CLINICAL SKILLS

Most of the mental health cases in my internship unit are conduct disorder, depression, anxiety, ADHD (Attention deficit hypersensitivity disorder.) I had the opportunity to learn from my mentors the symptoms of these mental health cases and how to handle. I was taught the kind of things to look out for in determining the mental health condition of a patient. This includes following:

Daily Activities:

-Does a child perform according to their age levels,

-How much guidance and support a child needs,

-Dining situations,

-Going to bed and waking up.

Functional and Operational guidelines:

–Age,

-Mental functioning,

-Social functioning and flexibility.

Interaction and Contact:

-Interactions related to other children,

-Adult reciprocity.

Emotional and mental well-being:

-Mood and mood swings,

-Self-esteem and self-image,

-Worries and fears,

-Empathy,

-Concentration,

Impulsiveness.

Co-operation with parents:

-Interaction between the child and parents,

-Parenting coping and resources,

-Parents ability to guide and support the child.

I also  had a very fruitful discussion with my mentors regarding the drugs that are commonly used in the ward. This included the following;

1. Mood stabilizers:

-Fluoxetine, Seronil 5mg-20mg

-Escitalopram, Cipralex 2.5mg-20mg

-Citalopram, Cipramil, Sepram 10-40mg

Common side effects:

Headache, restlessness, generally not sedating, exacerbation of suicidal thoughts (warning), (sexual effects)

Interactions:

Fluoxetine enhances the effectiveness of risperidone.

2. Antipsychotics:

Risperidone; Risperdal, Risperidone 0.25mg-2mg

Aripiprazole, Abilify 2.5mg-15mg

-olanzapine, Zyprexa 2.5-25mg

Quetiapine, Ketipinor 12.5mg-300mg?

Common side effects:

Sedating, especially olanzapine and risperidone

Weight gain with olanzapine, risperidone; less with quetiapine and abilify

fat/sugar metabolism disorders; least with aripiprazole

Stiffness

Disorganization

Emotional blunting

ADHD (Attention-Deficit/Hyperactivity Disorder) MEDICATION:   ADHD medication is usually considered after a confirmed diagnosis by a qualified mental healthcare professionals. This often involves a thorough evaluation including interviews, questionnaires, and sometimes psychological testing.

Usually, ADHD symptoms include the following;

inattention (6 symptoms)

hyperactivity (3 symptoms), and impulsivity (3 symptoms),

Methylphenidates:

Medikinet : 5mg; duration of action 4 hours

Medikinet CR : 10mg-40mg

Equasym retard :10mg-60mg

Concerta :18mg, 27mg, 36mg, 54mg; duration of action 12 hours

Test to monitor when administering Methylphenidates:

Blood Pressure and Heart Rate: Regularly check blood pressure and heart rate to monitor for hypertension and tachycardia. These should be measured at baseline (before starting medication), shortly after starting, and periodically during treatment.

Electrocardiogram (ECG): Obtaining an ECG before starting treatment in individuals with a history of heart disease, a family history of sudden death, or symptoms suggestive of cardiovascular disease.

Height and Weight:Regularly track height and weight to monitor for potential growth suppression. This should be done at baseline and at regular intervals

Common Side Effects

Appetite Suppression: Leading to weight loss, particularly in children.

Insomnia: Difficulty falling or staying asleep.

Headache: Mild to moderate headaches.

Stomach Pain: Gastrointestinal discomfort, often mild.

Dry Mouth: Feeling of dryness in the mouth.

Nausea: Sometimes accompanied by vomiting.

Increased Heart Rate: Tachycardia.

Increased Blood Pressure: Hypertension.

Other medications for ADHD include the following:

Lisdexamfetamine (Elvanse ): 20mg, 30mg, 50mg, 60mg, 70mg; duration of action 10

hours.

Atomoxetine (Strattera ):10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg

Guanfacine (Intuniv): 1-3mg; continuous effect

Side Effects:

Insomnia: Difficulty falling asleep or staying asleep.

Decreased appetite: A loss of appetite, which can lead to weight loss.

Dry mouth: Feeling thirsty or having a dry sensation in the mouth.

Headache: Mild to moderate headaches are reported by some users.

Nausea: Feeling sick to your stomach or experiencing stomach discomfort.

Anxiety or nervousness: Increased feelings of anxiety or nervousness.

Irritability: Feeling easily annoyed or agitated Increased heart rate or blood pressure: Stimulant medications like lisdexamfetamine can elevate heart rate and blood pressure.

Some therapeutic measures used to deal with mental health condition I learnt frome my internship place includes the following;

1. Speaking regularly with a therapist can help you understand and manage your feelings.
2. Practising deep breathing
3. Meditation
4. Practising yoga
5. Playing of musical instruments.
6. Doing things you love can help boost your mood.

ETHICAL COMPETENCY

I worked in according to the principles of professional ethics and analyse the importance of attitudes and emotions in mental health and addiction care. I also took in consideration the general human rights, ethical guidelines for nursing care and nurses, principles of mental health and addiction care, specific instructions in the placement unit, and legislation by Complies with collective rules and instructions.

I acted in accordance with general objectives of the study module, assessed my achievement of the objectives and exploited feedback. I Worked within the professional guidelines in nursing care and working community.

TEACHING AND GUIDANCE

I did recognise and understood the need for guidance given to me by my mentors  as a student, patients and family members, fellow students or staff. I made guidance plans with objectives based on appropriate knowledge and demonstrates versatile and appropriate use of different guidance methods.

WORKING COMMUNITY COMPETENCE

I sat in some of the multidisciplinary team meeting and got the opportunity to meet the most important collaborators of the internship unit and experienced working in a multi-professional team.  Interactive skills, peer work, team work and networking and multi-professionalism was at play.

I experienced the expression of opinions in team work and the display of willingness for collegial and professional way of working. From this meeting I realize   the significance of multidisciplinary teamwork for the patient. I also got myself abreast with how the collective mental health and addiction care service system operates for the benefit of the patient.

I also participated in the family day. The patient’s parents visited to have, breakfast, lunch, played games together. They also had discussions with the nurses regarding the welfare of their children.

The family week is also ongoing. I had the opportunity to be with one family where we practice different relaxing techniques.

EVIDENCE BASED PRACTICE AND DECISION-MAKING COMPETENCE

I chose a case study on depression as my internship assignment. In trying to come up with remedies and therapeutic ways of coping with depression, I utilized evidence based and experience-based information in Mielenterveystalo website.

CULTURAL COMPETENCY

As a student nurse I took into consideration cultural sensitivity and its meaning for nursing care for patients and their families. I respected the values, norms, religion of the patients knowing how valuable it is to them in trying to provide them with the needed care.

I conclusion, i had a fruitful five weeks of mental health and substance practice. I am most grateful to my two mentor Anssi and Sini  and the entire nursing staff for their cooperation guidance..