For this clinical rotation Emily and I were in the New Horizons building which housed the adolescent boys. We got to meet nurse Nancy right away, whch was a first for me. I was excited that we got to actually meet a nurse at the beginning instead of after or around lunch time. She talked with us about some of the diagnoses of the patients on the unit. We read a couple of charts and found that one of the boys was being discharged. He was supposed to have gone home on Thursday but his parents said they were unavailable and would pick him up on Saturday, so Nurse Nancy was making sure all the paperwork was updated and ready for the discharge on Saturday. She then got a phone call letting her know that she had a new admit to the unit so we all walked up to the administration building to start the process.
Emily and I watched as she got background information and past medical history from the mother. At the beginning of the process Emily and I were standing up against a wall listening and watching as the patient bounced around on the floor and tried to take meds from the mother's bag and started taking snacks out. He was presenting with a lot of ADHD symptoms. He then came up to me and untied my shoes, I asked him if he was going to tie my laces back up and he proceeded to tie my laces back. He then went and did the same thing to Emily. When he was done with tying up her laces he then grabbed on to my left leg and hugged my shin tightly. He then did the same thing to Emily and when he got tired of that he then tried to hold both of our lower legs at the same time, since we were standing so far apart he was unable to hold both of our legs at the same time so he just held on to my leg. Nancy then suggested we sit down in one of the chairs by the windows so we did. When we sat down the patient then same to sit on the floor next to the chair I was in. He wedged his head between the arm of the chair and my left leg and rested his face just above my knee and tried to hold my hand. Nurse Nancy told him he needed to respect my personal boundaries, he didn't move. As the patient got bored and moved around the room getting into things he shouldn't be touching or playing with his mother would just say "don't do that" but wasn't stern. My observation was that the mother did not set limits or rules or any kind of boundaries with the patient and was afraid to discipline him. When I mentioned that to Nurse Nancy, she said "I am so glad you noticed that, that was a great observation".
When Nurse Nancy finished the assessment she took Emily and me back to the nurses station in New Horizons. There she gave us the new patient's chart to read. It was very interesting to see a note in the chart from a physician that said "mother admits that she is inconsistent and does not discipline". It was then time for the boys to go to lunch so we went to the cafeteria where we ran into the boys from the week before, they remembered us so engaged in conversations with us. After the boys ate lunch we went to eat our own lunch and then it was time to go to the clinic to watch the physical assessment and mental evaluation. This didn't take too long since the mental health evaluation was done mostly as the patient and the NP student were walking to the clinic. The physical assessment was brief also since the patient had a complete physical 45 days prior. Was was interesting was watching this patient (which was the same one we saw Nurse Nancy assess in the morning) as he interacted with the boys from his unit as they were in line for lunch, he was defiant but was not bouncing around nor was he clingy and whining. He also acted differently when the male NP was evaluating him, he sat and listened to the questions and kept saying that he just needed to be outside all the time and his classes should be taught outside. To me this patient is used to getting his way and is not used to being told no and acts out negatively when he is told no. Looking back, I feel this is probably true of a lot of these patients and since the parents are not willing to say no more often or set boundaries they are also not willing to tolerate or parent the patients and feel the patients need medication or hospitalization to make them better.
Today I felt sad/frustrated when I realized that this patient was probably just acting out because his mother doesn't feel like parenting and would rather send him off for someone else to fix. In the future I feel like I can use this knowledge to help me better understand children in mental health facilities and not think that they are all suffering from a mental illness.