how to make a stay in a psych hospital better for a very intelligent patient

Specialties Psychiatric

Published

If you have a highly intelligent patient (18 y/o with a bachelor's degree already), who seems to be growing increasingly agitated from the lack of stimulus in a psych ward, what would you suggest?

There's not much besides TV for them to do, and no family in the same city to bring anything in for them.

Thunderwolf, MSN, RN

3 Articles; 6,621 Posts

Specializes in Med-Surg, Geriatric, Behavioral Health.

Personally challenge him/her.

This can often entail having him/her initiate a personal journal to self explore or placing positive expectations for growth on him/her.

"What is one thing that tipped the apple cart for you that brought you to this point in your life? What is one thing that you can do today/tomorrow that will put your cart back in order?"

Have the patient come up with his/her own answers...not you...while providing the challenge in a positive manner.

Instead of seeing intelligence as a handicap, view it as a strength. Therefore, use it.

Also, it helps to be mindful that while a young adult may be very mature in one dimension (cognitive), there may be other dimensions less mature (emotional, relational, et cetera). These other areas may be helpful to explore or to consider.

zuzi

502 Posts

Specializes in trauma, ortho, burns, plastic surgery.

Before decide anything else... what Dx patient has... don't choose any activities related or closed activities with his Dx.

If is high intelligent teen ager then, Thunderwolf, I don't think so that a stimulation of the less mature dimensions of his personality is a good response.... he will "think" because cognitive part is high level, that you will perceive him like dumb or young or imature and then he will cut all possibles communication with environment.

All others totally agree with!

llg, PhD, RN

13,469 Posts

Specializes in Nursing Professional Development.

Of course ... be sure that any planned activities don't hurt him or his progress in dealing with his diagnosis.

Very intelligent people often need something to sink their teeth into, so to speak. What reading resources are available? Can he get access to books or magazines that could provide some interesting things for him to read? Is there some project he can work on ... some problem he could solve ... one that is NOT related to his illness and could serve purely as recreation and relaxation? Is there a skill he can learn (e.g. artistic, game, etc.)? Is there adequate opportunity for physical activity? At his age, that might be a good diversion that he could enjoy.

From what you say, it sounds like he needs some activities that can serve as recreation/relaxation. What resources can you access? I assume he is not allowed internet access ... but can he have a computer or a kindle? A computer or kindle could serve as a platform for electronic books, games, work projects, etc. that could be controlled by the staff.

Jules A, MSN

8,863 Posts

Specializes in Family Nurse Practitioner.

I'd agree with reading materials maybe some educational and some just for fun. His diagnosis might make a difference and from my experience one of the negatives with our bright pts is that they might try and engage you in an argument of intellectualization. If so I usually confront it for what it is and if there are truly legitimate questions will go forward. If it is just them circling around in an argumentive attempt to pass along grandious comments of how smart they are, deny their illness or debate medication I usually wrap it up pretty quickly. Good luck.

Swandive

10 Posts

This is the same patient I posted about in the other thread, the one called "pathologizing behaviours I think are normal".

She definitely can't have a computer or kindle, and doesn't have anyone to bring stuff in for her- she doesn't know anyone in the city and her family is in another part of the country.

It would definitely be overstepping boundaries if I brought her in a book from home, right? What about a book of Sudoku or something like that? I'm pretty sure this oversteps a boundary, and I don't really think I should do it, although the idea has occurred to me. The hospital library only has medical journals/textbooks, which seem like a bad idea.

We have some art supplies, including watercolour paints and national geographic magazines. I've thought about challenging her to use her abundance of free time to teach herself to paint or draw - something relaxing and productive that can be as intellectually stimulating as she wants to make it. I like this idea, because she's a perfectionist and it's outside her comfort zone of what she's naturally talented at. I could potentially print off internet pages about painting techniques/activities from the nurses station, and that seems to violate less boundaries than bringing in a book.

She keeps quoting Foucault at me.

I've been thinking about making some journal prompts designed just for her, but I'm not sure what direction to take them in.

BTW, physical activity is one 1/2 hour of swimming every two weeks. I wish medical administrators thought of psych pts. holistically, as they do with med surg patients. I'm working at a "top" psych specific institution, and for most patients they don't have social workers, psychologists, or opportunities for exercise. Sometimes I leave feeling absolutely horrified. This is one of the reasons I'm thinking of switching into a BSN program from a bachelor of psychiatric nursing program.

Swandive

10 Posts

(I hope this post didn't come off as whiny or negative - I'm feeling really down about my clinical lately)

Thunderwolf, MSN, RN

3 Articles; 6,621 Posts

Specializes in Med-Surg, Geriatric, Behavioral Health.

Naw, you are doing fine.

You are learning...a process...asking questions, improving your knowledge base.

Let's kick back together and wait for additional member feedback.

Hugs

Swandive

10 Posts

Hey Thunderwolf,

Thanks for your support!

I've been reading back through the archives, and I really appreciate your insight on quite a few issues.

Jules A, MSN

8,863 Posts

Specializes in Family Nurse Practitioner.

Why don't you ask? We can bring in books or magazines for our patients but I would guess it varies based on the facility.

Despite being in a different city the fact that no one has visited her or sent a care package would be something else I'd consider. Not that many of our patients don't have a supportive family, just that something doesn't sound congruent if this patient is as "together" as you have presented. Does she have an axis II diagnosis? Good luck.

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