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"Her delusion had been part of her reality,"
Luna said. "When you're a psychiatric nurse, you
never put aside your physical assessment skills."
Sometimes-but rarely, psychiatric nurses said-patients
become violent. Cohen has been burned by a cigarette,
strangled, bitten and had her blouse ripped. But that's
after nearly 30 years of psychiatric nursing, she said,
and she has learned to follow procedures to deal with
violent behavior. "When you think of it, the number
of times I have been attacked are so few given all the
time I've worked."
One of the most difficult parts of psychiatric nursing
is reminding yourself that the patient who is spitting
or swearing or striking out at you is ill and has no
idea what he or she is doing, Saxe said. "You can't
let yourself fall into being angry or hostile back toward
the patient. That may be the greatest burnout factor
for psychiatric nurses-controlling yourself."
The other difficult part of the job is explaining to
families, community members and the public that mental
illness is nothing to be ashamed of. Even her own family
would not understand if she were admitted to a hospital
with a mental illness, Saxe said. 'd be hush-hush about
it because it is such a social stigma."
Part of her job is making sure that patients know they
are acting strangely because some part of their brain
is out of balance. "They come in and they feel
bad because they're different," she said. "I
can show them that they have the ability to correct
the imbalance through medication, through therapy, so
let's do that."
Watching people who had been brought into the emergency
room screaming in terror leave the hospital calm and
confident with their symptoms under control is her greatest
reward, Saxe said. "I can make a difference. I
can get them back to their baseline so they can walk
out that door and go on with their lives."
An important and exciting part of treating the chronically
mentally ill, Henley said, is involving the patients
in their own treatment and helping them to set goals,
including what they want to do for a living, where they
want to live, and what they need to take care of themselves.
"It's really hard work," she said, partly
because the patients' goals don't always match what
caregivers think they should be. One of the patients
in Henley's facility was a concert pianist whose illness
kept her from performing or giving lessons. While in
the facility, she regained enough confidence to give
lessons to others there. "But she is not interested
in continuing to do that when she leaves," Henley
said. "She is not using the wonderful gift she
has because of her illness."
But as the woman learns to work with her illness and
control its symptoms, she may change her mind about
teaching piano again, Henley added. "That's the
best thing. What we're seeing now is not hopeless. We're
offering so much more than we were able to offer back
in the 1960s."
Despite the frustrations from lack of resources and
compensation, care for the mentally ill has come a long
way since the days the women in the New York state hospital
fell through the porch, she said. "A big part of
the allure of psychiatric nursing is hope."
Contact Cathryn Domrose at kaguilar@well.com
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