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What's so scary about psychiatry?

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Author What's so scary about psychiatry?

sassygirl

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Sat Oct 08, 2005 12:10 pm

It's mighty quiet on the Mental Health front lately. Thought I might pose a question that might help me dealing with the anxiety that I see when the new undergraduates start their placements on our ward:

1. How is psychiatry presented in your workplace?

2. How was psychiatry presented during your training?

3. Why do you think psychiatry is scary? or dangerous?

It's interesting that by the time the students have finished their placements they (mostly) report having a really positive time, have really enjoyed the placement and have learnt heaps. They initially think it is going to be really dangerous and violent and are quite pleased that it is not like they imagined.

Psych is a still that all nurses need to work in all areas of nursing. I actually believe that it is safer than ED and perhaps even parts of aged care.

let me know what you think?

sass

Darren

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Oct 08, 2005, 12:40 pm

I have to agree with you Sassy.

I have worked in almost every arena of nursing, including a few years in mental health. I have been physically assaulted in a private surgical ward, in a community setting and in an aged care facility, but not when working in a specialist psych facility.

On at least one of those occasions, the situation was escalated by other staff members who reacted badly and inflamed the situation rather than managing the obviously escalating situation. By the time I was able to get involved I walked into a volatile situation and was then trying to protect the other staff member involved. I think psych facilities, while generally facing potentially much more volatile and dangerous situations, can in fact be safer work environment because

  • there are good protocols in place
  • staff are aware of the dangers
  • fellow workers are also trained and skilled in defusing situations

Of course there remains the tragic circumstances that are not controlled or managed and are usually highlighted in the media as well.

sassygirl

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Nov 07, 2005, 05:23 pm

I can only sigh.. in our newspaper today (the age) they had the wonderful news that they will look into an undergraduate program that specialises in Mental Health to assist with the chronic Mental Health Nurse shortage. Then they went on to tell everyone how dangerous psychiatry is, how 75% of psych nurses have been abused, how x% have been assaulted. What hope do we have....

I would argue that my psych unit is safer than any Emergency Department, or any dementia ward. All of my staff are aggression management training (yes all, the ward clerk, the allied health, the nurses and the doctors) with an emphasis on managing people who are angry, and identifying it before it is an issue. We have high dependency areas and seclusion rooms for those most at risk.

Please, don't believe the hype in the media.... the reality is not what they love to write about.

mattycat

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mattycat
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Dec 31, 2005, 12:38 am

I firmly believe this is another area only given lip service at Uni. We had a day or two of mental health focus, but patients with psych issues turn up in any ward or ED and must be recognised and treated appropriately. In country ED we had some quite dramatic moments and I learnt heaps just from being there. My best friend is bipolar, a recently spent a day in a major local ED after swallowing floor cleaner and trying to kill herself and taken there by police. They let her go 5 hours later after chucking up blue vomit, with her promising to see a GP next day. Two months later she had not seen one. Almost no follow up :-( No meds from hospital who had her record including previous detentions. Sad but may one day slip through system and just be another statistic :-(

sassygirl

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Jan 01, 2006, 01:34 pm

Hi Matty, looks like you and Darren have been busy on the forum today. Happy New Year to you all.

What a sad story you have Matt, unfortunately not a story in isolation. Mental Health would have to be the most poorly funded and government supported field of medicine/ nursing around. Yet as you say the need for psych skills covers every area of health.. most importantly in the ED department. Sadly the admissions are based on the most needy and discharges on the 'least' unwell. We now discharge based on reduced risk, not improved mental state. I wish I could offer you and your friend some advice.... at least she has a good friend.

jen

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Dec 30, 2008, 11:07 am Last edited Dec 30, 2008, 11:07 am update #1

" What's so scary...."

Working in a psych ward, a mental health unit, or what ever you want to call it.....

That's not scary....

Fronting up to your first shift in jail.... in a secure unit for the 'criminally insane'..... now, that was the closet I've come to scary.

But of course, there was nothing to really be 'scared' of..... the guys in jail would never touch a nurse. It's the same culture as the 'treatment' a child sex offender would receive. The nurse is respected by all, so if you break that trust.... you're 'waisted'.

However, there are some situations to be very wary of. Eg. working in the 'real' lock up unit.... the aggression containment unit of a forensic hospital, inside a jail complex. But you will find, the highest level of safety procedures in any working mental health environment, along with very high staff ratios. Plus, you have the added security of the Prison Officers, who do all the 'manual handling' for you.

I worked ( for a short time ) in a major jail hospital in NSW.

Every time there was a 'major' incident, one member of staff videotaped the whole procedure, as evidence.

This is probably either 'illegal' or considered 'unethical' in the ordinary hospital environment.... but is common practise in jails.

So, even the most 'scary' work environments can and are, quite safe places to work.

regards,

modified: Tuesday 30 December 2008 11:08:29 am - Senior RN

Crystal

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Feb 13, 2009, 05:18 pm

personally i dont think mental health nursing is scarey i think it would be quite interesting and something that i will defiently be looking into in a few years time. the only reason im waiting is that i would prefer to get experience in more generalised areas of nursing before settling into a 'specialised' area of nursing as im just starting out in my nursing career. i think the biggest problem with people finding mental health psychiatry nursing 'scarey' is lack of knowledge, lack of info available and what people see and hear in new papers, crappy internet sites and movies/tv. i really think that there needs to be more seminars/workshops/education on psychiatry nursing and then hopefully there will be more nurses willing to work in this area of nursing

Senior RN

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Feb 19, 2009, 08:29 am

Crystal,

Don't get too tied up in 'theory' and university lectures....

It's about 'real' people, not people in text books.

When you're got someone going completely 'off the planet' at you, and there's just you and that person... ther's no time for thinking back to a lecture you once sat through, or that major assignment on bipolar affective disorder....

You won't find in any text book, the best ways to de-escalate a raving manic, or an aggressive pychotic THERE AND THEN !! It's just you, and them !! ( sure, you probably have a 'duress alarm', but it takes X amount of time to respond, and you could be knocked out on the floor in the thirty seconds it takes to find you.

I think I may have mentioned it eleswhere, but I always carry a packet of cigarettes with me, in my top shirt pocket. I can always point to them, and say " come on mate, let's go outside for a smoke. Tell me what's going on..."

Yeah, I know, a number of facilities are, or have tried going 'smoke free'..... but it won't work. Aggression more than doubles in psych. units, when the fools in upstairs offices make 'blanket' decisions like that.

Anyway, I still don't think psych. is "scary"..... you just have to be CONFIDENT in yourself, and have more than one 'backup' plan, should a patient 'go off' in your face....

regards,

Mirabell

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Mirabell
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Jun 20, 2009, 12:43 am Last edited Jun 20, 2009, 12:43 am update #1

Hi Sassy,
I would like to point out psychiatry from another view - perhaps just something to think about. When I was half way through a nursing degree and in the top 15% at uni, I was diagnosed with a mental illness. I had to give my nursing away at that time because I became so unwell. When I had previously studied EN for 1 year before going to uni, I was curious about the pscyh wards with the "crazy people", but when I became on the other side of the fence (which I would not wish anyone to be on) - I got to see a whole different view point. People talk about psychiatric nurses being hit, bitten, etc. etc. and I do not disagree that this does happen - but sadly another thing I saw was that many patients are also injured (some quite badly to the point of broken bones) from nurses who let their anger of situations get the better of them. Emergency nursing is also another area where I have seen psychiatric patients treated badly. Those of you who work in psychiatry / emergency will know exactly what I am referring to - sadly very few people speak up about it because it creates tension and difficulties in the workplace.

For patients who go into a hospital - they can see their rights, but in reality their "rights" are very limited. If a patient complains about being assaulted - it is often their word against the nurses. And believe me, very few nurses report their colleagues to the correct authorities because it puts them in an awkward position with their colleagues. In WA (and I imagine the rest of Australia) because of the laws governing privacy, a patient will have little success in seeing that a complaint is even reviewed before the nurses board - because the patient needs to provide the nurse's board with the nurse's surname - and nurse's don't wear surnames on their badges. Also, because of Privacy Laws, the nurses board is not legally allowed to phone up the hospital and ask for the nurses surname, even if they have the nurse's first name, date of incident, and shift the nurse was on. If the patient goes to the police - they have to file an incident report, and once again - it is the nurse's word against the patients. Even when other patients have seen things happen - they (chief psychiatrist etc) refuse to interview patients to find out what was seen after it has been reported to them.

From the view of a psychiatric patient, nurses can choose to go into psychiatric nursing. On the other hand - when you are a psychiatric patient, unwell and don't have a choice about where or whom you spend your time with, it is absolutely terrifying. It is also terrifying when other patients tell you to avoid a particular nurse because they have an "aggression problem".

I don't know why nurses fear mental health nursing - it should be the patients who fear it - and they are trapped whether they are in a hospital or outside, in their own personal hell. I have come across some brilliant, BRILLIANT nurses in my time - but I found, in general, that the nurses who have trained in the UK had the most empathy and confidence and seemed to know what they were doing. If I can generalise once again, they also seem to be the most skilled at defusing situations. On discussion with one of these nurses, I came to think that perhaps it is because of their different and extensive training they have in the UK in mental health. Australia could certainly learn a lot from UK nursing.

I hope to go into mental health when I finish my nursing - I am sure once again I will see another side but I am fortunate to have stood in the shoes of a patient and can hopefully bring this experience to helping those in need.

modified: Saturday 20 June 2009 8:11:00 pm - Mirabell

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Dec 04, 2009, 11:28 am

We all draw upon our own ' personal ' experiences, and we tend to draw 'generalisations '.

I can tell you, that I have seen really good nurses ' drawn over the coals ', based upon a patient's complaint.

.... and it doesn't have to be a real situation. A patient's delusion or hallucination can cause the nurse to be suspended. Nursing admin. place the patient above staff, in my experience.

Eg. ( a real life situation at my hospital several years ago ) Night Duty. Nurse ( male ) with flashlite, doing rounds. Opens door to female patient's room. Patient wakes up, screams at nurse to go away. Nurse complies. Next morning, patient reports " a man came into my room. He was looking at me. I felt him touch me all over. I screamed, but he wouldn't stop".

Nurse suspended from duty. Removed to another ward. This was despite the patient's diagnosis of ' Paranoid Schizophrenia '.

I have so many examples of how admin. favour patients over staff.

In NSW these days, the concept of RISK MANAGEMENT has overtaken all other considerations. Once a nurse has a single patient complaint against you, you may as well start looking for a NON NURSING job !!

Mirabell

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Mirabell
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Feb 06, 2010, 01:29 am

Hi Senior RN,

I can understand your own personal situations with "a raving manic or an aggressive psychotic" are obviously different from my experiences as an inpatient in hospital. My own personal complaint comes from a nurse who almost broke my wrist in a locked ward - other patients (who were NOT psychotic I might ad) witnessed it. The doctors report also documented the condition of my wrist after having to be transferred to another hospital to have it x-rayed.. I fought for 2 years going to numerous agencies including The Mental Health Law Centre, the Police and The Chief Psychiatrist, to have this nurse's surname released to the Nurses Board of WA so that they could at least do a hearing. But, because of privacy laws governing WA, this never happened. I gave up after 2 years - the nurse still works at the same hospital doing night shift. I'm sure you get to see people who have delusional psychosis and aggressive patients, but from my time in hospital my experience was that most of the inpatients had depression, bipolar, schizophrenia and PDs - amoung these there were very few people who intentionally tried to cause problems (and this was on a locked ward). I find it hard to believe your comment about complaints against nurses, especially seeing as, in WA, all complaints have to go through the nurse's board.... and the nurses board WILL NOT look into a complaint unless the surname of the nurse is handed to them! WA also has the privacy law where a nurses surname will only be given out to the police if the patient dies (I guess then they wont be complaining after all).

marizandres

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Aug 19, 2010, 02:02 pm

Psychiatry is not scary or even a bit. It somehow gives you a bit of perspective of different personalities and how to deal with them. Working in a psych ward is actually fulfilling especially when you're able to connect and understand and touch lives. You can in fact learn something from the patients.

psychoRN

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Oct 09, 2012, 08:54 am

Psychiatry is "scary" because a lot of people, perhaps the majority, do not want to be exposed to themes and incidents that psych nurses deal with on a daily basis. Many people find concepts such as suicide, self harm, sexual abuse and rape, addiction etc, quite confronting - and understandably so. As psych nurses, we are trained to deal with such issues, and our knowledge and training, combined with an interest in psychiatry and a desire to work in the field empower us to handle the challenging aspects.

I have been assaulted several times, involved in physical restraint, witnessed the direct result of successful and attempted suicide, viewed some absolutely horrific instances of self harm --> none of this was pleasant, obviously, but it is just part of the job - a job that I enjoy.

Why? Because I like psychiatric nursing. It is as simple as that, you either like it, or you don't.

No joke - I would be far more traumatized if I had to complete a week of shifts on a busy surgical or general medical ward - because that is the type of nursing that I dislike.

Generally, nurses and students who I have observed as being "scared away" from psychiatric nursing were never really suited to it in the first place. That is not to say that they were "weak" or "unworthy" of course, simply that they were unsuited.

Monkeyhanger

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Nov 02, 2014, 06:52 pm

Here's a clue: Mental health nurse training has been reduced from three years to three weeks. Would you employ an electrician or a plumber who'd done three weeks training or fly on a plane whose pilot had done three weeks training? Australian nurses in mental health have all the competence and confidence you'd expect from people who have completed three weeks training. Now the people who are training them have themselves only completed three weeks training.  Sadly, the single greatest component of their training is the management of aggression training they do when they get a mental health nursing job so it's the only skill they feel confident in using.

snapey

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snapey
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Nov 06, 2014, 11:35 pm

" Mental health nurse training has been reduced from three years to three weeks"

Where on each did you hear that? I have spent an entire semester learning mental health at uni, and that is the basic mental health for nurses not wishing to pursue a MH career. I am going to continue doing MH nursing in third year and will be spending 10 weeks on placement at MH facilities, as well as 4 units dedicated soley to MH.

Once I graduate my undergraduate nursing degree, I will be doing a grad year in MH nursing, and undertaking a year long postgraduate diploma in MH nursing.

Can you tell me WHERE I can get this supposed three week training course which makes me a RPN? I'd love to save my time doing the year long diploma.

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