Jump to content

nervous about psych clinicals

Posted

Specializes in L&D/Maternity nursing.

We began our psych nursing course today and clinicals start this Thursday. I've been told time and time again by my peers and instructors alike that I do very well with clients and that I do such a great job in interacting and talking with them. However, today my professor and clinical instructor (who is another professor in the department) was said we will have to unlearn everything that we just learned in Fundamentals. That Psych nursing is different and its not taking vitals, passing meds and all the other typical "nursing" stuff, but rather a lot of talking with our clients. I totally understand that, and am very intrigued, however when I volunteered for a role play exercise with my professor, I had NO idea how to refocus the conversation back to my client (i.e. my professor who was playing the part). When she went off on a tangent about how cute my glasses where and asking where did I get them, I went blank because I knew I shouldnt respond with "thanks, I got them at such and such place" and felt for the first time that I had NO idea what to say or do.

I understand how and why a therapeutic communication is supposed to work, and understand Peplau's model and the stages of development for a therapeutic relationship, however talking/interacting with a person in this manner seems so......I dunno, awkward I guess?

A long winded post later and I guess my original question was this: Will this style of communication/working relationship between nurse and client get easier? I fear that I will go to the unit on Thursday and Friday and just totally freeze come time to talk with a client, and thats not at all what I want!

Edited by melmarie23

Soon2BNurse3, ADN, RN

Specializes in M/S, Tele, Sub (stepdown), Hospice. Has 11 years experience.

Well, I don't know if I'd agree with unlearn everything else you've been taught....this is just something that's different than that and takes more communication skills than technical skills. I was really worried when I had my mental health clinicals but it did get easier. You're never going to have the perfect words but just keep doing the best you can. If you can, shadow an RN and see how he/she communicates with the patients. Good luck...I'm sure you'll be just fine!!

Therapeutic communication techniques feel v. awkward and artificial to everyone at first, but, the more you do it, the more comfortable and natural it will become. Hang in there, and keep practicing! These are skills you will use everywhere you go in nursing, throughout your career.

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

I think we are shadowing one of the staff RNs our first day or two, so that will be helpful. Thanks Soon2BNurse3. I do now that per our programs rules, we are not allowed to pass meds, or even be in any sort of physical contact with the clients on the unit, so that rules out much of what we were doing in our Fundamentals course (we were on a med-surg floor for that rotation, but our actually med-surg course is yet to come). If in a clients room, we have to be as close to the doorway as possible, among a whole laundry list of other rules.

elkpark, I know that therapeutic communication is useful in other areas of nursing and do see its benefit. Seeing it on paper/in text is one thing though...and actually doing it is another! Its a completely different way of communicating and it was just so hard to try and get my thoughts out into the right words when I was role playing today. But as they say, practice makes perfect, so hopefully it will all come together here soon.

Thanks you two. :nuke:

AOx1

Specializes in ER, ICU, Education. Has 15 years experience.

melmarie23, one thing that really helped me when I was a student was to put yourself into the patient's position and also in the RN role. This helps not just with psych, but with most classes. I would do this in study groups. For example, if we were studying a patient that was experiencing hallucinations, one of us would play the role of pt, and the other the role of the RN. It really helps you understand things on a different level.

I ask my students to role play a lot. I'm sure were also rather nervous being in a role play with your instructor. You can do this, it will just take time. Althought the focus in psych is quite different, the basics are the same. Pts respond well to someone who is genuine, who expects and gives respect, and who cares about them. The communication thing will take time.

melmarie23, one thing that really helped me when I was a student was to put yourself into the patient's position and also in the RN role. This helps not just with psych, but with most classes. I would do this in study groups. For example, if we were studying a patient that was experiencing hallucinations, one of us would play the role of pt, and the other the role of the RN. It really helps you understand things on a different level.

I ask my students to role play a lot. I'm sure were also rather nervous being in a role play with your instructor. You can do this, it will just take time. Althought the focus in psych is quite different, the basics are the same. Pts respond well to someone who is genuine, who expects and gives respect, and who cares about them. The communication thing will take time.

This actually helped one of our study group a lot. The person was VERY nervous about being with psych patients, and seeing the worst case scenario in our study groups helped them feel calm. Of course I liked playing the person with hallucinations...who knew all that theatre would come in handy in NS :coollook:

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

This actually helped one of our study group a lot. The person was VERY nervous about being with psych patients, and seeing the worst case scenario in our study groups helped them feel calm. Of course I liked playing the person with hallucinations...who knew all that theatre would come in handy in NS :coollook:

funny you should mention theatre...my professor was a theatre major in her past life! :D

thanks for the encouragement and words of wisdom.

Yes, therapeutic communication techniques are v. different from the everyday interaction we're used to. I used to teach the required ther. com. course in a BSN program (required of all the health-related majors, not just nursing), and the students would show up for the first class grumbling, "Why do we have to take a class in communicating?? I've been communicating with people all my life. :yawn:" By the end of the semester (or even mid-terms), they were saying, "Wow, this stuff really works!" You don't realize it until you work on ther. com., but most of what we take for granted as "communication" in everyday life only serves to shut the other person down and close off any real communication. And most of us don't really listen to other people -- we spend the time that they're talking thinking about what we're going to say next. Ther. communication really does involve learning a whole new set of skills (beyond just what to say to someone), and that always feels awkward and difficult when you're starting out.

Psych clinical (in most programs) does focus primarily on practicing your communication skills (in terms of tasks, that is -- I don't mean to minimize the importance of learning about illnesses, medications, etc.) One of the things I found helpful as a student (back in the Dark Ages) was to picture a person I knew who was really good at this, and just blatantly do an "impression" of that person when talking with clients. Having an established "role" to play helped me get over the initial discomfort and gave me a template of sorts to follow. As I got more adept and comfortable over time, I was able to find my own, individual style.

Funny that mad mentioned theatre -- I've always insisted that there is always an element of theatre in psychiatric nursing, in that we don't respond "genuinely" to clients ("OMG, that's the grossest thing I've ever heard!" is never a helpful or therapeutic response ... :)) -- we run all of our responses through what I call a "therapeutic filter." That is, we take our honest, "genuine" response and translate it into something therapeutic, rather than just blurting out whatever we think or feel.

In my experience, most students have been apprehensive at the beginning of psych clinical, but end up enjoying it (or, at least, getting through it intact! :)) I hope you have a good experience. Best wishes!

Edited by elkpark

BabyLady, BSN, RN

Specializes in NICU, Post-partum.

I was afraid of this one the most...but in the end it was my favorite!

Very interesting...and yes, you do have to find the humor in it, even though some of the cases are sad.

It was also the easiest rotation.

truern

Specializes in Telemetry & Obs.

I remember my first day of psych clinical....I sat in my car with the door open because I was afraid I would puke in my car. Finally I started home and called hubby on my cell to tell him I just *had* to quit NS because I couldn't do psych and they would make me go back. Ended up hanging up on him (getting NO sympathy there..hehe) and called my mother who didn't think I should have to go "there" anyway. I had to pray like crazy before going back...asking God to let me see the person, not the illness, and to help me help them. Anyway, by the end of the clinical I was crying again...but this time because I loved it and didn't want it to end. :D

You'll get the hang of therapeutic communication before you know it and I guarantee whatever you learn in this rotation will serve you all thru your nursing career. Good luck :)

I just finished my psych rotation...and IMO it was a waste of my time. But each person will come from the experience with different feelings about it. My best advice is to talk naturally with the patients....if you're sitting there trying to come up with only therapeutic responses, it's not gonna come natural. Sometimes the pt will pick up on this and shut down. Nobody can be purely therapeutic ALL the time, even though it is something to strive for. Also don't feel discouraged if the patients don't want to talk. I spent a lot of my clinical days just reading over charts or playing cards with patients because they didn't want to talk. Good luck to ya

pinkiepie_RN

Specializes in General adult inpatient psychiatry.

Therapeutic communication is not so much different from everyday day-to-day communication when you think about it and if you're good in general with communication and patients, I'm sure you'll pick it up just fine. Not every patient will want to talk though, or respond in a way you'd expect a non-psych patient to respond and that's when you have to get creative. Sometimes you can be superficial if it gets the ball rolling, like asking "What do you think about the weather?" etc. I didn't love my psych clinical so much at the state hospital, but I did learn and grow both personally and professionally from my interactions with patients. I worked as a tech in a psych hospital, so I had an edge, but know that communication is central to nursing and what you learn may be helpful even if you work in a different specialty.

Good luck!

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

You all are so great. Thanks so much for sharing your experiences. I know I am just letting my nerves cast doubt upon myself. I will be fine. I just have to keep telling myself this.

We also had our second lecture today and I walked away a bit more at ease. I think once tomorrow is over and done with, I will be feeling better about this rotation.

Again, thank you.

About 20 years ago I was med level 1 certified and took care as a tech MR patients with dual diagnosis of different varieties. 8 men in a long term facility and most were explosive type disorders. This 9 month job had help me gain some idea of what Psyche clinical would or could be like. Our ADN program would not let us work with the MR patients so we either worked on the adult or adolescent unit. I had an absolute blast. MY favorite times where in "group therapy" sessions on the unit both adolescent and adults. The out patient was not as interesting for me.

I found for me the most important part of therapeutic communication at Psyche was purely LISTENING. Silence was even OK. As my Psyche instructor pounded in our heads "Silence is Golden". Just that they knew, I was there for them genuinely, not to judge them. Just to be there to be of any help I could be.

Let us know how it goes after your first week! :)

Musky

Edited by muskylounge
grammar

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

I feel sooooooooooo much better. These last couple days were great on the unit. I am now feeling a bit silly about how much I was psyching myself out about this rotation.

The psychiatrist on my team is amazing. I am in awe on how well she interacts with these patients. Just being in team and pulling some of our patients in to interview has been such an experience. I've learned so much just watching her interact with these individuals. Its been very rewarding.

I had a good couple conversations with patients today and am very much looking forward to next week's clinicals. I am excited to go to clinical which is awesome. It was silly to even worry.

pinkiepie_RN

Specializes in General adult inpatient psychiatry.

I feel sooooooooooo much better. These last couple days were great on the unit. I am now feeling a bit silly about how much I was psyching myself out about this rotation.

The psychiatrist on my team is amazing. I am in awe on how well she interacts with these patients. Just being in team and pulling some of our patients in to interview has been such an experience. I've learned so much just watching her interact with these individuals. Its been very rewarding.

I had a good couple conversations with patients today and am very much looking forward to next week's clinicals. I am excited to go to clinical which is awesome. It was silly to even worry.

Sounds like you're in for a treat! Have a great time and keep us posted on how things go throughout the rotation!

Forever Sunshine, ASN, RN

Specializes in LTC. Has 7 years experience.

I was scared out of my mind. But I heard from other students who have done the psych clinical that they actually enjoyed it.

To be honest, I thought I was going to get attacked and beaten by the patients. The patients are for the most part HEAVILY medicated. The signs you see in them(screaming, shouting, tics, etc) are usually symptoms of their medication.

One of my clinical days I was on a classic psych unit. You name it, and it was there. I don't know if it was the phase of the moon or the barometric pressure but the patients were OFF THE WALL.

But in psych there is alot of communicating with patients. I was most worried about what the hell am I going to talk about with these people. They like to talk about weather, their hobbies, your hobbies, their families at home. and food. Oh my god food is a favorite with some of them!

Just remember keep your guard up but not too up, make yourself look like someone they can trust and talk to. Alot of psych patients just want someone to sit and talk with them. The staff on the unit doesn't always have time to do that. But if the patient doesn't want to talk to you. They will let you know.. either nicely or ..not nicely lol

Remember limit setting and listen to your gut when finding a patient to talk to.

If you have some downtime, look at some of the charts and see if the patients story matches up to the truth.

Guest
This topic is now closed to further replies.