NursingZen

Last week was our first half day on a Psychiatric nursing floor. To say my classmates and I felt like fish out of water would be a huge understatement.

To enter this acute psych unit, a nurse has to unlock two doors; he warns us to always check the corners of the doorways for patients who might try to dash out an opened door. As we step on to the unit, a thin sprightly man in a large red T-shirt walks past us at a furious pace and greets us with a hello. We learn he paces miles each day from one end of the unit to the other.

Imagine an ‘L’ shape floor with rooms lining the halls and a large stark but sunny common area in the middle of the floor. The common area is lined with chairs with about 10 people sitting in the chairs. Most of them are directed toward a large-screen TV in the corner, while a few stare straight ahead. We enter the nurse’s station, which they call the fishbowl, and indeed it feels like one when patients press their faces into the window to look at us. It also feels a little like a command center because we can easily look out at all the action in the common area. Well, inaction would be a more apt description.

We spent some of the morning pressing our nurses for a clear idea of what it is they do exactly, what the nursing plans are, and what we could do. We were on “med-surg mode,” which meant we were ready to go, and we were hypervigilant about being scolded for sitting down, chatting, or otherwise not doing much. Med-surg broke us in, alright. At first we couldn’t even sit down and relax for more than 5 minutes. Gradually it became clear that med-surg mode wasn’t Psych mode. Psych nursing is its own thing entirely. I’m still figuring out what it is exactly, but in the meantime we were to try to talk to the patients and assess their condition, watch certain ones while always keeping our back to the wall, and try to engage them with games and crafts. The disorders on this unit range from schizophrenia to major depression and suicidal ideation to alcohol withdrawal.

Taking a deep breathe, I introduced myself to some of the more ‘present’ looking patients and tried to chat. One person was tearful and didn’t want to talk because he was thinking about his wife. Another looked like Spock. He replied slowly with one or two words, then proceeded to stare at me without blinking for some very long minutes. Oh how I fumbled with my hands! I awkwardly placed my hands in my pockets, behind my back, across my chest, and in front of me in a teepee formation, all during just one brief conversation. Hmm. Yes, I think I’ll go now.

Games sounded like a good idea. A nurse assured us at least one or two people would come flocking to us. We found a brand new deluxe Uno set and set up shop at a card table. Oh we had high hopes…but we sat in vain. We tried to rope in some of the more talkative folks, but one gentleman whom we thought held the most promise shook his head and said, “No, no, I can’t even think my way out of a paper bag.”

Mission defeated, we retreated to the fishbowl to gather our wits and read up on the folks we interacted with.  Then it was lunchtime, and the end of our first morning. We vowed to have a better plan tomorrow.

Four weeks of Pediatrics ended last week. I think our Peds professor is the kindest, most fair, and most accessible teacher so far. I feel that if I drop in on her six months from now, she’ll make me feel completely comfortable and welcomed. She’s young and vivacious … I hope she sticks with teaching in the MEPN program.

This week began our Psychiatric-Mental Health Nursing course, which encompasses two full days of lecture and three half-days of clinical. We begin at 7:30 and end by 1 pm, which leaves us some glorious afternoons to do with what we wish.

Prior to the start of Psych, I had apathetic feelings about it. I couldn’t place my finger on why, since I always do my best to be positive and enthusiastic about every new experience. Then in class on Tuesday, something clicked. As the instructor talked more and more about mental illness, depression, schizophrenia, and the stressors and risk factors in people’s lives that precipitate mental disorders, I felt something like quicksand weigh down on me. In no time at all, I began to feel claustrophobic. I had trouble breathing, and then tears started to spill. I had to pinch the bridge of my nose to hold them back.

It dawned on me that I’ve been anxious about Psych because I didn’t want to face the mental illness that has been in my family. I didn’t want to recall that my father was depressed, yet I didn’t recognize it and didn’t do anything to help him. I also didn’t want to be reminded of the fact that another relative is depressed and deteriorating because of Parkinson’s disease, yet I haven’t had the strength or know-how to deal with it. And although I’m writing this down here, I’m not saying I’m ready to face those things head on. I guess I’m writing this because it’s important to me that I acknowledge and make real that this is what’s going on with me this week.

Unexpectedly, Psych might become the most challenging and rewarding class for me this year. Maybe, hopefully, it will help me face my personal issues and equip me with knowledge to help my loved one. I make no promises, but I’m going to try my best to keep an open mind and an open heart.

More later about the first week of Psych clinicals, which has been a mixed bag.

Evidently, after 3 weeks of not having clinicals and a lot of free time on hand, I lost some momentum for blogging. I really appreciate that some of you are still coming back to read and chat with me.

Starting two weeks ago, everyone in the class got assigned clinicals. Some people go for two days a week, others for one. I go for one day of clinicals each week for 3 weeks. My C.I. is new to the role, and a little frazzled, but my group kept kissing her feet for helping out.

As in Med Surg, we follow a nurse and focus on assessing and giving medications for one of her patients. As I followed my nurse on her morning rounds, my first reaction was shock, then sadness. That day none of her patients’ parents were present, so after just a few minutes assessing each child, we left them lying alone in their bed. It’s bad enough to imagine adults lying around bored and lonely, but children … can you imagine them alone for hours at a time? As the morning bustle died down, the nurse and I were able to revisit the babies to cuddle them; the nurses can even put babies who are not on isolation precautions into a car seat and bring them out to the hallway and nurse’s station for more human interaction.

My patient during this first week was a 10 month-old boy with a GI problem. He was also developmentally delayed; at 10 months he still couldn’t sit up. He had a fairly flat affect, but was adorable. Imagine Stewie from Family Guy. I’ll call this kid Stewie, too. Another of my nurse’s patients was a 4 month-old who had been in the hospital since she was born. Because a part of her intestine is non-motile, she has two ostomy bags to drain digested food. I was told that it’s likely she will never be able to eat food.

Aside from feeling nervous about touching these beings that seem so incredibly fragile, the most challenging part of the day was trying not to feel pissed at Stewie’s mother for not being around. My nurse had told me that his mother rarely comes to see him. My initial reaction was to judge her.

Then I found some time to read Stewie’s social and family history, and everything fell into place. His mother is a teenager. She lives in a town far away from the hospital. She works nights at a low-wage job. She can’t afford to travel to the hospital or stay in a motel near the hospital. The father is a substance abuser and is out of the picture.

At only 10 months old, the child is going to be transferred to a pediatric skilled nursing facility for an indefinite time.

Pediatric nursing seems to see the sickest of the sick, as well as children from broken homes and children who have been neglected and maltreated. Pediatric nurses have to be skilled at not only working with kids, but also with their caregivers, and they have to be even more cautious about boundaries. I had suspected that I’m the type to get too emotionally involved with vulnerable children and unfortunately so far I’ve been right.