Advice for Nursing student placed in psych pediatrics?

[FionaA]

I'm in my last year of nursing school and I'm about to start my pre-grad/consolidation semester. My placement is at a Mental Health - Inpatient Unit for children and adolescents. I am not sure what to expect and exactly what I will be doing. My last placement was on a med-surg unit so there was a lot of the typical medical procedures with tubes, injections, wound dressings, etc. But with psychiatric nursing, I am a little apprehensive and not really excited because I've been told by my friends who had been on these mental health units that you don't really do much. I'm gonna be working 32 hrs a week on this unit so it will be a big part of my life the next few months till I graduate. Can anyone offer me some advice or give me an idea of what goes on in mental health inpatient units ? Thanks a lot.

[gardenvarietyRN]

This sounds like an interesting experience. What you learn there can help you work with the general population later. You will have many patients in the future who have psych problems but will be treated in on non-psych floors for their medical issues. I have never worked in a peds psych unit before (only had short visits) but would advise the following;

1. review developmental levels (such as Erikson's or Piagets) your profs will probably want you to write some reflective statements so understanding and quoting them will be useful
   
2. review psych drugs for emergent, acute and long term maintenance, recognize their side effects (include the ones that happen after long term use- toxicity)
   
3. review eating disorders and drug abuse
   
4. boundaries for both the patients and their parents
   
5. watch the parents, this part will be especially interesting if parents are allowed on the unit
   
6. issues to always consider is patient and personal safety, manipulative behavior, boundaries, and therapeutic interaction
   
7. since this is your consolidation semester keep in mind of how each patient will grow with their condition, how he/she will function in society, how this effects their families and immediate community, what public health policies may affect this person in the long and short term, etc, you get the idea...
   

Good luck and have fun with nursing.

[Whispera, MSN, RN]

It's important to be with the patients. Sometimes staff have so much paperwork to do they stay behind the desk. Your most effective intervention will be to spend time with your patients, getting to know them, earning their trust, and just listening. Review therapeutic (and non-therapeutic) communication skills.

This semester will help you no matter where you work. There are psych patients everywhere.

As for there being not much to do....it's up to you to figure out what you can do that will help your patients. Dream up some groups. Do medication education. Mostly just BE with them. It can be totally fascinating.

[marshmallowstar, BSN, RN]

Peds Psych is my passion it's where I got my feet wet and where I always want to go back. I agree with the other posters, be there, be present. Get to know your group coordinator/MHTs they do a lot of the groups and you can learn some great tips and tricks from them. Developmental stages are big for assessment, most psych kids have trauma histories that affect how they cope. You'll have a 13 y/o who's abuse started at 5 so they still respond like a 5 y/o to stressful situations and you have to intervene/deescalate like you would with a 5 year old but teaching them the expectations of a 13 y/o's behavior. Get to know the level system/behavior modification system so you can be effective and interact and not just a bump on a log that has to way for regular staff to intervene. Don't under estimate the power of coloring with a 7 year old or reading to a 4 year old or joking with a 12 year old. One of the main roles I see us having with this population is showing them that things don't have to be like they are at home. Grown ups don't have to act like what they've seen before, when you do something wrong you get a timeout not get hit. That adults can not like the thing you did but still like you. Odds are you're sending them back into the environment that helped create some of the MH issues, give them light at the end of the tunnel. Remember there is a biological component to what's going on too. Trauma changes brain chemistry, childhood psychosis, adhd, and bipolar dx are very real things. Ask about suicidal/homicidal ideation and hallucinations. Asking frequently helps take the stigma away and may encourage a kid who has been afraid to report psychotic symptoms to open up.

Again this my passion, I could talke about it all day everyday. :) Hope it goes well. Let me know if you have any questions or need any support.

[GeneralJinjur]

I work in an acute facility, so I do a lot of wound care for self-injury. It gives me the willies sometimes, where it wouldn't if it were a surgical or accidental wound.

I think its important to recognize how emotionally draining psych can be. The child/adolescent units have a lot of energy compared to adult units, which I enjoy, but it can be very tiring, especially when they are turning that energy to self-harm or acting out. I also find them to be the sneakiest population. They can come up with elaborate schemes to distract staff while another pt snags something forbidden or dangerous. Another thing you'll see is that psychotic kids are more open about their hallucinations. They don't have the polish that older patients have gained for explaining what they're seeing.

Finally, this will give you the opportunity to focus on self-care as a nurse. How do you relax after work? How do you continue to be available and non-judgmental when pts share experiences that curl your hair? These are useful skills for any nurse and psych will let you develop them faster. :) Let us know how it goes!

[vikkirn]

I love playing with the kiddios esp the babies 4-12. It is really an eye opener to what most of these kids have been thru. I could not even imagine it. Most importatantly is to listen talk and be playful then you will do alright. Last thing you need to be is stern non-smiling and demanding. They will respect well sorta lol for just being you. Its fun to me if I could just get over the staff I work with i would truly love my job.