Lookingonthebrightside’s Weblog

Well I’ve done four long days so far. It’s very interesting. I’ve definately learned stuff in that time. I’ve learned things I don’t know but didn’t know I didn’t know. That’s good. It’s the first stage of developing competence in a skill, moving from unconscious incompetence to conscious incompetence. I like the way this article applies the competence cycle to nurse training.

A particular situation, well patient, has been a real challenge. He’s acutely psychotic. It’s obvious from how he is presenting that he is extremely delusional, his thoughts are very disordered, he’s feeling paranoid and he’s hearing and responding to voices. He’s also pacing and occasionally running from one end of the ward to the other. He appears to have boundless energy. Every now and again, he’s tearful and has asked one of the male nurses to hug him a couple of times. The man is clearly extremely unwell and seems to be getting worse rather than better.

I’m so aware of having no clue as to how to ‘be’ around him, what to say and what not to say, when to persevere with communication and when to move away and feedback to a trained nurse the way things are going. They seem to be at least partly able to assess how his psychosis will develop over the next few days as the medication is adjusted. They also seem partly able to contain him and encourage him to sit for a while. They can temporarily de-escalate his mood and behaviour. I have, at points, asked him to sit down when he’s been pacing and offered reassurance that he’s safe and it has calmed him for a while. But I don’t feel so confident to approach him when he’s running up and down the ward, roaring. I want to be able to do what they can do. But he scares me.

I had a chat with someone about this guy and how I feel. I was really honest. They basically encouraged me to ask somebody to be nearby while I experiment with different ways of de-escalating situations when I feel ready to have a go. I feel safe with the team here. It’s a good place for students. They are free with the feedback – good and bad – so you really know where you are. So I will take every opportunity to begin to learn ways of dealing with acutely psychotic patients and trying the various methods out.

I want to be a good nurse.

I love this placement.