Being A Psychiatric Ward Nurse: Dealing With Complex Situations, Essay.

Duties and Challenges of a Psychiatric Nurse

Question:

Discuss about the Reflection On Practice Portfolio.

I work at the psychiatric ward of a hospital. It is quite a different experience than the normal nursing job. People’s perception about a psychiatric nurse is different as they see us as a mother-figure who consoles the depressed person, passes out medication and makes the bed for the patients. Of course, that is also the part of our job and as a nurse; it is my bound duty to care for the patients. However, what people do not know that we have grown a steel armor behind out care-giving mother figure. We have to coordinate the ward when a violent patient attacks the other patients or the nurses (Morse et al. 2012). In a psychiatric ward, the patients attack nurses more often and every nurse of every psychiatric ward has been attacked (Townsend 2014).

I and the other psychiatric nurses have to maintain many complex situations throughout the day. I have to pursue the severe paranoid and schizophrenia patients to take their daily medications. As I am a psychiatric nurse, I often find it difficult to maintain a cordial relationship with the patients (Van Bogaert et al. 2013). All of my patients battles with mental illness. Sometimes the patients become angry and the outcome is not always well. However, I try to be compassionate towards them and use many kinds of audio visual aids to keep our relationship as good as possible. There are some patients in my facility who are suffering from severe depression and they thinks that their life worth nothing. As their primary caregiver, I always try to cheer them up with inspirational cinema or I show them some YouTube videos. Their happiness also makes me happy as I feel I am responsible for their health (Rössler 2012). Many patients in the facility are very talented and have knack for many inspirational and creative works like painting, photography and writing. I inspire the patients to pursue these works as it keeps them happy and helps them to recover from their mental illness very fast. I also have some knack about photography and painting for a long time. Because of this, I try to indulge the patients to do this type of creative work. I also organize poetry recitation program for the patient as they recite their own poetry. It helps me and the other nurses to know about their current mental state (Rankin 2013).

Compassionate Care Towards Psychiatric Patients

I feel very proud when I see my patients be recovered and get out of the facility to be a competent teacher, painter or a photographer. As a psychiatric nurse, I think I possess the value of compassion, which will help me to become a competent nurse for my practice.

Scenario:

A patient named Jasper Smith (age 72) was admitted to my ward after being diagnosed with severe schizophrenia, dementia and hyponatremia. The doctor prescribed to restrict his fluid intake into just 750 ml per day. The mental condition if the patient leads him to demand fluid more. If he is not given the fluid according to his requirement, he starts screaming very loudly, and sometimes becomes violent towards the nurse and the ward boys. The senior nurse has provided a nurse in his service to care for the patient. The nurses takes turn to take care of him from time to time.

I was at his care today morning, and during that time, he said to me that a nurse slapped him when he demanded a bottle of juice yesterday night. He started crying while stating the incident. He also said that he wanted to complain the incident to the nurse manager of my ward, but had forgotten to tell him. He will again try to complain the nurse manager about this incident and even will complain to his son about the incident. I consoled him and also apologized to him about the incident. I also assured him that, the nurse will never come to his service and I will talk to the nurse manager by myself about the incident. After being released from his service, I went to the nurse manager to discuss about the incident and together we decided to lodge an incident report (Baldwin and Barker 2013).

The patient Mr. Smith has schizophrenia, dementia and also suffering from hyponatraemia. Due to his hyponatramia, the patient has very low sodium level, which leads him to have confusion.  As the patient has schizophrenia, the patient might also be a psychotic. The patient is also suffering from forgetfulness. This patient has made a serious allegation that a nurse member of my ward has slapped him. The nurse manager and I have checked who was at his service yesterday. Both of us have doubt about whether Mr. Smith can be trusted or not about making this serious allegation against a competent nurse of our ward (Lucas 2012).

Handling a Patient Allegation of Abuse

I played the role of the recipient in the allegation. When I heard about the allegation, I tried to understand and to make sense of the situation. I thought if the allegation were actually true, the patients of my ward would be in vulnerable stage. As a ward nurse, I am aware that the patient is delusional and psychotic but I was surprised to see that he has a variety of the recollection. I was also startled as he started to cry while recalling the incident.

After listening to the incident, I self-examined my condition and decided that I would do what I needed to do, that is to take care of my patient. Therefore, I took a step and went to the nurse manager. When the patient saw that his allegation has been taken seriously, he seemed pleased but was still in a lucid state.

The part of being a ward nurse is to give the best for the welfare of the patient. As a ward nurse, I just followed my duty towards my patient and told my nurse manager about the incident. I told my nurse manager about this incident even if the patient has reduced capacity of recalling and have a questionable reliability issue (Hansson et al 2013).

As a registered nurse, my duty is to ensure that my patient is not in a harmful situation. I just followed the basic rule from the code of ethics, which is to take care of the patients. I have thought about discussing this incident with the accused nurse unofficially, but I backed out from that decision because I felt that that could change to the course of action (Hilsdon 2012).

As I analyzed the situation properly, it gave me a deep insight about the situation and I was able to take the appropriate course of action.

As the nurse manager has assumed that he possibly has really abused, she removed the accused nurse from his service. This decision seemed appropriate to me. As the patient is delusional and psychotic and both the nurse manager and I have doubt about this allegation, the nurse manager had not suspended the accused from the service. She warned the accused about the graveness of this allegation and instructed the accused to behave properly with the patients (Fortinash and Worret  2014).

When I analyzed the overview, I concluded that there should be two possible outcome of the situation. Either, I did not believe or I believed his allegations. This has created a big conflict in my mind and I was driven to analyze the situation more deeply. Help from the nurse manager has also guide me throughout the conflict and helped me to realize that the problems should be seen in a holistic approach, one should act appropriately according to the approach (Happell, Platania-Phung, and Scott 2013).

The Social Stigma around Mental Health

The newspaper article I am reviewing is named “Worker in Expanding Patient-Abuse Scandal at Whiting Forensic Freed After Posting Bail” which was published in the newspaper named Hardford Courant on 6^th September, 2017. The incident happened at Connecticut’s Whiting Forensic Division Hospital, which is regarded as Connecticut’s most maximum-security mental hospital. Reportedly, 31 staff members of this hospital abused a 62 year old male patient by putting a diaper over his head, putting salt in his coffee instead of sugar, placing a mop over his head after cleaning a floor and also kicking him. The patient was residing at the hospital from 1995 after being diagnosed with schizoaffective disorder, ASD (autism spectrum disorder) and many other medical conditions. After they were arrested, there are many calls have been made to police after the arrest with many other stories of patient abuse in this hospital. The patient is in trauma after suffering this kind of extreme abuse. All the 31 employees were fired after the reveal. There was a patient named James Bell died there at Whiting after being restrained by the staff member (KOVNER 2017).

When I decided to work on a psychiatric ward, the main reason was to care for those patients who have suffered from a social stigma because of their condition (Corrigan et al. 2012). All medical practitioners have to swear an oath, which is to take care of the patients in all condition. The nurses also have to follow a certain code of ethics. However, in the real ward, social stigma around mental health is more prevalent from the ancient time. Even in today’s world, people consider the mental patients as a burden over the society and unfortunately, some of the medical practitioner thinks the same (Lindwall et al, 2012). These medical practitioners treat the patients as animals. In the above-mentioned case in Whiting, all the accused has tortured the victim in a sadistic way. I think this incident relates to the social stigma around the patients who has a mental condition.

Sometimes the patient’s does not report these incidents as they think that because of their condition, the authority will not believe them. Because of the ancient stigma around mental health, the patients are also ashamed of the fact and decide not to tell anyone about the problem (Hansson et al 2013).

When I first started coming to the psychiatric ward, I felt that the social stigma around mental health is hard to go. However, as a ward nurse I try my best for the welfare of all the patients. As I have mentioned earlier that being a nurse at a psychiatric ward is being no less than a warrior as the violent patients have attacked me for several times (Ilic 2012). Nevertheless, my job ethics taught me to be compassionate towards the patients. As a healthcare practitioner not only, I help the patients to recover their illness, but also help them to return in normal life. This knowledge has helped me to overcome the stigma around mental health (Pescosolido et al. 2013).

The social context around mental health has been stigmatized from ancient history. This tradition is the same for every country. As I am a nurse working at a psychiatric ward of a hospital, I am responsible for the health and wellness of all of my patients; I try to indulge them in some creative works according to their likeness (Mak and Cheung 2012). This helps them to think of me, as their friend and they feels free to talk to me when needed. This led me into the receiving situation in which Mr. Jasper Smith, a patient with schizophrenia and delusion talked me about an incident. The patient accused a nurse of abusing him. However, the patient is delusional, and might accuse falsely; I decided to take the matter to the nurse manager (Robson et al. 2013).

 There have been a recent incident in which 31 ward staffs has inhumanly abused a patient with mental condition, and many incidents like this has been resurfacing. I think that the stigma around mental health has to do with it. The social stigma around mental health has been around since ages and still going strong. As a healthcare professional, I have been trying to and will still try to break the stigma. I will encourage the other ward nurses and the people around me to break the stigma as well. Helping the patients turn into the mainstream is needed (Tucker et al 2013).

References:

Morse, G., Salyers, M.P., Rollins, A.L., Monroe-DeVita, M. and Pfahler, C., 2012. Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), pp.341-352.

Rankin, B., 2013. Emotional intelligence: enhancing values?based practice and compassionate care in nursing. Journal of advanced nursing, 69(12), pp.2717-2725.

Rössler, W., 2012. Stress, burnout, and job dissatisfaction in mental health workers. European archives of psychiatry and clinical neuroscience, 262(2), pp.65-69.

Townsend, M.C., 2014. Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.

Van Bogaert, P., Wouters, K., Willems, R., Mondelaers, M. and Clarke, S., 2013. Work engagement supports nurse workforce stability and quality of care: nursing team?level analysis in psychiatric hospitals. Journal of psychiatric and mental health nursing, 20(8), pp.679-686.

Baldwin, S. and Barker, P.J., 2013. Ethical issues in mental health. Springer.

Fortinash, K.M. and Worret, P.A.H., 2014. Psychiatric Mental Health Nursing-E-Book. Elsevier Health Sciences.

Hansson, L., Jormfeldt, H., Svedberg, P. and Svensson, B., 2013. Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness?. International Journal of Social Psychiatry, 59(1), pp.48-54.

Happell, B., Platania-Phung, C. and Scott, D., 2013. Physical health care for people with mental illness: Training needs for nurses. Nurse Education Today, 33(4), pp.396-401.

Hilsdon, J., 2012. Rethinking reflection. The Journal of Practice Teaching and Learning, 6(1), pp.57-70.

Lucas, P., 2012, November. Critical reflection. What do we really mean. In 2012 Australian Collaborative Education Network National Conference (p. 163).

Corrigan, P.W., Morris, S.B., Michaels, P.J., Rafacz, J.D. and Rüsch, N., 2012. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric services, 63(10), pp.963-973.

Hansson, L., Jormfeldt, H., Svedberg, P. and Svensson, B., 2013. Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness?. International Journal of Social Psychiatry, 59(1), pp.48-54.

Ilic, M., Reinecke, J., Bohner, G., Hans-Onno, R., Beblo, T., Driessen, M., Frommberger, U. and Corrigan, P.W., 2012. Protecting self-esteem from stigma: A test of different strategies for coping with the stigma of mental illness. International Journal of Social Psychiatry, 58(3), pp.246-257.

KOVNER, J. (2017). Worker In Expanding Patient-Abuse Scandal At Whiting Forensic Freed After Posting Bail. [online] courant.com. Available at: https://www.courant.com/news/connecticut/hc-whiting-abuse-arraignment-20170906-story.html [Accessed 25 Sep. 2017].

Lindwall, L., Boussaid, L., Kulzer, S. and Wigerblad, Å., 2012. Patient dignity in psychiatric nursing practice. Journal of Psychiatric and Mental Health Nursing, 19(7), pp.569-576.

Pescosolido, B.A., Medina, T.R., Martin, J.K. and Long, J.S., 2013. The “backbone” of stigma: identifying the global core of public prejudice associated with mental illness. American journal of public health, 103(5), pp.853-860.

Mak, W.W. and Cheung, R.Y., 2012. Psychological distress and subjective burden of caregivers of people with mental illness: the role of affiliate stigma and face concern. Community Mental Health Journal, 48(3), pp.270-274.

Robson, D., Haddad, M., Gray, R. and Gournay, K., 2013. Mental health nursing and physical health care: A cross?sectional study of nurses' attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness. International Journal of Mental Health Nursing, 22(5), pp.409-417.

Tucker, J.R., Hammer, J.H., Vogel, D.L., Bitman, R.L., Wade, N.G. and Maier, E.J., 2013. Disentangling self-stigma: Are mental illness and help-seeking self-stigmas different?. Journal of Counseling Psychology, 60(4), p.520.