One of the most unpleasant experiences for me during my hospitalizations has been the way some of the nursing staff treat you. They often treat your physical symptoms as if they were some sort of act you were putting on. If you faint, they take the position that you didn't really faint, but that you were simply trying to get attention. They will leave you on the floor or tell you to get up if you want to avoid going to the quiet room. They will frequently talk behind your back regarding these incidents.
The situation becomes more serious when they write up your "fake" fainting spells in the charts and you have to end up justifying your physical complaints to the psychiatrist who is treating you. This is especially bad because you frequently don't know each other and the psychiatrist first learns about you through your charts. Valuable time is wasted justifying your behavior in your meetings with the psychiatrist rather than focusing on the issues that brought you to the hospital.
It is difficult to say what motivates these nurses who have prejudged you. Are they burnt out by their heavy workload? Do they feel they must establish who's the boss? Do they feel that the patients are trying to put one over on them?
It seems to me that some of these nurses enjoy the power the have over their patients. These are the nurses that should not be working in psychiatric hospitals. They fail to remember that it is the patients who ultimately provide the funds which are used to pay them. Instead they view their patients as a problem to be managed and controlled. In this context, patient behaviors are closely monitored for any sign of rebellion that might undermine the nurse's authority. In this scenario there is little room for compassion or openness. The patient nurse relationship becomes one of struggle and conflict, rather than one of caring and understanding.
Frequently, the patient's needs are viewed as a distraction from the nurse's other duties. A good example of this is the night shift. The nurses would like everyone to be in bed sleeping so they can do their paper work. If a patient is unable to sleep, they are offered sleep medications. If the medications are refused, the nurse threatens to put them in the quiet room or place them on a 5150 (3 day hold). Being quiet is not enough to satisfy these nurses, the patient must be asleep (unconscious).
To add insult to injury, the patient is viewed as not making progress and being confrontational if they stand up for themselves in these situations. The nurse is able to use the power of the charts to indicate that the patient is uncooperative and not serious about his/her treatment plan. This can translate into more days in the hospital. At its worst, the patient can become very frustrated and angry over the lack of respect and child-like treatment. If this anger builds, the patient may explode and be placed in restraints and locked down. Unfortunately, the nurse simply views this as a validation of their prejudicial attitudes towards "uncooperative" patients and reinforces these prejudices.
Ultimately, these experiences can leave a scar upon the patient who can no longer trust their caretakers in the hospital. This leads to anxiety and fears about being hospitalized. A person who is fighting depression often has low self-esteem that is eroded further by these bad hospital experiences. They are very reluctant to enter the hospital even though they may feel they need hospitalization. In the worst case, a patient may avoid getting the necessary hospital care because they believe they will be treated with disrespect and contempt. The patient may spiral down further into depression and may even commit suicide if they have nobody or nowhere to turn to.
It is important for hospital managers to weigh the benefits of order versus the patient's need to have confidence that their concerns will be heard and not neglected, made fun of, or used as a weapon against them. It is easy to see the benefits of a hospital that is run with an impersonal iron hand. Paper work gets done, the ward is quiet, and nobody complains. The manager must look beyond these superficial indicators to see if the patient has confidence in their nursing staff, the patient feels their concerns will be addressed, and does the patient feel cared for? These indicators should be given more weight and the manager should seek feedback directly from the patients in a confidential way such that the patient has no fear of reprisals. Until these issues are addressed, hospitals will not fulfill their mission nor will patients be safe.
Nurses would do well to remember the Hippocratic oath, "First do no harm". Sticks and stones do breaks bones and sharp words will hurt you. Patients with physical ailments resulting from "sticks and stones" rarely have to worry about their nurse's attitudes towards them, but psychiatric patients who are least able to defend themselves against, "sharp words" are routinely victimized by them. In conclusion, when will advances in health workers attitudes match the strides made in psychopharmacology?