Accompanied a patient to get an x-ray on his hand after he punched a wall in frustration. He broke his knuckle in two places, the radiographer said it’s unlikely to heal on it’s own and he’ll probably need surgery. The patient was totally in denial, “I’ve got really strong hands because I played hockey for years, it’ll be no problem”.
Observed a dermatology review on a patient that has weird rashes all over his body.
Did an ECG on a patient with my fellow student.
Sat in on the morning multi-disciplinary team meeting. This is like handover except it’s with all the psychiatrists, doctors, welfare officer, head nurse, activities coordinator and social worker on the unit.
Held a beauty therapy group that I was asked to run (because the activities coordinator was allergic to the products). Only one person came, so I asked her if she’d like a facial and manicure. She couldn’t stop rambling from topic to topic the whole time (part of her illness) so I had to keep saying to her in a soft voice “just try to not to talk, relax and enjoy it”. She said she really enjoyed it and that it was so relaxing, despite not being able to stop talking for more than 10 seconds.
I approached one patient who has been wearing the same shirt everyday for the last 2 weeks and some people have commented that he stinks. I suggested he wash his shirt, gave him a sachet of washing powder and offered him a hospital shirt. He was very offended and said, “I’m a grown man, I know when to change my shirt, it’s not your job to tell me”. I said I didn’t mean to offend him, it was just a suggestion and totally up to him whether he wants to wash it, and thought maybe he didn’t have any other shirts.” He said “well I just washed this shirt two days ago actually”, although it looked really dirty and gross. So I just said, “no worries, that’s fine”. Then five minutes later I saw him change into a new shirt and take the other one to the laundry, LOL.
Only one more week to go now, I have a feeling it will go by fast. I’ve done a lot of work on my assignment again this weekend, but it’s still not finished.
Saturday, January 29, 2011
Wednesday, January 26, 2011
Lots of drama in the psych ward
Time to catch up on what's been happening. Today was a hectic day, the unit was very understaffed with 2 nurses (out of 6) calling in sick and no one else could (or would) come in to fill in. So me and the other student nurse were given the responsibility of doing the ward rounds all day (checking on each patient every 30 minutes). I did that for the first couple of hours and then he took over. Also, the night before one of the patients had trashed his room destroying everything he could including smashing the window. So the smoking courtyard which the window was connected to was out of bounds because of all the broken glass. The rest of the patients were unsettled by it of course and needed to have their smokes so they just smoked inside. The patients was put into the high dependency unit and then he smashed that room too even though it has very thick hard to break special glass. He somehow managed to pull the bench which was bolted down and used that to smashed it. And there was blood all over the floor. He was taken into police custody after that.
So today the ward was pretty frantic. I got asked to run a yoga and meditation class in the morning which went really well for those who attended. One of them was from the high dependency unit and the staff said it was the calmest they had ever seen her. I have been doing a lot of one on one time with this patient over the last two weeks because I have a good rapport with her and she behaves well whenever I am around but unfortunately can be very childish and aggressive with other staff. So we've been bribing her with the promise of 'time with Kate' if she is good for a few a hours. I usually take for a walk around the other part of the ward for 30 minutes to an hour, sit out in the courtyard, chat, encourage her to write in her journal, and help her interact positively with the other patients. The other day I was allowed to take her outside the unit and outside on hospital grounds which was the first time she had left the building in about a month. She needed money from the ATM to buy cigarettes and it turned into a bit of a shopping spree buying something from the cafe (capuccino for her, and donut for me), gifts (for herself) from the gift shop, and so on.
With the same patient I also got the chance to look in her ear with an otoscope because she thought she 'might have a cigarette filter stuck in there'. When I asked how it got in there and when it happened she said she 'was trying to block out the voices' and that it was 'about a month ago'. I looked in her ear and it was indeed lodged in there. Got one of the doctors on the ward to try to get it out with tweezers but it was too delicate so she had to go to the ear specialists in the other part of the hospital. After that she said 'I've learnt my lesson', LOL.
So today the ward was pretty frantic. I got asked to run a yoga and meditation class in the morning which went really well for those who attended. One of them was from the high dependency unit and the staff said it was the calmest they had ever seen her. I have been doing a lot of one on one time with this patient over the last two weeks because I have a good rapport with her and she behaves well whenever I am around but unfortunately can be very childish and aggressive with other staff. So we've been bribing her with the promise of 'time with Kate' if she is good for a few a hours. I usually take for a walk around the other part of the ward for 30 minutes to an hour, sit out in the courtyard, chat, encourage her to write in her journal, and help her interact positively with the other patients. The other day I was allowed to take her outside the unit and outside on hospital grounds which was the first time she had left the building in about a month. She needed money from the ATM to buy cigarettes and it turned into a bit of a shopping spree buying something from the cafe (capuccino for her, and donut for me), gifts (for herself) from the gift shop, and so on.
With the same patient I also got the chance to look in her ear with an otoscope because she thought she 'might have a cigarette filter stuck in there'. When I asked how it got in there and when it happened she said she 'was trying to block out the voices' and that it was 'about a month ago'. I looked in her ear and it was indeed lodged in there. Got one of the doctors on the ward to try to get it out with tweezers but it was too delicate so she had to go to the ear specialists in the other part of the hospital. After that she said 'I've learnt my lesson', LOL.
Sunday, January 23, 2011
Electroconvulsive Therapy
Had an interesting day today. Got to observe a patient having electro convulsive therapy, aka electric shock treatment. It was first thing in the morning and along with another nurse I accompanied the patient down to the theatre, witnessed all the pre-op stuff and putting her under general anaesthesia, doing the electric shock which gives them a seizure, staying with her for half an hour while she woke up and then take her back to the ward. It was nothing dramatic like in the movies where the patient screams, only lasted about 1 minute and they are completely unconscious, but very interesting none the less. As she woke up from the anaesthesia she was very wriggly and restless, ripping blood pressure cuff and cords off her, and kept trying to get out of bed so we had to hold her down and tell her to relax. Then when she start talking it was absolute gibberish, like another language, or english but 'word salad'. Then she'd ask perfectly 'I'm not making any sense am I?' or 'Do you know what I mean?' And we'd laugh and say no.
This weekend I worked really hard on my assignment which is worth 50% and has to be done while I'm on this placement. It's gotta be handed in (in Melbourne) 5 days after the placement finishes so I'm trying to get it pretty much all done while I'm here. More on what it's about later.
I've got lots more to write about on my blog, things I've been experiencing and learning about, but I will try to catch up a bit more tomorrow because I need to go and start getting dinner ready tomorrow. Have
This weekend I worked really hard on my assignment which is worth 50% and has to be done while I'm on this placement. It's gotta be handed in (in Melbourne) 5 days after the placement finishes so I'm trying to get it pretty much all done while I'm here. More on what it's about later.
I've got lots more to write about on my blog, things I've been experiencing and learning about, but I will try to catch up a bit more tomorrow because I need to go and start getting dinner ready tomorrow. Have
Sunday, January 16, 2011
Week 1 on psych ward
Day 2
• Four hour training workshop on how to use the computer record keeping system.
• Back to the psych unit and buddied up with one of the nurses. Went round with her to meet the patients. Part of the nurse’s duties is to check on the patients every 30 minutes or hour (depending on their risk level) and record where they were and what they were doing. This is a legal document (duty of care). Some patients burst into rambling talk when you say hi to them and I’ve noticed that sometimes the nurses just walk away while they’re doing that. At first I thought it was rude but what else can you do. You could spend half an hour just standing their listening to the nonsense coming out of their mouths.
• Besides that, just gave out meds when they were due, including one anti-psychotic injection in the arm, and responded to patients’ requests. One patient requested use of the boxing gloves which they can use if they want to punch the wall or whatever to release frustration, then I had to take them back off him 10 minutes later when I realized he was using them to have a real boxing match with another patient.
Day 3• In the morning, the clinical placement officer from my university called me to and told me there had been a ‘mix up’ which was why the psych ward had no idea I was coming, but that she’d talked to them and ‘luckily they will take me’. Found out later that actually my clinical educator on the ward had called her and slightly reprimanded her for not organizing my placement properly, and insisted she call me and apologise because it must have been a bit stressful for me after driving all the way up from Melbourne. Hah! Some apology. My uni is incapable of ever admitting to making mistakes. Everything is the students’ fault and we should just be grateful for all the hard work they put into getting our placements at all times. I’m so over complaining. I just want to get through the rest of my course now, get my degree and get on with my nursing career.
• Back to my placement - the mental health nurses on the ward all seem like a really nice bunch of people. They are very welcoming and helpful. Today I chaperoned a patient to another part of the hospital to get an echocardiogram. That’s an ultrasound of the heart and needs to be done before commencing Clozapine treatment for psychosis. The drug can cause myocarditis, an infection of the heart muscle, so the heart has to totally free of any pre-existing heart disease. It’s a last resort treatment when other drugs haven’t worked.
Typical day for the mental health nurse:• Handover (1 hour)
• Unit rounds, check on the patients
• Give out meds when they are due
• Do any obs as required such as vital signs, alcohol or drug withdrawal scale, weight, or wound dressings.
• Participate in activities with patients
• Attend to the patients’ issues and requests, including counseling, admissions and discharges.
• Write up file notes.
Day 4• Two hour manual handling workshop. Learned how to use all the special equipment for moving patients. Probably won’t need this on my placement because on the psych ward the patients are not immobile but it’s a requirement for anyone working or doing a placement at the hospital.
• After that I went back to the ward and this time I was placed in the High Dependancy Unit. This is the section for patients that need to be checked on every 15 minutes because of suicide risk or risk of ‘misadventure’ which means they are likely to do crazy things such as have sex with another patients or start a fight with another patient. The nurses stay behind a screen to keep an eye on them and for their own safety. Even the chairs in there are all soft so they can’t do any damage. Their cigarette intake is controlled (eg. no more than one per hour) and the nurses have to give them their cigarettes and light them for them. Usually they don’t let students work in that unit until the third or fourth week of their placement so it was pretty cool that they thought I could handle it. The patients in that section are pretty scary.
• Four hour training workshop on how to use the computer record keeping system.
• Back to the psych unit and buddied up with one of the nurses. Went round with her to meet the patients. Part of the nurse’s duties is to check on the patients every 30 minutes or hour (depending on their risk level) and record where they were and what they were doing. This is a legal document (duty of care). Some patients burst into rambling talk when you say hi to them and I’ve noticed that sometimes the nurses just walk away while they’re doing that. At first I thought it was rude but what else can you do. You could spend half an hour just standing their listening to the nonsense coming out of their mouths.
• Besides that, just gave out meds when they were due, including one anti-psychotic injection in the arm, and responded to patients’ requests. One patient requested use of the boxing gloves which they can use if they want to punch the wall or whatever to release frustration, then I had to take them back off him 10 minutes later when I realized he was using them to have a real boxing match with another patient.
Day 3• In the morning, the clinical placement officer from my university called me to and told me there had been a ‘mix up’ which was why the psych ward had no idea I was coming, but that she’d talked to them and ‘luckily they will take me’. Found out later that actually my clinical educator on the ward had called her and slightly reprimanded her for not organizing my placement properly, and insisted she call me and apologise because it must have been a bit stressful for me after driving all the way up from Melbourne. Hah! Some apology. My uni is incapable of ever admitting to making mistakes. Everything is the students’ fault and we should just be grateful for all the hard work they put into getting our placements at all times. I’m so over complaining. I just want to get through the rest of my course now, get my degree and get on with my nursing career.
• Back to my placement - the mental health nurses on the ward all seem like a really nice bunch of people. They are very welcoming and helpful. Today I chaperoned a patient to another part of the hospital to get an echocardiogram. That’s an ultrasound of the heart and needs to be done before commencing Clozapine treatment for psychosis. The drug can cause myocarditis, an infection of the heart muscle, so the heart has to totally free of any pre-existing heart disease. It’s a last resort treatment when other drugs haven’t worked.
Typical day for the mental health nurse:• Handover (1 hour)
• Unit rounds, check on the patients
• Give out meds when they are due
• Do any obs as required such as vital signs, alcohol or drug withdrawal scale, weight, or wound dressings.
• Participate in activities with patients
• Attend to the patients’ issues and requests, including counseling, admissions and discharges.
• Write up file notes.
Day 4• Two hour manual handling workshop. Learned how to use all the special equipment for moving patients. Probably won’t need this on my placement because on the psych ward the patients are not immobile but it’s a requirement for anyone working or doing a placement at the hospital.
• After that I went back to the ward and this time I was placed in the High Dependancy Unit. This is the section for patients that need to be checked on every 15 minutes because of suicide risk or risk of ‘misadventure’ which means they are likely to do crazy things such as have sex with another patients or start a fight with another patient. The nurses stay behind a screen to keep an eye on them and for their own safety. Even the chairs in there are all soft so they can’t do any damage. Their cigarette intake is controlled (eg. no more than one per hour) and the nurses have to give them their cigarettes and light them for them. Usually they don’t let students work in that unit until the third or fourth week of their placement so it was pretty cool that they thought I could handle it. The patients in that section are pretty scary.
Sunday, January 9, 2011
First Day of Mental Health Placement
Arrived in Canberra safe and sound with my cat after a 7.5 hour drive from Melbourne. Exhausted yesterday but recovered today in time for my first day.
A bit of a shaky start, nothing too bad but they didn't even know I was coming! I had called the 'clinical educator's mobile about a week ago to confirm and ask where I have to go and what time to be there etc and I didn't get any reply. Tried again a couple of times but always straight to voicemail. So this morning I called the hospital phone number the from my uni's info and no answer. Ended up just called the main hospital reception and asked to be put through to the nurse's station in the psych ward. They told me that clinical educator doesn't work there anymore and just come down and we'll get you sorted out. When I got there they said they didn't even know I was coming! But there were three other students from Albury-Wodonga campus that were all totally organised. My campus' clinical placement office lived up to their terrible reputation of being very disorganised. Anyway, not my fault, and luckily they said it's no problem.
As usual didn't do much today being the first day. Got a tour around the hospital and the ward. It's the only involuntary mental health ward in the state and has a high dependency unit where patients are monitored every 15 mins. Read through all the policies and procedures and welcome pack and sat in on handover. The nursing staff seem nice and welcoming and my clinical educator is very nice and accomodating. Patients are mainly bipolar, schizophrenia and depression (suicide risk).
For the first two weeks I'll be doing afternoon shift (1:30 - 10:00pm) and for the second two weeks I'll be on morning shift (7:00am - 3:30pm).
Should be a very interesting placement and I will keep you posted!
A bit of a shaky start, nothing too bad but they didn't even know I was coming! I had called the 'clinical educator's mobile about a week ago to confirm and ask where I have to go and what time to be there etc and I didn't get any reply. Tried again a couple of times but always straight to voicemail. So this morning I called the hospital phone number the from my uni's info and no answer. Ended up just called the main hospital reception and asked to be put through to the nurse's station in the psych ward. They told me that clinical educator doesn't work there anymore and just come down and we'll get you sorted out. When I got there they said they didn't even know I was coming! But there were three other students from Albury-Wodonga campus that were all totally organised. My campus' clinical placement office lived up to their terrible reputation of being very disorganised. Anyway, not my fault, and luckily they said it's no problem.
As usual didn't do much today being the first day. Got a tour around the hospital and the ward. It's the only involuntary mental health ward in the state and has a high dependency unit where patients are monitored every 15 mins. Read through all the policies and procedures and welcome pack and sat in on handover. The nursing staff seem nice and welcoming and my clinical educator is very nice and accomodating. Patients are mainly bipolar, schizophrenia and depression (suicide risk).
For the first two weeks I'll be doing afternoon shift (1:30 - 10:00pm) and for the second two weeks I'll be on morning shift (7:00am - 3:30pm).
Should be a very interesting placement and I will keep you posted!
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