The rotation I'm completing right now in nursing school is psych, which I hear is one of the least common areas of nursing that students plan on specializing in...When we started our lectures and were preparing for our first clinical, I was nervous. What would I say, and what would I see? Would there be violence? I had no idea what to expect.
It quickly became apparent that through therapeutic communication, nurses and physicians or psychiatrists can quickly build a trusting relationship with these patients, and help them reflect...or begin to process. It was intimidating at first, but honestly it's all about being real. They are real people, just like us! It wasn't so scary after that "real"ization.
The nursing process looks very different in a psych environment - most all of the interventions have to do with communicating. It's almost easier to learn a skill like starting an IV line, with a very specific process. With communicating, it's all spur of the moment, by the seat of your pants. But in a way, even more rewarding! By planting the seeds of hope, we can see the wheels start to turn and really get a sense that we're helping our client in an important way.
Early in this rotation I learned about ECT - electroconvulsive therapy. I had honestly never really heard of it before, and was shocked to see that it was on our report for almost half of the patients on the unit that first clinical. What in the world? I started asking questions and doing research...and learned that this treatment has been used for nearly 70 years, and while we don't really know how or why it works, it DOES. It is used primarily in patients with severe depression, and depression that is unresponsive to medication. One of my clinical instructors shared that she's seen patients so depressed that they were unable to eat or care for themselves, almost comatose, and after one treatment of ECT were up, walking, eating, and talking. While the treatment needs to be repeated every so often, it does seem to be very effective for these patients.
When first used, the ECT would actually induce real seizures, and this was extremely painful for the patients. Not fun! But with the advancement of medicine and use of various meds, we now do the procedure in the OR under sedation and is not traumatic for the patient at all. In fact, it only takes about 30 seconds for the whole treatment. I believe they are intubated to protect the airway, which would take longer than the actual treatment itself.
ECT has been controversial lately, as the safety of this procedure has been questioned. The APNA's statement on ECT concludes the following: "It is the position of the American Psychiatric Nurses Association that ECT is a proven therapy and that further clinical trials are not necessary to establish its safety and efficacy. APNA urges the FDA to classify these devices in an appropriate manner to assure that patients have access to ECT while at the same time assuring that ECT devices function safely and in manner intended. APNA believes that ECT operated by properly trained professionals and in circumstances of medical necessity offers patients with severe depression an option that would otherwise be unavailable."
Overall, this rotation has been eye-opening. I've learned so many skills in working with folks that can help not only with patients, but in all of my relationships! I'm more patient with my kids and husband, and even more aware of my body language and expressions every day. I'm especially intrigued by substance abuse and recovery, which has just been covered at the end of the course. I'm thankful for our exposure in the various clinical sites during this course, and look forward to our next rotation...on to OB!
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