Clinical 342 week 1
So we began the morning at Methodist Specialty and Transplant hospital, I was excited to be in a new location and seeing new patients with different diagnoses. I was also I excited to be back at a hospital and I was really wishing to go get into the OR and see some transplant surgeries rather than head to the psychiatric units, but someday I’ll get in there. Anyways we had our brief orientation in the cafeteria before heading up to the floor and meeting with the nurse director Mrs. D. She then went into detail about each unit. There was Level One adult, it’s also known as the psychiatric ICU. This is where all of those patients who “don’t play well with others go”, here we would see patients with schizophrenia, manic bipolar disorder, things like that. The other unit is a Level Two adult unit, it is more for the depressive bipolar patients and major depressive patients. These patients are less “dangerous” for the most part. The next unit is the Chemical and Substance Abuse unit, a lot of patient’s after detox are here trying to get stable enough to leave the hospital and be on their own. This is a frequent fliers unit, a lot of the patients have been admitted several times, they just keep relapsing. And the final unit is the Geriatric Unit, lots of Sundowners Syndrome and disorders that are mainly among the older adult population. I was assigned the Level One unit, it’s actually the unit I preferred. My classmate and I started our day listening to the FLASH conference, which helped give us an idea of which patient’s we wanted to meet. The staff then showed us around the unit introduced us to the patient’s on each side and then we got to go sit into a male patients therapy session and the women’s group session. The men and women are split up so we went and say the male patient’s therapy session in the group room and the women’s was held in their group room. After attending the therapy sessions we went back and looked through charts, especially some of the patients we had heard about in FLASH. After we went to lunch and came back I spent the majority of my time looking through a particularly fascinating patient’s chart. He is a male, 24 years old and schizophrenic. He was actually the patient that I had listened in during his therapy session. I read through his chart thoroughly, I analyzed his drawings that were in his chart. That really concluded my day, I was unable to attend post-conference so I headed out after reading his chart.
The therapy sessions were very interesting, the male patient was very open and talkative, whereas the group therapy with the women was quiet and I wasn’t sure if any of them were actually paying attention. It was probably easier for the male patient to open up and talk to the therapist because it was a more therapeutic setting. It was just the patient and therapist all the questions were directed to him, he was able to speak openly and freely because it was truly his time to spend with her. Unlike the women’s group therapy, even though there were only 3 different women in the room, none of them seemed interested in the topic of the day, relaxation techniques. The therapist tried to get them to deep breath, use guided imagery, and even muscle tensing and relaxing therapies, but it appeared to me that none of the patients were actually participating. The highlight of my day was being able to look up the patient that I had observed in therapy. He was the first schizophrenic patient that I had ever seen and it was very fascinating to me. His chart revealed many different obsessions he had. One being female anatomy and sex. The second was his love for his stepsister. And third a very strange relationship he had with his mother. There were also statements about curing AIDS/HIV. He had actually mentioned that he was discovering the cure for HIV/AIDS during his therapy session, he had been storing bottle of his urine and saliva for the past 3 months and he was going to cure AIDS/HIV with his urine and saliva somehow. I was very shocked, I had never in my life seen anything like what he was drawing in the charts or heard anything like the words he was speaking, it was honestly like something from a movie! Today my knowledge of growth and development helped me when I was reading through this patient’s chart and realized that a lot of what he was saying really sounded child-like. He would write about how much he loved his mommy, both his handwriting skill, spelling level, and his choice of words were very child-like. I was reminded of the stages of growth and development by Erickson and this patient reminded me of a 6 year old. The stages important up to the age of 6 are trust vs. mistrust, autonomy vs. shame & doubt, and initiative vs. inferiority, the patient seemed to be undeveloped in all of these areas.
When looking back at the patient I realized something really important, this was his reality. The fact he was trying to find the cure for AIDS/HIV by using his urine and saliva, was real for him. We all can look at the patients like they are crazy for saying what they are saying but at the end of the day, that’s all the know, its not crazy to them because that’s the reality in which they are living. It made me realize how scared these people with schizophrenia must be, living with voices running through their head and not being able to control their own thoughts. Being able to observe a schizophrenic patient was very interesting and even though we learn about these disorders in class it’s nothing as compared to meeting with the real person.
I really hope to be able to talk with patients next week, I really didn’t get to do that this week, which was disappointing because talking with patients is one of my favorite parts of nursing. I hope to never forget to have empathy for people with mental illness. It’s just as important to treat a psychiatric patient the way you would any other patient who doesn’t have a mental illness. I was reminded today that you should never question a schizophrenic patient’s delusions. The therapist was really excellent in asking the patient questions but not questioning his delusions. As I was listening to her interview I was able to think about ways that could talk to patients someday as well.