Lacey Hastings

Journal

Psychosocial Rehabilitation- Bill’s Place

Week 1

My first couple days at Bill’s place were really great, I am truly enjoying It there already and just get a

great vibe from the environment there, and how they do things. I even spent a couple hours of my free

time just reading about brain injuries, as I have just found that so interesting! I feel like I’m already

fitting in there, the residents have taken to me well, and I am just having a really great experience so far,

and have learnt so much already.

10.3 ‘Identifies clients need for assistance from community resources’- I was having a 1:1 with a

young guy (20 yrs. old) at Bill’s place, he was having a hard time that day, was upset and we were

chatting about what was making him feel this way. He was expressing he is lonely, how he hates it at

bill’s place, how he doesn’t have any friends and has no social life. He said he can’t stay there anymore

because if he stays at bills place he will continue to live a sad, boring life and he doesn’t want that. I

recognized and empathized with this, he felt cooped up, he felt trapped, and most of all lonely. While

bills place does have activities’ for the residents, I feel this client needs addition community resources.

He needs something to do during the day and possibly some evenings, he needs to socialize with some

people his own age and do some things that young guys like to do, he needs more to focus on, and he

needs more people to talk to, in my opinion. Thus I identified this need, and feel there might be some

options through the NBIS (Nanaimo brain injury society), the men’s centre, Nanaimo youth services

association, and possibly VIVRS. With some additional community resources, this may help his feelings

of loneliness and boredom, and may help with finding more meaning or satisfaction in his current life,

while still furthering his recovery.

1.03 ‘ Makes pertinent observations’- Last night at bills place when we were in the clubhouse

getting ready for dinner, I noticed one of the residents over in the hallway, he was pacing back and

forth, muttering under his breath and looked to be agitated. I had went for a short 1:1 with him earlier

that day for a coffee, where he expressed some anger towards being at bills place and how he is much

different from the other residents and feels angry towards the other residents; after the coffee he

calmed down, joked a bit, and mentioned he would help cook dinner. However once in the clubhouse

with all the residents I noticed this calmness fade, his behaviour change and him start to get agitated. A

couple of the residents were getting really into the superbowl game and I could see this particular

resident annoyed by this, I could foresee some conflict in the future, as the resident was close to voicing

his agitation to the other residents (in my opinion). So I just went right over to him and asked him if he

wanted to come outside and get some fresh air with me, we could go for a walk or whatever he wanted-

and he agreed. When we got outside he just started to vent, talked about how he is just losing control of

his anger since his injury, how he just gets so angry that he is in this situation, and many more things

along these lines. We continued to talk for a while, and he ended up thanking me for getting him out of

there because he was about to ‘freak out’ on someone. So I feel I made a ‘pertinent observation’ of a

change in behavior and potentially escalating behaviour, and removed the resident from the situation

and redirected him.

9.02 ‘ Promotes a therapeutic milieu’- there is a particular client at bills place that some of the staff

talked to me about, just mentioning to be weary when working with him because he doesn’t like many

people, doesn’t like to talk, and can get very paranoid. However I was asked to take this residents blood

pressure twice that day, and I was initially a little nervous. I decided I needed to come with a different

kind of approach. I knocked on his door explained I needed to take his blood pressure and when he let

me in I just asked him if he would like me to make some coffee, he agreed so I made a pot and we sat

down and had some coffee before I did his blood pressure- although not talking much. I turned on the

news, and sat far enough away from him, to try not to make him uncomfortable. I took his blood

pressure and then mentioned to him I’d be back after lunch to do it again and that maybe I could

hangout for a bit if he’d like and he nodded his head. I asked the staff what was something don liked or

something maybe I could do and they mentioned ice-cream, which we had in the staff freezer, so the

next time I went down I showed up with ice-cream, and he seemed pleased with this. Again we just

turned on the superbowl, I sat with him, we watched that while he ate ice-cream, chatted about things

here and there, and I waited till after to take his BP. He did end up talking with me, he wasn’t overly

chatty, but we had a couple good conversations and things went good in my opinion. I feel like by

coming into his place, having a coffee, sitting on the couch, watching TV and keeping things really

relaxed, that I was promoting a therapeutic milieu for this particular client. We were in his comfort zone,

the environment was very calm, and we just sat and ‘hung out’. I feel like if I did this a few more times I

could build a good therapeutic relationship with this client, where he might be able to trust me, and just

enjoy my company. He did end up calling me his ‘angel’ of the day, so I’ll take that as a good sign!

Next week I’m going to work on more of the 10’s in regards to community resources, work more on that

1:1 time of building a therapeutic relationship, and some integration of theory based knowledge in

regards to psychosocial rehabilitation interventions and techniques.

Week 2

My second week at bills place went really well, I'm continuing to learn lots and enjoying my experience.

4.02- Prepares, implements and evaluates teaching plan This week I had the opportunity to

implement client teaching, a residents lab value came back that his sodium was really low ( this

continues to be an issue), and he was put on a fluid restriction. The staff asked if I wanted to go down

and discuss this with the resident, explain to him what his lab tests results came back as, what this

meant, and what we would need to do. They explained to me that this resident drinks water excessively,

as he has dry mouth from his antipsychotics, so this may be difficult to initiate a fluid restriction. They

also explained that he didn’t take ‘orders’ very well, or direction, that he didn’t like being told what to

do and might get upset, so to be very nonchalant and casually explain the situation, and not to be bossy

about it or demanding, as this would cause confrontation. I decided I would just go down and chat with

him, hang out for a bit before I brought it up, just to establish a more relaxed environment/conversation

before getting into details. I decided that after a while of talking I would bring up the test results, discuss

the situations and that we both could chat about a plan for his fluid restriction. Which Is what I did. After

a while of chatting I just said "hey remember that lab test you went for this morning, well the results

came back and your sodium is really low, which is why you have been feeling off". I then explained that

because of this, he can’t drink as much fluid, as the fluid gets rid of more sodium, we discussed this for a

bit and he asked me a few questions which I answered. We then discussed how this meant he could only

have up to 800ml of water a day, and we rationed out how much that would be in his water bottle, and

made a plan that the staff would bring down that much water in the morning and that would be all he

could have. We made a plan to not get the orange juice he normally gets on his grocery shop and to

reduce any other fluids throughout the day. We discussed how he would be taking ‘salt tabs’ and

discussed what the goal was, and how he just needs to stick to this until things are balanced again. The

resident took this well, he expressed concern for how hard this would be for him, but decided it would

be fine and that he would stick to this plan. We put up some reminders in his place ( as he has memory

deficits from the brain injury) and reminded him verbally throughout the day. After implementing this

teaching plan, I evaluated how I thought it went, which I thought it was effective, and the client stuck to

this plan, although having some difficulties, so I would say all in all I thought it was effective.

10.02- ‘Demonstrates Awareness of the community resources available’ I have been getting

familiar with different community resources thus far, and have been taking into consideration how I can

utilize these in the future. We took a resident to the Nanaimo Family life Association, as he wanted to

seek out some additional supports and counselling. We did an intake with him and I learnt all about

how they match the clients up with counsellors and what group counselling sessions there are, how the

meetings work, etc. I learnt about the workshops they have, which take part in the evenings and during

the day on Monday and Tuesday, these workshops include Health self-esteem, effective communication,

personal boundaries, assertive skills, stress management, managing anger, conflict resolution, grief and

loss and creating change. I thought it was amazing that they had so many and can see how useful this

would be for clients, as there are so many areas, where they may need support and guidance. I am now

aware of this resource, and could refer clients there if needed.

I also became familiar with ‘Nanaimo Disabilities resource centre’ which works on increasing accessibility

for people with disabilities- including brain injury and developmental disabilities. We referred a client

there who had a goal of gaining computer skills, and this community resource offers a ‘computer

school’, this is completely free and no pre-requisites are needed, people can just come in and get basic

computer instruction, and is individualized to each person, the curriculum is designed for each student

based on their needs, goals and abilities. This can help in employment areas such as getting familiar with

word and excel, navigating employment websites, or for social reasons such as social media sites, blogs

etc. This was part of this resident’s psychosocial rehabilitation and is a great resource for him. I now am

aware of this resource, and could refer clients there if they had similar goals and needs in this area.

6.05- Interprets behaviour of self and others

There is a young guy at Bills place that has been struggling with depression the last couple weeks, been

feeling very low and has poor coping skills. I was asked to spend a little bit of time with him before one

of his appointments. We went over to his residence within bills place, started with doing some laundry

and then sat down to chat/watch some t.v. He was very quiet, zoning out on the t.v., and didn’t seem to

be interested in my company. I had seen him with the other staff that he is very comfortable with , and

he really expresses his feelings to them, and even though he feels very down, he chats with them

frequently. I noticed myself trying to compare to that, trying to overcompensate for the silence, and

trying to get that conversation with him where he could use me as an additional support. I wasn’t pushy

or anything, but I noticed myself doing all the talking and asking too many questions, as I felt

uncomfortable with the silence. I then sensed that he felt that as well, and that led to even more silence

on his part. Thus I interpreted my behaviour and feelings of being uncomfortable to be sensed by him,

and thus I think his behaviour was a reflection of this, he wasn’t as open and willing to talk as he was

with others. Something I also recognized was that I needed to give him more time to warm up to me, he

isn’t just going to bare his soul to me when he’s only met me a few times and doesn’t quite know me

yet, as I wouldn’t open up to someone ether if I didn’t trust them or have a good relationship with them.

Thus I recognized that I needed to just be there in the silence with him and be comfortable with that,

and start to build up that relationship, before I expect him to trust me as he does the others- as I’m sure

that took time as well. Also the behaviour of comparing myself to the staff, isn’t helpful for anyone. I am

my own person, I am learning and I have different qualities and a different personality, thus I can’t

compare myself to how others do things and how clients take to other staff members, I need to focus on

myself, and building therapeutic relationships with clients on our own terms, finding our own common

ground and getting to know one another.

Week 3

I had another great week at bills place, with lots of good learning experiences!

6.07- ‘During goal –oriented interactions demonstrates empathy, warmth and respect’

There is a resident at bills place that is fairly new, he suffered a traumatic brain injury less than 6 months

ago and is working on his rehabilitation and recovery. He suffers short term memory deficits, doesn’t

remember what he does in a day, wakes up and doesn’t remember where he is, or what is going on, and

is having a really tough time with day to day functioning. There are many goals set in place for him,

many activities, reminders, and strategies for the staff at bills place to assist Adam with rebuilding his

memory and rebuilding skills of daily living. I’ve had the opportunity to work with Adam a few times now

while at bills place, doing some 1:1’s and just interacting with him throughout the day. He gets very

frustrated with his current struggles and memory deficits and finds many tasks frustrating and upsetting.

In working with Adam I’ve spent a lot of time recognizing he’s a young guy (27) he had his independence

not long ago, owned his own house, had a good job, a girlfriend, he had a lot going for him, and now he

wakes up every morning wondering where he is and what’s going on, forgetting what he’s done in a day,

and struggling to take care of himself. I think about my boyfriend and think how hard that would be for

him and for us going from where if he is now to where this guy is, and how hard that would be. I’ve

spent a lot of time trying to understand and being empathetic for his situation and have demonstrated

this to him, while he’s chatted with me about how frustrating it is to be a bills place and how he just

wants to be in his own home, I’ve emphasized with this, and demonstrated empathy when he expresses

emotions about how hard it has been since his accident, and I recognize this when we are in goal-

oriented interactions, and remember the struggle he is going through. I have demonstrated warmth

with this resident by just being soft and comforting, just sitting with him and listening, by going for a

walk with him and being as nice and friendly as possible, by showing him compassion and interest and

just being myself really, warm and empathetic. In goal oriented interactions I’ve been supportive and

patient, encouraging and understanding and I’ve shown him warmth and compassion. I’ve shown him

respect by not trying to act like I know what he’s feeling or what is best for him, but by simply listening,

supporting and understanding him, I’ve made an effort for it not to seem like I’m ‘working’ on him, or

‘studying’ him as a student, but that I’m there to keep him company and help him out however I can,

I’ve just really made an effort to convey to him that I don’t pity him or feel bad for him, that I respect

him as a person and respect and empathize with what he’s been through and going through.

5.11- ‘Assumes responsibility for own professional development and updates skills and

knowledge base according to needs of the consumer population’

In being at bills place and working so closely with acquired brain injuries and traumatic brain injuries I

realized that we haven’t learnt about brain injuries in our curriculum or really focused on them. Thus I

recognized that it was important for me to be more knowledgeable in this field, and the responsibility in

my own time and some time at bills place, to research brain injuries, to learn more about the side effects

and the results of brain injuries, to learn about best practices and ways of interacting and

communicating better with individuals suffering brain injuries. I took some time to read about the

benefits of group counselling for people with brain injuries and the benefits of that, what medications

are good for improving cognitive functioning, what some of the current research in neuroplasticity is

saying, etc. I took this responsibility to further my knowledge on thus my professional development, I

figured there are times where I am going to have clients who have suffered brain injuries and who may

have underlying mental illnesses or have resulting mental health concerns from a brain injury etc., and

that I need to be competent and knowledgeable in this area.

5.01- ‘Evaluates own nursing performance’

Sunday at clinical I got the opportunity to do an intramuscular injection in the dorsogluteal for an a

typical antipsychotic. I was nervous before going to practicum that day because I hadn’t done an

injection in the dorsogluteal and read in my textbook that it wasn’t recommended because of the

chances of hitting nerves or blood vessels. However this resident would only take the injection in the

dorsogluteal not the ventrogluteal, the staff had already been over this many times with him , so they all

just do it in the dorsogluteal. I spent the night before looking up the appropriate land marking, finding

the greater trochanter and the iliac spine, drawing an imaginary line half way between and then two

fingers up from that. I went over this again and again and even practiced doing the land marking on a

family member. When it came time to do the injection I land marked perfectly (according to my

mentor), however I noticed that when I went to aspirate I held the needle a little to firmly (so that it was

steady) and the client expressed that this was uncomfortable. I recognized this, and now I know for next

time not to hold the needle too firmly in place because I might be pushing it in instead of just keeping it

steady and this isn’t best practice. My mentor taught me a couple techniques for this and I practiced on

an orange a couple times; I feel confident I will do it more competently and less uncomfortably for the

pt., the next time!

2.08 ‘Participates in planning the resolution of ethical dilemmas’

I didn’t make any decisions in this scenario however I was involved and learnt from it.

One of the residents at bills place that I spoke of last week who is currently having very low mood and

believes he is suffering with depression; we took to get counselling at Nanaimo family life. This guy is

only 20 years old, he’s been through a lot of life changes, he’s upset about losing touch with his friends,

his mom isn’t around much and he has poor coping skills. However the plan by both the resident and my

mentor was to try out this counselling and see how things go, and they both agreed this would be good

and that this was the best plan. However that even this residents mother suggested to him that he was

‘mentally sick’ and needed help from the doctor, with this resident being so young and wanting that

attention from his mom, he went right to my mentor and suggested that he was ‘mentally sick’ and

wanted to make an appointment with the psychiatrist to get on medications right away. My mentor had

a hard time with this, as her thought process was that he was so young, he was already on a bunch of

medications and she didn’t believe he needed to be put on antidepressants or a mood stabilizer right

away, and that he should give the counselling a try, and she also believed all this was coming from the

mother, and that the resident was just believing what his mother was saying. However that wasn’t her

place to decide that for him, she discussed his options with him and discussed what she would

recommend as a plan, but ultimately this was the residents decision. He decided yes he wanted to see

the psychiatrist so my mentor took him. He told the psychiatrist some things that my mentor believed

also came from the mother that would almost guarantee a prescription, however again this wasn’t her

place to intervene. He was prescribed a mood stabilizer. My mentor sat down with him and they made

a plant to still follow through with the counselling, try out the medication and then revisit this in a

couple weeks.

It was interesting just to see the ethics behind it, as he may not have needed to be on that medication

and he may have been just fine going to counselling and learning to cope rather than taking medications

at such a young age, however autonomy and choice comes in to play, it’s his right to make those

decisions for himself, and we can’t make them for him, even if we figure it’s better for him. It was just

unfortunate to see that his mother could just say you are ‘mentally sick’ and he believed it and ‘played’

the part (in a way).

7.04 ‘Verbalizes observations to appropriate persons’

Just the other day at bills place I went to deliver meds to one of the residents and noticed his

behaviour/mood was quite a bit different than I had noticed the other times id been around him, he was

very agitated/upset, would barely speak and was pacing back and forth. I knew he had a 1:1 with his key

worker that day, so when I returned to the office I just verbalized to her what I noticed and the

behaviour I saw, just to prepare her for when she went to her 1:1, she has a great relationship with him,

so I figured if I filled her in she could better prepare for what to do with him that day, based on his mood

and so she was aware of how he was feeling prior to going out In the community with him. I feel like

this was a display of competence in this area, as I noticed a change in behaviour, recognized this was out

of character, and that the key worker would want to know, and verbalized this to her.

Week 4 (1day) and Week 5

I feel like I had another great couple of days at Bill’s place and that I’m really starting to get the

hang of it there and fit right in, I have built some really great relationships with clients and am

continuing to learn tons and build on my skills.

8.09- Recognizes and interprets the manifestations of emotional and physical states

There is a resident at bills place that has been experiencing mental distress and many stressors

since his brain injury. He has been battling with depression and anxiety and his brain injury has

made daily activities very difficult for him. In recognizing the manifestations of this, I noticed

that the client is very ‘tired’, always complaining of having no energy and tiring out very easily,

this being a manifestation of the depression as well as the brain injury (physical) as simple

activities, especially cognitive, take a huge toll on individuals with brain injuries, making him

very tired.

There is another client that suffers seasonal depression, and this past week he was ‘sore’ ‘tired’

and ‘achy’, he usually walks every day, including up to the office to get his meds each day,

however this past week he complained of being too sore to walk anywhere, and that he was

too achy. This was identified as somatic pain, his depression, worsened with the season and

lack of sunlight, manifests as achy, sore pains for this client.

Another client has been experiencing much pain in his legs due to peripheral arterial disease,

which has greatly impacted his physical activity. This physical state has started to wear on this

client, and his mood has been impacted. The manifestations resulted in a depressed state or

lowered mood, both due to the lack of activity, as well as the pain from his legs.

6.01- Recognizes the effect of ones behaviour on others

There is a gentleman that is in the transitional program at bills place, thus he lives

independently however the staff see him every day and take him for 1:1’s often. I spent some

time with this man and noticed that he can be very negative, go on rants very easily, and get

agitated very easily, when fixating on things that make him angry or past experiences that have

made him angry. However I also picked up on his pleasant mood when he discusses traveling,

architecture, and cats! He loves to look at houses when going for a drive, and loves to cruise

around the malls and just get out cool gadgets. What I noticed with him is you have to

counteract his negativity with positivity; you have to do lots of redirecting, and changing of the

subject. With him, I notice that when my behaviour is positive and interested in having a

discussion with him about positive things and interest he has, his mood changes. That instead

of just always letting him rant and just nodding or agreeing, if I change the subject, redirect him

and keep positive, he remains positive, and keeps from going on rants and working himself up. I

recognized that If I structured my behaviour in a certain way, and interacting with him in a

certain way, that our conversations and our time spent together could be in a more positive

manner, and that we could have a more effective therapeutic relationship.

7.08- Documents observations and psychiatric nursing actions on appropriate records

There is a new client at Bill’s place that has had fluctuating moods, mainly low moods, and been

very agitated ( only 6 months since his brain injury) and he has very severe memory deficits. I

was asked to take on his 1:1 on the weekend, and we were asked to clean out one of the suites

that he used to be in but moved to an upper suite. While cleaning I noticed that this resident

didn’t need any direction, he just started sweeping, vacuuming, wiping counters, moving

around furniture, this was unlike him as he needed continuous prompting and reminding of

how to do things such as personal hygiene, food prep etc. I also noticed his mood was very

pleasant while cleaning and hanging out, we listened to music, chatted a ton, and really had a

good 1:1 time. We even spent a bit of time discussing how he enjoys doing custodial duties, and

how he feels a lot better when he has something to do while at bills place, and is helping with

things. I recognized the importance of many things that took place during this interaction, the

resident’s mood, his engagement and his effort in cleaning without the need for direction or

prompting, also the fact that he expressed this is something he enjoyed. I went to the daily

notes binder, under this resident’s staff and documented this for other staff to see, and made

sure to make a note in the front part saying “see Adam’s notes”. I documented appropriately

and competently to bills place protocol, and document appropriate nursing actions that took

place and pertinent information that needed to be shared.

Week 6

I had another great week at bills place, totally feeling comfortable there now and continue to

learn more and build on my skills every day that I'm there, I am really taking every opportunity

that comes my way for more experience and to build more skills.

6.06- Takes appropriate action in nursing situations

At Bills place we don’t have too many ‘medical’ nursing situations, however I feel this example

applies. There is an older gentleman at Bill’s place that for the past few months has been very

unsteady, with a combination of damage to his leg, low sodium and side effects of meds, he has

been having many falls and hasn’t been getting out much due to this. However just this past

week, things have been getting better, with control of his sodium, a change in his meds, and

with his physiotherapy and massage therapy increased, he has been more steady. He

requested that someone start taking him out for a walk so he can build back his strength, start

getting exercise again, and really to just get out of his place and get some fresh air. I was asked

to take him, and with this being his first walk since all his falls I was a bit nervous. We decided

just to walk up and down departure bay to start off. Bills place has a pretty steep drive way, so

my first action was to get someone’s assistance with getting Don down the driveway, even

though he insisted he was fine, and fought me a little bit on this. However thank goodness I did,

as when he went to walk down the driveway with his walker it was going so fast that slipped

out from under him and he would have fallen down the whole driveway if me and the other

lady weren’t there to grab his arms. Once we got on the flat surface things were going well, I

brought some water as I knew don hadn’t been walking for quite some time and was out of

shape. Don is a very stubborn, independent person and doesn’t like to be told ‘take it easy’ or

‘let me help you’, or anything like that for that matter, so I knew it would be a bit of a challenge.

At first he was walking very fast, I could see him huffing and puffing, his walker wobbling and

him start to lose his balance a bit. So I just softly spoke to him and just mentioned how nice it

was to get out for a walk and how relaxing it was, and then just mentioned how we don’t need

to be in a hurry, just enjoy the walk, and when I thought he looked like he needed a break I just

said hey don can we stop for a break, I’m a little tired. When we stopped I just explained that

on the way down departure bay we should go a little slower just because I’m a little worried

about the walker coming out from under him, he started to argue with me a little bit, so I just

said just for me don, I’m a worry wart, and it will help me relax a little bit if you take it slower,

so I don’t worry about you falling. The rest of the walk went well, he took it nice and slow, and

we had a great conversation. I went inside with him after the walk and just made sure he was

doing okay, as it was a big work out for him, got him some water, got him settled in and did a

quick assessment.

I feel like in this situation I took the right actions and the right approach with the client, I took

safety precautions, made sure the client was doing okay, monitored his respirations and his

gate, and managed to get him to follow my instructions and precautions, without agitating him.

I feel like I handled the situation well, and we accomplished a goal of the clients, and set future

goals for walking and exercise.

9.09-Facilitates the client to utilize his/her capabilities to his/her maximum potential

I have done meal planning and meal prep a few times now with one of the younger clients at

bills place, where I feel I have facilitated him using his capabilities to his maximum potential. I

feel like a lot of the support workers, for the meal prep, just kind of make the meals and the

clients watch and do small things. However I have noticed that this young resident is capable of

a lot of things, his ADL’s are not impacted, and he has the ability to make decisions and execute.

So I decided to just kind of be there in the background but not take the lead role, I wanted him

to take over, to decide what to make , and to ultimately prepare the meal on his own, I would

of course be there for support, questions, and any safety concerns with the oven, etc. The goal

for this resident is to gain more independence, and part of being independent is planning and

preparing meals, and I think this resident is able to do so, with a little more practice and

assistance from bills place. I explained that I was just going to be there to oversee and if he

needed my help I would be there, but that I believed he was competent in preparing his own

meal, which he seemed to really like, I think he felt more confident and empowered.

He did really well, he chose exactly what he wanted to make, he prepped the food, cooked it

appropriately and cleaned up after, I was really impressed. I jumped in a couple times just when

he had questions about cooking times and when it came to food safety, but overall he was very

independent and competent in this activity. I feel like I just gave him a little more power and

responsibility, I think he often just continues to not do certain things that he couldn’t do before

because others do them, and he doesn’t think or forgets that he can do them. With stepping

back and letting him be capable and be competent, giving him the confidence and the

opportunity to do things on his own and to learn things again, I think this really helps him, and

will help him get closer to his goals for independence, and to achieve his maximum potential.

10.06- Participates with community resources to ensure continuity of services for client

One of the clients at bills place has been going to VIVRS (Vancouver Island Vocational and

Rehabilitation Services), he has had over 5 appointments now and has been going on his own. I

went with him for his next appointment and thus participated in this community resource. I sat

in on his appointment, and ultimately experienced what he experiences. This was just to get an

idea of what has been going on in the appointments, what they are working on, making sure

Terry is getting what he wants from this resource, and that things are on track with his plan- of

why he is accessing this service. Participating like this helps to ensure the continuity for this

client, to make sure things are going smoothly, things are consistently progressing, and that the

client is getting something from this service. I was able to see that he was working on his

resume with his worker there, that they were building a list of his skills, past employment and

ideas for future employment, and that they have been making employment goals and setting

goals for him prior to employment, such as getting a bicycle for transportation to and from a

job. I was able to see the continuity in this service.

Week 7

5.13 ‘ Identifies social and ethical issues relating to psychiatric nursing practice’- just this past

week at Bill’s place there was some issues with clients smoking marijuana on site. One of the

residents has a medicinal marijuana license, however he gives this to other residents and that’s

where the issues start. Also there is an offsite resident that has started to come on site and sell

(illegally) marijuana to the residents, and continues to jeopardize the future at bills place, of

those residents. Bill’s place is a dry facility; there is no tolerance for drugs. Therefor this has

been a major issue, as residents are breaking this rule. It’s also hard, as a staff member there, to

know when the resident who has a license, is smoking medicinal marijuana or smoke the

illegally bought marijuana. As well as the fact that we can smell it, however we don’t know if it’s

resident smoking illegally, or the resident with the license. Thus this can be identified as a

‘social’ issue, relate to psychiatric nursing practice- at bills place.

Ethically, there is a resident at bills place whose parents and occupational therapist decided

they wanted a log kept in the resident’s suite of everything that happens that day, of all the

activities the individual partakes in, the 1:1s, and visits, etc. However, they also want staff to

write any rejections of activities and 1:1’s, as the parents and the OT want this young resident

to participate in everything and they are having some behavioural issues with him, and what to

know when he is turning things down, or when he misses activities or cancels them. Since this

was requested by the parents and the OT, and then by the manager at Bills place, this became a

required policy for bills place. However, the issue comes in because this turned into a very

negative task. As the resident could see this log, it was out In the open for him, and he was

getting very upset and pissed off by this communication going on, about him, that was very

negative. Staff were writing, ‘Adam turned down all offers to hangout, refused to participate

and didn’t care to show up’ etc., and Adam was not scratching this out of the log, and getting

very angry with the staff that were writing in it. Altogether, this turned into a very negative

thing, and showed no therapeutic value. Ethically, this turned into an issue as the staff, even

though they felt wrong about it, were required to, not only by their boss, but asked to by the

parents and by the OT, thus leaving staff feeling torn about what they should be doing, what

was best for the client, but still following rules and requests. Thus this was identified as an

ethical issue relating to psychiatric nursing- at bills place.

5.05 ‘supports professional goals and standards’ - I have set professional goals and standards

while being at bills place, such as getting the hang of utilizing community resources,

understand how to apply PSR in practice, and working on my therapeutic use of self. These

coincide with the standards of a RPN, as well as competencies required of us. Each day while

I’m at Bills place I look at my journal of what goals I am working on, and what areas I need to

get a better grasp on, and I focus on this, I seek out opportunities to reach them, and I practice

in whatever interactions are appropriate. Thus I am supporting professional goals and

standards I have set for myself and that are set for me as a student RPN.

10.01 ‘ Seeks information from other resources for incorporation in assessment and

treatment plan’- There is a brand new client at bills place, who is newly recovering from a

traumatic brain injury. Therefor he needs resources and services, and he was identified to be a

good fit for utilizing the Nanaimo Brain Injury Society (NBIS), thus I have started to research the

services they offer, the information they provide, and how this can be utilized for Cody. I have

been in contact with NBIS In regards to this client, and have started incorporating some of their

services into a plan for him. I can look at what they have to offer, read their suggestions,

information, etc. and then in an assessment of Cody’s treatment plan and current condition, I

can see what would work for Cody and what might be useful. For example, Cody has some

deficits in regards to physical movements, walking, hand coordination, etc. - as a result of his

brain injury. Thus I have started to look into the ‘Grow Your Brain with Exercise’ program

offered by the NBIS, and am started to look at his treatment plan to see if this would be

beneficial in combination with his physiotherapy, and through his assessment I can see if he

needs further help with his coordination and if this kind of exercise they offer would be doable

and/or helpful for him.

Thus I am seeking out information, and working on incorporating it into his treatment plan and

assessment.