Help And Hope For Nurses Inflicted With Sud And/or Mental Illness
The Intervention Program can help nurses inflicted with substance use disorder or mental illness. The Program does this by assessing each nurseâs individual recovery needs, referring nurses to appropriate treatment based on those needs, monitoring each participantâs success in recovery and returning the nurse to work in a safe manner.
If you are an RN needing assistance, or if you are seeking help for an RN in need, please call Maximus at 1-800-522-9198.
For more information about the Intervention Program, please also refer to General Information page.
For additional resources for nurses and employers, please also refer to Additional Resources page.
Quick Hits
Nurse Care For Schizophrenia Patients
Schizophrenia Schizophrenia is a mental illness characterized by perceptional impairments and impairments in expression of reality manifesting as auditory hallucinations, paranoid delusions in the context of significant social or occupational dysfunction . Diagnosis is based on the patient’s self-reported experiences and observed behavior. An increase in dopaminergic activity in the mesolimbic pathway of the brain has been found to be associated with the disease . Treatment by pharmacotherapy is done with antipsychotic drugs that suppress dopamine activity. Schizophrenia patients usually show comorbid conditions, including clinical depression and anxiety disorders . Disorganized thinking, auditory hallucinations and delusions are common symptoms. Patients in advanced stages of schizophrenia exhibit frequent agitations and bizarre postures .
Drug and psychosocial interventions for the symptoms of schizophrenic disorders contribute to a lower incidence and prevalence of schizophrenia. Nurses will be able to offer better care through the use of nursing models and theories in the care of Schizophrenics. Protocol for assessing standards of care for people with a diagnosis of schizophrenia have major implications for nursing practice . The theory-practice gap in psychiatric nurse care of Schizophrenics needs to be addressed as a matter of urgency.
Reference
Copyright 2008- American Society of Registered Nurses -All Rights Reserved
Implications For Practice And Future Research
The results from this study could be used to develop nurses readiness and capability to encounter patients with mental illness and to respond appropriately to the patients somatic and mental care needs. Awareness of nurses encountering will help to advance the teaching and training of nurses in PEC. To provide appropriate care based on the specific patient, one needs insight in the patients lifeworld. This might be a challenge while developing interventions for education in PEC. Therefore, interventions need to be dynamically designed to caught different aspects of the patients lifeworld. Further research that focuses on patients with mental illness in PEC should be carried out. It would be valuable to explore what can provide the best possible care and how to maintain and protect the autonomy for patients with mental illness in their encounter with PEC.
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Treatment Decision And Follow
Before discussing new treatment options and making a treatment decision, Sam was queried about the degree of involvement he would like in making decisions about treatment and services. Sam indicated that he would like to be involved in most decisions, but he also wants some assistance and reassurance as requested when making decisions.
Because Sam is socially isolated and does not have family or other social support to encourage him to maintain his oral antipsychotic treatment regimen, he and his care team discussed switching to an LAI antipsychotic. Sam was concerned that the injections would be painful, but he also welcomed the opportunity to be relieved of remembering to take multiple pills every day.
Various strategies exist for switching clients from oral to LAI antipsychotics. In general, gradual overlapping is less likely to result in rebound and withdrawal effects compared with abrupt discontinuation of the old and initiation of the new antipsychotic . This strategy may be particularly relevant to maintain therapeutic levels during the initial weeks of LAI therapy .
Sam agreed to weekly phone calls from his nurse to monitor his well-being and to remind him to return in two weeks for his follow-up appointment. After he is stabilized on his new medication regimen, he would like to consider receiving fewer follow-up phone calls so that he can learn to manage his illness more independently.
Laying A Foundation For A Trusting Relationship
The encounter was described as important to the creation of an ongoing trusting relationship. The aim was that the relationship should be confidential and that both parties should dare to enter a conversation about mental illness. Encountering an unknown patient was perceived as easier than encountering well-known patients because the nurses had fewer pre-understandings. The ability to read the patient, find confidence in the conversation and establish encounters without time pressure facilitates a trusting relationship.
That you should think about like, trying, as long as they are not aggressive and you don t feel threatened, try to get away and talk to them in peace and quiet, cause you will find out much more then, but I guess it all depends on how threatened you feel.
Some techniques were mentioned to facilitate trust. These included moving the patient away from a stressful environment, not interrupting, conveying security, and showing interest and respect. If the patient was perceived as having confidence in the nurse, it was easier to talk about anything.
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Breaking Down The Patients Barriers
In encounters with patients suffering from severe mental illness such as suicidal behaviour or psychosis, the respondents often found the patient difficult to reach. This was described as the patient having a barrier. The nurses needed to break through these barriers to gain access to the patient. However, this was sometimes experienced as impossible as the barrier was too high. The nurses would then make fruitless attempts to calm and divert the patients by talking. However, this was experienced as difficult due the patients specific mental illness or their being unreceptive to communication.
Several times when I have been there, she has taken tablets I try to talk with her, I mean when she has been awake, so I do try talking with her or she is rather closed off, she wants to, is not so interested in talking. So, she is really difficult to reach, but I talk to her anyway.
Being able to encounter the patient with calmness and respect was described as essential. Doing so requires the ability to form some idea of what the patient is thinking. Active listening without interrupting was important. Children were described as being able to show trust and adapt to the nurses, but adults were described as demanding, requiring more thought and reflection in communication.
How Your Experience Can Help Others
Having a professional who understands what its like to have a mental illness can be hugely beneficial to patients and colleagues.
For your patients, youll be able to talk with them about these issues and share your experiences. As youre more on an equal footing with them, it may be easier to discuss their issues with you. Knowing that youre not judging or dismissing their struggles.
Youll have a more genuine response and a better idea of how to support them through this challenging time. This interaction can help show people that theyre not alone and that they can live happily despite their mental illness.
On the other hand, it may help your colleagues without mental illnesses to see things from a different perspective. So that they can be more aware of their actions and words moving forward. As well as reflect on their own mental health.
Youre also more likely to notice signs of poor mental health and be better equipped to handle emergency situations. Or just general chats around the subject in general.
Overall, if youre able to utilise your experience to help others then itll make you a better nurse.
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Depression And Anxiety In Nurses
By Natalie Vaughn, MBA, on November 9, 2020
While most nurses are eager to discuss their profession with friends, family, and colleagues, conversations surrounding depression and anxiety among nurses remain taboo, despite the prevalence of these mental health conditions within the field.
According to the Robert Wood Johnson Foundations Interdisciplinary Nursing Quality Research Initiative, 18% of nurses exhibit symptoms of depression double the rate within the general population. These numbers have increased significantly during the COVID-19 pandemic, with 50% of nurses treating patients with COVID-19 reporting signs of depression.
But as long as the stigma associated with mental health persists, many nurses, for fear of being viewed as weak or inferior, will continue to avoid seeking the mental health support they need. It falls on the shoulders of nursing leaders to support their staff and create spaces that encourage self-care over silent suffering. Mental health should be a priority for any healthcare facility, helping them improve their nurses overall well-being as well as the quality of care they provide their patients.
Causes And Risk Factors Of Schizophrenia
Although the actual cause of schizophrenia remains unclear, physiciansknow that the etiology ofthe disorder is multifactorial and has genetic and environmental factors.The most significant risk factor for people with schizophrenia is having a first degree relative with schizophrenia.Various studies have concluded that the interaction of genetic risk with environmental risk significantly increases the likelihood by least 9 times that the individual will have schizophrenia .
Maternal depression during pregnancy significantly increases the risk of schizophrenia in offspring if one of the parents has a psychotic disorder. It is believed that the genetic risk of schizophrenia presents itself in two ways. The first is the polygenetic interaction of multiple common variants of thousands of genes and the second is rare but included highly penetrant genetic events such as deletions or duplications of several variations .Researchers believe that hormones and physical changes in the body can be a factor leading to schizophreniabecause the symptoms of the disorder usually begin in young adults during a time of major change puberty going into adulthood,for example .
Self Quiz
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If You Are Asked About Your Psychiatric History When You Apply For A License In Any State Your Approach Should Be To:
Respond honestly and factually to the question asked.
Attach letters from treatment personnel who can honestly support your success with treatment.
Attach a letter of recommendation from your current employer discussing your nursing practice and your success at work.
Attach your latest performance evaluation from your immediate supervisor.
Remember that if you falsify or intentionally omit information requested, you may be denied the license you are applying for.
Consult with a nurse attorney or attorney in your state who can help you formulate any required statements, responses to questions asked and documents that are required to be included with your application.
Signs And Symptoms Of Substance Abuse/impaired Practice
Unfortunately, most people suffering from substance use disorder or mental illness deny the problem. Many times they are the last to recognize and admit that they need help. Patient safety depends on early identification of those registered nurses who misuse substances.
Signs and Symptoms of SUD
- Increased isolation
- Smells of alcohol or marijuana
- Narcotic discrepancies
- Changes in drug ordering patterns
- Patient complaints about reduced pain relief
- Offers to administer meds for other RNs
- Volunteers for extra shifts
- At facility on days off/at odd hours
- Leaves worksite frequently to use the restroom, lounge or to the parking lot
- Bizarre behavior
- Poor work performance
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What Does This Mean For Nurses
For starters, it’s no secret that nursing school is incredibly stressful. I
n fact, a little over 82% of nursing students experience stress along with other co-occurring mental illnesses such as anxiety and depression.
It’s important to consider how stress will play a role in nursing school and if it will play a role when you become a nurse.
Unfortunately, nursing can be an incredibly stressful job, where you have the lives of other patients on your hands.
To be successful as a nurse with Schizophrenia and not allow stress to impact you negatively, consider the following:
1. Taking the Proper Medication
There are various treatment options for people with Schizophrenia, but all include taking medications.
These can include different mood stabilizers and psychotropic medications.
It’s important to talk to your doctor or psychiatrist about your medications and continue to take them regardless of whether or not you feel better.
Taking your medication might help you get through the stress of the day when working as a nurse.
2. Practice Self-care
Whether you’re a nurse, an office worker, or a stay-at-home parent, self-care is always a critical component of stress reduction.
Practice self-care techniques such as taking a hot bath, meditation, yoga, and deep breathing exercises.
3. Consider Therapy
People with Schizophrenia can benefit immensely from different types of therapy, including cognitive-behavioral therapy, family intervention, training programs, and much more.
Nursing Care Plan For Schizophrenia 5
Nursing Diagnosis: Fear related to suspicion of the motives of others secondary to schizophrenia as evidenced by fearful feelings.
Desired Outcomes:
- The patient will continue everyday activities.
- The patient will verbalize understanding and recognition of fears.
- The patient will make use of coping methods to control fear.
- The patient will exhibit effective coping strategies to improve psychological and physical comfort.
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What Will You Do With John
John is suffering for auditory and visual hallucinations. It is important to tell the nurse what you have observed and any triggers that may have occurred prior to this episode. Also, ask the following questions: Did something happen? Did he have a visitor? What is in the environment? Did he sleep last night? You can try to distract John with an activity as long as you and he remain safe. You will want to stay on the same side of the room as where the door is so that your escape, if necessary, is not blocked. You will also want to report his eating habits over the last few days as well as his appearance. Try to get him to wash himself and change without agitating him. You may need the help of the nurse to do so.
Select one of the following methods to complete this course.
Establishing Explicit Boundaries And Control
The importance of establishing explicit boundaries related both to the nurses personal safety and the safety of the patient. Some encounters required a seemingly harsh approach, ranging from being very determined to using physical constraints. Nurses also described presenting alternative care options or demanding that the patient consider alternative responses as a way of establishing explicit boundaries and controlling the encounter. However, this required the nurses to be sensitive in assessing the alternatives in each unique patient encounter.
I will say: You need help and if you come with me, we can go to the psychiatric clinic, where you will get help and then well go, you and me, and my colleague will drive and it will be all smooth, nice and calm, and we could sit and chat all the way and stuff and you can tell me. But otherwise, I would have to, yes well, then the police would have to come and get you, to help us get you to hospital and it will not be that good, I promise you.
Encountering patients with mental illness required the nurses to have knowledge of how to proceed to provide the best possible care options for each patients unique situation. The nurses experienced their responsibility as having to take control of the situation so that things proceeded in a proper way. This required being like a spider in a web, with a general overview of the patients situation and different care alternatives.
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Voluntary And Compulsory Detention
More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it’s necessary.
People can also be compulsorily detained at a hospital under the Mental Health Act , but this is rare.
It’s only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder and if detention is necessary:
- in the interests of the person’s own health and safety
- to protect others
People with schizophrenia who are compulsorily detained may need to be kept in locked wards.
All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.
An independent panel will regularly review your case and progress. Once they feel you’re no longer a danger to yourself and others, you’ll be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.
What Is Schizophrenia
Schizophrenia is a severe mental health disorder that can affect anyone during their adult lifetime.
Most symptoms of Schizophrenia appear during early adulthood when someone is in their mid to late 20s.
This means you could be a nursing student or even already working as a nurse before you begin to notice symptoms of this disorder.
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Where To Find Work
Stigma against schizophrenia and other mental disorders can be a real barrier to employment. In some countries, only one or two out of 10 people with schizophrenia have jobs.
Some jobs may be better suited for you than other lines of work. The right kind will depend on your work experience, education, and how severe your symptoms can be. It makes a big difference to have a supportive work environment and understanding co-workers and managers. For some people, jobs that require some physical labor may be easier than more sedentary jobs that demand a lot of mental concentration.
A few tips for your search:
Think about your strengths and skills and look for jobs that line up with those traits. People with schizophrenia hold all kinds of positions, including senior managers and other professionals, cleaners and laborers, and salespeople. You may not have experience in a certain field, but if the job tasks fit your abilities, give it a try.
Keep an open mind. You may want to work full time. But part-time jobs may be more manageable for you, especially if you are also enrolled in rehab or supportive programs for your schizophrenia.
Reach out to agencies and advocacy groups. Many organizations have connections with employers who understand some of the unique challenges and gifts of people with schizophrenia or other mental health conditions. The National Alliance on Mental Illness provides a list of job resources for people with physical and psychiatric disabilities.