Nursing - Mental Health

Murder in Chatswood

Thursday, April 29th, 2010 by shoils

I am sure everyone has by now heard about the murder that occurred in Chatswood on the 27.4.10.

stalker

This murder took place around the corner from my workplace (that is a scary thought in its self) but reports state that the murder may have been by the victim’s patient.

The report doesn’t say that she works in the mental health field but it does say that they suspect that it was one of her mental health outpatients.

It is very worrying to think that the patients we look after, whether we work in mental health or not, can get a hold of where we live, who our family members are and our personal details. How does this happen? How is it that our personal details are so accessible to the people that we look after?

I have a very close friend that works at Long Bay as a mental health nurse. She once told me that they are not to bring in their mobile phones to ensure their security and to keep as little detail of their personal life out of the facility. This may make it harder for her patients to track her down in the outside world but in reality all they need to know is her full name and they can track down her address, phone number, and who her family is. It is not hard.

When I was in training I did a placement at Rozelle Acute Mental Health Hospital and one of the nurses there told me about how she had to move house because one of her patients stalked her when he was discharged.

According to law our work place is not allowed to disclose any personal details to anyone, including fellow work mates but in today’s day and age is this enough?  When this law was passed we didn’t have internet and whilst back then this may have been enough to protect nurses from patients or their relatives from finding us but now it is all too easy to look someone up on the internet and find all of their details. So how are we supposed to protect ourselves? Would it be wrong if nurses remained anonymous at work? Or, we use nick names instead of our real names?  And our  name badges have our selected names on it instead of our real names?

How are we to protect ourselves from patients finding us and causing emotional/physical  harm?

Do you have any suggestions? Have you experienced a scary situation with a patient or their relative? Please share your stories or Ideas.

Image source (http://www.fotosearch.com.au/photos-images/stalking.html)

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Helpful Relatives In Health Care

Wednesday, September 30th, 2009 by Ruth Guevarra

This is the last of my 4 night shifts… woohoo! I must admit, I’m not a night person at all but nothing much I can do about not working the night shifts I’m afraid. I’m just whinging a little, but what did I learn from these experiences? Well, I was surprised myself!

shaking_hands-lockstockb-sxc

For the past 2 nights, I have been getting patients admitted to ICU due to drug overdose with self harm. A bit of a daunting task for me, as I’ve never looked after one before. Luckily for me, one of them had a family relative stayed with the patient overnight, which was handy because I have another patient to watch over the night that is becoming confused due to sundowners syndrome or electrolyte imbalances. I wouldn’t have survived that night without the helpful relative making my very anxious patient comfortable and giving her reassurance.

The following night, I had another patient with polpharmacy overdose who is now medically cleared and waiting for a psychiatric bed. I read his story on the notes. He was greatly depressed due to so many social and emotional issues. He was remorseful of his actions and wanting to get back on track after his brother visited him from interstate and offered to help him and live with him. He is the only family that he’s got.

You see, I learned something valuable about life through these experiences. For one thing, I learned that we need each other to survive and to get back on our feet when we stumble and fall. No man is an island its true!

As for my relatives who I live with, they make sure I get enough sleep during the day by keeping the house quiet. Plus, they have prepared food for me when I wake up. We help each other and that feels good! Makes life a lot easier.

What about you? What are your experiences with helpful relatives in the hospital? How does your family support you as a nurse?

Also Read: 5 Truths About Working Night Shifts

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Mental Illness 101

Monday, September 21st, 2009 by patience

funny-pictures-sad-cat-blackandwhiteThere has been quite a lot of discussion amongst the members of Nurse Uncut about having to manage difficult patients and their relatives. The focus has been mainly in Aged Care and I guess that’s because it’s becoming the biggest sector of people who are unable to care for themselves and/or their relatives are unable to care for them either. It’s under these stressful circumstances that undesirable traits and behaviours are much more evident.

I think many of these difficult people may have had undiagnosed (or diagnosed but not adequately managed) mental illnesses most of their lives. Statistics show that 1 in 5 Australians will experience a mental illness sometime in their life. Globally, mental illness is expected to be the 2nd biggest health issue of the 21st century!

As people grow older, their capacity to cope with their mental illness or disorder diminishes and they can no longer hide or manage their anger, depression, anxiety, paranoia or compulsive behaviours. It takes a person a lot of emotional and mental energy to manage untreated mental illness and most people towards the end of their lives just get too tired. Those traits and behaviours then become more evident and florid and so it falls upon our health system and nurses to care for these people. It’s then often labeled as dementia; and dementia is not a label – it’s a sentence!

So does it have to be that way? I don’t think so, I think we just need more education and understanding about mental illnesses.

Mental illnesses, like all illnesses, have complex origins. No single “thing” causes a mental illness or disorder. It is usually caused by a “hot-pot” concoction of genes, brain chemistry, learned behaviours, certain parenting styles, social, financial and geographic circumstances, personality type, personal and environmental stressors, childhood relationships and attachment style. All of these factors may come together to place a person at risk of developing a mental illness. Some people will never develop a mental illness even if they have lots of risk factors, but others will and why they do or don’t is still being researched very carefully.

Another factor about mental illness is that it is often termed “generational” which means that families often exhibit the same disorders and/or illnesses and these are passed down from generation to generation just like heart disease, diabetes and other familial disorders. It’s also in our family that we learn behaviours like resilience and coping, identifying and managing emotions and self esteem.

Many mental illnesses begin early in life. Here is a very simplistic example: (and – for ease of language I will use mother but it may be any caregiver father, foster carer, granny, grandad etc) If a mother experiences an undiagnosed and untreated ante or postnatal depression this mental illness may effect the way she cares for and relates with her baby. This is turn may effect the way the baby attaches and relates to his mum, lessens his resilience to coping as well as managing his emotions and normal stresses. This in turn can predispose the growing child/adolscent to behavioural disorders as well as depression/anxiety in later life. The cycle then continues.

Mental illness may present masked by many physical signs and symptoms, not just “crazy behaviour”. Headaches, rashes, fatigue, tummy and bowel troubles, palpitations and sweating are just some. Undiagnosed and untreated mental illnesses have an enormous impact on providing health services because many people present to health services with these types of physical complaints that can be investigated and treated over a long period of time as other organic illnesses. The primary presenting mental illness is therefore easily missed by health workers who haven’t had any training or experience in mental illness. When a mental illnes is missed and untreated  it may become chronic and like all chronic illness it is much more difficult to treat.

Mental illnesses affect the way people think about their world. Left untreated, these thinking patterns become habitual and hard to change and become part of everyday thought patterns and expectations.  These people’s conversations sound as if  they always expect the worst, and speak about things in global terms (ie “people always do mean things”) or catastrophise (my whole life is a disaster).

Another less understood aspect is that when a mental illness is recurring, and is treated appropriately the patient will go into remission periods which may last for years. However, the illness in remission can’t be ignored and ongoing monitoring by health professionals is essential, as well as teaching the patient and family how to recognise warning events and symptoms to prevent or quickly treat a relapse.

If it sounds serious and complex that’s because it is and that’s why all nurses in all specialties need education and training in recognition and referral of people with suspected mental illness so that they can get help early. A program called “Introduction to mental health” should become mandatory training for nursing staff – just like we do child protection, CPR and manual handling mandatory updates. This is also called “increasing mental health literacy” part of the mental health state and federal plans.

As for those patients and their difficult relatives? Watch them carefully. They may, because of their stressful surroundings and predicaments, be displaying symptoms of  a mental illness. What can you do? Well just by understanding the symptoms, behaviours and reasons for mental illnesses and people’s responses to intense stressors, enables you to engage with and better manage people.

We need to normalise Mental illness and think about it as you would any other illness. Remember how scary caring for someone is when you don’t undersand what’s wrong with them then you  – once you know and you have guidelines and a road map you can calmly get on with caring for your patient and their relatives

Many of the new practices that are being introduced in health such as “working in partnership”; “relationship-based work”; and “psycho-social screening” are all based in mental health research. These practices help us to understand and attend to the emotional and mental wellbeing of our patients as well as their bodies.

I began this piece by referring to the difficulties of Aged Care Nursing because that has been a “hot topic”. However, my nursing practice is in perinatal mental health right at the other end of the nursing specialty spectrum. And, I wrote this to provide a basic introduction to “mental health”,  and also because I firmly believe that if we are going to make an impact on mental illness, we have to start right at the beginning of life and during the critical period of mothering. Perinatal Mental Health is an extremely new, interesting and rewarding nursing specialty and one where my ongoing education helps me understand the many troubles of the lifespan and be able to make a sustained difference in the long term to all my clients whether they are new born or 100.

Do you have any questions, stories, or concerns that are related to mental illnesses? Do share them with us.

Image source: ihazacheeseburger.

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Dealing with Patient Aged Care Interference from Family Members

Monday, August 31st, 2009 by NU_Editor

horrified expressionI think I can speak on behalf of my nurse co-workers that we have all experienced interference from residents’ families and friends visiting the Nursing Home. You feel like a member of the Peace Corps instead of a nurse.

Case in point — MRS L wants to know what’s happening with MR P. Why does he have a yellow bag in the room she asks.

Where is the R.N?

My standard answer? “The R.N. will be with you shortly.”

I wonder how many times am I going have to say that today.

Then of course we have little MRS J. Oh, she doesn’t look happy. Maybe I should think of running away. It’s ok she just wants to know why MR J isn’t up yet. Whew. I explained that it’s been a hectic day and we have had a few people who have had to be fixed up early.

Oh no! Mr T’s family has a camera! Here we go again, have to explain that they have to seek DON permission to take photos etc. They don’t listen to me so our R.N. at morning tea had to go see Assistant DON to speak to the family.

Family start speaking in own language. I don’t have to be Einstein to guess what they are saying.

Mr F’s family comes in next to thank us for all the care we gave him. Left us with box of chocolates. Nom nom nom. We have a quick chat about the fun times we used to have with him.

After lunch,  we see a group down the hall way all getting cross because one of the resident wanderers is in the wrong room. We did try to explain he is confused. The group says Mr Wanderer shouldn’t be in their room and start shouting. I go and report to R.N.. RN goes down to speak to them.

During the round, I come across Mrs D who is crying amongst all the complaints. She feels all alone so I spend time with her.

Next thing I know, we have Mr Y’s wife on the buzzer complaining he needs to go back to bed NOW. We ask her if she can leave the room please as that is the policy of the facility.

She gets irate and asks “Why? What are you going to do?” We did explain we were putting him to bed as she requested. She left the room in a huff and goes to the DON. DON comes down and explain to us, he will deal with Mrs Y.

Most of the time we can handle complaints but some days, it just seems to be never ending and you are shocked if a family  is actually NICE.

Most common complaints that we get are: “Why isn’t Dad up yet?” and “Put Dad to bed now!!!!!” No one says please. Oh dear.

There are also a lot of kitchen related issues which we have to just pass on as we don’t have time to deal with them. Some complain that they don’t like the wheelchair their Dad is in. Can’t do much about that. If you don’t have your own, we have to use whatever one we can get.

There are trials and challenges that in dealing with relatives’ interference with patient care. We take it in stride. It is a hazard of our job, I guess.

What about you? What family interference do you have to deal with?

The smell issue always have to quietly remind them it is a NURSING HOME and we do the best we can .

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A day in the life of a Child & Family Health Nurse

Wednesday, August 19th, 2009 by patience

psychologistSo, here it is 0815 hours and the day begins. I unlock the door to the poor dilapidated house that we work out of. The house looks as forgotten as our service.

It is a grubby post-war affair that has seen better times but it’s all we have and our service is essential to mothers and babies who are experiencing significant post-natal difficulties.

3 Clinical Nurse Specialists (CNS’s) run the Family Care Centre. This is the one place that families can go and get free help for unsettled babies, postnatal depression and anxiety, feeding problems and parenting difficulties.

The first thing I do is go to the intake desk and check the diary. I see I have 3 home visits – 1 new client, 2 reviews and my usual space left at the end of the day for emergency clients. It’s a real bonus if this space isn’t filled, but it usually is.

This is a  usual day for me. I know 3 clients doesn’t sound like much, but in reality it’s 3 – 4 families we work with. So it may be 3 or 4 clients per visit. Do your maths that’s 9 -12 clients per day. But we only count the children in our stats!

I check the phone messages and see I have several from clients wanting me to call back. I make my phone calls first. My clients — all mums with babies and preschoolers all need my reassurance. Jane has called to tell me that last night she was so upset with her baby, she has bitten her! I ring her first. We discuss what happened and I reluctantly tell her I have to make a notification to the Department of Communit Services. She cries and I tell her I will come over and see her today so we can talk about why this happened. I put her into the emergency time slot.

The first task is then to call the DoCS Helpline and make my notification. I have no choice and I wish it could be different. I know Jane didn’t mean to hurt her baby – but I also know that she has such ambivalent feelings about her that I can’t risk ignoring the dangers.

The DoCS notification and writing up the notes take 40 minutes so by the time I’m finished I only have time to acknowledge the other CNS’s with a wave and a quick explanation, grab my notes, home visiting bag, car keys to our one and only allocated car and rush out the door to get to my first home visit at 9.30 am.

I have to check the road directory for my first visit, and once I’ve figured out where I’m going, I go! When I get there I’m greeted at the screen door by a sleek cat. I knock and call and finally I’m greeted by a forlorn young woman in a halter-neck dress. She can only whisper hello and I can see straight away that she is very unwell. I look for her baby and ask where he is.

You are my baby

Karen, the mum, waves her hand towards a little bundle on the floor in a corner and I see a little thing in a bouncy chair facing the wall all on his own. It’s not looking good and I sigh within myself. I can see there is a lot of work to be done here. Karen invites me to sit down and I suggest we bring baby Timmy over with us.

Karen is more interested in having the cat with us and so our meeting begins. Karen sobs softly and the 4-month old baby looks blank. These two sad people haven’t been able to form a relationship yet and I can see that we have no time to lose. I do my first mental health assessment of Karen and her relationship with Timmy. I carefully observe their interactions and determine my plan with this mother-infant dyad. They will need lots of interventions and I will need to get the ball rolling today.

Referrals to GP and psychiatrist for meds, psychologist for CBT and weekly visits from myself for mother-infant therapy. We will be working together for at least a year, probably more. After 2 hours I have finished my first assessment and take my leave.

Karen clings to my hand and I see in her eyes and face a look I’ve come to know so well. It’s heart-rending, because it’s such a mixture of despair, hope and lost loneliness. I promise her I will be back next week and will ring her to confirm a time. I leave her my details so she can contact me and then climb her garden stairs, very aware that her eyes are following me with hope.

I did see this young woman for a long time and she formed a very strong relationship with me. I had to be very careful as she wanted to idealise me and that’s always a danger sign! When you’re idealised it’s not very long before you can become a villain when you don’t live up to the unreal ideas that a client has about you. I had to work closely with the other members of the health team and let Karen know we were all working together.

In the beginning Karen wrote me lots of poems about me being an angel and saviour etc. but as she got better these stopped. When you work in mental health you have to have a really clear understanding of how people think when they are unwell and not get drawn into their often skewed internal worlds.

My next two visits were reviews — both mums had chronic depression and anxiety and having  children had exacerbated their conditions significantly to the detriment of their forming good relationships with their children.

One of these mums had a 3-year old boy who was so naughty and defiant, and a 6-month old girl with a genetic illness that needed frequent hospitalisations. This young woman had chronic depression and no energy to mother her children. I had known her since the birth of her fist child and we had worked on and off for 3 years.

This mum has had a troubled and abusive childhood and didn’t have the capacity to undergo psychotherapy (some people don’t). My work with her focused on ensuring she kept on with her meds, understood what the doctor was advising her to do, encouraging her in social activities and working on parenting skills which was mostly about increasing her ability to be show empathy to her children.

I was essentially her children’s interpreter because she had no idea why her children were behaving like children and she got so frustrated and angry with them! Every visit we would observe the children’s behaviour and we would ‘wonder together’ why they were doing this thing or that. It was an uphill battle, but she slowly got better with her parenting skills and her second child got a much better deal from her than the first one!

At 2.30pm, before my last visit I stopped at a shop, grabbed a sandwich and a juice and ate them in the car while I scribbled some of my notes. I phoned into the Centre to let them know where I was, that I was okay and my ETA back at the Centre.

At 3pm I arrived at my last visit. Jane was waiting for me with her husband, John. I was glad John had stayed home from his busy job to support her. He was looking grave and confused. He was trying to understand Jane, but he was having difficulty with knowing what to do. Thankfully we had built a good enough relationship over the last 10 months for me to be able to tell Jane and John that I had made a notification to DoCS and what this would now mean to the family and they could still welcome me at the door.

The baby was fine, she did have a bite mark on her arm, but I was more concerned about the psychological damage that a mother biting her child causes. Jane, John and I talked together for an hour. I did a risk assessment and we formulated a plan for how she could manage when she felt like this again.  I had to ensure the children’s safety and John had to be a big part of this.

In a way, this crisis was a positive event. Up until this point Jane had refused all meds and psychotherapy as she could not accept that she needed them. In Jane’s world anti-depressant medication meant personal failure. Now she had shocked herself into action and she now believed she did need medication. I called her psychiatrist while I was with the family and explained what had happened. An emergency appointment was made and we discussed medication. I was relieved at last we could make some positive progress.

I arrived back at the Car Cottage at 4.30pm. First stop….the ladies room! Then I greeted my just as busy colleagues and went to my desk to check phone messages. My first phone call was a return call to Jane’s allocated DoCS caseworker. Babies under 12 months are a high priority. After that I began the writing of my copious notes, chatting and joking with the other CNS’s and eating an apple.

By 5.45pm I was alone and pretty much finished my notes. I put them all away, locked the filing cabinets and shut up the dilapidated little house. I was tired, but okay. My work is worthwhile, I do this because all women and their children deserve to enjoy their lives together.

You know – almost all women want to be good mother’s to their kids, it’s just that some mothers just don’t know how to do it without some help and that’s what I’m there for.

And that’s the day of a Specialist Child & Family Health Nurse.

What about you? What’s your day like?

Note: All clients in this piece have been de-indentified.

Images courtesy of Photobucket and Photoxpress

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Right Nurse, Right Place, Right NOW!

Sunday, August 2nd, 2009 by NU_Editor

The Right Nurse Campaign is about protecting patient safety from budget cuts that undermine the proper nursing skill mix in healthcare settings. There is no doubt cutting Registered Nurse numbers poses a serious risk to patient well-being in our hospitals, Mr Holmes.

nswna nurse rally

The Glueing It together Report conducted by UTS and funded by NSW Health in 2007 states that:

Managing today’s clinical environments requires skilled nurse leaders who understand but can also manage this complexity to ensure a safe and work environment for staff and positive outcomes for patients.

Despite the findings in this report, NSW health has proposed the introduction of untrained nursing assistants or health care assistants. I am worried that the employment of these workers will not assist registered nurses but substitute us.

The Garling Report released this year stated that nurses were carrying out too many duties that did not require the expertise and skills of a registered nurse. Although this would suggest that more assistance is needed, this does not mean that we should relinquish nursing duties and cares.

Assistants In Nursing are valuable to our nursing teams but cannot and should not replace the jobs of trained and educated registered and enrolled nurses. Yesterday the Health Minister for NSW, John Della-Bosca, addressed the NSW Nurses’ Association’s Annual Conference. He claimed that he had heard of no plan to replace registered nurses with these new health care workers.

Unfortunately, as an association and as a professional body we cannot blindly believe this statement. My skepticism is based on information provided by members of the NSWNA who claimed that the NSW Department of Health already planed to replace 200 registered nurses.

On Thursday, hundreds of nurses who are members of the NSWNA took to the streets of Sydney in their lunch break to rally against the introduction of these health care assistance chanting “right nurse, right place, right time.” I attended this rally as I believe we need to protect our skill mix for the safety of a our patients and the nursing profession.

What do you think?

Note: Photo above is from a NSWNA rally in April 2009. Photos from the ‘Righ Nurse Campaign’ rally will be uploaded in our image gallery soon!

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