Psychosocial Insecurity

Our little unit is an open-door haven that former patients visit regularly. Even when they're visiting other folks in our building, they tend to wander by the unit, to see the staff and to see if they know anyone who's staying with us. It may seem unusual to some, but not to us.

Then again, some of the people who stay with us a long time (and they probably make up at least half of the unit) don't want to leave. They enjoy the security of knowing they'll have help whenever they need it, or twenty-four seven room service we like to call it.

Right now, we have a couple of folks ready to leave us and they are suddenly getting jitters. "Oh, I feel sick." "Oh, I can't do this (or that.)" "I don't have any help lined up yet." Surprise, surprise. If we got out our Carpenitos for nursing diagnoses, we'd surely have a lot of these psychosocial diagnoses: Ineffective coping, relocation stress syndrome and my personal favorite, ineffective denial.

Despite the best intentions of getting sick at the last moment to postpone discharge, our first discharge guy left. He not only left, he waited all day to do it. He couldn't rush, because his help wouldn't be there right away. As when many people leave, some people count down to the next time we'll have someone back...as a long-term customer again. Those maudlin thoughts just creep up, even if office pools are forbidden.

One guy keeps leaving and coming back, because we keep discharging him for medical issues too acute to be handled on a rehab floor. I wonder how long it will take before he doesn't bounce back again. Age and infirmity can do that to a person. While I was off this weekend, he was back for one day and returned to acute. He didn't even make it 24 hours on our unit. I guess our idea of stable is a little different than the acute hospital's idea of stable. Not breathing and cyanosis just are not good things.

If the internal excitement is not enough, we have prowlers looking for privacy violators. Yes, it's all because of the good ol' JC. They're on the loose so this is practice...just like those quarterly fire drills. The boss just about had a fit when I gave a chart to a doctor. I had to prove I saw his badge and look him up in the computer. Good thing he's a psychiatrist with a sense of humor!

All this and H1N1, too. It's going to be a rocking end of this year. I'm just crossing my fingers!

More to come...