nervous about psych clinicals

Nursey103, ADN, RN · May 26, 2009

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!!

elkpark · May 26, 2009

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 · May 26, 2009

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 · May 27, 2009

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.

madnurse2b · May 27, 2009

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 · May 27, 2009

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

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

thanks for the encouragement and words of wisdom.

elkpark · May 27, 2009

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!

BabyLady, BSN, RN · May 27, 2009

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 · May 27, 2009

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.

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 :)

Snwbdr · May 27, 2009

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 · May 27, 2009

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!