Learning experience in a psychiatric unit

Psychiatric Nursing in the Danger Zone

There are days going into to the state funded psychiatric mental hospital that you feel as if the nurse is being attacked from all sides. Maybe a suit of armor would be a better uniform than a set of scrubs.

As a mental health nurse you already expect the clients to be defensive because they have an illness they are trying to deal with new medications, family problems, dealing with their life hospitalized, internal issues that cannot be seen. For example: A client could have just gotten off the phone with a family member that did not go well. You walk down the hall as the first person he sees. You will be the one that get blasted with cursing, swears, and accusations. When in fact, you had nothing to do with his call.

Curse words no longer even make my eye brows raise up. I have been called everything in the book at one time or another. Even Xena Princess Warrior, (to this day is my favorite yet.) As a female on a mostly male unit, being called a 'bitch' is as normal as hearing your name. Depending on my mood – I will simple answer 'Yes how can I help you?" Or 'That is Mrs. Bitch." It throws them off balance, in their rage for a second to process your response.  In mental health your personality is just as important as your nursing skills to be able to speak to the client in whatever state of mind they are in at the time. If they smell your fear they will taunt you a lot more. Walk bold, even if you're scared.

Standing at the medication cart gives a nurse a few minutes of one on one time with the client. I have had interesting conversations and confessions over that med -cart. At the same time a lot of fist has slammed down with anger, water thrown, pills dumped in the trash, complaints over new medications or ones that were taken away. The experience is never the same from one day to the next.

A young male that stands out in my mind when I think of someone that made my skin crawl. Was a young  35 year old male who had been out of prison for about 10-14 days. He had spent 17 years in the maximum security prison for killing his wife. I was coming on shift one afternoon when he stopped in the hall with a "cat call". I stopped and redirected him of being inappropriate and I did not appreciate his gesture. He smiled, and said he was sorry.  I walked on the nurses' station for report – that I had not received for the upcoming shift. We were instructed to make ourselves aware of his past behaviors and a brief  history was given. As I read over his chart – I was shocked at the violence in his history.

When I returned to the hall, He approached me and again apologized for his behavior and wanted to know my name and if I was his nurse for the night. I shared the information he ask for and walked on.
However, he was determined to talk to me. He walked with me down the hall talking. Nice looking
male charming, and persistence. He asks if I knew why he was there. I said, "No I did not know?" He laughed.  I told him we would talk later if he wanted to tell me he could then. He agreed.

After the evening slowed down and others on the unit began turning in for the night he sat on the hall waiting to tell me his story. I went to listen. He began telling me he was not going to hurt me and that he just wanted to talk. I was in agreement that he did not need to hurt me. I am only listening. He told me about his story of stabbing his wife 32 times with a knife; after he had duct taped her to a chair. I had to ask…"Why would you stab her 32 times if you had he duck taped to a chair?" He said, "She was a women and women ask too many questions and would not shut up."  I continued. "Did you love your wife?" He stopped and looked at me and said, "You're asking allot of questions but I did. She wanted me to get out of the bike club I am in and I had to make a choice, Her or them. I choose them because they would come after me for the rest of  my life if I got out."

I told him I was sorry he had to make that choice. He paused. She was a good girl. I have regretted it every sense. Can I show you some pictures? " I said," Sure". He went to his room and brought back a envelope full of crinkled pictures that had been looked at a lot. He handed me a picture of a beautiful young women holding two small children. I ask, "Who's children?" He said, "They are mine, they don't know me. They were too small when I went to prison and I never looked them up when I got out."

He asks what I thought about Tattoos. I said, "I like hearing about the story behind them as much as I like seeing the designs" He said I am not trying to be cocky – I just wanted to show you and see what your comment is. He raised his shirt above his shoulders exposing his chest. He had a swastika on the left and a very detailed heart pumping demon blood on the right. I ask, "Why? What is the story for those?" He said, "Do you like them? I explained the art work is detailed and very artist. I do not like what they stand for."  He had a glare that came in his eye. I responded, "You ask me. I was honest with you." He agreed – I have not had any one listen to me in a long time. I am not used to women telling me her thoughts and me not break chairs or tearing something up. I told him I appreciated him remaining in control and talking to me that I needed to get back to work. He said as I stood up, "The demons in the heart are mine and the things that I have had to do in my life. The blood from the people that had bled because of me." I shook my head and smiled. "Ok – thank you for sharing that." I walked away.

I just sat and spoke to a man who is a part of a violent motorcycle gang, killed a woman in cold blood, and spent 17 years in maximum security prison.  He was never rude to me the 10 days that we had him on the unit. He was always glad to see me and we talked each shift he was my client. There is no doubt in my mind that when he went back out on the streets of his home town – he continued the life he was leading. 

Who would have thought working in mental health the many types of people I would meet. We are told in our facility that we are not a 'hazard' duty, we are acute care. As I smile to myself, I just sat and spoke with a man who had committed murder and being evaluated to stand trial for another murder he witnessed. Some how … I find that a little more than acute care.

Angela is a nurse that has worked for 21 years in the same state funded psychiatric hospital assisting some clients that others might refuse to treat. She works on the psychiatric ward.

 

She also runs her own company on the side and supports other nurses in how to bring passion into their role at work. Out of the box remedies for speaking to people and more.

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