Psych Tech

In response to a question asked on a list, I posted this quick down-and-dirty review of the Psychiatric Technician role. I held this job from June of 2007 to June of 2008 in a chemical dependency inpatient unit and it is not only the source of many valuable memories, but also of just as many lessons that I will carry forward into Nursing.

Psych techs will handle routine data collection, such as obtaining vital signs and supervising urine specimens. They are highly visible in the milieu, observing the population for signs of impending crisis and handling workaday requests from the patients. They often facilitate educational groups and occasionally provide some one-on-one in the milieu to help a patient work through a train of thought. When appropriately trained, they will take shifts on 1:1 suicide, seclusion or restraint observations. They can monitor phone calls, search incoming admissions, escort patients to appointments and help defuse situations that are unsafe and inappropriate, including assisting with restraint.

Psych techs differ from their acute care counterparts mainly in that they have less involvement with the physical activities of daily living (ADLs) and more with the mental ADLs. Fewer bed baths and ambulation assists, more time spent in conversations and in helping emotionally labile people maintain. In the hospital, I spent much of my shift with body fluids and in the psych milieu with emotional dumping. Acute care was physically hard for me, with lots of running and lifting, while the milieu is said to be more mentally stressful, although it fits me like a glove.

Psych techs are often more educated, often possessing a Bachelor's in Psychology. I did not have such a degree, but I was a nursing student in my psychiatric rotation, which got me in. Psych techs are often on their way from undergraduate to somewhere else, such as a MSW, counseling or psychology doctorates. It's really a great way to get one's feet wet in a psychiatric setting because there is lots of patient contact time and also lots of support and backup.

To be honest, I loved the work and would have considered staying in it longer if it paid better. As a tech, I had little documentation to record and my day was mostly spent helping the patients get through their day. A very rewarding job.

At the time of writing this, I am over a month into nursing practice and beginning to balance my new responsibilities with my knowledge obtained from the tech jobs I've held. As I look forward to new skills and more opportunities to make a difference, I send a thank you back in time to the earlier me who made the decision to work with patients during nursing school.

Patient Care Assistant

From January of 2006 to June of 2007, I worked as a Patient Care Assistant in a hospital. I spent about six months in the float pool and then a year assigned to a respiratory unit. Moving forward as a new nurse, I find that my commitment to recording my rich experiences from this position is continuously back-burnered. The following synopsis is intended to temporarily fill the void by giving some idea of what this period was like for me.

When I applied for the position, I was a first-semester nursing student and a volunteer EMT. I was hoping to gain practical experience to support my future nursing career and vacillated a little bit between taking work as a part-time EMT, which paid more, or as a tech. I opted for the latter because I expected the in-hospital experience would benefit me the most in the long run. EMS would provide somewhat more medical care opportunities, but the tech position would allow me to work alongside nurses in their natural environment, so to speak.

The decision paid off on many levels. Not only did I get about 18 months of exposure to real-world nursing, but I also experienced hundreds of hours of invaluable direct patient contact. I became adept at many of the physical basics of nursing, such as giving bed baths, taking vital signs and monitoring intake and output, but I also became comfortable working with people who were in acute crisis and those with more chronic challenges.

In our healthcare system, it often seems that the lower down the licensing totem pole a job is, the more time is spent in direct contact with the patient. As a tech, I not only made a difference in people's lives through the tasks I performed, but often with just my presence. I wore a smile when I entered their rooms no matter how dirty I thought the job would become. I chatted brightly with people while I cleaned body fluids off them, I cheerfully ran errands for things that would make their days a bit easier and I listened to their fears and their stories. The system imposes limits on the amount of time nurses and doctors can spend socializing with sick people and I tried to help fill that gap.

During my time in acute care I received many compliments from coworkers, patients and their families for the quality of care I gave. I didn't work for these, however; they were simply the natural result of empathizing with people. There was no need to force myself to get through the workday - once I began moving from patient-to-patient, the hours flew by. Some memories that float through my head as I write this:

• A proud ex-Marine who was losing his foot to amputation due to poorly-controlled diabetes. For such a person, the loss of control was likely even worse than the loss of a body part. I spent time with him, listened to his words, shared my thoughts, did what I could to make him welcome. I learned how much this kind of thing helps when he told me exactly that.
• A lovely woman of more than 80 years who was practically incapacitated with respiratory disease. She had to breath through a tracheotomy and was often hooked to a ventilator. Her husband of many decades would visit frequently, wheelchair-bound and practically doting on her for hours even though she couldn't talk because of her ventilator needs. I used to change her radio stations, set up her audio books and play catch with her using the little gel ball Physical Therapy supplied. Laying there in that bed for day after day, she never failed to deliver smile when we came into the room.
• Another elderly roman, hands gnarled and twisted from arthritis, grateful when I would make time to help her eat as it was so much work to do so that she often gave up before her hunger was satisfied. We would try to get her up and into a recliner during the day to support her independence and she would thank me for being so gentle with her during this process. Her skin had the strength and feel of tissue paper. I always made a few minutes for social chatter with her - she said it added some life to her day.
  
• There was a man who was frail and wasted, not really all that old but worn away by COPD. I treated him with the same respect and dignity I would any healthy man I might meet outside the hospital and he commented many times before he died on how valuable this attitude was to him.
• A very obese lady with diabetes and respiratory disease who some thought of as a complainer but who was just lost and lonely.
• A young woman who overdosed on prescription meds and who had no idea how her life had led to this hospitalization. We talked.
• An old man who forgot from minute to minute and lived with the confusion and fear that might be expected from such a condition. Made some extra stops in his room - smiled and tried to exude calm reassurance. "Everything is safe - you have fallen ill and will feel better soon."
• A woman of generally good health who has acquired first pneumonia and then, in response to the antibiotics, a really fun nosocomial overgrowth of clostridium difficile or c-diff, that had her running to the bedside commode several times an hour. My challenge was not only to keep her clean and hydrated, but also to preserve her dignity in the presence of endless diarrhea and a male tech.

I have a long list of these memories. The common factor through all of them is the recognition of the patient as a human being in crisis as opposed to a task needing to be checked off.

I learned and observed many nursing skills during my stint as a tech in acute care. Not only did I see a bedside colonoscopy and watch innumerable dressing changes, but I also collected techniques used to deal with patients, families and with job-related problems. It was grueling work and at times I watched people I helped to care for worsen and even die. It was also rewarding work, though, and I made a real difference in many people's lives.

Heal The Person, Not Just The Body

Funny thing - old story came out in my Clinical Performance Appraisal (which I aced!) yesterday. Speaking about my approach to patient care during the past semester, I brought up the memory of a patient I'd handled as a tech in a local hospital. I took the job as a way of advancing my basic nursing skills, so I had a long-range focus even though it is essentially an
entry-level job.

The man was an ex-Marine (as am I) and he was also a diabetic and had respiratory issues. His disease left him essentially dependent on help for all his daily activities including personal hygiene and toileting. He was a proud man and did not respond well to the workmanlike attitudes of many of the career techs. He developed a reputation as being unpleasant and a bit of
a burden.

I approach all patients in a positive way despite reputations and I did so with him. He was not happy needing help with cleaning up the mess left from bowel movements or needing to be shaved or needing help repositioning himself in bed every two hours so sores wouldn't develop. Yet he also wasn't fond of the consequences of ignoring these need, either. I saw this in the first ten seconds of knowing him and I went in treating his just as he was: a complete human being in a rather unpleasant predicament. Instead of treating him as a job, I related to him as I would a friend. I did the tasks needed and I joked with him in a guy way about the various duties - no
ladies need eavesdrop!

Before long, we were sharing laughs (as best he could with reduced lung capacity) while I inspected skin, held his urinal or washed the stool off his backside. I treated him gently when I needed to move him around - he was quite wasted - but I treated in equally when we talked. His mood improved and his reputation proved unwarranted.

His family praised me, proving that this simple approach wasn't something they were used to seeing, and that is a shame. He eventually died, but I believe he did so with some sense of dignity and I think a part of that was due to the fact that I treated him as a human being. This lesson belongs in every nursing school and tech orientation!

I had a very limited scope of practice as a tech, but even without meds or dressings or diagnostic privileges, I had the one tool that makes the most difference to a patient: my attitude. We each have this awesome power to impact the person standing beside us and never have I seen a more powerful reason to do so than with the example of this man who needed simple human empathy more than all the expensive medical equipment he was surrounded with.

He is actually one of the reasons I chose psych nursing, in fact. There's no sense healing the body if the person inside is ignored.

If you ever get sick, you be sure to point out to everyone from the doctor to the tech that you are a human being, not a walking pathophysilogy!

Neal Vonada

(December, 1926 - April, 2008)
http://www.qagrizzlies.org/Features/Profiles/Vonada_profile.htm

I met Neal on MPositive. I was looking for a place to enjoy folks who seek to always look up and look forward – not always easy! In Neal, however, I found a kindred spirit who not only walked the talk, but who had endless stories from a life rich in positivity. He was not only committed, but also on a mission to bring his perspective to the world.

Neal once named me Word Weaver after reading a post of mine. I loved the name – he had that effect. He encouraged my attempts to bring positivity to my peers and my patients, and he urged me to expand my horizons without fear, as he himself had done. He reached across a continent and touched me, adding a little more gold to my life. I grew because of him.

I will miss Neal, yet I can't bring myself to bask in my own grief over this man's passing. It would disappoint him. Instead, I acknowledge my loss and then I look around to see who I can bring his legacy to in this moment. As he would desire. For as long as I am able to reach out with our message, he will still be touching this world.

Neal often told the story of how he would get babies to stop crying in various public places. Such a simple gift to give the mother, such a fitting image for Grandpatime, a superhero of simple things who appeared from nowhere and shared happiness. I wrote this haiku for him and, to me, it summarizes all things Neal:

When the baby cried
And the mother wanted to,
His smile was welcomed.

Thank you,

Darrell G. King
Rochester, NY, US

Social Proof Revisited

Good Morning America (GMA) aired a brief segment about a child crying on a busy sidewalk. Using hidden cameras, they filmed the various reactions of passing strangers. According to the report and those clips aired, most folks walked by without even glancing at the child. The most common exceptions were other children, at least one of whom convinced his mother to get involved. The most energetic intervention shown was a woman described as a grandmother who not only spoke with the child, but searched the area of the responsible adult and also intervened when an adult GMA employee started walking away with the child.

In his book Influence: The Psychology of Persuasion, author Robert B. Cialdini, Ph.D describes social proof by stating "that one means we use to determine what is correct is to find out what other people think is correct" (p116.) He further assets that this applies especially to determining correct behavior. I enjoy this book as it covers several areas related to the ways we influence each other, providing very clear examples and research. In this chapter, a host of experiments similar to the GMA scene provided some very convincing results paralleling the above.

Another interesting result was that people were more likely to intervene in staged emergencies when alone than when in groups or in the presence of actors who ignored the emergency. Social proof is a valuable time-saving tool for decision making. It appears that at times it can backfire by providing inappropriate information which is then not questioned. Should I follow the cars ahead of me in the traffic jam as they begin signaling for the next exit? Or was it a mindless stampede started by the guy who normally exits there? Is that pale, sweating elderly man leaning against the mall wall really OK as we all pass by or does he need an ambulance?

In using social proof unquestioningly, I am essentially surrendering independent thought in favor of the shortcut. In a confined building suddenly on fire, this can be a life-saving way to find the unseen open exit located by the first people out. Follow the crowd because it is following the leaders who are now outside and across the street. When the herd is reacting to a mistaken assumption or improper choice, though, the consequences can be less happy.

There are obvious questions for me, such as asking how often I use social proof as a crutch to support the easier decision; do I really want to get involved with the crying child? Will my intentions be mistaken when I stop to help and the mother suddenly appears to defend her child from the stranger? Maybe everything is just fine the way it is - everyone else seems to think so! I try to handle this type of thing by switching perspectives at the time, by questioning the little stories my fears make up, but it seems the tendency does not disappear just because I'm aware of it!

Some less obvious questions are related to the times I may not recognize the influence of social proof, or when I may see it but don't question it due to other distractions or more pressing considerations. What decisions am I making that are almost automated, that are perhaps not even in line with my beliefs or ethics? And what other influences are out there affecting me daily, nudging my behaviors this way and that, operating just under my radar?

Once again, I come back to focusing on the moment as a way of slicing through the confusion. Not as a cure-all, but as a path of improvement. It seems to me that much of the power of social proof is due to our habits of directing attention elsewhere, thinking about things unrelated to the moment we are standing in. Of course we find great benefits in anticipating future possibilities or in reviewing past scenarios, and I know I have developed those skills to a powerful level. And I understand I am not alone in this in my culture! When looking for reasons to develop the skill of fully entering the current moment, though, perhaps I should add this morning's GMA segment to my list.

Put simply, I suspect there are times when it is not proper to let others do my thinking for me and it seems the only way for me to recognize the danger is by being present and observant enough to see it happening.

Animals and Suffering

I recently read a post which described some of the harsher aspects of raising sheep commercially. I thought a bit more about my own relationship with animals and how I feel about their experiencing of life...

I grew up with cows, pets and wild animals. There were probably more non-human mammals inside the boundaries of my home town than humans. Maybe even without counting the cows! In this environment and given my mother's strong habit of anthropomorphizing pets, I learned as a child that animals were part of the family.

We went through many dogs when I was younger. We had one that got hit by a car, one that ran away, one that bit me and my father had to put it down - in my town, this last was done gangland execution style with a pistol. It seems I must have also learned that certain family members could be removed under the right circumstances - an observation that only came to me for the first time while reading a recent post.

The upshot of all this is that, to me, animals are people too. I don't attribute them with sentience, but who says people can't come in different flavors? I do observe emotional behavior and the obvious effects of sensation. I eat meat and wear leather, but I deplore efficient animal factories where life is perverted to produce resources for human consumption. Life is interdependent and it is not so ugly to consider different species living off each other in various ways. What seems sad to me is when a life form is intentionally robbed of the chance to follow its instincts and luxuriate in the glory of being alive. To live only to die seems somehow a diminishing of that magic time between coming and going.

I do learn from even the most tragic scenarios I run across, a kind of symbiotic act, but I also feel empathy as I learn and this is natural and confirms my humanity. On the road recently I saw a dead squirrel, flattened by traffic. Further on, a pigeon lay broken. It was a beautiful summer day, sort of the start of Spring for me as the temperature had risen enough that I had donned shorts for the first time. I thought of how the day might have gone for those two animals up until death, flitting about in the pleasure of warm weather and pursuing their little seasonal animal urges. Then all the promise of Spring ended abruptly.

Did I learn anything from their deaths? Almost my first thought after the above one was that I should enjoy this moment of my ride home because I might not see the end of the trip, which was only five more minutes in length. When life ends for one being, it may being value to another that still lives. This is not a bad thing. What corrupts the process is when we do not celebrate life while it is here.

As for suffering, if we think of pain or death as harsh, then life is harsh. If we think of life as beautiful, then are pain and death not beautiful as well?

Eden Unbalanced (An Essay)

During a discussion, there arose the question of how to reconcile the suffering around us with the concept of a loving God. What if there was no special reason?

In a dream, a vision, a window opened, a glimpse outward, as though for a moment or two vision bound to here unexpectedly perceived there. And I saw:

Eden Unbalanced
by Darrell G. King

In God, all things are possible and so evil embraces good, sadness dances with joy, the bright and the dark slide across the godscape in patterns beautiful and insane. In the multiverse all things are known and yet some must be tried in order to be experienced even though the experience is also known before the trying. Such is the way of infinity and so God, examining pain and misery, thought to try His image in a Concept bound to peace and joy, prohibited to suffering or hurt.

Eden is how we will say what He Created and this garden held one who was a true child, not the same for the absence of darkness but not so different, either. Life was celebrated, all were sated and yet none were hunted, sunlight and moonbeams washed over dancing forms beneath flawless trees atop perfect carpets of living mosses. Of course, this is only how it looked in the dream and I felt the reality would taste the same way, so this is how I will build my picture: an idyllic setting that would set itself outside the nature of things.

Balance is the way of God, however, and so the child, in part God itself, eventually came to notice that which was missing and then sought it out. The child reclaimed the knowledge of balance, of good and of evil in harmony. In learning it grew, but this was growth it was not designed to absorb and thus it did not become of God, but instead a sort of tormented potential of God. It fit neither in Eden nor in God. And so God made the Earth that the child could experience its turmoil in sufficient stages and manners that would not overwhelm its nature.

Forth walked the child into a new place Created with necessary structures under which it might learn to balance its Godhood. Adapting to the world, it became two and their forms adjusted to the rules of this material haven and multiplied, each new form of the same spirit yet pursuing answers independently, a doubling and redoubling of learning until they filled their classroom with the Quest. Each spark of life sought to understand, then brought what it gained back to the whole to be absorbed and to nourish growth until the child would be ready to step beyond the Creation and rejoin God.

Of course, this is but one way to tell the story and but one way in which Life can pass from one state to another. Of the many ways such things unfold, however, this is the one I was chosen to see and the one which I will tell of today.

D