Pediatric/Psychiatry Rotation Tips!

kk2021 · Mar 16, 2012

I don't have too many tips, but I can tell you how my mental rotation went! It was an acute inpatient unit, and there was a pretty high turnover rate. First thing in the morning, would get report. Then on the floor we would get all the vitals, bring the patients into the dining area, and assist those who needed help eating. We would do our mental status assessments at some point (whenever we got the chance). Then sometimes we would sit in with the doctors and residents as they discussed each case and brought in each patient to discuss how everything was going/any treatment changes. Other days we would stay on the unit and have really casual, conversational sessions on things like nutrition or relaxation techniques. Other times we would listen to guided imagery tapes. After lunch we would usually play a game, like pictionary, bingo, fill in the blank (like hang-man, but we didn't call it that or use the hanging man for obvious reasons;)), or finger painting. This hospital didn't want us, the students, giving meds for some reason, but we would observe the nurse who did it in the mornings. It was a pretty easy going rotation and very interesting! The main tip I can give is to just be as comfortable as you can be. I was worried at first thinking that I wouldn't know what to say or do around this patient population, but just jump in and don't hold yourself back! Just remember all those therapeutic responses you learned about in lecture:specs:

I'm currently in peds, but I've only had a week so far. I have a pretty bad teacher though. But basically we get report, check the charts, do an initial assessment (VS, check IVF, daily weights, etc), and start charting. We draw up our 9 AM meds and need to be prepared to give them by 8 with our instructor. After meds, we do baths and linen changes, more vitals, and more charting. And then we report off and are done by 12:30! We are off the unit pretty early compared to what I've normally done.

I know every hospital/teacher is different, but I hope that helps a little bit in terms of what to expect!

Aerielle · Mar 16, 2012

Wow!! Mental health seems so fun from the way you are describing it! I'm sure no other rotation will have us playing board games with our patients! :) I am less nervous for that rotation now! It was actually the one I was worried about more, because I really just did not know what to expect!

I feel like having a supportive instructor really makes a difference in the learning environment. I hope you it gets better for you soon! :) Let me know how the rest of peds goes for you! I heard pediatric med calculations are quite complicated?! (I haven't seen it for myself yet - I'm pretty good at the adult dosage calculations, soooo it must not be too bad?!?!?) And when an instructor is looking over your shoulder , you can't help but get nervous a bit!

All in all...THANK YOU! :) :) I'm looking forward to it all!

Double-Helix, BSN, RN · Mar 16, 2012

Make sure you are well rested and eat breakfast before you go it. Inpatient peds psych patients keep you on your toes constantly and you will need energy. They can turn in a second from happy and calm to angry and violent. You need to be alert for triggers and signs of escalating behavior so you can intervene quickly with de-escalation techniques.

Oh, I see now that you're peds and psych clinicals are separate. Well then:

The psych rotation is mostly about learning therapeutic communication. You'll be asked to sit and talk to the patients, and possibly sit in on meetings and evaluations. It's very interesting, but can also be a little scary and unnerving. You'll find that some patients are really willing to talk and others don't want to have anything to do with you. You most likely will not be giving any medications and if any dangerous situations arise, you'll be asked to get to a safe place and just watch. It's one of the easier rotations, skill-wise, but more difficult mentally and emotionally.

As for peds, I can't say per's dosage calculations are that hard, but I do them every day. They are weight-based, so you'll need to make sure you know the patient's weight in kilograms and how to convert pounds to kilograms. You also need to know the safe ranges for mg/kg or mcg/kg or g/kg dosing. A good pediatric drug book will tell you everything you need to know.

Kids test your nursing skills in a way that adults to not. They are often too young to be able to cooperate with standard treatments, such as taking medications. You've got to be creative to find ways to get them to be compliant (hint- give the medicine to mom). I'm sure you've done incentive spirometry on adults with pneumonia. Do you think a two year old will understand how to do that? So how to you get a two year old to take a deep breath? (Hint- blow bubbles or have them try to blow a tissue into the air). Use your imagination to do things WITH the child, rather than TO them.

When you go into your patient's room, talk and play FIRST. Don't just go in and start doing medical stuff. Introduce yourself to mom and dad. Ask if they need anything, how they slept, and tell them where they can get a cup of coffee. Explain what you are going to do to their child before you do it, and why. Getting mom and dad on your side will be a huge help when you need them to get little Johnny to take his medicine later. Never forget that the parents still want to be the parents. Give them a chance to feel involved and helpful. Ask if they want to assist with the bath, or feeding, or anything you are doing. ASK them what usually works and how they do things at home to make their child more comfortable. If the parents feel like you include them and care about their child, you will have friends for your whole shift.

Likewise, introduce yourself to the child. Spend a few minutes talking or playing with them depending on their age. Let them see your stethoscope and handle it before you try to listen to them. Listen to mom or take mom's blood pressure before you do it to the child. Explain to them what you are going to do and how it will feel. For example: "I'm going to take your blood pressure now. That means this plastic thing will wrap right here around your arm. Then it's going to blow up and feel tight, but it won't hurt. You just need to lay still and it will be done very quickly. But if you move around it takes longer and we might have to do it again. It's not going to hurt. Okay?"

Kids in the hospital are understandably fearful. So explain what's going to happen to them, and tell them when something isn't painful. But please don't lie to them, or they will never trust you. Never say, "This medicine tastes really good!" if it tastes like rotten onions. Never say, "It's not going to hurt" if it IS going to hurt. Tell them, "You're going to feel a sting when I give you this shot, like you're getting bit by a bug. But it only takes a minute and then it will go away and I'm going to give you a sticker, okay?"

Make sure you talk to the child life staff while you are at clinical. Ask them about their job and how they help with the kids. Child life is amazing and their job is NOT just to bring toys to the kids. They are great at distracting kids during procedures and teaching them about medical procedures in ways they can understand. Medical teaching is actually the main job of a child life staff. If you need to do anything scary or painful to your patient, such as a shot, IV, changing a dressing, etc. always try to bring a child life specialist with you.

Finally, just like in any clinical, be willing to learn and look for opportunities to help and participate. Remember that the nurses care about these kids too, and they need to feel like you care and are competent in order to trust you. So ask if they need any help or if you can do anything for them. If they say no, ask if you can just observe. They might not feel comfortable having a student do procedures on their patients.

Oh- and don't throw away diapers! On most units you need to weigh the diapers to find out how much the patient is voiding to assess their hydration.

leslie :-D · Mar 16, 2012

i'll tell you right now, i was horrible in my psych rotation.

it too, was a locked, acute unit and we had to pick a pt to follow for 6 wks.

i picked a hard-core, paranoid schizophrenic pt, and had to receive special permission to follow him.

it was awkward at first, since all he did was stare at me, completely non verbal.

finally....he tells me, "you're one of the good guys" and i reassured him i was.

well - wouldn't you know, my darned instructor had been (goodness knows where) listening and comes up to us in a flash.

she pulls me aside and corrects me by stating "you need to tell him you're name is leslie, and that you're a sn from __________.

all i could think of is my pt getting more paranoid as he watched us 'conspire' together.

another time, this late-stage aids pt (had encephalopathy) crying because *they* were trying to take his baby (a doll) away.

i assured this pt i would keep baby safe as i gently took it from him.

well - wouldn't you know- out of the woodwork is my darned instructor again...

pulling me aside (again) and demanding me to tell this pt that i am leslie, sn...and that you don't have any darned baby, but merely a doll...and no one wants your baby.

(right - let's try and orient to reality with some that is dying with acute brain trauma).

inevitably, i got kicked out of locked unit because of "enabling" all these folks.

i will never, ever understand psych - it didn't make sense...this "reality orientation"...

not for advanced mental illness anyways.

it seemed to agitate them more.

i'm all about wanting them to feel safe and comfortable.

in peds, i was in a chronic care unit hospital, where most kids wards of state with debilitating illnesses.

i had a 2yo who i became very attached to, so much so...i was given another pt.

i guess what i'm saying, is you will see where you may have challenges -

i can't do peds because i DO get attached...

and can't do psych because i DO enable.

you guys will find out what comes more natural to you than others.

i learned much through my mistakes.

leslie

hershdawg · Jan 21, 2013

i'll tell you right now, i was horrible in my psych rotation.
it too, was a locked, acute unit and we had to pick a pt to follow for 6 wks.
i picked a hard-core, paranoid schizophrenic pt, and had to receive special permission to follow him.
it was awkward at first, since all he did was stare at me, completely non verbal.
finally....he tells me, "you're one of the good guys" and i reassured him i was.
well - wouldn't you know, my darned instructor had been (goodness knows where) listening and comes up to us in a flash.
she pulls me aside and corrects me by stating "you need to tell him you're name is leslie, and that you're a sn from __________.
all i could think of is my pt getting more paranoid as he watched us 'conspire' together.
another time, this late-stage aids pt (had encephalopathy) crying because *they* were trying to take his baby (a doll) away.
i assured this pt i would keep baby safe as i gently took it from him.
well - wouldn't you know- out of the woodwork is my darned instructor again...
pulling me aside (again) and demanding me to tell this pt that i am leslie, sn...and that you don't have any darned baby, but merely a doll...and no one wants your baby.
(right - let's try and orient to reality with some that is dying with acute brain trauma).
inevitably, i got kicked out of locked unit because of "enabling" all these folks.
i will never, ever understand psych - it didn't make sense...this "reality orientation"...
not for advanced mental illness anyways.
it seemed to agitate them more.
i'm all about wanting them to feel safe and comfortable.
in peds, i was in a chronic care unit hospital, where most kids wards of state with debilitating illnesses.
i had a 2yo who i became very attached to, so much so...i was given another pt.
i guess what i'm saying, is you will see where you may have challenges -
i can't do peds because i DO get attached...
and can't do psych because i DO enable.
you guys will find out what comes more natural to you than others.
i learned much through my mistakes.
leslie

Wait, so your instructor told you to tell the patient that "baby" was not real and just some fake thing in his head? That seems very wrong in my book.

bubblejet50 · Jan 21, 2013

In my school we were taught to bring the patient back to reality, for example tell the pt that baby was not real, but now working with a population that is more psych than medical you never tell a patient a hallucination or idea is not reality. You can talk bout it when there is no hallucination occuring if needed.

Aerielle · Jan 21, 2013

I finished both rotations last November...loved both! :)

I grew so much personally as well as professionally throughout the mental health rotation, it was so amazing!

I am for sure thinking about specializing in pediatrics somewhere down the road! :)

In regards to hallucinations - I also learned that we are to reorient our patients to reality. At the same time we also have to do it in a sensitive manner, where we also validate the patients feelings.

allnurses Guide · Jan 21, 2013

There is no black and white in terms of how one reponds to a pt w/ hallucinations or delusions.

It is very individual and dependent on many variables.

Bottom line: it often relies on the nurse's intuition, judgement and ingenuity in that time in place and the focus is on safety first, then comfort.

Some folks can't do that and I suspect Leslie's instructor was one who couldn't.

It's too bad it turned Leslie off from psych, because it seemed she was doing just fine... it was her instructor that didn't get it.

LadyFree28, BSN, LPN, RN · Jan 21, 2013

Make sure you are well rested and eat breakfast before you go it. Inpatient peds psych patients keep you on your toes constantly and you will need energy. They can turn in a second from happy and calm to angry and violent. You need to be alert for triggers and signs of escalating behavior so you can intervene quickly with de-escalation techniques.
Oh, I see now that you're peds and psych clinicals are separate. Well then:
The psych rotation is mostly about learning therapeutic communication. You'll be asked to sit and talk to the patients, and possibly sit in on meetings and evaluations. It's very interesting, but can also be a little scary and unnerving. You'll find that some patients are really willing to talk and others don't want to have anything to do with you. You most likely will not be giving any medications and if any dangerous situations arise, you'll be asked to get to a safe place and just watch. It's one of the easier rotations, skill-wise, but more difficult mentally and emotionally.
As for peds, I can't say per's dosage calculations are that hard, but I do them every day. They are weight-based, so you'll need to make sure you know the patient's weight in kilograms and how to convert pounds to kilograms. You also need to know the safe ranges for mg/kg or mcg/kg or g/kg dosing. A good pediatric drug book will tell you everything you need to know.
Kids test your nursing skills in a way that adults to not. They are often too young to be able to cooperate with standard treatments, such as taking medications. You've got to be creative to find ways to get them to be compliant (hint- give the medicine to mom). I'm sure you've done incentive spirometry on adults with pneumonia. Do you think a two year old will understand how to do that? So how to you get a two year old to take a deep breath? (Hint- blow bubbles or have them try to blow a tissue into the air). Use your imagination to do things WITH the child, rather than TO them.
When you go into your patient's room, talk and play FIRST. Don't just go in and start doing medical stuff. Introduce yourself to mom and dad. Ask if they need anything, how they slept, and tell them where they can get a cup of coffee. Explain what you are going to do to their child before you do it, and why. Getting mom and dad on your side will be a huge help when you need them to get little Johnny to take his medicine later. Never forget that the parents still want to be the parents. Give them a chance to feel involved and helpful. Ask if they want to assist with the bath, or feeding, or anything you are doing. ASK them what usually works and how they do things at home to make their child more comfortable. If the parents feel like you include them and care about their child, you will have friends for your whole shift.
Likewise, introduce yourself to the child. Spend a few minutes talking or playing with them depending on their age. Let them see your stethoscope and handle it before you try to listen to them. Listen to mom or take mom's blood pressure before you do it to the child. Explain to them what you are going to do and how it will feel. For example: "I'm going to take your blood pressure now. That means this plastic thing will wrap right here around your arm. Then it's going to blow up and feel tight, but it won't hurt. You just need to lay still and it will be done very quickly. But if you move around it takes longer and we might have to do it again. It's not going to hurt. Okay?"
Kids in the hospital are understandably fearful. So explain what's going to happen to them, and tell them when something isn't painful. But please don't lie to them, or they will never trust you. Never say, "This medicine tastes really good!" if it tastes like rotten onions. Never say, "It's not going to hurt" if it IS going to hurt. Tell them, "You're going to feel a sting when I give you this shot, like you're getting bit by a bug. But it only takes a minute and then it will go away and I'm going to give you a sticker, okay?"
Make sure you talk to the child life staff while you are at clinical. Ask them about their job and how they help with the kids. Child life is amazing and their job is NOT just to bring toys to the kids. They are great at distracting kids during procedures and teaching them about medical procedures in ways they can understand. Medical teaching is actually the main job of a child life staff. If you need to do anything scary or painful to your patient, such as a shot, IV, changing a dressing, etc. always try to bring a child life specialist with you.
Finally, just like in any clinical, be willing to learn and look for opportunities to help and participate. Remember that the nurses care about these kids too, and they need to feel like you care and are competent in order to trust you. So ask if they need any help or if you can do anything for them. If they say no, ask if you can just observe. They might not feel comfortable having a student do procedures on their patients.
Oh- and don't throw away diapers! On most units you need to weigh the diapers to find out how much the patient is voiding to assess their hydration.

Ashley pretty much sums up my experience, lol

I had my rotations split...Peds was first with 2 12 hr shifts, same with psych...not sure if it will be the same for you, but yes, both can be intensive. I like Peds due to the difference in care...we calculated dosages before administering meds, engaged in child life, and was fortunate to rotate to the OR. Most of us had two pts, and did complete care with the instructor and was able to be with the nurse for the pediatric experience. It certainly built on my practice as a nurse!

In Mental health, we prettying supported the therapeutic milleu..we had games, art activities, played card games. Whenever there was tension or an exacerbation of their symptoms, which happened to one of my pts I was observing, I was able to discuss how she was actually feeling...that was therapeutic -meaning they really did appreciate us as students and were willing to welcome us on the ride. I was able to see how they "triage" their pts. I also rotated on a Med-Surg/Geri Psych floor, which was a great experience as well.