Meeting People Where They Are At
I think I forgot that I wrote this blog again, until a nursing professor from a university in the US emailed me to ask permission to use an entry as a recommended reading for a class they teach. Blogs are such an interesting thing for me. I love writing and for some reason I think that I will have a excess of free time to write. I have written many since I was 16 and discovered them in the vast expanse of the Internet. I have a few on the go right now that I most use as a means of reflecting on my nursing practice and also reflecting on being a parent. I do not think I ever expect anyone will actually read my ranting and sometimes academic thoughts so it was a pleasant surprise and welcome reminder that someone in the world may be reading this and that it may be helping fellow nurses in some way.
Yesterday I had a conversation with a student about what the appropriate intervention is when a patient that is being discharged openly tells the nurse that they will be going directly from the inpatient mental health unit to seek out illegal substances and get high. My response was something like, "we would thank them for being honest with us and then we would provide information about the potential to risks." I think that too often in healthcare and much too often on inpatient mental health units clinicians are approaching care from the perspective of idealization that the patient will continue in their life exactly as we healthcare professionals have told them to live it, even when a patient is explicitly telling us that no they will not. I think this attitude helps to perpetuate the process of patients telling clinicians what they want to hear in order to get discharged, or because they feel like the clinician is negatively judging them, or that they think they will get in trouble, or maybe they just want the clinician to stop talking. I saw this all the time in my previous place of employment and. It almost always led to unrealistic discharge planning and ultimately frustration of the staff if a patient ended up dangerously symptomatic in the community and required another hospital admission. Unfortunately, it seemed like the exact same approach was taken again with the expectation that when the patient got on board with the medical advice then they would find success. This is very much aligned with a mental health recovery approach. I think what works much better is listening to the patient and assessing where they are in terms of the Transthoeretical Model of Change, working with the matching intervention from that perspective, understanding that no matter how much we want the patient to be in the action stage they are going to be where they are at from their perspective, in their lives. I think this would result in so much less frustration of staff because then we can let go of this unnecessary investment in patients following through with a plan of care that we should have known was going to fail anyway. In my career I have sat in on complex case rounds where the clinicians sitting around the table would acknowledge that the plan would fail but still continue on with it. It did not just make me scratch my head and wonder why they would not just change the plan, it made me question the ethics of this route.
Yesterday I had a conversation with a student about what the appropriate intervention is when a patient that is being discharged openly tells the nurse that they will be going directly from the inpatient mental health unit to seek out illegal substances and get high. My response was something like, "we would thank them for being honest with us and then we would provide information about the potential to risks." I think that too often in healthcare and much too often on inpatient mental health units clinicians are approaching care from the perspective of idealization that the patient will continue in their life exactly as we healthcare professionals have told them to live it, even when a patient is explicitly telling us that no they will not. I think this attitude helps to perpetuate the process of patients telling clinicians what they want to hear in order to get discharged, or because they feel like the clinician is negatively judging them, or that they think they will get in trouble, or maybe they just want the clinician to stop talking. I saw this all the time in my previous place of employment and. It almost always led to unrealistic discharge planning and ultimately frustration of the staff if a patient ended up dangerously symptomatic in the community and required another hospital admission. Unfortunately, it seemed like the exact same approach was taken again with the expectation that when the patient got on board with the medical advice then they would find success. This is very much aligned with a mental health recovery approach. I think what works much better is listening to the patient and assessing where they are in terms of the Transthoeretical Model of Change, working with the matching intervention from that perspective, understanding that no matter how much we want the patient to be in the action stage they are going to be where they are at from their perspective, in their lives. I think this would result in so much less frustration of staff because then we can let go of this unnecessary investment in patients following through with a plan of care that we should have known was going to fail anyway. In my career I have sat in on complex case rounds where the clinicians sitting around the table would acknowledge that the plan would fail but still continue on with it. It did not just make me scratch my head and wonder why they would not just change the plan, it made me question the ethics of this route.
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