PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL

Reflective Journal Psychosocial Rehabilitation Regional Treatment Centre Abbotsford. Student Name Dermot Connolly Stenberg College

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL

Monday July 29th 2013 I had quite a busy and interesting day today. I spent today with my assigned nurse and it started with one of the clients complaining of right flank pain so I assisted with his assessment. The client stated he had being suffering from the pain (rated 9/10) for a few days, but this morning it was particular painful. The clients vitals were taken and they were all within the normal range. While appendicitis was a possibility, it was unlikely as the client did not complain of any rebound pain and flank pain is typically associated with kidney problems. Client did state that his methadone had helped with the pain however the physician was also called and report was given to him over the phone. The Client was prescribed T3s and a urinalysis with C+S was ordered to test for suspected kidney stones. In addition, the client was placed on the waiting list to see the doctor for the following morning. I also noted that the client also has a history of suffering from anxiety and has verbally spoken out about his anxiety surrounding his impending release from prison. In the afternoon I also got to assist in a medical procedure surrounding a client who suffered a seizure. Earlier in the morning during rounds, one of the parole officers noted that one of the clients was on the ground on his cell. The client in question has a history of seizures and he reported the incident to one of the nurses who took his vitals and completed an assessment on the client before charting the incident. A short time later during afternoon medication, the client was observed slowly going to ground having what looked like another seizure. The unit was placed on lockdown and I participated in the treatment of the client with the other nurses. The client was placed on his side and allowed to have his seizure. The client had a generalized seizure as he did

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL not lose conscience during the seizure which lasted approximately 20 minutes. After his seizure he was placed in the recovery position and was orientated X 1 to name only. The crash cart was utilized to administer O2 at 15 L/Min while his vital were taken every 5 minutes. The client blood pressure was slightly elevated but all other vitals were within normal range. The clients

blood glucose levels were also taken which was also within normal range. The clients condition was monitored for the rest of the day with no other seizures reported. Client became oriented X 3 within a few hours of the incident. After the incident, I took the liberty of reviewing the emergency protocol for seizures on the unit and I was pleased to note that the protocol was followed correctly with the exception of not calling 911 as the seizure lasted greater than 5 minutes. In addition the protocol also recommended the administration of valium to the client after the seizure was also did not happen. Overall today was a very interesting, eventful and busy day, during which I feel I gained a lot of new experience. Tuesday July 30th 2013 What I really enjoy about this clinical rotation is the fact that I get to job shadow so many different people working in different disciplines of mental health. Today I got to spend the day in the psychiatric hospital and I really enjoyed the experience. In the morning I got to speak with the psychosocial rehabilitation coordinator and I got to ask her about the rehabilitation clinics she runs within the facility. She informed that the program in quiet extensive and runs for 9 months with strict criteria surrounding who can participate. Groups are kept quiet small (max no of 8) with homework assigned to each participant as a condition of their graduation from the program. I had asked if I could sit in on the next program and she informed that I was welcome to only the

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL next didnt start until Sept 30th. So perhaps if I return to the regional treatment centre for my preceptorship, I can help run this group. I also got to experience some extreme behaviors on the psychiatric ward today where I spend most of my morning in the isolation cells talking to one client who was locked up for violent behavior. The client had removed the sprinkler head from his cell and was scraping of the paint from the walls. There was a danger that he would self harm so most of the morning was spent in

negotiations with the client to obtain the sprinkler head. The client was diagnosed with extremely antisocial behavior and he eventually gave up the sprinkler head after his request to be transferred back to Kent was granted. I really enjoyed the experience despite the abuse that was directed at me. I even got to assist in the transfer of the client by helping to clean out his cell and was present for his removal off site. I also felt I learnt a lot about seclusion rooms today. While I am opposed to the fact that their use can easily be abused, I witnessed today that they are sometimes very necessary, especially as one client in particular has being in his seclusion room for several years. While this might seem extreme, it was explained to me that the client has a long history of self harm, to the point where he has completely cut of his own scrotum and testicles. Over the years, when the client has shown some improvement, some of his privileges have being returned to him, only to see him self harm once more. Today also helped me to understand the difference between the rehabilitation unit and the psychiatric hospital within the regional treatment centre. The rehab unit is a lot more stable with clients who are either in need of additional care of who have low levels of functioning. The psychiatric hospital is a more diverse mix of clients from minimum security to maximum as the

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL

regional treatment centre is the only corrections facility in the lower mainland with a psychiatric hospital onsite. The level of exposure I am getting in this rotation is helping me to better understand the diversity of roles and responsibilities that lie within the mental health sector which I find very encouraging. In addition, it is helping me to focus on which area of psychiatric nursing I would like to work in when I am finished. I really want to work with acute psychiatric illness as I feel it will give me the exposure I am looking for to help me perfect my skills. I am also very interested in working in the community side of psychiatric nursing where I am helping the client become rehabilitated into the community. This is something this clinical rotation has helped me to better understand. Thursday Aug 1st 2013 I started today supervising the clients take their glucose readings and met with a client who just had his leg amputated after receiving an MRSA infection. He was adjusting to the change quiet well and was waiting for a prosthetic leg. We also examined his second leg which was also badly infected and we talked to the client about his feelings as he was aware that he was likely going to lose the second leg as well. After our 1:1 consultation, I also participated in his multifunctional team clinic where his goals towards recovery were discussed at length with the rest of his multifunctional team. In the afternoon I participated in a second treatment team meeting with a second client where we discussed his recent news where the granddaughter of his victim agreed to meet with him. He talked at length about his anxiety surrounding the meeting and his recent achievements. Some of these achievements include his insight into trimming his beard and wearing long sleeves to cover

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL his tattoos before the meeting. We also discussed some of the goals he had achieved since being

incarcerated such as addressing his personal hygiene, recognizing his depressed mood and noting what activities being him enjoyment such as playing his guitar. Finally we discussed at length his future goals such as his need to maintain employment, remain compliant with his medication and returning to school. In the late afternoon I volunteered to give some intramuscular injections. I gave two injections to one client, Leuproline into the left gluteus and Flupenthixol Decanoate into the right gluteus as per the request of the client which was supervised by the RN on duty. Friday Aug 2nd 2013 I began this morning by again supervising the clients as they completed their blood glucose checks. I felt it was good experience to help me better understand the process of self medication. As part of their developmental goals many of the diabetic clients are encouraged to self administer and check their own insulin levels. An RN or RPN must be present at all times to verify the correct medication and dose. The correct glucose levels are verified beforehand before completing the MAR. I also took the opportunity today to administer a clients eye drop medication and in so doing complete another competency. The client was a recent recipient of a donor eye and I administered one drop of Azopt and one drop of Combigan into the clients left eye. The process was very straight forward and the client responded well with no voiced concerns.

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL

On Tuesday, I had booked an appointment Sylvia a clinical social worker and I met with her this afternoon. I had requested the meeting as I wanted to get a better understanding of the role the social worker plays in the psychosocial rehabilitation of a client. I felt the meeting would help me greatly as I began preparing to write my clinical assessment. Sylvia was a great source of information and very helpful in answering any questions I had. I left the meeting with a much clearer understanding on how the clients internal assessments and programs are combined with treatment team minutes to help determine the psychosocial needs of the client. In the late afternoon I attended an internal training session on gangs and their affiliations within the prison system. It was an excellent presentation which helped me to better understand the level of gang activity not only in the RTC but also across other correctional facilities within Canada. I was also very impressed by the fact that RTC conducted such internal training sessions with their staff.