|This is me. Under my blanket. Now you are really intrigued on what this post is about, eh?|
Working with a countless number of psychiatric patients in my line of work, I have noticed a fairly common trait In many patients suffering from a mental illness. They enjoy spending time underneath their covers. I have some that sleep under their covers. Some that talk to me while under their covers, even as they eat dinner under there. I have some that hide under the covers when something new or different is happening, or they meet someone new and don't know how to deal with it....
So i sat there one day, at work, wondering why some people did this. I came to the possible conclusion that they were maybe just scared of us. Some patients with psychiatric disorders are very paranoid and it is instinct for them to be afraid of anyone they don't know...and even some they know well. So then I laughed to myself. I laughed at the thought of them being scared of us, because I am scared of them. It reminds me of my extreme fear of SPIDERS. I am deathly afraid of spiders. Deathly. But if I had a nickel for every time someone (usually my dad or mom) say "They are more afraid of you.", I would be a millionaire. So its a lot like that. We're afraid of each other.
I have very good skills in working with psychiatric patients, but I do not like doing it. I find them too unpredictable and despite me doing every trick in the book I know of to calm them down or to keep them calm, I've had too many experiences where they turn on you in a minute and someone gets hurt. I shouldn't be afraid, I know this. I am trained well for the specific experience of self defense in the appropriate medical situation, whether it be a psychiatric patient or not. We all know a couple tricks on how to get out of a tricky hold or how to talk our way out of it. Most of the time. I've been in a couple tricky holds but have gotten out of them very quickly but usually I never get close enough to put myself in that vulnerable position or I take the necessary precautions first, so that I won't get hurt. We've had a couple nurses get sent to the ER because of injuries from patients. But despite me being confident I can get myself out of a tricky grasp/hold or whatever, I still don't like being there.
There is a fine line, a very fine line, on the verge of caring, earning and having trust, and still protecting yourself. For example...This week I have had a very interesting patient. He is in his 40s and was a previous alcoholic and got himself into a MVA and therefore landed himself into a bed for the rest of his life with seizures, and post-stroke behavior. He rarely talks, and if he does, he is really pissed at us. He won't eat. He is occasionally combative. His eyes are always glazed over, and I'm pretty sure he is having seizure's a lot more often (is that grammatically correct?) than people think. But it's hard to say. I'm not a doctor. I just spend a lot more time with patients than the doctors. But whatever.
Anyway, there have been many instances where during report, the previous aides are like, "Mr. Smith (not real name) has been extremely combative. He is trying to hit us and it is very hard to change his diaper. So, good luck with that." At first I was afraid and I was a ball of nervousness fire and my stomach churned because I hate reports like that. I've had him for four days now and have never had a problem.
I don't necessarily like going in there regardless, but it's my job and I do it. I remain calm at all times because we are trained to do that. (Side note- I don't think I was ever actually trained or taught how to "remain calm" but I think I sort of just picked it up naturally and it sounds a lot better on everyone's behalf if I just say we were trained to do it)...anyway, I remain calm even if he threatens us or hits us, I explain everything we are about to do, i speak in a soft, gentle voice, I morph my eyes into very gentle, caring eyes that wouldn't hurt a fly (that is a very important skill!) and we move forward. I have never had a problem. This works with 89.4% of my psychiatric patients. (That is a statistic I just made up in my head but it seems accurate to me). Some are just crazy no matter what and that is just that and thats when you have to bring in the big guns. But with "Mr.Smith", the point I was trying to make is this: I sometimes let down my self-defense precautions in the trust that he will not harm me, because in order to properly show compassion and care to him and earn his trust, how can I be posed in the position of personal self defense? Sometimes, you can't do both. Its a fine line. And every patient is different. Its a fine balance between trust and judgement with everyone.
I have been told many times during the past four years that I should go into psychiatric nursing because I am so good working with them. They are calm with me. People seem to dig my morphed caring, gentle, soft voice and my morphed caring, gentle, soft eyes. It's like a tool. The best part is, I can do gentle, soft, caring eyes & voice one minute in one room for one person, then go see my 20 year old patient in another and be "cool & hip but nursy-professional at the same time" for that person, and then go see my 45 year old patient and be just plain old "realistic and nurse-professional" or I can put on my serious face for the grieving family that is losing a family member and I can sit down and answer all their questions and do everything I can for them, or I can put on my comedy routine for someone that needs a laugh. Its a lot of work! But I love it, I like being able to "morph" into a different person whenever I want. I think It would be tiring being the same person all the time.
But even though I have been told I am good with psychiatric, and I do see why they may think that, I simply do not enjoy the unpredictability. I get too nervous. No one can see that. But it's true.
On an ending note, (I have to share this because it made me so happy to hear). I walked past a room, when I was doing my usual rounds making sure everyone was comfortable, happy, warm, cold, not-dying, etc., when I noticed my friend-male-aide talking to one of my patients. I also noticed that the patients foley had about 2,000cc in it, which is nothing new because the foley fills up approximately every 4 hours. So I snap on some gloves and get the cylinder and empty it. So male-aide and male-patient finished their conversation and I joined in for some of it, with my gentle-soft-caring mannerisms with a slight touch of comedy (it was an appropriate time to use them) and we all laughed and then we tucked him in and went on our way. As we left the room and applied the usual dose of alcohol to cleanse our hands, he said to me (the aide):
"You've probably already heard this many times by now, but you are going to be a very good nurse."
And that's why I keep fighting, why I keep fighting through this impossible nursing program. Why I keep fighting through all this stress to be that type of nurse that everyone seems to think I can be. Thats why. I just need to have the same confidence in myself that everyone else can already see....
Thanks for reading everyone. I have one more psychiatric-nursing type post coming tonight or tomorrow(more likely) so look forward to that...or don't, if you prefer my non-nursing posts....which will start coming when my semester starts and funny things start happening at school that are post-worthy. :-)
~A Writer in a Soft-Gentle-Caring- Nurse's Body