Compassionate nurse

Where Is the Compassion in Psychiatric Care?

“There is nothing weak about kindness and compassion,” former President Barack Obama said in his eulogy of Elijah Cummings, the Democratic Congressman who died last week. “There is nothing weak about looking out for others. There is nothing weak about being honorable. You are not a sucker to have integrity and to treat others with respect.”

While President Obama was speaking about a man working in the highly polarized world of partisan politics, I heard his message as a psychiatrist, working in a field that too often views compassion as unnecessary and even as a professional weakness.

One local hospital’s psychiatric services website states of its mission:

“To provide our patients with the best care, we depend on the compassion, expertise, and strength of one another. We come to work knowing that our patients need us and that our colleagues support us and this allows us to strive daily to be the best health care providers — and people — that we can be.”

Frankly, talk is cheap. Too many hospitals fail to live up to the mission statements they proudly display.

I know many excellent psychiatrists and psychiatric nurses whom I would confidently recommend to someone I love. To me, this is the greatest mark of professional respect. However, a few of my colleagues disgrace their profession and blemish the work of the compassionate, enlightened majority who strive to maintain their patients’ dignity.

Sadly, I have learned from too many of my own patients about unprofessional, demeaning, abusive treatment they suffered at the hands of both doctors and nurses at psychiatric clinics and hospitals across the country. I have witnessed this offensive behavior first-hand since I was in medical school.

Most of my patients who have been admitted to a psychiatric unit describe the experience as traumatic, terrifying, or both. One went directly from my office, accompanied by a parent, to the hospital. Within a few hours, her clothing had been forcibly removed by a group of security personnel, including men, one of whom groped her breasts. She was so traumatized by the abusive treatment she endured that she refused to return to the hospital when she needed help. Instead, she took her own life.

Other patients have recounted being held down and forcibly injected when they were not being aggressive or combative. Another was humiliated by the taunts of a nurse and a ward clerk. (I witnessed this myself.)

Due to the cruelty my patients have encountered, and through many years of experience, I fear for the safety of patients when they become acutely ill. Of course, I worry about the harm their brains and bodies may sustain due to their illness, but I also fear how they will be treated by the staff they will encounter if admitted.

Those admitted to a psychiatric unit are usually very ill, sometimes disruptive, and potentially violent. Due to the severity of their symptoms, they might lack insight regarding the nature of their illness and their need for treatment, yet they are still human beings worthy of respect.

Some staff on psychiatric units excuse their hostile, dehumanizing patient interactions as a necessary response to a dangerous working environment. Their appalling behavior is not about the safety of staff or patients; it reflects a desire, whether by an individual or the entire clinical team, to exercise power over a vulnerable individual. If their behavior is acceptable, reasonable, and appropriate, why do they always deny it occurred? Invariably, the patient is blamed or accused of dishonesty.

Psychiatrists and their clinical teams are given extraordinary power to limit a patient’s freedom and to treat an ill person who lacks insight, sometimes against their will. Patients and families trust us to use that power responsibly.

We are judged as a society by how we treat our most vulnerable members. The abuse of power and the use of humiliation and violence demonstrated by some staff on psychiatric units have no place in a just and civilized society, much less in a medical setting, which is meant to be both safe and settling.

Those individuals who abuse patients, or fail to protect them, must be held accountable by colleagues, professional licensing bodies, and patients and their families. Regrettably, a complaint from one doctor is easy for a hospital to ignore. To provoke meaningful change, we all need to speak up.

I urge anyone who experiences or witnesses a dehumanizing, threatening, traumatizing or humiliating psychiatric clinic or hospital interaction to speak out. Write to the hospital, health authority, or professional college where the event occurred. Then, perhaps the hospitals and licensing bodies will demand that mental health professionals do what they’re supposed to do — care.

Source link: https://www.psychologytoday.com/intl/blog/psyched/201910/where-is-the-compassion-in-psychiatric-care

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How to be Assertive: Learn Standing Up for Yourself

Assertiveness is a skill that can be learned, and it is a communication that can help an individual express his or her thoughts, feelings, views, opinions, etc., without being inhibited or aggressive or without disregarding the thoughts, feelings, views, opinions, and ideas of others. The term assertiveness was introduced by Andrew Salter in 1949. Being assertive can help you in both personal as well as professional life. If you are an assertive person, it is likely that you are better able to cope with anger, stress, and other demanding circumstances.

So who is an assertive individual and how is he different from a nonassertive individual? To understand this we have to consider the behavior styles of people in relation to others along a continuum (Dennis Jaffe, 1984), where passive and aggressive behavior lie at each end of the continuum and assertive behavior is right in middle of the two. Passive individuals are too scared to express their thoughts and feelings. Such persons are often shy and surrender to the demands of others in order to feel accepted, especially they find it difficult to say ‘no’. Passive style of behavior is used by people with codependent personality. On the other hand, an aggressive individual often tries to intimidate others and try to gain control of their thoughts, needs, and feelings. Such individuals have complete disregard of others’ feelings. This type of behavior style is often employed by individuals who display Type A behaviors. Now comes assertive style of behavior, which is the preferable style where an individual is able to express his or her thoughts and feelings and protect his or her rights without belittling others’. Such people are more open, considerate, and are tolerant of the feelings of others; also, they have high self-esteem and confidence level.

Assertiveness recognizes that there are legitimate personal rights, which have been described by various therapists and include the following:

  • Being able to say no without feeling guilty.
  • Having the right to change one’s mind regarding anything
  • To ask for help with directions or instructions
  • To ask for what you want
  • Being able to express or experience feelings
  • Right to feel positive under any circumstance
  • Right to commit mistakes without feeling embarrassed
  • To have one’s own opinion and beliefs
  • To object to unfair criticism or treatment
  • Being recognized for one’s achievements or contributions
  • To be able to take time to develop a response to a question or comment

Not every individual is born assertive. We are often less than assertive in our conduct towards certain people especially of higher authority, such as parents and bosses. However, not being assertive can also occur when we deal with someone by whom we feel intimidated. These can be people of opposite sex, individuals who are perceived as more attractive than us, and every unfamiliar person. Since assertiveness is a skill it can be learned and with repeated practice it can become part of our personality. Following techniques help a great deal in developing assertiveness:

Woman-saying-noLearn to say ‘No’: Saying ‘no’ is perhaps the most difficult thing to do for some individuals so much so that they put other people’s need before their own. Saying ‘no’ is sometimes considered rude, which is a misconception. Saying ‘yes’ when it is impossible for you to say so can lead to feelings of bitterness and victimization. That is why being able to say ‘no’ when you don’t feel like saying ‘yes’ is a critical attribute if you want to be assertive in life. Equally important is to learn saying ‘no’ without letting the feeling of guilt creep in. Understand and accept your limits and don’t feel bad about them. In case of personal obligations, try to diplomatically refuse your help at that particular instant.

Learn to use ‘I’ statements: Being assertive means being able to express one’s feelings and emotions by using ‘I’ statements. Learn to own your thoughts, feelings, opinions, ideas etc. Also, using ‘I’ statements doesn’t make the other person defensive because ‘I’ seems less accusatory. For example, “you are wrong” seems more attacking than “I disagree.”

Use eye contact: Assertive people are comfortable maintaining eye contact while interacting or expressing their thoughts to others. Lack of eye contact makes a person appear as having less conviction in what he or she is saying. It also indicates dishonesty and insecurity. Start using eye-contact while interacting with a short time interval of about 1-2 seconds and then progress up to 8-10 seconds period. But, beware! just as lack of eye contact indicates lack of confidence continuous staring is often taken as violation of personal space. So try to avoid staring at people.

Improve body language: Being assertive without appropriate body language sends mixed message to the other person. The way you carry your body plays an important role. It is important to have an erect posture with body weight equally distributed between both legs along with good eye contact and tone of voice. The center of gravity should be directly above the feet.

couple-talkingBe open to criticism: Learn to accept criticism positively. You can disagree with the criticism and have the right to convey your difference of opinion but you must do it without getting angry or defensive. Take negative feedback as an opportunity to learn something new or improve yourself.

Disagree peacefully: This skill is employed when one has to express a differing view and want it to be acknowledged too. When ideas and opinions are expressed peacefully so that different viewpoints can be analyzed properly during a conflict or during the process of decision making, such disagreements are considered as healthy disagreements. Being able to remain comfortable during a confrontation is the hallmark of assertiveness.

Practice: Like any other skill, assertiveness too requires practice, a lot of practice, in fact. Stand in front of a mirror and imagine different scenarios where being assertive would be beneficial, and practice your response. Work on your body language, your tone of voice, eye contact, and communication. Use assertive communication like ‘I’ statements, and ‘No’ statements. And remember to start small. At first, try assertiveness skills in situations where the risk is low and then gradually apply them to tougher situations where the stakes are high. For instance, before applying those in work place with your boss, try them out first with your friends or spouse. Evaluate the results so that you can improve your skills. Remember it takes time and practice to learn a new skill whether it’s playing a guitar, or badminton or developing assertiveness.