What Nurses Need to Know About Cutting

Chronic consitions anf acute care crises are not the only area in which nurses serve their patients. Nurses must be vigilant to observe compulsive and dissociative disorders beginning among their patients in care. When a patient is at risk for harming themselves, the situation becomes a health care crisis.

Patients under monitoring will exhibit patterns of normal behavior. Then changes in a patient’s habits will stand out.  One aberrant behavior that signals the need for attention is cutting. Cutting may sound odd, even absurd to most people when first encountering the medical disorder. But cutting is no laughing matter. It can affect housewives, adolescents, students, and profession people of all ethnicities  and at every education level.

Yet the  problem of cutting is more widespread than thought at first, although experts cite early underreporting as a major factor. Many caregivers may not wish to risk their position on an intervention. Irregular nursing staffing can result in turnover that prevents consisted reliability between caregivers with an opportunity to see cutting symptoms.

Cutting is a problem that has become a recognized part of the vocabulary of disorders and psychological signs of emotional distress in people. Striking mainly juveniles and adolescents, cutting is a practice where the physical mutilation of the skin serves no purpose but abuse. Cutting flourishes in environments where body checks and inconsistent observation is the norm.

Both women and men suffer from cutting. The inclination will start small, and the disorder will build as the victim of cutting behavior learns to harm themselves routinely. Cutting may be hidden by hobbies such as carpentry, fishing, sports, and crafts where cuts and abrasions can be shrugged off as casual. Where cold weather can conceal skin condition, nurses should urge patients to change into a gown for evaluation. Many doctors who skip the full-body evaluation can miss the signs and symptoms of cutting right under their nose.

Cutters are trying to treat their emotional pain. The individual will start to experiment and transfer feelings of emotional pain to a physically concrete manifestation of cuts, bruises, lesions, in areas not regularly seen by others. This is regularly in the lower arms and forearms, which can be hidden by long sleeved clothing. The individual will withdraw from normal social activity if it reveals their cutting scars or lesions.

Therapy for cutting involves multiple disciplines. Treatment involves  confronting the cutter in a safe space and  from their caregivong usually takes the form of two tiers of treatment. Skin cuts are treated for infection and bandaged, and mild painkiller is prescribed. Psychiatric examination and counseling make up the other part of treating cutters.

It would seem that those in metaphorical pain would avoid seeking actual pain. Yet for many this is bringing their pain into the open. Wound care nurses should be wary of patients who pick at scabs or worsen wounds and lesions between dressings.   Yet the exhilaration and catharsis of the cutting ritual allows the individual to achieve emotional release from psychological pressure. Cutters can form bonds with website friends online part of the cutting world.

Cutting is usually done by persons who feel helpless to control important aspects of their lives. Cutting is generally a shameful secret they hide. Cutters should not be condemned, but take in recommending the case for treatment. Friends should report this to a doctor or physician for further investigation.

Signs and symptoms of self-injury may include dermal scars that can be seen in those who have been practicing the self-abuse of cutting for some time. Referrals to the appropriate speciaist are encouraged.

Cutters may distinguish themselves by having sharp objects like pins, knives, switchblades, or razors on hand. They may be seen to wear long sleeves on their arms  and long pants unseasonably in hot weather. Cutters often exhibit difficulties in having close friends near, or holding long-term friendships or have difficulties in interpersonal relationships. The intimacy and familiarity required in these relationships make it difficult for the cutter to hide the cutting habit.

The habit of cutting may become a compulsion for some , one they wish to hide. Conditions in the cutter’s life may lead them to question their existence and voice thoughts of hopelessness or confusion. Stressful life events such as loss of a loved one, decline in social contacts,and new changes in negative life experience may signal a potential for cutting.

The patient or individual will mull over questions about his or her personal identity, such as “Who am I?”, “Where am I going?,  “What am I doing here?” They may exhibit panic and confusion when confronted with obstacles.  Nurses should be alerted to patients with pronounced skin conditions and the above mentioned problems.

Patients involved in cutting behaviors will experience behavioral and emotional instability, such as uncontrolled crying or mood extremes.  Cuters may ecperience problems with impulse control, and be subject to violence aggressiveness or other taboo behaviors. Cutters form a new routine, replacing the chaotic unpredictability of their problems with the “control” of the cutting instigation.

There may be a detectable change in patients, from an external viewpoint. . A patient who usually goes out for a walk or shops with friends and suddenly elects to stay in or avoid phone calls may be a patient considering cutting or performing the cutting practice as a way of coping. The cutter’s disorder is marked acute when the individual finds solace or relief in cutting.

Nurses should discuss with the charge nurse, roommate, staff nurses and social if they have overheard the patient make statements of helplessness, hopelessness or worthlessness. Futility and despair are the emotional hallmarks of a cutter. Intervention is only possible if the caregiver or nurse steps in and speak up.

Recognizing Medication Side Effects

Today a hot topic in nursing efficiency and best standards in healthcare is maintaining corporeal integrity and patient health despite heavy medication orders.  Nurses administering medication therapy to patients need to be watchful for side effects. Harmful side effects can be fatal. Any nursing performing 24 hour triple checks should converse with charge nurses and consult communication logs to verify any symptoms of a problem with a new medication that may have appeared.

Nurses should not wait to be directed by other staff or pharmacy advisors but verify from administrators,  Internet resources or the drug literature what the potential side effects are. Patients have a right to know what these side effects are before the medication is administered for the first time. If there is a potential drug-to-drug interaction, a delay may be in order while the physician is notified. Another drug may be substituted to eliminate potential problems, side effects, and patient discomfort.

The obvious benefits of nurses maintaining a rapport with their charges become evident here. A caring treatment nurse or observant and communicative med nurse can know what condition the patient’s skin normally is, what skin products the patients use, and under what circumstances irritation or rash incidents arise. Is the patient a complainer or do they hold back complaints?  Do they follow the same bathing and skin cleansing regimen daily? Does the patient use water that is hard, too hot, or for too long a period? Nurses should work closely with nurse’s aides to make sure unknown skin problems do not arise in conjunction with new medication administration. Both problems happening at once muddle the waters.

Patients in hospitals and long-term care  facilities usually do not handle their medications and thus cannot read the warning advice. They may not have Internet access or know how to spell the name of the medication. It is irresponsible and unprofessional for a nurse to force, trick, or dispense new medication to a patient without advising them of these risks and getting their permission. Violation of these rights can result in oversight agency scrutiny,  facility citation, and/or a nursing  license revocation.

For these reasons, any nurse should be mindful of the potential side effects of new medications. And over time, patients may develop allergies or new unpleasant and painful drug reactions. Before nurses sign off on pharmacy memoranda detailing potential interactions with the medication, they should review the nurse assistant’s body check documentation as well as the licensed nurse progress notes from every shift since the inception of the drug’s administration.

While some people have faith in homeopathic medicine, medical science is predicated on conservative and well-tested treatment advice. Unless the patient is utilizing off-label benefits of the drug for conditions other than those initiating the drugs’ order, nurses should follow the exact dosages and administration schedules the physician recommends.

Patient healthcare involves ongoing maintenance of functioning body systems. This includes circulation and muscle support to the dermis, musculature, and epidermis.  These systems undergo changes when systemic alteration occurs. Drug administration via the vein, orally, or topically is encountered by the body as a systemic alteration. Patients receiving therapeutic care require new and additional surveys to maintain the integrity of the skin.

The skin is the largest organ in the human body. The color, texture, febrile nature, friable veins, diffusion of capillary circulation, and moisture content of the skin tells the story. Changes can be tracked and documented to show the progress of a treatment for a condition or illness.

Nurses learn anatomy to understand how the heart and muscles drive the circulatory system. These functions are involuntary. They also stimulate immune system responses that are designed to protect the body’s regular functions.  The response of the immune system and the hypothalamus is governed by genetic  rules which are predetermined at birth. Generally these operate for everyone the same way.

But due to the infinite variation between one human body to another, individuals will differ when a foreign substance, such as a toxin or strain of bacteria is inserted into the bloodstream. The body’s response should be reviewed for the things the patient can communicate, and the things that can be observed.

Thus,  Person A may have no response to ingesting plant spores. But Person B may have no tolerance for plant spores. This intolerance is not a cognitive communication. It is expressed by changes in body functions exclusive of other medical problems.

The body dysfunction  evinces itself in a set of symptoms visible to the eye. It might be a rash, bumps, and/or itchy patches of skin . Sometimes the condition will irritate the patient to comment. For nonverbal or inert patients, symptoms such as swelling, striations, “weeping”, bumps or other dermal eruptions may occur.

Patients may not be able to see what is going on. A full body check is in order at least daily, before and after treatment. These data items should kept well documented in the patients chart for physician review. Symptoms such as nausea, inflamed throat, vomiting, loss of appetite, rash, hives, unusual numbness of extremities and more should be noted carefully. Nurses suspicious of side effectsvof medications should chart an intervention in the patient’s care plan. Wellness should  be achieved without the above mentioned side effects. It is for the doctor to determine whether or not the benefit of such medication outweighs the irritation and discomfort the patient undergoes.

Symptoms of side effects should be evaluated with reference to the patient’s normal condition and status. Failure to chart regular full body checks and regular medical examinations can cloud the issue. And only the facillty being alerted to signs of anaphylactic shock, observed by a nurse,  can save a patient when extreme side effects (akin to allergies) are present. Immediate medical attention is triggered by the predictive and denoted set of side effects described on the warning labels required by law to accompany all medications.

Patients receiving new orders for ongoing conditions or diseases with new symptoms must be protected from the natural occurrence of allergies and untenable side effects. Signs of side effects of given medications is nature’s way of making sure the body does not ingest any more harmful material.

Patient medication forms part of therapeutic intervention for serious conditions. Antibiotics are an accepted and highly recommended response by physicians to lab tests, clinical consultant, and referrals to a specialist. Antibiotics are adminiatered to the human body three ways, internally, orally, and topically. Creams, gels, sprays and powders can be applied directly to the skin or affected area. Oral antibiotics are administered  by mouth and sometimes by other means.

Infusion Vein therapy (Intra Venous therapy)  is administered by access to the vein. The needles’s access to a skin based channel allows direct systemic delivery of antibiotic material. Yet an etiquette prevails to ensure patient safety, operator efficiency, and an optimum outcome.

Dosages of antibiotics in the above mentioned methods are governed by strict standards. The I.V. medication is calculated by laboratory tests, “peak and trough” reports, creatinine levels and patient weight. Maintenance of kidney function is imperative.

Nurses who follow the signs of allergy, medication symptomatology of side effects and problems of specific medication types can offer their patients a wholly beneficial skill set that will enhance treatments and drug administration. Patients can enjoy greater quality of life,  without dosing errors, unnecessary discomfort,  or negative drug interaction.

 

Nurse Training Issues

Nurses need to be trained to treat patients and all their needs, as required. Nurses cannot pick and choose which chores they need to do on which patient, nor do they get to arrange the timeframe that suits them best. Often a case load of needy patients means that the nurse will be juggling various needy patients as well as performing paperwork responsibilities, charting, and intaking new patients at the same time. Not to mention answering the phone and dealing with walk-in clients.

Nurses must be ready to say “yes” to every task. They may be reassigned to other wards or areas as needed. Nurses must groom their computer and Internet research skills to match today’s technological advances. There will be slow days and there will fast days, but nurses are responsible for treating all patients at the highest level of care no matter what their time limitations are.

For example, in a clinical care situation in training, a nurse might have to alter the setting on a EKG machine or test out various pharmaceutical applications on a patient to achieve the best result for lowered blood pressure. But the time and physical availability for results and communications in real time versus training environment may not match the situation reality. Phones on the ward training, another nurse needing help, or a new admission coming onto the scene may distract a nurse.

Nursing students have a training experience that is simple cases of ongoing treatment cases. but in reality medical care plans are much more complex. Patients may be resistant to treatment or not observant of dietary restrictions or their rest order as given by the physician. Nurses on the job often give qualified objections because they have not had a chance to speak with the doctor before issuing pain or treatment medications to a patient they have never seen before. Patents are likewise alarmed they are not seen or given a consultation before a dosage regiment is instituted.

Nurses are the key communicators in this scenario. Nurses in this instance carry more responsibility to review both the patient set of criteria and the data involved with possible side effects of a drug. They must weight this information against the patient’s benefit, versus the entire set of pharmaceuticals being introduced to the patent’s bloodstream. Often a nurse can spot a contraindication before anyone else, and the thrust is upon them to do so. Nurse must also counsel the patient and asses them psychologically at all time. When shifts change, nurses must convey both verbally and in writing the most timely changes in patient assessment to the next charge nurse. These must be done in accurate medical terminology in a transparent style.

Is the patient a physical threat to themselves or others? Is the effect of any change or restriction in medication or privileges affecting them negatively? Are they speaking to themselves or others in a manner that shows a change in self esteem or motivation to heal? Some patients may create incidences of panic disorder and need to be housed a negative ion chamber. A psychological evaluation referral is appropriate at this time. They may try to not take their medication, create obstacles to treatment, or become even more ill. Student nurse skills must adapt and grow to meet the situation.

It is hard to train a nurse for the variety of challenges and issues that come up for their patients in this kind of scenario. Occasionally physicians will be flexible and change to the individual care plan will be made. It is vital to the medical outcome that these circumstances be communicated to the next nurses and on-call physicians. Being able to perform simple tasks like recording dosages and medical administration while balancing management of multiple patients can get tricky.

Where Have All the Good Nurses Gone?

Those familiar with the nursing landscape and the patient options universe have been noticing a talent vacuum for some time. Has the general quality of nursing fallen off? Where have all the good nurses gone? Hospital policy and budget cuts, public mental health policy and supervisory practices combine to eradicate the best and most talented nurses out the door.

Risk averse nursing workplaces are becoming harder and harder to find, thanks to Social Security’s failure to keep mentally ill populations locked appropriately in pace. Mentally ill patients now take up regular population beds, a violation of nursing care in ethics if not in deed. Because these are not actually critical care patients, i. e. no amount of direct nursing care can restore mental logic or activities. Many new nurses (and old ones) do not have concentrations and/or documentation and licensing for strictly psychiatric patients, even if patient organization loads and assignments offer them these patients!

Consider: if a nurse applied for a position of equivalent nursing station in a psychiatric ward they would not be accepted because they did not have the credentials or experience. These patients would formerly have been residents of hospital wards more suited to round the clock care specific to this kind of patient need. And ward backups could otherwise have absorbed the extra patient care load.

But burnout of regular nursing staff and nursing shortages are behind this new gap in patient care. Why, as one old pro asks, should they wear themselves out simply because the State wants to save a few bucks on medical costs? They don’t get paid more for severely heavier care demand patients. But according to the present model of overstuffed wards, they are expected to do the work!

This “Lost Generation” of nurses will pass on thankless extra work, thank you very much. Generally speaking, more experienced nurses in older conventional labor models could be counted on to fulfill more complex nursing tasks to more demanding and more complex critical care patients, such as dementia, Alzheimer’s, or even Huntington’s Disease cases. But many experienced nurses looking to retirement do not feel the same push to fulfill additional case work per patient for no additional compensation.

More experienced nurses are simply not to be depended upon anymore to “pick up the slack” because newer grads want the easier cases and managerial staff can’t be troubled to properly supervise them. The charge nurses assign them to heavier load patients. Nurses are likely to pass on extra shifts or extra duty and extended hours, because they will simply get dealt the harder tasking. Nurses are likely to call in sick and take the personal time owing than spend the day chasing a thankless care load.

Many new nurses are “new grads”, shining with brand new diplomas but heartily lacking on practical nursing experience. New grads, as they are being termed are simply not experienced enough to care for mentally ill patients. These patients can be a significant drain on ward care time, because they need nurturing and coaxing to eat, take medications, and need more intensive body nursing than an ambulatory patient. And ambulatory and non-mental patient populations are deleteriously affected. Patients who “behave see the “problem children” get all the attention.

How taxing is the average mentally ill patient on a regular care ward tasking? Take for example the fictional case of “Robert Fickle,” an aging dementia victim undergoing unilateral amputation of the right leg. His care requires negative ionization chamber care and round the clock nursing care of a (1:1) one to one ratio assigned directly to him. But there is no rest for those on the same ward as Robert Fickle.

Fickle has transformed a quiet and orderly ward into a chaotic and noisome irritant. Bawling incessantly, he wears down every nurse and supervisor. Encouraged by the attention he receives, Robert continues to yell and scream if he does not get the attention of every person who passes into his field of vision, and yells abuse at other patients or staff if they do not instantly hurry to his side. The social worker licensed to carry out medical activities for Robert Fickle is only employed onsite from nine a.m. to five p.m.

Robert has abandoned all attempts at coping and spends all night yelling at nurses and passersby in the ward. Robert refuse to wear his hearing aid and can be heard all the way down the hall on a nightly basis, haranguing nurses for hours about fictional missed appointments he must get to (at five o’clock in the morning). There is no way to shut the noise out and other patients suffer to no avail.

Robert’s constant verbalizations wear out the nurses, who must complete the charts and medicine dosages of other patients while this noise is going on. It is very distracting and nurses feel put upon to keep their performance error free in this environment. The new admissions to the ward are accompanied by family and visitors, who are struck with amazement at this spectacle while their loved ones are taken into “restful” hospital care.

Sickle’s “condition” rule the ward. He refuses to stay in bed and insists on sitting in the doorway of his room, heckling patients and hospital staff, employees and visitors alike as they walk by, with imperious screams and abusive catcalls. Hospital policy limits what nurses can do or say to limit this nuisance. Numerous complaints from other patients go on “deaf ears”.

So, where are all the good nurses? Looking for alternate employment, or counting their days until retirement. And considering that any of us might be the next “Robert Sickle”, that is food for thought indeed.

A Day in the Life of a Professional Nurse

The pace of a day in the nursing profession can be hard to get used to. Thinking about nursing skills and remembering important information isn’t enough. Nurses need to update their knowledge of each patient’s chart, comprehend endorsements from the earlier shift, hand off important duties to qualified staff such as supervisors, certified nursing assistants and licensed vocational nurses. Case management responsibilities may fall to a desk nurse, but the medication nurse must serve as a conduit of patient wishes and advocates for patient care.
The pace of the shift takes its cue from the total number of patients the nurse is responsible for, and the frequency of calls to the bedside from each patient. If the patient needs accelerate and the number of calls spike, it is appropriate to notify the nursing supervisor or the Director of Nurses to staff accordingly. Specific chores such as giving IV medications, assessing new intake admission patients, recording vitals for special needs patients, and delivering special treatments such as dialysis and/or oxygen administration can fill a shift before you know it. (And then there is still the charting to do).
As in every job, timing in and out is important to maintain the integrity of the facility’s nursing acuity. Oversight agencies evaluate the timekeeping rolls to derive the accurate account of the nurses assigned at any one time. A nurse who regularly arrives late or misses an entire day of work creates a practical problem that may take hours to solve. In the case that no other staff are available, other nursing staff may have to increase their workload and absorb that nurse’s patient assignments and duties. This can have a negative effect on patient care and reduce the allotted time each nurse can regularly spend with their patients. Patients will notice and feel passed over or that their case has been “rushed”.
Timekeeping is an essential but irksome chore for every professional nurse. Arriving to work on a timely basis and staying after when needed are invaluable qualities in a career nurse. Flexibility in scheduling makes any nurse a prize who is very attractive in a competitive hiring market. Nurses who arrive constantly on time will be given priority and also will get preferred responses to requested time off. Nurse who regularly call in sick or miss work, for any reason, will find themselves short hours or written off the schedule altogether.
Nursing is not always just about medication or vital statistics. The term “bedside manner” is a joke in some circles, but a very real and desired trait in professional nurses. Each patient needs to feel as if their needs are being met. Positive statements, cheerful questions, and small jokes can brighten up a patient’s day. Nurses can easily underestimate how the smallest word or gesture can seemed magnified to a patient with little outside or family contact. This directly affects the quality of care offered by the hospital or facility. During surveys and in feedback sessions, patients often remark on these issues. Positive feedback, online or via word of mouth, is crucial to any organization today.
Patients prefer to rely on key staff and feel better when the routine of their day is supported. The welfare of the patients is the priority of the nursing supervisor. New staff should maintain the behavior and tone of the other nurses. Otherwise, patients can feel estranged. A proper evaluation of the nursing staff should be their flexibility to medicate and treat each patient in the facility, not just the “chosen few”. (And charting must be consistent as well). Puzzling out idiosyncrasies is not a skill every nursing manager has. An hiring institution bringing new nurses on board expects a concordance to facility norms. To do this cheerfully and in a consistent manner is what every nursing home, private patient, or hospital wants.
Encouragement of activities and interventions according to the care plans in the patient’s charts will help the patient feel supported and well cared for. This kind of goal can help patients handle pain, lessen anxiety, and improve their ability to communicate ills and problems some patients might otherwise feel embarrassed or discouraged from sharing. The duty of care falls to the institution and its staff to observe the entire range of symptoms and conditions noted for that patient, as well as known contraindications and/or medical risks.
If a clinical condition becomes exacerbated, the nurse must be able to note increases in pain, swelling, blood pressure, blood sugar, nervousness sleeplessness, and general well-being, all from exchanging a few words with the patient a few times a day. The investment of a few jokes or special inquiries about personal interest or hobbies can pay off in certitude that a patient can rely on the nurse to note variations in their condition.

Some hospitals and nursing facilities have incentive programs for cross-checking symptoms
The manifestation of certain symptoms can be easily missed unless the nurse has established a rapport with the patient. A nursing supervisor often looks to key nurses who can be trusted to “handle” patients who have special interventions indicated in their care plan. Patients need guidance and instruction how to do things good for their conditions. Even if the nurse thinks the patients already know, reminders keep the patient focused on best habits for their own health.
Nurse should encourage patients on how to best elevate legs, attend community activities, perform approved exercises, work well with therapy professionals and stretch their muscles. Some patients may get in a “rut“ and need to motivate themselves towards physical therapy. But some patients just droop and drift into a pattern of inaction. The pattern of interaction should not be allowed to fall static. Just asking a patient what they are watching on television or what they are reading can bolster a patient’s attitude.
Regular familiarity with the patient, good understanding of their conditions and medications, a working knowledge of how to relate verbally to the patient and make them feel at ease, and an ability to confront your own fears and deal with people in a respectful manner that meets their expectations of an institution are all the traits of a successful modern vocational nurse. It is each nursing student’s responsibility to evaluate their own strengths and weaknesses, and to critique themselves and their peers for the benefit of all.