First Psych Clinical

snazzy-jazzy, BSN, RN · Oct 17, 2011

Good luck, I hated my psych rotation in a major psych hospital but I got through it. However, my father is a psych R.N and has been for 40 years. I think you're either going to love it or like me not be so impressed. I trained with people who had worked with my Dad and they assumed that I would be following in his footsteps.

Guest 360983 · Oct 17, 2011

If you're allowed to participate in activities that the patients are doing (gym time, painting, anything), jump in. I did my entire interview one day while playing ping pong with one patient. She said it was easier to talk when we weren't staring at each other and she appreciated that I saw there was more to her than a list of answers to questions. I was happy to do something beyond the monotony of group and sitting in the day room.

My professors wanted us to follow a specific format for talking with patients--start with an introduction, explain why you're both there, blah blah blah. It was more of an admissions interview, or even how an APN or MD would talk to a patient. I'm not great at talking to people I don't know, so I went up to patients, introduced myself, and asked if we could talk. I'd ask them if they wanted to talk about anything in particular; usually they'd start the conversation. If you ask about kids, you'll usually get a conversation going pretty quickly. Or, you could just ask them about why they're there and how they feel about it. Psych patients are sick, not stupid, so you'll have better conversations if you just talk (using therapeutic communication techniques) and skip any memorized scripts.

I loved psych. I met some really cool people and had fun talking to them.

chevyv, BSN, RN · Oct 17, 2011

I work psych and I would advise you to listen to the nurse you'll be working with. Many of my pts would hyperfocus on you and not in a good way. Make sure to brush up on giving IM's (I give a lot!). Always remember respect and never let them sense your fear. Many feed on it. If your uncomfortable, let your nurse know so she can help you get beyond that or have you stand out in a scary situation. Be safe. Watch your back and staffs back as well. Know how to call a code for help.

Oh, and wash your hands often. You don't even want to know what some pts do with their hands and other things.

Respect is a huge one for me. I've found that many times the respect I've had for my most difficult patients is remembered by them and they in turn have blessed me with the same. We all want to be respected. Good luck and have fun. It was my best rotation because it was never the same day twice! Always something going on. Read the charts and really get a feel for the different psych dx and bxs.

Guest 360983 · Oct 17, 2011

I work psych and I would advise you to listen to the nurse you'll be working with. Many of my pts would hyperfocus on you and not in a good way.

Forgot to add in my post--ask the nurse who would be good to talk with. That way you're directed towards the manic guy who wants to talk all day instead of the person who won't talk to anyone.

If you're a woman, keep your hair up. Not just in a ponytail, but attached to your head (like a bun, or clipped up). You never know what will happen and you don't want someone grabbing your hair.

IdrilRN, BSN, RN · Oct 17, 2011

I love psych! I learned that every bit of conversation doesn't have to be therapeutic after all you have to develop a rapport before they will trust you. You can offer a cup of coffee or offer to get them something to drink. If they have drawings in their room ask about it. Most of these folks can see right through you. Be sincere.

When I meet someone new at work, I start with simple small talk. Unless there is another immediate need. If you are real nervous try for someone who is about to be discharged. Remember that they are people too and having a rough time. They are not schizophrenic, bi polar, or depressed, they are people with schizophrenia, bi polar and depression.

That is all advice I just gave you. Sooooooooooooo

You sound nervous about going on a psych unit and talking with people who have a mental illness.

seizetheday · 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 :)

i've worked psych for 12 years and i would say that very few are just going through a rough patch. people go through rough patches all the time without being admitted to a hospital. most people who are admitted to a psych unit are there because they have a mental illness, they are sick and unwell, not just going through a rough patch. pretty everyone in hospital for any reason is going through a rough patch if they are sick enough to be admitted - but most have an underlying illness or injury causing the rough patch and psych is no different.

op - treat everyone you meet with respect and with understanding. listen. set clear boundaries. be assertive. look at prochaska and diclemente’s stages of change modeland target your interventions to where the person is at. help patients with realistic goal setting and with illness management. some may need medication or diagnosis education, or help finding resources and community services. try and keep your conversations focused on the here and now and on dealing with their current situation. be aware of patient cues increasing restlessness, agitation, abrupt answers, pacing and follow a patient's lead. if they ask for space, give them space. try to avoid question and answer interactions, instead have a conversation that incorporates your mental status assessment. find out about past successes, personal strengths and interests and how those can be utilized in the treatment plan. read up on neurocognition to get a good idea of what the brain is doing behind the behavior you see.

i hope you have a great placement.

Bortaz, MSN, RN · Oct 17, 2011

OMG student nurse in General forum! CALL DA IRON PANTY BRIGADE.

My advice to OP: Remember, PSYCH does not equal ignorant or stupid. Don't try to treat them that way.

emmanewgrad · Oct 17, 2011

Treat them as patients with a need for medical attention and remember you r there to learn and be part of this therapy. I look at peoples eyes when I talk, pts in these type of medical situations ( etoh, drug addiction, mental health) look at the floor while I talk. I have mentioned this to them when I feel comfortable and safe. I tell ten to look at me, that I'm there to help and not to judge them. I've had several thank u's and hugs. All for the sake of being a pt advocate.

AJPV · Oct 17, 2011

"Iron panty brigade" - love it! Wait, are we sure the OP isn't asking a HOMEWORK question??!!!!! :lol2:

My advice: avoid these phrases -

"Are you serious???"

"Wow, that's jacked up!!"

"Nooo waaaay!"

If you do that, you'll be fine!

CapeCodMermaid, RN · Oct 18, 2011

I did my psych rotation at a state mental hospital when there was such a thing...check out the movie The Snake Pit. It was scary. The main psychiatrist barely spoke English, there were no supplies, the patients were mostly naked and drugged to the max. I had a very therapeutic conversation with someone and then found out they worked there!! One woman walked around with a styrofoam cup with a bit of coffee and tobacco in it. She thought it contained "viable Negro babies" she could plant in the garden. It was the longest 3 months of my life.

Thank goodness the state of psychiatric medicine has vastly improved.

allnurses Guide · Oct 18, 2011

If you find yourself a manic and hyper-verbal patient, all you have to do is sit back and enjoy the ride.

The therapy kicks in when you just listen.