Samantha Ford Journal 4 11/4/2011 As this semester is coming to a close I am finding that my previous perceptions about psych/mental health

nursing stand true. For example, in my first journal entry I talked about how I and I believe the rest of my clinical group quickly realized that psych nursing was almost entirely different than the types of nursing we had been exposed to before. We were used to learning various psychomotor technical skills such as starting an IV, administering medications, and in general being much more hands on in the process of caring for patients during our clinical experiences. As I thought in the beginning of my psych/mental health clinical, psych nursing is less about being able to perform those skills and more about being able to connect with your patient and help them through therapeutic conversation. Spending more time at Coleman has definitely proved my thoughts to be true. I have realized that at Coleman specifically, in general terms, psych nursing is much more laid back than what I originally thought. From what I have seen the nursing staff at Coleman does administer medications when patients cant do so themselves, but they dont do other things such as morning care, therapeutic programs or work with the families too much. The nurses still do normal nursing care, but on a smaller scale. As we have talked about in clinical there are positives and negatives to this lack of structure seen at Coleman, but after participating in a teaching activity to the clients of the Crisis and Options Programs at Colemans and having favorable results and I think that having some sort of structured program/group activity can be beneficial to the psych/mental health population. This is something that I will take with me into my future nursing career. I think that all types of patients in long-term care facilities who are physically able can benefit from some type of structured program or group activity. For example, in gerontological nursing, in the care of the

Samantha Ford Journal 4 11/4/2011 elderly, having some group activities scheduled would be beneficial to the social and mental health of the patients. As I talked about in my first journal entry, I was concerned about the idea that the majority of patients who have mental health issues such as schizophrenia or bipolar disorder dont seem to ever get completely well or recover. I have seen this proven to be true in that while at Coleman I would see many of the same people in the Crisis Unit each week who didnt seem to be doing better, but at the same time I see many of the same people each week in the Options Program who seem to be doing good and sometimes even better than before. I understand now that while a patient may regress, they can still get better with the help of an interdisciplinary team. I still think that this aspect of psych/mental health nursing might be too frustrating for me for a long term career, but I better see the value in psychological nursing. My personal and professional goals for this semester were as follows: 1. To review the basic anatomy and physiology of the brain and related systems to help with understanding how some of the mental illnesses work the way they do and why the symptoms are what they are ect. 2. To learn about the more common mental illnesses because I feel that this knowledge will be helpful to me regardless of the field of nursing that I go into. 3. To become effective at initiating and maintaining therapeutic conversation to ensure that when interacting with patients I am meeting the health care needs of the patient. Finally, 4. To become familiar with the common medications used in this field and their side effects. Goal number one, to review the basic anatomy and physiology of the brain and related systems to help with understanding how some of the mental illness work the way they do and

Samantha Ford Journal 4 11/4/2011 why the symptoms are what they are was accomplished through reading our textbook and through lecture in class. Just as in medical-surgical nursing, it is important to know the structure and function and anatomy and physiology so you can be more knowledgeable and be able to implement effective and quality care interventions and then evaluate them. Goal number two, which was to learn about the more common mental illnesses was also accomplished through the required readings and lectures in class, but more importantly was reinforced through observation in the Crisis and Options programs. Some of the common mental illnesses within Coleman that I saw were depression, bipolar disorder and schizophrenia. They are all different disorders but can often lead to a common result. I also learned that substance abuse can often be seen with these and other mental illnesses and that thoughts of suicide or suicidal ideation, attempted suicide and suicide can often be an issue with dealing with these mental illnesses. So I have learned that careful assessment of the patient, not just physically, is in order no matter what setting you are in. I will take this knowledge and the knowledge I gained regarding suicide assessment and information about substance abuse related treatment medications with me into my future career. Goal number three was to become effective at initiating and maintaining therapeutic conversation to ensure that when interacting with patients I am meeting the health care needs of the patient. I dont believe I have become effective at initiating and maintaining therapeutic conversation yet, but I do believe I am on my way to doing so. I used my therapeutic techniques self awareness during the IPR paper, which consisted of me specifically trying to initiate and maintain a therapeutic interaction with a patient and I later recorded the interaction and analyzed

Samantha Ford Journal 4 11/4/2011 it. I now understand how important it is to use therapeutic techniques to initiate a nurse-patient relationship and maintain a successful nurse-patient relationship and to ensure a beneficial interaction. I also see that this is a definite skill that requires experience and therefore practice. This is also a skill that I will take into all future nurse-patient relationships and maybe even some social relationships if needed and appropriate. Finally, goal number four was to become familiar with the common medications used in this field and their side effects. I feel that I accomplished this goal through the required readings, lectures in class and also through the once a week medication presentations in post conference at clinical. I also learned about common medications used through shadowing some of the nurses at Coleman and doing a medication profile on a patient in my biopsychosocial assessment paper. I feel that I accomplished almost all of my goals completely and if not completely to some degree. I also feel that along the way I have learned new valuable skills that I can take with me into my future nursing career regardless of the area I work in. One of these valuable skills that I have seen myself grow in is my self awareness. Before this clinical I had never really considered how others perceived me and how that would affect the interaction between us. I had never heard of the Johari Window Theory and when I first learned I was somewhat skeptical, but through personal experiences with clients at Coleman I see that it is important to be aware of your own thoughts, feelings and values because these can affect your behavior and therefore your interpersonal relationships. The Johari window theory is a good way to become aware of your inner self and I feel that I used the Johari window theory competently

Samantha Ford Journal 4 11/4/2011 to look at my own self awareness and to become more self aware throughout the semester and specifically in my first journal entry when I first started learning about this important concept. Self awareness is such an important concept to understand because as I said before being aware of your feelings, values and stereotypes ahead of time allows you to have a more therapeutic interaction with your patient. This is because these feelings, values and stereotypes can affect your behavior which can affect your interaction with the patient and then of course affect the patients behavior, which can affect the entire nurse-patient relationship and can cause transference, countertransference or resistance to occur. This can also unfortunately lead to a failed relationship and overall interaction which is not beneficial, but actually harmful to the patients treatment. Another concept to be aware of is the use of therapeutic techniques such as using open ended questions, silence and rephrasing to promote a beneficial and therapeutic interaction. These techniques encourage elaboration and are important ways to ensure the patient is working through their issues and problems themselves and that the nurse isnt doing it for them. The understanding of the concept of self awareness and the use of therapeutic techniques go hand in hand because they are both needed to ensure a therapeutic interaction and ultimately a beneficial relationship. These concepts along with the skills gained from accomplishing my personal and professional goals along with the clinical experience at Coleman will be useful to me in the future, I believe regardless of the setting, and will allow me as a nurse to give quality holistic care to any patients I may care for regardless of their diagnosis.

Samantha Ford Journal 4 11/4/2011