Knowing the right thing to say
Written by: Ibukun Obidi, Nursing student, Schizophrenia Outpatient Clinic, St. Joseph's Healthcare Hamilton.
In our schooling, we are taught to have the awareness of concepts related to mental health. We learn that mental illness is and should be treated like any other disease process but even still, there seems to be an element of uncertainty around caring for patients with mental illness. I have always had an interest in psychiatric nursing but did not know exactly what it entailed. I have had mostly surgical clinical placements and had no previous exposure to caring for clients with mental illnesses which is why I was both very excited and nervous to finally have a psychiatric placement. I was placed at my first choice for placement options, St. Joseph's Schizophrenia Outpatient Clinic. This program provides care to people in the community living with schizophrenia or related psychotic disorders. While my previous clinical placements had specific task- based skills to master, I was ready to develop skills in self-reflection, communication, and emotional intelligence.
My first impression of this mental health placement was that it was much different than I expected. My knowledge of mental health nursing consisted of mental status examinations, monitoring clients' response to medications, and talk therapy. I was very surprised to learn about some of the interventions and nursing responsibilities that existed in the psychiatric setting. Clients' physical health was attended to just as importantly as their mental health. This was an eye- opening fact that mental health and physical health are so interconnected that at times, they cannot be treated separately. During my first week shadowing my preceptor, what stood out to me the most was the therapeutic communication skills of the nurses at the clinic. They were calm, very well- spoken, and always knew the right thing to say at the right time.
My biggest fear with having a psychiatric placement was not knowing how to respond to a person who was struggling. It was a great amount of pressure and responsibility knowing that for some clients, I as the nurse would be their only source of social support. What would I do if a client became angry and started escalating? What would I say to a client who shares with me that they're having suicidal thoughts? During my surgical clinical placements, I felt rushed to enter my patient's room, complete my task, and then leave to check on my next patient. Now being in a psychiatric setting and having plenty of time to spend one-on-one with clients, I did not feel competent in my ability to counsel clients through their mental health struggles. As the weeks progressed and I began personally connecting with my clients, I learned that understanding my client's lived experience gave me the information I needed to provide care. Empathy involves understanding the client's perspective, communicating to the client that I understand their perspective and acting on that understanding with the patient in a therapeutic manner. When I understood my client's vision of recovery and worked with them to set goals towards their treatment, compassion and empathetic care became easy for me. Knowing the right thing to say became less important and making my clients feel heard and supported was what I was aiming to accomplish. In this, I learned that it's okay and often therapeutic to allow for a silent moment. Being thanked by a client for just listening was something that made me feel like I was being helpful in terms of their care. When I reflect back and think about the subtle changes in behaviour of some clients over the weeks, I feel that I've made at least somewhat of an impact on their well- being. I feel very privileged to have gained the trust of clients that were struggling with mental illness and by the end of the semester, the pressure of being someone's sole source of social support is a responsibility that I've come to be most proud of.