Psychiatric Nursing Reflective Journals: Experience with Paranoid Schizophrenia - Essay Example

? Psychiatric Nursing Reflective journals Psychiatric Nursing Reflective journals Psychiatric Nursing Reflective journals Day An experience with Paranoid schizophrenia Mrs. Jones, 33 years old, had been admitted for paranoid schizophrenia. Recently she had been hearing “voices which were controlling her”. The other day I had noticed that she was tense generally but reserved in that she did not communicate freely. Her attire was unkempt and she seemed oblivious to the activities in the ward. I had to slowly coax her into having a bath and a change of clothes. She appeared inattentive to my instructions and needed three repetitions of what I had said for her to understand me. When she had obeyed my instructions, I admired volubly her pretty appearance and hugged her. To my queries, she had just stared at me as if she was scared but today she called me up. Seizing the opportunity, I moved up. Nervously pulling me to her side and looking around to ensure that nobody was within hearing distance, she whispered in my ear. Her neighbor was plotting to kill her and her husband, it seemed. She had heard noises from her backyard which sounded like gunshots when she had been in the kitchen at home. Her movements appeared jerky and speech was not incoherent but appeared monotonous. Realizing that her suspicious and guarded nature was characteristic of her condition, paranoid schizophrenia, I pretended to be a good listener to gain her confidence. She claimed that the neighbor of around her age was attracted to her and was eyeing her sexually. Several times he had approached her for sexual favors. She had told her husband about this but he did not believe her. At times the neighbor had thrown stones at her house when she was alone and had rung the doorbell several times. Each time she went to the door, there would be no one. Saying all of this at one go, she quickly pushed me aside when she noticed the nursing supervisor arriving. When the supervisor had left, Mrs. Jones again strode up to me and caught my attention. She told me that her husband was a good man but he did not believe her stories and told me to keep what she told a secret. Half an hour later, Mrs. Jones did not appear to want to talk with me. When I smiled at her, she seemed to have no recognition. I was a little taken back by the stony look on her face. Her husband had told me that she was a receptionist in a hotel and very much appreciated by the others and customers. Believing that she was then well, she had stopped her treatment. He had not noticed the medicines not being taken. This had triggered this episode. She had also not kept her appointments with the psychotherapist. Anyone would have believed this lady the way she told the stories. They would have been credible had they come from a normal person. The fact that she was admitted for paranoid schizophrenia reminded me that the stories could be delusions. Though I had studied about schizophrenia and its various forms and symptoms, this was the first time that I was in close contact with a person with schizophrenia. Having no physical deficiencies, Mrs. Jones could easily pass on the road without anyone realizing the depth of mental illness that she had, the extent of trouble that she could create and the magnitude of suffering that she went through. What she needed was sympathetic people around her and proper pharmacological and psychological treatment. A person who did not know her to be a patient could even irritate her unknowingly. This was the situation for most psychiatric disorders. When we were taught psychiatry, we never realized that most psychiatric patients became ill only occasionally and that most of their lives; they were presumably fine and able to work like Mrs. Jones. Treatment allowed them to be a part of normal society. However the treatment schedules should never be missed. I also noted that psychiatric patients should never be allowed to consume drugs without supervision. A family member had to take responsibility. This was another of my new learning. It would serve me well to remind the family that they were to be responsible for the medicine consumption for all psychiatric patients on discharge. It could prevent most of the episodes of mental illness and hospital stay. Follow-ups with the psychotherapist were equally essential. Had Mrs. Jones complied with these requirements, she would not have been here. Day 2 What I learned from Peter Peter Simon is the patient being treated for major depression on my duty. The poor boy tried to commit suicide in the afternoon and nearly lost his life after my duty hours. The patient in the neighboring bed was voluble about what had happened. This patient, also with depression, gave a minute-to-minute account of what had transpired. It seems that Peter was complaining about leg pain and was upset that the analgesic had not worked. The patient in the next bed appeared to have given him some advice to sleep it off. Peter tried sleeping but kept turning over and over in his bed. The other patient dozed off and it was when the nurse on duty made her rounds found Peter bleeding from his left wrist that everyone knew that something had happened. The neighboring patient immediately suggested that Peter may have been upset by the visitor in the evening. Peter was a little weak after the incident. Fluids were started; stitches were put and the necessary medication given. The therapist was notified. This incident has taught me that the psychiatric patients may make seemingly insignificant comments which may not have mattered in any other ward or produced any follow-up events but which become significant in this ward. He had actually told me that he had severe pain in his leg; I had failed to read into it. He had already made 10 suicidal attempts prior to admission. Had I been aware that the pain could have been imaginary, I would have understood that he was sickening for something worse which could be a suicidal attempt. This strange experience taught me to be more vigilant in my duties and that I had to learn a lot more before becoming a competent professional. Psychiatric patients are emotional and their every remark could be made with the patient thinking about something else or planning ahead. Closer and better interpersonal relationship could warn one of impending disaster. That “suicide is a preventive act” is a sentence that has to be written in capital letters in my head. Another possibility that could be involved is the fact that there must have been a triggering factor for the suicidal attempt. The pain experienced could also have been as a result of self-harm. I had failed to investigate in detail about the pain. Though I had given him an analgesic tablet, I realize now that the pain could have been imaginary or due to some harm inflicted by himself; both features increasing the risk of a suicidal attempt. An additional reason could have been the low socio-economic surroundings that he comes from. I should have diagnosed the risk of suicide in Peter and made attempts to find the root cause and worked towards improving his mental well-being. He had cut his wrist with his razor. As he had a history of previous similar attempts, this sharp instrument should have been kept away and made available when he needed it. I should have recognized the risk for suicide and reported it to the doctor who treated him and made a note of it in my handing-over report. This would have made the next duty nurse more vigilant and Peter would have been given additional medicines. I learned today to be extra vigilant in the psychiatry ward. Every word, every move or gesture by the patient could mean something. A patient diagnosed with major depression ran the risk for suicidal attempts and though I knew this fact, I had not applied it to Peter. Such a mistake would not be coming forth from me in future. Peter also would probably resort to the same method for suicidal attempt in future. This point will be noted in his discharge paper and his family would be warned. Today’s reflection will influence me a great deal in my nursing skills. The next time I have a depressed patient, I am going to extract sufficient details about his depression and suicidal attempts so as to be fore-warned about the risks he could face in the ward. Day 3 What Tom had taught me Tom was a patient in my ward who had schizophrenia. When I met him I found that he was a little different from the other schizophrenic patients. He was active but his actions did not appear to be with any aim. There was no motivation for his activity. I had seen him walking to the nurse’s station and then suddenly going back. This was repeated several times and he did not seem to know why when asked. The others nurses commented that he never smiled or reacted with pleasure when praised. He had hallucinations and delusions like the other schizophrenic patients. However he acted strange and silly at times and had problems with verbal speech unlike the others. That day when I saw him, he was actually going on repeating certain words. I left him to his practicing verbal skills. On reading up my lecture notes, I understood that Tom had the variety of schizophrenia known as disorganized schizophrenia. This accounted for the strange behavior and speech problems. Disorganized schizophrenia required a continuous lifelong therapy and was a fairly serious condition which needed a skilled psychiatrist and a team including the family doctor, psychotherapist, psychiatric nurse, family members and social worker. Treatment options were medications, psychotherapy, hospitalization, electroconvulsive therapy (ECT) and vocational skills training as for other schizophrenias but the treatment approach had to be specific for the patient. Psychotherapy could be individual or family therapy. I learnt that strange behavior and speech problems could be actually a part of a kind of schizophrenia. It also struck me that reading my lecture notes in connection with a patient in the ward, I am able to apply better and also remember better my theory. My approach towards the patient would be several times more competent too. Day 4 Instructions at time of discharge of a depressed patient Peter was going home today after his eventful stay. When I arrived in the ward, his friend informed me that Peter was looking forward to going home as he had been discharged. He had made plans to catch up with his music lessons as he loved them. When he became depressed, they were the first to be stopped. Peter was smiling and conveyed the impression that he was much better. The significance of Peter going home struck me and I realized that this was the time for me to educate his family members and make arrangements to educate the colleagues at Peter’s jobsite. The family was receptive to my moves. They agreed with me that the stigma of mental illness should never affect people like Peter. Social inclusion would help them associate with the neighborhood community. They also realized that help should be sought early to prevent the risk of going deep into depression. Peter needed to be given medicines by one of them and he should not be allowed to do it himself. Peter was informed about the therapy he had to undergo which could be cognitive behavioral therapy or a short problem-solving therapy or interpersonal therapy. The therapist met Peter and arranged sessions with him. Good mental health needed to be promoted through community programs and support. These services had been considered to be better than hospital- based services. Risk for depression episodes needed to be prevented as much as suicides. The family had to be able to identify the suicidal thoughts by becoming emotionally close to Peter. Peter had a tendency to indulge in suicides and needed to be watched. The family members were to be warned against abusing Peter or being harsh with him. Peter’s low self-esteem at his workplace and conflicts with the others needed to be eliminated by educating the colleagues at his workplace. Workplace interventions helped reduce the depressive episodes and suicidal incidents and produced a healthy working environment. Peter needed to be encouraged to participate in community events. I understood that no stone was to be left unturned to allow Peter to have lesser episodes of depression and suicidal attempts. The community and workplace were to be made harmless to Peter as their influence was of a high level. Education was the best method to keep the community informed and workplace environment healthy. I shall be using the experience with Peter to other situations with depressed patients and psychiatric patients in general. Read More