Author: David Foley, PhD, MSN, RN-BC, MPA
Title: Assistant Professor
Institution: Frances Payne Bolton School of Nursing
Through participation in this clinical exercise the student will:
1. Identify three safe, evidence-based, alternative interventions to enhance relaxation and social interaction in the psychiatric-mental health clinical setting
2. Explore and affirm safety as a top priority in the psychiatric-mental health inpatient setting in order to minimize risk for patient, student, faculty, or staff injury
3. Review the importance of interdisciplinary collaboration
Facilitating psycho-social and psycho-educational patient groups is often required by students during their Psychiatric-Mental Health clinicals. Although these groups have typically focused on arts and crafts or simple discussions to promote individual expression, by maintaining a safe and restorative clinical milieu, students can carefully plan and conduct psycho-social and psycho-education patient groups that allow opportunities to teach and role model communication, relaxation, and socialization strategies.
One highly successful recent example was the “Pop Up Coffee House,” an idea that seems discordant with the expected sedate milieu of a typical inpatient psychiatric-mental health unit. Nevertheless, as many patients mirror established patterns of socially isolation in their home setting and thus remain seclusive in the inpatient setting, the opportunity to explore social strategies and communication skills in a non-threatening atmosphere can be highly beneficial. Given rapid patient turnover, this group strategy can be employed by students multiple times during the same clinical rotation. Of course, students carefully communicate with each patient’s assigned nursing staff to determine if any elements of the group experience might be contra-indicated.
1. As with any psycho-educational and psycho-social activity, this group has planned goals that correspond to course objectives and is carefully monitored by clinical faculty and facilitated by nursing students.
a. Students are required to submit their activity proposal to clinical faculty using a Psycho-Social/Psycho-Educational Group Submission Form no less than two weeks before the activity.
b. Faculty reviews the form for safety and appropriateness of teaching/learning strategies, and then returns to students, who then submit their group’s plan to the appropriate ancillary floor staff: Recreation Therapy, Occupational Therapy, Music Therapy, or Art Therapy as applicable.
Keeping in mind established safety policy and procedures, students acknowledged the following unit routines must be supported even as the group progresses:
c. As with any other unit-sponsored activity, floor staff must have unfettered access to the activity room in order to perform patient safety rounds. Nursing staff often enter to retrieve patients to meet with their Psychiatrist, Social Worker, or visitor.
d. Any patient who displays inappropriate language or disruptive behavior is offered appropriate redirection and supervision nursing students, faculty, or unit staff as appropriate. Occasionally a disorganized and thus unintentionally disruptive patient may enter and through successful verbal redirection, is able to remain with the group.
This group approach attempts to manipulate as many aspects of the milieu as possible in order to convey a relaxed, non-threatening atmosphere where patients experiencing a variety of psychopathologies will feel comfortable.
• Sound: An inexpensive sound machine produces healing sounds such as the rainfall or ocean waves.
• Lighting: Small disposable electric tea light candles promote a restorative, relaxed atmosphere.
• Smell: Pure lavender oil dispensed on cotton balls and then carefully hidden from view provides an aroma that his highly discordant with typically hospital odors and is thus a pleasant surprise.
Upon entry to the activity room, patients find multiple interactive stations, each with a specific purpose. To observe safety as a top priority in the psychiatric-mental health care setting, faculty remained in the room at all times to insure students were provided with careful supervision at each station. To make the experience as normalized as possible and in keeping with current unit practices, decaffeinated coffee is available so that even patients who are acutely ill or reluctant to interact in any of the following activities may still attend and simply enjoy a cup of coffee.
• Aroma therapy
o Aroma therapy essential oils vials remained in the student’s hand at all times. Patients were offered to try 10 different fragrances and then look through an accompanying booklet that explained their significance and the benefits of having one’s home environment smell as pleasant as possible.
• Personal grooming: nail care and make-up
o Lipstick, blush, eyeshadow and nail polish were made available. Only neutral colors were offered.
o Cross-contamination of make-up did not occur by using disposable cotton swabs.
o Gloves were worn by students at all times.
o Gloves were changed with appropriate handwashing between each patient.
o As expected, female students typically staffed the grooming station, although a male student occasionally offered to paint nails. Students utilized the opportunity to provide guidance on appropriate color choices and application and insured all make-up containers were accounted for at the conclusion of the group.
• Hand massages
o Students explained the benefits of hand massage to each patient prior to commencing.
o Gloves were worn by students at all times
o Gloves were changed with appropriate handwashing between patients.
o Only unscented, hypo-allergenic lotion is used.
o Patients were advised they could discontinue their hand massage if they felt uncomfortable. To the contrary, patients and staff have reported the experience to be very restorative. Although he conversation is typically effortless, to decrease any sense of initial unease, patients may look through a magazine while receiving their hand massage.
o Patients were engaged in conversation by looking through magazines with students.
o In particular, older patients often enjoy looking through magazines with a nostalgia focus and then sharing past experiences with students.
o Magazines were also provided to patients who wanted to engage with the group as a peripheral participant.
Post Group Follow-Up
Immediately following the group, students are asked to document in the electronic medical record using the standard, daily template utilized by other ancillary therapies who conduct groups. The template asks the student to identify the type of activity utilized, the patient’s level of participation, barriers to participation, response, and effectiveness of the strategy. Students occasionally have questions about documentation, providing them with another valuable opportunity to engage in interdisciplinary collaboration.
Feedback from floor nursing staff has been overwhelmingly positive. In fact, a number of the floor staff have briefly attended one of the groups, if only to receive some aroma therapy and or sit down with their client in a relaxed, leveled playing field.
The group activity is one of the dominant topics in the day’s clinical post-conference. Students have been overwhelmingly favorable in their response, observing that the group achieved its intended goals of promoting social interaction in a relaxed, and often enjoyable manner. To date students have been very supportive of conducting this same group multiple times throughout a semester.
Following the clinical day, students are asked to reflect and submit their written reflection to faculty using the Critical Reflection Journal Template. This document asks students to relate their experience with group participation and facilitation to one of the course objectives, classroom content, their daily goal, and future nursing practice.
With careful planning and supervision, the “Pop Up Coffee House” activity has been employed as part of the student’s psychiatric-mental health nursing clinical experience for over 10 years. It has been received by seasoned staff with anticipation, demonstrating even seasoned nurses can appreciate the benefits of alternative therapies and promoting effective socialization.
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See attached files:
1. Critical Reflection Journal Template
2. Psycho-Social/Psycho-educational Group Submission Form
1). Critical Reflection Journal
2). Informal feedback from students, patients and floor staff
3). Demonstration on clinical area