Derek Cantu
NURS 342-Mental Health
Mental Health Journal (4/22/2016)
The clinical rotation for mental health involved being on the Geriatric floor of the Methodist Transplant and Specialty Hospital. Nursing students that were assigned to this floor included Breanna Herrera, Louis Rodriguez, and myself. On this particular day, we were all working on the Geriatric floor. The clinical day started at 0630 where Breanna and I went up to the fourth floor of Methodist Specialty and Transplant. The clinical day took place on Friday, April 22, 2016. The day involved all three of us doing simple task that were needed throughout the day, doing vital signs as needed, helping with round checks, and sitting in and socializing with the patients. We helped out the registered nurses and tech any way we could and they helped get us involved in any way they could while we were on the floor. This day involved communication with the patients which was really beneficial.
The clinical day went by really fast. There were 8-10 patients on the floor today and a lot of nursing staff so for the most the part we were able to provide one on one care if any of the patients needed it. The day started by all the patients eating breakfast in the common room. After they ate, a registered nurse came in and went over the daily goals and plans for the floor. The main thing she emphasized was fall risk. She got the patients to interacts with her and asked them what were some of the reasons for a fall risk. I had not seen this meeting done on any other floor at all while being at Methodist Specialty and Transplant. It was a good overview for the day because it gave the patients and idea on how to seek help for anything and not be afraid to ask for help. Two patients had been admitted overnight which I was able to talk to one of them after breakfast. One of the reasons I was able to talk to her was that I had to monitor her because all her vitals were really low. Upon taking her medications, she had a low blood pressure and heart rate. When she was administered her medications, her vitals continued to drop when they were checked 30 minutes later. At that time the patient had become light headed and dizziness and the nurse brought her to me for me to keep an eye on her for the next 30-45 minutes. This is one thing we learned not in Mental Health but our Nursing Health Assessment class. As nurses we are required to always check vitals when administering medications to see if we need to withhold any medication and that is exactly what the nurse did. She did not withhold any medications but she checked to make sure that none of them lowered her vitals more than what they already were. Also she reassessed the patient to see if the vital signs changed and they did which prompted the nurse to ask the patient questions. This is when she was assigned to me. She was not allowed to go anywhere by herself for the next 30 minutes unless I was with her and she was not allowed to walk due to a fall risk. The reason she was there was because she had a thought about killing herself. This was the second time she has had an admission at the hospital. When I asked about what triggered her thought she could not give me a clear reason nor explanation. She was waiting to see the doctor which could have helped with the situation. Another patient which I spent a lot of time with as well was very interesting. She could talk for long periods and not hesitate once. I was not able to look at her charts but from what she was saying she feared she was going to die by the AC or heater. Her method was that someone was going to try and kill her in her sleep by either turning the AC low or high to make it cold or hot. By doing this, she claimed that her body would stop working and that she would not be able to move or defend herself. She believed somebody was out to get her and she had even made a comment that the night nurses were going to harm her. The interesting moment of the day with her was when the nurse tried giving her the medications she was supposed to take for the day. According to what we are taught in class, if the patient refuses medications you do not force them to take them. You educate them on what the medications do and clarify how they can help the patient. When the patient continues to deny then you withhold the medication and document that the patient denied all medications. The nurse did exactly what we are taught in class. She told the patient all the medications she had to take and the patient argued with her which is when the nurse told her she did not have to take the medication if she didn’t want to. The patient’s reasoning was that the medication was not what she takes at home so therefore it was wrong. If the medication was not the right color, size or dose she was not going to take it. At this point, the nurse told her she was not required to take the medications. The patient did not take the medication so the nurse documented that the patient refused medications. Also what did not help this patient was she became aggressive when someone tried to tell her something otherwise. A trigger for her was when chairs were dragged on the floor. She was a very interesting patient that could talk for hour on end. Overall the nurse administering medications did a good job on applying things we have been taught in class and implementing them into her practice.
When looking back I recognized that one nurse was real involved with the patients while the other two did not participate much. You knew which one the patients liked and who got involved the most because the patients remembered this particular nurse’s name. They knew who got involved with them and helped them out numerous times throughout the day. I want to be the nurse that the patients enjoy and remember who I am because I was so involved with them. Sitting back and listening to these patients’ life story is really unique of how each one is different. Looking back, the stories they told seem very realistic, but in the back of my mind I have to consider what to believe and what not to believe. Being able to use therapeutic communication is something that I am gaining more confidence in the more I do. Talking with patients was the main focus for all of us today. Being on the geriatric floor, many of the patients want to talk to you and all you can really do is sit there and listen. One patient today talked for a long time to Breanna and I. I eventually took a break because she had been talking for about an hour. Looking back to day one, I had no idea really how to respond and ask questions, but now I am very conformable talking to patients. Reflecting back on this clinical day, I will say that not many things took place today, but it was enough to give me items to discuss. The events were small, but big enough to teach me something. Being involved today with events helped by finishing off the clinical rotation strong.
I know I have said this before, but it will be critical that I learn how to communicate with these patients because if I plan on continuing my career path I will get numerous patients with some mental disabilities. I know that my future will entail many different types of patients and I must be ready for whatever comes through the door. The knowledge I learn each clinical is helping me further my nursing skills to be diverse and ready to adapt to any patient I have to see or help. Also, I want to be a nurse that is a patient advocate and will do all I can for my patients. Every patient is unique in their very own way which is why I need to get to know them. I will make it a priority for all my patients to remember my name. In the future, I plan on using the skills I learned today to find ways to improve and implement them into my nursing career from here on out. I have analyzed different things while being on the floor and I will do all I can in order to help my patients receive the best care they possibly can. I will have to follow all items I am taught in class because today was a clear example that a lot of the material will be put to use. All things I learn in class and clinical only further my knowledge which I can only hope will make me a great nurse one day.