What was your Psych clincial like?

BunnyRN · Jan 2, 2006

in psych

1. worked with schizo pt

2. dealt with bipolar both depressed and manic (this was interesting)

3. witness paranoid pt. signs and symptoms (it's amazing how they think) beware whatever you do (don't wisper)!!!

4. did i forget to mention more manic folks (with all those grandiose ideas, where some truth may lie)

5. saw the eps symptoms (antipsychotic meds, so horrible)

6. it was interesting talking to the clients (don't use why???)

7. i learned so much in psych, and i've learned to look at mentally ill people differently,

8. we all have some mental problems, but some of us know how to deal with it before we cross the reality line to psychosis.

9. i've seen the way the clients used the many different defense mechanisms to help them deal with their anxiety (regression, reaction formation, denial, etc...

10. overall, psych made me realize that at anytime in my life, when i'm under stress to seek out for help before i lose control of it all. anxiety can be very overwhelming at times. nursing school is all the stress that i need for now!!!

11. exercised with the patients

12. played games with them.

13. encouraged them to express their feelings (very big in psychiatric nursing)

14. overall, i loved my psych clinical rotation!!!

15. we did not wear our nursing uniform.

16. like i said before communication with the clients, is extremely important during your psych clinical. just enjoy it!!!

you can find this, which i previously posted at:

https://allnurses.com/forums/f50/share-your-highlights-semester-134567.html

AgentR · Jan 2, 2006

My psych clinical was....interesting! I didn't enjoy it, and but then again I went in planning to hate it. Mine was at a state institution, so I had a much different experience than those at a private hospital. Basically, we just talked. The bad part was that so many student nurses, med students, psych students, etc came through that the patients were really guarded and talked about superficial stuff. It was hard to get to the therapeutic stuff. We also went to art therapy, occupational therapy, recreational therapy, etc with the patients.

The nurses were great. It was awesome to see them in action trying to de-escalate a patient.

Overall, I feel like I have a much better understanding of mental illness, and a lot more respect for what the patients go through. But...I still didn't like the rotation. :)

Daytonite, BSN, RN · Jan 2, 2006

My psych clinicals were done at a V.A. hospital that was a psych facility. We were all scheduled on a locked unit of schizophrenic patients. Many of them were participating in an experimental drug program. It required that they go completely off their current meds for treatment of their schizophrenia, so they were all in different phases. What a zoo! They were all experiencing symptoms of their schizophrenia. I suppose that's kind of rare to find such a huge group of these kinds of patients all in one place, but the V.A. hospitals are able to do this.

The patients had a meeting every morning in their day room. The staff and one or two of the doctors lead the meetings. They discussed things that were going on, specific problems with some of the patient's behaviors that were affecting the unit as a whole, and allowed for questions to be brought up. The patients have free range to roam the unit unless for some reason they have been put on restraints into a lock down room for behavior problems. In this isolation room, the hospital bed was bolted to the floor and there was nothing else in the room. If a patient was placed in isolation lock down one nurse sat with them in the room if the patient had been placed in leather restraints as well, as they had to be physically checked every 15 minutes. (While you're in a psych unit, ask to see what the leather restraints look like and how they work. Also read the facility policy on their use.) The day room had a TV, books and games and is generally where a lot of the patients hung out. Some patients had permission to leave the unit and could wander throughout the entire facility. If you've never been in a V.A. facility, let me explain that they have all kinds of things for the vets to do: game rooms, smoking rooms, the cafeteria, they can often go outside, etc. We had a process recording we were supposed to be doing as well as working on our therapeutic communication skills. There was plenty of oppotunity to talk with these patients because they were up and ambulatory and didn't need the physical nursing care. I remember one young patient in particular who came up to several of us and told us he was hearing God telling him to kill his father. It was so sad. There was another patient who exhibited "word salad" speech who was very intriguing to talk with. You could see the confusion and mental anguish on the faces of these patients. The nurses explained to us that many of these patients were aware that their symptoms were just that, symptoms of their disease. There was one incident we witnessed where two patients got into a shouting match, but the staff intervened immediately and quieted the situation down very quickly. Nurse abuse by patients is very high on psych units and although I never saw it happen where I was doing my clinicals, the staff talked about their awareness and concern about it. It is a much more common problem on psych units than on regular med/surg units. It lead to my decision to do my senior research project on physical abuse of nurses by patients.

The nurses on the unit made sure the patients got their medications. They led small group discussions with the patients and they observed the patient behavior. They intervened when there was friction between the patients. They had to institute controls on patients who went out of control. Like other facility nurses, they were often on the phone talking with the doctors about a patient's treatment orders.

Since the unit was locked, meaning the doors going into and out of the unit locked upon closing, we could only get in and out by having a person on the staff who had a key to the door to let us in or out. That bothered some of the students. I later worked on an IV Team in another V.A. hospital that had 3 locked psych units. We occassionally had to go up to them (I don't know why they always seem to put them on the very top floors of the hospitals) to put a saline lock in someone going for some procedure. We would have to ring at the door to have the staff open the door with a key. Upon entering the unit, we would usually get a small entourage of patients who followed us around as we did our IV work. It always made me think of them as a pack of little puppy dogs who just followed one another around. Mostly, they were harmless. They didn't have anything else to do. You haven't seen the definition of "nuts" until you've been exposed to patients in locked units like this. I appoligize for using the terminology "nuts", but lay people use it all the time and there really is a big difference between someone who is psychotic and someone who just has behavior oddities.

At the time, I, like my other fellow students, was kind of scared that one of these patients would suddenly act up and strike out at one of us. Nothing like that ever happened. Looking back on it, I would have to say that we were given an opportunity to see a lot of different psychotic behavior that most nurses might never get to see. The fact is that units like that are fading away. I wish I had been more assertive about seeking out more patients to interact with. However, like many scared students I just wanted to complete my clinical time there and get out and go home where I knew it was safe.

mitchsmom · Jan 2, 2006

Ours was much as described above. Our two clinical groups went to two very different facilities - one was a private place that is renowned for treating eating disorders and drug addiction, the one I went to included the public crisis stabilization unit for the region (the CSU was a locked unit, which many of the students were apprehensive about but turned out fine), a 30 day residential rehab for drugs/alcohol, another unit for severely mentally ill people who "graduated" from the CSU. an outpatient center, a pediatric CSU, etc. So we saw a wide variety of patients all in one facility - I talked with everyone from a schizophrenic who killed someone to alcoholics to 10 year old bipolar kids to a girl with borderline personality who liked to cut herself, etc. etc. etc.

I wasn't looking forward to that rotation (I already knew a lot about mental health & have been around a fair number of mentally ill people and it's all kind of frustrating to me because I wish we could do more among other reasons)... anyway we mostly talked & observed patients and staff, did process recordings based on conversations with clients, and did assessments like Beck Depression scale and mini mental assessment, etc. Even though I wasn't thrilled about doing my psych rotation, I learning things & liked it ok.

Our approach was very straightforward: "I'm a student and I'm here to learn about _______. Would you like to share what you know about that with me?" (something to that effect). Most of the people were very open, if they weren't then you just respected that & moved on, like you would with anyone. We always asked the staff which patients would be best/most appropriate to talk to so it worked out well. Have fun, it's very interesting!

LauraLou · Jan 2, 2006

My psych rotation was at the state psychiatric hospital. The pts suffer from severe mental illnesses and some have been hospitalized for years. Because of a lack of funding, none of the pts get individual counseling, just group activities like art and music. The goal is to get pts on meds, stablize them and discharge them. Most of them end up back in the hospital because they go off their meds once discharged. Because none of them get real therapy, their issues aren't resolved and most never get better. I was deeply disturbed by the whole experience. I really wish I had never gone there.

SFCardiacRN · Jan 2, 2006

I was so dreading my psych rotation. Several weeks of being locked up for 8 hours a day with "crazy people" gave me the shivers! It turned out to be my favorite rotation in school. The psych nurses were incredible. I really learned to appreciate their skills. The patients were not as dangerous as I was expecting. Before things would get out of hand, the staff seemed to sense it and would have the students back down while they took over. I learned more in psych than in any other rotation.

bowkerj · Jan 2, 2006

Thanks everyone for your descriptive replys - Keep them coming! Sounds like you each had very interesting times in psych. I am looking forward to it - seems like there is a lot to learn about. I hope I get into a peds psych clinical - I feel the younger folks (in general) have a better chance at recovery - it gets harder as we get older!

J

MIA-RN1, RN · Jan 2, 2006

I was on a locked adult psych unit. I worked w/ a paranoid schizophrenic, person w/ psychotic break, bipolar person, spent a day at outpatient, watched an ECT, and spent a day at an inpatient chemical addiction recovery program. I also attended several group sessions while on the unit.

It was interesting. I learned: Don't ever ask "why", and use lots of open-ended, broad, or leading communication. Also, when the instructor tells you to 'go out in the milieu and interact with someone' she generally does *not* mean hang out and talk with the techs lol.

mona b RN, BSN, RN · Jan 2, 2006

My psych rotation was at the state psychiatric hospital. The pts suffer from severe mental illnesses and some have been hospitalized for years. Because of a lack of funding, none of the pts get individual counseling, just group activities like art and music. The goal is to get pts on meds, stablize them and discharge them. Most of them end up back in the hospital because they go off their meds once discharged. Because none of them get real therapy, their issues aren't resolved and most never get better. I was deeply disturbed by the whole experience. I really wish I had never gone there.

That is so sad isn't it. This is a huge problem....no support or inadequate support and many of these patients end up right back in the hospital.

det01 · Jan 3, 2006

I did mine on a child/adolescent unit. I loved it! Granted, I do think this particular type of psych nursing requires a lot of patience and understanding, but so does any other type pf nursing. We were able to do outings with the kids. It was one of the best experiences I have had in nursing school! (And I will be done in August!) That being said, some of the things in child/adloescent psych can really get to you...you may go home and cry a few times.

I think psych nurses do a lot on top of meds and med teaching. Psych nurse do a lot of charting. They also doe a lot of counseling (on top of what the counselers do). There is a lot of advocacy involved. They help make sure that the person has a place to go, adequate coping strategies, and help if they need after they are dismissed from the hospital. In some cases the nurse may be asked to go to court and help other proffesionals get the patient disability benefits.

In some cases there are even home health psych nurses. They actually go to the homes and check on the patients (well actually I have been told they call them clients or consumers now in order to lessen the stigmas associated with being mentally ill). I actually also did a couple of visits with a nurse doing this. The home health thing was one of my "enrichment" experiences that we had on top pf clinical. I was also at an "adult day care" type situation where the mentally ill can come and go to groups and just hang out. They are also fed a meal. These places usually have at least one RN on staff. They also give the clients their meds there (thus the need for a RN on staff).

Psych nursing is actually one of 3 areas I would go into. I would prefer the child end of it, but I perfer to treat children of adults in anything I do. That is one of the things that is great about nursing - diversity in jobs/

mona b RN, BSN, RN · Jan 3, 2006

I think psych nurses do a lot on top of meds and med teaching. Psych nurse do a lot of charting. They also doe a lot of counseling (on top of what the counselers do). There is a lot of advocacy involved. They help make sure that the person has a place to go, adequate coping strategies, and help if they need after they are dismissed from the hospital...

I feel exactly the same way. Psych nursing involves so much interaction both emotionally and intellectually. There is so much teaching involved. The only other rotation I had that had as much teaching was OB.