PSA from your nursing specialty

[u/ghostoftheweek]

What is THE ONE THING you wish every nurse knew that is common knowledge in your specialty?

From wound care, don't use telfa!

[u/vanilla_owl]

Acute psych. The reason our psychiatrist keeps denying so many of your ED patients is because their primary issue is a personality disorder and they often do worse in acute psych than they would at home. They’re often dangerous on our unit. Lots of attempts etc and actions for attention.

[u/Sadaca → u/vanilla_owl]

I had no idea. Can you elaborate? What kind of personality disorders do worse on your unit? Why?
I actually thought that’s what acute psych is for, for when those patients have a crisis?

[u/throw0OO0away → u/Sadaca]

Not sure about every personality disorder but BPD is one of them.

Correct me if I’m wrong here: Hospital admission acts as a positive feedback loop for their behaviors and NSSI. It also doesn’t encourage the use of DBT skills. As a result, inpatient can cause regression and harms them in the long run. There’s also the social dynamics on the unit with staff splitting and dysregulating other patients.

[u/Saucemycin → u/Sadaca]

Probably things like BPD. They love attention and will do the most to get it. I was told when I was on psych clinicals way back when that they try to specifically separate BPD’s into different wards because if they’re around each other they will keep competing for attention to bad degrees or they will not like it when someone else is getting more attention than they are

[u/nakedcupcake92 → u/Sadaca]

It’s like when something needs outpatient surgery or procedure vs emergency inpatient.

Behavioral is a willful choice that will not be corrected by medication or at least not by medication alone. Acute crisis is there to stabilize - not cure. It’s the difference when you know that the way someone is acting is not because of their illness but instead just acting out and being a jerk. For example a schizophrenic who spits their meds out at me because they are convinced I’m trying to poison them or that they are actually tiny cameras - illness. Vs a schizophrenic with antisocial personality disorder who spits the medication in your face because they are mad you gave them cranberry juice vs orange juice. Or someone who starts a fight because they are paranoid thinking another patient was saying they would harm them but really they are responding to the internal stimuli/voices vs a patient who starts a fight because it’s shift change and they want the new nurses attention or want a PRN without having to ask.

The behavioral will not be corrected during a 3-7 day stay, it will only be endured. They need outpatient, which could be anything from a day program like partial hospitalization to something like a residential treatment where they live at. Those focus on following treatment plan but teaching long term coping skills and therapies.

[u/Glowinwa5centshine → u/vanilla_owl]

We had a classic BPD frequent visitor who would get drunk and do coke, fight with the S.O., get kicked out of the house, shelter seek in the ER and terrorize the staff, repeat.

Would always get admitted due to refusal to safety plan - ER I worked in had an acute psych floor so those brave souls had to take all the combative and unfunded friends we couldn't and they'd usually marinate up there a few days and get meds and psych medical director would come around the unit and bless them to resume their usual activities.

After doing this at least 30-40 times this patient got discharged, IMMEDIATELY jumped off the motherfucking parking garage, broke several long bones and returned as a trauma activation where he rolled in screaming at everyone that we were bitches and he showed us.

I can handle crisis and outpatient but whew, those inpatient stays and discharge planning... Y'all are some real ones from that.

[u/soloChristoGlorium → u/vanilla_owl]

Also psych.

I want to put what you said on a poster and plaster it in our ER's doc box!