Rachel's Clinical Experience (day 1 & 2)

On Wednesday, I had my first clinical experience in the Wagner-Jauregg Clinic. I was on a teen/youth open inpatient psychiatric unit. I was paired up with a PMU student named Gotti, who I worked alongside the whole day. When we first got to the unit, I was introduced to all of the staff and many of the patients. I was then showed around the unit for a sort of orientation including what the patient’s rooms looked like and included, various supply rooms, and the sterilization room. Immediately upon walking into the unit, I noticed the atmosphere was very different in comparison to my experiences on psychiatric units in the U.S., even those for children. The unit was colorful, well lit with natural light, friendly, full of artwork and decorations, and equipped with pass time activities such as a pool table, foosball, and a hammock. After being oriented to the unit, I accompanied all the other staff on the floor into the room where the patients were eating breakfast. Breakfast continued with the social educator (may not be exact translation of her position and may also be a position we do not have in American hospitals) discussing with the patients who would be their primary nurse for the day. After breakfast and since it was Wednesday, the patients were asked to return to their rooms to change the sheets on their beds, vacuum, and clean their rooms. I thought this was a great way to help teach and maintain a sense of responsibility in the patient’s lives considering some patients come and stay for a couple months at a time. After the patient’s finished cleaning their rooms, some left the unit to go for a morning activity of rock wall climbing. This clinic really emphasizes all kinds of therapies and offers such a range of therapeutic activities. However, I stayed on the unit and was introduced to the computer documentation system at the clinic. This seems to have a similar set-up to documentation systems back home as far as documenting the patient’s history, progress, medications, and therapies. After taking a look at the computer system and have some discussion about why patients are admitted to this unit, how long they stay (2-3 days for an acute crisis, 3 weeks for a diagnostic stay, and 8-10 weeks for a therapeutic stay), and some about patient safety, I joined some of the staff and patients for a group session with a therapist. This session was in German, but Gotti was able to translate some throughout the session and then explain everything after the session was over. This session was a time and place for the patients to voice any grievances or concerns about the environment, rules, or the group. The therapist then had the patients engage in some bonding activities. The activity for the day was a game where the patients had to line up in order from tallest to shortest (or lightest eyes to darkest, oldest to youngest, etc.) without using any words and then after a short time, reevaluate the ordering using words. After lunch, we joined the staff for a meeting in which they discuss as a group how the morning has been going, what problems or progress they have been seeing, etc. I thought this was a very effective method of communicating and ensuring that progress was being made with patients. I also found it refreshing and encouraging seeing how well the nursing team incorporated students into their team. They were really very welcoming and very focused on making sure we understood everything that was going on and the reason certain therapies were taking place. During this meeting, we also had some very interesting discussion on the problem of certain addictive, illegal drug use among young people in Austria. I was also able to learn about a form of psychosocial therapy called Dialectic Behavior Therapy, which they use in patients with PTSD or Borderline Personality Disorder. This therapy focuses on ensuring that the patient learns coping skills and ways to manage their emotions. However, before starting the therapy, the staff emphasizes an assessment of the patient’s home environment and access to a home, plans for work, and whether or not the patient has a peer group or supportive relationships. Later, after playing a few rounds of pool with my partner and a few patients, we accompanied some of the patients to music therapy. This was a great experience to have because I was able to witness how the patients were encouraged to work together to perform a song (actually a Nirvanna song) with a group on the drums, electric guitar, bass, and vocals. It was really neat to see the patients enjoying working on a skill and working together, encouraging and laughing with one another. I found the unit to really foster a sense of healing and to be therapeutic because of all the outlets they offered the teens to take their minds off of stress and the triggers that may be back home and learn to deal with their emotions in a way that will be therapeutic and constructive.

Day 2 began with breakfast and a morning meeting and then playing a few rounds of pool and foosball with some of the patients. The patients and staff found it pretty funny that we call the game foosball and not table soccer; they were surprised to hear we use a German word. After some bonding time with the patients, Gotti and I accompanied one of the patients to his individual therapy session. This was in German of course but it was very interesting to see the two of them interact and Gotti was able to translate for me after the session. The session ended with a game of Uno and some bonding time for the therapist and the patient. After lunch, I actually had the chance to sit down with the therapist/ special needs educator and ask her questions about what her role looks like in the healthcare team. She told me about all of the different therapies available to the children such as art, music, occupational (which is called ergotherapy in Austria), and skills training. Skills training includes activities such as learning coping skills, learning to cook so that the patient can take care of themselves once they are living on their own, problem solving training, and ways to manage their stress in healthy ways. She talked about how she often takes patients out into the community to help them discover interests that they may have so that the patient can be encouraged to pursue these interests and activities when they are stressed and as an outlet for their emotions. She will often take patients out hiking, biking, skateboarding, into the city, and to do different art projects such as ceramics. She also took the time to talk to me about the training they do with the patients to prepare them for returning home or a group home if needed. Patients are also allowed to return home on the weekends, if possible, especially if they are staying in the hospital for a longer-term stay. I shared with her how beneficial I thought this was because it gives the teens a chance to try out their home environment throughout their time of therapy at the hospital and see how they respond to stressful triggers. We also talked about how each week, she has a meeting with her whole team of therapists, psychologists, nurses, etc. to discuss the progress each child is making and to see if they need to reevaluate any plans. She also checks in with different therapists and healthcare team members throughout the week to evaluate progress and discuss any challenges. My experience on this unit was that communication seems to be very effective and open fostering an environment of progress and healing for these patients. After meeting with the educator for a while, Gotti and I were shown the closed/ locked unit that is for patients who are in more of an immediate crisis state. I was walked through the restraint system and all of the safety checks that they must follow in the event that they have to use them. Then, after sitting down with one of the nurses and discussing some of the diagnoses of the patients and what they were doing to specifically help these patients, we joined in on another therapy session but this time it was a group therapy session. Experiencing the difference between how an individual session was run versus a group therapy session was very interesting and I was able to understand more since the therapist was able and so kind to translate as she went along with the games and activities.

My experience on this youth psychiatric unit the past two days has definitely been very impactful and has had me thinking very much about what can be done to improve mental health care in the U.S. I am so thankful to have this opportunity where I am learning from a healthcare system that puts so much time and energy into mental healthcare and that has a very holistic approach that is evidently working and truly making a difference in these young peoples’ lives.