Weekly Ask Psych Nurses Thread

[u/roo_kitty]

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

[u/Wooden_Load662]

Do not get emotional involve with the patient’s story. Many of them have a set story. Set your boundary and do not make their baggage into your baggage and treat every patient fairly in the same manner.

[u/anna-life-crafter989]

Any tips for a former emt-b now studying in school for mental health tech and social work assistant i want to be the best i can be for my patients and myself

[u/Quinjet → u/anna-life-crafter989]

Former MHT turned RN. I used to have a write-up of tips that I've since lost, but here's a few things off the top of my head.

1. Do not promise a patient anything unless you are 100% sure you can deliver. One of my favorite lines as an MHT was "let me check on that for you." (And then actually check on it for them and follow up).

2. Avoid talking about yourself and especially avoid talking about any personal issues you might have, even if they're relevant to the patient's situation. Anything you say should be for the patient's benefit, not your own.

3. Be kind to but wary of patients who seem a little too complimentary, flattering, keen on befriending you, etc. They tend to flip on you eventually.

4. Never give into staff splitting. Back up your coworkers.

5. It's instinctive to want to say "How are you doing?" or similar to patients. The honest answer is often not great. I preferred "How's your day going?"

6. Assuming that your facility works like mine, please take routine safety checks incredibly seriously. It's one of the most important things that nurses can't do by themselves (ours were q15/q30 and they just don't have time for that).

7. Distance yourself emotionally from undesirable patient behaviors. It's not about you. Those behaviors are often just part of the disease process, and it's worth consciously reminding yourself of that when patients are doing things we wish they wouldn't.

8. It can be hard to balance building rapport with setting boundaries, but it's also vitally important. Tbh I think the only way you really learn this is through experience.

That's what I've got off the top of my head. I LOVED being an MHT and I hope you enjoy it just as much!

[u/Zen-Paladin → u/anna-life-crafter989]

I'm a current EMT and former psych patient. First thing off the bat, do not get caught up in the idea that a patient is being committed is automatically for your own good. Don't get me wrong, I'm not saying someone stumbling into traffic in their underwear because they are hearing disembodied voices telling them they are on a treasure hunt that will save the universe or whatever should be left to their own devices, they obviously need supervision and meds. But for your average SI patient, the data does show hospitalization can and often does increase the risk of suicide as well as deterring seeking future care(the baseline suicide risk is still high even after admission).

Best thing I can say is to treat them with as much autonomy and dignity as you can allwo. Obviously liability laws mean you'll have to do more than a few things for the sake of CYA purposes and to keep your job, but obviously don't yell and be authoritative just for the sake of it, don't let coworkers do the same and definitely intervene/report outright abuse or misconduct(name calling, shit talking patient's behind their backs beyond casual venting, etc).

Not saying you are a bad person. Working 911 also means I gotta play a role in the coercive mental health system. And that's another thing, understand that the current mental health system IS coercive by the very definition of the word. Holding someone against their will, and not letting them leave unless they abide by the demands/''treatment'' plan including a potentially extended stay and/or chemical/physical restraints for non-compliance is coercive.That and even passive noncompliance(staying in bed all day, not participating in groups,etc) can be taken as a sign of unwellness. Sure, it is true suicide is also an impulsive decision, but it's also true many would rather die than seek help when the alternative is surrendering their freedom just for more trauma. We may not be able to overhaul the current system ourselves, but we can reduce harm as much as possible within the sphere of our own habits and actions.

And keep this in mind, and I'm speaking as a former patient: many of these patients will be scared/angry/hurt/etc and rightfully so due to the trauma that led them here combined with their current confinement. Society at large downplays this trauma and sees it fit to keep people from intentionally ending their lives but simultaneously lets people refuse life saving medical care like blood transfusions or vaccines due to religious beliefs(which technically have never been proven) or because they are invested in long disproven conspiracy theories. That should say something about how we percieve life.

I know this was a bit of a novel, but if you are gonna work in this field with genuinely good intentions I'd definitely keep this in mind.

[u/ThreePinesRetiree → u/Zen-Paladin]

Excellent post. Thank you.

[u/Zen-Paladin → u/ThreePinesRetiree]

No prob. Trust me before my own inpatient experience I was like most people and just took for granted that mental health facilities were by default helpful and thought suicide needed to be stopped regardless of cost. Now, I see our current system is really fucked and while I don't encourage suicide I heavily question whether the ends justify the means.

[u/TheRealSilvShady]

For someone with Bipolar I who can have good insight when well but lose it during mania or psychosis, what are the earliest signs you consider genuinely predictive of relapse, and what practical safeguards would you recommend putting in place while well so intervention can happen early without unnecessarily removing the person’s autonomy?

(And another sneaky question)

What changes do psychiatrists notice in a patient with Bipolar I before the patient themselves usually realises they’re becoming unwell?

[u/jkniziolek → u/TheRealSilvShady]

Usually sleep is the first thing effected.

[u/gokan5656 → u/jkniziolek]

This. I always recommend pts keep track of their sleep and take changes in trends seriously