Sharon is a 47 year-old female who was in and out of the hospital (like a revolving door) two to five times a year. This started in her early 20’s and continued through age 40, which is when she was admitted to Access Healthcare for psychiatric home care nursing.
In the past six and a half years Sharon has only had one inpatient admission, which was a voluntary admission of six days. In the past, she would generally decompensate so badly that law enforcement would put her on an inpatient 72 hour hold status, and the stays were generally weeks rather than days. She proudly proclaims that her psych nurse has taught her to take care of her mental illness.
Donna
Donna is an 82 year-old woman who has used alcohol most of her adult life as a coping skill. Historically, when she was upset she would binge drink. She has been seen by a psych nurse for six and a half years. She has been taught healthy coping skills, stress management, and the use of positive self-talk rather than binge drinking. At a recent visit, she was asked, “Donna, have you done any binge drinking lately?” she replied, “No, thanks to the psych nursing I don’t have to drink anymore. I have ‘skills’ for the first time in my life.”
Mr.B
Mr. B is an eighty year old man with a diagnosis of paranoid schizophrenia and DM II. He was living in an assisted living apartment in rural Minnesota. His behaviors escalated and he was sent to the hospital. From there he was sent to a facility which could provide a higher level of care. He then was discharged back to the assisted living apartment, with a request for psychiatric home care nursing visits. When I first met Mr. B, he was irritable and angry about what he had been through. He refused to allow me to set up his meds, or take his antipsychotic medication. I had his case manager come to my next appointment with him. She explained to him that he needed to continue with home care services to be able to stay in his apartment.
My next appointment with him started with him being tense and yelling about how he had been treated- referring to his hospitalization. I told him that he sounded angry and asked if I should leave. He quieted down and apologized for his behavior. He continued to refuse med set up- I did finally get him to tell me why. “I have a hard time opening those med boxes, then I spill the meds and can’t find them with my eyesight being so poor.” I asked him if he thought that if I had seven pill bottles with the day in large print if he would let me set up his meds in that. He agreed to try this and came to like having me set them up. He continued to refuse the antipsychotic medication due to the side effects from it and it was discontinued. His behaviors have remained stable since his hypertension and diabetes are well controlled. The occasional outbursts which occur during my appointments are easily de-escalated by listening to his concerns and working with him on a plan to address the concerns.
Mrs.P
Mrs. P. is sixty four years old. She has borderline personality disorder, DM II, depression, and manic episodes. One of her coping mechanisms was to pick at the skin on her feet until she would have open areas. These areas would become infected, putting her at risk of becoming septic, or needing an amputation. She would minimize the problem- “they are not that bad, they always heal up”. She was unable to see how deep and bad these areas looked. With her permission, I took photos if the areas with a digital camera. I then showed her the pictures. She was shocked at how bad the areas were. I continued to take pictures at each visit so she could see if they were healing, or if they were looking worse from picking. She has been able to go for longer periods of time without resorting to picking- she has developed other coping mechanisms.
She can be manipulative and tries to pit her PCAs and homecare nurses against each other. I have set firm boundaries with her- letting her know that she either needs to talk to the person or their supervisor about her complaint instead of attempting to have staff “take sides”. She has tried to give me presents and to be my “friend”. I let her know that I can’t accept things and that this is a professional relationship, not that I am a friend who comes to visit. She has come to respect me for setting these boundaries, but still has to test me periodically.
