Derek Cantu
NURS 342-Mental Health
Mental Health Clinical Journal (March 11, 2016)
Today was the first day of the clinical switch between Methodist Transplant and Specialty and San Marcos Treatment Center. The day started at 0830 where the group met in the administration building and then went to orientation. After orientation, Kenzie Cunningham and I were assigned to Springhill 1 East and West to the boys’ side. On this particular unit, we sat in the nurse’s office and looked at a few charts then after that just observed what the nurse did which did not include too much. The day involved us also going to the cafeteria for lunch and the clinic as well.
After reviewing the clinical day, I felt like not much took place and we were very limited on what we could observe and partake in. The day started by Kenzie and I looking at patients’ charts for the first hour and then after that we had read all about we could take. While doing this, the two of us talked and compared to some extent about the different things in the charts. One thing I noticed right away was that the center is still based by doing everything with paper. The San Marcos Treatment Center still has paper charts and have not updated to everything electronically like some health care systems. Also their Pixus was not up to date and they still did it all by hand by comparing a patient’s chart to the medicine. A thing I learned about their medication system was that it needs to be cleared three times and that the nurse and someone else must sign off that the medication was given. If I had to do the system that the nurses were required to do, I would be worried to some extent just because there is not a computer automatically withdrawing the medication for you. Another experience I got to receive at clinical today was going to the clinic for two assessments and one psych evaluation. The first child was seven years old and had just been admitted the night before. He needed an abbreviated assessment unless the Nurse Practitioner felt otherwise. The child was cooperative with the NP until it came to him receiving a PPD shot. The child immediately burst into tears and did not want any part of the PPD shot. One thing I found interesting was the NP did not force the child to receive the shot, she did offer a snack if the child would allow her to give it to him. I found that the way the NP approached the situation was very professional until she told the child that he would get it a lot worse later because it was not her giving it to him. This caused the child to break out even louder into tears because he did not like needles. All the child wanted to do was talk to his mom first about the shot but did tell the NP that he did not give consent to receive the shot. This took me by surprised because not most children know that, but he did and he was sure to voice it. When we got back, I read over the child’s chart and it honestly amazed me. I would have never thought that a kid like that could have been so serious by some of the reasons he was at San Marcos Treatment Center. I would have never imagined a kid that size to be so hostile and threatening. I will get more into this in the next paragraph. After this assessment, Kenzie and I got to see another one that involved a psych assessment as well. This patient was also new as well and was a very interesting to say the least. She was very aggressive when she talked to the Psych NP and would not stop moving her legs. When she got very mad, the leg movement would increase. Finally, she got very aggressive and the Psych NP had to stop and calm the patient down. He used a therapeutic technique of having the girl stop moving her feet and close her eyes and take a deep breath. This worked and he continued on with the evaluation, it was not very successful. The girl did not say much, but when she did she became very aggressive and just wanted to get out of the treatment center. Another moment I found very unique was getting to attend the honor ceremony today. I was very observant at this event because all the kids were in the gymnasium. The kids were very excited to receive this honor even for the slightest things. Like from a personal standpoint of the past, people who receive A and B Honor roll in public schools do not get as excited for that honor as the kids at the San Marcos Treatment Center. The excitement that each kid displayed was very sentimental to them and you knew it made the kids’ day by them receiving the honors. Also, the friends of the individual would also get very excited for their peers and be overjoyed with excitement. You do not see this much in today’s society in public schools. This is one thing that I still think about as I write my journal. Every child had a different reaction and by them receiving the support they did only helped. Both the boys and the girls were very loud with cheers and seeing that shows the support that each group gives to their members. Overall, the day did not involve much, but what I was able to see had a lot of interpretation and analysis that could be done. If I could repeat today, I would change how I interacted with the kids at lunch. I will get more involved next time and talk to them more. I wish we could have gotten more involved with the children, but due to the center rules it is not really allowed.
When looking back on the day, I felt like it was interesting to see how some kids could be diagnosed with a mental health problem. I would have never imagined that children this young could have such serious issues and aggression. Being around the children at the center give you a different outlook at life and worries you in some aspect. I had in the back of my mind that this worries me when I plan on having children, but then I would change what I was thinking because it is too early for me to be thinking about having kids in life. Being the religious person that I am, I had to alter my thinking to realize that everything has a greater purpose and there is a reason for all of this even if it is not prominent at the time. The thoughts I had from clinical were basically that how could children so young and innocent be so sick. The children here come from all over and some have very serious issues. The boys that were on the floor today had some very vulgar words and it just makes you think of how did they learn these words. Also, I thought about what issues or events took place in this children’s’ lives that could have caused this altered thinking. A lot events could have taken place on the outside that caused the children to have the issues they do and develop as shown with the mental issues. This clinical taught me that not everybody is the same and needs patient centered care based off of their issues. It is very important that each child receives the proper help in order for them to have a future and success in overcome their problem. For them to be able to go out in society, they must be able to control their instincts and thoughts.
The knowledge I gained today will be useful for me especially if I plan on working in the ER. There could be some cases when I see pediatric patients and will have to know how to assess and approach them. I felt like I got somewhat of an idea of that by being in the assessments of the new admits. I will have to be able to communicate with these patients and know when I am not successful how to re-ask the question and how to calm them down if needed. All types of patients will come in and in order for me to figure out what is wrong I will need to be ready to assess even if it involves their mental ability. In the future, I can take what I am learning now and implement it in ways I feel is better and more beneficial to the patient centered care.