First Psych Clinical

xtxrn, ASN, RN · Oct 17, 2011

They are people, too. And a lot have been talked down to for various reasons. When I worked psych and alcohol/drug rehab, it was a wonderful experience. Some patients are easier to deal with than others, but as a student, I found that having someone to talk to who wasn't having to deal with meds and paperwork was a "treat" to them :)

Most are just folks going through a rough patch, and had the good sense to get help. (unless you're on a chronic unit). They can be someone like a neighbor, dentist, friend, or family member- just needing help.... the locked doors can be intimidating, but I found that the staff were good about letting students in and out as needed....

Just remember that behind the diagnosis is a person. The disease is not all they are :)

PinkRocksLikeMe · Oct 17, 2011

I wanted to start by saying I am not a nurse, I am a EMT that is headed into nursing school but I have worked at a county jail for 4 years and a local ED as well. I do intake at the jail: vital signs, medical history, TB shot, labs drawn, etc MOST of the inmate population is on some sort of mental health medication. I see people (employees, not inmates) come in there with the syndrome that I can only describe as someone that must have been REALLY picked on in school and they feel now they are running the show and they are going to make sure the inmate knows that the jail is there playground. I cannot stand people like that and 9 times out of 10 they can turn a situation that would have been fine, into a escalated knock down drag out. 1st and foremost these people are real people with real feelings just like anyone else. If you talk to them with RESPECT they will most times give it to you. Some are mistrusting of people because they have been hurt, abused and bullied most there life, but yet again if you treat them with respect they will return it and open up and trust you, some take more time than others. Yelling DOES NOT make someone that has a mental health issue repond any better, in fact they usually shut down on you and things go south. These people have had lots of pain in there lives, they could tell me stories that would bring tears to my eyes, that I would have to finish up the intake without making it known that I am upset. Most have drug and ETOH problems, I truly believe, and this is just my:twocents: but I believe that most of the people that have issues with drugs and ETOH are doing these things to take away the mental pain they have it only for awhile. Just respect them, listen to them, don't be afraid to listen to their stories, you may learn a lot and do not be afraid to tell your patients when/if they do open up to you about hurt they have in their lives, you can tell them that you are sorry they happened to them and validate their feelings. That means so much to people. Then you are going to meet the few that I feel are so far gone, it would be a long road back to normal for them, they can scare you, try and intimidate you, manipulate you and do whatever they can to get negative attenrion, they completely bypass trying to get positive attention. They can say sexual explicit things to you, do not let that get to you, they are only looking for a reaction. If you get a weird feeling about a patient and you start getting that little feeling in the pit of your stomach that something is getting ready to happen dollars to doughnuts it is getting ready to. Make sure you know your surrondings and where your escape place is, never leave yourself alone in a patients room, you have someone go with you if possible, if not you put your back to the door with the door open and go from there. You will find most patients are just trying to get centered, just treat the patients with dignity and respect. The latter patients are truly few and far between. Didnt mean for this to turn into a novel but we the inmate population made up of several mental health patients so that is what I can add for what it is worth.

PS one more thing, dont tower over them if they are shorter than you try to get on eye level with them if you have to hunch down a bit to get eye to eye for some reason it seems to intimidate patients

Goood luck you will do great!!

Jenn

elkpark · Oct 17, 2011

The good news is, you are going to say the wrong thing -- and everything will turn out ok anyway. :) The point of the clinical is to practice and learn, and no one expects you to be good at this stuff to begin with. Stay calm, keep your eyes and ears open, listen more than you talk, and do your best.

Best wishes!

allnurses Guide · Oct 17, 2011

The good news is, you are going to say the wrong thing -- and everything will turn out ok anyway. :) The point of the clinical is to practice and learn, and no one expects you to be good at this stuff to begin with. Stay calm, keep your eyes and ears open, listen more than you talk, and do your best.
Best wishes!

This is so true... you will say the wrong thing, many times over your career, if you decide to pursue psychiatric nursing. However, if you go into it with a good heart and good intentions, then you will do fine. The key is, like said previously, they are people just like you. ALWAYS remember that. Because I'm ashamed to say it, but it can be easy to forget that there is a real person with real hopes and dreams and real fears and a family that loves them (or once loved them, in some cases :crying2: ), when you are looking at someone who is screaming and cursing and striking out at staff and tearing up the place, or someone who is walking around the unit with a blank stare, talking to themselves.

ExpatHopeful, LPN, LVN · Oct 17, 2011

Honestly, I found the hardest part in my psych clinicals to be starting the conversation in the first place. We were generally just herded into the common area of the unit where the clients would be eating/watching tv/talking to each other or themselves and told to 'go for it'. Our instructor would then just sit and watch us fumble through. I found it really weird to start a conversation in such an artificial way. But I think you just have to take a deep breath, fake some confidence and walk up to someone and ask them if they'd like to talk. Some will say no and that's okay. Some you'll start talking to and 5 minutes later think "what did I get into?" But it's a learning experience. Be confident and have a sense of humor about the whole thing. It is a strange forced interaction, but you can't change that.

The unit you're on will make a difference too. I was on a unit with a lot of schizophrenics and while the conversations were a lot odder I found the clients easier to approach. The last 2 days we went to an addiction unit and the conversations were more normal but it was harder to get them started because the clients were very aware you were only a nursing student and weren't going to be there the next day. A few really wanted to talk but most just wanted to be alone or talk to their friends.

You'll get through it one way or another!

green217 · Oct 17, 2011

Hello incurable optimism,

This post is one of those "if I have to do it all over again..."

When I was in the nursing school, they always talk about therapeutic communication, and we mocked it a little bit. Why? It always involve repeating back what the patient just told you. It sounded very silly, but as you know, the purpose is to validate the patient's ideas and emotions regardless if their right or wrong.

Well, I wish I used the time to practice therapeutic communication because back then and still now.... I'm always eager to give advice. I always assumed that when people talk about their problems, it's because they need advice. The problem is I like to get down to solution ASAP. So people give me hints:

"I don't want your opinion or help" or

"You miss the point. Did you even hear me?" .... and even

"Your solutions are impractical in my life. We live in a different world."

The result is they distance themselves from you. I'm not saying do not give advice, but your main focus should be gaining excellent listening and therapeutic communication skills. Good luck.

green217 · Oct 17, 2011

Also, many of the psych patients are in a bad phase of their lives. One phase doesn't portray their whole lives. Humans are so complex that even a serial thief can convey genuine love to his children.

During these bad times, all they may see and feel are the bad things in their lives.

Your job is to bring out the positive ones!! Try to know their hobbies, what makes them smile, how cute their kids are, etc.

Just help them see the positive side of their lives.

classicdame, MSN, EdD · Oct 17, 2011

when I did psych clinicals I was miserable, partly because we were restricted to the day room and the inmates (yep! criminally insane) were allowed to smoke. Smoke makes me ill. Anyway, I endured somehow. Now I know that EVERY nurse is a psych nurse. If nothing else, the anxiety of illness can bring out the worst in the patient, family and friends. So, jump thru this loop, but do pay attention to what works and what does not work in communication. Respect and kindness are magical.

systoly · Oct 17, 2011

Focus on your objective, disregard everything else. Remember, language is only one part of communication. Sit in front of a mirror and observe your own body language (not just for this assignment, but for interviews as well).

GGT1 · Oct 17, 2011

Psych was my easiest clinical during Nursing School.

I know every facility is different, but the patients on our unit were mostly medicated and back to baseline. It was really easy to talk to them... Do you live close by, do you have children, tell me about your children, what's your favorite food, what's your favorite holiday, yada yada yada. Really the easiest clinical... we were not able to give meds, help in personal care, or really anything but participate in group activities and communicate with the patients. Good Luck.

Smitty08 · Oct 17, 2011

Also, when I had my students in psych. I always advised them to quickly find out where all the games and art supplies are kept. Games are great ice breakers, even just a deck of cards. Also, as noted above, you WILL say the wrong things sometimes but if you are genuine, you'll do just fine!