This week we had our first clinical rotation at San Marcos Treatment Center. Everyone was paired up with a partner, except for one student (me) since there are an odd number of us in the group and taken to a different building/age group to observe. Since I was the only not with a partner, I got to pair up with the CNC. She is the nurse directly under the nurse supervisor at the facility. At the time I got to the building where the CNC was stationed the boys (patients) she was in charge of caring for were in the gym playing basketball. We sat in the nurses station talking about her nursing career until it was time to administer medication to two of the patients. We both walked down to the gym and I watched as she asked the patient his name and date of birth and looked at the information she had on the patient to make sure he was getting the medication he was supposed to take. Then I watched as she administered the tylenol to the second patient that had fallen on the gym floor during the basketball game and hurt his back. We got to hang around in the gym with the patients for about 10 minutes. During that time I spoke to a few of the patients that were not playing basketball and were just sitting against the wall or some that were sitting on the bleachers. The boys sitting against the wall said that they were just not the sports playing types and that is why they were just sitting against the wall.
I found it very interesting that this facility does not use a pxis system to control or monitor the medications. The CNC showed me the med room in the building she was stationed in and it was a little closet that held plastic pencil boxes that had hand written labels with the patients names on them. She said inside each pencil box is the patients medications. The nurses station remained closed and locked the entire time even when the patients were not in the building. As I was going through the patients charts reading some of the diagnoses they had I understood why the door had to remain shut and locked at all times.
The CNC and I then went to the cafeteria and mingled with a couple of the patients that were eating their lunch. One of the patients was pretty interesting. He was no longer required to be escorted around the campus and even had a job working in the gardens on the campus. He will be 18 in March and has been at the facility for five years. The CNC said that he was brought to the facility from Puerto Rico five years ago because was very involved or ran one the drug rings there. He didn't speak any English when he first arrived. I tried to look at his referral paperwork but it was all in Spanish so I could not read it. He will be released when they are able to find him a place to live and a job he can survive off of. The patient hopes to have his family fly to the U.S. and live with him once he gets his own place. The experience with this patient has taught me that not all of the patients in a psychiatric facility are bad people.
I really enjoyed my experience on this day at the facility and I hope to have further interactions with more patients. On this day, I recognized that my therapeutic communication skills were effective when one of the patients in the gym was telling me that he was not able to play basketball with the others because his foot hurt. I used open ended questions and asked the patient where it hurt and how he hurt it. He said that he hurt his foot and his wrist on one of the times he ran away from home. In the future I hope to use more of the therapeutic communication skills and get my patients to open up more to me and use that as a tool to help me treat them.