Psych Nursing Rotations- How Do You Get the Most Experience From Your Clinical Site?

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    I am in Psych Clinical Rotation, and I was assigned to a dual-diagnosis crisis center. It is basically a non-profit organization, which houses up to 12 clients, and helps them to rehabilitate into society. They have rotating set of councilors 24 hours a day, and a nurse practitioner which comes in twice a week for about half the day each time. The councilors give the patient their medications, and it is very much a home setting- very relaxed, welcoming, and homey for the most part. As it is a crisis center, the clients can only stay 90 days max, and if they need further assistance, then they are sent to a similar setting for a limited time, until they can regain independence, or be transferred to a board-and-care.

    The current set of patients which reside their are patients who have bipolar disorder or schizophrenia (or both), and a substance abuse issue- usually past meth or alcohol addiction. They APPEAR to be stable, and have not done any unusual types of behavior- the most unusual one for me so far is a patient who hears voices at night, and parts of the day. Basically, they appear to be fairly normal people, that had a hard life and trouble with their mental illness, and turned to drugs for one reason or another. Currently, I spend lots of time talking to my patients, and getting to know them on an individual level- where they are from, what is their story, why are they here now, ext. I ask them a lot of questions about themselves, and try to assess their knowledge of things such as dental care, sleep, hydration, and nutrition so that I can educate them on these things.

    However, when tragic subjects come up- such as an experience with rape, or being beaten as a child, I have NO idea what to say. What is the most therapeutic response in a situation such as that?

    Also, I have difficulty knowing how to assess their mental health issues, as I am a little worried as to how I can make them feel comfortable telling me these things, when I have relatively little experience mental illness- except for bipolar disorder, which after years of having a person in my life with that disorder, I am still having difficulty being therapeutic with them during manic phases as they are extremely aggressive during these episodes.

    Aside from therapeutic communication, I would also like to work on nursing interventions with them, as I feel that I currently have more of a role as a councilor, rather than an educated nurse with med-surg and public health knowledge. I do realize that therapeutic communication is the foundation, but I would really like to also bring things to the table that the patients may not be getting from the facility, and that I as a nurse should be doing/focusing on. What do you recommend I be teaching my patients regarding their health? Many of them have lived on the streets for years and years, but I have never been homeless. I can definitely IMAGINE what it must be like, but I as I have not had to live that way, I truly cannot know what it is like. I am not sure what common useful nursing topics may be helpful for them?

    I would really like to use my time in clinical to "work" as I would if I were hired as a psych nurse, because the home I am in is very friendly, involved, and allows us to work within our skill set of giving medications with supervision, and talking to patients. I want to take advantage of my time, and get the most that I can out of my limited time in psych.

    I love public health nursing, and psych patients are often neglected d/t their mental illness. What skills can I do now, so that when I work in the field I can understand this population, and do my best to assist them?

    Please help!

    Thank you.
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