Advice for student beginning psych clinicals?

PRNMEDS · Aug 25, 2005

I think this issue has been discussed numerous times in this forum so you may want to check some of the older threads. That said I will post a quick reply that hopefully will be of some help.

REMEMBER:

1. Be yourself. Don't try and act a certain way because you think it will impress the patient or gain their trust etc. They will spot a phoney immediatley.

2. Always treat patient with respect, and dont lie to them (make false promise etc.) If you say you will do something - DO IT. If not you lose there respect immediatly.

3. Maintain boundaries. Sounds easy but can be difficult. Patients will try to erode this and be your friend. Your not there to be a friend, yout there to provide profesional help. You want a Theraputic Relationship, not a personal one.

4. Always be alert and ready to respond. No matter how calm or rational a patient may seem there is always potential for irrational and possibly violent behavior. Remember they are in a Psych hospital for a reason.

5. There is always other staff and or supervisors that will assist you if you need it, and dont be afraid or ashamed to ask for help.

As for what should be thinking about:

How can I help this patient. What can I do that will help him or her most.

POSSIBLE SITUATIONS:

ANYTHING. You never know what you will encounter. Depending on type of unit you may encounter violent patients, self injurious patients. Patients that are totaly psychotic and make absoulutely no sense at all. Unlike med surge where you can kind of prepare for things (know dealing with post op Knee surgery or Tonsilitis etc.) in psych each patient and situation is different and you just have to ASSESS the situation and do what needs to be done.

Final piece of advice. Try not to be afraid, or at least not show it. Patients pick up on that quickly and if they think you are not in control it makes it even harder for them to be.

Good Luck - and would love to hear how you make out.

healer_energy · Sep 19, 2005

Thank you for this. I also will be starting practicums next year so I will print and keep your words. At the moment I work with late stage Alzheimer residents and I feel that this has given me some valuable experience as far as being aware of what is going on around me and responding with genuine caring,without fear, yet with alertness. They do live at a more instinctual level without the overlay of social expectation. I was wondering if mentally ill patients are also hypersensitive to others in the same way. In other words, can they sense or read others more acutely in the same way that a blind person can smell or feel their environment with more depth. Or is it that what they sense matters more to them or affects them more? :uhoh21: A more healthy person might be able to dismiss many stimuli in their enviroment as being non-threatening and so actually attend less to them.

Can you also suggest a search term that would get me to the previous advise re clinicals that you alluded to?

Sonya

elizabells, BSN, RN · Sep 19, 2005

Can you also suggest a search term that would get me to the previous advise re clinicals that you alluded to?
Sonya

I searched "advice student psych clinicals" and "advice psych clinical" and got zippo.

Thunderwolf, MSN, RN · Sep 23, 2005

Here are two threads on this topic:

https://allnurses.com/forums/showthread.php?t=109819&page=2&pp=10&highlight=clinical+rotation

Preparation for Psych Clinical - allnurses.com Nursing for Nurses

https://allnurses.com/forums/showthread.php?t=82297&page=2&pp=10&highlight=clinical+rotation

LPN student First day of psych rotation, HELP! - allnurses.com Nursing for Nurses

Hope this helps

Wolfie

elizabells, BSN, RN · Sep 29, 2005

Here are two threads on this topic:
https://allnurses.com/forums/showthread.php?t=109819&page=2&pp=10&highlight=clinical+rotation
Preparation for Psych Clinical - allnurses.com Nursing for Nurses
https://allnurses.com/forums/showthread.php?t=82297&page=2&pp=10&highlight=clinical+rotation
LPN student First day of psych rotation, HELP! - allnurses.com Nursing for Nurses
Hope this helps
Wolfie

Thanks, TW!

CharlieRN · Sep 30, 2005

Good advice so far.

One small but significant bit. Never hang your keys from your belt or neck, or walk aroung the psych unit playing with them. Your Keys are a visible symbol of your power and staff status. The biggest visible difference between you and "them" is they don't have keys. Swinging your keys sends the same message as a prison guard or a cop swinging a billy club. Don't do it.

In most psych units I have worked on, the staff and patients both wore street cloths. There will be a "dress code" for your unit. It may not be written or it may be subtlely different from what is written. Pay attention to what your peers(nurses) wear and how they act. Do female staff wear skirts? Heels? How much variety is usual? Is the clothing of mental health workers or psych aids the same or different? Are male staff wearing jeans and T-shirts or jackets and ties? In any case beware of sending blatently sexual or threatening signals. I don't care if it is normal in your peer or ethnic group to wear slacks so tight people can count your change, wear something looser at work! The T Shirt with the beer company logo is not work wear. Neither is the one with the cleverly insulting saying on it.

Safety is always a nurse's first responsiblity. Most important, your own! Wear clothing you can run in. If it is around your neck, will it break away if it is grabbed? I wear a jeweled cross, it was my 25th aniversary present, so it is important to me. But it is on a thin gold chain. If it is grabbed, I may get cut a little but not strangled. The chain will break. A nylon string would not. Never carry weapons, at least not where they can be seen. A knife is a poor self defense weapon in any case. I would feel safer carrying a clipboard.

You are there to make the patient's situation safer in various ways. That is your job. If the situation seems unsafe to you as a student, ask experienced staff. Its possible that they did not see the risk. More likely that with their greater experience they see it as minimal. If you are frightened for your own safety avoid the situation if you reasonably can. It is not reasonable to put patients at risk to protect yourself from risk. On the other hand a dead nurse can help no one.

elizabells, BSN, RN · Sep 30, 2005

thanks charlie. they warned us about wearing things around the neck - most of us wear our IDs on a cloth lanyard they handed out at orientation. bad idea.

FUTURE_RN_08 · Sep 5, 2008

We are to wear No laynards because they could be dangerous. We have to dress very conservative and wear nothing suggestive. Many of these patients are hypersexual. One thing I have learned is to never have yourself blocked in a room where you can not get to the exit if needed. Be careful when you got out of the locked ward that a patient does not try to sneak out. Also, do not give them details about your life. Some have been known to have tracked students down, and you sure dont want that to happen.

felixfelix · Sep 5, 2008

I've been told that the whole "pt. stalking nurse" thing from the last name on their badge is greatly exaggerated, but then again, like a ca dx, if you're the person on the wrong side of the dx, the odds don't matter.

rn4ever? · Sep 12, 2008

The basic ones like.....

dress appropriately
don't give out personal information
don't make false promises or agree to keep secrets with patients
set limits
avoid touching as it might be interpreted as something sexual
make sure you knock before entering a patient's room and introduce yourself
if you are unsure of the rules of the unit, ask a staff member before committing or agreeing to do something that a patient requests you to do
if you are entering a patient's room, make sure you are by the door and can get out when needed.
treat the patients with respect
in a locked unit, be extra careful when opening the door