third rotation.

The third and final rotation has begun! This clinical has to do with mental health, and I am currently working in a acute care/lock-down psychiatric ward. Joy? I think so too.

I already knew going in that mental health isn't exactly my cup of tea, but I was motivated to make the best of f it. We were given the option to choose which unit we'd like work on: 2 rehabilitation options, and 1 lock-down unit. Seeing how I like a challenge, I jumped all over the last choice.

My clientele is different than anything I've other experienced - the patients have schizophrenia, mania, depression, paranoia, personality disorders, etc etc. In addition, their illness have exacerbated either by not taking their medication, self-medicating with ETOH/drugs, or a combination of both. All that to say, this unit is a little world in itself.

Only 2 students can be on the unit, so I feel privileged to work in such an intense/potentially dangerous environment. It is a 10-bed unit, but the primary goal of maintain safety can be challenging. The unit protocol takes some getting used to: counting plastic cutlery on returning lunch/dinner trays, taking away shoe laces & belts, patient rounds every 15 mins, bullet-proof glass surrounding the nursing station, routine checks from the security guards, etc.... it could be compared to a jail, I suppose!

Unfortunately, I'm having a hard time connecting with my Instructor. I can't get a 'sense' of how I am doing, and often his blank stares and silence leave me confused as to what I should do. It's odd. He's odd. Anyways. This unit has had no lack of surprises! I hope it makes the last 2 1/2 weeks go by quickly.

Cheers!
D.

second rotation: FIN!

Well, almost finished. Tonight is my final shift!

And of course, in typical karma fashion, I am caring for the toughest patient on my last two shifts.

Mr. Patient is going through ETOH (and suspected drug) withdrawal, and thinks he's being imprisoned against his will in a camp somewhere. So he screams bloody murder on regular intervals, bites out his IV, and yanks on his arm restraints so hard that we've replaced them twice. He yells at everyone for a large knife or a lighter, begs for a Tim Hortons coffee, and threatens to call his big brother. All while receiving sedatives and morphine every 30 minutes. Fun? I think so too.

I have never been sworn at so much in my life - I'm certainly building a couple new layers of thick skin!! I don't mind being sworn at, however I get really agitated when his expletives cause the visitors of the other patient in the room to escort their children outside. Now that's unacceptable. He was rather surprised when his 'Barbie-doll nurse' (yes, that's what he calls me!!) told him to shut-up on the spot. Swearing in front of children is NOT cool.

Dealing with someone in this type of mental state is exhausting. The constant yelling, swearing, attempting to escape... I have a deeper respect for those who deal with this daily: cops, psychiatric nurses, etc. Props to you. I don't know if it is the withdrawal that is making him act out in such a way, or if he is consciously doing this. It's really challenging to care for him as a person - making sure he is comfortable, having ice chips at all times, assessing his restraints, changing his bedding - while being told to f--- off and being called a variety of unpleasant things. Certainly a challenge.

And it's funny to think about how we've been taught in school to communicate with difficult patients. Let them get out their anger. Actively listen. Sympathize. Collaborate. Compromise. Communicate. Yada yada yada. Really, folks? That entire Communication class is of ZERO help right now. ZERO!

Besides all of that, I do like having him as my patient - my Instructor gave me this assignment (plus 2 others!) because she thinks I can handle it, knowing full-well what kind of shift I would have. I appreciate the challenge, it's making me think creatively and quickly to make sure that not only my patient, but myself and other nurses stay safe while caring for him. It's certainly never a dull moment!

D.