April 8th was our second-to-last day of clinical experience for the semester. On this occasion I was assigned to the “geriatric psych” floor at Methodist TSP. Most of the student sin my clinical group were observing ECT therapy that morning, so I was the only student nurse on the floor, together with two RNs and two techs.
When I first entered the unit the nurses were meeting with the nurse from the previous shift. They were anticipating having only one tech that day and were complaining about how difficult it was to manage between a male tech (“if he can’t do female per-care he’s no use to me!”) and the complicated new bed alarm system. So, I made a particular effort to be useful in any way I could. I was able to realize the RN role by being part of the team and volunteering for whatever was needed. I felt fairly confident that I could do whatever patient care activities they needed—and be at least as useful as a tech. One “job” I was assigned was simply to be with the patients in the multipurpose/dining room. Because of the high fall risk of several of the patients it was important that they never be left alone in there. On previous clinical experiences this semester I spent most of my time in the nurse’s station. On this day, however, I was with the patients for the whole day—except for one visit to the nurses’ station to learn more about a patient with memory loss. For the first time I was present while the patients at their breakfasts, and saw the daily assessments they filled out. I also got to see the group teaching performed by the RN to orient the patients and inform them about how to prevent falls. I had conversations with a number of patients, assisted patients with mobility or other impairments, and participated in the occupational therapy and then observed the recreational therapy group.
I was surprised to discover that the patients were (for the most part) functioning at a much higher level than I had anticipated. I knew that other nursing students assigned to this floor had inserted Foleys, and that the floor was equipped with special beds, so I was expecting to encounter frail, elderly patients who were bed-bound and incontinent. Instead, it turned out that most of the patients were about the age of my parents, and many were not yet retired. I was also very surprised to discover how well educated they were. The group of patients I met included a retired nurse, a retired physician, a college professor and playwright, and another woman who mentioned having a degree in English. As far as I could determine, most of these patients had been admitted due to suicidal ideation, suicide attempts, or due to their own fear of self-harm. This led me to wonder if highly educated people are somehow at higher risk for depression or suicide. (Certainly when I was in graduate school I remember a lot of classmates mentioning therapists, antidepressants, and medication for anxiety). Our textbook asserts that “low socioeconomic status” is a risk factor for depression and doesn’t say anything about educational attainment (Halter, 2014, p. 253). That left me wondering whether and why this population would be so different from the general population with depression or SI. The patients I met were also very open about discussing their mental health treatment and symptoms and were not nearly as withdrawn as I would have expected. In a previous clinical experience unrelated to mental health I had encountered a patient having a panic attack, and I had found that very unpleasant to deal with. On this occasion, though, I didn’t experience any such aversion.
One thing about this experience that might impact my future practice would be the importance of adjusting patient teaching to the needs of the patient. It was jarring to switch from a discussion about graduate programs and philosophers with the patients one minute, then have the RN ask them whether they knew the date or what city we were in (yes, they all were alert and oriented). I think patient-centered care should entail a little bit more flexibility. Of course it’s important to fully assess and educate patients, but it is more effective and better for building rapport if it can be done in a way that responds directly to their needs.