Thursday, August 11, 2005

At my second job, where I work psych, I'm a "floater" -- while this always makes me think of swimming pools, what it really means is that I work wherever I am needed.

Almost always, I'm needed in child psych. There are several reasons for this; one is that there are quite a few child psych units (segregated by age and whether or not the illness is acute or longterm) and only one adult unit. In addition, unlike the child units, the adult unit has a full complement of nurses.

Someone wanted to take some vacation, though, so last weekend I worked adult psych.

It's a lot different on the adult unit than it used to be, even 5 years ago. Then, patients stayed for a week, or two weeks, or a month...sometimes months. Now it's 3 days for many, and rarely longer than a week.

While I'm sure that someone, somewhere has a reason for this (and it probably has a lot to do with costs and insurance), from my end it doesn't appear to be working well. Just as someone is starting to feel stable again, s/he is sent home; maybe to return again in a week, or two weeks, or a month.

I do understand that our adult unit is for "acute" cases and people who need very long-term care can go to the state hospital or a group home, and there are home health nurses for those who need help with medications. But I still think that most people would benefit more from a week or 10 days.

Emotional or mental illnesses aren't like cancer, or wounds, or any of a number of illnesses or disorders in which progress can be quantitatively measured -- lab values, size, redness, swelling, color, quantity, reflexes -- which is what makes psychiatry difficult. There are outside observations (which may differ with the person observing) and patient report.

What we nurses look for are hygiene, appropriate interactions, appropriate emotional responses, full facial responses (for example, when you smile do your eyes crinkle up too?), appropriate gestures, appropriate conversations...in addition to what the patient says and what the patient DOESN'T say.

Not only that, but since there is no particular "normal average person" to base appropriateness on, it can be difficult to say, "Yes, that's abnormal" because "normal" emcompasses a wide range of behaviours.

So when you only have someone for 3 days, how do you know what's normal for that person? Swearing like a sailor (do sailors swear all that much? I've always wondered) is normal for my friend Bev, but if it were me, you'd know something was really wrong.

The other thing I want to say about adult psych? The only real difference between me and you and almost all of my patients is that I have keys.

10 comments:

Gone Away said...

Ye-e-es, Nurse Ratchett always held the keys, as I recall. And how many Jack Nicholsons do you have locked up? ;)

But you're right - it's economic pressure that too often decides when a patient has to leave care these days.

Keeefer said...

It seems that governments live by extremes. It was only, what, 30 yrs ago that we would lock these people away almost indefinately and try to cure them by pumping them full of drugs or electricity or both. Now we seem to believe that a few pills a chat with the nurse, maybe a pat on the head and a hot bath, will instantly make you sane enough to go back and live in your house. Im not sure what the answer is but im fairly certain it is neither of the above.

Ive had to visit a few(hmmm how to word it) mental care centres? does that work?
I find them scarey places. Im not sure why, maybe its media portrayal or maybe i get unnerved when people stand RIGHT next to me staring at my ear while drooling onto their jumper. What ever it is that unnerves me i know i couldnt work in one (well at least not on my own....at night....with or without keys).

Jodie said...

Clive, I have only one thing to say to you: BWAA-HAA-HAAAA!

And Keeef, I do think it's the media portrayal. :) Most people who are there are there because they are majorly stressed and couldn't deal with or majorly depressed. Back in the bad old days, the drugs did make people drool and look like zombies. That's rarely the case anymore. I know restraints are an unusual occurrence these days, at least in mental health. :)

Keeefer said...

An interesting point Jodie.....just what keys do you have when you're on 'nightshift'????


:)

Keeefer said...

An interesting point Jodie.....just what keys do you have when you're on 'nightshift'????


:)

Ned said...

I had an odd and rare opportunity yesterday to overhear some exchanges between an adult psych patient and those who were attending to and watching him. I can only say this, that some of the brusque attitudes and dismissive behaviour towards him by those people was saddening. I realize that they cannot respond to every request or desire of the patient and that some of what the patient says or does may be for effect or result in a dangerous situation. But I felt that they gave him somewhat short and unfeeling answers without much explanation and you could feel his tension level rising.

I think the most important and difficult task for caregivers in that situation must be taking precautions without dehumanizing the patient.
I don't really know what was right in that situation, but I know what was going wrong.

Rhodester said...

As a former sailor, I can say with all authority that YES, they do swear- a lot. Not all of course, but most.

Jodie I don't think I ever mentioned to you that I hung around mental institutions in the mid-eighties. This was because I knew a schizophrenic young woman and her Mother, and I was always helping them out by driving Mom to and from whatever given place Jan was incarcerated in at any given time, and lending moral support.

I saw things I'll never forget- and like you, I have stories that would amaze and/or sicken people who don't have experience with the mentally ill.

This was in San Diego and when I moved to Sacramento to take a radio job in '87, I lost track of Jan and her Mom, Mary, so I never knew what happened to them. Jan was severely affected and was forever "a danger to herself or others", so I'd imagine she didn't fair well. I went by their old house on a return trip down there around about 1998 or so, and it was gone- the whole neighborhood had been renovated and in place of the old house was an apartment complex.

Frankly, I was rather fond of Jan so I'm not sure I'd want to find out whatever happened to her- it couldn't be good.

Jay said...

It is unfortunate that for most people the problem will only be compounded during a 3 day stay, and then upon meeting the real world where their problems still exist, things tend to explode. We can only hope that they pursue getting help on their own time.

D Bunny said...

Well, the price that society is paying for the lack of mental health care is that our jails are getting fuller by the day.

Now I'm not implying that mentally ill people are criminals. But if you're not making decisions well, you find yourself in trouble with the law. I can think of five inmates just off the top of my head who wouldn't be in jail for months on end if they had gotten treatment and medications on the outside.

Sad thing is, jails are not mental hospitals. Yet mentally ill patients are put there alongside true criminals, and the doctor that comes in once a week does the best he can to try and regulate the psych meds.

So the insurance companies are saving money by restricting treatment, and the taxpayer is picking up the tab by paying to jail people who didn't get the help they need and now can't function appropriately in society.

Ms. Not Together said...

I haven't been hospitalized (yet), but my latest breakdown I was in Integris' group thing (the name escapes me) the end of March, beginning of April. Well, my insurance changed in April. I couldn't see the psychiatrist I had been seeing as part of the program, because he's not on the list. I now have bills I can't pay. And my insurance is moderately good!
My depression hasn't gone, but it's not real bad right now. I can't afford another breakdown.