在许多医疗环境中, 恢复遵循已定义的路径, where healing is visible and progress is linear.
When treating patients with mental illnesses, however, that’s often not the case. And that, in turn, requires a different mindset and a more holistic approach.
Core attributes for success in psychiatric nursing
在 Stewart and Lynda 雷斯尼克神经精神病院 皇冠hga025大学洛杉矶分校, which treats both children and adults, nurses have “a real passion for looking at the whole person,” 帕特里克寂寞芳心首席护理官，注册护士.
Communication and interpersonal skills are critical, but so is simply being present.
“我认为我们的关键技能之一就是能够坐在一个非常不舒服的人身边，和他们一起传递同情,鲍勃·班甘吉说, DNP, 皇冠hga025大学洛杉矶分校健康中心的护士教育家.
许多来雷斯尼克神经精神病院的护士选择精神科护理而不是其他医学专业，因为她们想帮助战胜精神疾病的耻辱, 许多人有家庭成员或其他人的个人故事，他们的生活受到心理健康问题的影响.
为寂寞芳心, who has family and close friends who have struggled with mental illness, 他在护理学校的经历也影响了他专攻精神科护理的决定.
“I had a professor who taught mental health, and she was amazing,” Loney recalled. 另外, the professor’s daughter had developed schizophrenia while enrolled in medical school, 这一系列事件一直困扰着朗尼，并突显了精神疾病对人的影响. “It was so powerful to me,” 他说. “Here’s this really high-functioning person – it really can strike anyone.”
而许多人选择精神科护理是因为精神疾病固有的复杂性, 对于那些更习惯于在其他医疗机构工作的人来说，治疗不一定遵循传统的途径，这一事实可能是一个挑战. It requires what Loney calls “the therapeutic use of self,，其目标是陪伴患者度过他们的心理健康之旅，而不是“修复”他们.
“你必须接受这种内在的奖励，因为你知道自己在帮助别人，”本甘吉补充说. “You may spend weeks working with someone only to see them decompensate. 而是通过发展一段关系, you may be the first person your patient ever opens up to, and this may help save their lives.”
Communication and trauma-informed care
As part of orientation and training, 所有的护士, 雷斯尼克神经精神病院的护理伙伴和治疗师都必须获得降级技术的认证, 使用行业标准的为期一天的课程，重点是通过尽可能地化解或缓和危机来成功地管理危机情况. They also complete a refresher course every year.
Bencangey, 谁来教这些课程?, 还为所有来雷斯尼克神经精神病院工作的医生提供了一个简短的版本，作为他们住院医师的一部分.
Loney解释说:“我们教授了一个如何应对的基本框架，但这只是一个框架。. “Humans are really complicated, unpredictable things.”
当有人激动的时候, 能够评估需要什么并帮助恢复平静感需要个性化的方法.
“It’s listening a lot more than talking,朗尼说. “It’s being very patient and having a calm voice even when you’re not feeling calm, and trying to listen for meaning and understand how to meet the patient’s needs.”
这可能需要一些解码, 他说:“下面, there’s usually a message that’s real and worth listening to, but it gets lost in the agitation or the confusion or the physical behaviors.”
Related and also essential: a commitment to providing trauma-informed care, 它承认病人的行为是他们的疾病和过去经历的表现.
“We look at patient behaviors as the tip of the iceberg,” Bencangey said. “水面以下的一切都是这个人的历史和他们经历过的所有事情. What we’re seeing in the moment isn’t about us; it’s about something traumatic that’s happened to the patient. Not taking those behaviors personally is a key skill in de-escalating situations.”
护理人员也接受过培训，认识到不同的方法在不同的精神病情况下效果最好. When working with a patient who’s manic, 例如, it’s important to remember that “they’re not intentionally doing anything, 这就是疾病本身,朗尼说. Many patients initially have trouble sleeping, and they may be irritable or even giddy or grandiose, 他解释说. They may need to be reminded to eat, drink water and take their medications, 他说, but it’s important to do so in a way that’s thoughtful and patient.
类似的, 一个有妄想症的病人, “you’re not going to be able to talk them out of it,朗尼说, adding that trying to do so might just frustrate them. 而不是, “it’s important to remain calm and empathetic, avoid arguing and redirect them back to the task at hand.”
某些患者群体也可能有独特的通信需求:例如, 与患有精神疾病的儿童一起工作意味着要考虑到具体的疾病以及儿童的发展水平, 他补充说.
基于关系的方法
In some situations, a patient may respond differently to one staff member than another. “When somebody’s going into a crisis, we find out who has the best rapport with them, who has the best chance of helping them,班甘吉解释道.
这之所以成为可能，是因为雷斯尼克神经精神病医院的工作人员都与所有患者保持定期联系, 鉴于不同的工作人员领导治疗小组，并在病房的社交空间与患者互动, a practice known as “milieu therapy.”
作为一个团队工作还包括警惕与药物相关的变化或其他问题，并与医疗人员进行沟通. “That’s a lot of what psychiatric nursing is: observing and assessing, and making sense of what you’re seeing,朗尼说. “All of the disciplines – social work, 职业治疗, 医生, 护理——我们的关系非常紧密, and everything’s very interdisciplinary.”
Empowering nurses and improving patient outcomes
雷斯尼克神经精神病医院目前正在寻求重新指定为磁铁认可的机构-这是护理卓越的标志，只有少数独立的精神病医院有.
获得指定是一个漫长的过程，主要是基于护士主导的倡议. The hospital first received the designation in 2019; being redesignated as a Magnet facility includes a site visit to evaluate additional initiatives that have taken place since then to continue to improve patient outcomes.
Loney引用了最近的一项倡议, "Welcome to 雷斯尼克神经精神病院" videos for patients, implemented in 2021 to supplement existing print and online welcome materials. “我们希望为喜欢视觉和听觉学习形式的个人提供另一种选择,他解释道. 这四个系列的视频是为雷斯尼克每个项目的患者定制的，可以通过医院的网站访问, 皇冠hga025大学洛杉矶分校健康应用, 或通过二维码.
Loney指出，这些视频是一个合作项目，也包括了该组织成员的意见 Patient and Family Advisory Council of past patients and their family members.
Members of the council play a vital role at 雷斯尼克神经精神病院, Bencangey added: In addition to meeting monthly to provide feedback and suggestions, they share their stories as part of new-hire orientation, 这是非常强大的吗. “Their personal stories provide the context of why we do what we do,” 他说.
听到这些观点也强调了与精神疾病患者一起工作的细微差别, and the reality that all too often, being discharged doesn’t mean being “cured.”
Loney说:“我们的大部分病人在离开我们很久之后还会与这些问题作斗争。. “We believe people can get their highest level of functioning, and our job is to support them getting there.”
