7 Things Nurses Deal with that Make Others Freak Out.

By: Lee Nelson

Being a nurse involves seeing, hearing, smelling, touching and dealing with some of life’s not-so-pleasant things. Nurses face it all from the grossest to the most stunning situations that would make the normal person squirm or run. They build up an immunity to it, but it’s still something that can make them very wary. Yet, they never stop a beat of helping the patients that they have been trained to see through it all.

“We see it all,” says Barb Gallogly. She is senior lecturer and coordinator for Post Baccalaureate Nursing Program at Henry Predolin School of Nursing at Edgewood College, Madison, Wis.

“We are the eyes of the physician and the ears of the respiratory therapist. We are in a position of privilege to be with the patients on a minute-to-minute basis. People trust us, and people open up to us,” she says.

And those patients trust them not to run away when things go from bad to worse or when they need them the most.

Things That Nurses Face That Make Them Unique, Strong And Oftentimes – Saints


It’s not pretty. “But sometimes some of us still gag at vomit and other things that come out of bodies,” says Kristin Gundt, chief nursing officer at Community Hospital in Grand Junction, Colo. “It all depends on how much you are exposed to it, but that doesn’t mean you have to like it. We all have triggers that makes our own bodies react to it.”

Gallogly agrees that there are still things that make her gag. “But you have to rise above it, and work with it, and not to let your own personal feelings or reactions get in the way of good patient care,” she says. “A nurse must remain respectful of the patient and be calm when all hell breaks loose.” (Is your patient difficult beyond their physical condition?


In Gallogly’s office hangs a lithograph with a person who has germs all around and the words, “Please Wash Your Hands” stamped on it.

“I’m a germaphobe. As a new nursing grad, we didn’t wear gloves or masks back then. We never thought anything about it,” she says. “But now, there is anti-bacterial gel at every entrance – gel in and gel out. That’s hammered into our students now.”

She sees a lot of infected wounds, and a lot of people put into isolation because of infections. “Universal precautions don’t cut it anymore,” she says.


Sometimes when someone else is vomiting, the sound itself can set nurses off with their own gagging reflex. “Or sometimes you hear someone with diarrhea and the gas with it, and it can set something off in you, too,” Gundt says. “But we try to hide our reaction for the patient’s sake.”

She adds that one of the hardest smells to stomach is when a patient is bleeding from their intestines or stomach. “You might have to excuse yourself if you are going to gag or throw up. You don’t want to make the patient feel like even the nurses can’t tolerate it,” she says. “But it smells so bad.”


“We don’t know what death will be like from one person to the next. It can be smooth to really traumatic to really messy. It can be awful,” says Gundt.

One time comes to mind for her when she was a home health care nurse. The elderly lady had a relative come during the last stages of her death. The relative was panicking because she didn’t understand death and all the things that happen when the body shuts down

“People are incontinent. They can’t hold their bowels. Nothing in them is awake anymore,” she says. “So, I kept her clean, changed her and turned her, and made sure she got pain meds. I stayed with her and the relative. It’s the people that are alive that are panicking. People are scared to be alone with the person who is dying.”


“Most people’s jobs aren’t like this,” Gallogly says. “You learn really quickly to become a great multi-tasker and set priorities all the time. You usually have three or four things coming at you. You learn to delegate to others that can help you.”

Some days, it will be overwhelming. You leave work thinking that you didn’t do a good job. “With budget cuts, nurses are expected to do a lot more with less. It’s hard to give quality nursing care, and we want to take care of that whole person, but so much is coming at us. That’s frustrating,” she says.


“We don’t just take care of the person, but the whole person which includes the family,” Gallogly states. “If the family is demonstrating behavior that are precluding progress or treatment for the patient, then we pull them aside. You never know what is going on with them. We don’t know their histories. There is usually a reason for their behavior.”

She says it’s easy to label people as the “crazy daughter” or “hysterical mother.” But that doesn’t solve any problems or help anyone. “We try to explore those dynamics and include them in what we are doing with the patient,” she adds.


When people are sick, their behaviors aren’t necessarily their norm. “They lash out at us, hit us, spit on us and swear at us. There is a lot of physical and emotional abuse,” says Gundt. “Sometimes, it’s very unexpected. You never think some of these people will strike out at you because they seem stable as can be.”

Gundt adds that nurses try very hard to not put themselves in a situation to be hit or hurt. “If it’s a family member that we feel is being obnoxious, abusive or unrealistic, we won’t hesitate to escort them out or get someone to do so,” she says. “But we will start with way less restrictive methods. We try to keep people on our good side.”

Nursing isn’t all roses and sunshine. But most people understand that when they go into the profession. It’s not easy. It’s not always pretty. But for those who choose it, they say they do it because they want to help people. They want to educate people to live healthier, happier lives no matter what squeamish circumstances they have to confront.

Reposted from: https://nurse.org/articles/things-nurses-deal-with-that-make-others-squirm/

The Little Things.

“Yesterday I overheard a nursing student snark, “yeah, this is why I’m in nursing school – so I can pass trays.” And if I hadn’t been up to my eyeballs in other things to do for my patients, I would have stopped and said: You’ve already missed the point entirely.

I’m not sure why you DO think you’re here. If you hope to be a good nurse (or coworker, or person with a heart), you’re going to spend the majority of your working life doing things you SO mistakenly think are beneath you. You are going to pass trays with a smile – excitement even, when your patient finally gets to try clear liquids. You will even open the milk and butter the toast and cut the meat. You will feed full-grown adults from those trays, bite by tedious, hard-to-swallow bite. You will, at times, get your own vital signs or glucoscans, empty Foley bags and bedside commodes without thinking twice. You will reposition the same person, move the same three pillows, 27 times in one shift because they can’t get comfortable. You will not only help bathe patients, but wash and dry between the toes they can’t reach. Lotion and apply deodorant. Scratch backs. Nystatin powder skin folds. Comb hair. Carefully brush teeth and dentures. Shave an old man’s wrinkled face. Because these things make them feel more human again.

You will NOT delegate every “code brown,” and you will handle them with a mix of grace and humor so as not to humiliate someone who already feels quite small. You will change ostomy appliances and redress infected and necrotic wounds and smell smells that stay with you, and you will work hard not to show how disgusted you may feel because you will remember that this person can’t walk away from what you have only to face for a few moments.

You will fetch ice and tissues and an extra blanket and hunt down an applesauce when you know you don’t have time to. You will listen sincerely to your patient vent when you know you don’t have time to. You will hug a family member, hear them out, encourage them, bring them coffee the way they like it, answer what you may feel are “stupid” questions – twice even – when you don’t have time to.

You won’t always eat when you’re hungry or pee when you need to because there’s usually something more important to do. You’ll be aggravated by Q2 narcotic pushes, but keenly aware that the person who requires them is far more put upon.

You will navigate unbelievably messy family dramas, and you will be griped at for things you have no control over, and be talked down to, and you will remain calm and respectful (even though you’ll surely say what you really felt to your coworkers later), because you will try your best to stay mindful of the fact that while this is your everyday, it’s this patient or family’s high-stress situation, a potential tragedy in the making.

Many days you won’t feel like doing any of these things, but you’ll shelve your own feelings and do them the best you can anyway. HIPAA will prevent you from telling friends, family, and Facebook what your work is really like. They’ll guess based off what ridiculousness Gray’s Anatomy and the like make of it, and you’ll just have to haha at the poop and puke jokes. But your coworkers will get it, the way this work of nursing fills and breaks, fills and breaks your heart. Fellow nurses, doctors, NPs and PAs, CNAs and PCAs, unit clerks, phlebotomists, respiratory therapists, physical and occupational therapists, speech therapists, transport, radiology, telemetry, pharmacy techs, lab, even dietary and housekeeping — it’s a team sport. And you’re not set above the rest as captain. You will see you need each other, not just to complete the obvious tasks but to laugh and cry and laugh again about these things only someone else who’s really been there can understand.

You will see clearly that critical thinking about and careful delivery of medications are only part of the very necessary care you must provide. Blood gushing adrenaline-pumping code blue ribs breaking beneath your CPR hands moments are also part, but they’re not what it’s all about. The “little” stuff is rarely small. It’s heavy and you can’t carry it by yourself. So yes, little nursling, you are here to pass



Reposted from: Whitney Koenig

‘I want to talk!’ Waterloo students demonstrate for better mental health support

Months of waiting for counselling and the culture of high productivity has University of Waterloo students demonstrating at arts quad Thursday morning.

“I want to talk!” One student chanted. “We want to listen!” The crowd answered.

WaterlooWalkout for Mental Health was organized after a 22-year-old student in his fourth year of study died by suicide on campus on Monday.

About 200 students showed up. Some held signs. Others shared their struggles with mental health and what they believe is a lack of support on campus from counselling services.

“It seemed like they didn’t care about what I had to say,” said Iman Abbarao, who has been studying at the university for almost four years.

“The other day I told my friends that if I didn’t have family and friends in downtown Toronto, I probably would have taken my own life at some point along this journey,” she said in front of the crowd of students.

Iman Abbarao Waterloo mental health

Iman Abbarao, a student in her fourth year, said the only way she can get support is to leave campus and take a two-hour GO bus ride to downtown Toronto where her family is. (Flora Pan/CBC)

One after another, students recalled times when they went to counselling services but were told the next available appointment is months away. Other students spoke about abuse, sexual assault, depression and post-traumatic stress disorder.

Chelsea MacDonald, a first year student studying theatre performance, said she is angry about the state of support available for students.

“And then something like this happens, the university tells me go to counselling services. I can’t even f–ing get an appointment,” she said.

Mental health report

Matthew Grant, the university’s director of media relations, said at the rally that it was “very brave” for the students to share their experiences with mental health.

He said the mental health report being released on March 14 will have recommendations for improving student mental health on campus. There is also a town hall where the president will talk about the report and address student questions.

Currently, there are 22 full-time equivalent counselling services staff and 2 full-time equivalent psychiatrists serving 31,380 undergraduate students and 5,290 graduate students.

For comparison, at the University of Guelph, there are 16 full-time counsellors, one full-time psychiatrist and one part-time psychiatrist serving about 23,000 students.

A Wilfrid Laurier University spokesperson said for approximately 14,500 full-time equivalent students at the Waterloo campus, there are more than 30 staff, a mix of full-time and part-time physicians, nurses and counsellors, at the Student Wellness Centre who address mental health concerns.

Sundus Salame waterloo mental health walkout

Sundus Salame said the pressure to succeed academically is intense and she frequently feels like despite studying very hard, she isn’t good enough. (Flora Pan/CBC)

‘Very competitive’ culture on campus

Aside from the long wait times for counselling, students mentioned the pressure to succeed academically and getting good co-op job placements makes it very difficult.

“Somehow I have to be superhuman, or I have to have some kind of time-turner to catch up with all of these deadlines and readings,” said Sundus Salame.

“A lot of people here are pushed to just work 24/7 just to get 80 average, just because the courses are designed to just weed out anyone who does less than an excessive amount of work,” she said.

Chelsea MacDonald waterloo mental health

Chelsea MacDonald is in her first year studying theatre and performance. She lives in a one-person suite in residence and says she feels isolated. (Flora Pan/CBC)

In her speech to the crowd, MacDonald said students on campus are so wound up in the “grind for grades, grind for co-op,” that there is very little feeling of community.

Despite having friends, she said she frequently feels lonely.

“I don’t feel safe in my dorm anymore,” she said, “Because I know if I was ever, ever, at that point, how long would it take for someone to find me?”

Sarah Welton Waterloo walkout

Sarah Welton organized the walkout in a matter of days after the 22-year-old student died on campus. (Flora Pan/CBC)

Sarah Welton, who organized Thursday’s walkout, said coming to the university as a second-year student was “very alienating, very isolating.”

“I’ve heard so many people express the same sentiment over and over again,” she said.

“I don’t feel that all these reports they keep sending out are going to do enough, if they aren’t actually trying to take action and make some real concrete changes around the university.”

Reposted from: http://www.cbc.ca/news/canada/kitchener-waterloo/university-of-waterloo-campus-mental-health-1.4567382

Players from NHL, junior leagues seeking brain scans without team involvement.

More than 200 current and retired National Hockey League players have taken concerns about existing or potential brain injuries into their own hands by visiting a neurosurgeon in Kingston, Ont., for MRI brain scan procedures.

Dr. Douglas James Cook says at least 120 former and some 80 active NHL players have undergone the scans over the past two years. He said that about 50 active players combined from the Ontario Hockey League and Western Hockey League have also been tested at Queen’s University over the same time frame.

The tests have not been done with the oversight or formal participation of any of the active players’ teams, Dr. Cook said in a series of interviews with TSN.

“Some guys come because teammates tell them about it,” Dr. Cook said. “Some players bring a teammate with them and then when they come for a follow-up say, ‘Can I bring these other two players with me? I think they might be interested.’”

TSN could not independently corroborate the number of NHL players who have had the tests completed.

Dr. Cook, who operated twice on Tragically Hip lead singer Gord Downie after his brain cancer diagnosis, said the technology used to measure the flow of blood through the brain’s millions of blood vessels is new and that his methodology for analyzing the data collected is unique.

Following a brain injury, Dr. Cook said, the flow of blood can accelerate through damaged or stressed parts of the brain as the brain directs oxygen-rich blood to the affected areas. In other nearby parts of the brain, blood flow can slow if it is redirected to injured areas in need of repair.

“We simplify it for players,” Dr. Cook said. “We explain that there are areas of stress in the brain after an injury and that there are changes in blood flow that we can monitor in those areas of stress.”

Dr. Cook said he’s discovered blood flow abnormalities in the brains of about one-quarter of the roughly 80 active NHL players he has examined.

“Unfortunately there are a number of them,” he said. “They just are not comfortable telling anyone about it.”

Dr. Cook said he’s talked about his testing with some NHL team owners and is hoping to meet with the NHL Players’ Association to discuss the testing. The NHL Alumni Association has also been involved in helping to build awareness of the tests, he said.

NHL Alumni Association president Glenn Healy declined to comment.

“We think this is exciting but it’s also controversial,” Dr. Cook said. “From the players’ perspective, some are concerned about what we might find out, what we might see. Some people don’t even want to know what’s going on in there. They know that they have accumulated damage and don’t necessarily want to face it. And obviously there are always concerns from the owners’ side. …  We worry the [NHL] perspective and perhaps the owners’ perspective is that this … is potentially damaging for the reputation of the league.”

The active players who have been tested include some of the NHL’s top young stars, a source told TSN. Their identities have not been made public and Dr. Cook declined to identify any players involved in the tests, citing privacy rights.

Toronto neurologist Dr. Charles Tator once taught Dr. Cook when he was in medical school at the University of Toronto and calls the 39-year-old Cook a rising star in the field of neurology.

“He was very inventive when he was working in my lab. He’s smart and well trained and he’s an expert on blood flow. … He told me about this project at least a year ago. … He’s a clever guy and has attracted their [NHL players’] interest. There is word of mouth and players encouraging their colleagues to go. That’s the way it happens.”

Dr. Tator said he has also examined NHL players in his Toronto office, but said he’s worked with far fewer players than Dr. Cook.

“Many players are capable of independent thought and they are concerned and sometimes they are pushed into seeking other opinions from their families if their families detect some alteration in behaviour,” Dr. Tator said. “Despite the best efforts of the NHL officials to play down concerns, there is concern among players’ families. They are thinking more about it. And this is escalating as time goes on.”

After finishing his residency and PhD in Toronto, Dr. Cook moved to California and worked at Stanford University, establishing himself as an expert in cerebral blood flow. In 2013 he returned to Canada and began working at Kingston General Hospital.

Using the nearby Queen’s University MRI machine costs about $600 an hour, Dr. Cook said. Players are not charged for the exams. The costs are covered with funding from Queen’s and from a family foundation whose administrators want to remain anonymous.

In Kingston, Dr. Cook said that the brain scans take about 45 minutes. Patients lie down inside the MRI machine and put on a facemask known as a rebreathing machine, which controls the amount of inhaled oxygen and carbon dioxide.

Dr. Cook said the MRI is then able to identify areas of the brain that have been damaged.

“We’re looking at the brain’s vascular physiology following injury,” Dr. Cook said. “There are patterns of impairment that are recoverable and there are patterns of impairment that set in and become more permanent. So we are using this as a technique as a way to detect concussion and also to identify the chronic syndrome that we see in older athletes as they age – issues like sclerosis, scar tissue, impaired vessel function and flow. It’s an exciting technology in a lot of ways.”

Dr. Cook said he began examining patients with suspected brain injuries four years ago and has received about $1.5 million in funding so far. After researching military personnel with a grant from the Canadian Institute for Military and Veteran Health Research, the Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council offered funding for a study of varsity football players at Queen’s.

Brain injuries and concussions are perhaps the most polarizing issue facing the NHL. On one hand, the NHL’s critics, who include nearly 200 former players who are suing the NHL, say the league has not done enough to educate and protect players from the long-term consequences of repeated head trauma. They point to NHL internal emails that show senior league officials have scorned independent medical experts who scrutinize or critique the NHL’s medical decision making.

For its part, the NHL has argued that any interested players could seek out medical journals and do their own research about the impact of brain injuries. Moreover, its officials point out that the NHL was the first pro sports league in North America to introduce baseline neurological testing for its players.

Reposted from: https://www.tsn.ca/players-from-nhl-junior-leagues-seeking-brain-scans-without-team-involvement-1.1014879

A New Shift.

It’s been an incredibly busy term, so I haven’t had much time to keep up with my blog or really not think about anything outside of school. Since i’ve come back from my trip in the UK i’ve felt like I had to hit the ground running trying to keep up with all my work.

I’ve honestly really dreaded this term, moreso for the school aspect. To be honest, I think I say this every term, but really you think you’ve conquered one mountain (the last mountain) in nursing school only to be hit with another 2. That’s literally how nursing school feels like at times.

Pathophysiology has really kicked up a notch and now the midterms are over (I did okay), I still don’t feel like i’m sitting in a great spot walking into a full year cumulative exam. Considering I witnessed a number of people sitting in a similar spot fail pharmacology last term and have to stay back a year. Then on the other hand, I thought microbiology would be an okay course, but after that midterm yesterday i’m honestly starting to feel really discouraged with the whole course. It made me even more angry to hear her blame the students for “reading the questions” in the wrong lens, rather than accepting that maybe she made the exam too hard. I find it highly doubtful that 150 people (half the class on the left of the curve) are really that incompetent considering they made it this far in the program.

I think the only part i’ve really enjoyed about this term has been my clinical. As much as I hated how much the strike disrupted my term last semester, I’m really glad i’ve gotten to experience some 12 hour shifts. As exhausting as they are, they actually go by relatively quickly and it’s a great learning experience to actually spend a whole day on a single patient. I was fortunate enough to get to sit in on an endoscopy and colonoscopy and see what the procedure actually looks like and what the physicians look for and then the role of the surgical nurses and what part they play in the procedure and administering and maintain the anaesthesia. I was super fortunate that my patient was willing to let me use that as a learning experience considering how invasive the procedure is. My group as a whole have got to do some pretty cool things, like watching a toe get amputated (not super jealous considering I hate bones), injections almost every week, VRE swabs, or getting to go down to watch hemodialysis with their patients.

To be honest, I know i’ve mentioned it multiple times but I didn’t think i’d enjoy general medicine as much as I have so far. I know it’s definitely not an area I would want to work long-term post graduation, but it’s honestly been a tremendous learning experience and confidence booster. It’s still hard to get used to how to chart everything because there’s a lot but i’m so grateful for the nurses who have been there to answer my questions or make me think deeper.

I think my favourite shift had to have been last week. My patient was an elderly person who was in for something that had been relatively minor but because of her age impacted her ability to move. As a new nurse it always makes me a bit weary when delirium is mixed in because that increases their falls risk. When I asked how the patient ambulates (aka how do they move or get out of bed), the nurse simple stated that they didn’t. When I inquired further the nurse stated that the “patient was old and didn’t like to be moved and that was their right” and to “not worry about it”. Keep in mind this person had been in bed since they were admitted (ie multiple weeks). I felt very unsettled hearing that considering the importance of trying to at least encourage them to ambulate.

When I went to do my head to toe assessment, they were so pleasant and engaging. I was worried they’d be a bit confused having been woken up but they were quite chatty and I got to learn about their life and children and what it was like growing up in the area considering they have lived a relatively long life. I began to ask how they moved around. They began showing me some small exercises their family members had taught them and how she had a rotating lunch/dinner guest list their sister had made for them. I asked them if they wanted to try to get out of bed and why they had turned down physiotherapy’s assistance. This is when I found out that the physiotherapist that had tried to move them a month ago had tried to do a solo maneuver which hurt the patient and made them scared and that’s why they requested to stop.

It wasn’t until the patient’s grown child came later in the afternoon that we really began talking about the importance of moving and trying to understand why physiotherapy never came back to reassess them. I also brought up how nice it would be for the patient to at least be able to sit in a chair for a few hours a day to get some mobility and a different spot to enjoy her paper. Luckily in the moment, the nurse who reported to me stepped in to check on us since her patient was next door and I asked if it was possible to explain to the family why this issue was never re-addressed with the patient. I also brought up that maybe we could at least get them a geriatric chair to sit in as a start and that maybe we could order a new re-assessment to be done for the patient. While the nurse seemed a little flustered to not be able to explain the whole situation or the details (because they obviously just took the blind advice of others) it was at least a start. No patient should ever be left in bed because it increases the risks of pressure ulcers, DVT, infection (especially in lying supine), loss of muscle, depression, etc. While a patient has every right to decide what to do, as a nurse we have a duty to at least ask every day or explain the importance of moving.

It was evident from my patient showing me their mini expercises and bicycle kicks that they wanted to retain mobility and strength and wanted to get out of bed, but no one ever had asked them what they wanted to do or why they had turned down physiotherapy. Moving a patient alone can be scary for both partners, and it made me angry that no one had really investigated this further but rather played it up to the patient age. The patient shouldn’t have to be in bed for that long, considering they had already developed pressure ulcers on the coccyx and heel.

It wasn’t until I came back from my dinner break and went to check on my patient and perform vitals that I had found that the nurse had brought up her a geriatric chair to use the next day. Seeing the look on their face honestly made my entire day. They were so happy and grateful to be able to attempt to use it tomorrow. While it made me a bit sad to inform her I wouldn’t be her nurse tomorrow when they asked, I knew they’d be in good hands with another student nurse the next day. But to hear a patient actually thank me and say because of my actions I made it happen for them and that they’d think of me when they sat in the chair tomorrow made me incredibly grateful to be in this profession. As silly or small as it sounds, to the patient this was momentous.

But really, the patient shouldn’t have to thank me. I did my job. As a nurse I have a duty to advocate for my patients, and this was just simply that. They deserved more than what they were getting and if it were my loved ones I would expect the same from the nurse caring for them had I not gone into this field. I know nursing can be stressful, tiring, and demanding, but at the same time patient safety should triumph everything. I

t makes me angry when nurses sit around (especially when they have students taking patients off their load) and they sit their on the internet or phone ignoring the call bells because “it’s not their patient”. Yes it can be daunting to go into a room and know nothing about the patient (ie. falls risk, medication allergies), but the LEAST we can do is check what is wrong the patient perhaps they are lonely or scared, confused, and offer a bit of comfort or direction, or perhaps it is something more urgent and serious but can wait a bit. But even in those cases we can at least inform them that we will let their beside nurse know and acknowledge their call for help.

Having lost their independence, knowing they’d never be able to live on their own again and basically losing the ability to walk over night, it was something that meant a lot to them. Just to be able to sit in an actual chair again, even if for a few hours a day.

While I know I won’t get the same patient again tomorrow, I am excited to know I have one more 12 hour shift this term where I can go back and hopefully pull up a chair beside them in their new chair and chat. Being in a hospital room can be pretty boring and dreary but I think it’s kind of cool that while i’m still new I have the time to do these kinds of things and really get to know the patients as a person rather than as a number.

I don’t know what tomorrow will bring but i’m excited to find out when I get back on to the floor tomorrow morning and meet a new face.



Grieving mother launches drive to reform emergency psychiatric units.

By late November, Ottawa wedding photographer Ryan Parent was in crisis. He was struggling under the weight of depression and anxiety, a burden made worse by his fear of returning to hospital.

Parent, 37, had gone to The Ottawa Hospital in June because a friend was alarmed by his manic behaviour and by his online posts about the Earth being flat.

In the emergency department, doctors referred him to the hospital’s Psychiatric Emergency Services (PES) unit for a more thorough assessment.

Both the General and Civic campuses have secure PES units inside their emergency departments. The units feature spartan, windowless rooms to limit the visual stimulation of patients. They’re designed to ensure that both patients and staff are safe while the individual is assessed and a mental health referral is made.

Parent spent 56 hours in one of the rooms at the General campus, waiting for a bed to open up on the hospital’s psychiatric ward. Ryan’s grandmother, Ruby Parent, visited him in the PES unit on June 3. She said his room opened to a small anteroom, from which a locked door led to the hospital hallway. The anteroom featured a window with bars through which patients could speak to a nurse.

This is a picture that Ryan Parent took of his room at The Ottawa Hospital’s PES unit. OTTWP

Ryan, she said, was well treated by staff and received permission to go for a walk. “But it was not a nice place, it was just like a cave,” she said, “and I think it must have been very despairing for him.”

A bed did not become available, so Parent was eventually discharged without a new diagnosis. At home, he told his mother he would never go back to what he called “that jail cell.”

“He said it was the most traumatic time of his life,” said his mother, Ellen Parent.

Ryan continued regular visits with an outpatient psychiatrist, but his mental state declined that summer. His fear of returning to The Ottawa Hospital mounted.

On the evening before he died, Ryan was in a paranoid state. He closed all the blinds, set the family’s home alarm system and discussed with his mother his fear that he had done something wrong, and would be locked up. They talked about going back to the hospital for help the next day.

“On the morning of his death, Ryan came into my room and said that he loved me but that he didn’t want to go back to the hospital,” Ellen Parent said. She told Ryan that was OK.

Ryan returned to his room. Later that morning, Parent discovered him slumped in his closet. He had hanged himself.

“My son who so badly wanted to live took his own life,” said Parent, who firmly believes her son’s experience in the PES unit played a role in his death.

“I do feel strongly about the fact that the ‘cell situation’ prevented Ryan from seeking more help — he was left with feelings of hopelessness and unrelenting fear. … I’m not saying that was the cause of his suicide, but he became terrified of the hospital.”

Ryan Parent is not the only patient who has been unsettled by the hospital’s secure and sterile PES unit. This newspaper spoke with two other psychiatric patients who were also disturbed by their experiences in the units.

But Dr. Katharine Gillis, head of The Ottawa Hospital’s department of mental health, defended the PES units as state-of-the-art.

She said they were created to give patients a private, safe and calming environment where they could be assessed by a dedicated team that includes psychiatrists, mental heath nurses and social workers. Previously, Gillis said, people who were having a mental health crisis were assessed in boisterous emergency departments, often in cubicles that offered little privacy.

Many people who come into the PES unit, she noted, are having an acute mental health crisis. “You have individuals who are really struggling: They’re over stimulated; they’re sensitive to their surroundings, to people being around,” Gillis said. “So we deliberately, in crafting these types of spaces, aim to have them provide low stimulation.”

Security measures, she said, are tailored to the individual. “When we think about a good patient experience, I think safety is an essential component.”

Although she could not speak to the specific details of the Ryan Parent case, Gillis said secure, low-stimulation PES units are now a standard hospital feature. “These elements may potentially appear unusual to someone who may see it, but these things are really part of what we want for this very acute, agitated phase,” she said. “This is not unique to The Ottawa Hospital.”

Dr. Gillis said there’s no defined limit of time for a patient stay in the PES unit. Staff will take the time they feel is appropriate to make a good assessment, she said, while keeping patients reassured and informed about the process.

“Our patient guiding principles are respect, compassion and safety,” she said.

Ellen Parent, however, contends the units are inhumane; she wants to see them eliminated.

“I feel it’s my duty to try to prevent anyone else from every going through that experience again,” she said. “A patient in distress does not need to be put in solitary confinement for hours on end.”

Ryan is not the only patient who has expressed concern about the units.

Joanne, 34, said she was three months pregnant and extremely depressed when she went to The Ottawa Hospital in April 2016. She went to the emergency department and explained to medical staff that she could not stop crying. She said she was having suicidal thoughts.

Joanne said she was sent to the PES unit for a psychiatric assessment. She spent 24 hours in the unit before being transferred to the hospital’s psychiatric ward.

“It was a very scary experience,” Joanne said of her stay in the PES. “It honestly felt like a jail cell.”

Joanne would spend two months in hospital and be diagnosed with depression, an eating disorder and obsessive-compulsive personality disorder. But it is her time in the PES that bothers her most.

“I would like them to remove it or at least don’t make it seem like we’re in jail,” said Joanne, who gave birth to a healthy son late last year. “We have mental illness, but we didn’t ask for that.”

Another psychiatric patient, Deanna, has twice stayed in the PES unit. She suffers from anxiety, post-traumatic stress and chronic pain. She called the unit “a dungeon.”

Deanna said her shoes, clothes and phone were taken when she entered the unit. She had to obtain permission to go outside for a smoke, and was accompanied to the bathroom by staff. (Gillis said security measures are individualized based on an assessment of each patient’s condition.)

Deanna said she felt so humiliated and isolated after her second stay in the PES that she has vowed not to go back.

Now 34, Deanna said the psychiatric ward is a more “humane” place where patients can wander around — the ward’s doors are secured — and visit a common area to read, watch TV or talk. She said she’d like to see the PES units revamped along similar lines.

“I don’t want to be treated like I’m an inmate down at Innes (the Ottawa-Carleton Detention Centre on Innes Road),” she said.

Parent contends psychiatric patients should be treated like anyone else who comes into the hospital, and assessed in the emergency department, not sent to a unit that can magnify their sense of isolation and paranoia. This is the situation at most other Ottawa area hospitals, including the Queensway Carleton Hospital, where a crisis-intervention team assesses acute mental health patients in regular emergency department cubicles.

“It’s just so wrong to send vulnerable people into that cell kind of situation, it has to stop,” Parent said. “I think every day of the people being put in there.”

Gillis said the hospital will be consulting with its patient and family advisory group before designing a PES unit for the new Civic campus, which is expected to open in 2026.

Resposted from: http://ottawacitizen.com/news/local-news/grieving-mother-launches-drive-to-reform-emergency-psychiatric-units

Antidepressant drugs do work, review on almost 120,000 patients concludes.

A vast research study that sought to settle a long-standing debate about whether anti-depressant drugs really work has found they are indeed effective in relieving acute depression in adults.

The international study — a meta-analysis pooling results of 522 trials covering 21 commonly-used antidepressants and almost 120,000 patients — uncovered a range of outcomes, with some drugs proving more effective than others and some having fewer side effects.

But all 21 drugs — including both off-patent generic and newer, patented drugs — were more effective than placebos, or dummy pills, the results showed.

“Antidepressants are routinely used worldwide, yet there remains considerable debate about their effectiveness and tolerability,” said John Ioannidis of Stanford University in California, who worked on a team of researchers led by Andrea Cipriani of Britain’s Oxford University.

 Cipriani said these findings now offered “the best available evidence to inform and guide doctors and patients” and should reassure people with depression that drugs can help.

“Antidepressants can be an effective tool to treat major depression, but this does not necessarily mean antidepressants should always be the first line of treatment,” he told a briefing in London.

‘Depression causes misery to countless thousands every year and this study adds to the existing evidence that effective treatments are available.’– Dr. James Warner

According to the World Health Organization, some 300 million people worldwide have depression. While both pharmacological and psychological treatments are available, only one in six people with depression in rich countries gets effective treatment. That drops to one in 27 patients in poor and middle-income countries.

The study, published in The Lancet medical journal, found some differences in the effectiveness of the 21 drugs.

In general, newer antidepressants tended to be better tolerated due to fewer side effects, while the most effective drug in terms of reducing depressive symptoms was amitriptyline, discovered in the 1960s.

Some well-known medicines — such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine, sold under the Prozac brand — were slightly less effective but better tolerated.

The scientists noted that their study could only look at average effects, so should not be interpreted as showing that antidepressants work in every patient. Only around 60 per cent of people prescribed depression medication improve, Cipriani said.

“Unfortunately, we know that about one-third of patients with depression will not respond to them,” he said. “It’s clear there is still a need to improve treatments further.”

Several experts not directly involved in the study said its results gave a clear message.

“This meta-analysis finally puts to bed the controversy on antidepressants,” said Carmine Pariante, a professor at Britain’s Institute of Psychiatry, Psychology and Neuroscience.

James Warner, a psychiatrist at Imperial College London, added: “Depression causes misery to countless thousands every year and this study adds to the existing evidence that effective treatments are available.”

Resposted from: http://www.cbc.ca/news/health/antidepressants-meta-analysis-1.4546709

Talking about mental health in Asian communities.

Happy to have been able to work with such a strong organization in blogging about my experience with being diagnosed with depression. I became acquainted with Mind while living in the UK to pursue my Master’s and finally had a chance to figure out a way I could help contribute to their cause in ensuring  everyone experiencing a problem gets both support & respect that they need.

This has been a project that had been in the works for a few months and i’m finally happy to share the result of having such a supportive organization help to share my story. I’m also incredibly humbled from the support I have received over the years in sharing my journey and to be fortunate to have helped others begin theirs.

While I have been fortunate to have the support of my family through my journey, I recognize that this is a prevalent issue amongst the Asian community in terms of stigma and the lack of support in terms of talking about  mental health. Hopefully by contributing to the conversation I can help other young people, especially minorities, find the courage and support they need to navigate and access an often complex mental health care system.



Read more “Talking about mental health in Asian communities.”

Cultural Competence in Promoting End-of-Life Care for Muslim Patients.

Just a little infographic I put together last term as part of my learning plan. Cultural competence is essential in providing patient centred care.

As healthcare providers we need to be aware of our patient’s backgrounds as it often has a direct influence on promoting well-being in our patients. It can relate to why our patient isn’t eating, thinking at a deeper level maybe the patient or the GI system is not used to the food being served at the bedside. Perhaps as a nurse, it is important to advocate for our patients in obtaining the foods they are accustomed to (ex. rice).

I think sometimes in healthcare we fail to recognize things that are quite important to our patients. Part of what inspired me to create this learning plan was having had the opportunity to sit in the nurse’s lounge on my first shift and overhearing the nurses talk about a particular patient who was at the end of their life. They were not quite sure how to fulfill this patients personal and religious wishes and could not understand why the patient’s family refused to remove him from life sustaining measures, even after multiple family meetings were held.

Having not understood where these issues stemmed from, I decided to do a bit of research into the patient’s faith and quickly discovered that removing the patient off of life-support would be considered suicide under Islamic faith.

While we can’t be expected to know everything as nurses, we should do our due diligence in researching things, particularly in regards to religious backgrounds. Religion is a huge part in many of our patients lives, and being able to incorporate or understand particular aspects is vital in promoting health and well-being.

Anyways, just some food for thought 🙂