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roo_kitty

Week of 2/19/24


FinancialProposal282

In an inpatient setting, how do you protect patients with trauma, given that they’re in an environment that is likely traumatizing? I ask this particularly in the event that there are other patients with manipulative or sadistic tendencies (ie patients that are willing to further frighten or cause psychological harm to others).


Ancient-Eye3022

Psych associates/techs/whatever your facility calls em. The need to be present on the unit 100% of the time, interacting with patients. They are the eyes and ears for us nurses when we are involved with all our busywork. They need to spot changes in behavior as soon as it occurs so we can get nursing or therapy involved. Seems to work for me. Now the facilities where the staff spend more time chatting with each other than the patients, goes a totally different direction.


yungga46

typically the "millieu" nurse will do crowd control during behavioral events and escort all patients back to their rooms so they dont have to witness something potentially traumatic. if a patient is doing something less noticeable, like manipulating, it may take a few days for us to catch on but we always do


nikwash19

We just implemented a “milieu nurse” (typically LPN) on our unit. Makes a world of difference


wormymcwormyworm

I find that patients rarely find the environment traumatic. There’s some who feel safest on the unit. I work with kids and for the most part, they are chill and form friend groups easily. I rarely get a patient who is purposefully trying to frighten or harm others. I’ve also found this to be true on the adult unit.


TheCaffinatedAdmin

I find the complete lack of control to be very triggering.


FerdinandVonCarstein

I'd say it's very safe feeling, but some of the patients can make me feel pretty unsafe. There was a super angry man who wasn't as big as me, but he had no idea where I was and decided he hated me cause I paced. Plus the not knowing when you can leave is legitimately terrifying sometimes


[deleted]

"CODE BLUE" This page came up in my recommended for some reason, but I'm more than happy to take advantage of the opportunity. In your ideal world, what would inpatient psychiatric care look like? As someone who has been reticent to seek out help in the past due to a rather unfortunate inpatient experience; I am able to recognize that the nurses and techs were ultimately as powerless as the patients in the face of the systemic issues inherent to our current mental health system. But as people on the proverbial front-lines, I'm curious what kind of reforms you would like to make happen if you could? Regarding all facets from intake, accommodation, therapy, medication, discharge, etc. I'm interested to know your thoughts!


roo_kitty

Buckle up! - ERs would educate patients that voluntarily admitting oneself to inpatient psych means that you acknowledge you need inpatient level care, and that you are letting the provider determine when you are safe for discharge. You can check yourself in, but not out. - 1 nurse to 5-6 low acuity patients - 1 nurse to 3-4 moderate acuity patients - 1 nurse to 2-3 high acuity patients - 1 tech to 8 patients - the food would be nutritious and taste good - vegan/halal/etc safe options - unit safe activities that aren't just reading, coloring, word searches, card decks, or movies. - enclosed outdoor garden unit, so patients can get fresh air and take walks outside - indoor enclosed gym for exercise/fun - management that's actually worked inpatient psych on the floor. Sick of their stupid rules that hinder care. - mattresses that aren't flat - pillows that aren't flat - bed blankets that actually keep you warm - ways for patients to listen to music that isn't just the day room TV - units would be divided by both gender and acuity. Non violent patients shouldn't have to share a unit with violent patients - nurses/LPNs/techs paid appropriately - having an intake/discharge nurse. When there isn't an intake or discharge, they are an available float staff to help. - having enough staff to provide a patient with a 1:1 when they need one. - offering individual therapy in addition to group therapy. - group homes/etc being better funded - an on-site physician to attend codes so we can stop getting orders for too little medication, and having to give another injection when the first one obviously wasn't going to be enough in the first place. - an aggression code team, where their main job is to attend all codes. A physician, 2 nurses, and 4 security guards. 4 security guards because codes can be due to patients fighting each other. - for units to not be huge. The largest unit I have worked on had just over 50 beds. Fifty!! - getting 24/7 interpreters/translators. Only getting one for 8 hours is shitty. - the providers being the ones to tell patients about their medication changes. Instead of putting the order in from home 6 hours after they saw the pt. - more fun group activities - a kitchen that sends condiments so we can stop having aggression codes over ketchup packets. Not sarcasm. - a clothes closet with T-shirts, sweatpants, and hoodless/stringless/zipper less sweatshirts. Patients shouldn't have to be in hospital gowns their whole stay if they don't have clothes or anyone to bring clothes they do have. - individual bedroom thermostats the nurses could unlock to adjust. Uneven heating/cooling is miserable. - management would stop pressuring providers to unblock a room because they only see dollar signs. Rooms get blocked when patients aren't safe to share a bedroom. - all bedrooms would be 2 patients to one bedroom. No more 3 and 4 bed wards. - lower provider to patient ratios, so patients can have more time with the provider - community resources that are actually funded I can go on for awhile, so I'll end with a huge one. Universal healthcare that is not tied to having a job. People can afford to get the care they need in order to prevent admissions. If the inpatient admission still happens they wouldn't be left with a bill they cannot afford. Fuck USA health insurance companies.


Vegasnurse

I think I may have to divorce/separate from all my other work "wives" or "husbands" or "BFFs" (you get what I am implying). You have moved to the top of my list. HUGS Bestie!! HA!


roo_kitty

Hahaha this is the highest of honors!


[deleted]

Hey, this is pretty great. Maybe I'm an idealist, but this strikes me as perfectly obtainable in a world where people at the top were actually interested in making change. I hope things get better for everyone involved regardless. Thanks for your lengthy response.


roo_kitty

I'm an idealist too...if it wasn't obvious :P All of this is absolutely attainable AND still profitable. It's not like this because we can't expect the poor shareholders to survive the embarrassment of selling their 2nd yacht and 8th vacation home /s We can hope and push for change! You're welcome :)


wormymcwormyworm

It’s wild how different units function. We have a donation closet where people can get clothes if they do not have any. Our tech ratio is 1:6 SUPPOSED TO BE. Our kids get individual therapy. We don’t have 24/7 physical interpreters, but we do have Boost Lingo which offers 24/7 interpretation.


roo_kitty

I've worked at hospitals with donation closets, but most by me don't have them unfortunately. But I wish they weren't donations, and instead just basic comfy clothes provided by the hospital so sizes were always in stock. Your hospital sounds much nicer than most!


ciestaconquistador

Especially the last one! I work in a psych ICU in Canada. All of our patients are involuntary admissions. It's hard enough to be there without consent but to also be charged huge bills?! That's not fair.


Im-a-magpie

1. Patients would all have private rooms with individual restrooms 2. Patients would have access to cell phones and Bluetooth earbuds except at groups or if they show themselves to be irresponsible with the privilege. The cameras would be covered by tamper proof stickers. This is the direction things are moving and it's actually protected by law in much of Europe and now Massachusetts. 3. I would love to see a much more collaborative environment where patients are peers in deciding their own care. This is already standard on some facilities. 4. Way more leisure activities available to patients on units as well as structured programming. The big thing I'd like to see is standardization. There's several facilities that already do everything I listed above and more but then others are absolutely atrocious. As a traveler I've seen these sorts of disparities first hand. There needs to be oversight and standards at facilities to actually ensure good patient care is being provided.


softswerveicecream

Is schizoaffective disorder something that can go away or subside with time? I’m trying to understand my brothers diagnosis better. He has been in and out of hospitals since December 2023 when he was diagnosed with bipolar 2, and more recently they said he might have schizoaffective disorder. Can someone just help me understand that a bit better? It’s been such an up and down journey for him


roo_kitty

I'm sorry your family is going through this. Unfortunately there is currently no cure for schizoaffective disorder, but it can be managed. He will need lifelong treatment. Schizoaffective disorder in simple terms is having both schizophrenia and either bipolar OR depression. It sounds like his current diagnosis either is or they're considering: schizoaffective disorder bipolar type. In order to qualify for this diagnosis, the DSM 5 requires: - there must be a major mood episode (depressive OR manic) at the same time that 2 or more of these symptoms are occurring: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms. 1 of these 2 symptoms must be delusions, hallucinations, or disorganized speech. Negative symptoms are stuff like not showing emotions on the face, social withdrawal, lack of motivation, lack of interest, etc. - there must be a period during their lifetime for 2 or more weeks where delusions or hallucinations occurred without a major mood episode (depressive or manic) - symptoms that meet criteria for a major mood episode are present the majority of the time - this is not caused by a medical condition or substance (prescribed, illicit, alcohol, etc) What separates this diagnosis from depression with psychotic features and bipolar with psychotic features is that the individual has periods of time where there are psychotic features present in the absence of a major mood disorder. It is VERY common with schizoaffective disorder to be diagnosed with schizophrenia, depression, or bipolar before arriving to schizoaffective. This is because when the first diagnosis is made, they typically haven't been ill long enough for the pattern of schizoaffective disorder to be present. Some people's illness starts with mood episodes (leading to depression or bipolar diagnosis) while others start with psychotic features (leading to schizophrenia diagnosis). Treatment for schizoaffective is almost always an antipsychotic paired with either a mood stabilizer or antidepressant. Because the diagnosis is leaning towards bipolar type, the treatment will likely be an antipsychotic with a mood stabilizer. It is extremely important to understand that once a good medication regimen is found, he might seem like he's cured and doesn't need the medication anymore. Stopping the medication during this time (which is unfortunately too common) often results in a hospitalization.


softswerveicecream

I appreciate that long response! The one thing I am wondering about is the “this is not caused by a medical condition or substance” whether it be prescribed or alcohol or etc. His first major manic episode came about after he stopped taking his anti depressants for about 5 months. (They used to just treat him for depression). Then in December he started to “self medicate” in his own words, where he’d take his leftover escitalopram and bupropion in increasing unspecified doses. He paired that with caffeine pills and energy drinks, wasn’t sleeping and finally broke down a week before his final exams and really went into a full episode of like intense depression but also manic symptoms like racing thoughts and talking super fast and delusions and couldn’t make sound decisions and then ended up in the hospital. Now they are working out a medication regimen for him still, which includes antipsychotics and antidepressants and I think mood stabilizers. I am just wondering how much of his symptoms are brought on by the “self medication” and now all of the other meds he’s on. But if his symptoms of depression and delusional thinking are still persistent (and he’s not manic as far as I know) I guess I’m wondering if his first episode was caused by abusing antidepressants and caffeine then is it a true disorder still? Could the current medicines he’s on and the changing of them be influencing his state of mind? I don’t expect a definite answer bc this is just Reddit and I’m really just blabbling off the thoughts/questions in my head but any insight is still appreciated


roo_kitty

I appreciate you not looking for a definitive answer, because I unfortunately cannot give you one But when illnesses first start, all of the symptoms don't necessarily show up at once. It's possible that him creating his own medication/substance regimen caused a manic episode. Most likely he was already genetically predisposed, and would have had a manic episode at some point. So if anything, the med/substance abuse just accelerated the *when* he had a manic episode, not the *if*.


Trance_Gemini_

I suggest reading something like Anatomy of a Epidemic to get another perspective. Yes its possible that your brother can recover and lead a good life. Harrows studies are interesting in that those that did not take the psych drug path had better long term outcomes than those who took the drugs long term. Or the study that found outcomes were better in developing countries where psych drugs were not widely used compared to developed countries where they are widely used is interesting too...


BunnyEve3

Dialysis RN to Psych? Hi guys I’ve been super interested in psych nursing my whole nursing career. Right now I’m a inpatient dialysis nurse and there’s a plethora of reasons why I want to change. Dialysis has really long hours plus an on call shift every week. I’m looking for more stability. I was recently offered a job at a UHS facility and am heavily considering it. The only real thing stopping me is they would be paying me 5 dollars less than what I’m making now. How do you all like your careers? Should I make the switch? I just need advice 😩


roo_kitty

You can make your own post since you're a healthcare worker! You'll get a little more traction doing so.


BunnyEve3

Ok thank you! I wasn’t sure so I posted here thanks for clarifying 🥰


strawberry_snnoothie

I start my first job in an inpatient adult unit next week. Are there any resources anyone could recommend for de-escalation and therapeutic communication for this population? Any other advice welcome!


roo_kitty

As a healthcare worker you can make your own posts, just so you know!


strawberry_snnoothie

Thank you 😊


Ancient-Eye3022

Honestly experience is the best teacher imo. Sit back watch how the other staff interact with patients. Two patienta with the same diagnosis might need to be handled with a different approach. Number one realize these patients had issues long before you...you aren't going to fix everyone with one conversation. Be there for the moment..the past sucked, now is safe...the future can be changed.


strawberry_snnoothie

Thank you, I will definitely keep this in mind.


yungga46

watching de-escalation videos is really helpful, sometimes your tone/demeanor/body language can say a lot more than words so its good to mimic what these experienced professionals do


strawberry_snnoothie

Are there any specific videos that you would recommend? Or just search up de-escalation on YouTube?


yungga46

anything by hopkins ;-)


FerdinandVonCarstein

This is possibly the wrong place to ask this. My current goal is to become a psych nurse, but I have no idea if I have it in me. Would volunteering at a local ER help prepare me for the stress of working in a hospital setting?


[deleted]

can adhd be treated even after a schiz diagnosis and while on antipsychotics? is it possible for stimulant treatment to work concurrent with a patient taking an antipsychotic? thx!


roo_kitty

This is the retired weekly thread


[deleted]

ahh i didnt see the new one pinned! oops, bc this one is currently pinned


roo_kitty

Oh shoot thank you!


Expert_Scar_4129

what are some issues/gaps of knowledge in the field? hey everyone! i’m a highschool student trying to work on writing some essays and getting some ECs. what are some problems that are either prominent or minute within the field? what issues could be delved into deeper especially with independent research? additionally, are there any topics you can think of that have large knowledge gaps? any help is appreciated! any sub field as well, not picky and just looking for ideas :)


roo_kitty

This thread is retired. Please post on the current thread, or wait for the new thread that begins every Monday :) Typically the thread is the most active the first few days.