On March 11th my clinical group had our first experience at Methodist Specialty & Transplant Hospital in San Antonio. We began the day with an orientation led by a nurse educator called Dee. Later we began the actual clinical experience, and I was placed on the chemical dependency unit, per my request. We were advised to observe the role of the nurses on the unit. Since I have not yet submitted a care plan I was also looking for an appropriate patient who might be the subject of a care plan.
When we first toured the chemical dependency floor, I was a little intimidated by the patients. While the patients on the other mental health units seemed to be passive and largely ignored our presence, the chemical dependency patients seemed curious about us and teasingly asked “who is watching who here?” Later, Brianna and Francesca and I interacted with this group of patients during recreational therapy, a “processing session,” and as they watched TV. The recreational therapist asked the patients if they were OK with our presence, and they joked that they might have us thrown out. This seemed to set the tone that they were a close-knit group and that they had at least a little power over us. If they had chosen not to let us in we would have had an extremely dull day in the nurses’ station (where we might also have felt in the way). Fortunately, the patients allowed us to join in their games and therapy and later answered our questions, although they didn’t reveal much. I was a little surprised by how white, educated, and middle-class this group of patients was. I was also surprised by the close bonds that seemed to exist between some of them—especially two women who seemed to come from very different circumstances. H gave the impression of being a high-functioning young professional with a supportive family. Her constant companion, C, had a history of either bipolar disorder or schizophrenia (both were mentioned in the file) and had been brought to the hospital by the police for bizarre behavior. The two of them danced and skipped and mentioned that they had been up all night giggling together. I wondered how their bond had formed, when, and whether it was entirely healthy. I was certainly surprised that they seemed to be having so much fun.
I realized that evidence-based practice is essential when Dee talked about why it is important to keep patients comfortable as they undergo detoxification. Dee explained that while detoxing from alcohol can be life-threatening, patients detoxing from opiates only feel like they are dying. I can imagine that lots of people blame addicts for their addictions and that some health care workers might feel that heroin addicts deserve to suffer during detoxification. I have heard nurses elsewhere talk about disliking behavioral health because the patients won’t help themselves. That kind of thinking could easily lead a nurse to skimp on comfort care. However, Dee explained that research shows that the more comfortable a person is during detoxification the more likely he is to attempt to get clean in the future. That suggests that providing for comfort during detoxification can be lifesaving in the long term. A nurse who practices based on this research will pay more attention to the comfort of her clients and will probably feel more compassionate and more patient than a nurse who is guided by her instinctive sense that drug abuse should have uncomfortable consequences.
I hope that I will have the chance to spend a full day on the chemical dependency unit later in the semester. I’m especially interested in this area because my family has dealt with addiction, recovery, relapse and the long slow process of staying clean. I know that the few hours I spent on the chemical dependency floor last week are only a tiny moment in the course of treating addiction. I didn’t even see enough to sense whether these patients were committed to recovery, whether any of them had voluntarily sought treatment, or whether they have been through the cycle before. Listening to Dee and the other nurses talk about heroin use in San Antonio has made me more aware of indications of substance abuse I see in my own neighborhood. For instance, as the weather has gotten warmer I’ve noticed several people snoozing on the sidewalks along San Pedro Avenue. I live in downtown San Antonio and eventually I’d like to work in an emergency department in this city. That means I need to be able to spot signs of intoxication or withdrawal—and have some sense of appropriate nursing interventions.