Who do you Believe?

I hate scary movies. In fact, I make a point in life to specifically avoid all things scary. My version of "terrifying" is 'I am Legend' or 'The Sixth Sense' and anything past that, I have trouble even watching the trailer. After spending an entire childhood paranoid an ax-murderer is going to get me in my sleep and demons are chasing me up the stairs, and ghosts will be standing next to my bed when I wake up in the morning, and if I let down my hand off the bed a monster will eat it, and If i walk too close to a bed a hand will reach out and grab my foot, pull me under and eat me....you get the idea. I've finally gotten over all that (its about time) and i'm not about to retrogress back to that state of childhood paranoia. I remember having trouble sleeping as a very young child (under the age of 5 for sure) that someone was going to get into our house and my parents wouldn't be able to stop them and they were coming after me and there was no where I could hide. I mean, seriously, where does that even come from under the age of 5?  I should have just started with intense psychotherapy at that point and moved on.

Anyway, someone new in my life had the same childhood, terrified of all things scary. But then he learned to laugh at it, his mind learned to differentiate the movie world from reality, which I guess is what I have a hard time doing after scary movies   after all movies. So now, naturally, he loves scary movies, like 99% of guys out there. So he is determined to break my fear and slowly work me up to the scary as sh** movies like, "the hills have eyes", "the exorcist"...or....dare I say it..."paranormal activity".........*curls up in a ball*. I have my limits though- I refuse to do horror, aka people hurting other people...aka the SAW series. I will not ever do people with dismembered body limbs. Ghosts, yes, I can do that eventually, demons, sure bring it on, little girls coming out of wells? Absolutely, lets do it- teenagers with their heads spinning around? Awesome! But chopping limbs off in any manner and tearing guts out for fun? Never, ever. So thats where I am officially drawing my line.


ANYWAY, the point of this post....we are starting off small on this fear-breaking mission. Our first two are "SHutter Island" (which I actually have wanted to see) and "Zombieland" (this is more for a beginning comic relief than anything else).

I have kind of always been very intrigued to see Shutter Island. I knew kind of what it was about (psychiatric patients, the worst of the worst) and boy oh boy- I do that every day at work, so I wanted to see that aspect of the movie. But did things jump out at you? Was there exceptionally scary moments? I didn't want to take that chance, so I never saw it on my own. Until yesterday.

And it turns out....it wasn't scary at all! It was actually an amazing movie. It had a couple jumpy moments, but something is wrong with my reflexes lately....the jumpy moments happen and my brain reacts fast enough to tell my body there is no need to jump out of my skin like a lunatic. This comes in handy when my idiotic GPS consistently unexpectedly falls off my windshield in my lap when I'm going 70mph and I don't even flinch and inch.

But the movie is one of those that really get you thinking....Leo Dicaprio must have a thing for doing those, lol. But especially with my experience working with psychiatric patients, the really made me think more so than the average movie-watcher.

Since I don't think I can properly discuss what I'm about to discuss without spoiling the movie, DO NOT READ ANY FURTHER if you haven't seen the movie and DO plan to, one day! PLEASE DO NOT KEEP READING, because it will ruin the whole movie for you!

Okay. So the movie ends and you're like.....what? I have to see the whole thing over again to fully grasp what the heck just happened in the last two hours. The whole first 3/4 of the movie, you (the audience) firmly believes that Leo is a cop, sent to this psychiatric island to help solve a missing patient-case. About half way through we learn that he has to get off this island immediately, before they find a way to claim him as psychiatric and keep him on the island forever, doing experiments on his brain like the rest of the crazies he meets. So the whole first 3/4 you are rooting for this character, you are worried about him and you want him to get off the island successfully before they "get him". Then the plot starts to unravel and you see how the island is starting to make him go crazy, he starts to hallucinate, have intense dreams, tremors, odd flashbacks, PTSD, etc. But the audience is still under the belief that he is a cop and this is unfortunately happening to him, the island is bad and the island is winning. Then you, the audience , start doubting who to believe at all. Leo gives such a remarkable stunning performance that leads you down the rabbit hole, and all the sudden you find yourself rooting for not only (now insane) Leo, but for all  the psychiatric patients he meets, and you start really believing what they have to say, rather than the common sense coming from the island officials. You start becoming paranoid (like a psychiatric patient would) that all the things these employees are saying, no matter how helpful and genuine, is fake. Nothing is real, they are all there to hurt you. Leo brings you to the psychiatric world with such reality, you start to believe everything Leo believes.


Eventually, they make him so crazy that eventually he believes it himself. You, the audience, start to wonder, wait- who do I believe? Did the island make him crazy or was he crazy all along? Suddenly you realize- he is the one thats been crazy all along and you have totally just been mindf*cked by Martin Scorsese. In fact, he is the most dangerous, delusional patient on the island and somehow everything you thought you believed is now not true and you have to go see the movie again. It is unbelievable.


But it really got me thinking....there is this one scene in the movie that really, really made so much sense to me. For those of you that are still reading and have seen the movie, its the cave-scene where he is talking to Dr. Rachel. Rachel brings up the very valid point that....who deems someone crazy? If those island officials wanted to keep you on the island and make you seem completely insane, they totally could. Its easy to do. And once you are declared insane, no one ever trusts you or believes anything you have to say, ever again, no matter how valid. Employees that work with psychiatric patients don't believe you, they nod & smile because they don't want to believe you. Part of them doesn't want to be caught swept under down the rabbit hole. Who to trust, who is right, who do you believe? If something a psych patient says makes sense, you suddenly find yourself doubting your own sanity and you worry, which shouldn't happen, but it does. Its unfortunate- the lives that even the mildly insane live. Even if you spend a week in a psych unit for a minor breakdown, your reputation is forever tainted. Psychiatric patients all around the world are abused because who believes them if they come out and make allegations  anyway? Everything is just blamed on the insanity. Its horrific.

So thats my schpeel. All in all, it was one of the best movies I've ever seen. It hit especially home to me, as so much of it reminded me of my own job, and it really got me thinking not just about the movie but how I will forever see psych patients in a new way for the rest of my life. It will always be a constant struggle of not falling down the rabbit hole vs. trying to find some reality, reliability and validity in what your psychiatric patients tell you.  If a psychiatric patient tells you someone hit them, do you believe them or do you blame it on the insanity, delusion, and manipulation? Who do you believe?


If you read this far and didn't listen to me and didnt see the movie....first of all- I am mad at you, but second of all- go see it now. Or don't, because now you know the whole twist. SHouldn't have kept reading.....



~A writer in a Nurse's body

PS- Naturally, the preview twists the movie to make it seem a LOT scarier than it is. Funny how trailers work like that.


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A Nutsy Day

Today was another one of those situations at work where the psychiatric illusionaryishly (new word...) connects with me and although it is sweet and convenient for me, it makes hell for everyone else and is quite a problem.

It all started yesterday. I got report of the following on her "She has been awful all day. Thank god there is a psychiatric attendent in there because she is impossible to deal with."  So, awesome. So I conveniently dodged the first couple call bells from her room, but it was alas time for me to go in there. I had to relieve the attendent so she could go on break. So its all me in there with this lady (we don't even know what psych disorder they have) its all up to us to just....guess? Wing it? Go with the flow?

So the first thing she says to me  is this, "Oh! So nice! Finally! A Jewish Girl! They finally sent me a Jewish girl! Oh, you are so nice."  She went on to tell me that this hospital is full of Nazi's and all these blond people are German and they are making her nervous.

First of all, I'm not Jewish. I don't even think I look Jewish. But I certainly was not going to take away that misconception if that meant causing irritation. So I sat with her a couple minutes with her and got my initial assessment in. I realized she knew darn well what she was talking about. All her information later checked out to be correct. She also was no fool and she was diligently watching everything. And I mean everything. She also had this errie sixth sense where she knew things about people that I really don't know how she knew.  *Sidenote: She diagnosed me with a thyroid problem, I'm low in Vitamin D, I'm anemic (She said I look like a vampire and my hands are too cold), and that I should get my kidneys checked out. * Lol. I'll look into that.

ANother SIde Note:  The elder psychiatric patients, most commonly schizophrenics, but I have seen others, are always reallllly smart. They all studied at major universities in exquisite majors. Like my patient today, they tell brilliant stories of their younger years of travelling the world and studying. This really makes me to never want to be brilliant and smart, ever.

From that conversation on, I went in the room periodically to do my job (blood sugars, vitals, etc.) Each time she was delighted to see me. She would be talking very nicely to me, in normal conversation tones, and then someone would come stop in to say hi that she knew and she would scream at the top of her lungs to "get lost you crazy Mother F*****", and then continue on talking nicely to me.  For Shits and giggles, after he left, I asked, "Is he German?" and got an "Obviously."  in response.

Today was a little bit of a different story. She was missing an attendant all morning due to a lack of communication and travelling mishap. However, she was perfectly content, well-behaved, and preferred being by herself. However, due to a fixing of the lack of communication, her psychiatric aide showed up. Well, this caused all hell to break loose. Long story short, this patient is about to be a Code Grey (Security) because she is literally throwing things at people (she threw a bedpan at the aide) and storming around the room. On the plus side, she called security for us, meant to be against us,  not realizing that they would surely come up against her.  I happened to be busy in another patient room at the time and could hear the screaming through both doors shut.  I asked, "She's been fine without an aide all morning. Do we really need one?"   And I got back, "Yeah, so we can teach her that if she acts up and starts screaming, she gets what she wants and doesn't have to have an attendant?" ....."Good Point."

Well, the aide eventually left and one of our aides had to sit with her instead, while I went on break. I got back, and heard that she was refusing all treatment (meds, blood sugars, everything).  

I waited for her to calm down a little, and then went in- asked if I could grab her blood sugar, She says "Absolutely, my dear."  So I got that.  So the current aide asked if we could switch since the patient liked me. So I decided to sit with her on the 1:1. Thats when I began to realize that I was the only one she was listening to. Then it hit me: Borderline Personality Disorder.

I specifically remember from psych lectures that the key trait of BPD is manipulation to a certain staff member. They will praise you, pick you out, only listen to you, cause hell for everyone else, ask for you, and then...start asking for you to do things. Then, she starts expecting you to have all magical powers and answers for her. When you can't do something or you are not there, all hell breaks loose.

So, this is why I don't work on a psych ward. Never ever ever, thank you. I can manage perfectly fine on my own when need be, but I will never prefer it or willingly ask to be on a psych ward.

Interesting day.

~WNB

Schizophrenic Transference

So this past weekend at work during report from the day shift aides, upon walking by a certain room, I receive the knowledge of, "This one is from the (local psychiatric hospital). You have to be really careful with her, she is combative at times and even if she acts nice she will turn on you in an instant." And then the aide then proceeded to show me her scratch wounds on her arm.

 
 

I've received these warnings before during report and from nurses. So far, during the past five years of work, I have never been hurt by a patient.

 
 

These are my strategies:

- avoiding patients I know may hurt me

- asking for another person to come in the room with me when I have to go in or can't avoid room anymore

- "talking the patient down" when they get excited, violent, anxious, angry, etc.

- maintaining a calm atmosphere the whole time I am in room, without showing my anxiety/fear.

- explaining everything before you do anything to patient or touch patient in any way. And, introduce self and anyone with you when entering the room.

- And last but not least, using defensive strategies when physically threatened to protect myself but not hurt the patient at the same time.  (This is hard).

 
 

It's hard to protect yourself, protect your patient, and maintain a facade of calmness and at the same time come across as someone that will not be pushed around and is here to help you.

 
 

So, I'm a wimp, may I add. And I don't like working with psychiatric patients in the first place. But, for now, and maybe later, it's my job. So, as said above, I do have a couple tactics that I learned in my psychiatric clinical/class and learned by personal experience.

 
 

So it came time in my shift that I could no longer avoid this patient, I had to go in to see her. I didn't know anything about her other than what I got in that very short report. So, I used all my tactics. I introduced myself, I used my calm voice, I told her I was here to take her vital signs and her blood sugar. She said that was fine. We chatted a little...mostly about Yale, Harvard, cows, water, pencils, cheese and her friend Jenny. I replied with lots of therapeutic responses...I agreed with everything she said and showed interest and treated her with respect. I'll add here that she was in her 60s. We said goodbye and that was that.

 

Then it came time, a couple hours later, for me or my coworker to go and give the aide a break that was sitting with her from the psychiatric hospital. Because I am not brave and did not want to sit with her for thirty minutes, I sent my coworker in, but I said I'd be in to check up on her multiple times. I stayed nearby the room, helping nearby patients, and I could hear the patient (Lets call her Jane- not real name) getting very upset, and loud. I went in to help my coworker and as soon as Jane saw me she said, "Oh, good. You're here, I trust her! (me)." So I used my calm voice and I asked her what the problem was. She said my coworker was working with Satan and needed to leave. Me and coworker determined she needed to be changed (her bed was soiled), so I calmly told her we would be changing her. At the same time, I kept her focused on me and not on my coworker, and held eye contact and conversation. After we were done, my coworker said it was best if I stay in with her for the remainder of the break, and she would do some extra work on the rest of the floor. Well from then until 20 minutes later, It felt like 20 hours later.

This is where the art, blessing and curse of transference comes into play. As psychology terms go, transference is when your patient views you as someone they already know, unconsciously or consciously. If you act like their mother, they will unconsciously treat you like their mother. If you act like the sister they have hated their whole life, they will subject those feelings of hate onto you. So you can see how it can work for you both ways. Well, my situation is a little different. Due to the fact that I can not find any actual term for this phenomenon, I will call it "Dementia Transference" or "Schizophrenic Transference". Schizophrenics (Like Jane) make things up in their mind, they have delusions, hallucinations, people talk to them in their head.. Before their illness, it is common for them to have been very intelligent people. In their mind, what they say goes. They tend to be very paranoid of "outsiders" and are convinced of whatever the "voices" want them to believe. Sometimes these voices are good, but most times they are harmful and detrimental. They tell the patient to hurt other people or hurt themselves, etc. So I name it "schizophrenic transference" because I found out very soon into the conversation that Jane thought I was her daughter, "Lauren".

At first I played along. I really just wanted to get out of there unscathed, so I just talked to her, I nodded and smiled, answered questions. I tried to dig a little deeper to find out more about the "role I was playing". I found out that she thought I was Lauren because we shared common traits (brown hair and "crooked glasses" (as she put it-lol) and she thought I was pregnant, as Lauren must have been. [I'm not pregnant, I'm just fat, I guess] ). I found it interesting stepping into this person's life…or past life, I guess, and taking a look around. I see it like walking right into a person's mind, but walking in blind. You can see what is around you, what you are learning but not whats coming. That's where this starts to get tricky. Its all good and well pretending to be someone if it helps your patient, but what about when that relationship, the relationship between Jane and Lauren, and "me", goes bad?

I could tell she had mood swings, I knew that much. I knew she was starting to get agitated. Her IV was starting to hurt her, and I don't blame her for getting upset about this because it was bleeding and did look painful but at the time being, there was nothing I could do about it as an aide other than talk her out of pulling it out. She kept reaching for it, telling me that "mommy knows whats best" and "let mommy do what she wants". I tried to recover the situation- I carefully grasped her hands so she could not pull the IV- And played it off as if we were holding hands and tried to get her hooked on another trail of conversation. That worked for about ten seconds before she was back to IV. I tried the usuals, "Its helping you get better, It needs to stay in." or "I'll have your nurse come in and look at it". Then she started crying and told me "Remember when you were little, and you cried and you wanted something? I always gave It to you. Now give your mommy what she wants." . I didn't know what to say, except for "I can't let you touch your medicine." And surprisingly, she gave up after that. Another example: Jane- "remember when I taught you latin when you were three? You knew Latin when you were three." Me- *nods* Jane: what does "somethinginlatin" mean?" me: I don't know. I forget. Jane: YOU'RE SUPPOSED TO KNOW LATIN, THAT'S WHY I TAUGHT YOU!"

Then a "third" person came into the room, a person that I could not see, but she could, in her mind. I knew the situation in her mind was escalating when she wanted me to show this person my ID in order for me to remain "acceptable" to stay in the room. I guess I was granted acceptance by this mystery person. We then proceeded to stare at the clock that she thought to be a camera. We "took pictures". She told this third person about "me" [Lauren] and I could tell that this person was one of her voices that was telling her to do things.

Luckily, my time was up and the 1:1 attendant came back.

This isn't the first time I have encountered a situation where my patient thought I was someone else, usually a granddaughter or daughter of theirs. I've heard many of times that it is morally unethical to "play along" as a professional healthcare member, and that it is our job to "reorient them" and tell them I am their nurse aide and you are in SuchandSuch Hospital. But I've seen a lot of people get upset when we try to reorient them. It is a very thin line to walk on, and the line is made of ice that you can easily fall through at any moment. Letting transference happen can get you many places- you can learn a lot about your patient. Its like taking a ride on a flashback memory train of the patient's, and you are a fly on the wall watching their memory unfold and then suddenly you are called upon for information that only "Lauren" would actually know, not me. Then the patient gets mad and you are SOL either way.

So that's my experience with transference, schizophrenics and psychiatric illnesses. Yes, I did do a good job with her (besides the questionable transference), but I did not like being in there one bit. That's what I don't understand. How can I hate the thought of psychiatric nursing so very much and yet be so good at it? I guess that's another different blog. So anyway, I am back on the blogging machine! Lol. I (hopefully!) passed my test, and tomorrow begins my 10 day spring break and I will be a blogging monster, for I have many posts written down that I want to share. So keep checking back! Thank you for reading another long (and hopefully not boring) post!

As always, with immense amounts of love,

~A Writer in a Nurse's Body

PS- I feel sorry for whoever "Lauren" is out there. Her childhood was probably less than pleasant.

Nursing Student vs. Employee: Who's Right?

Yay an ethical dilemma! Well, a mini one, I suppose. Here's how it played out:

Patient: suffers from schizophrenia/manic/bipolar/notsurewhatelse. Gets extremely, extremely agitated and hyper when anyone new comes into the room to do anything. Does not like to be touched. When he is in hyperactive mode, he has to touch everything, has to see everything, has to touch you in order to feel safe around you.Tries to communicate but it does not make sense.

So keep that in mind.

2 nursing students get assigned to him for the day because the instructor is intrigued by the feeding tube in him and wants the opportunity to teach her students.

There is one aide with the patient already, as he is a 1:1 and needs constant attention and supervision.

Setting: Patient is sleeping (rare occasion). Employee sees this as an opportunity to play cards.

Nursing Student (NS): Introduces herself to the aide. Approaches patient. "Mr. Smith" (not real name!). Patient does not respond. He is still sleeping. "Mr. Smith- I have to give you a bath." Patient does not respond...he is still sleeping. "Mr. Smith" NS rustles patients gown and shoulder. "Its time for your bath." Speaking louder.

Patient Aide (PA): "Um..He is actually sleeping. Do we have to do this now? He doesn't sleep often, I think its best if we let him sleep."

NS: "Okay. I'll come back later."

Nursing Student comes back later. With bucket of water, supplies and....her nursing instructor.

Yes, the Patient is still sleeping.

NS: "I'm back."

PA: "I see that. He is still sleeping."

NS: "Well, our day is almost done and I haven't done anything for my patient. He needs a bath and I need to do oral care, at least."

PA: "Well I'm sorry. Today is not a good day. He is sleeping and I do not want him to be woken up for a bed bath. He needs his sleep right now. When he is awake he refuses to keep his BiPap Machine on and his sats drop very low and it is a constant struggle to get it back on."

Nursing Instructor (NI): "Mr. Soandso, my student has been assigned this patient and has responsibilities to attend to his care, like all my other students do for their patients. She needs experience giving bed baths and oral care and working with the feeding tube."

PA: "Mr. Smith (not real name) won't let anyone except the nurses attend to the feeding tube."

NI: "Good. I'm a nurse."

PA: "This is really not a good idea. I do not want him woken up. I will be here for the next 8 hours with him, fighting with him because you and your student got him agitated over a bed bath. He doesn't like to see new faces, it is too much excitement for him."

NI: "Well I'm very sorry that we disturbed your card playing and I hope you can now enjoy a restful 8 hours of card playing because you are not diligent enough to do your actual job and take care of your patient. Goodbye."  Nursing Instructor and student march out of the room.

Later, they see me, an "Alliance", in the hallway.

NI: "Can you believe that aide? I am going to report him. He should be fired. He is awful."

I happen to know this aide based on him coming to do many psychiatric 1:1's on our floor and therefore am very grateful to his services. I also am VERY familiar with the patient.

Me: (playing dumb): "Oh, was Mr. Smith assigned to one of your girls?"

NI: "Yes, I thought it would be a great learning experience because of the feeding tube. I don't see what the big fuss is in waking him up, he is just sleeping peacefully, I'm sure he would fall right back asleep.."

Me: "Actually, this is the first time I have seen Mr. Smith sleeping in the last five days he has been here. If you had seen his behavior prior to today, you would not have handed him to a student as quickly, I don't think. He is a lot for us to handle and a lot for that aide to handle, especially because he is responsible for two psychiatric patients in that room (long story). Maybe next time you will get a feeding tube on a patient that will be more conducive to letting him or herself be a teaching example? I'll keep an eye out for you."



So that was that. I've been in both places, many many too many times. I have been that student. I have been that employee. Most likely, that very aide was probably on his fourth or fifth double shift and was gladly welcoming the opportunity to play cards while his patient slept. But that aide was 17-24 (Im very bad at guessing ages) and was assigned a job to do. Its not her call yet on whether or not its appropriate to go forth with nursing tasks. She is at the "Novice" stage in Benner's model, and is trying to do what she thinks is ultimately the right thing to do: Wake up a sleeping psychiatric hyperactive patient do give him oral care and a bed bath. Someone he has never met before.

I see where both sides are coming from and it was a tricky situation. Glad it didn't escalate into anything further.

The good news is, and strange news, is that Mr. Smith slept through it all.

Who's Afraid of Whom?

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

One day, when I'm old and retired and have nothing else to do, I'm going to write an autobiography.

Its title will be, "The Love Life of a Hypochondriac."

Its main focus is how FRIGGEN HARD It is to live life as a hypochondriac. Then it needed another twist, so I'll talk about how twisted my love life can be (is), and especially how my hypochondriac-ness extremely affects my love life.

*sigh*.

It is seriously hard living every day worried you might die. From a headache. Or a mysterious bump. Or a twitch in your eye. Or some mysterious poison someone might have put in your drink. Or a stomachache. ANYTHING. It seriously is a psychiatric condition. And I'm totally serious, It's how I feel. OK maybe I don't feel like I'm going to die every day, but every day (mostly every day-certainly every week), I come up with some catastrophic disease that I have. And it could kill me-eventually. Especially after going through my psych class-I have (I think) concluded at some point that I had every psychiatric condition....but I think, thats normal. No one is normal. THats the normal part. Ok now I do sound psychotic. No really, no one is normal. I think we all have a twinge of some psychiatric disorders, and some of us don't realize it. The depressed, the OCDers, the schizos, the bipolars....MPD's...all of them. Usually I'm lucky enough to breeze through each catastrophic (<<<am I spelling that right?) disease, for one week I have bipolar and the next I totally don't.

Lets just say I have NO clue why I'm going to be a nurse because half the time I think I'm dying because of a disease/infection my patient had that I had taken care of. I am very good at convincing myself of anything. Half the time I could create a headache, from thinking about getting a headache. If only I could cure myself that way. There have been many nights that I literally thought i was dying, and yet, Here I am--Alive. And well. (mostly). Doctors hate me. I can just tell when they are talking to me. All my tests come out negative. No one can find anything, because there is probably nothing there. Despite all my symptoms. I don't understand it.

THis will all be in my future book. So look forward to it. :-)

I'm such a spaz.

Tired, but better!

So today...today was interesting. I confronted failure--I got a bad grade on a previous written assignment that I thought I had done really well on. Not only did I do less-than satisfactory, but the teacher ripped it apart in front of everyone (the 7 of us) and had the nerve to be sarcastic and edgy about it. But something was different about it. I sort of took the grade...and just dealt with it? I mean yeah, I went through the normal stages of panic/anxiety/planning my back up for the rest of my life if nursing doesn't work out plan, but then I hit the point where I was like....Ok, thats over. Next? Which is really good progress, in my opinion. I guess at this point, I've already hit my rockbottom, I'm on my way back up, the semester is almost up, and I really don't care? Perhaps. But probably not...I do care. Who knows.

But today, that put aside, was good otherwise. I spent my entire morning in the psychiatric ward (for class), and spent the majority of my time there with my patient, a schizoaffective (newly diagnosed--oy). So needless to say, that was an interesting experience!! But i learned a LOT, and learning like that will always beat learning from a textbook. Not that I can honestly say I've opened the psych textbook more than twice, due to the fact that Med/Surg has taken all of my attention...

I also got to do art therapy with the psychiatric group today, there were about 6 patients, another student (whom I really like), and me. I was estatic when the therapist gave her and I a picture to draw too, being that I love art, and I probably need therapy. But my teacher told us "Dont draw anything too horribly depressive--The last thing I need is for a student to have a meltdown right now"----How nice, thank you for those kind, kind words.

Then I came home, went to the gym, ran off all that extra crap/stress, felt good, then got to sit outside in the nice sun and study (sort of :) ) . Running feels so good...Well I mean I really don't like it when I'm doing it, but I definitely feel its effects the whole rest of the day. I feel in a better mood, happier...I feel like I can think more clearly, I feel less tired, I feel like I get less headaches/stomachaches, and I feel less hungry. And when I do eat I feel inspired to eat healthier. And this makes sense to me, because the past week and a half I haven't gone to the gym....and, well you can put two and two together.

I should be studying right now...but I just can't seem to look at it today. Everytime I try I look at it and read at most a paragraph and then think I cannot possibly continue, it is far too boring. I lost my study-mojo. Not good....

Well I am proud of myself for what I would like to call a good day, and I came back on to write a second day in a row. Lets shoot for a therapeutic third! :)

~A Writer in an (overwhelmed) Nurse's Body <3

Psssyyyychhh!!!

Ok so my dreams...I usually don't and won't talk about them. I very much so believe in the power dreams have, the power unique to every individual. For some, they have the power to show clips of the future. For others, dreams bring people back to certain memories, so rich and real that they wake up and wish they could go back again. Other dreams bring an opportunity to talk to someone you miss, whether they still roam on this planet or not. Others let you try an experience that maybe you always wanted to try or were too scared to try, and boy does it feel real. Others let you have a conversation with a celebrity, or someone you've been wanting (or avoiding) to talk to. Others just recreate an image of what your underlying subconscious is trying to say, just in a sometimes funny or scary fashion.

Well last night I had this dream that I was at work. (If you don't already know, I am currently employed working as a nurse aide in a hospital). It was busy on the floor, I had been seeing a lot of patients. I started not to feel well, and I realized that Matthew was on the floor too...as some type of employee (aide, security, transfer..etc.). Whatever he was, he was working with the same patient I had to see. Matthew asked me to bring him something, across the room. Except when I tried to walk, I felt so, so drunk. Now mind you, I've never been drunk so I can't actually say that thats what it felt like in the dream, but If i had to guess what it felt like, I'd say that. Everything was spinning, and I couldn't seem to put one foot in front of the other, it was surreal. Everything was so funny...I remember laughing a lot at the fact I couldn't manage to walk across the room. In my dream however, I knew that I wasn't drunk. I was at work, I hadn't had anything to drink. To me, It felt like a medical condition, that something was terribly wrong with my body (neurological). That's when I asked Matt to carry me away. To my surprise, he did. He brought me into an empty hospital bed and let me lay down. I wanted him to lie with me, but before I could remember anything else, I guess I fell asleep because the next thing I know, I wake up (Still in the dream!) and Matthew is lying on the floor. I am still in the hospital, but my bed had moved to this crammed space where all these back up supplies were kept. I slowly got up, since I had felt a lot better. Then Matt disappeared, and the door to the room opened, with a stretcher coming through with a patient on it. I immediately got up and went to help transfer admit this patient...I did my assessment, did the usual, got him comfortable. It was an older man AAOX3, so I wasn't too alarmed. THen i realized his bed didn't have a fitted sheet, so I asked Matt to grab me one from our supplies cart. But they were gone, so i ran to our closet and they were gone too. Then I realized the bed I had been sleeping on hadn't had one either. Then this nurse came running to me and told me patients weren't allowed to help with admissions or roam the halls without permission, and that I was supposed to be in bed. We were on a psych ward. There was no matt, it was an aide that had carried me to my own bed, everything was a hallucination...The "drunk" was a side effect to a knock-out medication. Then I woke up. For real.

I know...This is why I usually don't share my dreams because people think I'm on drugs. I always have had the gift(I think its a gift anyway) of having magnificently vivid dreams. They mean a lot to me. This one...well, you can see why they give me a lot to think about when I wake up. My rationale for it is that it is a reflection of my underlying fear of going to the psych ward this semester for clinical rotation. I know I shouldn't be afraid. Out of all people in my class even, I should be the least afraid, right? I have had multiple nurses, patients, co-aides tell me that I am so great with psych patients. I have this natural ability to calm them down, when they aren't too far gone. I can calm anxiety attacks down very well. I can help dementia patients come back to reality even for just five minutes. It comes natural to me...the psych ward this semester shouldnt be anything I'm not used to one bit...but that doesn't mean I'm not scared. I've mentioned this in another blog before, I hate patients being unpredictable...One minute they can be completely calm and the next they lash out and grab you. Some of our nurses and aides have been sent to the ER from this. Scratches, bites...they come easy and all of us have our scars. Its not that I'm scared of being hurt...thats not it. I guess I don't know what my true primary fear is. Something I have to think about. Maybe that will help my anxiety in terms of this coming semester (for Med Surg and psych).

Well, I have to go read for my Psych class now actually. Corny introduction stuff (yay).

For now, with love,

~A Writer in a Nurse's Body

<3

Stereotyping and “Cultural Awareness”

Classes started today. Well, yesterday really, but today I have seen all my classes (I have two). They seem to be pretty much what I expected. My Psychiatric mental health class Lecture seems to be a lot more interesting than I would have expected, but still hard. She told us she was the "APA Paper grading queen". Needless to say that's not good. But everything she taught today I agreed with wholly so I think I will like her, in terms of nursing and being a good nurse.

"Culturally Competent", "Practice good, cultural awareness", "Know your patients culture, their beliefs and practices".

These are all phrases I've been hearing the past…three courses in my Nursing program. Except today. All this time we have been taught to professionally accept each and every culture, each patient for who they are. Which is all good and well, however, the way we've been taught is to read their chart, see they are of a certain culture/ethnicity (sometimes it doesn't list their culture per say) and we have to reference a book, or a chart of some kind, to plan how we are going to act or what we might say when with our patients. All this time I've done what I was told, whatever, I need to get the grade, right? In my recent experience, my last clinicals (Peds and OB), I had a patient of my own each week. First things first, people naturally look at names and make assumptions. I try not to, I really do, but everyone does. Second, it lists their primary language. I can't help but groan when it says something other than English. But I consider that understandable…it will be hard to communicate with my patient for the entire day. OK so then we have to make a plan for them based on their culture. But sometimes (more than not), I consider their culture to be….American! Is that such a thing? I meet them and they practice nothing out of the ordinary…no specific religious beliefs or practices, no specific foods they eat or health practices specific to them, no anything. Another time I had a patient that was from the Congo and moved here when she was 16, now she is mid-twenties. I thought, while reading her chart that boy, I am going to have an interesting day. But I met her and low and behold, perfect English, was just as "American" as you or me.

The point I'm trying to make here ( I promise there is one) is what my teacher pointed out…Exactly what I've been thinking all this time. That patients cannot be categorized by culture! I can't look at a chart and see "Asian" and plan my whole day based on if they think it's rude or not to make eye contact, be in personal space, eat certain foods, etc. She made the point that yes, keep it in mind, all those lovely things, but never act on them until you get verification from the patient. Meaning, meet your patient, make your assessment, ASK THEM if you haven't already figured it out, what they eat, if they have any specific cultural practices, if they need certain special needs met. Nurses can't be mind readers. Yes, we are naturally good at picking things up in our assessments but we can't automatically know. Thing is, if we see someone is Indian let's say, even if I know everything about the specific Indian culture (which I don't, trust me), I can't be positive that he/she even agrees with his own culture! You have to ask not assume.

I guess I consider myself American, as much as I squirm when I say that. No, I'm not unpatriotic; I love my country, most of the time. However the term "American" in other countries generally brings about a bad name, bad reputation. Yes, I have eaten McDonalds in my life, yes, I have a cell phone, an ipod, a laptop, whatever. I guess it depends who you ask, but Americans are usually portrayed as "Lazy, fat, want things done without having to do them, etc.". If I travelled to another country and needed healthcare, and they saw I was American, how would they treat me? I certainly wouldn't want them to base anything after any stereotype they might have, before they met me and then made their plan of care.

That's another point. I hate Western Medicine. Western is generally deemed what we practice here in America. Doctors are very different here, things are different in general. How we do things, how we come to diagnoses, how we do procedures, how doctors dish out drugs first thing without solving the initial and primary problem ( I really hate that). Eastern medicine (Europe, Asia, etc.) does things very differently and I can only pray America can learn, or so help me I'm moving across seas. They solve problems holistically, they approach things differently. They treat the body as a whole, not systemically. They turn to alternative methods before procedures, unnecessary tests, drugs…And as for the medical portion, I consider them to be far ahead in terms of research.

Well I need to research this topic before I say anything else. It bothers me a lot and is very important to me. I have to go switch my laundry now, but I might go back and edit this and add more later on…Til then, toodaloo!

~A Writer in A Nurse's Body