Psych clinical fear

Biol20fan · May 14, 2009

Know who is around you at all times, don't go into a patient's room alone, and always make sure you have an exit. Also, the patients are still humans, so treat them as such (not saying you wouldn't :imbar), no matter what their dx is. I had some of my best clinical moments in Psych. I truly miss that experience, because it stretched my ability for compassion, awareness, and understanding like no other clinical has. Plus, it's a blast when you are playing Scrabble with the patients. :yeah:

Bottom line: be aware, but be present. Go into it with an open mind and open heart, but not so open that you could be taken advantage of (if that makes any sense).

Sorry, I'd explain more, but my brain is fried right now (do we have "brain frying" or "brain melting" smilies?).

lamazeteacher · May 14, 2009

If you're on a unit with psychotic patients, you'll notice a look in their eyes that is unlike other peoples' expressions. For me, that was the most marked symptom, especially in schitzophrenics. You'll know it when you see it.

Be appropriate with them, as you role model mental health. Smile when it's right to smile genuinely, don't look like the "Cheshire cat" in "Alice in Wonderland". Curb frustration and anger - there's too much of that everywhere and psych patients' coping skills aren't great. You'll get to know what they want and need. In other words, treat them like anyone else.

Family dynamics can be loaded. Hopefully before you meet patients' families, you'll have heard what the deal with them is, and how to communicate effectively. Look for cues that patients have had enough, and then visiting hours are over.

pinkiepie_RN · May 14, 2009

Having had some psych clinical experience before I started my psych nursing clinicals, I have one big thing to say: it depends on where you are. I work in acute psych inpatient, where the avg length of stay is 3-5 days. I had my psych clinicals in a state hospital where patients stayed for years. They didn't strike me as "more" sick than the acute patients, but the thought process behind interventions was different, if that makes sense. Groups in the state institution were more about ADLs (patients were lower functioning) and groups in the acute psych inpatient facility often were more focused on coping skills, stress management as the patients were higher functioning for the most part and had just hit a rough spot. Patients in the state hospital were also sometimes court mandated and had been found "not criminally responsible" by reason of mental illness. Just a heads up!

I agree with what everyone else has said so far. Psych patients are certainly still people and they go through the same things you and I do. You may work or have class with people who have an Axis I diagnosis and never even know it if they're on medication or in therapy. You'll encounter psych patients on the med-surg floor too, because they get sick just like everybody else. The most important thing to take home is that in psych nursing, there aren't as many fancy interventions like IVs, NG tubes, etc, but you will find them (particularly dressing changes). In psychiatric nursing, the most important form of intervention is you. You are a therapeutic device and talking is one of your best tools.

Good luck!

goodstudentnowRN · May 14, 2009

I will be doing psych too in three weeks. Great advice!

cursedandblessed · May 14, 2009

i'm looking forward to psych. people have all sorts of mental problems and just because they're in the mental health hospital or ward does not necessarily mean they are dangerous. look at each patient holistically, and individually and go from there.

most importantly, never make assumptions about people.

lamazeteacher · May 14, 2009

When I was at my 3 month psych rotation at a government hospital in 1958, we nursing students and R.N.s weren't allowed to intervene (talk) with patients. It was "Pass the meds, see that their mouth is empty after taking an oral one, and that they swallowed it, and shut up". The doctors had hundreds of patients each, very crude medications to use, and patients all seemed to do the "thorazine shuffle".

Some student nurses rotating through, years before, had taught a "simple" Schitzophrenic patient to sing "Home On the Range", and make beds. It was thought to be a great break through! I gave him a pencil (no pens allowed) and paper, and he wrote the most amazing poetry! However, "functional", he was not!

I noticed on my off duty time, that many people I saw on the bus had the same vacant look patients had, and commented to a professor about that. His response was, "Ah, but they're coping outside, our patients are here inside, for all their lives". 51 years later, I'm realizing that we all, on the outside of mental hospital walls, are merely coping (hopefully the best we can) with what life hands us. That is getting so heavy these days that I'm thinking "barely coping" is more like it.

Those people who brandish firearms and kill others in public places illustrate the extreme need in society for psychiatric treatment; and especially follow-up. I have in mind the VA Tech killer who had been diagnosed at age 8, with a mental "disturbance". I can only guess at how spotty, if any psychiatric treatment, or love and acceptance he's had.

People with mental disease learn at early ages that it simply is not an accepted condition, and hide it. My wish for you who are anticipating your psych clinical experience, is that you'll learn to accept that mental illness is as common, treatable, and scary as physical illness. Please accept your patients' limitations as "normal" for them, and tweek them with your observations and caring attitude whenever you can.

Now things are much better nursing and med-wise. The challenge is still there, as is the need for more emphasis (and $$$) on appropriate care, and many health care professionals shy away and joke about people's mental health needs. Please notify your government representatives about any severe issues of neglect, mistreatment or need patients have, at facilities where you work. Let your voices be heard.

It is heartening to know that President Obama's opinion is that mental and physical health need to have equal treatment allocated. From his mouth to God's ear........

nurz2be · May 14, 2009

i'm looking forward to psych. people have all sorts of mental problems and just because they're in the mental health hospital or ward does not necessarily mean they are dangerous. look at each patient holistically, and individually and go from there.
most importantly, never make assumptions about people.

you are right in that not everyone is dangerous, but in the psych clinicals one should always assume the danger is there because if you don't and your turn your back on a patient it could be that patient's time to snap. we saw it several times in our clinicals with patients and staff.

my advice is to work with another student, watch out for one another. do your interviews with another student, the other student can be present but not be a part of the conversation. when you are in "groups" be very cautious of looking around at patients when you are talking to your group and laughing, there are patients there with very sensitive issues thinking they are "being watch and mocked." do not take these conditions lightly. they aren't necessarily to be feared but they are to be cautioned.

i had my psych rotations and i work as a nurse tech where i also have to sit with baker act patients and have had instances where the smallest things set them off, like a commercial on tv, and it can get out of your control in a very quick instance. i love these patients.....but i would not and do not turn my back on a one of them. those cute little old ladies can have the strength of an oxen when they get in a rage. be polite, show them respect, but keep your space, don't touch them without warning, talk in a calm and soft voice, most of all listen. even when they are going on about the man in the moon, being god, walking on fire, being followed, and in whatever they are telling you there is a story, there is a person in that story and what they are telling you is very real to them.

have fun and good luck

nikki.p · May 14, 2009

I do work with patients in a nursing home and a lot of them have mental problems. So for me it isn't that I am working with the mentally ill, but maybe the new setting. I don't know, clinicals in general freak me out! But I am a big girl and I'm sure it will be fine. Thanks for your replies! keep them coming!

cursedandblessed · May 14, 2009

thanks nurz2b: my experiences come from the outside of the hospital mostly, my husband was in one of the two sites my school uses for mental health rotations when he got sober 5 years ago. i have more background with alcoholics/substance abusers because of his involvement with aa/alanon, and their club that he is a part of. the social gatherings have given me the opportunity to watch some of the mental issues that go along with the stages of sobriety, i find it facinating (in a weird clinical sort of way, i guess because i lived through it as the spouse of one).

i'm recognizing places people are in:

those first months where they're still feeling like the world should owe them something because they got sober. and the mind games some of them play, by holding their families hostage by threatening to drink if they don't get their way.

and the second year (terrible twos as my husband calls it) when there seems to be (for many i've seen) a frustration that they've proven they can be sober, so why can't they drink?

then there is the comorbidities that seem to go along with the alcoholism, other mental illness (i was reading today that 33% of alcoholics have some other mental problems, and that 33% of those with mental problems have substance abuse problems (reviews and rationales-not sure which year)). **yes i've started reading for fall semester, lol. **

pinkiepie_RN · May 14, 2009

If you're unsure of policies/procedures in your clinical facility, ask! Always use your clinical instructor as a resource. One of the cool things I found with psych clinical was that my instructor was very available during the clinical time because she didn't have to help with meds or treatments, etc. Just keep an open mind and I'm sure you'll be fine. I had a friend who went into psych with a negative concept of it in her head and it showed to her clinical instructor; she almost failed the clinical because she wasn't at all interested in being involved with her patient and their interpersonal recordings. :)