Setting aside (suppressing?) my traumatic past during pedi psych unit clinicals.

[LonghornChic, BSN]

Hi all,

During registration last semester, we received a few choices of psych clinical sites. All of the choices were known psych clinics or hospitals. I chose a state hospital. As we were doing orientation today, I find out that my choice for clincials will be split up between two hospitals with one being a pediatric psych unit. My heart sank because I specifically did not sign up for pedi for a reason. During a large part of my childhood, I was subjected to some very traumatic events that put me through years of therapy. This therapy did not require any prescription treatment or long term treatment or leave me with a dx that I need to report to the BON.

I am aware that I will encounter children in the nursing field and I am completely fine with that (I worked in family practice and peds clinic for several years). However, I am not prepared to take care of any children that are in psych units or in therapy due to certain events that occurred in their childhood. I started to feel physiologically ill when I learned we were going to a pedi psych ward.

I spoke with my professor afterwards without going into too much detail about my past and she said that I could be accommodated with older children during clinicals. I think this might work but now I'm worried about being assigned a teen with a similar past as I had. I think I can handle an older teen much more than a younger child but I still worry about finding myself in a situation I don't want to be in. I feel that if I keep probing and asking for accommodations, my clinical evaluation grade will be affected negatively. How can my professor determine if I am a clinically competent student if I have such a narrow group of patients? It's too late to transfer to another site also. My question is

-Are there coping methods that nurses use when dealing with patient situations that mirror their past? Have you asked for accommodations?

Any advice is welcome.

[direw0lf, BSN]

I specifically want to help children and teens with a traumatic past. And I know plenty in my program who want nothing to do with peds!!! (For various reasons). If you want to know my shameful secret, I don't look fwd to nursing home assignments or placements, I don't want that population. But I could mentally do my job for them. Do you think you can mentally help pediatric patients..or you don't want to? Big difference! I had some traumatic issues in my past too. It's not easy when something triggers, but I guess I just .. well I don't know I can cope and someone else can't it's not because I'm stronger or better. I used a lot of meditation, like on a weekly basis whether or not I needed to. I think that does help for when you do need it. Since you don't have time maybe you could talk to your school's psychologist? Just talking about it and getting it all out what and someone helping you understand your fears and stuff might make it so much more easier to do this.

[LonghornChic, BSN]

Thanks for your advice!

It's not that I do not want to work with this population, it's that I do not feel mentally or emotionally prepared enough to deal with children who have been through a certain type of child abuse.

While I do agree that seeing a mental health professional will be of benefit to me (especially since situations such as these easily trigger anxiety), I do not believe that this particular time would be good. I fell like that deep wounds would be opened again and I'd have to deal with this on top of being a nursing student.

I am a very driven nursing student who has done very well in aspects of school clinicals and theory courses. If I absolutely had to do clinicals here, I would find a way to make it work temporarily. Even if that mean nightmares and panic attacks post clinical.

I just wish I could bury this down for now and find a better method to cope at the moment.

[CountryMomma, ASN, RN]

I feel your panic and apprehension, OP. I had the same feelings when I started my rotation at the state Psych facility. Just hearing the lock click behind me when I hit the floor made my skin crawl and my stomach lurch.

I started talking to the counselor at school to help me refresh my CBT and unpack some of my feelings. I, like you, had traumatic childhood events and worked hard to avoid situations that would make me deal with it again. Good news - there's no kids on Med-Surg lol!

Check out your school's counselors, realize this is short term, and take care of yourself - rest, eat, sleep.

[direw0lf, BSN]

Well.. this is just my thought and you know what's best for you better than me. It's not going to be better to wait until you're working as a nurse and it could be worse if you are having trouble coping and make say a med error, as an RN.

I know where you're at..I used to not be able to say the word abuse like you don't want to spell out the type.

But you don't need to totally open wounds (my guess is they aren't really closed though) you can tell the school psychologist you don't want to that you just need coping mechanisms here. Really..the psychologist will probably be all too happy not to play Freud and like helping you with coping strategies. If you feel it's too deep you can stop seeing them at any time.

[LonghornChic, BSN]

Thank y'all for the advice. I'm going to consider making an appointment with someone at student health services. I'm really trying to sort this out before it becomes a much bigger issue.

[umbdude, MSN, APRN]

Thank y'all for the advice. I'm going to consider making an appointment with someone at student health services. I'm really trying to sort this out before it becomes a much bigger issue.

I think you should probe more to ask for accommodation. You can also tell your clinical instructor so she can assign you to older teens or those whose experiences are less triggering for you. You might have to disclose (confidentially) your past experience so that the instructor understands the seriousness of your emotions. I would expect that your instructor will understand.

Also, keep in mind that your level of interaction varies as a student. Even if you have to do mental status assessments, you don't necessarily need to dwell into the patient's traumatic past. Focus on the patient's current progress, symptoms, behaviors, and positive things you can do for them. Try to shift the focus on them...not yourself.

When I did my psych clinical...the facility I went to didn't even encourage us to do 1-on-1 interviews with patients (sadly the nurses didn't even do it). My instructor wanted us to just play games with the patients and observe.

All the best to you.

[TheCommuter, BSN, RN]

Count me in as someone who saw and underwent traumatic childhood experiences. Children don't trigger my unpleasant past experiences, although I'd rather not be around them in healthcare settings.

I also spent a chunk of my growing-up years being neglected by an addicted parent who used hardcore drugs out in the open, yet I was able to work in the chemical dependency unit of a psychiatric facility without any issues.

Compartmentalization is key...my patients go into one compartment, whereas loved ones go into another compartment. It keeps me sane.

[LonghornChic, BSN]

Thanks for all your advice and support.

I've been talking to my school mental health professional and my professor has been very understanding and accommodating. I'm slowly learning to separate these feelings from my "other" life.