Neuro-Psych Nursing


I’ve finished my first few days of clinicals in “the looney bin”, which is exactly how a patient described his/her surroundings.

As I have mentioned in previous postings, patient privacy is of utmost importance. It’s not only due to the lovely laws collectively called “HIPPA” by all healthcare employees (including housekeeping and maintenance workers) that I stray from specifics, but also because behavioral and mental health diagnoses are sensitive topics.

One thing I do want to get out of your mind is that being a psych nurse is nothing like what you would see on the movie A Beautiful Mind or other show where barbaric treatments are implemented. So far, I haven’t seen or heard from other nursing students that syringes of sedatives are jammed into patients nor disengagement of staff from patients. I have yet to see a room on the unit as stark as in the movie Girl, Interrupted. There aren’t heavy decorations of any kind, but neither is there a sterility to the environment either.

My first day on a Psych unit was actually last week. My fellow students and I got to see various units in the entire department – the one I observed was subdued as it was lunch. We were just supposed to see how the environment (milieu) was set-up. What rules and regulations were in the unit for safety of the patients and staff? What activities were offered to the patients for their day? What was the goal for the patients in that unit?

The past two days, I was actually on the unit as a student nurse. With no instructor always present, I was not allowed to pass meds (not like there were really that many anyway.) Mostly, I observed the patients, attempted to talk with one, and observed the staff in their work and interactions. What I didn’t expect was my lovely vasovagal respons to kick in – again – for the silliest reason.

My particular patient was considering ECT (Electroconvulsive Therapy) for treatment. Before engaging in a conversation with my patient in regards to his/her thoughts about consenting for treatment, I decided to watch the video about ECT that the unit provides as information.

I found the video helpful and a great resource. My adrenal glands did not.

I don’t know if it was seeing an actual patient rather than an actor portraying a patient that set me off. Or maybe seeing an outpatient procedure with IV lines and knowing that regardless of the muscle relaxants and anesthetic, the purpose of the shock was to trigger a seizure. Whatever it was, I felt “the first wave.”

Crap. Seriously, I’m sitting down! I’m not in the room with the person! There’s no blood! GAH!

I’m fascinated by the video, but my adrenaline refuses to calm down. A second wave. Dangit! I know I’m a little tired, but I had breakfast and coffee. I start moving my feet, then bouncing my legs. I get down on the floor and start moving my legs. This helps a bit, but then I decide to sit back in my chair right as my instructor comes into the room. I attempt to tough it out and tell her what I’ve learned so far from the video.

Then, I cave.

Sorry I’m moving my foot around so much. I have a highly developed vasovagal response, and I don’t know what’s bothering me about this right now, but it is kicking in.

We talk through it some, then I request permission to lay on the floor and move my legs around. “Do your thing, you’re fine!” My instructor is a pretty cool chic; I hope that I can be as knowledgeable and passionate about my future nursing specialty as she is. I don’t give a detailed history of my vagal responses, just that it first happened when I was 14 and that I was “that nursing student” who passed out and spent her first clinical day in the ER.

And since my instructor is a practicing Psych nurse herself, she was encouraging me to do whatever I needed to bring my anxiety down. I shared with her that I was working with a counselor on campus as a prophylaxis for depression and that we had been working on self-care. Thankfully, since I was able to lay on the floor this time and pump my legs, I returned to “normal” in about 5 minutes.

I think once I feel the first few waves, there is a secondary anxiety of NOT wanting to experience an “episode” again. Yay – anxiety about anxiety. So, while frustrating, at least I didn’t end up in the ER again and have the unit wonder what the heck was wrong with the student nurse.

After that, I could get on with trying to converse with patients who had mood disorders and seeing the staff de-escalate threatening patients. I can’t wait until I get some time on the more intense wards or crisis units.

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2 Comments (+add yours?)

  1. Stewie
    Jan 24, 2013 @ 23:23:41

    Oh, btw, did you get the nursing position?

    Reply

  2. Stewie
    Jan 24, 2013 @ 23:22:28

    NOOOOO! Not again. Maybe you should just take up jogging in place 🙂 Anything to help the situation. I’m not sure that I would be able to work in a psych unit. If I am questioning my own sanity, how could I?!! You go girl!

    Reply

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