1. Describe the learning setting. Include where it took place, the role of other persons who were involved with you, and any materials and methods employed which assisted your learning.
Ingleside is a relatively small “Mental Health Center” located in Rosemead, California, right off the San Bernardino Freeway. There are five main inpatient dormitory facilities: adolescent boys, adolescent girls, adolescent co-ed, adults, and intensive care. The staff on each ward consists of a charge nurse and nursing assistants. Each patient is assigned to a psychiatrist, psychologist, physical therapist, recreational therapist, occupational therapist, and social worker from the hospital’s staff. All adolescents attend school on the premises.
Teaching methods available to the nursing assistants (the position I held) include a 25 session In-service Education Course, held one hour a day for five weeks on a continuing basis. There are also staff meetings every day and larger meetings once a week, and frequent conferences with staff from other departments.
2. Describe your participation and responsibilities in this setting.
I held two slightly different positions while at Ingleside. For the first three months I worked the evening shift on the boys ward, and for the last three months I worked the day shift on the girls ward. The two wards of course were different, and also the two shifts were different. The patients were in school much of the day, so we spent more time with them in the evenings.
With the girls during the day much of my time was taken up shuttling them from one activity to another. All of them had to be supervised at all times when they were off the ward. Sometimes girls would be too upset to go to class and if they didn’t have an appointment scheduled with their therapist it would be our responsibility to talk with them and help them out with their difficulties.
We had more time in the evening with the boys. I played a lot of basketball and ping pong with them, but when there were no scheduled activities I would spend hours at a time talking with one boy or a group of boys about what problems had brought them to Ingleside and how they saw themselves eventually working out these problems.
Once a week there was a family meeting in which I would participate by bringing two or three of the boys from the ward and acting as a representative of the ward so their families and the social worker who ran the group could hear how they had been doing. As the social worker was inexperienced and I had been in group therapy for six months he liked to let me help run the group.
One of the projects I initiated while at Ingleside was a small meditation group for the boys. By the time I got clearance from all of their psychiatrists to start we only were able to meet for a few times before I transferred to the girls ward, but I felt this was a very positive experience for them. I also initiated rap groups with the boys in which we discussed realistically what was happening to them without any heavy authority figures around to be careful of. I had recently emerged from a long period of drug use and they felt a strong sense of empathy with me, as I obviously spoke their language and understood a lot of their experience.
My responsibilities included writing progress notes on each patient three times per shift, and at times restraining patients who were physically acting out.
3. Describe new skills and/or knowledge derived from this learning activity which contribute to your Degree Plan.
In the Basic Inservice Education course I learned the history and concepts of the mental health center, what roles I was expected to perform on the ward, how patients are admitted to the center, how to write up patients’ behavior to help implement the nursing plan, some basic physical nursing techniques including checking vital signs, and how to deal with certain medical emergencies such as seizures and cardiopulmonary arrest. A large part of the course was devoted to Erikson’s developmental theory and how to apply it to the adolescents we were working with. We learned the theory of the therapeutic milieu and some of the basics of psychopharmacology.
I learned how to talk to overtly psychotic patients. The background for this learning took place in absorbing the supportive tone that my therapist had used with me in less extreme situations, attitudes that were suggested in the inservice course, and from my sense of empathy from having had some severe disorientations in using psychedelics. I found that severely disturbed patients could feel comfortable and understood when talking with me.
I attained some skill in leading family therapy groups simply by having participated in group therapy for six months and then being thrown into family therapy situations where I was the only person who had any experience whatsoever. I had very little theoretical background but was able to facilitate some communication and understanding that had not taken place before.
4. Self-Assessment: Evaluate this learning activity. Mention such things as the quality of the experience itself and its personal significance to you.
This was my first experience of any kind working in the mental health field. The only background that I had going in was six months of individual therapy and six months of group therapy and the desire to learn about the field. The staffing at Ingleside was very complete, with professionals and para-professionals of every type. Being on the bottom of the hierarchy and watching all these people work with children whom I knew from spending eight hours a day with them gave me a lot of understanding of the role of mental health professionals within a medical model. I found that I disagree pretty strongly with the medical model, in which the psychiatrist is the ultimate authority in all matters. I saw a lot of unethical behavior by these psychiatrists, who would come say hello to a patient once a week and enter in the notes that they had been seen every day for an hour a day. The psychiatrists had absolute power over what medicine would be given the “patient” and how long he would be in the hospital. The whole assumption was that the patient was sick. A lot of these young people were obviously minor behavior problems, but not to the extent that they needed a fully staffed hospital with medicines and doctors. Only a few of them clearly needed treatment more expert than just some good parenting and some good peer relations. And yet they were being taught that they were mentally ill, a really damaging blow to the self-image of an adolescent. The main task for many of them was to rise above the anger that this evoked so they could be seen as being calm enough that they were considered “cured”..”
With this sort of negative feeling about the model within which I worked, I was able to be open minded enough to see how everybody justified their work as “helpful.” But for me the main personal significance was that I decided I did not want to have to endorse the medical model by participating in it with involuntary patients for whom I did not feel it was appropriate. The quality of the institution may have been high in regards to the professional expertise of all its specialists, but I encountered precious few people who were really interested in bringing about actual conditions of mental health. I always felt that a radical reorganization of the hospital to a much more egalitarian society would have been necessary for that. But I did feel there was potential for me in the “mental health” field, because there are people who feel in need of help and should have a supportive atmosphere in which to gain or regain their balance. I decided to try a children’s home in the mountains that was not run on a medical model and seemed to be a much more liberal minded organization.
5. Describe the methods of evaluation and feedback used during the learning experience itself.
I was given a three and a six month evaluation by my nursing supervisors, which I felt were very fair and even flattering. I had frequent feedback and evaluation from my peers in daily staff meetings at shift change. All adolescent ward staff met once a week, and Ardie Jones, clinical specialist, met with us on the ward once a week to discuss any problems that could not be handled in any of these other contexts.
6. Describe the material products of this learning experience, if any.
Graduation certificate from Inservice course.
7. List the forms of testimony and evaluation that you will include in your portfolio as demonstrable evidence of learning. Please attach these.
Evaluation by Ardie Jones RN.
Evaluator: Ardie Jones RN
1. A brief self-description: your relationship with the student relative to this learning experience; professional and/or academic qualifications. You may attach a resume.
I became acquainted with Mr. Levin during his employment here at Ingleside from May of 1974 to November of 1974 in my capacity as Clinical Specialist in Psychiatric Nursing. My position includes responsibility for nursing inservice education, both formal and informal, the formulation of policies and procedures related to patient care and consultation to nursing personnel regarding clinical concerns.
I have been employed at Ingleside since June of 1973. My work experience includes 3 years of teaching medical-surgical nursing at California Lutheran Hospital School of Nursing, two years as a Clinical Specialist in psychiatrist nursing at the Veteran’s Administration Hospital, Brentwood, and one and a half years as a Psychiatric Nurse at UCLA Neuropsychiatric Institute.
I hold a Bachelor of Science degree in Nursing from UCLA, and a Master of Nursing degree in Psychiatric Nursing also from UCLA. During my master’s program, I minored in education and did specialized work in evaluation, had supervised practice teaching experience, and conducted inservice programs for nursing staff at UCLA-NPI.
2. Describe the student’s learning in this experience. Mention observable growth, skill development, information mastery, aesthetic sensibility, or other evidence of acquired learning. Use the back of this sheet if necessary.
Mr. Levin worked on two Wards during his employment as a Nursing Assistant. The patient populations on both wards were adolescents with a variety of problems ranging from acute psychotic disturbances to behavioral problems of greater or lesser severity; one Ward is for adolescent boys and the other for adolescent girls.
During his employment, Mr. Levin was an active and enthusiastic participant in our Basic Inservice Program, a 25-hour course designed to give new employees a beginning knowledge of psychiatric nursing concepts necessary for good patient care. (see attached course outline) In every area, Mr. Levin demonstrated an ability to understand new concepts and apply them in patient care situations. His immediate supervisor rated him as excellent in initiative and in creative responsiveness to Ward problems, ability to make positive changes in response to criticism, motivation and openness to new learning, ability to contribute in multidisciplinary care planning meetings and ability to work with overtly psychotic patients and patients of all kinds whether individually, or in groups. Mr. Levin showed increased skills in behavioral recordkeeping, and orienting new patients, and used excellent judgment in potentially dangerous situations which sometimes involved the use of restraints.
Mr. Levin earned the respect and admiration of those who worked with him. He began a patient meditation group, which, while short-lived, was very helpful to the patients. He also helped lead a therapy group where patients and their parents were guided in solving problems within the family.
His co-leaders in this group evaluated his skill and knowledge levels as excellent.
Mr. Levin’s ability to apply theory to the care of patients was particularly evident in the subjective but extremely important area often called “attitude”. .” He projected a warm, loving attitude towards patients and staff alike. His calmness and ability to think things through and help others to do the same was much appreciated.
When initiating his meditation group, Mr. Levin showed himself to be persuasive, persistent, non-threatening and flexible to suggestions from Administrative personnel.
In summary, I would evaluate his learning during this work experience as a concentrated, high level, theoretical and practical experience which encompassed abilities, skills, and knowledge necessary to function successfully as a psychiatric nursing assistant, with patients, with other staff and with Administration.
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