Child/adolescent psych position

Orca, ADN, ASN, RN · Apr 11, 2012

I didn't work extensively in child/adolescent, but I did work some. One day we had a kid about 12 years old who was an absolute terror, running through the unit, screaming, throwing stuff. We finally got him into the seclusion room. One more attempt at oral meds, he spit them at the medication nurse. I told her to get me a 10cc syringe and an 18ga 2" needle. She brought them in and I showed them to the kid. "It's the pills or this", I told him. He took the pills.

Strategies for getting patients to take you seriously will come with time. Be as truthful as possible (you will learn that there are times when you deliberately dodge answering a question honestly). Try to develop a rapport with each patient, but know that this won't always be possible, and that it isn't a reflection on you. For instance, we had a patient on my adult unit who was a rape victim. I apparently resembled her rapist. She apologized for not fully trusting me, but I told her that I understood, and I let others handle the bulk of her care. Each situation is different, and with time and experience you will become more adept at dealing with them.

decembergrad2011, BSN, RN · Apr 12, 2012

I am still just a student doing my preceptorship on an adolescent psych unit, so take what I say with a grain of salt

However, I have found that the kids respond better to the younger crowd. The hardest part about looking or being young is finding a fine line between acting like a meanie authority figure and acting like a friendly peer. I have seen an MHA endorse drug use by talking about his experiences when he was younger, in an attempt to connect with an unresponsive patient, and that's NOT the way to go. However, I have connected with kids talking about everything from my own experiences with bullying to CounterStrike (a PC first-shooter game) to movies and music. One day this semester I had my hair in a side braid and one of the girls was so excited because I looked like "Katniss from the Hunger Games" and that was a way I could connect with her.

I believe that if you are genuine with them, and don't give them the run around, it's better. With the 16 and 17 year olds, I'm completely straight with them about the fact that they will not be given a doctor's clearance to leave unless they participate and cooperate with treatment, since they do have the choice to refuse meds. Remember your therapeutic communication skills because they are just as important with kids, but sometimes you will have to change your tactic. I often find myself talking about everything BUT the issue at hand with my patients until they feel comfortable enough to trust me with the heavier topics. Of those skills, listening is the most important part, and remembering little things about the kids and bringing them back up later in the shift is key. For example, I had a kid who talked about her cousin's quicinera and it was an important event for her. Remembering that detail and asking her about the progress of the event was a way to connect with her even days and weeks after she had told me about it.

If you can find a common interest with the kids, explore it as much as possible. Pets, movies, games, whatever. But most importantly, remember that they are children and sometimes they are just moody because they're going through puberty. Sometimes they have horrific family situations and it's hard not to judge. Keep your own affect appropriate and your voice even-keel. If you get angry or anxious around them, they can smell it out and will exploit it. Keep your limits perfectly clear.

And most importantly, DO NOT TOUCH THEM. The most I have ever done with a kid is a "fist bump" and that's a rare occassion. Accusations do get made in the psych world and it's better if you never have to deal with it!