Pysch Nursing clinical

Hospice Nurse LPN, BSN, RN · Aug 14, 2011

I absolutely LOVED the psych clinical we had in LPN school! We spent 2 full weeks at the state hospital, had class in the morning and spent the p.m. w/ our assigned pt. Elk Park stated it very well---you get out of your clinicals what you put in. I still remember my pt--she was 37 @ the time and had the worst OCD I've EVER seen. She had been at the state hospital for 15 years. If I remember correctly, she had a mild case until the birth of her child. From there, her disease took off.

I worked in a short term psych hospital for about a year and eventually ended up in hospice. You WILL be doing psych nursing there. I'm now in a BSN program, but don't do my psych rotation for another year. I am looking forward to it.

Aren't you glad we have so many nursing specialities? You couldn't pay me enough money to work in L/D or peds.

jenniferclare · Aug 14, 2011

I just finished Psych, and I can only speak for my own experience, but I think it's a valuable insight to an area of nursing that otherwise doesn't get much credit. Regardless of whether it's the direction you may want to take in your own career path, it's interesting to see how things work in other specialties.

In my rotation, focus was on learning therapeutic communication techniques, identifying blockers and really learning on how to read people - many of these patients are not only in the "prison" of their own illness, but are there as inpatients because they took extreme measures to cope with their situations or illness in general. You may see some because of their experience with substance abuse, and you may see others because they were, indeed, trying to end their life.

I was actually quite surprised at how much I still had to learn about true therapeutic communication techniques, particularly when I realized that I could not rely on establishing a relationship with my patient through similar interests or commonalities, as self-disclosure should be minimal. I've relied on that *a lot* up to this point, and many times, I had to consciously think about a strategy to establish rapport, get the information I needed, and be therapeutic at the same time. For me, it was easier said than done.

If you find that you aren't interested in Psych nursing, I would encourage you to use this opportunity to strengthen your nurse-patient communication and relationship skills, regardless of how well you think you're already doing. You can also delve in deep on the psychotropic drugs and realize that some of the symptoms that you may see on other floors could very well be due to the side effect of these drugs, or perhaps to a substance that the patient hasn't disclosed.

Good luck!

jennifer-clare

mtdnk · Aug 14, 2011

It sounds like you may have missed the objectives of the psych clinical. Though it may sound biased coming from a psych clinical educator, there is so much to learn....but you do have to put yourself out to learn it!

Firstly, you should not have a 4 hour "conversation". You utilize therapeutic communication techniques to assess your patient (knowledge of illness, medication, therapies, symptoms, etc). There is a way to ask questions that will facilitate a best answer. In addition, you also interact to intervene (teaching is a HUGE piece of any nursing practice area). You interact to evaluate effectiveness of interventions. The most difficult part of psychiatric nursing is that you must be comfortable in "use of self". You don't have any busy stuff to hide behind in psych, it's just you and the patient.

While you are interacting with the patient, you have to analyze their verbal AND nonverbal responses. What is the patient really saying? How does the affect match the mood? Of course, you must also be aware of how you are presenting to the patient-nonverbal behaviors speak 1000 words!!!

I read a study while completing my MSN that indicated that the role of the therapeutic relationship is essential in both the patient having positive regard for care and the clinicians job satisfaction. If you take the time to establish positive rapport with your patient (regardless of practice area) their perception of the quality of care is higher than the clinician who is "perfect" in technique, but lacking in "caring". Sounds like a no-brainer, but developing a relationship with your patient takes skill. It is in your psychiatric rotation that these skills are focused on. I tell my students that this clinical experience will definitely allow them to learn about psychiatric illness and treatment approaches, but equally important it will help them learn about themselves.

Of course, the day should also include interdisciplinary treatment rounds, participation in RT, observation of medication administration, review of admission status,-I could go on and on.

The great thing about nursing is that there's a lid for every pot. The one thing I can guarantee you is that regardless of the practice area you ultimately choose, you WILL have to incorporate psychiatric nursing skills. For example; you should develope a therapeutic relationship with every patient (individual, family, community), every patient experiences anxiety, right? You need to know how to assess, how to intervene.

I think it is great that you started this thread, many people don't really get the importance of the psychiatric rotation. This is a great way to take a closer look and perhaps save a peer from suffering the same fate :)