Psych. Clinicals help

CinLPN2RN · Jul 12, 2005

Hi there,
I am now into my psych. nursing quarter and we have started clinicals. How should I deal with a client that is being extremely inappropriate? Thanks for your help

Ah, Psych clinicals. I had them last term and am so glad I'm on summer break. I remember how nervous I was!!! I lived through it and even aced the final.

As for your question, I recommend setting limits right away regarding inappropriate behavior.

ie: patient is dancing in the hallway and grabbing her crotch singing vulgar language to people passing by. I walk by and she made comments about my booty (and lack thereof). My response? "That behavior is inappropriate." Her immediate response, "I'm sorry, you're right." (No kidding, really happened.)

Do not be afraid to say this to patients, they hear it all the time and know it to be true. KISS it. (Keep It Short and Sweet OR Keep It Simple Stupid).

Another phrase that works when a patient asks you permission to do something you are unsure if they are allowed, "Ask your (insert appropriate title)" Caseworker was the term we used.

Have fun, Psych can be what you make it. If you go into it with a open mind, you might enjoy it!

Cindy

amberc · Jul 12, 2005

Thanks Cindy, I don't think Psych will be my favorite, but I will get through!!!

Amber

Ah, Psych clinicals. I had them last term and am so glad I'm on summer break. I remember how nervous I was!!! I lived through it and even aced the final.
As for your question, I recommend setting limits right away regarding inappropriate behavior.
ie: patient is dancing in the hallway and grabbing her crotch singing vulgar language to people passing by. I walk by and she made comments about my booty (and lack thereof). My response? "That behavior is inappropriate." Her immediate response, "I'm sorry, you're right." (No kidding, really happened.)
Do not be afraid to say this to patients, they hear it all the time and know it to be true. KISS it. (Keep It Short and Sweet OR Keep It Simple Stupid).
Another phrase that works when a patient asks you permission to do something you are unsure if they are allowed, "Ask your (insert appropriate title)" Caseworker was the term we used.
Have fun, Psych can be what you make it. If you go into it with a open mind, you might enjoy it!
Cindy

CinLPN2RN · Jul 12, 2005

Thanks Cindy, I don't think Psych will be my favorite, but I will get through!!!
Amber

So how have your clinicals gone so far?

Cindy

Jami RN, BSN, RN · Jul 12, 2005

Can you be more specific about what inappropriate behavior your patient is exhibiting?

If the patient is just generally being inappropriate, be direct and honest. Tell them, "That behavior is inappropriate," and then re-direct them by saying something like, "If you need to do that, you need to go to your room and do it privately. That is not allowed in the day room."

If the patient is making inappropriate remarks directed to you, such as sexual advances or personal remarks about you, again tell them, "That is inappropriate." You can add, "I am a professional and do not appreciate remarks like that, or "I do not have personal relationships with my patients."

If you feel threatened in any way, or if your verbal interventions don't work, you should let the unit staff handle the situation. I'd let the unit staff know anyway, just because they should be aware of how this patient interacts with others. The behavior might be an ongoing issue that the staff is trying to work on with the patient, and they may need to intervene with consequences or verbal counseling.

Most psych patients know they can push the limits with new employees or students. I used to work adolescent psych for violent offenders and while most of the kids were pretty manageable on a daily basis, they would really put on a show when we had students on the unit. Psych clinicals can be very intimidating, and you should always be on your toes and aware of what's going on while you're on the unit, but try not to be so intimidated that you have a miserable clinical.

amberc · Jul 13, 2005

My clinicals are ok, I am assigned one client for the entire quarter to follow. We have to use therapeutic communication and participate in group, etc. My client chose me as a student, it was almost like they were picking "girlfriends". Anyway as far as inappropriate my client proceeded to ask me if I had children and if I breast-fed, along with a few other comments. I just said that his comments were inappropriate and changed the subject. This is going to be a long quarter. :rolleyes:

So how have your clinicals gone so far?
Cindy

toadie · Jul 13, 2005

i graduated in may and just past my boards last week. i remember my psych clinicals well. :rolleyes: the best advise i can give is to be assertive and self assured with these pt. sometimes they can be manipulative and testing. no matter what don't let them knock your confidence:) :)

CinLPN2RN · Jul 13, 2005

It is hard to set limits, but it is really good practice and it can get easier over a few interactions. Good job telling the ct about inappropriate comments. He'll test the limits again, I'm sure.

It's really strange how they set the clinical up. Did all the cts "choose" their student? How very different.

The clinical may go faster than you think. The best part of psych for me was the care plans were easier. Pathophysiology was easier too. Yay neurons!!!

Good luck, and feel free to PM me if you want some info.

Cindy