Red is the nurseBlack is the patientItalics represent questions not on the form
Nursing History and Assessment Tool (Mary C Townsend, 5th edition)
Conditions of admission
Accompanied by: police
route of admission: ambulatory; handcuffs
admitted from: ER
Client Name: Joe XXX
Setting is a desk and 2 chairs. (pause) discuss the implications of various arrangements of the room. Take a snapshot of each position.
Joe is less than 40 and more than 20 years old. Joe is disheveled in appearance. He is also wearing earmuffs. His words are slurred as if he has a clothespin on his tongue. He has scars on both forearms. They are particularly bad on his left arm. He smacks his lips and grimaces at intervals. (see video of tardive dyskinesia) moderate facial and lips. He rarely makes eye contact with the interviewer. At times he appears to be responding to stimuli that aren't there. (see video He seems distracted and to have a hard time keeping focused. He has scars up and down his arms which appear to be surgical scars.
Description of nurse: matter of fact. Dressed business casual. No jewelry. No low cut clothing. No cleavage up or down. No jeans. What is the message given to someone when you over dress or underdress? What is the skinny on jewelry? Nothing around the neck.Camera shot of the patient.
Hi. I’m Nancy. I am a nurse here. We need to talk about a few things this morning. But we can go as slowly as we need to. Before we start, is there anything that I can do for you to make you more comfortable? nope Well, if you think of anything, you can stop the process at any time and I can try to help you. Would that be okay? yupOk. Lets start with some basic information about you. Do you know how tall you are? I’m 5’7”How much do you weigh? 150#You are 33 years old. Right? yup
(Smiling) I’m assuming that you are a male? yes
Who should we call if there is an emergency? Do you have a family member or significant other that
you would like us to notify? “Well, nobody really cares about me anymore. I guess I’ve worn them all
out.” (looking at the floor.a little forlorn)
So - your problems have caused issues for everybody around you.? Sounds like we have some things
to work on. I hope so. But you need to know.I’m not sick. I just.well.do you.I.can’t remember.what
were we talking about?(trailing off)
We were talking about how your issues have caused problems for people around you. But we can come
back to that. Okay?
Have you ever been married? I am divorced. I guess I screwed up.tell me about that I had a very nice wife. We loved each other a lot. Then I got sick and everything
Do you know what your diagnosis is? “ I’ve been diagnosed with bipolar and schizophrenia. I don’t think
they know what they’re talking about.”
If I were to ask you why you are here today, what would you say? I’d say I don’t know what to do. I
can’t think clearly. I’m afraid for me.
Tell me more about that.You are afraid for you?
(becoming more disorganized and agitated) I.I don’t know.I need to.People don’t think I.
Have you had thoughts about taking your own life?
Oh, for sure.
Have you ever tried to hurt yourself?
yes but I’ve never pulled it off. I might be too chicken. If I really want to succeed at this, I need to go put
my head down on a trax rail like that guy on the news last night and let someone else do it for me.
So, it sounds like you’ve put some thought into this. Do you have any other ideas about how you might
Not right now but I’ve thought of putting a gun to my head
Do you have a gun?
No, but anybody could get one.,
ok. You are in a safe place right now. Can we make a contract that you will not do anything to hurt
yourself while you are here? I don’t think I want to do that now.
I understand. Could we contract for 12 hours of your safety? I think I could do that.
okay. You are telling me that you can be safe from hurting yourself for the next 12 hours. That means
that we need to work on this between now and 9:00pm. Do you understand that at 9:00pm I will be back
talking to you about additional time and another contract? yes.
Now, I need to also ask you, have you ever had any thoughts of hurting others?
not really. I mostly run away when I feel afraid of others.
Let’s move back to the information that we will need to help you while you are here. Are you ready?
Has anyone else in your family been diagnosed with schizophrenia? Not that I know of.
Can you describe what it was like growing up? My family was completely normal. So was I. My mother
and father were teachers. I have 3 brothers. My older brother disappeared from our lives when he was
about 20. The other two went to college. I did, too. I got married just before I was ready to graduate
and within a year, I started to have problems. About 3 months after I married, I started to need to wear
Okay, we need to talk more about the earmuffs. But first I need to get some more basic information from you. I wonder if you could tell me what your mother was like. Oh, she was a nice person. She struggled with her mother. Grandma was kind of “difficult”. But, her problems with grandma aside, Mom loved us and gave us everything we ever needed.
And your dad? What about him? Well, they were both teachers and they did everything together with us. They were very good parents. So, when you say you’ve about worn your family out, what happened? Well, being a child and being an adult are two different things. I’ve done some things that they say have worn them out. I think they would talk to you, and it’s okay with me if you talk to them, but they don’t have the energy for me anymore. Also, they don’t want me around my 2 younger brothers. Talk to me about this brother who left. I don’t know much. He started fighting with everybody when he was about 16. He got really odd. And then he disappeared. Mom said he acted a lot like Grandma. Tell me about your medical history. I think I had my appendix out when I was little. Other than that, there is nothing.
Now tell me about your psychiatric history There’s not much to tell until I got married. That’s when everything started to get weird. It started with the whispering. My wife was thinking I was pretty great and that she loved me alot. After about three months, she started to think I wasn’t such a good catch afterall. I confronted her with her thoughts and she denied them. Are you saying that her thoughts sounded like whispers? At first. But as her thoughts became more and more negative, they also got louder and louder. She eventually left me and had a restraining order placed against me. That’s when I got the earmuffs and tried to stop the broadcasts.
Things haven’t gone very well since then. I’ve been in and out of jail. I’ve been on Thorazine, which made my face do strange things. (I think the FBI nurse knew she could hurt me with Thorazine, which is why she gave it to me.) Anyways, they gave me abilify after that and the broadcasts got better for awhile but I couldn’t afford the abilify and quit taking it. That’s why I’m here. Have you ever used any illegal drugs? Well I did try to get the voices to go away with some pot but it only made me scared so I never used it again.
Do you have any friends? nopeWhere are you living? just around. Don’t really have anyplace to goHow do you take care of yourself? sometimes I can get into a shelter for the night but I really don’t like to. They have agents of satan there who try to take your stuff. But if its cold, I do what I can. The most important thing is my earmuffs.
Were you raised in/do you practice a religion? (grinning and looking up) God is great. God is good. Let us thank him for this food. Have you ever had a job? Yes, I worked in a bookstore in college. But I lost it about 3 months after I married. I haven’t really tried to work since then. Maybe that’s why my parents are so done with me.
What do you do when the stress gets to you? Well, the earmuffs, of course. And when they don’t work, I have some earphones that used to work but somebody stole my radio that I used to plug it in to. Sometimes it works if I can find a place where nobody is thinking.
So, tell me why you are here today. police.
How did you get the police’s attention? I got a coat out of a store. I needed it to cover up my clocks. They really bother me and I was desperate. I know not to steal but I had no choice.
your clocks? tell me about them Thats something else that happened after my divorce. I started growing clocks under my skin and the ticking keeps me awake at night. I go to Italy every once in a while to have them removed and that gets me some sleep. But lately, I haven’t been able to go. Italy! How do you get to Italy? busYou do have scars on your arms. Tell me about them. The doctors in Italy take them out for me. But the doctors here won’t do it. Over here, I tried to get it out myself but I messed up. Look here (pointing to a healthy spot on his arm) here is where one is starting to grow. See how it’s getting a little swollen around the edges?(looking at his arm) You know that while you are here, we will be working together quite a bit. I don’t see where your arm is swelling, but I do see a lot of scars here. Some of the scars look like they have been there for awhile and others look fairly new. I want you to know that I will tell you the truth. I am a person that you will be able to count on to test your reality. I’m not ever going to lie to you. Okay. We said earlier that we would take some time to discuss how your issues have caused problems for people around you. Can you tell me more about that before I take you to your unit?
Well, this is so painful. Mom and Dad are just so worried all the time. It’s almost like they think I caught something from my older brother and that I might give it to my younger brothers. And my problems can take up absolutely all of their time.I guess you could say I’ve cut myself off from them. I don’t want them to know how bad this is. It is why I want to stop living. It would be better for everybody if I just left.
Now, I want to remind you that we have a contract. Do we still have until 9:00 tonite before we really have to worry about your safety?I said 12 hours and I meant it.
I will not be here at 9:00pm but I will be leaving instructions for the next nurse to address this with you. Can we agree on that?yupOkay, then, before we go to the unit, I need to tell you that there will be someone with you at all times. Do you understand that? yupI know that you already said that we could talk to your family members. Would you sign a waiver allowing us to do this? yup. Great.
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