00:02
When we are thinking about helping
this person with self-management,
learning how to
manage their life
in this disorder,
we really need to understand that
there are different approaches.
00:18
One might be that they
need to be hospitalized,
or in a therapeutic community,
we call that Milieu Management.
00:27
Being able to put them in a
place where they feel safe.
00:31
There are also medications
that help to manage aspects
and symptoms of these disorders.
00:39
We also have to think
about case management.
00:42
Because a disorder doesn't only affect
one person, it affects a family.
00:48
A person with a
personality disorder,
if they are living
with other people,
is that living environment
actually activating
all of these maladaptive
coping behaviors?
How can we manage this case so
that we can help this person
develop other coping mechanisms
and also allow them to
have community supports.
01:13
We want to make sure that at least while
they are in the hospital, in our care,
we establish clear boundaries.
01:21
And one of the things that
I think is really important,
there are so many times that
I speak with students who say,
"I don't really need to
know about this because
I'm going to be working
in orthopedics."
I just want to make sure
everyone understands
that people with
personality disorders,
and people with psychiatric
disorders, they break bones
and they end up in orthopedics.
01:47
People with personality disorders and
people with psychiatric disorders,
they have children.
01:53
And they often go into the
hospital to have those children.
01:58
And they are in
labor and delivery.
02:00
So understanding your patient,
even though your focus might
be the delivery of a baby,
understanding your patient,
being a nurse, and seeing the
individual in front of you
comprehending that we are complex
individuals each one of us.
02:19
Understanding that if there
is a personality disorder
that exists in a person
who's about to give birth,
having some of these disorder
management tools in your belt
really helps you to provide
that safe environment
not just for this patient,
but for all your patients.
02:38
So establishing
clear boundaries,
what are the rules and regulations
within your unit that you're working?
Understanding the contract that
you have with this patient,
that if they feel depressed, if they
feel like they want to kill themselves,
they will call you or call someone
before attempting to do so.
03:01
You want to know that
that can be verbal,
but it can also be written if
you are in a psychiatric unit,
we often use written contracts.
03:11
And we want to make sure that
it's not us saying to the patient,
"This is what you better do."
That doesn't work.
03:18
When we are going to arrive
at a solution for someone
that has to be
arrived that mutually.
03:25
There has to be
buy in from both.
03:27
It's a negotiation.
03:30
And nurses,
we are very good negotiators.
03:33
So I'd like you to think about
some of the different types
of therapies that we do use.
03:40
One of the therapies
that we use is called
Dialectic Behavioral Therapy.
03:46
Now, dialectic behavioral therapy is not
something that a nurse is going to do.
03:52
Dialectic behavioral therapy
is a therapeutic intervention.
03:57
It is therapy that
the patient will
undergo with a therapist
who is trained in DBT.
04:05
And part of DBT is
learning new coping skills
and having the patient learn
them and then evaluate them.
04:14
It uses dialogue to be able to
rework some of the destructive ways
that the patient has learned over
a lifetime to deal with crisis,
even just threat without crisis.
04:27
We also want to know that
this teaches our clients
that there are multiple ways
that they are able to decrease
some of these suicidal ideations,
these thoughts that they have.
04:39
And also to slow down some of those
emotionally reactive patterns.
04:46
We sometimes say their
knee jerk responses,
they happen without thinking.
04:52
And finally, it teaches the
patient how to have a new pattern
of thinking and behaving.
04:59
So one of the things I do as a nurse,
when I'm working with a patient
who needs to learn a
new way of thinking.
05:08
I usually say to them,
"If you have two dogs,
a good dog and a bad dog.
05:13
And the good dog and bad dog
get into a terrible fight,
who's gonna win?"
Most of the time, people say,
"Oh, the bad dogs gonna win."
And I say, "Why?" And they
say, "Bad dogs mean,
bad dogs gonna hurt the good
dog, bad dogs always win."
And I'm going to say to them,
"The dog that's going to win
is a dog you're going to feed."
If you feed that bad dog,
that bad dog's gonna get really strong.
05:40
But if you feed that good dog,
if you stop feeding
that bad dog,
that good dog is
going to get strong,
and the stronger
the good dog gets.
05:50
And the longer the
good dog stays strong,
the more the bad dog learns that
it's better to be the good dog.
06:00
So when these patients
are going to go home,
and that's an important
thing to remember,
our patients with
personality disorders
and psychiatric disorders do
not live in an institution,
they live in our neighborhoods.
06:15
So we want to make sure that when these
people are going home, our patients,
that we are giving them the resources
to be able to continue their recovery.
06:28
Because just being in the hospital
to get medication management
or to learn some new skills,
that's fine for while they're there.
06:37
But we want them to go
home and have a good life,
be a good neighbor,
be a good partner,
be a good parent.
06:44
So let's consider,
what kind of risk factors
they might have in
their environments.
06:51
And also think about
their protective factors,
whether they belong to a religious
group that they can count on,
whether they have a job
that they're going back to.
07:02
We want to make sure that they know
that we are available for them,
and that we've set up so that
they have a follow up appointment,
that if they require
ongoing therapy,
that they're going to be
able to get their therapy.
07:16
If they need to have
medication that upon discharge,
they're going to have
their medication.
07:22
I had one patient
who upon discharge,
I realized she didn't
have her medication yet.
07:28
We were able to postpone her
discharge for one day to allow her
to get the medication she needed from
the hospital for at least one week.
07:38
And to set up so that she
had our medications sent
and ready for her in her
own neighborhood pharmacy
so she'd be able to fill
that when she got home.
07:50
We also want to make sure that
we are able to have the person
understand their disorder,
understand that it is a disorder
and help them with
psycho education.
08:05
Teaching them the importance
of taking their medication,
the importance of being able to do their
small steps towards their recovery.
08:14
Teaching them patience
with themselves,
perhaps getting their
family into family therapy,
so that the whole family can work towards
the recovery of this one individual.