Psych Clinical Worries

CDeniseGo · Jan 18, 2010

Basically, we just talked to the clients that wanted to talk to us, as well as observe their day and eventually put on a group presentation for them. They are very nice and as long as you look at them as people like you do your medical clients (meaning: not a diagnosis or illness), then you will be just fine. Personally, it was my most enjoyable rotation so far, and it has me wanting to become a psych nurse when I am ready to retire.

kcochrane · Jan 18, 2010

We usually had one patient. We passed meds and basically buddied up with them all day. Encouraged them to go to groups, shower, etc. I really enjoyed it. Every after two weeks, I could see some patients really improve. I also would like to eventually go into psych after getting some acute experience.

Nothing like what is portrayed in the movies.

I remember before I went my Uncle had to tell me the story of the student nurse that was killed escorting a psych patient down the stairs to an appointment. Mind you this was over 30 years ago before they had a safeguards in place. Sheesh!

izzycatswimRN · Jan 18, 2010

My instructor met with my group briefly after class on Friday. Apart from intimidating the heck out of us all (we fail clinical if we turn in an assignment late...not that that will be an issue for me) she didn't really tell us much. I'm hoping for more information on Tuesday during our orientation period. Each clinical day we're going to a different unit. Has anyone had experience with an ECT unit? I'm really very unsure how I feel about that particular type of treatment and am not looking forward to that day next week.

kcochrane · Jan 18, 2010

ECT is a lot different than it used to be. For some it is the last resort and does work. So don't worry about it. You should also be told about safety measures like not letting the pt. get between you and the door. But I never felt fear when I was at my psych rotation for 8 weeks.

pinkiepie_RN · Jan 18, 2010

My instructor met with my group briefly after class on Friday. Apart from intimidating the heck out of us all (we fail clinical if we turn in an assignment late...not that that will be an issue for me) she didn't really tell us much. I'm hoping for more information on Tuesday during our orientation period. Each clinical day we're going to a different unit. Has anyone had experience with an ECT unit? I'm really very unsure how I feel about that particular type of treatment and am not looking forward to that day next week.

ECT is run sort of like a clinic. Patients sign in, are put under sedation, the procedure is administered, patient recovers in "post op", and then returns to the outside or their respective unit. It can be administered while a patient is inpatient or outpatient and it's come a long way since it was first introduced.

Here are some links I picked up for a patient that their clinical instructor really liked. It can be a last resort and there are some long term side effects (memory loss being the key one) but it's often considered life saving for some people.

http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129

http://www.medhelp.org/lib/ect.htm

missy--kay · Jan 18, 2010

I was very nervous about psych rotation last semester, but I really enjoyed it! We didn't have one specific patient, but an area. The inpatient clinic I was at had 5 different areas: adult inpatient, adolescent inpatient, adult acute, adolescent residential and outpatient.

We did alot of interviews, care plans, charting, we sat in on all the therapy sessions (except one on one with family), doctors' meeting... etc.

I learned so much during that month, and would not be opposed to working in that area.

Good luck!!

rn/writer, RN · Jan 18, 2010

I worked psych for many years. Here are a few tips:

Don't turn your back on a patient. At first this feels awkward, but it soon becomes automatic.

Keep in mind that psych patients are people. People who have problems, to be sure, but they are not the problems themselves. Nor are they their diagnoses.

Try not to fall for manipulative tactics. "You're the only one who has taken the time to listen to me." Not likely, what with individual counseling sessions, group therapy, and possible 1:1 conversations. "I think my therapist dislikes me." Probably projection. Or perhaps the patient has been disruptive or uncooperative and the therapist has tried to set some limits. "Could you see if I can go for a walk later?" The patient should be scoping our their own privileges. A likely scenario for this one is that they know they aren't on the correct level to take a walk off the unit, and they want you to try to work it out for them.

Psych can be a fascinating place to work.

I wish you all well.

diane227, LPN, RN · Jan 18, 2010

I agree with the above and DON'T give anyone any personal information like your phone number of email address. You will see a lot of different personalities in psychiatry. Manipulation is a big problem for certain patients with personality disorders and it takes a while and some experience to learn how to deal with them. One thing you might want to read up on is how to tell when a patients behavior is escalating and how to defuse the situation. Don't go into a room alone with anyone. Stay out in the open area with your patient. You will find that your patients are people like everyone else, some who have suffered inhumane abuse in their lives. They are trying to cope like everyone else. And remember the first rule of psych. Don't give advice, get the patient to talk. Remember to phrase your questions in a non accusatory tone. It will be very interesting and you will do fine. Know your psych meds however. They are complicated and have some bad side effects sometimes. A lot of patients are on psych meds and you will see them in all areas of nursing where you work so you need to be aware of these meds.

NSALVADORE · Jan 18, 2010

My experience was interesting to say the least! I was assigned one patient who Id have to do my paper on and I spend a good amount of time observing and talking to. We'd also mingle and talk to many of the other clients! If there is anyone dangerous or worriesome they will warn you, we got a group report in the morning so we heard what was going on with all the patients! We ran groups everyday, sometimes more than one. It could be anything from meds, coping skills, relaxation, goal planning to like a game group!

ECT Like someone else explained is run much like a clinic, they're all brought down prepped and one will come in, be anesthetized, given treatment, sent to be monitored and on to the next! From talking to the clients, many of them have GREAT results from it, very minimal side effects (tired that day and only one I met had short term memory loss) and they all felt it was worth it! It was a great experience to be able to go down and observe the procedure!