Most of the time, I get emotionally touched when families come in my office requesting for information about our services. Who wouldn’t? It is true that our Hospital is not very well known in the area. In addition to being referred to as “a place where mad people are treated”, it would make sense why people don’t know “exactly” what is going “in” there. Some family members, after giving the information about our services, the first question they ask is: “do you think my son/daughter can change?” This is a fundamental question not to ignore. And the parents are really serious when they ask this type of question.
Two weeks ago, I was exchanging with one parent who was telling me about his son who had turned into a drug abuser for more than 4 years. This poor mother had tried all means to help his son, but nothing had worked. Fortunately, she didn’t get hopeless. After hearing about our hospital, he turned to us hoping that we could “change” his son from being a drug abuser into being a good boy again. At the end of the exchange I told her something that she seemed not to like. “We don’t have magic power to change people”. Even though she didn’t like it, I couldn’t put it in another way to make it sound better. This is the reality. I continued telling her that “we don’t change people”; however, we “integrate them”; we help them realize their potential; we help them regain their capabilities; we provide them a milieu to set up new goals in life; last but not the least, we help them to correct what is “off beam” in their behavior and their way of acting and reacting.
For the last 6 years we have had another patient who kept coming back to our hospital because he couldn’t follow correctly his treatment. After a long investigation of his case, we finally figured out that the really problem lied in the family. His family had not arrived at a point of accepting this patient as the way he is. They had wanted their brother to change, but not to change themselves. What do you do when you can’t change it? May be you change the way you look at it, the way you think about it…He couldn’t be changed. They only needed to accept him, understand him, and integrate him. At the hospital, this patient was perfect; yet, at home, he was different. What did we do? No magic! We had to tell this family that they couldn’t change their brother; what they needed to do was to change their home ambiance: their way of loving him, of interacting with him, of talking to him, of listening to him…
Is that they way it is? – No, you can do something to make it better, accommodating, and acceptable. On the other hand, - Yes, at some point, you can’t change the way the person is. Sometimes we tell people, “this is the way we do it, go and do the same at your home, then you will see the change you need”. We have tried to find ways to involve actively family members in our care, to make them understand that we can’t do it alone. In psychiatry we don’t treat the patient, we treat the family. It is like a coin one side being the patient and the other, the family. You can’t take one side without the other. That’s the way it is.
Jean-Clement, RN, BSN
Sunday, October 31, 2010
What matters - 2nd part
Little by little Mr Laposte became a person of attention to everybody, staff as well as residents. Everyone seemed to observe him, not that he was a really “stranger”, but mainly, because everyone wanted to be the first to observe the change in him. It was like a parent waiting to see his baby making his first step, or to hear the baby making his or her first word. It is a memorable moment. Time passed, and Mr Laposte was not showing any improvement. However, we remained patient.
After a certain period, Mr Laposte started showing some signs of improvement. Mr Laposte accepted to put on clothes. Though he could not do his laundry, he showed that staying naked was not an option. Obviously, he saw that everyone did the same; so, why not him. Mr Laposte was on medication called “Orap” a neuroleptic medication mostly given to chronic schizophrenic patients in this situation. Something that touched the staff was a certain behavior that could be observed on a daily basis. When everybody was away, after eating, Mr Laposte could come to the refectory to watch TV, alone! This was something. Nobody dared to disturb him. In addition, though he couldn’t eat together with others, he would bring his plate back after eating for washing.
The staff spoke to him, but he never showed a sign of understanding what they were talking. However, they never got discouraged. They tried to speak in all possible local languages to see if he could get any word. But, silence was the reign! He was once shown a room where he could sleep, but he had refused to stay in. At some point, during the day, he could walk around the building to explore inside through the windows as if something was interesting in there. As we observed all these actions, we were getting really excited that Mr Laposte was becoming another person. Hope started showing up. What we didn’t know was that Mr Laposte was going to reveal his real name, to speak with his comrades, and to be the person to join others in the refectory, to have a bed in the room, and to do his laundry. How it happened?
Read our 3rd part to find out.
Jean-Clement, RN,BSN
After a certain period, Mr Laposte started showing some signs of improvement. Mr Laposte accepted to put on clothes. Though he could not do his laundry, he showed that staying naked was not an option. Obviously, he saw that everyone did the same; so, why not him. Mr Laposte was on medication called “Orap” a neuroleptic medication mostly given to chronic schizophrenic patients in this situation. Something that touched the staff was a certain behavior that could be observed on a daily basis. When everybody was away, after eating, Mr Laposte could come to the refectory to watch TV, alone! This was something. Nobody dared to disturb him. In addition, though he couldn’t eat together with others, he would bring his plate back after eating for washing.
The staff spoke to him, but he never showed a sign of understanding what they were talking. However, they never got discouraged. They tried to speak in all possible local languages to see if he could get any word. But, silence was the reign! He was once shown a room where he could sleep, but he had refused to stay in. At some point, during the day, he could walk around the building to explore inside through the windows as if something was interesting in there. As we observed all these actions, we were getting really excited that Mr Laposte was becoming another person. Hope started showing up. What we didn’t know was that Mr Laposte was going to reveal his real name, to speak with his comrades, and to be the person to join others in the refectory, to have a bed in the room, and to do his laundry. How it happened?
Read our 3rd part to find out.
Jean-Clement, RN,BSN
Friday, October 29, 2010
News at MSP
Most everyone at MSP today is rejoicing, but not everyone of course. Due to the presidential elections expected this Sunday, the 31st October, this Friday was declared a paid holiday on the whole territory of the country. Which means, no work! What else can we rejoice for? In addition to this Friday, Monday is another holiday of the Church, the All Saints. For some staff members, the weekend will take 5 day without without working. We wish them a wonderful break.
However, break is never a break, especially for the Brothers who are permanent at the hospital. There are always people knocking at the door, bring patients who can't wait for this long weekend to be over. We try to do all to accommodate them even if we can't provide full care.
During this month of October, the MSP has been grateful to welcome 4 novices from NDI (Notre Dame de l'Incarnation) sisters who were doing their practical training following their canonical year. We wish them a fruitful formation.
We are expecting Brother Felicien, the Director, to be back by the next week to take over his responsibilities after a month of holiday.
Jean-Clement, RN, BSN
However, break is never a break, especially for the Brothers who are permanent at the hospital. There are always people knocking at the door, bring patients who can't wait for this long weekend to be over. We try to do all to accommodate them even if we can't provide full care.
During this month of October, the MSP has been grateful to welcome 4 novices from NDI (Notre Dame de l'Incarnation) sisters who were doing their practical training following their canonical year. We wish them a fruitful formation.
We are expecting Brother Felicien, the Director, to be back by the next week to take over his responsibilities after a month of holiday.
Jean-Clement, RN, BSN
Friday, October 22, 2010
News from MSP
Everyone is doing fine at MSP. Apart from the rain season that is beating us now, everyone is doing his best to provide the best care. Br Felicien is attending the training in Belgium and we wish him all the best.
What matters
Mr Laposte, as he was named because he was found near a post office, was one of our residents who inspired MSP in its delivery of care. When Mr. Laposte was brought to MSP no one has thought that he would later on reveal his really name, his family and become part of his family again. This process took more than five years, five years of transformation, five years of patience, and five years of love.
Mr. Laposte was found naked near the post office, in the city of Yamoussoukro where he has been rooming for a period that no one knows. According to the public, he was first seen since his younger age. Mr. Laposte could have been grown up in the street where he was left by his family who didn’t want of him. Left alone with no one to take care of him, he became vulnerable of any danger from diseases to accidents that he was not able to avoid. While young, a vehicle passed over his arm which was left broken.
As he arrived at MSP, Mr Laposte was given a full shower (which he didn’t enjoy at all) and was given clothes to cover his body. Few minutes later, he removed all clothes because he preferred to remain naked as he has been for long in the streets of Yamoussoukro. This was his norm. He never dared to join other in the eating room. Eating normal food was only for aliens. He preferred uncooked food. From his side, I guess he looked at us as strangers; on the other hand, we looked at him as a stranger. He refused to enter into any room; he refused to eat any cooked food; he refused to put on any clothe; and, finally, he refused to speak any word to anybody.
Inside Mr. Laposte there was a human being who needed care, love, and patience to reveal himself.
Follow us next for the 2nd part
Jean-Clement RN, BSN
Mr. Laposte was found naked near the post office, in the city of Yamoussoukro where he has been rooming for a period that no one knows. According to the public, he was first seen since his younger age. Mr. Laposte could have been grown up in the street where he was left by his family who didn’t want of him. Left alone with no one to take care of him, he became vulnerable of any danger from diseases to accidents that he was not able to avoid. While young, a vehicle passed over his arm which was left broken.
As he arrived at MSP, Mr Laposte was given a full shower (which he didn’t enjoy at all) and was given clothes to cover his body. Few minutes later, he removed all clothes because he preferred to remain naked as he has been for long in the streets of Yamoussoukro. This was his norm. He never dared to join other in the eating room. Eating normal food was only for aliens. He preferred uncooked food. From his side, I guess he looked at us as strangers; on the other hand, we looked at him as a stranger. He refused to enter into any room; he refused to eat any cooked food; he refused to put on any clothe; and, finally, he refused to speak any word to anybody.
Inside Mr. Laposte there was a human being who needed care, love, and patience to reveal himself.
Follow us next for the 2nd part
Jean-Clement RN, BSN
Monday, October 11, 2010
Service Nursing à la MSP -1-
L’équipe de nursing répond à trois types d’activités :
1. Fonctionnement de service médical et paramédical
Ce sont les membres de l’équipe Nursing qui font tourner le service surtout la gestion quotidienne. L’équipe prend en charge le fonctionnement et l’organisation du service en se préoccupant des dimensions humains et scientifiques (gestion des lieux d’hospitalisation, la logistique en produits de nettoyage, l’intendance et l’accueil (secrétariat), administration des soins nursing et médicaux, des rapports humains et interpersonnels, hiérarchique institutionnels.
2. Activités et intervention globale
Les membres de l’équipe nursing assurent la prise en charge de l’accompagnement psychosociale de toutes les personnes hospitalisées dans la MSP sans aucune distinction. Il s’agit d’une prise en charge collective de personnes ponctuée. Les soignants gèrent la vie des résidents attentifs aux situations individuelles des personnes hospitalisées. Cela se manifeste dans leur esprit d’écoute et d’observation des résidents en vue de dépister à temps les effets secondaires induits par les neuroleptiques. Toutes les interventions pour le bien des résidents doivent être rapporter dans un cahier d’échange d’information pour une meilleure continuité de prise en charge et d’assurer la cohérence dans l’information. Les informations sont communiqués oralement ou par écrit (affichage).
3. Les activités et innervation de soins individualisés
Les membres de l’équipe nursing appliquent aussi des prises en charge plus individualisés dans le cadre de l’application du système de référence et de recouvrement de rôle ; c’est une dimension thérapeutique centrée sur la relation particulière soignant – soigné initiée dès l’admission du patient.
Dans le cadre de cette fonction, le soignant prend en considération individuellement la personne (résident) dans son circuit hospitalier, l’apprendre les bonnes manières facilitant son adaptation dans ce nouveau milieu.
En grosso modo, la personne au référence est une interlocuteur privilégié pour la personne hospitalisée, son entourage (famille) et surtout fournir les informations à l’équipe de nursing et pendant la réunion pluridisciplinaire.
Aussi le référent joue un rôle intermédiaire entre la famille et les partenaires sociaux du résident ; ce qui maintien un relais institutionnel pour faciliter les formalités administratives et financières.
A continuer...
1. Fonctionnement de service médical et paramédical
Ce sont les membres de l’équipe Nursing qui font tourner le service surtout la gestion quotidienne. L’équipe prend en charge le fonctionnement et l’organisation du service en se préoccupant des dimensions humains et scientifiques (gestion des lieux d’hospitalisation, la logistique en produits de nettoyage, l’intendance et l’accueil (secrétariat), administration des soins nursing et médicaux, des rapports humains et interpersonnels, hiérarchique institutionnels.
2. Activités et intervention globale
Les membres de l’équipe nursing assurent la prise en charge de l’accompagnement psychosociale de toutes les personnes hospitalisées dans la MSP sans aucune distinction. Il s’agit d’une prise en charge collective de personnes ponctuée. Les soignants gèrent la vie des résidents attentifs aux situations individuelles des personnes hospitalisées. Cela se manifeste dans leur esprit d’écoute et d’observation des résidents en vue de dépister à temps les effets secondaires induits par les neuroleptiques. Toutes les interventions pour le bien des résidents doivent être rapporter dans un cahier d’échange d’information pour une meilleure continuité de prise en charge et d’assurer la cohérence dans l’information. Les informations sont communiqués oralement ou par écrit (affichage).
3. Les activités et innervation de soins individualisés
Les membres de l’équipe nursing appliquent aussi des prises en charge plus individualisés dans le cadre de l’application du système de référence et de recouvrement de rôle ; c’est une dimension thérapeutique centrée sur la relation particulière soignant – soigné initiée dès l’admission du patient.
Dans le cadre de cette fonction, le soignant prend en considération individuellement la personne (résident) dans son circuit hospitalier, l’apprendre les bonnes manières facilitant son adaptation dans ce nouveau milieu.
En grosso modo, la personne au référence est une interlocuteur privilégié pour la personne hospitalisée, son entourage (famille) et surtout fournir les informations à l’équipe de nursing et pendant la réunion pluridisciplinaire.
Aussi le référent joue un rôle intermédiaire entre la famille et les partenaires sociaux du résident ; ce qui maintien un relais institutionnel pour faciliter les formalités administratives et financières.
A continuer...
Saturday, October 2, 2010
What makes psychiatry challenging, but also exciting...
Tuesday, the 28th September, 2010
It is Tuesday, holah! I love Tuesday for the main reason that I can have extra 30 minutes of sleep. As you can realize now, I love sleeping, something normal for a new grad. Anyway, on Tuesday I wake up at 6h30 am, do my morning prayers for 15 minutes before breakfast, which at this time takes about 20 minutes before morning change of shift staff. It is almost the same game every Tuesday morning. This Tuesday is a little special though. I have on my agenda two delegations to make: sending blood sample to the lab and renewing a prescription of one patient who is usually followed by another clinic. I have in my mind the person I have to send; however for some reasons, this person is not there. For confidential reasons, I have to do it by my own. In addition to the appointment I have planned to meet with some parents, I am trying to see how to accomplish all those plans in my morning schedule.
After the staff I usually have my meeting with the nursing staff to give the tasks and assign patients. After the staff, I delegate one nurse to do blood draw as I do the rounds to patients.
At 9h30 AM, I am off to the clinic for blood analysis and renewal of the prescription. This is somewhere 12 km away from our hospital. The interesting and at the same time sad part is that it took me the whole morning to be ready with those two activities. In some general clinics, you have to wait till you get tired! Emergency in your eyes is not always emergency in his/her eyes.
It is noon already and I am back at the hospital. As I arrive, two parents are waiting for me to discuss about financial difficulties they have. At the same time, I am tired and hungry as my lunch time is nearing. It has been hard to make it always at the table. After receiving the parents I close my office off to take my break. It is about 1PM.
At 2:30PM I am back in my office. Together with the pharmacist, we are creating a program to facilitate a good inventory of medications. As I mentioned ahead, one of my responsibilities is to supervise our pharmacy, to make sure that everything is being done in order.
It is already 4PM, and in five minutes I have a staff meeting together with the day shift and night shifts to exchange the activities of the day. Today, the meeting goes on till 4:30PM and everyone is getting ready to go home. As I return to my office, I remember that I had to go the general hospital to take the results of the labs and then pass to the pharmacy in the city where to usually take our medications. This usually doesn’t take too much time.
At 6:25PM I am back at the hospital with medications. As I enter the pharmacy, one nurse comes to me to inform about one patient who had refused his evening medication and aggressive and now who is being held in the isolation room because of an attempt to escape. The nurse asks me what to do…I prepare myself to call the physician and ask her to prescribe something. As the phone is on the voicemail, I inform the nurse to continue the observation for another 2 hours to see if the patient will calm down.
It is 7:15PM; I am sitting at the table starting my supper. Five minutes later, the nurse on the night shift calls me for another patient who can’t be found anywhere. So what? He just escaped! It is night and nowhere can he be found. As opposed to what we usually do, this time we can’t do any miracle. Usually, in cases like this, we try to trace out and mostly we succeed to catch the patient before he/she goes far. But during the night we are limited. I just can’t do anything more.
At 8:00PM I am watching news on TV getting ready for my sleep, the only break I have for the day. How I wished the night was longer! Anyway, I just have to go.
Good night everyone.
Jean-Clement, RN, BSN
It is Tuesday, holah! I love Tuesday for the main reason that I can have extra 30 minutes of sleep. As you can realize now, I love sleeping, something normal for a new grad. Anyway, on Tuesday I wake up at 6h30 am, do my morning prayers for 15 minutes before breakfast, which at this time takes about 20 minutes before morning change of shift staff. It is almost the same game every Tuesday morning. This Tuesday is a little special though. I have on my agenda two delegations to make: sending blood sample to the lab and renewing a prescription of one patient who is usually followed by another clinic. I have in my mind the person I have to send; however for some reasons, this person is not there. For confidential reasons, I have to do it by my own. In addition to the appointment I have planned to meet with some parents, I am trying to see how to accomplish all those plans in my morning schedule.
After the staff I usually have my meeting with the nursing staff to give the tasks and assign patients. After the staff, I delegate one nurse to do blood draw as I do the rounds to patients.
At 9h30 AM, I am off to the clinic for blood analysis and renewal of the prescription. This is somewhere 12 km away from our hospital. The interesting and at the same time sad part is that it took me the whole morning to be ready with those two activities. In some general clinics, you have to wait till you get tired! Emergency in your eyes is not always emergency in his/her eyes.
It is noon already and I am back at the hospital. As I arrive, two parents are waiting for me to discuss about financial difficulties they have. At the same time, I am tired and hungry as my lunch time is nearing. It has been hard to make it always at the table. After receiving the parents I close my office off to take my break. It is about 1PM.
At 2:30PM I am back in my office. Together with the pharmacist, we are creating a program to facilitate a good inventory of medications. As I mentioned ahead, one of my responsibilities is to supervise our pharmacy, to make sure that everything is being done in order.
It is already 4PM, and in five minutes I have a staff meeting together with the day shift and night shifts to exchange the activities of the day. Today, the meeting goes on till 4:30PM and everyone is getting ready to go home. As I return to my office, I remember that I had to go the general hospital to take the results of the labs and then pass to the pharmacy in the city where to usually take our medications. This usually doesn’t take too much time.
At 6:25PM I am back at the hospital with medications. As I enter the pharmacy, one nurse comes to me to inform about one patient who had refused his evening medication and aggressive and now who is being held in the isolation room because of an attempt to escape. The nurse asks me what to do…I prepare myself to call the physician and ask her to prescribe something. As the phone is on the voicemail, I inform the nurse to continue the observation for another 2 hours to see if the patient will calm down.
It is 7:15PM; I am sitting at the table starting my supper. Five minutes later, the nurse on the night shift calls me for another patient who can’t be found anywhere. So what? He just escaped! It is night and nowhere can he be found. As opposed to what we usually do, this time we can’t do any miracle. Usually, in cases like this, we try to trace out and mostly we succeed to catch the patient before he/she goes far. But during the night we are limited. I just can’t do anything more.
At 8:00PM I am watching news on TV getting ready for my sleep, the only break I have for the day. How I wished the night was longer! Anyway, I just have to go.
Good night everyone.
Jean-Clement, RN, BSN
Journal of a new grad-nurse in a psychiatric hospital
First two months after graduation (June and July)
School is over! What a joy! After four years of uncountable nights and days, there is only one day that I am eagerly expecting: graduation day. On this day, the past is forgotten and the future is even not thought of. The only moment is now, to celebrate and to enjoy. The day after graduation day, I am realizing that things are taking another lead. Passing the NCLEX-RN exam comes into the equation, even before thinking about a carrier or where to work. Two days after graduation I am again on the school desk preparing for NCLEX-RN exam. It is not only about getting the title RN after my name, but also the overall evaluation. Everyone sends me messages of good luck and courage despite the fear and anxiety. Four weeks passes preparing and revising, and the day comes to show that I deserve the title.
The 26th June, 2010, on a Saturday morning, I am very anxious to see my results. I can’t even sit to calm myself down. As I open the computer, and login, I get a surprise! Oyeeeeee! I passed! So what?
Three weeks after passing the NCLEX-RN exam, I find myself in a psychiatric hospital acting as a nurse manager. This is something I had never thought of. Can you believe it; I can’t neither. But it is happening. My days at the hospitals are full of stories, challenges, and discoveries. Writing them on the paper can make up a book heavy to carry and long to read. However, some stories deserve to be written down and to be shared.
The following events happen almost every day, during weekdays.
It is 5:30am, on Monday morning. Ding! Ding! Ding! My alarm clock is always earlier than me. Luckily! It is 5:30am and I have to wake up to get ready for my morning prayers at 6:00am. I always take 30 minutes to take shower and to get ready. It sounds more, but I do take time on myself. It is the only time I have to physically do my self-examination. It makes sense. I do assess others almost every day, why not me.
At 6:15am I am in the church for the Eucharistic celebration. Why not start my day with spiritual food? I guess it is important. Actually, there is no guess, it is obvious!
At 7:15am I am on the table taking my breakfast as fast as I can (eat fast, obviously more). This is an important meal of the day; therefore, I need to make sure that I take something in at least before starting my day.
By 7:30AM I am at the hospital for the morning change of shift staff meeting. This is an important meeting of the day during which programs and activities of the day are exchanged between teams. Most of the times we get to speak about some hospitalized patients who require special observation. Depending on what is to be exchanged, the meeting can take about 20 minutes or more.
At around 8:00AM I am back in the nurses’ office for another meeting during which tasks are shared between nurses. It is during this meeting that care plans are communicated. It usually takes less than 5 minutes. After this meeting, most of the things goes unpredicted.
Jean-Clement, RN, BSN
School is over! What a joy! After four years of uncountable nights and days, there is only one day that I am eagerly expecting: graduation day. On this day, the past is forgotten and the future is even not thought of. The only moment is now, to celebrate and to enjoy. The day after graduation day, I am realizing that things are taking another lead. Passing the NCLEX-RN exam comes into the equation, even before thinking about a carrier or where to work. Two days after graduation I am again on the school desk preparing for NCLEX-RN exam. It is not only about getting the title RN after my name, but also the overall evaluation. Everyone sends me messages of good luck and courage despite the fear and anxiety. Four weeks passes preparing and revising, and the day comes to show that I deserve the title.
The 26th June, 2010, on a Saturday morning, I am very anxious to see my results. I can’t even sit to calm myself down. As I open the computer, and login, I get a surprise! Oyeeeeee! I passed! So what?
Three weeks after passing the NCLEX-RN exam, I find myself in a psychiatric hospital acting as a nurse manager. This is something I had never thought of. Can you believe it; I can’t neither. But it is happening. My days at the hospitals are full of stories, challenges, and discoveries. Writing them on the paper can make up a book heavy to carry and long to read. However, some stories deserve to be written down and to be shared.
The following events happen almost every day, during weekdays.
It is 5:30am, on Monday morning. Ding! Ding! Ding! My alarm clock is always earlier than me. Luckily! It is 5:30am and I have to wake up to get ready for my morning prayers at 6:00am. I always take 30 minutes to take shower and to get ready. It sounds more, but I do take time on myself. It is the only time I have to physically do my self-examination. It makes sense. I do assess others almost every day, why not me.
At 6:15am I am in the church for the Eucharistic celebration. Why not start my day with spiritual food? I guess it is important. Actually, there is no guess, it is obvious!
At 7:15am I am on the table taking my breakfast as fast as I can (eat fast, obviously more). This is an important meal of the day; therefore, I need to make sure that I take something in at least before starting my day.
By 7:30AM I am at the hospital for the morning change of shift staff meeting. This is an important meeting of the day during which programs and activities of the day are exchanged between teams. Most of the times we get to speak about some hospitalized patients who require special observation. Depending on what is to be exchanged, the meeting can take about 20 minutes or more.
At around 8:00AM I am back in the nurses’ office for another meeting during which tasks are shared between nurses. It is during this meeting that care plans are communicated. It usually takes less than 5 minutes. After this meeting, most of the things goes unpredicted.
Jean-Clement, RN, BSN
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