One of the most difficult aspects of nursing school is the occasional sense of disconnect between classroom learning and real life. Oftentimes, on exams, we are asked what we would do or say in a given scenario, yet it is challenging to ascertain what actions we would actually take when faced with the situation in practice. Today’s simulation gave us the opportunity to explore and reflect on how we react when communicating with patients facing mental illness. We were forced to think on our feet and adjust expectations on the fly. Overall, it was a very valuable experience, and I felt that my group and I overcame a number of challenges to ultimately finish the simulation with a greater understanding of effective therapeutic communication skills.
Prior to this simulation, I took my time reading each patient scenario, taking detailed notes on various lab values and medications, and preparing a series of questions and responses I wanted to utilize. Unfortunately (or fortunately!), this carefully developed plan went out the window almost immediately. Upon meeting the first patient, who was experiencing mania, I realized that I had to completely change my approach to meet the patient where they were at. This made me anxious at first, and I worried I might fail the simulation if I couldn’t get the patient to focus and teach her about her diagnosis and medications. However, in our first debrief, I learned that the most important aspects of these interactions were establishing rapport, learning about the patient, and providing for safety. Moreover, as it turned out, our group talked about medications less and less as the scenarios progressed. Instead, we focused our attention on learning about the patient and ensuring they trusted us and felt supported.
One of my most important takeaways was learning that, in mental health nursing, things rarely happen quickly. Each patient, even those with the same diagnosis, can have vastly different histories and presentations. Thus, the nurse must be willing to take time to get to know each patient and their unique story. This is often a lengthy process–patients may be slow or unwilling to open up, and even when they do reveal more about themself, willingness to change and adherence to treatment are often present. It is unrealistic to think that the patient will engage in open and honest communication, receive education on the next steps in their treatment plan, and demonstrate a willingness to accept help all in the same brief interaction. Just like most physical ailments, healing happens slowly, and challenges can occur along the way. Thus, I learned that it is perfectly fine not to cram all of my newly-acquired nursing knowledge into one teaching session, and that it may actually be more beneficial to avoid excessive teaching and instead focus on the patient’s comfort and trust.
As a whole, I felt that the greatest challenge I faced was navigating resistance to change. Of the patients our group saw, two were completely in denial about having a problem, and the other two were still skeptical about engaging in treatment or unable to see their current problems. I struggled to strike a balance between presenting reality and refraining from arguing. However, I learned that the best way to elicit positive change was to learn more about the patient and find their sources of hope and goals, then tie this knowledge into how potential treatment could be beneficial. I felt that our group navigated each scenario with respect and empathy for the patients, and as the simulation progressed, we got more comfortable working with one another and making the conversation flow more easily.
Though I am now more confident to address mental health challenges in a clinical setting, I still feel that I need much more experience with my communication skills. If anything, I felt that today’s simulation showed me how unprepared I am to treat these patients in the real world! Thus, I hope to continue to find opportunities to practice these and learn from other nurses. Today’s simulation was a great first step in becoming more comfortable with providing appropriate and effective care to patients facing mental illness.
