Maegan Taylor
Clinical 342
Mrs. Dutton
Clinical Journal #8
This week at Methodist Specialty and Transplant we reported to the floor at 0630. This week I was back on the Chemical Dependency floor. When we got to the floor the nurses were getting ready to take report from the night shift nurses. My nurse, Kelsey, took me into the exam room to get report from the nurses so that there weren’t any distractions from receiving/giving report. After this we walked around to each of the rooms and met her patients for the day and then went to look at their charts and morning medications. Kelsey let me know that it was very important to assess your patients before you pull meds so that you know if they are in need of any of their PRN medications. While she went through charts and medications and pulled her medications for her patients I helped the patients fill out their menus for the next day and handed out their breakfast trays. By the time all of the trays were gone, Kelsey was ready to give her patients their medications. We went to the patients that needed to have their vitals signs taken first, the patients on heart medications such as beta blockers, so that we could get their vitals into the system and give their medications all at once instead of having to come back to give one or two pills after talking to each of her patients. While rounding on each of the patients she did a short assessment where she asked about pain, last bowel movement, and also did her CWA and COW scale assessments on the qualifying patients. After passing medications I looked at a couple of patient charts to better understand why they were in the hospital until it was time to go to FLASH. Then when that was over we went back to the floor where the patients had their recreational therapy and their progressive group therapy. In both of these it was really about talking about why they were in there and connecting with what they wanted/needed to do when they were discharged.
I really enjoyed following Kelsey today. I liked that when she got report she made sure that there weren’t any distractions so that she could really focus on what the patients were there for and what the recommendations were for that patient from the night nurse. I know that in class we learned that we are only supposed to pass one patients med at a time, and that its bad practice to get all of our meds for all of our patients at once, but I don’t know that I’ve seen that in any of the hospitals that we have been in because they either organize the medications in drawers or have bags to put them in that are labeled with the patients names. I also liked that she was very informative like were supposed to be when giving medications to her patients. I think that of all of the nurses on the CD floor, Kelsey is by far the most thorough when meeting with her patients and doing their assessments. I was really appreciative that she also took the time to go through all of the medications that she was giving with me so that I could better understand why she was giving them to the patients. During groups the patients talked a lot about why they were there and it was interesting to see what other mental health problems that they had with their CD detox hat they were dealing with. For instance, one patient had bipolar disorder, and in order to cope with one of her breaks she used what she referred to as “bars”. There was also a man that was there that was having hallucinations both visual and auditory, whom was moving things and talking to people who weren’t there. This was really interesting to see because we have talked so much about people who may hear and see things that aren’t there in class but to see it is something that is much more shocking. I honestly was a little scared at first because I was thinking to myself “what if he goes into a manic phase and starts throwing things and getting physical” but the tech was very clear that it was almost just like he was sleep walking and that they don’t typically have problems with patients who are experiencing hallucinations.
When looking back on this clinical experience, I am really proud of myself for recognizing things that we have been taught that they do differently in the hospital such as passing meds. I think that if I do decide to go into mental health I cannot look at it from the scared point of view because being scared of the patients can lead to errors and mistakes. I think that when you have a patient that is undergoing detox and is experiencing things that we may not see all of the time, you have to be sensitive to that person and find a way to help them if you can, and keep an eye on them. I think that if I could repeat today, I would change how I approached the situation of the man having hallucinations. I didn’t mention it earlier but he had a bi-pap machine on to aid his breathing and he kept taking it off, and the tech asked us to put it back on if he took it off. But instead, I went and told her that he took it off so that she could put it back on. If I could go back and change that I would hope that I could realize that the man was not going to hurt me, but I could’ve helped him.
I think that in the future this experience will help me because I will know what is going on and how to deal with the situation. It will also help me to know that in any situation you have to take care of the task at hand and try not to let your personal feelings get in the way. I think that on one hand it was good that I was concerned about safety because that is the first thing that we are taught to assess when we enter a room, but I do not think that it should interfere with our practice if there isn’t really a safety issue. When we first came into this mental health clinical I didn’t think that we were really going to learn all that much because we weren’t able to do much, but this experience has really taught me what mental illnesses look like and how to respond in some of the situations we are going to have to deal with in the nursing profession.