First externship in a psych floor, what to focus on?

[Coumarin]

My Psych rotation was pretty much observation, attending group meetings, some interviewing of patients, and helping nurses with whatever I could. this was a similar response from other students as well.

I was placed in a psychiatric floor for my first externship. I will be on an unlocked unit. My school instructor told me that rarely are there IVs, foleys, trachs, pretty much few patients that require a lot of hands on care/nursing skills. I'm concerned that I will be an observer with not much to do. I also don't want to be a burden to my preceptor and follow her for the entire shift. Every week, I need to submit 5 measurable outcomes to reach. what should I focus on? How I can make myself useful and make the most out of this experience?

[nursefelly]

Hello HiimRose,

I'm only a newly accepted nursing student who hasn't even registered for her fall classes yet. I know nothing about what is expected during clinicals. So keep that in mind when reading my input.

While I have never experienced psychiatric nursing, I have personally been hospitalized on a psychiatric unit before (4 times in my life time ). The times that I ran into nursing students, when we were not in group, they spent time talking to and getting to know us patients. I found it comforting to be able to talk to and share my story with the nursing students and I think they really gained something from talking to patients. There's a lot you can learn from listening to the patients and learning the chain of events that led them to a hospitalization. From a patient's perspective, do not be afraid to talk to them because they will appreciate it and remember you.

[nurse lala, BSN, RN]

I agree with nursefelly that your greatest contribution is being available to the individual patients for an opportunity to share and process information. Your job is to be present. To engage the person and ask about what brought them into being on a psych unit. Use active listening skills to encourage discussion. Your availability and attention are appreciated by the nurses as well as the patients.

[pinkiepieRN]

My school instructor told me that rarely are there IVs, foleys, trachs, pretty much few patients that require a lot of hands on care/nursing skills.

Your school instructor was right. When I worked psych, the skill/task I performed the most was simple wound care. I can almost guarantee that you'll never see a trached patient on a psych unit, although you may have an IV here and a Foley there - depending on the rationale for the intervention.

The skills you'll be practicing the most are assessment (physical and mental status), crisis intervention/management, therapeutic communication and documentation. These are all VERY valuable skills, so don't think you're missing out especially if you selected to be on a psych floor for your practicum/externship.

You'll also see admissions, discharges, falls, medical emergencies (rapid response/change in mental or physical status), infections with ABT (UTI, pneumonia, upper respiratory infection, wound infection) and psych patients don't leave their medical issues at the door to the ED when they're admitted. You'll likely see a lot of DM and HTN and sometimes there were patients on HIV/AIDS medications. You might see patients who are on Coumadin with regular monitoring. You'll do patient education on medications (purpose, potential side effects, interactions), discharge planning/instructions, medication/treatment compliance and then some more patient education. Also, you'll see substance abusers in withdrawal from a drug of choice. They might be on a taper of Clonidine or Ativan, with Q2 or 4 hour monitoring and assessment.

What should you focus on? I'd say therapeutic communication, assessment and documentation are the three "biggies". Surely there's at least one or two patients on the floor who are needy or "attention seeking" who will benefit from your ear (as will the staff). You'll learn assessment skills, enough to suggest mental illness in almost anyone if presented the right way. With that assessment comes documentation. Doctors are going to look for nursing report to help with med adjustment, because it's not as clear cut as reviewing vitals, labs and/or procedures and testing.

[Mandychelle79, ASN, RN]

In three years we have had 2 or 3 patients with a trach and they performed their care themselves.

I have had to cath both males and females and wound care we do a lot of