Teaching psych, what is most important/valuable?

Whispera, MSN, RN · Dec 1, 2008

My opinion is...most nurses don't go into psych, specifically, but they'd have to live in a locked box to not have patients with psychiatric problems. So, as a psych clinical and theory teacher, my main priorities were to help them learn about the stigma of mental illness, and to work on their interpersonal/listening skills while becoming less frightened or intimidated by patients with mental illnesses. Of course we got into the specific illnesses too. They always told me that clinicals were more valuable for real learning than reading the books. On-the-job really makes the difference after graduation too.

DavidLCPCCSADC · Dec 1, 2008

The movie "Canvas" is excellent and looks at the effect on the family in addition to the thought disorders. "28 Days" is just plain over-the-top silly, "Clean & Sober" is better for CD. "Leaving Las Vegas" is romatic nonsense and doesn't come any where close to representing ETOHism...."When a Man Loves a Woman" would be a better choice.

As for what should be empsasized more in nursing school, attempting to explain and describe the very real pain & sufferring of the patients and their families Also, the ongoing dance between the patients rights to refuse tx and the clinical interventions needed to provede medical care and appropriate assistance.

Jules A, MSN · Dec 1, 2008

My opinion is...most nurses don't go into psych, specifically, but they'd have to live in a locked box to not have patients with psychiatric problems. So, as a psych clinical and theory teacher, my main priorities were to help them learn about the stigma of mental illness, and to work on their interpersonal/listening skills while becoming less frightened or intimidated by patients with mental illnesses. Of course we got into the specific illnesses too. They always told me that clinicals were more valuable for real learning than reading the books. On-the-job really makes the difference after graduation too.

Good point. I never really got why nursing students are frightened. I found it intriquing, course maybe thats why I'm here now. :) It actually kind of annoyed me when students acted silly about our psych rotation. Wait till they see how many patients with psych issues they will deal with on the floor, lol.

Mr Ian · Dec 7, 2008

I'd move away from the disorders - it's too 'medical model' and that's where psych nursing lets itself down.

I'd focus more on 'rapport' and some of the softer science things like empathy, awareness, self-awareness. I'd also look more at interventions in terms of talking someone through an acute episode, negotiating care, motivaitional techniques. These are the things I see lacking in new grad nurses today - it's all about hard science and seems to ignore the wider issues of mental health and new grads are coming out all clued up on the science of MI and what it is and isn't - but absolutely no idea how to relate that to the hands on practice of helping someone deal with it.

The new grads still have the characteristics of a good psych nurse but not the molding to put it into good practice.

Mish56, BSN, RN · Dec 7, 2008

You've gotten some really good ideas here, sylubus done. I will try not to repeat any of the great ideas already posted.

I work in acute inpatient, so that's my viewpoint.

I have always wanted to train some of my newer co-workers, by having them wear an ipod, with 1-2 hours of auditory hallucination type recordings. You know, standard stuff...deragatory comments, laughter, mumbling chatter, that sort of thing. It could teach them how hard it is for some of our pt's to navigate the world.

Teach them that nobody asked for their illness. I have yet to hear a 5 year old say "when I grow up I really want to be schizophrenic!". Our population is almost ignored by society, a little kindess and respect go a long way.

As far as the movies go, how about a little historical persective, my favorite "One Flew Over the Cukoo's Nest"?

I'll sign off,

Mildred Ratchet

Mommy_of_3_in_AL..RN · Dec 10, 2008

Ok, new grad here, and i went into nursing loving psych...came out hating it. Our instructor, although great at what he does, is not a good teacher. He doesnt have the connection with his students, and he doesnt take the time to listen to them..he is more of an "if i say it then its right" person. No room for discussion or argument. I am the type that if i think something is correct, i will argue with you until proven wrong. At least let me state my case. So, that is my advice. Be open to your students and let them express themselves.

Also, when you are doing clinicals, make sure you let the students interact with the patients. Do not encourage them to look at the chart half of the day in order to get a ton of information about an irrelevant assignment, just because you like to give homework. After 2 years, i have really only talked with one of my patients. And make sure you assign them interesting patients that are willing to share their stories and really give the students a look at their disorder. Try to shy away from the depressed patient who looks at the wall all day and refuses to speak. I know those patients make up a large majority, but the student isnt going to learn much sitting there staring at a wall with them. And they will go away from clinicals without the one on one conversation you want them to apply to their assignment, feeling like they have just wasted their whole day and their patients.

Allow them to sit in on as many group therapy sessions as they can. Art, music, OT, whatever. I really learned alot being in a room full of different kinds of people with different disorders. And allow them to speak to any patient on the unit that would like to talk to them..not just assign one patient and expect them to spend all day together.

In theory, stress theraputic communication, different disorders and how some are only borderline different from others and make it hard to diagnose, and MEDICATIONS! Indications, contraindications, side effects, everything...as well as the antidotes and atypicals, because there is a lot of psychopharmacology on boards!!!

stellina615 · Jan 6, 2009

Here are a few things that I wish had been more clearly emphasized in my mental health nursing class before we we set foot onto the unit:

1. Psych patients are not afflicted with mental illness because they want to be ill. People with depression, schizophrenia, bipolar d/o, etc. are normal people trying to make it through their day-to-day life like everyone else, only with the added complication of an illness. Although this may seem obvious, many students are very apprehensive about their psych rotation and end up treating psych patients like a different species. My class was shown a video about a girl in her mid-twenties who detailed her experience about the onset of her schizophrenia. I think it was helpful for many students because it gave a storyline about someone who didn't suffer from mental illness changing into someone who did.

2. Knowing a little about the DSM is very helpful! I don't recall even going over the DSM in school, but when I began my job on an inpatient psychiatric unit, it was "axis II this" and "GAF that." I had NO IDEA what anyone was talking about. I did speak to the clinical educator on our unit about including a DSM introduction in the new hire orientation, but it still would have been useful to know in school.

3. Help the students develop ways to set boundaries with patients who may not have good boundaries of their own. I notice now with students on my unit that some of the more manipulative patients (why do students always seem to get assigned to the most borderline patients of the bunch?) get students to do things for them that they would never ask of the regular unit staff. On my psych rotation for school, a schizophrenic patient asked me to go on a date with him and I was so floored that I didn't know what to do. Although he was ill, it was clear that he knew what was and was not appropriate to say to staff and patients on the unit when one of the nurses reirected him about his comment. Teaching a student to say "that's not appropriate," or "I'm not comfortable with that, let me get someone else to help you" will go a long way.

I think it's great that you're looking for ways to improve your class. Your students are lucky to have such a teacher!

Best,

Erin

Quilter0225 · Jan 11, 2009

Nope...you are correct.
Nursing school does not prepare nurses enough for psych. Like in many areas of nursing, it is "on the job" training....and whatever that individual nurse decides to take in addition to that...once completing nursing school. However, this is not just in psych nursing, but in many areas of nursing when a new grad or new nurse begins practice.
And I totally agree with you...if you work in psych as a new grad or as a new psych nurse...additional training is needed and should be encouraged. Otherwise, what you don't know will either get you hurt or will be harmful to the patient.

I am a new grad starting out in pedi psych. Could anyone suggest books, websites, sources of CEUs, etc. that they found to be helpful? I completely reread my psych textbook cover to cover. It is a good general guide, but doesn't say much specifically about peds. I would like to start doing CEUs now to better educate myself for the unit. Any thoughts would be helpful.:)

diane227, LPN, RN · Jan 11, 2009

Safety, the way to deal with manipulation, and medications. Psych meds are very complicated and students need to know those meds in detail due to the potential side effects.

Thunderwolf, MSN, RN · Jan 11, 2009

I am a new grad starting out in pedi psych. Could anyone suggest books, websites, sources of CEUs, etc. that they found to be helpful? I completely reread my psych textbook cover to cover. It is a good general guide, but doesn't say much specifically about peds. I would like to start doing CEUs now to better educate myself for the unit. Any thoughts would be helpful.:)

One place to learn is here, at allnurses, on this forum. Do a search regarding some topics in this forum. Ask questions, folks will answer.

nkochrn, RN · Jan 20, 2009

I thought I had a pretty good psych teacher in my ADN program and enjoyed learning about it, but I HATE dealing with it. LOL Don't have much choice in a rural ER though.

I wanted to suggest a movie for your class. I saw it in College Psychology and again in my Psych classes. It was about a girl named Sydney with multiple personalities. I don't remember for sure what the movie was titled. It might have been titled Sydney.

nkochrn, RN · Jan 20, 2009

OOPS, just realized the name of the movie was Sybil!

http://www.imdb.com/title/tt0075296/