Tales from the Psychiatric Nurses Station – Child/Adolescent Part 1

It has been a while since I’ve written on here so I thought I would come on and say hello.  Alot has happened on the unit that I have worked for about a year.  Among the lack of sleep from my thoughts racing due to the kids on my mind from all of their traumas to being in school again to work on my Bachelors degree.  I’d like to give you two the brief case studies  on my most memorable patients and how they’ve impacted me.

Over the past year I have learned a lot about child and adolescent psychiatric care.  Never before in my life did I think a small child would have to endure the pain, horror, and terrifying abuse that some of these children have had to face. Seeing the look on the faces of these children who have been sexually abused by relatives, family friends, or rarely strangers; rips at your very soul.  I find sleep escapes as the child’s face enters my mind’s eye, an image of them cowering in the corner fills my thoughts. I’m paralyzed with reality and I am not a confused child who is inexperienced in the trials of life and all that is evil.  I am not the abused.  The same child has been to 4 or 5 different foster homes in the span of 4 weeks.  She has no one to love her and she asks me “can you be my mommy?”

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Walker Appoints Political Donor’s Son to High-paying State Job

I’m angry.  Scott Walker has again proven that his claims of changing “Business as Usual” in Wisconsin were baloney.  Yesterday it was exposed that Brian Deschane, a 27 year old college dropout with hardly any work experience and son of the Wisconsin Builder’s Association Vice-President was given a high-paying state job.  At first Deschane was hired to work as the “bureau director of board services, a job that paid $64,728 a year”.  Then two months later he received a raise and promotion to be the administrator “overseeing environmental and regulatory matters and dozens of employees at the Department of Commerce” with pay being $81,500 per year.

But, the State is broke.

Full story available here, courtesy of the Milwaukee Journal Sentinel investigative reporter Daniel Bice

Also read the comments section if you dare, it is funny and alarming all at the same time.

Oh I forgot to add that he still hasn’t paid a fine for his 2nd DUI from 2008 and a lien was filed against him in 2009 for around $800.  If you are making $81,500 per year and before that a $65K per year, you cannot tell me that one paycheck couldn’t pay this fine.  What an asshat.

How Walker’s Budget May Kill People

With the collective bargaining issue being the main concern of most media and the public something somehow made it under the radar.  Walker’s budget guts Badgercare (Wisconsin’s Medicaid program), Seniorcare (an RX program that had a $20mil surplus), Familycare (a program that helps pay for long term care costs for disabled and poor elderly), and ends the end-stage chronic renal program.

In my area of Wisconsin, Milwaukee, we’ve had hospitals close due to just being so overburdened with Medicaid patients that they were losing money horribly and the hospital systems felt it better to have those patients become absorbed into other hospitals. With hospitals further losing Medicaid dollars, which hardly cover the cost of services if at all, this will cause the hospital systems to do two things, raise prices on cash paying patients (they sign contracts for pricing with insurers) and cut staff, most likely nursing.  Nurses are the biggest of a hospital’s budget.

There is no mandate in the State, as in other states, that say there is a limit to how many hours or how many patients we have while we work.  It is totally to the discretion of management, who when pushed by their superiors will give you more and more.  Evidenced-based research has shown that high patient:nurse ratios increases medical error and patient death.  Hospital systems though will have no choice but to implement these changes in order to stay at even.

This may be why Republicans are for tort reform, by making these cuts they most assuredly ensure patient harm and death and want to protect the doctors and hospitals (not nurses though) from malpractice suits. (The previous sentence is speculation but I think a fair assessment)

Patient safety has been studied thoroughly as even retention rates (vs. recruitment rates) are inversely related in the effect they have on patient mortality (death).  Hospitals that retain nurses more than recruit them have higher rates of people staying alive after being admitted.  Also the limit according to the nursing community as to what is reasonable for patient load is between 4-6 patients, depending on who you ask.  At 6 patients, you develop neurogenic bladder, don’t take lunches or breaks, and stay late charting.  For some reason we’ve accepted this.

So although this may be an unintended consequence of his budget bill, and most assuredly cutting these low income Seniors off their very cost-effective program will decrease drug utilization causing need for more catastrophic care in the hospitals, cutting the end stage renal program (kidney failure) will do the same, I say will because you are on the path to death anyway it will just be faster and more painful so not totally Scott’s fault on that one but it will be quicker, and then the increased strain on the nurses as hospitals cut staff to make up for the shortfalls they will incur which will cause error and death due to no limit on the number of patients you can have at once.

So Scott Walker, I submit to you.  You may think you are saving the State money, then handing it out to your Corporate buddies, but you are just shifting the costs from the whole state to a few, that is not shared sacrifice.  You did not think this one through and the deaths that will result will be their blood on your hands too.

Fitzwalkerstan

Yesterday as the angry silent majority began speaking up, one of our Democratic Senators (I believe could have been Assemblyperson) from the State of Wisconsin coined the new name of our state, officially for sale:  Fitzwalkerstan.  I find it rather witty and relevant.  Amongst the various Twitter feeds I was reading for the day, I noticed Fitzwalkerstan was top trending and I have to say, never before have I laughed but sat in awe of the irony at the same time.

Some of the posts were humorous yet absurd, others were humorous but true, some more were dead on, and a few were complaining that we scored something for our team that the MSM cannot hide away (and it is on Wisconsin public record, yus!).  I feel this term for our state (used to be Packerstan which I was perfectly happy with) completely encompasses the political reality of the situation.

We have the two Fitzgerald brothers the heads of both the State Assembly and Senate, their father the head of the State Troopers and then good old Scott Walker, our King Governor in Chief and well “stan” although incorrectly attributed to only fascist Muslim regimes, just means land.  The State Troopers also have a new name, “The Palace Guard” as attempts to force out and prevent protesters from coming into OUR building, the people’s house, the State Capitol have been highlighted in the press.

Illegal meetings aside, raping workers and the State of 50 years of precedence for “budget issues”, dividing the middle class making them all hate each other and wish low wages and bad benefits on each other while the rich who are benefiting from the tax breaks on the backs of those same middle class are sipping champagne and dancing giddy all the way to the bank (that one in the Bahamas btw).

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Mindfulness and Personal Truth

Warning! It’s long

 

I haven’t been blogging for awhile, this is due to a host of reasons I won’t bore you with.  Today I was listening to some music on Youtube as well as joined a message board with a hot topic: Religion.  I do not want to get into a rational vs. irrational argument, we do irrational things every day like use gas guzzling cars and credit cards our reasons in our own minds justify it at the time even if it is proven a foolish thing to do.

I don’t know if it is the time to reveal my personal beliefs, a lot of my friends/family know them however, it is a misunderstood belief that since I am publicly on the Internet need to have all my bases covered for.  I will say it is not a traditional religious belief and leave it there.  How I found myself at this spot in life though is interesting.

I was raised in a Christian denomination that taught brim-fire and horror.  Everything was the work of the “devil”, an entity god created but now could not control until it was “time”.  We were taught to view ourselves as lowly, terrible people who hardly deserved the air we breathe.  We were also taught that there is this list of things you need to achieve before you can enter the pearly gates.  Perfection was required, at least in the viewpoint of others’.  The “perception of evil” (people judging you for your deeds) was your fault if you didn’t hide it well enough basically.  Even if you were not guilty, if it looked like it, it was bad, evil.  This quest for perfection was tempered with a seemingly contradictory message that all are forgiven and saved from a blood sacrifice given by the very same god that required all of this in the first place.  My question was always “Why was it necessary then?”  If I’m to be judged for my deeds, should I then judge the deity I am worshiping of their deeds?  I found a lot of things that are crimes in all 50 states, it didn’t fit with my idea of “god” or the “Divine.”

So I began a quest, to find not only truth as I saw it, but myself.  I don’t profess to have all the answers right now either but I will be forever seeking, forever learning.  The human brain is an amazing thing, an individual nerve cell can transmit 1,000 impulses per second of which you have 100 billion neurons in the brain. Now I could do the math for you guys but I may miss some zeros, you get the point.  (What do you call 100,000 billion? ) One tool in this journey has been meditation or as some call it mindfulness, refusing to get caught up in the everyday garbage of life for a moment, to “steal a moment” for myself and remove my emotions, thoughts, concerns and not allow myself to let life bother me for at least 10 minutes a day.  My thoughts brought questions which brought the ensuing research (at times at the mercy of my schoolwork).

As irrational as philosophy is at this moment, things that harm no one else are benign if even irrational is a good term to use.  Some argue that not ensuring rational thought is necessary so that you do not become the prey of some psychological manipulator. I think rationalism is human nature, a rational explanation is the one we look to first to answer questions we have no answers to.  Sometimes rational explanations just don’t quite cut it. For instance, why do people base jump?  Their brains are saying “No crazy what is wrong with you!” while their will is saying “Go for it!”  Rational people do not jump off buildings because of risk of dying or maiming yourself.  Does it make base jumpers bad people? No. Why then do people jump off cliffs and buildings?  I’m going to go out on a limb here (no pun intended) and say because they enjoy it.

For me that is why I pursue spirituality and religion, I enjoy it not because I have to.

 

Cross posted at this spot here

Which Came First? The Conundrum of Dual Diagnosis

In Mental Health it has been known that many with mental illnesses will self medicate, some of the people who do this then develop addictions.  Some practitioners view the addiction as a side effect of the mental illness that will magically go away once the mental illness is treated.  This is far from true, however.  The problem is many view addiction as a weakness in morality rather than a true medical illness.  The new school of thought is that we are to treat both of these conditions equally, as primary diagnoses.  I tend to agree with this as the evidence supports negative outcomes when you treat just one or the other instead of both equally.

12-step programs are designed to look at any drug as negative, even if prescribed by a physician so they are ill-equipped to treat someone with addiction and Bipolar Disorder who does need to take antidepressants and mood stabilizers to live a productive life.  Sure you may treat the addiction to heroin but you leave the person with grappling with shame and guilt if they do take their psychotropic medications.  If the person does decide to go cold-turkey on the medications that work to help them cope with their myriad of symptoms, you risk a very high chance of hospitalization due to the symptoms of Bipolar Disorder.  The chances of relapsing then on the drug addiction is high because the person is in a very vulnerable state.  I’m not suggesting there isn’t room for Alcoholic’s Anonymous, I am suggesting we need more programs for those who have Dual Diagnoses.

Once someone has developed an addiction, something that has a myriad of causes, is it even necessary to ask “why did this develop?”  In some respects it is, if you can get to the heart of the matter and fix it, you may end up having a better chance of recovery.  But for certain individuals, ones with mental health disorders such as Post-Traumatic Stress Disorder, Bipolar Disorder, and Schizophrenia it may be better to try and get them on the road to recovery of both at the same time.  In that course of treatment, teach those individuals to use medications and hospitalization as tools to manage their illnesses.  I think we see Mental Health treatment as for the weak and “crazy” and therefore it becomes a form of punishment.  During my Advanced Practicum we studied the Recovery Model, it is very promising, in my opinion, for the future of Mental Health.

Cross posted here

Today is the Beginning of the Rest of My Life

Today I took my final nursing exam.  I do not know my score yet, but I do know I have passed the class (pretty confident at least) and that I will be graduating on Friday.

As I look back over the last two years of hard work, blood, sweat, and tears (literally) I begin to realize how fast time flies for one and for two what hard work and determination can bring you.

The last month was filled with stress as I had to write 5 papers, take 6 exams, and complete a Mental Health Assessment on Milwaukee County.  It brought a lot of information out from underneath the rug we have swept it under.  For instance, in two years the estimated 15,000-20,000 homeless in the Milwaukee area went from roughly 30% of the homeless being mentally ill to 41.1%, substance abuse is close as well.  The main reasons for homelessness were eviction/foreclosure, unemployment, and family breakup.  I will save more of that assessment for a different post since I think it needs to be addressed.

Now for this post, back to the happiness…

I have decided to pursue psychiatric nursing with the goal of becoming a DNP in behavioral health for HIV patients.  They do have physiological needs but the psychosocial needs are just as if not more important.  Gotta help someone find purpose in order for them to care about life.  I completed my advanced practicum at an area behavioral health hospital that is world renowned and my Instructor is putting in a letter of recommendation for me since they are looking for some RNs.  I was surprised at how much I liked psych nursing.  My last patient, a transgendered woman, really touched my heart and affirmed that I was in the right field.  It is one thing to have an Instructor tell you, but when a patient does it means even more.

I figure I’ve been through a lot of drama in my life and can relate in a lot of ways to the struggles people face.  Because of that I genuinely want to help them heal and feel loved, to help them be the holder of the pen writing their own story, to help them be the master of their own destiny.  Many people think psychiatric nursing is like the movie “One Flew Over the Cuckoo’s Nest” but I assure you times have changed dramatically.  In fact the place I am hoping to work is working towards restraint free care, by therapeutically defusing situations before they become that dangerous.

I do get saddened though that my step-father thinks it is bunk science, to me it is rather commonsensical.    You are teaching people how to interact with the world in a productive manner and how to take control of their own lives for the better.  You are building them up until they can take over as their own decision maker so they do not harm themselves.  One thing about psychiatric illnesses that are misunderstood is that most of them are not what one would typically think of.  Sure we have many with Bipolar disorder and schizophrenia but most people are just depressed and in a crisis, they need a safe place to sort it all out.  And too, some have been damaged irrevocably as children and now as adults were never able to move into that developmental stage.  It makes you realize what a sick, cruel world we live in but it also shows you the real crux of humanity.  All humans have weaknesses, we all have moments where we feel life is so awful it is not worth bearing, we all have defensive egos at one point or another, and we all need someone to just listen.

So now onto Friday, when I walk down the aisle to get my nursing pin, candle, diploma, and say the Nightingale pledge.  I know I will cry, I’m a sap, but hey it’s my party and I’ll cry if I want to… ^-^