No matter how much academic or hands on training you receive preparing to become a nurse people are such unique creatures and considering the fact that every experience is different....let me just say our work is definitely a challenging task.One thing I decided early in my course of study was psychiatric nursing WASN'T for me!
As part of our training, we spent a week at the Mississippi State Hospital. Yes, our very own Bedlam.
We toured the grounds, interviewed patients and had numerous group discussions about caring for patients with psychotic (mental) disorders.
Don't feed into their delusions, re-orient the patient, never get caught between the patient and the door (always keep an avenue for escape, in other words), treat them with dignity and never invade their personal space.
Okay...sounds easy enough.
It's just that when you're face to face with someone who's having a psychotic episode it's pretty hard to remember exactly what it is you're supposed to do.
Your safety and the safety of others is often the only thing on your mind which brings me to the story I want to share with you.
Last night we weren't too terribly busy in the emergency department.
I was planning to leave at 1am instead of 7am since things were so slow.
Shortly before I was about to get off I noticed a name on our patient tracker. This young woman had been in the ER the last 2 nights for seizures.
She's 19 years old, morbidly obese and has some cognitive issues. I guess developmentally delayed would be an appropriate word choice.
Her complaint last night was seeing dead people. She informed the triage nurse that she had been seeing these "dead people" all day and they were telling her to kill herself.
Once she was placed in the room. I immediately headed her way.
I had taken care of her the night before and hoped that by seeing a familiar face she would be easier to deal with. Although she was 19, her behavior the night before had been more like that of a young child around 8 or 9 years old.
She exhibited no signs of violence or psychotic behavior at that time.
When I entered her room I asked her about her mom (who had been with her the previous night). She told me her mother hadn't come. The patient had been brought in by an ambulance.
This is how the conversation went from that point -
Me: What's wrong?
Patient: I see dead people
Me: How do you know they're dead?
Patient: Because I feel it
Me: Are they here now?
Patient: Yes! (patient jumps up as if moving away from something or someone)
Me: I understand this must seem real to you. But the only people that are here are the nurses, the doctor and me and you.....(pause)
Patient: (eyes roll back in her head as she starts walking toward me with both fists clinched)
Me: (EXIT! STAGE LEFT!!!! with the patient behind me and security behind her)
End of my conversation with patient....
After security escorted the patient back to her room, I took a seat at the nurses station. Some of the other nurses took over and were able to calm the patient down.
Could I have handled the situation differently? I don't think so.
The young lady was agitated and exhibiting what I perceived as threatening behavior.
Do I feel good about they way I handled the situation? No, but when 300lbs is charging at you with both fists clinched and only the whites of their eyes showing....I didn't feel like I had many choices.
I wasn't dead yet and I certainly didn't want to wind up one of the decedents she had been fellowshipping with all day.
A well learned lesson in life is knowing your limitations.....I KNOW MINE.
