psychnurseAMA

A patient opened her abdomen with a small scissor, nicked her intestines and were found with half her guts in her hands on the floor. You could smell the shit in the corridor outside. I've had nightmares about that one.

A less gory one is having to force feed an anorexic patient with a history of abuse. Seeing the terror in her face as she was held down by the staff and hearing her scream while we forced an NG tube down her nose is something which I'll remember till I die. She was down to 30 kg and would've died if she didn't get any food, otherwise I would've never done it. We tried to motivate her for a week to eat, but it was clear that she wasn't able to do it. When she got better, she thanked us for it, however the experience was horrifying.

A good day is a day which I'm able to build a good relationship with a patient and get them to trust me. Where we are able to joke around and interact in a good way, regardless of whatever issues the patient has. As I usually say, just because you are suicidal doesn't mean you can't have fun.

A bad day is any day where I have to use force, be it to get a patient to take medication or restraining them. It feels like we've failed whenever we have to resort to those means. Although sometimes, it just isn't possible to break through a patients psychosis or delusions without forcing them to take medications. Still sucks.

Some of the worst cases I've seen is in the security unit where you have patients on the highest doses of the heaviest antipsychotics and they are still psychotic and delusional to the point where they are a danger to themself or others. They shuffle around corridors in a daze, terrorized by things we cannot see. It's heartbreaking. Schizophrenia is a shitty disease.

Sometimes I think that not becoming jaded is one of the biggest challenges a psych nurse faces. The best thing you can do is to educate yourself on why they illicit the behaviours they do. Most patients with borderline personality disorder have been severely abused from a young age, and self-harm is one of the ways in which they cope with their inner pain. The more understanding you have, the easier it is to look past the challenging behaviours. If you can change the thought of them being unwilling to help themself, and rather see it as them being unable to help themself(yet!), it's much easier to deal with the frustration.

I strongly recommend Linehan, M. M. (1995). Understanding Borderline Personality Disorder:The Dialectic Approach and Batemans Handbook of Mentalizing in Mental Health Practice.

A patient knitted a pink hat with a lot of frills on it for one of the older male nurses as a thank you when she was discharged from the unit. He wore it with pride the whole day.

Wow, that's a good question. I think the nursing profession has been very good at standing up for patients rights throughout history, which is something to be proud of.

I got a patient with complex PTSD, history of self-harm, anorexia and borderline personality disorder to tell me that she was having a tough time. She'd been tortured by her parents her whole childhood and taught that any sign of weakness would lead to her being beaten. It took me a month to get her to trust me enough that she could talk to me, instead of resorting to her usually coping mechanisms of cutting or dissociating. It might seem a bit silly to count a conversation as the biggest success story ever, but I've honestly never felt more successful as a psych nurse.