Saturday, October 6, 2012

Week 3 to 5 of Semester 5

Emotional Burden
This semester so far has been a difficult one.  Studying about mental health is new to me and often very demanding on an emotional level.  The wards are wandered by tortured and lost souls.  Many weep inside because of lost ones, difficult moments, lost opportunities, histories of abuse... many of the patients are suffering.

Unlike other wards, I can't give them a pill to make the pain go away.  Their pain is much more difficult to soothe.  I sit with them, talk with them, and listen to their stories.  My heart is often heavy as I hear how much they hurt inside.  Sometimes they are not suffering from depression; sometimes they have an illness like schizophrenia or bipolar disorder.  Unfortunately, the end result of these illnesses is still often suffering.

Most people don't know what to do when someone has a mental illness.  So people with mental illness tend to get the short end of the stick with jobs, education, relationships, etc.  That's not to say that they don't achieve these things; they often do.  It's just that, when I see them, they have hit a rough spot.

Some days, I go home and I feel sad.  I wish I could do more, say more, sit for longer, care better, etc.  I spend time thinking over how I could have done things differently or what I could do next time to make things better.  When I get back to the ward the next week, however, they are often gone or I am assigned different patients.
Who's Responsibility Is This?
My teacher taught us that nurses often feel responsible for their clients.  When things go wrong, they feel bad and as though they have not done their job properly.  She said that it was okay to feel bad for the clients, but that we should not feel responsible for them.

She drew a pie chart and called it the responsibility chart.  She began to divide the chart into wedges.  For example, family played a part in how the client turned out, the people that abused the client played a part, the health care system, society, friends, work, environment, choices made, and the list goes on.  She asked us where we fit in.  We agreed that nurses were part of the health care system and society.  However, we ourselves were just teensy lines in the wedges because other people also played parts in those wedges.

As just teensy parts of the responsibility chart, she pointed out that if we did our portion well, then our job was done.  We did not have to feel responsible for the entire pie chart.  If we did feel that way, then we would get burned out.  She cautioned us against taking on too much responsibility on an emotional level.  It was better to step back once in a while to re-examine the pie chart so that we could be better aware of when we took on too much.
Do Your Job
She also cautioned us against overstepping our boundaries in other ways.  She said that nurses have a lot of power over patients because we see them in some of their most vulnerable moments.  She didn't want us to abuse our power.

For instance, one day we will meet patients that have done terrible things.  As nurses, we have the power to control how much pain medication they get, how we treat the patient, and how much attention we give to them.  We could technically give a bad person less pain medication as a way to punish them.

My teacher says that we need to remember that we are not judges and we are not policemen.  Our job is not to judge or to punish.  Our job is to care.  So when a bad person comes to the hospital, we have to treat them with as much respect and care as a good person.

This is no easy task, so she taught us to avoid as much media information as possible (regarding that patient), to rehearse before meeting the patient, and to always ask ourselves, "If this was any other patient, how would I act? How would I treat them? How much pain medication would I give them?"
The teachers are trying to help us with developing better ways of coping.  It's good because I often feel overwhelmed by how much hurt is on the mental health ward.  My teacher at clinical said that it was fantastic that I was able to connect so well with my clients, and that I was so open to listening to them and helping them.  However, he cautioned me to be extra careful with taking care of myself.  He said that it would be easy for me to get burned out if I wasn't careful.

I feel a little warm and fuzzy from the praise, but the warning hits home too.
To help me cope so far, I have taken up some new/old little habits.

  1. Petting Poggles - I discovered that I become very calm when I pet Poggles.  He is very sensitive to my emotions because he is such a terrified little fellow.  So I think I have learned to calm myself down when I am around him.  I talk soothingly to him, sing him little songs, and move slowly and gently in touching him.  I enjoy the time interacting with him.  I try to make it a positive experience for him and the focus on making it positive for him means that I have to think of good things that would  make him happy.  
  2. Painting pets - a girl on the hedgehog forum asked if someone could paint her hedgehog for her.  I volunteered.  What started as something nice for her turned into something nice for me.  I discovered that I loved painting in digital watercolour.  It's a nice break for me and it makes someone else happy too.  So now I take breaks and paint pets  :)
  3. Eating stuff in the garden - I've been lazy with tending the garden this year, but the garden has been growing anyways.  I love going outside and picking tomatoes to eat, picking beans to cook, picking blueberries, raspberries, strawberries... it's fun!  One of my favourite things lately has been finding hidden beans.  I have some densely growing sugar snap pea plants and impatiens have grown up and hidden many beans.  It's fun to peek in the flowers to find them.
Almost Over
My mental health rotation is almost over.  Next week will be my last day there.  Will the last day be able to convince me that I should work in mental health one day?  

Right now, it seems too hard.  There is honestly less of the typical work on a mental health ward to do.  The patients tend to be pretty healthy aside from their mental illness.  That means less medications to give out, no wounds to clean so far, no bathing/toileting, no beds to even make... I'm basically getting rusty in all my usual nursing skills.  

Despite hardly any of the usual bustling around, mental health nursing seems like hard work.  I know that my teachers say that I'm helping by talking to them, spending time with them, and listening, but I just don't feel like I'm doing anything.  There isn't anything really tangible to help me identify success in my work.  On the surgical ward, I can watch a wound heal after days of cleaning it.  Here, the wounds are invisible.

I wish I could say something positive and enthralling, but I just don't seem to be able to wrap my brain around mental health nursing yet.  So many things frustrate and confuse me.  I could go on for days about it.

For now, I guess, I'll just keep plugging along.  

Have a happy Thanksgiving!
My Nursing School Diary


John Toft Basketry said...

vanyIts been a long time since I have visited your blog or others I follow. Thanks for your heartfelt insights about working on a mental health ward. Go where your feelings take you.

I was raised on the estate of a mental hospital in England where my father worked as a baker. One summer job in my university years was as an aid on what was called "The Idiots' Ward." (No politically correct phrases then.) It was a nightmarish experience, but rewarding too. I appreciated my father;s work with the ten or so "lads" that helped him make bread for the 1500 or so patients. His bakery was a safe work envirnment for them.

Good luck in choosing where you will go in your nursing career, Take your empathy with you said...

Hi John, thank you so much for your comments. I really appreciate that you stopped by, and I found your account of your history in a mental hospital in England really interesting!

I would love to hear more about it!

Was "Idiot" in reference to a specific mental illness? What made it so nightmarish for you, but also so rewarding? The patients worked in the bakery with you?

Thank you for your well wishes and I wish you well too!

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