I’m a mental health nurse working on locked ward with females with personality disorder - ask me anything

[Dino90]

Please ask away if there’s anything you’d like to know

I understand that far more women than men are diagnosed with bipolar or borderline PD. Is any consideration given to the thought that most of these women are actually suffering from hormonal fluctuations? Some women can be extremely sensitive/allergic to these fluctuations, causing them to exhibit quite extreme behaviour.

Do any of the health care professionals you work with ever even consider this?

I'm an adult field nurse who comes across at least one PD patient a shift. I have no training and often find myself exhausted trying to keep up. Can you recommend some reading to help me better care for them. It can be quite challenging.

OP

Not posted as yet. Found many of the answers informative. Ditto from others working in the field.

I'm sorry pp have had such difficult individual experiences with services, but would echo that justifiable anger is vented at the organisations involved and/or lobbying and supporting for fundung/policy change. I get it, I've had and seen inadequate care, been enraged. It's less raw for me years after.

Some other comments, I've just had to bite my tongue.

I work at a junior level in older adult physical nursing, and volunteer in mental health. Even at my lowly level, I'm constantly aware of holistic risk assessment towards my patient, of my patient, other patients, staff, me. Before accepting an admission, during admission and treatment, planning discharge. When I use patient, that's for understanding. Patient, service user, passenger, member, participant, client included.

Holistic risk assessment is an intrinsic part of patient focused care and is multi facetted by definition.

Compassion, empathy and understanding are needed. Of course. As is 'a strong sense of yourself' (as op put it), knowing your own triggers, vulnerabilities and when/what to leave at the hospital door (I'm not good at this).

peaceanddove

Don't know about how widely it is elsewhere, but I know of an Expert by Experience programme attached to University of Derby where doctors, consultants & nursing staff inc CPN are educated about PMDD and hormonal fluctuations. I think it is still supported by a specialist pharmacy educator, who explains the effect of hormonal fluctuation on medication efficacy.

Emily Grace on twitter is said expert, and has been doing loads of national media stuff recently, BBC breakfast, R4 Women's Hour etc

Hi OP,
I work in a&e and we have one or two patients who come in almost daily from a unit like yours with self harm which requires a&e attendance. These patients are not allowed to leave the unit unattended and when coming to a&e have 2 members of staff with them.
These patients seem to be able to acquire mirror/glass/knives on a near daily basis and do DSH to a degree requiring them to to go to a&e.
Whilst an inpatient, why is this allowed to happen?
(Sorry, I think this reads like an accusation, I don't mean it like that. I am sure it is to do this risk assessment for these specific patients, but would appreciate if you could give any insight.)

@peachgreen

Are you aware that when you address a contentious issue, you retreat behind platitudes and jargon?

No she doesn't. She gives a clear answer based on her expert training and experience. You just don't like it because it's not what you want to hear.

I disagree. OP has done this in response to various posters re ASD being missed, lack of basic medical care having been experienced, safety with male HCPs and other questions, in addition to the trans issue.

@Everysinglebloodytime

There are a number of posts, written between 23.33 and 0.13 which unfortunately demonstrate a lack of understanding and a lack of willingness to see reality, driven by fixed ideas about a subject and a desire to shoehorn that issue into every conversation.

It's an important issue, absolutely, but OP has answered you. Repeatedly. You've chosen to ignore someone who actually knows what they're talking about in favour of propaganda and your own fixed beliefs.

OP doesn't appear to be aware of the Equality Act and how it might pertain here, as she asked about the law. That's far too big a gap for her to be considered to know what she's talking about. And this isn't a criticism of her: staff in this field should be provided with appropriate training. It's not their fault if they aren't, and you don't know what you don't know.

*Are they allowed to smoke?

Yes, though there’s talk of us becoming a smoke free hospital in which case they won’t be able to*

We are supposed to be a smoke free hospital but they still smoke just outside reception! Some have vapes. When patients come into the Place of Safety they will mostly complain of not being allowed to smoke.

How much interaction is there between patients? And how much of it is unsupervised?

Hi all,

Thank you for all your questions and thoughtful responses to some of my answers, particularly those that have been so supportive (as well as those that have challenged me in a constructive way!)

As many PPs have already mentiond, this thread now seems to have been derailed by increasingly heated discussion about gender. One poster has had more than one of her posts removed, most recently for insinuating that I’m racist. Unlike when I’m at work and have no option other than to engage with this type of conflict, I’m going to choose to end my participation in this thread here.

I’ll think about perhaps starting another thread about just a specific aspect of what we do (management of suicide attempts/ self-harm if anyone would find this interesting perhaps?), in hope that it won’t be derailed in the same way.

Thanks again all

Yes please OP!!

Mgt of alcoholics would be FAB too - invaluable to far too many of us.

That is a real shame. I have nothing to ask myself but have enjoyed your insight. Sometimes people really can not leave things alone and see they are going after the wrong person.

Thanks for the thread OP.

Fellow mental health nurse here. :waves:

I never used to like that client group, especially people with EUPD, but with time I've had more empathy. Most of them have had totally f*cked up childhoods, to the point I think complex PTSD is a better term to describe their symptoms and how they started.

Thank you for the thread OP and I am sorry it had to end before I got a chance to ask my question (I was interested in why you had chosen to work in a locked ward rather than community based setting).

Anyway, I found your responses interesting and measured, well done for your work in such a challenging job.

It's a shame this thread had to end as I have found it really interesting. I'm relatively new to mn so if you did do another thread how would I find it??

@Dino90 Damn, I found the thread a little too late. I had a question about dealing with being attacked by a patient. Someone close to me is a support worker and had this happen in a PICU. It has really shaken them up and caused huge anxiety about returning to the same ward. I was surprised there was no follow up/attempt at restorative justice with the patient. I was hoping to know if, in your experience, it’s possible to move past the event and overcome the anxiety it causes or whether staff commonly leave as a consequence of being attacked. If anyone else in the field is reading I’d welcome thoughts as am trying to support the individual as best I can!

@BryanAdamsLeftAnkle

I'm an adult field nurse who comes across at least one PD patient a shift. I have no training and often find myself exhausted trying to keep up. Can you recommend some reading to help me better care for them. It can be quite challenging.

The Art and Science of Mental Health Nursing: Principles and practice (4th Edition) by Ian Norman & Iain Ryrie.