I have officially finished my last clinical of my psych/mental health nursing class! I really enjoyed this rotation and I have to say it was different from other clinical experiences. Before you get to psych, you will have rotations on medical/surgical type floors. This means a lot of physical assessments, medication administration, changing linens, IVs, and helping patients with activities of daily living(showers, getting dressed, ect.) Psych clinical is a totally different ball game. It is all about therapeutic communication and group therapy sessions. This clinical I have colored, danced, exercised, and participated in group therapy! It was fun and different and honestly a nice change from the usual clinical routine. Today I’m discussing the different psych settings I went too, along with a little information about clinical paperwork and performing your assessments.

Acute Inpatient

We went to a state psychiatric hospital and two private psych hospitals for our acute inpatient experience. These facilities had units for both adults and children. The majority of the patient population included schizophrenia, schizo-affective, bipolar, and some personality disorders. Most people were there because they either had thoughts of harming themselves or others, or they had become unable to care for themselves. They could be an involuntary admission, which meant they are legally mandated to stay at the hospital because they were a harm to themselves or others, or unable to care for themselves. While at clinical we practiced our assessment skills by interviewing clients, reviewed charts for labs and medications, and also attended group therapy sessions. I had the opportunity to go to a health and wellness therapy group where we danced and exercised! They weren’t messing around either, we did planks, push-ups, squats, and lunges! It was pretty awkward for me at first, but turned out to be a lot of fun. The patients loved it, so that made it that much better!

Detox Center

I went to a detox center for my last day of clinical today and it was a good experience! Everyone here was a voluntary admission, meaning they chose to be there. This site allowed us to see what it is like for people to go through a medically managed detox. In order to prevent the complications that can arise from withdrawal (seizures, DTs, death) they give the patients medication to help keep them safe during withdrawal. The patients in this facility were withdrawing from alcohol, benzodiazepines, or opiods. These three types of substances are physically addictive, meaning coming off of them can cause life-threatening withdrawal symptoms. Cocaine for instance, only causes a social withdrawal. The patient will feel sick, and they will have the craving for the drug, but they won’t die from coming off the drug. Therefore, they do not detox in an inpatient setting. Some of my classmates were able to get in some practice with their PPD placement skills for new admissions (I have done these for my job before.) I was able to do my first urine-drug screening and a breathalyzer test on a patient and document the findings, so that was new for me!

Long Term Rehabilitation

We went to a long term drug rehabilitation facility that was specifically for woman who had a substance abuse disorder. They were either pregnant or had children up to the age of 6 years old. The woman detox at the Detox Center if needed, and then upon discharge they transfer to the rehab facility. They live at the center for approximately 6 months were they attend group and individual therapy along with help on obtaining job skills, getting their GED, assistance applying to college, parenting classes, and financial counseling. They also attend Narcotic Anonymous and other recovery meetings in the community.  Their children are also able to come and live with them while they are in the facility. The children are either in the nursery if they are infants, or play/preschool for the toddler to six year old while the mothers are in classes/therapy. Before and after the mothers 8a-4p day of classes during the week and all day on the weekend, the mothers are fully responsible for their children. Staff is available 24/7 if assistance is needed, and the mother and child stay in a dorm room in the facility. It also had a common area and full kitchen for their use, as well as a very nice play area for the kids. It was an amazing program and I loved the experience! It was sad to hear some of their stories, but it was also very hopeful to seeing them get help.

 

Clinical Paperwork

Our paperwork was definitely a bit time consuming! Each week we had either a twelve hour clinical, or two eight hour clinical. For each clinical week we had to do a patient profile which included the patient’s labs and treatments with rationales, drug cards, a care plan, and a psycho-social assessment. The psycho-social assessment definitely was the biggest change! This is a assessment that is documented in a narrative charting style. You assess the client for everything from hallucinations and delusions to how they pay their bills and their social support. Mine usually were at least two typed pages of information. My biggest suggestion is to use your rubric! Make sure you include everything on the rubric, along with an example and quotes as to why that is true or not true for your client. For example, if your client is having hallucinations, you need to ask what kind are they experiencing (auditory, visual)? What are they saying/doing? Are they telling them to hurt themselves or others? Saying your client has the problem is not enough, you have to say why! Always provide the evidence in your charting and paperwork!

Overall, clinical this term was a great experience! I know a lot of people are scared about psych, but I am here to tell you you have nothing to be scared of. It can be hard and slightly awkward to go up and have to ask people about thoughts of suicide, hallucinations, or their drug use. I found that if you use a calm, professional, matter-of-fact manner, you can ask people just about anything! A great way to get a lot of people talking is to introduce yourself, explain that you are here to learn about mental health and practice your assessment skills, and then ask them what brought them into the hospital. Usually, people will tell you everything you need to know with that simple conversation starter! In your nursing career, you will be asking the hard questions. This is the time to start practicing, before you are on your own! Good luck!

How did you like you psychiatric clinical? Do you have any questions for me or suggestions to add?