Mental Health Clinical

[katyq82]

This is not a gripe as I'm totally willing to do what is expected of me here, but I'm wondering what other students have done during their mental health clinicals? I am in the second semester of an ASN program and we have 30 hours of mental health clinical. We are on a very interesting inpatient floor but we don't do anything but observe and try to have conversations with the patients. We don't pass meds or go into the patient rooms, only the common areas. We attend any group therapy that may be offered that day, but I go on Sundays so it is very quiet. I do understand that I am not qualified to do much at all and that mental health is different from med-surg for example, but it does feel like a waste of a day to sit on a couch for 10 hours. The patients understandably don't want to talk to me (a stranger) about their mental health in the common area. Just wanted to know if this is the way it is done at other schools or if there are other models out there?

[elkpark]

Well, you're right -- sitting on a couch for 10 hours is a waste of time. Facilities typically set the limits on what students are allowed to do in psych clinical (no meds, no physical interventions), and it's a shame that you're there on Sundays, when the treatment isn't and things like group therapy aren't happening. The focus of psych clinical is typically honing your therapeutic communication skills (in addition to learning about psychiatric disorders and their treatment). While it's true that people are not going to be v. receptive to the idea of opening up about their personal issues to a stranger "cold" ("Hi, I'm Susie from XYZ nursing school, would you like to talk about your feelings?" ), it is often effective for nursing students to do something like start up a board game or a jigsaw puzzle, or some kind of group activity, to engage the clients and, once you are doing something together, it's easier both for you and for them to talk. Also, most every psych dayroom/common area I've been in over the years (and that's a lot) has at least had some quiet corner that is a little more private that can be used for conversation. It's also usually possible/permissible to sit in the doorway of a client's room, where you are still visible in the hallway (and the client is inside the room) to have a more private conversation, although you should certainly check that with your instructor before doing that.

Like everything else in nursing school (and life :)), what you get out of your psych nursing clinical will largely be a function of what you put into it. The kind of observation and communication skills you are supposed to be working in this rotation will benefit you throughout your career, in any setting with any population. Best wishes for your journey!

[AliNajaCat]

Don't do what we did, which was to pack up half the ward in our own cars with no staff or faculty and drive them into the city to see the Planetarium show at the Museum of Science. Nobody stopped us, we told them ahead of time, but apparently it never occurred to anybody that it was a CRAZY G-DDAM IDEA to let a bunch of 19-year-old nursing students take a dozen people who had been institutionalized since the Eisenhower administration in our own cars for a field trip. Ummmm, I sorta forget whose idea it was .... yessiree, that's my story and I'm sticking to it.

Good news: We didn't lose anybody. And one of our delusional buddies, whose particular thing was that he was "The Lost Taurus," was apparently deeply affected by the show about the Crab Nebula... which, for those of you who didn't get the Girl Scout Stargazer badge is in (wait for it.....) the constellation of Taurus. He apparently wasn't lost after all-- there he was, all over the dome, bigger'n life.

And to this day I can't hear the song, "I Can See Clearly Now (The Rain Is Gone)" without seeing Carol, Shelton, Bobby, and the rest of them in the day room.

Oh, have some fun with it. These people know why they're there, they know people are afraid of them sometimes; treat them like normal folks as much as you can. It might be a treat for them. Watch out for the borderlines is all.

[It's like a Vit C]

I truly feel that the psych rotation in almost every nursing program is probably very similar to what you're describing. Most students just want to move on and forget about it. The best advice would be to use your time to read up on the meds and diagnoses that you are encountering. Know what meds are for what symptoms and what doses are effective. I guarantee that mental health problems will follow you throughout your nursing career no matter what area you work in. A strong foundational knowledge of basic psych principles, symptoms, and medicine could save you when you encounter a distressed patient in a medical setting and no hospitalist knows how to treat them.

[NurseLauraM]

My psych rotation was very similar, although it was on a weekday so we had more staff there. We still didn't do a lot in terms of interventions or technical skills. Although most patients didn't want to speak directly about their mental illnesses right off the bat, I found that many opened up naturally when we engaged them in board games, puzzles, etc. I learned a lot just by listening to their stories.

I also learned that psych is not for me because even as a student, I felt emotionally exhausted at the end of each day. It was a locked unit and there were a lot of heartbreaking stories. I have so much respect for psych nurses.

[Double-Helix, BSN, RN]

My mental health clinical was about 80 hours in a chronic and acute care psychiatric hospital. We couldn't give meds, although we did have to look up the medications, indications, side effects, etc. and do a care plan. Definitely didn't go into patient's rooms. The care plan was primarily based on chart review as well as whatever semi-lucid conversation you could have. We also observed group therapy when it occurred. We had to write a paper on a theorist or influential figure related to mental health nursing or medical care and were given clinical time in the hospital's library to work on it. The only other thing I remember doing is observing the psychiatric evaluation of a man who had been transferred from jail after being arrested for a violent crime. It was my first day, the man was probably legitimately antisocial and had me scared for my life by the time I left. I still remember the way he stared at me...

[katyq82]

Thanks for sharing! I feel better about my school knowing that this is a common experience. Being a naturally shy person, it was difficult for me to directly question patients when it was really unrelated to their care but we did end up playing lots of board games and I learned how to play gin rummy. :) I did also learn from observing patient behaviors and connecting the dots with their diagnosis. I am not interested in working in psych but at least now I have seen what the environment is like and I can be more aware when caring for a medical unit patient who also has a psych diagnosis.

[UnicornMagic]

I am in Psych right now, and this is exactly what we do. Build a rapport with the patients and they will open up. If not, move on to another patient. This is a great opportunity to practice your therapeutic communication skills. Bring a deck of cards, play with the patients. You likely wont be allowed to pass medications or do procedures during your pediatric rotation, either, just shadow. No clinical time is wasted time.