I haven't updated this for a long time, but Allison suggested, so here it is.
Rob Ford and Don Cherry suggested that the man who killed he police officer when he was psychotic was playing at being mentally ill and should not have been found not criminally responsible.
Though I think the man should be treated and be certified until he is once again clear from his psychosis, and ensure that he is continuing to be treated, the idea that someone would be able to fake illness is kind of far fetched. There are people who do try to fake illness but I highly doubt in this case that this man was doing it-he had been in hospital after all. I am not sure what kind of psychosis he had, but he was examined by doctors who found him ill.
I guess the issue is whether he knew what he was doing was wrong-and also did he really understand the extent of it?
Working with people who have an illness similar to this guy, I would say that untreated mental illness should not be criminalized. Treatment itself is no fun time-being kept in a facility with no ability to choose treatment, and I would suspect, fairly significant restrictions on day to day activities is not a walk in the park. Mental health icu's are not places where people have 'fun'.
I don't think people have any really clear understanding of either what mental illness looks like, or the treatment itself. The media portrayals are terribly inaccurate. One Flew Over the Cuckoo's Nest and Girl Interrupted do not explain mental illness or effective treatments.
No one chooses to have mental illness, at least anyone I have come in contact with, nor have I heard anyone who works in mental illness health care suggest that it would be a good way to get out of jail. Sure, I would bet there are some anti-social types out there who might try it, but really you would be trading in one set of restrictions in jail, for another set in a secure mental health facility. Neither would be at all appealing to anyone looking at them.
At least when you get out of jail, you are done. I would think that if you had killed someone as a result of your illness, you would be on a community treatment order for the rest of your life-meaning that you have to be under psychiatric treatment forever-taking medication, seeing your mental health team etc. The drugs are not a walk in the park. And treatment for mental illness is difficult-medication is part, but so is healthy lifestyle, understanding the illness, etc etc. And treatments still are not totally effective, a person could be doing everything 'right' and still get ill. Much like someone could do everything right for their heart condition, and still have a heart attack.
I know this isn't an exact analogy, but if someone had been driving a car, had a heart attack and lost consciousness and killed that police officer, would we find the driver guilty?
Sunday, March 31, 2013
Thursday, August 30, 2012
So much for posting monthly
But since September is almost here, with the feeling of renewal, I will post again!
I have been thinking about how though making change to improve things is at times extraordinarily painful, that there are great pay offs. There have been multiple changes at work, significant ones, and I can see results that are so very positive. Such as family members saying how much they appreciate care, and thinking back to what we used to do, and now have changed things dramatically.
Like no visiting hours-with no problems. Like avoiding blanket rules and instead focusing on what specific patients need.
It is so easy to get caught up in the negative and lose sight of what we're doing, but looking at our care-I think we do a great job. And I didn't think I'd say that 5 years ago.
I have been thinking about how though making change to improve things is at times extraordinarily painful, that there are great pay offs. There have been multiple changes at work, significant ones, and I can see results that are so very positive. Such as family members saying how much they appreciate care, and thinking back to what we used to do, and now have changed things dramatically.
Like no visiting hours-with no problems. Like avoiding blanket rules and instead focusing on what specific patients need.
It is so easy to get caught up in the negative and lose sight of what we're doing, but looking at our care-I think we do a great job. And I didn't think I'd say that 5 years ago.
Wednesday, February 29, 2012
Really
So this course I am taking ia all about relational ethics, which I would think I would be all over.
But I'm not.
I get that nurses need to be aware and willing to relate to their patients and always open to considering the effect of their care and interactions. It certainly makes sense to me.
Where I struggle is with the constant navel gazing (As Mom would put it) on how important this relationship to people getting better.
Naturally, if you are having care from a nurse, and you get good, competent, interested, engaged nursing care-that is what should happen.
But is some of this focus on the importance of nursing care, based on our own self interest?
I was looking up environment and effect of it on care and how nurses manage.
All the articles were written by nurses. well, given that it is central to what nursing does, ok I get it. But does every interaction with a nurse have to be a long relationship, or can we have small, kind interactions that do the job just as well?
I keep hearing about how as nurses we don't have enough time. But perhaps we are looking to the past too much, when people were in the hospital for a week or 2 after having a baby with no complications. Sure, there was lots of time for nurses to interact, but it wasn't needed. And though I do believe that as nurses we have an important role in people getting better-are we overestimating this role to make ourselves feel more valued? Would people get better anyway, and how much is about our needs, not the patients.
But I'm not.
I get that nurses need to be aware and willing to relate to their patients and always open to considering the effect of their care and interactions. It certainly makes sense to me.
Where I struggle is with the constant navel gazing (As Mom would put it) on how important this relationship to people getting better.
Naturally, if you are having care from a nurse, and you get good, competent, interested, engaged nursing care-that is what should happen.
But is some of this focus on the importance of nursing care, based on our own self interest?
I was looking up environment and effect of it on care and how nurses manage.
All the articles were written by nurses. well, given that it is central to what nursing does, ok I get it. But does every interaction with a nurse have to be a long relationship, or can we have small, kind interactions that do the job just as well?
I keep hearing about how as nurses we don't have enough time. But perhaps we are looking to the past too much, when people were in the hospital for a week or 2 after having a baby with no complications. Sure, there was lots of time for nurses to interact, but it wasn't needed. And though I do believe that as nurses we have an important role in people getting better-are we overestimating this role to make ourselves feel more valued? Would people get better anyway, and how much is about our needs, not the patients.
Monday, January 9, 2012
art and science
It has been a long time since I've posted, but my goal is to update this at least once per month. My other goal for the new year is to exercise and I have been doing that with success, so I will accomplish this!
I have been reflecting upon what is the art and what is the science of nursing. When I was taking my undergrad, instructors would refer to this and though I acknowledged that there was both within nursing, I don't know if I considered how this looks in mental health.
One of the reasons that some in nursing don't like mental health is because there are not a lot of physical skills, like inserting a catheter, starting an IV etc. Most of our time is spent talking, listening, and intervening in those fashions.
I think I kept trying to quantify the communication as science, and I think many in psychiatry do this want to make mental health a 'real nursing' job, with quantifiable measures and recognized by the dominant medical discourse. Hence the overreliance on medications as a 'cure'-it meets scientific/biomedical standards-medications are studied extensively and the medical community can measure side effects, efficacy etc. Not to mention our society's determination to find cures through pharmaceuticals, but that's a whole different topic.
Really, I think within mental health, the art piece is foremost, and how do we measure that?
Specifically, I was thinking of how I intervene with a patient who is angry, distressed etc. Sure, I can set out some guidelines on how to speak, what my body language should look like, but how do you scientifically quantify empathy, understanding, and gentleness?
I had a situation with a patient, who was angry and suggested to the nurse that since I had a fairly good rapport with the patient, perhaps I could try intervening. It all turned out well and the patient resettled, but when thinking about what I did, versus what could have happened, I don't know if I could quantify what I did. Obviously, I made eye contact, had open body language, listened, but how do you exactly replicate caring, and isn't that caring and empathy, the art of nursing? Now if I had jumped in and had a more intrusive intervention, such as calling a code white and giving a medication intramuscularly, perhaps it would look like I was doing more-that kind of thing lends itself to measuring much easier, held patient this long, gave this medication in this spot with this dose, this many people present. Perhaps that is part of the reason people want to jump in and deal with the situation physically and quickly-it seems like a more societally valid form of intervention? Follows the biomedical discourse?
I think within mental health, it is the artful ability to listen so that the patient knows you hear them, and the genuine connection between nurse and patient, it is not the science of 'maintain a leg's length distance while keeping direct but not intense eye contact'
Within nursing there is a difficult balance between keeping scientific rigour in our practice, while recognizing that it is the art of nursing that differentiates this branch of health from medicine. We need to balance evidence based practice with the artful interactions and human compassion. If we nurse while only using the scientific background, the empathy, caring and humanness is lost. If we only use the art of caring, it can degenerate into doing things because we've always done it this way, leading to care and interventions that may or may not work.
Interesting stuff, maybe next time I'll reflect on the biomedical reliance on medication to cure.
I have been reflecting upon what is the art and what is the science of nursing. When I was taking my undergrad, instructors would refer to this and though I acknowledged that there was both within nursing, I don't know if I considered how this looks in mental health.
One of the reasons that some in nursing don't like mental health is because there are not a lot of physical skills, like inserting a catheter, starting an IV etc. Most of our time is spent talking, listening, and intervening in those fashions.
I think I kept trying to quantify the communication as science, and I think many in psychiatry do this want to make mental health a 'real nursing' job, with quantifiable measures and recognized by the dominant medical discourse. Hence the overreliance on medications as a 'cure'-it meets scientific/biomedical standards-medications are studied extensively and the medical community can measure side effects, efficacy etc. Not to mention our society's determination to find cures through pharmaceuticals, but that's a whole different topic.
Really, I think within mental health, the art piece is foremost, and how do we measure that?
Specifically, I was thinking of how I intervene with a patient who is angry, distressed etc. Sure, I can set out some guidelines on how to speak, what my body language should look like, but how do you scientifically quantify empathy, understanding, and gentleness?
I had a situation with a patient, who was angry and suggested to the nurse that since I had a fairly good rapport with the patient, perhaps I could try intervening. It all turned out well and the patient resettled, but when thinking about what I did, versus what could have happened, I don't know if I could quantify what I did. Obviously, I made eye contact, had open body language, listened, but how do you exactly replicate caring, and isn't that caring and empathy, the art of nursing? Now if I had jumped in and had a more intrusive intervention, such as calling a code white and giving a medication intramuscularly, perhaps it would look like I was doing more-that kind of thing lends itself to measuring much easier, held patient this long, gave this medication in this spot with this dose, this many people present. Perhaps that is part of the reason people want to jump in and deal with the situation physically and quickly-it seems like a more societally valid form of intervention? Follows the biomedical discourse?
I think within mental health, it is the artful ability to listen so that the patient knows you hear them, and the genuine connection between nurse and patient, it is not the science of 'maintain a leg's length distance while keeping direct but not intense eye contact'
Within nursing there is a difficult balance between keeping scientific rigour in our practice, while recognizing that it is the art of nursing that differentiates this branch of health from medicine. We need to balance evidence based practice with the artful interactions and human compassion. If we nurse while only using the scientific background, the empathy, caring and humanness is lost. If we only use the art of caring, it can degenerate into doing things because we've always done it this way, leading to care and interventions that may or may not work.
Interesting stuff, maybe next time I'll reflect on the biomedical reliance on medication to cure.
Sunday, July 25, 2010
Questioning status quo in mental health
There are many things in nursing and health care that seem to happen because 'we have always done it that way'
Sometimes that's good-after all Florence Nightingale said that having a clean hospital would keep people healthier-it turns out that handwashing works.
Sometimes I don't know the purpose of it. Why do psychiatric patients sometimes have to wear pyjamas? After all the nurses are wearing street clothes-why don't the patients?
Not all psychiatric patients do, but some have to, and I actually don't know the reason why.
I suppose it is because of the risk of people running off-part of some illnesses includes lack of insight-meaning people don't realize that they have a mental illness-so people would rather not be in hospital because they don't see the need for it. Another part would be safety-having people in pyjamas gives an opportunity to examine clothes and make sure there is nothing harmful in pockets etc. And I would think another advantage would be that if someone has been neglecting their hygiene due to another sign of illness-lack of self care-clean pyjamas is an improvement.
So, there are some good reasons for it. But there are also some problems with it. Wearing pyjamas singles you out as a psych patient-not just another patient in the hospital-but the only patients who wear the pj's.
Another issue is that it is not good to wear pj's all day. 'Normal' people don't do that-and a sign of getting better when you are sick is wearing clothes.
A large issue is that people feel embarrassed wearing them-no underwear, just pj's, for women this is quite embarrassing-no bra, especially when you consider that substantial numbers of women in in patient settings have had violence -up to 70% have experienced physical and sexual abuse. Having to wear clothes that leave people feeling vulnerable and exposed could create harm.
Which is the better way?
I need to do research on this...
Sometimes that's good-after all Florence Nightingale said that having a clean hospital would keep people healthier-it turns out that handwashing works.
Sometimes I don't know the purpose of it. Why do psychiatric patients sometimes have to wear pyjamas? After all the nurses are wearing street clothes-why don't the patients?
Not all psychiatric patients do, but some have to, and I actually don't know the reason why.
I suppose it is because of the risk of people running off-part of some illnesses includes lack of insight-meaning people don't realize that they have a mental illness-so people would rather not be in hospital because they don't see the need for it. Another part would be safety-having people in pyjamas gives an opportunity to examine clothes and make sure there is nothing harmful in pockets etc. And I would think another advantage would be that if someone has been neglecting their hygiene due to another sign of illness-lack of self care-clean pyjamas is an improvement.
So, there are some good reasons for it. But there are also some problems with it. Wearing pyjamas singles you out as a psych patient-not just another patient in the hospital-but the only patients who wear the pj's.
Another issue is that it is not good to wear pj's all day. 'Normal' people don't do that-and a sign of getting better when you are sick is wearing clothes.
A large issue is that people feel embarrassed wearing them-no underwear, just pj's, for women this is quite embarrassing-no bra, especially when you consider that substantial numbers of women in in patient settings have had violence -up to 70% have experienced physical and sexual abuse. Having to wear clothes that leave people feeling vulnerable and exposed could create harm.
Which is the better way?
I need to do research on this...
Saturday, June 26, 2010
Caring
We had a 1 day education inservice (thank you big pharmaceutical for providing unrestricted educational grant) and one of the topics was on caring.
We spent a lot of time on this topic when I was in school-what exactly is it, how do nurses do it, and what happens when it is not being done?
It is central to nursing-and I find it a fascinating topic. The presentation was based on the presenter's research on how nurses care while in stressful situations. Her research showed that caring is a choice that people consciously choose and that though environment plays a part, that it does come down to the individual's decision. Her thought and I would agree, is that nurses who are able to engage in this are happier and can provide quality care despite various circumstances.
I was discussion this a colleague, who is a social worker, he said that though he enjoyed the presentation, that his perspective tended to be more on the environment and how that impacted care. Makes sense when you also consider that nursing tends towards individualized interactions, whereas social work tends towards looking more at systems. Both of course frequently move in and out of those frames of reference.
Naturally both play a role, but I do think that it does come down to more of a conscious choice in the particular workplace I am in. It is easy to get caught up in the idea that we don't have enough money, there is not enough time, there are too many patients. But when compared to most health care systems in the rest of the world, we are far and away able to offer superior care. So why does it seem that it is not enough?
What would be enough?
Yes, I would like to be able to ensure that more people with mental illness have access to timely, prevention focused care, and I agree that we are often stretched to do this, but I can't say that I go home at night feeling that people have not received good care-and honestly when I do, it is more likely to be as a result of what I see as uncaring nursing. On an individual basis.
I never really thought of myself as being someone who sees things as more individual responsibility, with my patients, I encourage people to act within their ability to change, but also strongly believe that societal systems have hugely impacted the onset of mental illness and ability to manage mental illness.
But it seems with nurses working, that I do see their behaviour and actions in terms of individual choice. What is the difference for me then?
I suppose because though nurses have in the past (before the 1980's?) been a devalued group, now they are not. They wield a great deal of power within the healthcare system-without nursing, healthcare does not function. we are paid well-I would venture to say, very well. We are professionals-well educated, and self regulating. Generally we are well respected-depending upon which study you look at, nursing is at the top or near the top of the lists ranking professionals who are trusted.
Why are we still acting in ways that seem to take the stance that the system works against us, that we don't have control, that we are not respected then? I think that this sometimes victim focused mentality leads to uncaring nursing. Because if I am a victim too, why should I have to put so much effort into doing a caring act? How can I gather enough energy to care for others if I am being trampled on?
I think that we need to recognize and acknowledge that we have power within the health care system and that we need to be using that power respectfully-whether interacting with the health authority, each other, and above all with patients. Would that help?
We spent a lot of time on this topic when I was in school-what exactly is it, how do nurses do it, and what happens when it is not being done?
It is central to nursing-and I find it a fascinating topic. The presentation was based on the presenter's research on how nurses care while in stressful situations. Her research showed that caring is a choice that people consciously choose and that though environment plays a part, that it does come down to the individual's decision. Her thought and I would agree, is that nurses who are able to engage in this are happier and can provide quality care despite various circumstances.
I was discussion this a colleague, who is a social worker, he said that though he enjoyed the presentation, that his perspective tended to be more on the environment and how that impacted care. Makes sense when you also consider that nursing tends towards individualized interactions, whereas social work tends towards looking more at systems. Both of course frequently move in and out of those frames of reference.
Naturally both play a role, but I do think that it does come down to more of a conscious choice in the particular workplace I am in. It is easy to get caught up in the idea that we don't have enough money, there is not enough time, there are too many patients. But when compared to most health care systems in the rest of the world, we are far and away able to offer superior care. So why does it seem that it is not enough?
What would be enough?
Yes, I would like to be able to ensure that more people with mental illness have access to timely, prevention focused care, and I agree that we are often stretched to do this, but I can't say that I go home at night feeling that people have not received good care-and honestly when I do, it is more likely to be as a result of what I see as uncaring nursing. On an individual basis.
I never really thought of myself as being someone who sees things as more individual responsibility, with my patients, I encourage people to act within their ability to change, but also strongly believe that societal systems have hugely impacted the onset of mental illness and ability to manage mental illness.
But it seems with nurses working, that I do see their behaviour and actions in terms of individual choice. What is the difference for me then?
I suppose because though nurses have in the past (before the 1980's?) been a devalued group, now they are not. They wield a great deal of power within the healthcare system-without nursing, healthcare does not function. we are paid well-I would venture to say, very well. We are professionals-well educated, and self regulating. Generally we are well respected-depending upon which study you look at, nursing is at the top or near the top of the lists ranking professionals who are trusted.
Why are we still acting in ways that seem to take the stance that the system works against us, that we don't have control, that we are not respected then? I think that this sometimes victim focused mentality leads to uncaring nursing. Because if I am a victim too, why should I have to put so much effort into doing a caring act? How can I gather enough energy to care for others if I am being trampled on?
I think that we need to recognize and acknowledge that we have power within the health care system and that we need to be using that power respectfully-whether interacting with the health authority, each other, and above all with patients. Would that help?
Friday, May 21, 2010
Medicare
The idea of extraordinary drug coverage seemed like a good one to me when the Romanow Report came out, but didn't really think about it as I haven't known anyone personally or professionally needing that kind of coverage as BC has pretty good pharmacare.
As with most things, once you know someone affected, this changes perspective. As in a family member needing a super expensive medication costing about $20,000-$24,000/year and the province they are in has a terrible pharmaceutical program.
How this can be when it makes so much money off of industry is beyond me-but I guess they don't have a debt do they? As if that matters when you are sick.
The arbitrariness of this kills me. For a related disease, drug is covered, though I noted when looking through the special coverage form that you pretty much have to be at the end of the line treatment wise before they will consider covering. This seems to be true of most of the drugs I saw on the document.
Yes, because multiple hospital stays are so much cheaper aren't they?
In relation to psychiatry, I saw that a drug we pretty much routinely give here, is not covered there, unless you get special authority, and that is after you have developed nasty side effects from older drugs.
This is not to say that I think newer drugs necessarily are the cat's meow-after all pharmaceutical companies like to make a lot of money and new drugs do this for them. But if we know that a drug is effective, why wouldn't we cover it (as in we-the government and taxpayers) rather than spend the money on repeated hospitalizations, ineffective medications, and the like?
As with most things, once you know someone affected, this changes perspective. As in a family member needing a super expensive medication costing about $20,000-$24,000/year and the province they are in has a terrible pharmaceutical program.
How this can be when it makes so much money off of industry is beyond me-but I guess they don't have a debt do they? As if that matters when you are sick.
The arbitrariness of this kills me. For a related disease, drug is covered, though I noted when looking through the special coverage form that you pretty much have to be at the end of the line treatment wise before they will consider covering. This seems to be true of most of the drugs I saw on the document.
Yes, because multiple hospital stays are so much cheaper aren't they?
In relation to psychiatry, I saw that a drug we pretty much routinely give here, is not covered there, unless you get special authority, and that is after you have developed nasty side effects from older drugs.
This is not to say that I think newer drugs necessarily are the cat's meow-after all pharmaceutical companies like to make a lot of money and new drugs do this for them. But if we know that a drug is effective, why wouldn't we cover it (as in we-the government and taxpayers) rather than spend the money on repeated hospitalizations, ineffective medications, and the like?
Friday, April 9, 2010
Friday
How is it that a 4 day workweek feels more like 7?
Actually, it doesn't.
Rather today just seemed long and I believe it had to do with hormones. Though being irritable does not help when dealing with narcissistic people.
I am reading a book called The Sociopath Next Door, about the sociopath next door.
Interesting and the rate of sociopaths is about 4%, schizophrenia and bipolar disorder are about 1% each, which means there are way more sociopaths around than one would think. I think that rate in the book may be a little high-antisocial personality disorder (which sociopathy is a subset of)is about 2-3% if I remember correctly.
It discusses the concept of conscience which I find interesting and uses the example of the Milgram experiment-where Milgram told people that during the study, the subjects were to administer an electric current to other participants if they got a wrong answer. The subjects never actually delivered an electric current, but thought they did and Milgram kept pretending to increase the voltage-with the people pretending to get the current would act as if they were. The current would be increased to life threatening levels and the subjects kept going along with it-something like 90+% went along with it. Interesting on many different levels, though of course his experiment has a lot of ethical issues-like how did those people feel administering the current? Anyhow, when the person telling the subjects to increase the current wore a lab coat and was a doctor, people were more likely to go along with it. If the experimenter was presented as a working class citizen, people were less likely to continue shocking.
Authority plays a big part in what we are willing to believe and influences what we think is the right thing to do.
This reinforces to me the importance of understanding and carefully considering what I think and considering how my actions as an authority figure (ie nurse) may impact patients etc. And also to consider how it is important to develop and stand by my beliefs, after a lot of reflection, and not just blindly follow.
The book sort of boils down conscience to the ability to love/care for others, and that by considering how our actions impacts others leads in part to our conscience.
All very interesting and I would write more, but have to go nap.
Actually, it doesn't.
Rather today just seemed long and I believe it had to do with hormones. Though being irritable does not help when dealing with narcissistic people.
I am reading a book called The Sociopath Next Door, about the sociopath next door.
Interesting and the rate of sociopaths is about 4%, schizophrenia and bipolar disorder are about 1% each, which means there are way more sociopaths around than one would think. I think that rate in the book may be a little high-antisocial personality disorder (which sociopathy is a subset of)is about 2-3% if I remember correctly.
It discusses the concept of conscience which I find interesting and uses the example of the Milgram experiment-where Milgram told people that during the study, the subjects were to administer an electric current to other participants if they got a wrong answer. The subjects never actually delivered an electric current, but thought they did and Milgram kept pretending to increase the voltage-with the people pretending to get the current would act as if they were. The current would be increased to life threatening levels and the subjects kept going along with it-something like 90+% went along with it. Interesting on many different levels, though of course his experiment has a lot of ethical issues-like how did those people feel administering the current? Anyhow, when the person telling the subjects to increase the current wore a lab coat and was a doctor, people were more likely to go along with it. If the experimenter was presented as a working class citizen, people were less likely to continue shocking.
Authority plays a big part in what we are willing to believe and influences what we think is the right thing to do.
This reinforces to me the importance of understanding and carefully considering what I think and considering how my actions as an authority figure (ie nurse) may impact patients etc. And also to consider how it is important to develop and stand by my beliefs, after a lot of reflection, and not just blindly follow.
The book sort of boils down conscience to the ability to love/care for others, and that by considering how our actions impacts others leads in part to our conscience.
All very interesting and I would write more, but have to go nap.
Friday, March 26, 2010
Put On Your Big Girl Panties
OK, vacations are good, but then I have to catch up on all this stuff when I get back.
Not that it was even too much, but week was exhausting. Mostly because I had to listen to people complain without any solution.
Like, did you think nursing was going to be easy and calm? please. Find another career if you can't handle stress. Suck it up buttercup.
I put the magnet that Anne gave me-Put on your big girl panties and deal with it-on my file cabinet. I would put up the cross stitch that Laura gave me too, but perhaps that is too much, given that patients might see it and I don't mean them.
Why as nurses do we always think that we need to control everything? Everytime something unusual/challenging happens, our immediate response is 'we need more rules' For the love of Pete, let it go! Not that I'm all loosey goosey, I like to be as bossy as the next nurse, but why freak out about everything? Yes, we work with people who have poor boundaries, are impulsive, poor communicators, and disrespectful-but they are my coworkers and I have to put up with them.
ha ha
Anyhow, if you are working in psychiatry-did you think it was going to be with only the pleasantly mentally ill? Oh yes, sure this woman is mentally ill, but her delusion is that I'm God and she must do everything I tell her?
OK, must stop whinging-I do love my job, but occasionally feel exhausted. Alternative is to plod along and do basics without advocating for change, which is not an acceptable alternative...
Not that it was even too much, but week was exhausting. Mostly because I had to listen to people complain without any solution.
Like, did you think nursing was going to be easy and calm? please. Find another career if you can't handle stress. Suck it up buttercup.
I put the magnet that Anne gave me-Put on your big girl panties and deal with it-on my file cabinet. I would put up the cross stitch that Laura gave me too, but perhaps that is too much, given that patients might see it and I don't mean them.
Why as nurses do we always think that we need to control everything? Everytime something unusual/challenging happens, our immediate response is 'we need more rules' For the love of Pete, let it go! Not that I'm all loosey goosey, I like to be as bossy as the next nurse, but why freak out about everything? Yes, we work with people who have poor boundaries, are impulsive, poor communicators, and disrespectful-but they are my coworkers and I have to put up with them.
ha ha
Anyhow, if you are working in psychiatry-did you think it was going to be with only the pleasantly mentally ill? Oh yes, sure this woman is mentally ill, but her delusion is that I'm God and she must do everything I tell her?
OK, must stop whinging-I do love my job, but occasionally feel exhausted. Alternative is to plod along and do basics without advocating for change, which is not an acceptable alternative...
Saturday, March 13, 2010
Advocacy
As nurses, we are supposed to be advocating for our patients everyday and should be considering how to promote health and well being. This in some way makes me think of nursing, considering customer satisfaction-if the customer is not satisfied with their service-then they leave, taking their business elsewhere. Really, though I certainly am not an advocate of for-profit health care, I think we should always be considering how we increase 'customer satisfaction' I read a letter to the editor of the Canadian Nursing Association magazine, by a nursing student who believed that by referring to patients as clients that we are stepping towards acceptance of the for-profit system and eroding public health care. This was not something that I had ever thought of. I actually think of client as being perhaps, a more empowering term than patient. But I have no idea why I would even think this-other than from working with people with disabilities, we tried to discourage any kind of labelling-rather than seeing people as patients, residents or even clients, see people as people!
So, it is interesting that sometimes, nurses start to resent patients, and start seeing them as not deserving of our care and seeing them as 'drains on the system.' And if we consider a customer satisfaction kind of approach-the issue with hospital care is that people don't have a choice, especially people requiring psychiatric care, who don't have money and have been an oppressed group. Again, I am not in no way advocating a for-profit system, or a 2 tier system in any way. But I do wonder if we consider how we should be viewing our patients, clients, system users, whatever you want to call it. I don't think that we need a competing system-ie HMO, to address these issues, but I do think we need to consider the satisfaction people receive out of this system. Instead of believing that people should be happy with whatever care they get, shouldn't we be thinking of how to improve our care delivery?
I see also, when nurses start to see themselves as victims of patients! I think this might happen more in psychiatry, where we can be dealing sometimes (though much less than people think) with aggressive people. And in some cases, nurses may be on the receiving end of a violent patient, resulting in injuries, which certainly meets the standard of being a victim. I think though, it is important to consider that as noted by CRNBC, that as a nurse, we have more power, and must always be considering how that impacts our care.
This is a challenge sometimes in psychiatry. We deal with a disempowered group, as nurses we hold much more power. It is only relatively recently that mental illness has begun to be seen as illnesses that are blameless. Or rather, as a society, we have just recently started to see mental illness as perhaps not the person's fault-sometimes. Health care still sees people with mental illness as less worthy of care than someone with a physical problem. And nurses working in psychiatry often perpetuate that idea-'oh, I'm not a real nurse, I work in psychiatry' I hate that! Give your head a shake! If you don't see yourself as a real nurse, leave, and let nurses who see themselves and their patients as deserving of real nursing care provide advocacy and care to patients who are entitled to professional, supportive nursing interventions!
So, it is interesting that sometimes, nurses start to resent patients, and start seeing them as not deserving of our care and seeing them as 'drains on the system.' And if we consider a customer satisfaction kind of approach-the issue with hospital care is that people don't have a choice, especially people requiring psychiatric care, who don't have money and have been an oppressed group. Again, I am not in no way advocating a for-profit system, or a 2 tier system in any way. But I do wonder if we consider how we should be viewing our patients, clients, system users, whatever you want to call it. I don't think that we need a competing system-ie HMO, to address these issues, but I do think we need to consider the satisfaction people receive out of this system. Instead of believing that people should be happy with whatever care they get, shouldn't we be thinking of how to improve our care delivery?
I see also, when nurses start to see themselves as victims of patients! I think this might happen more in psychiatry, where we can be dealing sometimes (though much less than people think) with aggressive people. And in some cases, nurses may be on the receiving end of a violent patient, resulting in injuries, which certainly meets the standard of being a victim. I think though, it is important to consider that as noted by CRNBC, that as a nurse, we have more power, and must always be considering how that impacts our care.
This is a challenge sometimes in psychiatry. We deal with a disempowered group, as nurses we hold much more power. It is only relatively recently that mental illness has begun to be seen as illnesses that are blameless. Or rather, as a society, we have just recently started to see mental illness as perhaps not the person's fault-sometimes. Health care still sees people with mental illness as less worthy of care than someone with a physical problem. And nurses working in psychiatry often perpetuate that idea-'oh, I'm not a real nurse, I work in psychiatry' I hate that! Give your head a shake! If you don't see yourself as a real nurse, leave, and let nurses who see themselves and their patients as deserving of real nursing care provide advocacy and care to patients who are entitled to professional, supportive nursing interventions!
Sunday, February 7, 2010
Dealing with Awfulness
There are some things that people should never get exposed to, yet they do happen. People who nurse see things that just should not be seen and have to manage things that are not supposed to happen. This is not limited to healthcare providers naturally, but they are the ones I am thinking about now. How do we cope with this?
This is something I have been trying to process since there was a terrible thing at work last week. Interesting, since I work in psychiatry and know all the signs and symptoms of critical incident stress, and yet when going through it, though I know theoretically that all the signs and reactions are normal it is the continuing feeling that my responses are abnormal. That I should not in fact, even react to things that are traumatic. I became really irritable, tired, detached, angry, and even had a flashback.
Thankfully, today I woke up and felt much better. Though I will watch myself to make sure that it isn't just momentarily repressed and also that I give myself time to continue to deal with it.
The other thing I think about is, after going through terrible events, how do we not detach, blame, become reactionary, in short-not think through things rationally? After all, that is naturally how people cope with these types of things-yet these reactions are not necessarily beneficial to ourselves or our patients. I can see the allure of doing this stuff too. After all, I left work Friday, found I had a parking ticket and my reaction was, 'How could I get ticketed after all, I just went through a terrible thing? I don't deserve this!' My deciding consciously, a long time ago, to park in 2 hour parking areas, despite the risk of tickets is why it happened. It is totally unrelated to anything to do with my week or the fact that I am a nurse. Yet, I felt that the bylaw officer should be doing me a favour and just know that I had a bad week.
I see this kind of reaction in other forms by the people I work with. 'If only this situation had been present, then this wouldn't have happened'. I got really pissed off by this, because in actual fact, the things they mentioned, would have had no bearing and would not have stopped it from happening. I though, 'Are you stupid? Don't you think things through?' This reaction was in part, due to my displaced emotion, but also came from the fact that I pride myself on being logical and become irritated when people are not.
Which also means that I get angry with myself when after a critical incident, that I react emotionally and without being totally rational.
This is something I have been trying to process since there was a terrible thing at work last week. Interesting, since I work in psychiatry and know all the signs and symptoms of critical incident stress, and yet when going through it, though I know theoretically that all the signs and reactions are normal it is the continuing feeling that my responses are abnormal. That I should not in fact, even react to things that are traumatic. I became really irritable, tired, detached, angry, and even had a flashback.
Thankfully, today I woke up and felt much better. Though I will watch myself to make sure that it isn't just momentarily repressed and also that I give myself time to continue to deal with it.
The other thing I think about is, after going through terrible events, how do we not detach, blame, become reactionary, in short-not think through things rationally? After all, that is naturally how people cope with these types of things-yet these reactions are not necessarily beneficial to ourselves or our patients. I can see the allure of doing this stuff too. After all, I left work Friday, found I had a parking ticket and my reaction was, 'How could I get ticketed after all, I just went through a terrible thing? I don't deserve this!' My deciding consciously, a long time ago, to park in 2 hour parking areas, despite the risk of tickets is why it happened. It is totally unrelated to anything to do with my week or the fact that I am a nurse. Yet, I felt that the bylaw officer should be doing me a favour and just know that I had a bad week.
I see this kind of reaction in other forms by the people I work with. 'If only this situation had been present, then this wouldn't have happened'. I got really pissed off by this, because in actual fact, the things they mentioned, would have had no bearing and would not have stopped it from happening. I though, 'Are you stupid? Don't you think things through?' This reaction was in part, due to my displaced emotion, but also came from the fact that I pride myself on being logical and become irritated when people are not.
Which also means that I get angry with myself when after a critical incident, that I react emotionally and without being totally rational.
Saturday, January 16, 2010
Change
Though health care is always changing, people who work in it seem to find the process difficult. Not that I think health care providers are alone in finding change a challenge, but it is interesting that people working in these areas continue to work in them, sometimes feeling a lot of anxiety about change knowing that change is inevitable and will be on-going. It's not like say, working as a philosopher, where change might be a little less frequent.
I am in a new position again at work as educator, which is a good change, but of course comes with its' own stress adjusting to a new position, trying to learn a whole new set of skills, changing to non-shift work life (which is more difficult for me than shift work-I like longer shifts with more time off). Happily, this week after 2 weeks in my new role, I thought, 'I like this job!' This may be a new record for me as it takes me a long time to adapt to new things and I stress a lot about having to do new things perfectly. Nevermind that this is impossible.
So, how have I managed to enjoy it when usually I feel a lot more stress at this point in changing work roles/jobs?
I think I have forced myself to do different things even though they stress me out. I have worked on seeing mistakes as learning opportunities-clichéd, but necessary if I am to live with my errors. I have to tried to also admit, recognize when I have screwed up. I really hate doing this, it is terribly uncomfortable for me. Medication helps. Another big part of it is enjoying my area of work-working in the hospital in psychiatry is where I want to be, so switching roles within that environment, still means I am in a field of work that I love. I feel valued with the work I do and I feel that I can promote change, and I can see the change I am promoting! Though it is not without its' struggles, I do see it as benefiting patients in a meaningful way, which really makes me feel pleased.
On that note, a policy change which a group I am a part of, looks like it will be implemented within the whole health region-not just our little corner of it! I feel a huge sense of satisfaction with this-because even though implementing this policy has been stressful at times, it seems that others see it as a useful and patient centred approach!
I am in a new position again at work as educator, which is a good change, but of course comes with its' own stress adjusting to a new position, trying to learn a whole new set of skills, changing to non-shift work life (which is more difficult for me than shift work-I like longer shifts with more time off). Happily, this week after 2 weeks in my new role, I thought, 'I like this job!' This may be a new record for me as it takes me a long time to adapt to new things and I stress a lot about having to do new things perfectly. Nevermind that this is impossible.
So, how have I managed to enjoy it when usually I feel a lot more stress at this point in changing work roles/jobs?
I think I have forced myself to do different things even though they stress me out. I have worked on seeing mistakes as learning opportunities-clichéd, but necessary if I am to live with my errors. I have to tried to also admit, recognize when I have screwed up. I really hate doing this, it is terribly uncomfortable for me. Medication helps. Another big part of it is enjoying my area of work-working in the hospital in psychiatry is where I want to be, so switching roles within that environment, still means I am in a field of work that I love. I feel valued with the work I do and I feel that I can promote change, and I can see the change I am promoting! Though it is not without its' struggles, I do see it as benefiting patients in a meaningful way, which really makes me feel pleased.
On that note, a policy change which a group I am a part of, looks like it will be implemented within the whole health region-not just our little corner of it! I feel a huge sense of satisfaction with this-because even though implementing this policy has been stressful at times, it seems that others see it as a useful and patient centred approach!
Sunday, September 20, 2009
CBT
I went to a workshop on CBT (cognitivebehavioural therapy) for psychosis this week and it was very well done. The presenter was a Dr from Britain and he was lovely-down to earth, funny, with a lot of good information. As he presented you could easily understand his perspective on mental illness/psychiatry-which was that the person with the disorder was the expert in their life and what they needed to be well-rather than the medical system telling people what they needed to improve things.
This is a perspective that I believe is sorely needed in health care and especially psychiatry. I suppose by my statement it could be presumed that *I* am the one calling the shots by telling health care providers what they need to do, but to be honest I think that ethics and ethical care are not relative theories based upon what each person deems ethical. I think that ethical care can be brought down to right/wrong, good/bad in some situations. We need to be gathering perspectives, respect different cultures, and respect individual choice, but in the case of people providing care I believe that there should not be an option in terms of whether following ethical practice. Too often in psychiatry I think that we dismiss the patient's rights/beliefs/thoughts/ choice and cover ourselves with the thought that 'oh, they can't decide that right now, they aren't capable of making that decision' and don't look for ways in which people can manage their own care. We have case conferences where everyone except the patient is there determining the course of their life. We force people to take medications that we ourselves wouldn't touch with a 10 foot pole and then wonder why they 'go off their meds'. We enforce blanket rules with little consideration for individual need and then wonder whay someone 'acts out' when getting frustrated. We certify people, taking away their right to move freely, make life impacting decisions about own health care and then wonder why they get mad at us and resist being involved in the health system.
I get frustrated when our college of nursing responds to poor ethical practice with the reply, 'well, you have to work within the system, it'll confuse the patient if you don't follow the system's way of doing things' even when the way of doing things does not fall within best practice, prudent nursing, or minimal ethical standards. Can someone explain to me how this is OK? Why is this allowed? Why aren't people fighting this?
Before you know it, I'll be the weird activist standing outside health care facilities with a sign, people giving me funny looks as they make a large circle to avoid me.
This is a perspective that I believe is sorely needed in health care and especially psychiatry. I suppose by my statement it could be presumed that *I* am the one calling the shots by telling health care providers what they need to do, but to be honest I think that ethics and ethical care are not relative theories based upon what each person deems ethical. I think that ethical care can be brought down to right/wrong, good/bad in some situations. We need to be gathering perspectives, respect different cultures, and respect individual choice, but in the case of people providing care I believe that there should not be an option in terms of whether following ethical practice. Too often in psychiatry I think that we dismiss the patient's rights/beliefs/thoughts/ choice and cover ourselves with the thought that 'oh, they can't decide that right now, they aren't capable of making that decision' and don't look for ways in which people can manage their own care. We have case conferences where everyone except the patient is there determining the course of their life. We force people to take medications that we ourselves wouldn't touch with a 10 foot pole and then wonder why they 'go off their meds'. We enforce blanket rules with little consideration for individual need and then wonder whay someone 'acts out' when getting frustrated. We certify people, taking away their right to move freely, make life impacting decisions about own health care and then wonder why they get mad at us and resist being involved in the health system.
I get frustrated when our college of nursing responds to poor ethical practice with the reply, 'well, you have to work within the system, it'll confuse the patient if you don't follow the system's way of doing things' even when the way of doing things does not fall within best practice, prudent nursing, or minimal ethical standards. Can someone explain to me how this is OK? Why is this allowed? Why aren't people fighting this?
Before you know it, I'll be the weird activist standing outside health care facilities with a sign, people giving me funny looks as they make a large circle to avoid me.
Saturday, August 22, 2009
Teaching
Who knew? So, I start teaching at the university! Psychiatry clinical to 3rd year nursing students-I have no idea what it will be like. I feel like it will be a good opportunity to promote the idea that mental health nursing is 1) not scary 2) found everywhere in nursing 3) a fantastic place to work. I don't think that everyone will agree with #3, but I should be able to reinforce #'s 1 & 2 and perhaps people will believe that psychiatry is Pretty Awesome.
It feels strange to be teaching-title is Clinical Associate. Maybe I need business cards?
I don't actually start with students until mid-Oct, until then I kind of hang out-go to some meetings and try to wrap my mind around what I will be doing.
I didn't think I would be teaching at this point in nursing, but I actually am quite excited about the prospect. I think it really does have to do with wanting to promote psychiatry as a great area to work in. People get so weirded out by it and there is a lot of stigma to overcome. As mental health professionals we don't do any favours by making comments at the nursing station that reflect poorly on our clientele. Honestly, I have been thinking about how to prepare students for that-appreciating humour and using it as a release while at the same time respecting patients all the time. Also to remind myself in the future that kind of talk is not appropriate-whether I am teaching or working as a floor nurse. Hmm, I already sound like a Matron.
It feels strange to be teaching-title is Clinical Associate. Maybe I need business cards?
I don't actually start with students until mid-Oct, until then I kind of hang out-go to some meetings and try to wrap my mind around what I will be doing.
I didn't think I would be teaching at this point in nursing, but I actually am quite excited about the prospect. I think it really does have to do with wanting to promote psychiatry as a great area to work in. People get so weirded out by it and there is a lot of stigma to overcome. As mental health professionals we don't do any favours by making comments at the nursing station that reflect poorly on our clientele. Honestly, I have been thinking about how to prepare students for that-appreciating humour and using it as a release while at the same time respecting patients all the time. Also to remind myself in the future that kind of talk is not appropriate-whether I am teaching or working as a floor nurse. Hmm, I already sound like a Matron.
Saturday, August 1, 2009
Private health care
So, surgery done on my knee finally and at private clinic a few days ago. There was actually no difference in care or even really how it looked, I thought. Perhaps a nicer bathrobe to wear while waiting to go into OR. And the OR had this huge bank of windows looking out on a lovely view.
Because my surgery was work related I got my surgery done quicker-I must remember to ask Dr how long it would have taken at private clinic.
I don't feel bad at all about having it done quicker as I was thoroughly sick of using crutches-but don't know if it had been coming out of my pocket if I would have paid for it. I guess considering that my wage is being paid while I am off, it didn't affect me too much but if I had to be without income it might have been another situation.I would've had to do a cost-benefit analysis. Plus I also justify that the longer I am off, the more it costs as the gov't in essence pays my wage. If I had said no, will wait in line with everyone else-wouldn't have been covered at all. Rationalizations.
Nurse who saw me preop did not help my pre-surgery anxiety. Seemed nice enough, but too high energy and said 'oh my god' 'if your finger starts going blue then it's time to cut off the ring. Your finger will swell during surgery' when looking at ring finger as I couldn't get my rings off. Thanks, I knew that. Finger is swollen because joint does this weird double jointed thing, ring is bent and finger got puffy from me trying to pull the damn thing off. My pulse remained at 113-if she thought it would go down after that reassuring discussion it didn't. As it turns out finger was fine. didn't become gangrenous. The nurse who showed me into the OR was much calmer and nice. After the 1st anxiety-provoking nurse left the room after giving Richard and I a bunch of post op instructions, Richard turned to me and said 'what do we do?'. Teaching was not absorbed.
Because my surgery was work related I got my surgery done quicker-I must remember to ask Dr how long it would have taken at private clinic.
I don't feel bad at all about having it done quicker as I was thoroughly sick of using crutches-but don't know if it had been coming out of my pocket if I would have paid for it. I guess considering that my wage is being paid while I am off, it didn't affect me too much but if I had to be without income it might have been another situation.I would've had to do a cost-benefit analysis. Plus I also justify that the longer I am off, the more it costs as the gov't in essence pays my wage. If I had said no, will wait in line with everyone else-wouldn't have been covered at all. Rationalizations.
Nurse who saw me preop did not help my pre-surgery anxiety. Seemed nice enough, but too high energy and said 'oh my god' 'if your finger starts going blue then it's time to cut off the ring. Your finger will swell during surgery' when looking at ring finger as I couldn't get my rings off. Thanks, I knew that. Finger is swollen because joint does this weird double jointed thing, ring is bent and finger got puffy from me trying to pull the damn thing off. My pulse remained at 113-if she thought it would go down after that reassuring discussion it didn't. As it turns out finger was fine. didn't become gangrenous. The nurse who showed me into the OR was much calmer and nice. After the 1st anxiety-provoking nurse left the room after giving Richard and I a bunch of post op instructions, Richard turned to me and said 'what do we do?'. Teaching was not absorbed.
Monday, July 20, 2009
Being a Patient
I have been crabby most of the day-feeling like I'm bored, but can't really do anything because of my knee not cooperating, don't want to read, crabby with Richard, wanting to get stuff done but can't really do much, slightly angry about that, and wanting to get out of house-though was out earlier and didn't really do much to improve my poor humour.
Which led me to think, 'so this may be on a small level what it feels like for some people who have a chronic illness'. I say on a small level because I know this will correct with surgery, I'm not really in any pain-only discomfort when I overdo it, and I have adequate resources to deal with the situation-I'm getting paid my salary, getting treatment paid for, and getting it quicker-jumping the queue because it is work related.
But..it does give me a good insight into how frustrating it is to have a condition impacting my ability to live normally-not able to do the things I used to take for granted, and seeing how it impacts my relationship with people around me. Having to ask for things that I was able to do by myself, and getting angry over having to ask. Getting used to not having things done in the time and way that I am used to. This makes me appreciate the difficulty and enormous life-changing circumstances that others deal with. What would it be like to be so depressed that I couldn't leave bed? How would it feel to live with hallucinations and paranoia that others were wanting to kill me? And to have difficulty processing information in understanding that it is an illness to begin with? How it would feel to know that others around you are tired of dealing with your illness and are questioning whether they can live with you and know that the disease is not going to go away? To deal with knowing that life will never be the same?
At a recent seminar I heard that people with a high IQ who live with schizophrenia are at higher risk of dying by suicide (and overall risk of dying by suicide if you have schizophrenia is high-according to several documents 10% of people with schizophrenia die by suicide-though some articles state that rate may be lower-5% and again several note that if living with schizophrenia-40% may attempt suicide-huge numbers) as when some people understand the entire impact that schizophrenia may have on their life-they are unable to manage the impact of this and suicide. Pretty sobering and frightening to think of how hopeless people feel when thinking of their future and what they will do in it.
How would I feel to deal with knowing that the entire way I had pictured my life was not going to happen? Of course, we all deal with life changing directions multiple times, and know that plans more often than not, will not be what we had thought. But coping with such a different direction? I think that as a nurse I have frequently not paid enough attention to the strength and resilience people demonstrate in living through and making a quality life with their diagnosis/disease/illness.
Which led me to think, 'so this may be on a small level what it feels like for some people who have a chronic illness'. I say on a small level because I know this will correct with surgery, I'm not really in any pain-only discomfort when I overdo it, and I have adequate resources to deal with the situation-I'm getting paid my salary, getting treatment paid for, and getting it quicker-jumping the queue because it is work related.
But..it does give me a good insight into how frustrating it is to have a condition impacting my ability to live normally-not able to do the things I used to take for granted, and seeing how it impacts my relationship with people around me. Having to ask for things that I was able to do by myself, and getting angry over having to ask. Getting used to not having things done in the time and way that I am used to. This makes me appreciate the difficulty and enormous life-changing circumstances that others deal with. What would it be like to be so depressed that I couldn't leave bed? How would it feel to live with hallucinations and paranoia that others were wanting to kill me? And to have difficulty processing information in understanding that it is an illness to begin with? How it would feel to know that others around you are tired of dealing with your illness and are questioning whether they can live with you and know that the disease is not going to go away? To deal with knowing that life will never be the same?
At a recent seminar I heard that people with a high IQ who live with schizophrenia are at higher risk of dying by suicide (and overall risk of dying by suicide if you have schizophrenia is high-according to several documents 10% of people with schizophrenia die by suicide-though some articles state that rate may be lower-5% and again several note that if living with schizophrenia-40% may attempt suicide-huge numbers) as when some people understand the entire impact that schizophrenia may have on their life-they are unable to manage the impact of this and suicide. Pretty sobering and frightening to think of how hopeless people feel when thinking of their future and what they will do in it.
How would I feel to deal with knowing that the entire way I had pictured my life was not going to happen? Of course, we all deal with life changing directions multiple times, and know that plans more often than not, will not be what we had thought. But coping with such a different direction? I think that as a nurse I have frequently not paid enough attention to the strength and resilience people demonstrate in living through and making a quality life with their diagnosis/disease/illness.
Friday, July 10, 2009
Waiting
No change in knee status-continuing to wait for WCB to approve claim or at least process it. Since surgeon is on holidays, doesn't really make much difference, since I can't have surgery anyway. I see why people get so irate at waiting for decisions etc. as I am getting so irritated with this process. Still on crutches, knee still locked. It is good to be reminded of how frustrating the process is when you are on the receiving end of healthcare. Nevermind that I'd much rather be on the other end. Sigh.
Got together to review the new protocols for monitoring patients after being secluded and having rapid tranquilisation (giving people meds to calm them down after being extremely agitated). It was a really productive session and I think that what we developed certainly will help in monitoring patients and make us accountable in our practice. The tricky part is going to be rolling it out-how will people respond to these changes?
I find it interesting how in a rapidly changing environment such as healthcare, there are so many people who resist change. I know that I don't always respond well to change, but I do try to recognize that it is inevitable in life, not to mention in an area such as healthcare. What is it that we resist? Fear of the unknown? Fear that we won't be able to adapt? Anger that the other way worked perfectly fine, why should I change? Nothing bad happened before, why change now? Complacency that it is too much work to change, the way we do it now works, why go to all the trouble to change it? Given that one of my requirements as a registered nurse is to consistently be evaluating my own practice and developing goals for myself on areas to work on, I feel I have no choice but to do that. I suppose since I have been nursing for only 2 years, maybe I'm used to always having to reflect on my work as I did it all through nursing-constantly being evaluated and constantly having to develop goals. I got tired of it, but in retrospect, it helps now as I don't mind asking for feedback on what I'm doing. Not that I am happy when I screw up, but I thinking I am finally able to see this as a learning opportunity, rather than a personal failure.
One of the great things about this committee is the positive patient focus and agreement that all the members have in working together to improve patient care, with similar ethical focus. Makes such a huge difference in committee work. Working in groups where everyone does not have the same focus or have other agendas makes group work loonnggg and painful.
My sister-in-law and brother-in-law are visiting and we were talking about my work and she said 'it's great to see how passionate you are about your work. You've really found the job you love'. It's true, I do, and I don't understand how others don't feel the same way. I think this can be a problem as I get impatient and angry with people who just 'put in their time' the whole time they are at work. I think a weakness of mine is lack of tolerance for nurses who I perceive as not putting enough effort into their job or not doing their job up to my ethical standards. This obviously is not so good when I sit in judgement because then I can't recognize that there are different ethical responses to situations. How though, do you accept something when you believe it to be against our code of ethics? And how can I maintain my ethical principles without wanting to change situations to fit within the code of ethics? How many ways can you interpret the principle of maintaining dignity and actually maintain that dignity?
Got together to review the new protocols for monitoring patients after being secluded and having rapid tranquilisation (giving people meds to calm them down after being extremely agitated). It was a really productive session and I think that what we developed certainly will help in monitoring patients and make us accountable in our practice. The tricky part is going to be rolling it out-how will people respond to these changes?
I find it interesting how in a rapidly changing environment such as healthcare, there are so many people who resist change. I know that I don't always respond well to change, but I do try to recognize that it is inevitable in life, not to mention in an area such as healthcare. What is it that we resist? Fear of the unknown? Fear that we won't be able to adapt? Anger that the other way worked perfectly fine, why should I change? Nothing bad happened before, why change now? Complacency that it is too much work to change, the way we do it now works, why go to all the trouble to change it? Given that one of my requirements as a registered nurse is to consistently be evaluating my own practice and developing goals for myself on areas to work on, I feel I have no choice but to do that. I suppose since I have been nursing for only 2 years, maybe I'm used to always having to reflect on my work as I did it all through nursing-constantly being evaluated and constantly having to develop goals. I got tired of it, but in retrospect, it helps now as I don't mind asking for feedback on what I'm doing. Not that I am happy when I screw up, but I thinking I am finally able to see this as a learning opportunity, rather than a personal failure.
One of the great things about this committee is the positive patient focus and agreement that all the members have in working together to improve patient care, with similar ethical focus. Makes such a huge difference in committee work. Working in groups where everyone does not have the same focus or have other agendas makes group work loonnggg and painful.
My sister-in-law and brother-in-law are visiting and we were talking about my work and she said 'it's great to see how passionate you are about your work. You've really found the job you love'. It's true, I do, and I don't understand how others don't feel the same way. I think this can be a problem as I get impatient and angry with people who just 'put in their time' the whole time they are at work. I think a weakness of mine is lack of tolerance for nurses who I perceive as not putting enough effort into their job or not doing their job up to my ethical standards. This obviously is not so good when I sit in judgement because then I can't recognize that there are different ethical responses to situations. How though, do you accept something when you believe it to be against our code of ethics? And how can I maintain my ethical principles without wanting to change situations to fit within the code of ethics? How many ways can you interpret the principle of maintaining dignity and actually maintain that dignity?
Thursday, June 18, 2009
Injury Prone
So, sitting on the bed today I again threw my knee out. While putting on my knee brace, turned slightly on bed, pop from the knee, can't weight bear again. So, this is an interesting situation-what is it like to be a patient? Go to GP, who kindly fits me in within 1/2 hour. Refers me to ER, as still haven't heard back from orthopedic referral-going to ER results in quicker referral process. Richard is wheeling me around in wheelchair, as other option is to hop everywhere. I go through triage process, surprisingly, I am seen by ER Dr. and out of hospital by 1 pm, after getting there at 1130. Amazing, I kind of think-given about hearing about long time spent in ER and I knew this wasn't a serious thing-as in losing a limb, heart attack kind of thing. Now I have referral to orthopedic clinic for Tues. and am on crutches. Which of course, means I can't work. On the whole, it felt like I certainly got quick, effective treatment. I have to say though, that I think people responded slightly differently knowing that I work at hospital-a bit warmer, this may be just my perception and not accurate though. Plus, having a claim makes it quicker, and I don't think it was all that busy there today. I feel kind of embarrassed about being a patient-it does feel like I am putting people out. Not to mention how I feel about being off of work-as I am supposed to work this weekend- I wish I could just go and do something there, but seeing as how even navigating the house is problematic, I don't think it is an option.
On a positive note-the previous owners of the house had a grab bar in the bathroom-for the grandpa who was living with them. This has already come in handy.
On a positive note-the previous owners of the house had a grab bar in the bathroom-for the grandpa who was living with them. This has already come in handy.
Sunday, June 7, 2009
Mediocrity
Did I spell that right?
I have been thinking of the pressure there is to conform within workplaces. How it is difficult to be somewhat different in your approach and do the things that you think are best practice-even though others don't practice in that way. Not that I mean to imply that I am perfect, sadly fall far short of that, but how to continue doing things in what I believe is the right way, while still maintaining a collegial relationship. This can be a difficult thing. We all want to feel like our way is the best and it is difficult to get differing opinions. I know when someone approaches me and says 'oh, have you thought of this?' or 'oops, you missed this', I feel like defending myself, even if I think, 'yeah, you're right'. Hopefully, I don't appear defensive, but pretty sure I have-it is difficult to accept that though I want to never make a mistake dealing with people's health, I'm human = human error.
All that being said, I hope that I don't become complacent and stagnant and start coming to work on autopilot-pretty sure is kiss of death for patient care.
Yet there is a human urge to stay within the safety of the pack and not do anything to stand out, good or bad. So, you don't want to screw up and be eaten by the pack of lions, but neither do you want to come up with a new way of doing something, get the rest of the herd irritated with you, reject you, and still end up being eaten by the lions. Don't know if that analogy makes total sense, but general idea is there.
Given that I am Type A personality with job performance-my internal alarm clock goes off if I act in a way that I believe to not be 'good enough'. I end up being riddled with anxiety if I do something that isn't the right/proper way. And going home feeling that I have let down my value system is a much harder thing for me than going home feeling like I have pissed someone off because I refused to do something that I feel is wrong. Hmmm, perhaps this gives me an understanding of other people's motivation? If others find more value in being part of group, and see the emotional value of belonging as more valuable than acting according to less emotional, more idea focussed value systems, then it makes sense to be a part of group as their internal anxiety will increase when not part of it, just as my internal anxiety increases when feeling like I am not living up to being good enough.
I have been thinking of the pressure there is to conform within workplaces. How it is difficult to be somewhat different in your approach and do the things that you think are best practice-even though others don't practice in that way. Not that I mean to imply that I am perfect, sadly fall far short of that, but how to continue doing things in what I believe is the right way, while still maintaining a collegial relationship. This can be a difficult thing. We all want to feel like our way is the best and it is difficult to get differing opinions. I know when someone approaches me and says 'oh, have you thought of this?' or 'oops, you missed this', I feel like defending myself, even if I think, 'yeah, you're right'. Hopefully, I don't appear defensive, but pretty sure I have-it is difficult to accept that though I want to never make a mistake dealing with people's health, I'm human = human error.
All that being said, I hope that I don't become complacent and stagnant and start coming to work on autopilot-pretty sure is kiss of death for patient care.
Yet there is a human urge to stay within the safety of the pack and not do anything to stand out, good or bad. So, you don't want to screw up and be eaten by the pack of lions, but neither do you want to come up with a new way of doing something, get the rest of the herd irritated with you, reject you, and still end up being eaten by the lions. Don't know if that analogy makes total sense, but general idea is there.
Given that I am Type A personality with job performance-my internal alarm clock goes off if I act in a way that I believe to not be 'good enough'. I end up being riddled with anxiety if I do something that isn't the right/proper way. And going home feeling that I have let down my value system is a much harder thing for me than going home feeling like I have pissed someone off because I refused to do something that I feel is wrong. Hmmm, perhaps this gives me an understanding of other people's motivation? If others find more value in being part of group, and see the emotional value of belonging as more valuable than acting according to less emotional, more idea focussed value systems, then it makes sense to be a part of group as their internal anxiety will increase when not part of it, just as my internal anxiety increases when feeling like I am not living up to being good enough.
Thursday, May 28, 2009
Ow
I did some training/recertification on dealing with violent situations in the hospital and reinjured my knee that I sprained 2 winters ago skiing. Stupidly I heard it crack during 1 situation, then thought, oh well try again. Then ended up on the floor. Now I am icing it and thinking I will probably need to wear a knee splint thing tomorrow at work. Nurse, heal thyself.
We talked a lot about violence etc. Really, though people often think that in psychiatry that it is so unsafe, I hardly ever feel unsafe at work. Only if someone is being particularly difficult and that hardly ever happens. I think nurses are much more likely to get injured in long term care, with people who have dementia. Or ER, where people are coming in off the street-with who-knows-what going on.
When people go onto the psych unit, they tend to be surprised at how quiet it is. We obviously try to keep it low key for a reason, as loudness stresses people out, but I think how difficult it is for people on other units with machines beeping, call bells ringing, people rushing around. How does anyone sleep? It goes on all night. I remember when Dad was in ICU after his sugery and he got delerium and the nurses saying, oh he needs to get some sleep. Well, whenever was there, lights were on, it was loud, how does someone who is all drugged up, in pain and not in their own bed sleep through all of that?
There are many ways that in the hospital we make healing difficult for people and I think noise stress is not looked at enough. Along with about a 1000 other things.
We talked a lot about violence etc. Really, though people often think that in psychiatry that it is so unsafe, I hardly ever feel unsafe at work. Only if someone is being particularly difficult and that hardly ever happens. I think nurses are much more likely to get injured in long term care, with people who have dementia. Or ER, where people are coming in off the street-with who-knows-what going on.
When people go onto the psych unit, they tend to be surprised at how quiet it is. We obviously try to keep it low key for a reason, as loudness stresses people out, but I think how difficult it is for people on other units with machines beeping, call bells ringing, people rushing around. How does anyone sleep? It goes on all night. I remember when Dad was in ICU after his sugery and he got delerium and the nurses saying, oh he needs to get some sleep. Well, whenever was there, lights were on, it was loud, how does someone who is all drugged up, in pain and not in their own bed sleep through all of that?
There are many ways that in the hospital we make healing difficult for people and I think noise stress is not looked at enough. Along with about a 1000 other things.
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