Child/adolescent psych: Questions from a student nurse

[pghstudentnurse]

I had a shadow day on the child and adolescent inpatient unit. I really admire the work those nurses do, but I also feel that it must be challenging. My questions are, what are your biggest frustrations and your greatest joys with working with pediatric patients.

I never really thought of myself as a "kid" person until I did a rotation at the children's hospital and loved it. But my first love is psychiatry, so I thought that maybe I could combine those two by working in child/adolescent psychiatry. But it also seems that it would be difficult to work with children who have behavior problems and a history of abuse/neglect. Thoughts? Advice?

[hppygr8ful, ASN, RN, EMT-I]

So I have been doing ped/adolescent psych for close to 17 years. I love it and don't ever see myself doing anything else though I do occasionally float to adults. I have to say the biggest challenge I face daily is dealing with parents and family members who have either contributed greatly to their child's illness or who have unrealistic expectations of what constitutes effective treatment . Don't even get me started about the one's who have abandoned their kids to the system. I get that parents can only take so much especially with chronic cases but most have refused medications or treatment for their children for years then give up.

Hppy

[pghstudentnurse]

Thanks so much for the perspective. How do you handle behavioral issues with pediatric patients? One nurse told me that trying to "parent" these kids doesn't work very well, even though one would naturally want to order a child to not draw on the walls.

[hppygr8ful, ASN, RN, EMT-I]

Thanks so much for the perspective. How do you handle behavioral issues with pediatric patients? One nurse told me that trying to "parent" these kids doesn't work very well, even though one would naturally want to order a child to not draw on the walls.

We handle most behavioral issues by re-direction. We try to keep a stimulating and engaging environment. We don't get many who draw on the walls. We gets lots of self harmers which includes cutting and scratching at self, attempted hangings, banging heads on walls etc... Ordering a child to to any thing really isn't effective even from a parental perspective. I spent a lot of time meeting these kids where they are not where I want them to be. Care is patient centered not care giver centered. If you ask a patients what's going on right now that's causeing the behavior you can lead them through self calming and mindfulness strategies which work far better that ordering people around.

Suzanne.

[pghstudentnurse]

Thanks again for your thoughts and perspective. I appreciate you taking the time to reply.

[elkpark]

Working child psych can be a lot tougher emotionally than working in adult psych. When asked to compare the two, I've always said that, with kids, "The highs are higher, but the lows are lower." You encounter a lot of gut-wrenching, heartbreaking situations. The vast majority of the people in healthcare don't want to (won't) work in psych. The majority of people who work in psych don't want to (won't) work with children. Also, there are a lot fewer jobs in child psych than there are in adult psych. But those of us who like it tend to really like it.

[NICUMurse87, BSN, RN]

I was a mental health tech in school, but I worked with the adolescents on a not infrequent basis, and tend to agree with hppy. When things are going good, it's great. But there are too many times when we'd have a breakthrough with a kid, just to have their parent come to visitation and reverse everything we'd spent the week working on in a half hour. If you really want to get a sense of how utterly terrible a human can be, listen to the stories some of these kids have about their parents. You need a very strong resolve to continually work in that environment, stronger than I had, for sure.