Oh, how the days disappear...

I'm taking a short break tonight from what is becoming my heaviest academic semester. I keep reminding myself that I really do love this type of stress - finishing clinical practicum hours, papers, group projects, and all those other great parts of being in a PMHNP-graduate program! Despite the heavy load, I have taken some time to enjoy a couple extra-curricular things that I'd like to share with you.

I had the opportunity to attend a presentation here in Iowa City in mid-November that was truly moving - Jerry Friedman, a photographer and author, discussed his book "Earth's Elders: The Wisdom of the World's Oldest People." Friedman has travelled around the world, listening to the stories of dozens of supercentenarians, people who have lived over 110 years. It was fascinating to hear him describe some of the experiences of these individuals - their humor, faith, optimism, and the importance of their families. I feel honored to share my time with any elder, particularly those I have seen in the nursing homes this semester. And I got the sense that Friedman feels the same way about these supercentenarians! Have you seen this book? Or heard Friedman speak? I'd like to hear :)

Another neat thing that has happened since my first post is that I prepared and presented two lectures for nursing students in the Psychiatric/Mental Health Nursing course at UI. Before doing this as part of my Teaching Assistant role, I don't think I fully appreciated the time and energy that a professor dedicates to this component of the job! I loved sharing some of my knowledge and experiences with the class, and I was thankful for the insightful questions the students asked. My excitement and enjoyment in teaching just these two classes has me thinking more and more that I'd like to continue doing these types of things!

It is nearly every day that I consider something I learned or experienced at the APNA Conference... Today, my thoughts turned to how thankful I am to have had the opportunity to attend the Conference. As I am swamped with classes (and packing my bags for India), I think of all the psychiatric/mental health nurses I met and of all the hard work they have done. And I hope I'm on a similar path to becoming one of those great leaders.

Cheers!

~Bonnie

Hi! My name is...

With an introduction like that, how could I decline this opportunity to try my hand at joining my passion for psych/mental health nursing with blogging? Especially considering the impact the 22nd Annual APNA Conference had on me, something I certainly intend to share with you in coming posts.

So, who the heck am I, that graduate student in Iowa referred to in the previous post? My name is Bonnie D'Souza, and I'm enrolled in the Psychiatric-Mental Health Nurse Practitioner program at the University of Iowa. While I've been a nurse for just over 3 years now, my heart has been in psych nursing for much longer than that. I went into my BSN program at Lewis University with a strong suspicion of my future specialty and am intensely satisfied with how my interest has grown. My particular interests lie in geropsychiatric nursing, end-of-life and bereavement, and research.

Thinking in true Wheel-of-Fortune-style introductions... :) I've been with a wonderful man for 6+ years and married him 2 1/2 years ago. He grew up in India, and we're planning to travel there this winter. We don't have children yet but are hopeful to someday. When I'm not glued to my text books and computer for classes, I love to spend my time baking, drinking coffee, reading, wandering bookstores & libraries, and playing photographer.

(The graduate student APNA-Janssen Scholars - Thanks to Pat for taking this!)

I am one of the 30 individuals honored this year with being selected as an APNA-Janssen Scholar. Hopefully, you will be hearing from a couple of them on this blog throughout the year! A large part of that award was having the opportunity to attend the APNA 22nd Annual Conference in Minneapolis a few weeks ago. This was truly a wonderful experience, one that allowed me to meet and spend time with some of the leaders in psychiatric/mental health nursing. I'm not just referring to the keynote speakers and those who gave presentations or had posters, but all those nurses I met in the elevator or sat next to at the concurrent sessions. And how can I not mention the other APNA-Janssen Scholars? This group of nurses and future nurses, my peers, who are so bright, interesting, and talented. I have no doubt that our generation will continue to bring these qualities to psych/mental health!

I am looking forward to blogging over the coming year. I hope to share with you some of my experiences, thoughts, and questions as a young nurse in the PMHNP program. But it doesn't stop there - I also want to hear from you. What are your experiences and insights? What do you wonder about? It's in the coming together that we can accomplish powerful things!

You can begin by commenting on this first post - how neat is it that two of the people who comment on the first post will be selected to receive a book! That's great! I'd do it!!

Cheers!

~Bonnie

New Year, New Blogger & some Blog Candy

We've just wrapped up the APNA 22nd Annual Conference. This was our most successful conference to date with over 1,000 attendees. We are working on convincing a graduate student in Iowa to take over the blog for the year. Her enthusiasm is infectious and her insight into psych nursing and the world around her is eye-opening.

Hopefully, we will see her first post soon. Please welcome her and subscribe so you can get her latest posts. Also, don't forget to leave comments. We will randomly pick 2 people who comment on her first post to received the new book Carved in Sand.

Last Blog

My blogging for APNA is at an end. Hopefully the tradition can continue. Each year more and more nurses join APNA, increasing the ratio of members that are used to and familiar with online resources such as this blog. So this kind of thing should have a future. But without member participation it is quite difficult. This lack of participation is normal in the first year of any endevour though.

In the last year, especially the last 6 months, I have been adding to my fund of knowledge more then ever before in psych. nursing. But sometimes it get's lonely in the office. And belonging to an organisation like APNA becomes essential.

I go now to the first pre-conference session here in the Twin Cities. I hope I will see you at the conference. Thank you for sticking with me the last year.

Peace, Gisli

APNA Conference in 10 days

Hope everybody is fired up for our convention. I am getting excited.

as we all know, it is not easy to get a psych nurse excited...

Plan to go to the sleep workshop. I find I am giving out Trazodone, Seroquel and other agents for sleep quite frequntly. I review the sleep hygiene points but sometimes the few minutes I spend on it seem to fall on deaf ears. Sometimes I probably don't spend enough time on sleep hygiene with clients. It is way easier to just write out a script, at least for me, in the short term.

I am hoping this seminar will keep me alert and on track.

See you there.

Fear

I am getting somewhat used to practicing on this new level I find myself on. Still there is fear. Fear of failure, fear of not knowing enough, fear of harming others through my negligence, fear of litigation, loss of reputaton, etc.,etc.

The solution to my fears is simple, but not easy, at least not for me.

I accept what can happen can happen, although it as not as likely as the script writer of the acopalypse that sometimes occupies my brain makes it out to be, in his finer moments. By fully accepting the worst case scenario I am released from my fear.

Then I simply do my best one day at a time.

Most good ideas are simple, in my experience, at least to the person having them...

Benzo's, what are they good for, uhh.......

I guess I am a bit biased when it comes to the blessed benzo's. Cynical after my CD inpatient experience. Detoxing of heroin is a walk in the park compared to getting off long term benzo use. I have heard suggestions from psychiatrists I respect that it takes up to two years to detox properly from them. I have not found any research that supports this claim though.

I guess they can be helpful, short term, e.g. post trauma or prn occasionally, for people with no substance abuse history. But too many good people are being left too long on them. They become physically, and more importantly, psychologically, dependent on them. They are convinced "nothing else is going too work".

Being trigger happy with this drug category is a dangerous game. Usually other psychotropics can be found that serve the same purpose. Not to mention non-pharmacological approaches.It is frustrating to see people left on these meds. for years, with limited or no attempts to find other avenues to address the target symptoms.

My final analysis: Useful in certain circumstances, but should be prescribed with caution. Can solve provider/pt. short term dilemma's only to create much bigger ones in the future

Yibbiiii

Good news, at least for me...

Took and passed my certification test last Wednesday. Good to be able to find out right away like that, reduces anxiety, I am sure everybody around me is glad too.

Was unsure how I was doing when I was taking it. Had to answer 175 questions in 3,5 hours. Had 15 minutes left to review questions. A long test. A lot of questions.

Guess you had to have grad school work to pass it. Not a lot of facts, more focus on understanding. This is good. As graduate education, at least the high quality one, should not be testing our cognitive functions and memory. A MMSE is sufficient for that. Graduate education is supposed to help create a mind capable of critical thinking. So we can make the right decisions with the most current and reliable information available. After all information is always changing.

If any of you out there have yet to take the Adult PMHCNS exam and are about to this fall, do not hesitate to post questions here or send me an email at gislik@gmail.com.

I did feel though that ANCC takes too long sending out the Authorisation to test number. What is the hold up? This is not a government agency, the services are relatively expensive. They can't afford hiring one more person? Is the lack of competition making them complacent? Maybe there is a reason for this I am not seeing?

Other services from ANCC were excellent, but the delay remains strange.

I am back

I plan to post 1-2 times a week from now on. Summer vacation is over: playtime is over;)

I am now working as a mental health professional. Will hopefully be fully credentialled soon. Pressure is mounting at work as I am feebly building up trying to assume my future expected case load.

I must say I feel a bit rusty after my time off. I am trying to be tolerant towards myself. Allow my self to feel overwhelmed and anxious for now: "This is normal, for a while at least..."

Psychiatry is no easy business, as we all know all too well.

Staying focused on today and the present moment, and the client in the moment really is helpful.

I do admit that I spend way too much time in the court room, mentally that is. Maybe it is because I am a foreigner, not used to a litigious society. Maybe just because I am a new practitioner. Or maybe just because I am a "nervous Nelly"?.

I know it is quite useless fretting about the future, but I give it a shot regulalry just for the heck of it...;)

The true civilized world

Aðalvík


For those of you who read this blog, my apologies. Will be in the good company of mountains and the sea here in Iceland for a while.

I am boldly going now to a place I know well, no phones, no internet. Just seagulls, high mountain passes and the occasional pissed off polar bear.

Will post again next week as I return to, what we sometimes, for obsucure reasons, refer to as civilization.

Summer

Hope you have some vacation time coming...

Until the next time, enjoy the weather

APNA conference

The 22nd APNA annual conference will be in my beautiful home town of Minneapolis the days October 15-18, 2008 at the Hyatt Regency Minneapolis

Minneapolis is beautiful in the fall. Not too cold, not too hot. All the leaves turning yellow and gold. A nice peaceful spirit over the city. You won't regret coming here.

Be in touch if you want any "insiders tips" on what to do here. Although I have only been here for two years there are certain things I am catching up on.


See the this link or the link on the right for more info

Sign up now

See you there!

Self Care

Just got back from a weekend long stay at a hermitage. Observed the caged monkey (my mind)jump around a little bit. Took walks, worked out, slept.

This is one form of self care. A kind that works for me, among various other things of course.

Other things work for other people.

General self care approaches are things like adequate sleep, exercise, spending time with family and friends, dancing, spiritual practices like prayer and meditation, healthy eating habits, tolerance towards own imperfections, etc.

We who work in this business have, I feel, a moral duty to take good care of ourselves. After all, we are the tools we work with, and our work will only be as good as our condition allows it to be.

That does not mean, I feel, that we should be perfect. It just means that we owe it to our clients to do our best to keep "fit" both spiritually and mentally. That we try, in our beautiful flawed human way to be sharp and well polished instruments.

Self care is not self-ish. What is selfish is neglecting self-care. It not only precipitates rust-out and burn out, it also hinders us to be of service to those we wish to serve.

What works for you?

Have you done that lately?

If no, why not?

working guy

These are strange days.I have graduated from my program and have started working.

I am not yet certified in my field so I cannot prescribe meds yet.

I can however work as an APRN for six months after I graduate while in this delightful process of being certified. See the Minnesota Board of Nursing website

What that means for what I can do is unclear though. It seems I can legally perform as a P/MH CNS minus the prescribing. But nobody is willing to reimburse my employer until I am certified, and credentialed.

I naively thought this clause was put in the statute so we could practice right after we graduated...

If anyone out there has experience practicing in this strange twilight zone any feedback would be appreciated.

Mental health and scandals

Two scandals regarding mental health related facilities have been revealed in the media recently in Iceland.

One is regarding a Christian based substance abuse facility, where the "minister" and head of the facility was convicted for having sexual relations with a number of his clients. Sexual relations of the sort that would be deemed highly unorthodox by most. This facility was run, in large part, on government contributions which make this horrendous betrayal of trust even more serious, if possible.

The other scandal involves the chief physician at the only long term psychiatric forensic facility in Iceland. He has been issuing scripts for stimulants on names of patients who have never received such medicine, and then had an accomplish retrieve them from various pharmacies. This offense is further exacerbated by the fact that these false scripts were written out for some of the most vulnerable individuals in our society e.g. convicts.

Could this happen in any other field of health care?

Perhaps.

But the fact remains that these things seem to happen more frequently in our field than other fields of health care.

Are the standards for mental health care lower? Is there less regulation for these kinds of facilities? Could it be that there is still stigma in the community, and that is reflected in this lack of oversight?

Mental health services in Iceland

"Kleppsspitali", the biggest long term mental health care facility in Iceland, his role is changing, perhaps too slowly?



We enjoy universal health care coverage in Iceland. We have one of the lowest infant mortality rates and the highest life expectancy rates in the world. But we still have a lot of problems in our health care system, like anywhere else in the world.

This is especially true for our mental health care system. Talk of moving the bulk of the services into the community is common, but practical action is slow to take place. We have started taking some action. Experience from countries like Denmark and the UK help, and user groups make a strong lobby group with increasing numbers of celebrities and politicians stepping up to the plate and talking openly about their struggle with mental illness. This helps reduce stigma in the community and is empoering for other users.

Still we have a long way to go. There is hope. We see how we have built up a powerful substance abuse treatment field and attitudes towards substance abuse in the communiuty are rather healthy, I would think. That is a field were the users of the system took the initiative.

Perhaps that is the key for other areas of psychiatry as well?

No place like home

I am currently back in the "old country". Minnesota has a lot of cool things, but it does not have any mountains and it does not have an ocean near by. Both of which Iceland has in abundance.

I like mountains. They are good for looking at and walking on.
Here is one of my favourites.







I will tell you a little bit about nursing in Iceland later this week.

Graduation

Great things will occur in this building today



Today I graduate from the Graduate school of the University of Minnesota with an advanced practice degree in Psychiatric/Mental health nursing.

This is excillerating and scary at the same time.

My main goal for my first year of practice is not to seriously harm anybody.

I will wait until my second year of practice to start changing the whole treatment paradigm of psychiatry... ;)

Cultural competence

Somalia is a beautiful country in North-Eastern Africa


I have been thinking about this topic alot lately

Been working on a mental health needs assessment of young Somali males here in Minnesota, with a collegue.

We wanted to find out how to better reach out to and serve male Somali clients, ages 18-35 with a psychotic disorder, in Hennepin County.

I was quite humbled after we had done the twelve key informant interviews and literature search on this populations possible community mental health needs.

It is clear to me know how extremely helpful it is to know the fundamental background and history of any population we are serving. Especially those we see frequently.

The things I learned in this process include the importance of cooperation with community resources, again reminded to stop and listen and that families are my clients too, and how many barriers to serving vulnerable populations in this country are due directly or indirectly to economical factors.

I have a lot of learning to do, and a lot of changing too

Stress managment techniques in prison

I have been doing my "plan b" on the subject of stress managment techniques in prison. I reviewed the literature on this subject and examined the evidence base for managing stress through specific interventions in prisons.

Alot of cool stuff has been done in this field, especially when it comes to meditation in prisons. The entire Senegalese prison system adopted Transcendental Meditation as an intervention in their prisons.

Large meditation retreats have been held in India and the US with great anecdotal success.

No all we need is some evidence...

APNA 6th Annual Clinical Psychopharmacology Institute Conference

Psychopharmacology Across the Lifespan
June 20-22, 2008
On-Site Registration opens June 19, 2008
Hyatt Regency Reston

CLICK HERE FOR REGISTRATION FORM

This session below seems especially interesting. From my limited experience during my clinical internship this seems to be a huge issue. If our patients are suffering sexual side effects from , e.g. anti-depressants, adherence will not be high.

Sex, Drugs and Rock & Roll
Dr. Mary Gutierrez, board certified in psychiatric pharmacy practice and
seven-time Professor of the Year at the University of Southern California, will be
speaking about good sexual function and what can go wrong.
I encourage everybody who can to register ASAP. This is definitely an opportunity not to be missed.

PRICES
Early Bird Registration
Register Early and Save
only $745 until May 23, 2008:
APNA Members save $200 off the Early Bird Price
only $545until May 23, 2008
Regular Registration Fee $795 until June 2, 2008:
APNA Members save $200 off the Regular Price
$545 from May 24 - June 2
One Day Fee $290 for members/$390 for non-members

Happy Friday!

Don't forget. There is still beauty in the world...

Depression and Excercise

There are some strong indications that excercise seems to help reduce symptoms of depression. It can possibly help people on anti-depressants reach full remission and help prevent relapse into depression too.

Some studies on the possible benefits of exercise for the treatment of depression show that 2½ hours per week of moderate activity could signifcantly reduce symptoms of depression.

The research indicates that it does not matter if the exercise is frequently for a briefer time, or less frequently for a longer time. 50 minutes 3 times per week (2½ hours) and 30 minutes 5 times per week (2½ hours) are thus thought to have the same positive effect.

Excercise can include, gardening, jogging, walking, sex, biking or any other similiar activity.


Are your patients aware of this?

Restraints

One of the saddest things we psych nurses do in our jobs is to restrain our patients. We do this when there is danger of patients harming themselves or others. Nobody likes to participate in such an operation, neither the patient nor the staff. And such incidents can be drastically reduced with proper de-esculation methods, approach to patients and other methods.

The fact remains that placing patients in restraints is a part of most psych nurses job in the inpatient setting. Although, in many cases not a big part, fortunately.

In Iceland we only use "human restraints", we do not tie people down or restrain them using anything else but the human body, usually our arms. So coming here and seeing these chairs and tables used to "tie" people down was somewhat shocking. I am unsure if it is wrong though.

In Landspitali:University hospital in Iceland we work in teams, usually of three or four, to overcome and restrain a patient. All staff working inpatient psych are required to attend a week long course learning how to do this in a safe and efficient manner, and then are required to take a recap course for a day, every 6-12 months. The method used originates from the UK, but I have failed to retrieve material concerning its evidence base.

Somehow it feels more humanistic to restrain patients like this. It reduces the risk of staff being overly "trigger happy" since we will be with the patient each moment restraints are necessary. It also secures proper assessment and monitoring reducing the risk for adverse events like asphyxiation, or unnoticed heart attacks.

On the other hand it does take training and certain staffing levels to achieve this, and in certain patient populations, the intimacy of this procedure could be detrimental (e.g. sexually abused women, anti-social patients)either towards patients or staff.

As I said, I am unsure what is best. I would like to hear any input you might have. E.g. on the evidence base of "human restraints" vs. the other kind, your personal experience with either kind, and what you think is most important when approaching this delicate subject.

This weeks anti-depressant

"The Full Catastrophe"

"Am I not a man? And is not a man stupid? I’m a man. So I married. Wife, children, house, everything. The full catastrophe."

-Zorba the Greek

Those of you familiar with the movie "Zorba the Greek" might remember this quote. It is also to be found in the book, with the same name, by the Greek literary giant Nikos Kazantzakis, one of my very favourite authors.

The "father" of Mindfulness Based Stress Reduction (MBSR) named one of his best books on the subject after this quote: "Full Catastrophe Living" (Kabat-Zinn, 1990).

MBSR was Developed by Kabat-Zinn et al. in the Nineteen-eighties, it is based on ancient Eastern methods of dealing with the “Full catastrophe” of living Zorba refers too.

MBSR is a structured group intervention that uses the techniques of mindfulness meditation to relieve and/or remove symptoms of various physical and mental disorders.
Its main goal is, to put it simply: being in the moment without judgment.
The method is meant to methodologically create increased awareness with the practitioner that will in turn improve various physical and psychiatric outcomes (Kabat-Zinn, 1990).

There is an increasing body of evidence forming on its efficacy treating various mental and physical disorders.

I teach most of my patients the basic principles of the method, along with a short meditating exercise. Most of them find it extremely useful.

There are MBSR courses held all over the country. They usually take 8 weeks, with a three hour weekly session, one whole day retreat and extensive homework.

I attended one last summer. It proved extremely useful, although I have been a daily meditator for more than eight years.

For those interested in knowing more I suggest this website . To find a class near you go here. The book referenced below is a great introduction and a great read also.


Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York: Dell Publishing.

One problem solved, on to the next...

Serenity Prayer

"God grant me the serenity

to accept the things I cannot change;

courage to change the things I can;

and wisdom to know the difference."

Reinhold Niebuhr

Those who are atheists or agnostics can use "May I have the serenity ........." instead.

Either way this works.

Really nothing more to it.

Now that I have dealt with the complexities of living life I can get back to implementing the APA style on my plan b.

Spirituality and mental health

I had the privilege of being introduced to the work being done in Alcoholics Anonymous (AA)when working at a chemical dependency (CD) unit a few years ago. I heard amazing stories of recovery and hope through these "recovering alcoholics" who came to bring their message to the patients of my unit.

What is unique about AA is that their methods are all based on a spiritual foundation (not religious), and all though there is great controversy still surrounding this subject they have become a respected and trusted resource for those mental health professionals involved in the CD field. A place where many recovering alcoholics can find a philosophy and fellowship to maintain and improve on the work already done in treatment facilities and hospitals the "got clean" in.

I find it fascinating that, at least in this one field, CD, a spiritual approach is often one of the key components to a persons recovery. I can't help to wonder if perhaps we who work in other areas of mental health can learn something from this...

Perhaps the spiritual approach is not just for clergymen to contemplate. Perhaps we should, in some cases, place the spiritual recovery in the front seat, next to the physical health, and the mind will follow. AA has be doing this for more then 70 years, and it seems to work for them.

Of course I realize AA is perhaps not the appropriate place for everybody, but they do seem to offer exactly what some of our patients need. Perhaps a portion of other clients in the mental health field have similar needs. Needs we psych-nurses are in a unique position to help them meet.

I am a psych nurse. Now what?

These are the things that came to mind.

The opportunity to help. The autonomy. Helping people one on one, having more chance of having a positive influence in peoples lives. Developing my own style or approach in therapy, become respected in my field. Having the ability and credentials to have a real impact on things. Really making something happen. Touching peoples live in a deep and meaningful way. Creating a space for me and the client to work in and existing comfortably in that space.

Some more infantile and simplistic aspects do pop up though, that is a part of my humanity too: Doing something that is recognized as complicated and requiring skill (unlike nursing??). The respect. Not having to wear scrubs. Getting respect from environment.

In my experience the more ego driven things do not last though. They will not and do not sustain me through the hard times, the trying times and all the moments of truth that lie ahead and behind.

A sincere desire to do good, and a passion for the field. Those are the bigg'uns, for me... today...

Then it helps to get paid too

On the usefulness of being mindful...

Theres a hole in my sidewalk: by Portia Nelson

chapter 1..
i walk down a street
there's a dep hole in the side walk
i fall in
i am lost...i am helpless
it isnt my fault.
it takes me forever to find my way out.
________________________________________________________
chapter 2..
i walk down the street
there is a deep hole in the sidewalk
i pretend that i don't see it.
i fall in again
i cant believe i am in the same place.
but it isn't my fault
it still takes me a long time to get out.
________________________________________________________
chapter 3..
i walk down the same street.
there is a deep hole in the sidewalk.
i see it is there.
i still fall in...it,s a habit..but, my eyes are open.
i know where i am.
it is my fault.
i get out immediately.
________________________________________________________
chapter 4..
i walk down the same street
there is a deep hole in the sidewalk
i walk around it.
________________________________________________________
chapter 5
i walk down another street.

Burnout

"Burnout is a psychological term for the experience of long-term exhaustion and diminished interest (depersonalization or cynicism), usually in the work context." (Wikipedia.com).

I have had the “privilege” of working with a good many burned out healthcare professional in the eight years I have enjoyed (most often;) working in healthcare. There is a whole body of research and literature on this subject now but the major symptom, in my experience, is loss of joy. Not enjoying the client interaction anymore. Other beginning symptoms I have noticed are loosing ones insight: use of humor becomes increasingly inappropriate and comments are made to and about clients that are inappropriate. But the main symptom to look for is lack of joy, I think.

Because of the danger of this I do watch myself, emotionally, pretty intently, both throughout the day, and I do an inventory at night. I also do a bigger inventory approx. once a year. This hopefully all helps with my catching the early signs.

Also alerting my friends and close family of these symptoms so they can alert me if they see them popping up. Last but not least, it is beneficial, I think, to have a good collegial relationship with someone at the workplace. A person that has “permission” to alert me of potential beginning symptoms of burnout I might be displaying.

I am young and have not been in this business for that long, but still I have felt the stingy odour of burnout twice, emmiting from my sensitive skin. Both times I did not set down proper boundaries regarding my work hours and/or work conditions.

I am responsible for taking care of myself. And if my place of work is hurting me, I must do what is necessary to change the situation, and if that is not possible, leave.

Simple, not easy...

To type or not to type: that is the question

What I mean by this cryptic statement is wether one should be typing/documenting elctronically while seeing patients.

This becomes especially important if doing psychotherapy, or supportive therapy, which I think we psych nurses are doing, knowingly or not, through out most of our day.

Do we give our clients our full attention "multitasking" like that? Keeping our eyes on the keyboard, not on our clients, creating distracting movements and sounds. Can we truly be there for our clients typing/documenting at the same time? I know it is really hard for me to be fully present for my clients while typing. That is why I don't. But of course I have the luxury of being a student with time to document I would not normally have.

I wonder if I will feel the same way when I start to work this summer. Perhaps I will learn to be present for the client and document. Perhaps time constraints will give me little choice.

Some of the clinicians I respect the most do document while in the "session" so it can't be all bad?

I know when working as a staff nurse, wether it was outpatient, inpatient or home care I mostly kept client encounters seperate from documenting.

We will find out soon how my ideals fare in the "real world"...

I wonder how others deal with this issue or plan to deal with it??

The mask of the mental health professional

My wife does not like it at all when I go all “psych” on her so I have a strong motivation to put this mask away at home, since she is a passionate woman... This mask is, I believe, a common defensive mechanism for us working in this field. I tend to want to pathologize my environment when it “does not behave” and over-intellectualize behavior that upsets me. This of course can be at times extremely useful, but also sometimes a blatant misuse of my professional authority and knowledge. My professional and educational preparation can thus become a weapon of sorts, an instrument of harm that I use against the people around me. Normalizing my own behavior in an authoritative manner and pathologizing theirs.

I feel myself often resisting the urge of labeling friends and family thus and having to really focus to remember who they are, holistically speaking. The same is true for many of my patients also, when I think about it.

I do feel that my psych preparation and experience often is helpful in my personal life, but in a more unofficial and informal capacity.

Mainly I feel that it gives me insight, especially to deal with me. After all, I am my biggest problem.

So it begins....

My name is Gisli ("Gees-lee") Kort Kristofersson and I am in the Psych mental health Clinical Nurse Specialist program at the University of Minnesota. I am married and have a 5 year old son and a 6 month old daughter.My wife is also doing a graduate degree here at the “U” in educational psychology.

My main areas of interest are community mental health, spirituality and mental health and culturally competent mental health care.We came from Iceland in July of 2006, sold everything we had and got on a plane. It has been a fun and humbling experience so far.

My hobbies, if anybody cares, include riding my bike, arty-farty cinema, playing basketball, reading books (From fantasy to Faust), mountain hiking and hanging out with my kids and wife.

But I am especially interested in “all things psych”. This is the reason why I agreed to do this blog. I was asked to since I was one of the Jansen Scholars that went to the last APNA annual conference in Florida, October 2007, and APNA was looking for a voice of a young psychiatric nurse to speak out here.

I will be posting on this site until the next APNA annual conference, which will be held this coming October here in Minnesota, about two –four times a week. Sometimes short, sometimes long, but always on psych related issues.

I am hoping those reading this will comment frequently so we can create some live discussions about the various topics we nurses face in the mental health field.

One of the biggest liabilities of nurses as whole is our tendency to keep silent on the public level. My hope is that this will be a venue for us to practice speaking out. Letting go of the fears and cute little complexes that prevent us from expressing our views and perspectives to the public at large.

And it is my strong believe that we do have a perspective that must be recognized, if this system is ever going to improve.

I welcome comments from all, students and veterans alike. I hope I will be able to provide you with some insights in the months to come, but even more, I look forward to learn from you.

Top 10 reasons to Join APNA

Actually, this a top 5. We're asking our members to give us 5 more reasons that APNA is the association to join for psychiatric nurses. Please comment and let us know what you think. Look forward to hearing from you!