psychiatric nursing


Kintsugi or kintsukuroi is the Japanese art of fixing broken pottery with lacquer dusted or mixed with powdered gold, silver, or platinum, a method similar to the maki-e technique As a philosophy it treats breakage and repair as part of the history of an object, rather than something to disguise.”

I don’t think I’ve mentioned this on my blog before, but in my non-nail-art life I am a psychiatric nurse, and I work with children and adolescents struggling with severe mental illness.  Some of the kids dig my nail art, so lately I’ve been trying to paint designs that I think they’ll enjoy.  This is one of those, because it embodies the hope I have for all of them (and for myself as well): that we can find a way to live with our broken bits that makes our lives more beautiful, not less.

My boyfriend and I were in a taxi home last night and we got talking with the driver who was all chats with my boyfriend about him studying politics and law, just as we were about to get out he asked me about what I was studying.

When I told him I was studying psychiatric nursing he smiled in an almost pitying way and said “if I’m being honest, nobody is ever going to appreciate you” and I replied “Of course, I knew that going into the field”.

I know that nurses, especially psych nurses don’t get a lot of the respect that they’re due and quite frankly they’re put in very strenuous situations especially with patients families. People often think I’m crazy myself to put myself into that situation but the way I see it, someone has to clean up the mess, someone has to do the heavy work and as long as I know I’m making a different to one person at least, it’s all worth it.

And if that’s not the most Pisces/12th house stellium/6th house moon thing you’ve ever fucking read 😂


James, a deeply feeling man who began his working life as an auxiliary psychiatric nurse, shakes his head.

Many of the younger people who present at gender clinics have a history of mental health issues such as self-harming, social anxiety, eating disorders and so on. They see transitioning as their panacea.’

In addition, James says that the proportion of people attending gender clinics who are on the autistic spectrum is approximately six times higher than the general population.

‘The activist line is, 'Oh that’s because they’re trans so if they weren’t discriminated against and could just be themselves and transition they wouldn’t have mental health issues.’ That’s far too simplistic. I wanted to try to find the truth.’

In November 2015, James submitted his first proposed Masters Research title, 'An examination of the experiences of people who have undergone reverse gender reassignment surgery’, which was accepted.

'I had some people contacting me who said, 'Yes we’ve reversed our gender reassignment, but we’re so traumatised we don’t want to talk about it.’ It made me realise how very important the research is.

'Then a group of young women in the U.S. contacted me. They’d transitioned from female to male, had double mastectomies, then re-transitioned back to female.

'They’d stopped the hormone treatment that had been suppressing their menstrual cycles, but didn’t want reconstructive surgery to rebuild their breasts.

'I wanted to include them in my research, particularly as some of the women said they thought their original decision to transition to male had come from social and political pressure, not for psychological reasons.’

He submitted a revised title in October 2016: 'An examination of the experience of people who have undergone Gender Reassignment Procedure and/or have reversed a gender transition.’

James accepted the research might not be 'politically correct’, but felt it was important.

The next month the university rejected his proposal on the basis that 'the posting of unpleasant material on blogs or social media may be detrimental to the reputation of the University’.

'All I wanted to do with my research was listen to what people were saying and report it,’ James says.

'Society is changing so rapidly that a lot of people feel uncertain of their place in it and they’re looking for something. The fact is, the idea of trans identities is now being brought into the classroom and is all over the internet.

'I really think it’s good people who have transitioned have rights and they’re legally recognised in their gender. People fought for years for that and it’s very important.

'Some people need to transition and benefit from it. It’s a complex field, which is why we need to be able to have a healthy discussion about it and not feel afraid to do so.

This has all become a kind of Kafkaesque weird tangle. Somebody needs to call it out.’

Read more:

what i love about psych nursing

…because I need to remind myself sometimes (keep in mind this is personal to my experience <3)

1. The dark nursing humor - I know for a fact that this exists in all areas of nursing, but I think psych nursing humor is in a league of it’s own. Hey, we need to get by somehow!

2. It’s a lot less hierarchical - doctors and nurses are on a similar level. We treat each other like family and it is a less “yes doctor” than other areas I have experienced.

3. The patient contact on an interpersonal level. Where else do you get to sit down with your clients all day and chat? Sure, you are doing mental health assessments in the background but it’s always interesting to hear their stories.

4. It feel less task-orientated. Of course we still do physical assessments and manage their physical health as well as their mental health, but I have to say I don’t miss QID or post-procedural obs. It gets old pretty fast.

5. PARKING! I don’t know what it is.. less staff? I love not having to wake up an hour earlier than I have to because I know there will be enough car parks ;)

One woman tells of how her parents, upon discovering her crush on a physical education teacher when she was fourteen years old, first sent her to a psychologist “to find out if I was crazy.” When her parents’ persistent rejection of her sexual identification during her teen years caused her to be so depressed that she attempted suicide, they committed her to a hospital psychiatric ward where the nurses “tried to fix me up with boys” and the psychiatrists “made me feel I was the only one who ever felt love for someone of the same sex.” When her depression continued after her release, her parents again had her hospitalized, this time in a state mental hospital. She was not alone there, she says. She met a thirty-year-old lesbian who claimed “she had been in and out of institutions all her life for being a lesbian. I thought she was the sanest person there.” Similar stories were not uncommon during the mid-twentieth-century.
—  Lillian Faderman, Odd Girls and Twilight Lovers: A History of Lesbian Life in Twentieth-Century America

anonymous asked:

Hello! Totally irrelevant to the context of your blog, but I came across your most recent nail post on my dash and read that you were a psychiatric nurse. I'm interested in the nursing field (I'm a male) and was wondering if you could please give me a little insight on what being a psychiatric nurse is like? How is it different from being a bedside nurse in say, med-surg or ICU? What drew you into psychiatry? Hopefully I'm not bothering you too much with these questions!

When I was in nursing school, about 90% of the students could not wait for the psych clinical rotation to be over (some actively hated it, others were just uncomfortable or indifferent).  But 10% totally loved it, and I was one of those.

It’s not completely unrelated to other areas of nursing— I’m still assessing patients, implementing physician orders, charting like crazy, passing meds, and arguing with other members of the treatment team.  And I do deal with medical problems as they come up (feels like every week I’m examining someone’s hand for possible fracture after they punched a wall).

But it’s also very different from other types of nursing.  One of my major responsibilities is to manage the therapeutic milieu, which is a fancy way of saying that I make sure the hospital setting is as helpful to our patients as it can be.  Are there enough structured activities? Do the kids feel safe?  Is the unit too noisy or chaotic feeling? Who is fighting with who?  Who’s trying to fuck who?  Who needs new shoes, or a notebook, or a special type of shampoo? 

This also involves overseeing our PNAs (psychiatric nursing assistants), and making sure that our whole direct-care team is being consistent and therapeutic in how we interact with patients.  Are we setting the right limits, are we giving enough encouragement, are we maintaining healthy boundaries, do our patients feel heard?  It’s not unlike parenting— we’re teaching the kids we work with all kinds of unspoken things, and we need to make sure we’re modeling the right kind of behavior.  Interpersonal skills are important in all kinds of nursing, but it’s really the bread and butter of psych nursing.

I also do a lot of crisis management.  Maybe two kids are threatening to kill each other and I need to find a way to diffuse the situation.  Maybe someone is feeling suicidal and I need to talk them through that and make sure they don’t have opportunities to act on their urges.  Maybe someone has stripped their clothes off and is trying to break the windows with a chair.  There are not necessarily rules for dealing with the situations that come up, which is different from other areas of nursing. On the one hand this allows for a lot of creativity and independence, and makes my work life feel like an adventure.  On the other hand, sometimes I feel totally lost and have no fucking clue what to do or say.

It’s a meaningful job, but also profoundly sad at times.  It’s an exciting job, but also a draining and sometimes dangerous one.  I know it’s not for everyone, but personally I love it.

Ego Defense Mechanisms

Freud believed the self, or ego, uses defense mechanisms, which are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings or events.

When anxiety becomes overwhelming, the ego reduces anxiety by unconsciously clocking the impulses or distorting them into a more acceptable and less threatening form. This is called ego defense mechanism. Defense mechanisms provide initial protection for the personality because they help reduce anxiety, however, the real problem that caused the anxiety is not addressed and solved, and so, the relief is only temporary.

The ego defense mechanisms are:

  • Substitution - When the individual replaces a goal that he cannot achieve for another that is more realistic and more readily available. (Woman who would like to have her own children opens a day care center)
  • Compensation - When the individual makes up for a perceived lack in one area by emphasizing capabilities in another to maintain self-respect and self-esteem. (Nurse with low self-esteem working double shifts so her supervisor will like her)
  • Sublimation - When an individual transforms an unacceptable impulse, whether it be sex, anger, fear, or whatever, into a socially acceptable, even productive form. (Person who has quit smoking sucks on hard candy when the urge to smoke arises)
  • Rationalization - When an individual unconsciously makes reasonable explanations or excuses to justify unacceptable thoughts, feelings or behaviors. (Student blames failure on her teacher being mean)
  • Conversion - When an emotional conflict is unconsciously changed into physical symptom that can be expressed openly and without anxiety. (Teenager forbidden to see X-rated movies is tempted to do so by friends and develops blindness, and the teenager is unconcerned about the loss of sight)
  • Undoing - unconsciously doing an act of atonement for some wrongful actions done in the past. The behavior, which is the opposite of the earlier unacceptable behavior or thought, is an unconscious effort to correct in the present the wrongdoings in the past. (Person who cheats on a spouse brings the spouse a bouquet of roses)
  • Identification - When an individual models the actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal. (Nursing student becoming a critical care nurse because this is the specialty of an instructor she admires.)
  • Introjection -  When an individual accepts another person’s attitudes, beliefs, and values as one’s own. (Person who dislikes guns becomes an avid hunter, just like her best friend.)
  • Denial - When an emotional conflict is blocked from awareness and the individual refuses to recognize its existence because it is too much for the person to handle at the moment. (Diabetic person eating chocolate candy.) 
  • Displacement - Redirecting emotions or impulse to a safer substitute. (Person who is mad at the boss yells at his or her spouse.)
  • Projection - Unconscious denial of unacceptable feelings and emotions in oneself while attributing them to other. It is the tendency to see one’s unacceptable desires or traits in other people. (Man who has thought about same-gender sexual relationship, but never had one, beats a man who is gay.)
  • Reaction formation - When an individual behaves in exactly the opposite manner from one’s true feelings, desires or thoughts. (Person who despises the boss tells everyone what a great boss she is.)
  • Regression - The person engages in behaviors appropriate at an earlier stage of development when stress creates problems at the present stage. According to Freud, when threatened, an individual retreat to the last time in his life when he felt secured and safe. (Five-year-old asks for a bottle when a new baby brother is being fed.)
  • Repression - Threatening thoughts, feelings, ideas that are anxiety provoking are involuntarily pushed into the unconscious, which cannot be remembered at will. However, the anxiety associated with the repressed memory cannot be forgotten and will be reactivated whenever the person experiences anything that can be associated with the repressed thoughts, feelings or ideas. (Woman who has no memory of the mugging she suffered yesterday.)
  • Intellectualization - When an individual strips emotion from a difficult memory or threatening impulse when talking about it or responding to it. (Person shows no emotional expression when discussing serious car accident.)
  • Suppression - When an individual consciously and voluntarily excludes from awareness those ideas, feelings and situations that are causing discomfort and anxiety. (Student decides not to think about a parent’s illness to study for a test.)

Source: Psychiatric-Mental Health Nursing (Videbeck) & Psychiatric Nursing (Sia)

    mental health nursing thoughts

    I never thought I would end up becoming a psychiatric nurse but I love it. My 1-year anniversary of becoming registered is coming up, and so far a big chunk of my experience has been in intellectual disability mental health. I just moved to acute adult mental health and I learn more and more every day.

    Did I wish I were in med-surg instead? Sometimes. But so far I have absolutely no regrets and I plan on sticking around for a while. 

    So far I’ve learned to leave all the shit at the door, and to trust your fellow nurses. A good team makes such a big difference and they will be the ones to help you through the tough times whether it be personal or professional <3. 

    Just dropping some info about a survey on BPD

    Deans and Meocivic (2006) asked 65 registered psychiatric nurses in Australia to complete a 50-item questionnaire concerning their reactions to people diagnosed with borderline personality disorder (BPD). A majority of the respondents indicated that they considered BPD patients to be manipulative (88%) and engaging in ‘‘emotional blackmail’’ (51%). More than one in three (38%) saw them as ‘‘nuisances,’’ with 32% indicating that BPD patients made them angry. Relatively few nurses felt that patients with BPD were fascinating (21%), charming (13%), or fun to work with (11%). A study of 65 psychiatric nurses in Ireland by James and Cowman (2007) produced similar results. Three quarters (75%) agreed that they found clients with BPD very or moderately difficult to look after and 80% agreed that BPD clients are more difficult than other clients.

    anonymous asked:

    Is it bad that I want to like Tamlin again?

    No. I like him as a character. I think Feyre should stay the heck away from him, but he’s not a lost cause. There was ZERO evidence to suggest he couldn’t change. He’s not all bad. He was an ass in the first book, had a bit of PTSD he wasn’t properly dealing with, and then after UTM, he just crashed. And his trauma ate him alive and there was no one qualified around to help him. Same as there was no one qualified around to help Feyre or Lucien, right? Tamlin needs help. And he has to want to help himself to be able to get the help he needs. (I’m related to a psychiatric nurse practitioner who read the books and I’ve picked her brain about Tamlin many times.)

    He’s not a bad guy. He has done bad things. But to reduce him to just being a bad guy or an abuser is to lack a fundamental understanding of mental illness and trauma.

    And that’s hard for people, to walk in someone else’s shoes or to see the situation from their perspective. It’s kinda like when Mark Wahlberg said if he’d been on that 9/11 flight it wouldn’t have gone down. It’s easy, and comforting, to think that we would have acted differently, that we could have altered the outcome somehow. But that’s a beautiful, ignorant lie. Because we can never know. And It’s easier to judge other people for wrongdoings or for what they did or didn’t do than to consider the alternative—that we would have done the same thing.

    So if you ask me, Tamlin gets to come back from what he did. We always get to come back. (Unless you have a personality disorder, which Tamlin doesn’t have.) But we have to do the work, and we have to own what we did and suffer the consequences of our actions. If I were Feyre, I’d forever stay the hell away from him. And if she were my friend in the real world, that’s the advice I’d give. But that doesn’t mean Tamlin doesn’t get to be saved too. And it doesn’t mean that he can’t learn from his actions and change. We get to come back. Always.

    I think to be a good mental health nurse, councillor ect… You don’t have to be non-judgemental. In fact you can be the most judgemental, opinionated, extremist person on the planet. You just have to look and sound non-judgemental.

    Someone will tell you they burgled a vulnerable old lady. She only had a twenty pound note in the house, and that pissed them off so they punched her in the face on the way out, hoping she died. Someone tells you the only thing that turns them on is the thought of strangling a woman until she stops breathing. Another will tell you they already did that, to their 10 year old daughter.

    You probably have strong feelings and things you want to say to this person. If you didn’t, I would be concerned. But you don’t say anything. You don’t even have to try and empathise with them. You take all your thoughts about this person and lock them in a box labelled ‘My thoughts.’ They stay in the box, and you can be someone else.  

    Now speak to these people like how you would like to be spoken to. And listen, actually listen. Don’t just wait for your turn to speak.