how to survive acute psychiatric ward placement

[bindawang1989]

Hi, I am a year 3 nursing student. In this year we have surgical acute clinical placement, mental health placement (which includes acute psychiatric ward and community rotation), and elective placement. I have passed surgical placement but failed mental health placement.

I got good comments from RN mentors of community settings but at my final week of the psychiatric acute ward, I didn't do well. My RNMs said I lack initiatives and my communication was poor.

In order to be prepared well for next time, do you have any advice to pass this paper? It is easy to show my passion and initiatives on the surgical or medical ward but for mental health nursing how can I show initiatives in the ward?

Really appreciate if you could give some study tips for surviving mental health clinicals.

[Nurse SMS, MSN, RN]

It is impossible to answer this without more specifics. What kind of communication was poor? What does that mean? Lacking initiative implies you were not actively caring for your patients. Were you fearful while there? Confused about what to do? What problems and interventions showed up on your care plans?

[direw0lf, BSN]

I started psych this semester. What our clinical teacher tells us is that therapeutic communication is a skill that we need to work on and will improve in time. She also says that we've encountered "psych" patients before. In med surg, peds, OB, you have probably had a patient who's had depression, anxiety, ADHD, dementia, schizoaffective, etc. You've probably used therapeutic communication with all your patients before. Maybe if you think of your psych clinical as no different from how you would talk to someone on a med surg floor, it will come naturally to you. You basically ask the same questions "What brings you here today?" on any unit. I'm still learning, but what I've learned so far in psych is that you want to help the patient become aware of his/her feelings and help them to realize what their goals/options are for their best interest. So if they are in there for depression and alcohol use, you ask "Do you go to AA meetings? Do you have a sponsor?" if not help connect them to those resources. HTH.

[verene, MSN]

In acute pysch safety -of patient, self, and milieu - is top priority. Even though the flow of psych nursing is very different from a medical floor you still use a lot of your nursing skills and clinical judgement. During my acute psych rotation I'd get report, check-in with patients briefly (assuming they were awake), and then start digging into the patient chart. Just like medical floor I want to know new orders, labs, recent vitals/fall risk, medications, and patient history, and look over recent notes from the team.

Assessments may look different in psych because you don't go in and do a full head-to-toe in the same fashion as other floors, but it is important to still assess each and every patient you care for - both psychologically and medically. I find taking vital signs a good starting point to approach a patient and will try to have a chat with the patient afterwards both for my assessment and to see if the patient has concerns to bring up with the team or goals for the day that I can help them meet. Always ask about pain or physical changes the patient may have noticed. Many psych patients have co-morbid conditions and many medications can have significant negative side effects. Finally asking these kinds of questions and having these kinds of interactions will provide a lot of information for your mental status assessment (e.g. if the patient can't sit still to have their blood pressure taken, or can't track the conversation about daily activities, or tells you their arm is missing when it is still clearly attached to their body).

The more time you can spend out in the milieu interacting with patients the better. Even though it may seem like you are just having a conversation with some one (about anything really) or are working on a craft project together, every interaction is a source of information for you, and therapeutic social interaction also benefits the patient. Being a calm presence out in the milieu can also help to keep the unit calm partly because if you are calm and confident in the patient area patients are more likely to be as well - also because by being out in the milieu and interacting directly with patients you have a much better sense of where everyone is at and can head off issues before they arise.

It can take a little while to wrap your head around psych so find some strong nurses on the floor to emulate and to ask for advice. Also remember that most, if not all, patients in the in-patient psychiatric population have trauma of one sort or another in their past. Treating each patient as a unique human being (not their diagnosis) and truly listening to them and their story, and working along side the patient for recovery (rather than forcing the issue) can go a long way towards building trust and starting to undo some of the trauma. (And also make you life easier - a patient is MUCH more likely to take their scheduled medications with out issue if they have some degree of trust in the person handing them over).

[BBboy]

For me personally, I've spent about 2 years in the mental health settings prior to working in a hospital so communicating with someone that would be found in a setting such as a psych clinical wasn't too difficult. It really is all just about therapeutic communication. Try to maintain an amicable nurse-patient relationship, he a positive individual. Honestly you should, for the most part (as you know there are exceptions in the psych field), approach this clinical as you would other clinicals. The only things I had to refrain from was sharing personal information

[bindawang1989]

thanks for sharing your such a great clinical experience!

[bindawang1989]

Thanks for your great answer.