Clinical Journal 3
This week’s clinical was very interactive with the students at the facility and with facility staff itself, as I was able to interact with the nurse-practitioner and ropes therapists. I was able to observe a rope exercise be done by one of the units while facilitated by a ropes therapist, which not only exceeded my expectations and understanding but challenged me as well. I enjoyed interacting with the children within the unit and viewing group therapy because it provided a highly valued learning experience. Beginning clinical was different this week because I felt more at ease with interacting with the children this time then before because I was not going to be doing it in a lab coat. Not having to be in the lab coat I felt less constricted, physically and emotionally because the children were not associating me as a doctor or someone in an authoritative position but someone just starting a conversation. I felt that this wardrobe change allowed me to interact with a younger age group that typically associates lab coats with doctors and allowed me to build trust quicker than being in the normal attire.
I was able to interact with an individual that showed various symptoms of explosive anger and manipulation. I first interacted with the individual who was sitting alone in the activity area on the unit while waiting to leave for their lunch. This individual has spent almost 3 years at the facility which was evident with his knowledge about codes and abbreviations used to classify members. He explained to me the various codes (green, yellow and blue) he had witnessed and been a part of during his stay and what they meant, it was interesting to hear a child discuss facility codes as if they were days of the week. In a conversation between the individual, Mrs. Sharp and myself as he explained two abbreviations that he had been classified. He stated the abbreviations and then explained that one was for self-harm and the other for anger, it is evident that spending so much time at the facility he has been able to pick up on higher level words grander than a 5th grade level. Observing this individual in group therapy in the afternoon I noticed a change in domineer, he was no longer quiet and choosy with his words but was just acting out and choosing his actions. All of the boys were in the open area waiting for group therapy to begin and while he was there he interacted harshly with others, by shoulder “bumping” a more reserved boy repeatedly and standing on top of the coloring table to kick the window repeatedly. Seeing his change in behavior with physical interactions with others and himself was interesting compared to the words previously exchanged over a lunch table. I waited to see if a staff would intervene his actions but no one did for quite some time. I am not sure if the late response from staff occurred out of a plan of care in place or if the staff had other distractions occurring simultaneously. The thing I did best when interacting with this individual was reserve my emotions and remain calm, I did this the best when I was sitting at the coloring table and the individual jumped on top of it, kicking the plastic window pane. I was immediately uncomfortable being in such a disadvantage point because I was concerned about being kicked in the face. I remained calm as he looked at me for a reaction, received none and then turned away to continue to kick the window. After remaining calm and not reacting, I was then able to stand up and walk away from the situation.
Spending time in the clinic with the nurse practitioner was educational and a little boring, because it was a slow day for admissions. The nurse practitioner explained the two different charts used with admissions to Luis and myself, one chart had multiple boxes to check and was a more thorough assessment as compared to the other that consisted of checking vitals, listening to the heart and lungs and administering a PDP test. I was able to observe an admission assessment of a female going to Spring Hill 2, whose domineer was nervous despite her interactions with everyone in the room being bubbly and bright. I found it very interesting when the patient showed extreme stress with the small needle used for the skin test and stated “I know I have my past with razors but I cannot deal with needles at all”. My analysis of this interaction was the importance of mental attitude. In this scenario it was thought-provoking that an individual that had done self- harm with sharp objects, was terrified of another similar object that was being used for a medical reason. Once again I was reminded of the importance of mental health and its impact on a person’s life. Another valuable interaction I was able to witness at clinical was the ropes course. The ropes therapists explained that by having the children climb up to new heights it challenged their own self confidence and ability but as wel,l as developed trust and team skills. After watching the process of the course I agreed with the statement, a main skill that is used is the ability to perform skills with others as well as individually. There were various positions where a child was able to perform a skill individually but understand that they contributed the success of the other person climbing. I found myself not only nervous for the individuals but for myself because I wanted them to be successful and push themselves to complete the task but also knew I would be nervous to do the exact same.
I value this clinical in a lot of different ways compared to my med-surge clinical because of the difference in environment. At this clinical I am learning by listening and observing a lot rather than practicing skills, which gives me the ability to value client care as a whole. Client care is not limited to the skills and assessments performed but can be done through words, silence and simple gestures. As my last clinical day at this treatment center draws near, I hope to be able to get enough information on a patient next week to do a care plan. I plan on ending my time at this clinical site with not only new appreciation for mental health but as well as practice of creating a care plan for a specific patient.