Therapeutic Communication

Mashira · Jun 4, 2011

I'm also a new grad psych nurse. I've been working for almost four months now and I've realized that a lot of what we learn in school is 'perfect world' scenario. Sometimes, there is just no 'textbook' answer for what the patients say. It's taken me a while to learn how to take what you get from a textbook and apply it to a real life situation. For the most part I've learned from watching more experienced nurses in my facility that aren't burned out. There are a lot of bad habits (power struggles, yelling, and acting superior) that you could pick up from others that work in this type of setting. Be careful to pick your mentors wisely. I never let my 'mentor' know that she was teaching me. Just observe. Observe everything, the good, the bad, the ugly. Then analyze the crap out of it. How did the patient respond? How could the response have been better on both parts? How would what the nurse say make you feel? Why? What would you rather hear? And then go off of that. At least, that's what I've been doing and I'm willing to say I don't feel half as clueless as I did four months ago. It's a process, and if we're doing our job, we'll never feel like we've really 'got it', there's always something to learn! Best of luck and congrats on your new job!

ajt575s · Jun 5, 2011

Thanks so much! I feel so completely clueless right now and just hope I don't embarrass myself. It's very reassuring to hear that you're doing so well!

Mashira · Jun 6, 2011

I certainly know the feeling. If your facility is anything like mine, you got little to no orientation and then were thrown into the deep end, expected to sink or swim. It's rough, however, it's VERY satisfying to swim your way out. Feel free to add me as a friend and send any questions my way. I'm not on here a lot (mainly facebook) but I'm willing to help out any way I can. Lord knows I could have used the help in the beginning! You'll do wonderfully, and you have a great support system and tons of knowledge to tap into on this forum!

Davey Do · Jun 8, 2011

I want to echo Mashira's suggestion of observing your Peers and seeing what techniques work and which don't. We learn as much from our so-called bad Teachers as we do the good Ones.

Emulation is a very good way of institutionalizing a trait within our own personalities. At first we may imitate the actions of others, but eventually those actions which once belonged to someone else become a part of who we are.

And "being who you are" is a very important part of the equation here. Most of us can spot a faker- someone who is just reading the lines written by another. And most of us who are attempting "to thine known self be true" are uncomfortable with this technique.

So, my strongest suggestion to you, ajt575s, is to be yourself. The techniques, the information, the lines, the comebacks, the knowing how to act will all come with time and experience. Don't loose who you are in this process. Only you can be you, and the Process will be easier if don't try to change who you are.

Oh yeah- EXPECT to embarrass yourself. It's a learning process. For that matter, ALWAYS expect the unexpected. Then, you won't be surprised when the unexpected occurs.

The very best to you, ajt575s.

Dave

MickeyTong · Jun 12, 2011

Hi ajt575s

It is unavoidable that when you start out you will seem like RoboNurse reading from a textbook. Guidelines and theory are a bit like armour - they help us feel safe when we jump into dangerous, unknown territory. And working in psyche, you really don't know what someone will say to you......."my life is worthless", "I'm married to Shania Twain", "they want to kill me because I know who killed Princess Diana", "I want sex with you", "that's not medication, it's poison", "my thoughts are all over the internet", "my father had sex with me for 12 years", "if I touch the door handle I'll be contaminated", "when can I go home?" "what do you think of my diagnosis?" "nurse Smith doesn't like me", "I've cut myself", "My husband beats me up and brings prostitutes home", "alcohol is legal, what's wrong with heroin?", "do you have children?"

Please don't think you have to get things 100% right 100% of the time. As a newbie, your experienced colleagues should not be expecting any polished displays of professional expertise from you. It is inevitable that you will get things wrong, probably quite often. But, unless you are being deliberately malicious, you will do your patients no harm. Don't feel offended (or incompetent) if experienced nurses tell you where you went wrong or how could have done better: you're new at this and it's not an easy job. Kudos to you for jumping into the water with us - most people just run away.

Therapeutic communication skills don't come naturally to anyone. With experience, and lots of reflection, (both of which take time) some nurses make it look easy, sometimes they can make it look like fun. But they still get it wrong sometimes.

Welcome to the wonderful world of psyche. Don't give up. You'll have a dark patch where you'll think something like: "Maybe I should sell burgers instead". But keep going: we need people who care.

jewlsRN · Jun 13, 2011

Remember feeling the same way when I started in psych right out of school a year ago. All the advice here is great! I would add that sometimes the best therapeutic communication is nonverbal. Sometimes just sitting with someone quietly is what they need the most. Even when someone is yelling, ranting and raving....being calm in return can do wonders to de-escalate the situation. Everything is situation-based and each interaction is unique. Sometimes redirection is necessary, while others times being outright and boldly direct is needed. Follow your instinct and yes, expect that it won't always go 'textbook' style....but, along with a heart for psych stay strong and persevere....this population needs more people who care. :-)

IdrilRN, BSN, RN · Jun 20, 2011

I will echo what everyone else is saying. I think psych nursing is the best thing ever. I started here 2 1/2 years ago as an LPN and now I've graduated to an RN, I know I made mistakes at first not even having a clue how to talk to people, but it did get easier. I was worred about saying the wrong thing but I quickly learned every interaction isn't in therapeutic mode, one has to establish a rapport with the patients. If I see a book at their bedside I will ask about it, or if they happen to be from the same home town (we live in a small state and get people from all over the state) I mention it, asking about pets and so fourth.

Self disclosure is something to be careful with. I don't discuss anything personal, like where I live now, or maritial status stuff like that, it's not their business.

My favorite and most used interactions I use, as I work the night shift "Seems like you are having trouble sleeping......" OR "how did you sleep last night?

Oh make sure you introduce yourself. Remember these are real people who are unable to cope with what is going on in their life at the moment.

Sometimes we have a group of people who sleep all night, they could have been here for two weeks and I never saw them awake, or sometimes our group is loud and rowdy, up at 5am complaining that they can't go out and smoke or have "real" coffee...... mmmm must be frustrating for them......

One person, usually someone who is intrusive and or manic can throw the whole place off. Even in a place full of mentally ill patients, there is a person they all will single out.

Boundries, keep them. If the rule is no showers till 6am, then that is for everyone. Don't give into the it's only 15 min, because then next day someone else will want it, or want one earlier. That might seems like a small thing but when you have a person who is pushing limits already it gets tricky. Rarely we will let someone use the patient phone outside of the time limit, but that is only if they were just admited and need to let someone know where they are. and it's usually only for 5 min.

Well that's all I can think of for now. As I said, I love psych nursing.

It's a wonderful sight when a person with psychosis leaves their castle in the sky.

conure girl · Oct 7, 2011

Hi,

I know this is an old thread, but I liked the advice I was reading in it.

I am a new grad and was just hired as an acute care MH nurse on the night shift. Your posts have been helpful as I gear up to start my new career. I was wondering, IdrilRN, what responsibilities the RN has during night shift since hopefully many of the patients are sleeping? The LVNs give meds at my facility. Also, are there other key phrases you find yourselves constantly using with the patients? I only had a short MH rotation 2 years ago. thanks.

fizz872 · Nov 11, 2011

Hi Conure Girl,

I just started work as a charge nurse on the graveyard shift in a psychiatric hospital. My job typically consists of double checking the charts, making sure all providers orders are documented and carried out, and getting the hospital ready for another day of patient care. We also get frequent after hours admissions that I manage. You're right about most of the patients sleeping. Of course that's most, not all. We frequently have patients that won't sleep for days at a time, and often spend the entire night talking to or making requests of the nursing staff. It's important to remember with these patients that it is your job to help them improve their condition. Sitting and talking for an hour may be exactly what one patient needs, but it may feed into the attention seeking patterns of another. Always be thinking "Is this what's best for the patient, or just what's easiest for me". Also be on alert for patients who develop a pattern of inadequate sleep. Their are few conditions that don't become exacerbated with chronic sleep loss. Hope this helps.

conure girl · Nov 12, 2011

Thanks, Fizz--that gives me a clearer idea. I think learning how to evaluate patients who want a lot of attention will be difficult for me as a new nurse. Your point that it is not always in a patient's best interest to sit and talk is a good one for me to keep in mind.