Although theoretical preparation clearly is important, there is no substitute for the learning that takes place during clinical experiences. Clinical experience is acknowledged as being the core of nursing education. As nursing student without previews experience in mental health, I was reflecting the same attitude held by general public that mentally ill patient are dangerous, prone to violence, unpredictable, and to some degree responsible for their illnesses. Also, at the beginning of the semester, I felt unprepared, anxious and stressed before starting mental health clinical but the positive relationships with clinical staff gave me confidence and increased my satisfaction with the clinical experience. However, I found that over the course of the clinical experience and through observation and active participation that I started feeling less anxious and more comfortable interacting with the patients in the facility.
The few first clinical days, I was fearful to be around patients suffering mental illness such as anxiety disorder, mood disorder, psychotic disorder, personality disorder and so on. I felt that one of those patient may smack me or hit me , especially that on the first day of clinical one of the patient in the facility was right on the back of one the student sniffing on her hair. After time in the facility, I start feeling a little more comfortable around the patient. Then a different fear start, which is how to pick the right words in the right situation .for instance, a hallucinating patient start making a story from the picture of the celebrities on the magazines on the table of the lunch room, at that time I felt that my theoretical learning would not help me on how to communicate with this patient. So, my only option was to keep listening to him, show interest in his stories and give little to no feedback by nodding my head as I did understand the subject of the conversation.
Furthermore, many times I felt that I had become very emotional and had empathy toward young girls’ patients especially those who got physically or sexually assaulted by close family member. For example, a teenage girl who was sexually assaulted by her grandfather and what worsen the situation that her mother knows but she didn’t do anything to help her. Also, another situation where a young female women in her early twenties had made many attempt to commit suicide.As a result of absent family support after her mother passed away when she was 15 years old, her father have another family in Japan and she was sexually abused by her own brother. As a woman and a mother of two girls, I felt that I cannot stand those kinds of situations where I had to be very careful, patient and cautious all at one time.
However as nurse student, I was trying hard to separate between my feeling and clinical setting and to keep acting and responding to patient in an appropriate professional way. Clinical setting was a great learning experience for me as I got to see how mentally ill patient in the real world instead of a bunch of descriptive words in the psychology book. For example Miss P diagnosis was psychotic disorder, bipolar disorder and major depressive disorder. I was very impressed to see this patient bizarre behaviors during a ten minutes team meeting in which the patient flip from showing a strong personality at the beginning, to an angry person in a few minutes later, to be an actor ,then laugh then cry then laugh again in such a short period of time. Moreover, I felt that the nurses and staff provided to me and other students a welcoming and relaxed atmosphere by answering our questions, allowing us to join staff meeting and group therapy and counseling. In my opinion, the stuff attitude toward student is an important component in creating a positive clinical experience.
These negative and stigmatizing attitudes seem to be more prevalent at the begening of the nursing program with more positive attitudes reported by students in their final year of training (McCann et al., 2010, p. 34) these attitudes appear to have a significant influence on nursing students’ career choices. However, orientation to the clinical areas should not only familiarize students to the physical environment and policies and procedures relevant to the clinical setting, but also must acknowledge students’ anxiety and offer students strategies to address this. The lack of experience contributes to student stress in clinical practice and can lead to nursing students being confused about their roles (Grav, Juul, & Hellzen, 2010). AS a result, students often demonstrate a lack of confidence and a sense of inadequacy with their role of therapeutic interaction.
Therefore, clinical staff and nurse educators need to be effective in anticipating and alleviating clinical stress for students. It is important that educators encourage students to advocate the people they are working with, but to do this, students need support. Emotional support is identified as being an important component of the role of both the clinical mentor/preceptor and the academic lecturer/instructor (Koskinen et al.,2011). However, with appropriate support nursing students will grow in skills, knowledge and confidence throughout their clinical experience.
Through the clinical experience, I have learned something new about myself. I have learned basic counseling skills by listening to the patient, identifying potential problems, empathizing with him and providing basic care to prevent further problem. I didn’t know that with just a few simple words of encouragement and empathy, it could please and calm a mentally ill patient. Communication can make the patient, feel relaxed and cheerful. For example Miss H end up in the facility as a result of an attempt to commit suicide.
In addition to medication, one to one therapy and group therapy helped Miss H to look at the reasons and causes which led her to find life meaningless and thinking of death as an escape. Finally, I have learned that supporting recovery requires a cultural awareness embedded in the vision of values and trust (NHS, Scotland, 2011). Therefore, this working relationship to recovery is a very valuable process which puts the responsibility on promoting personal and professional growth and understanding. To conclude, I hope to improve further in my psychosocial and counseling skills as I continue my journey in nursing.
References Koskinen, L., Mikkonen, I., & Jokinen, P. (2011). Learning from the world of mental health care: nursing students’ narratives. Journal of Psychiatric & Mental Health Nursing, 18(7), 622-628. doi: 10.1111/j.1365-2850.2011.01711.x
NHS Scotland, (2010) An Evaluation of the Impact of the Dissemination of Educational Resources to Support Values-Based and Recovery-Focused Recovery Learning Materials. McCann, T., Clark, E., & Lu, S. (2010). Bachelor of Nursing students career choices: A three year longitudinal study. Nurse Education Today, 30(1), 31-36. Grav, S., Juul, E. M. L., & Hellzen, O. (2010). Undergraduate nursing student experiences of their mental health clinical placement. Nordic Journal of Nursing Research & Clinical Studies / Vård i Norden, 30(1), 4-8.