. Mom introduces one boyfriend or maybe more? Is boyfriend living with them? Is boyfriend abusive?

I dunno - sometimes we do this to our kids by our actions.

Granted, this was my first reaction. I see this a lot in the ER in our small town. Women putting up with abusive men in order to . . . sheesh, I don't know the answer to why . . . but it certainly effects the kids.

I also understand that you can be the best parent you can be and still have kids who mess up badly.

This kid needs help, regardless. I hope he gets the right kind of help.

[carolmaccas66, BSN, RN]

Get him on his OWN and have a long talk with him. He is exhibiting extreme rage and fear - and I would bet any money - in my experience and opinino - that the mum's boyfriend has a lot to do with it. The Mum has probly turned a lot of her affection away from the boy onto the boyfriend. I'd also check for signs of any abuse.

[PetsToPeople]

Figures, a family in desperate need of guidance and support and a nurse who has nothing but complaints about how difficult they made her day, followed by other nurses patting her on the back with "yes, it is soooo hard for us isn't it"...then you take the person with a the problem and stick them under a microscope and talk about all the things they do wrong that you would never do that way.

I mean, seriously, what role could the man in the relationship, also defined as the other half of a relationship, who may be acting as the father for the child if, I don't know, his bio-dad skipped off, financial and emotional supporter of the family and mother, etc possibly have in the choice of what will happen to this child, possibly tear apart the family and cause him and his girlfriend emotional turmoil? Please note my excessive sarcasm.

And how dare the mother not just automatically fork over her child, who is struggling with serious mental health issues that the parents are not able to handle on their own, as they are not licensed psychiatrists/psychologists, to a nurse who obviously feels that they are a burden to her and on an md's orders who is not even there!

How dare the mother, desperately wanting to help her child but afraid of handing her child over to strangers, afraid that the child will hate her for it or if her actions will cause more harm.....

No, I am not sorry you had a difficult day, I am sorry that you weren't able to get that child in a seperate room guarded by an officer so you can get the parents out of panic mode and sit down with them and ask them what was going on, when did this start, etc and help them to make the best decision for themselves. Rediculous, sometimes I can't believe the stuff I read on here. I know that as a nurse you can't help everyone, but it sound to me like you didn't even try.

[itsmejuli]

It's parents like these that show me how NOT to parent my children (whenver they come along)...

I won't say what I'm thinking.

[xtxrn, ASN, RN]

Figures, a family in desperate need of guidance and support and a nurse who has nothing but complaints about how difficult they made her day, followed by other nurses patting her on the back with "yes, it is soooo hard for us isn't it"...then you take the person with a the problem and stick them under a microscope and talk about all the things they do wrong that you would never do that way.

I mean, seriously, what role could the man in the relationship, also defined as the other half of a relationship, who may be acting as the father for the child if, I don't know, his bio-dad skipped off, financial and emotional supporter of the family and mother, etc possibly have in the choice of what will happen to this child, possibly tear apart the family and cause him and his girlfriend emotional turmoil? Please note my excessive sarcasm.

And how dare the mother not just automatically fork over her child, who is struggling with serious mental health issues that the parents are not able to handle on their own, as they are not licensed psychiatrists/psychologists, to a nurse who obviously feels that they are a burden to her and on an md's orders who is not even there!

How dare the mother, desperately wanting to help her child but afraid of handing her child over to strangers, afraid that the child will hate her for it or if her actions will cause more harm.....

No, I am not sorry you had a difficult day, I am sorry that you weren't able to get that child in a seperate room guarded by an officer so you can get the parents out of panic mode and sit down with them and ask them what was going on, when did this start, etc and help them to make the best decision for themselves. Rediculous, sometimes I can't believe the stuff I read on here. I know that as a nurse you can't help everyone, but it sound to me like you didn't even try.

Just curious :) What area of nursing do you work in?

[AndiSN]

Wow PetsToPeople, that was really nasty. You actually had some valid points but they kind of got lost in the hateful way you came across. That nurse came on here to vent from a situation that was frustrating to them which is what a lot of people do on here.

While I had some similar thoughts regarding the mother's struggle and the boyfriend's right to be there, I completely disagree with your approach. I truly believe that there is something to be learned from your ideas of how the situation could have been handled better but unfortunately that probably won't happen. Instead of trying to help a fellow nurse learn from a situation that post looked more like you were trying to tear them down. Chill Pickle

[dirtyhippiegirl, BSN, RN]

I probably spent more time on psych units as an adolescent than off of them. I had an unstable home life but most of my issues weren't really environmental. (I'm one of ten kids and none of my other siblings had the same issues that I did.)

From the perspective of a former patient, I think I would interpret the boy's "this" statement as both a lack of control and a lack of those in power correctly interpreting whatever is going on in his head/thought patterns/etc. And, yes, the third option means that he has half a brain. I said the same stuff all the time.

For what it's worth, I spent a lot of time IP but my mom absolutely refused to let me go residential. As a foster parent, she "knew what kind of kids went to those sorts of places" and, in hindsight, probably didn't want to let go of whatever authority she had over me. At one point, I was a 70 lb anorexic whose self-injury issues were landing her in the ER 2-3x a week. I desperately needed long-term treatment but my mom continued to refuse.

I turned out okay, I guess. So it does happen. But I'm pretty sure that most of my treatment providers would have had the same questions about my mom that you do about the boy's family.

[PetsToPeople]

Of course your just curious xtxrn, because you would like say that I can't possibly have a valid opinion on this situation unless I have been a nurse for 2 yrs or more, right?

Actually, I have been a vet tech for over 10 years, and although you may not agree that it has anything to do with nursing and people, I would argue to the contrary. As a matter of fact, as a vet tech I spend more time working with the clients, aka parents, in getting them to do the necessary care for their pets, whether it be vaccines, emergency care, elective surgery, etc. If I can't get to my clients then I can't help my patients, which is my number one goal.

My team always knew that I was the person to go to for any difficult clients who were not interested in doing what was most important for their pet, mainly because they are all animal people and could care what the person thought, they just wanted to care for the pet. But you have to get through the people first. My specialty was the "I got the darn dog for free, why would I pay hundreds for you to fix his shattered pelvis (after he fell out of the back of my pick-up truck, duh) when a bullet only costs ten cent", as the dog is laying there on the floor with his bone sticking out of his leg gasping in pain, a dog who happens to have a not so great temper even when he isn't in pain.

Most people aren't bad, they just aren't exactly smart, lol, they need someone to stop what they are doing, look at them and really see them, see what they need and who they are and not see them as some burden, some thing to be checked off their to-do list. The qualities I learned as a vet tech are going to make me an awesome nurse and I have complete confidence in that. Is nursing and being a vet tech exactly the same, NO, so don't try to skip around the topic at hand by going into a vet tech vs nursing rant becaue I dont care. I have treated ANIMALS better than many of you treat your PATIENTS and that's the darn truth. And I didn't treat them so well because I am some "weird" person who thinks animals are better than people, no, it's because they were my PATIENTS. I would come in early, leave late, work 12 PLUS hr shifts more than 3 days in a row, I got paid less than HALF what most new grad nurses do, no benefits, no health insurance, got bit, scratched, yelled at, looked down at by patients cause I am "not the vet", dealt with inner office politics and backstabbing, got pooped and peed on, been treated like an idiot by vets and I could go on and on, every rant you have had about nursing I can match, but NONE of that mattered, because nursing is WHO I AM, IT'S WHAT I LOVE.

When I am getting ready to leave at the end of the day, an hour or more after my 12 hr shift ended, my uniform stained with various fluids, exhausted, feet and knees aching, my vet, clients or co-workers not having patted me on the back, I go over to my patient, resting quietly, comfortably, with no more pain, I lay my hand in his fur, silently checking his vitals, his IV placement and fluids and urinary catheter/urine flow, he barely opens his eyes, exhausted, as I pull his cover over him before I go, no growls, no snapping, because throughout my care I showed him gently, firm, compassion, I didn't expect him to care, I expected to still get bit, snapped at, growled at, get my double meaing here?, but my reward, is occasionally, occasionally and unexpectedly, I get a silent thank you. Because I cared, because I tried, because I took extra time at continuing education seminars on how best to communicate with patients and how to deal with aggressive pets, because I made it my priority, because something else mattered to me than myself, I put myself out there and I made a difference in the existance of a living thing and that's my karma.

What I am sick to death of is being surrounded on a daily basis by self-involved, spoiled, mean spirited people who don't know what they don't know and aren't willing to try and learn. It's not just nurses, vet tech's are the exact same way, you just want to sit on your pedestal

I find peace by surving a purpose higher than myself, and no I am not talking god, I am talking about (semi) self-less compassion and mercy, giving of myself without expecting something in return, to my family and to my patients. It's not easy, by any means, I am only human, but it's so much better than worshipping at the almighty pedastal of ME, ME, ME.

I know this may sound harsh, but no one will learn when they do less than what they are fully capable and instead of learning, they are patted on the back for mediocre and then are never able to grow. When I grippe at the OP it's because I know she can do more, and I am not just going to pat her on the head and say "good girl" and hold her back.

“I’m only one person and I can’t do everything. But I can do something. I will not let the fact that I can’t do everything prevent me from doing what I can.” ~Helen Keller

I repeat this to myself on a daily basis, it's not just a random quote placed here to show off how smart I think I am.

(I apologize for any misspellings)

[dirtyhippiegirl, BSN, RN]

] Is nursing and being a vet tech exactly the same, NO, so don't try to skip around the topic at hand by going into a vet tech vs nursing rant becaue I dont care.

No, you just give blatant misinformation to people apparently because you don't care.

[Anna Flaxis, BSN, RN]

OP, it sounds to me as if the boy wasn't really very lethal in his intent, if at all. And it sounds to me as if the mother was trying to do the right thing, but wasn't really sure what the right thing was.

In a case like this, I don't think focusing on the boy's behavior is very helpful, and I don't think placing blame on the mother is very helpful (I'm not accusing you of doing these things, just thinking out loud here).

This is a *family* that needs intervention. The boy sounds to me like someone who has a lot of pain in his life that isn't being addressed because nobody knows how. The mother sounds like someone without adequate tools to deal with the situation. The mother's boyfriend sounds like someone who is invested; he showed up when he didn't have to.

All three of them need therapy; the boy needs help learning to deal with his pain, and the adults need help learning how to help the boy. It really doesn't sound like commitment was necessary.

[PetsToPeople]

No, you just give blatant misinformation to people apparently because you don't care.

To what blatant misinformation would you be refering? We could get to the point more quickly if you would actually back up your claim.