Psychiatric Visit

P-1: Front view of Mental Hospital, Pabna P-2: Photo with our honourable teacher.at
Mental Hospital. Pabna

Introduction:
On 20th March, 2023. Mymensingh Nursing college, Mymensingh organized a psychiatric
field visit with BSc in nursing 3rd year students of Pabna mental Hospital, Pabna.
Accompanied by our honourable teachers. We reached there at 9.00 a.m. and we were
received by the honourable authority of the hospital. We got some noticeable information
about the hospital from them. The mental hospital was founded by Mohammad Hossain
Ganguly at the village Hemayetpur in Pabna District. The Civil Surgeon built the hospital in
1967 at The Shitlai Landlord's palace in the city. After two years, the hospital was relocated.
The new location was built on 111.25 acres of acquired land at Hemayetpur village by the
hospital authority, which paid compensation to Anukulchandra Chakravarty for the land. The
60 bedded hospital has been extended to 90 beds over nine years. The hospital was
transformed into a 500 bedded psychiatric hospital in 1996, with the addition of an additional
300 beds many years after the addition of 50 beds. There are 10 Wards with 14 wards for
men and 5 wards for women. The hospital has two stores, Of the 500 beds in the hospital.
24% are paying beds and 76% are ordinary beds. It has indoor and outdoor facilities. It has a
welfare society that helps patients and it is registered with the government.
They lead us to the inside of the hospital and we joined a class, taken by Dr. Mozaffar
Hossain.
The objectives of the class was –

1. Definition of psychosis and neurosis.

2. Distinguish between psychosis and neurosis.
3. Identification of the major types of mental illness.
4. Description and reorganization of the clinical features of mental illness.
 P-3: students attending a class which is taken by Dr. Mozaffar Hossain

5. Discussion and identification of biological, socio- economic factors which contribute

to the occurrence of mental illness.
6. Development of skill in early detection, prevention and rehabilitation of such cases in
the society.
7. Development skill in implementing treatment and carry out nursing care plan
according to nursing process.
8. Development of skill in administering psychotropic drugs to the mental disorder of
the patients.
9. Making diagnosis and prevention of complications due to side effects of psychotropic
drugs.
10. Observation, assisting and preparation of psychotherapy group therapy, family
therapy & Electro Convulsive therapy (ECT).

From that class, we learned about-

 Psychosis:
Psychosis refers to an abnormal condition of the mind described as involving a loss of contact
with reality. People experiencing psychosis may exhibit some personality changes and
thought disorder.
 Neurosis:
Neurosis is a group of uncertain functional neuro psychical disorders that exhibit themselves
in the specific clinical phenomena.
Factors contributing to mental illness:
We learned about so many factors contribute to mental illness, such as - Biological factors,
socio- economical factors, environmental factors, psychological factors, and socio-cultural
factors. Biological factors include genetic factors that is mostly common among all of the
factors. Research shows that 12% of people’s mental illness occurs for the gene that comes
from father and 46% of people’s mental illness for the gene comes from both father and
mother. Others associated factors are also responsible in many ways for mental illness.

Clinical features of mental illness:

Generally the clinical features that are seen in a mental patients
1. Sleeping problems
2. Concentration problems
3. Excessive fears or worries
4. Feeling sad and depressive mood.
5. Suicidal thinking.
6. Paranoia
7. Anger issues
8. Inability to cope with stress 10. Mood sweing
9. Excessive use of alcohol or drugs.
Major types of mental illness:
The major types of mental illness that are
generally treated in the hospital-
1. Schizophrenia 8. Drug addicted patient
2. Mania 9. Conversion disorder
3. Delusion 10. ADHD (Attention Deficit
4. Anxiety disorder Hyperactivity Disorder)
5. Illusion 11. Intellectual disability
6. Hallucination 12. Personality disorder etc.
7. OCD
Development of skill in early detection, process of mental illness, implementing
treatment and administering psychotropic drugs:
The important skills that should be developed in psychiatric nurses are-
1. Self-awareness and self- acceptance.
2. The ability to think critically.
3. Good Communication skills.
4. Emotional intelligence.
5. Understanding.
6. Supportive ness.
7. Empathizing with the patient.
8. Proper observing skill of checking relevant papers and prescriptions.
9. Advocacy skills to meet the needs of patient's properly.
10. Managing skills to carry out the treatment property.
11. Adequate knowledge of psychotropic drugs and the administration methods.
12. Proper Knowledge about the side effects and complications of psychotropic drugs.
13. Clear concept about & rights of medication administration, such as - right patient,
right drug, right dosage, right route, right time etc.

Observation, assisting and preparation the patient for psychotherapy, group therapy,
family therapy and Electro Convulsive Therapy (ECT):
1. Observation of the mental status of the patient and assess the medical history of the
patient
2. Assist the patient to attain clear concept about the psychotherapy that will be given to
him/her.
3. Reducing fear and anxiety and improving confidence by explaining the procedure.
4. Maintain proper privacy and removing jewelleries that can interrupt the therapy
5. Providing appropriate environment and make the patient comfortable.
6. Removing any kind of unnecessary object that can disrupt in the concentration of the
patient.

After giving clear concept about the above topic we finished the class then our honourable
teacher guided us to the ward of the hospital. We were divided into four groups, each group
consists of 25 students with the guide teacher. We were in Group A under the supervision of
our honourable teacher Momtaz Begum, Lecturer of our college. Firstly we visit male
psychiatric ward. There we introduced with a Nursing Officer of the ward by our guide
teacher. The Nursing Officer explained us the types of mental patient that are being treated in
the ward such as schizophrenic patient, manic patient, depressive patient and the patient
suffering from delusional disorders and so on. The environment of the ward was well
organised and clean. There was proper ventilation and lighting also enough space
for the patients.

We took an interviews from some patient of the ward. One of the patient name was Aryan
Khan, he loves music especially English song. In his perspective one should maintain ones
privacy even his parents. He thought his parents didn’t maintain privacy with him. We
interviewed another patient named Haran. He thinks that he has no mental illness and his
family forcefully took him there. He was very monic and euphoric. He also sang a song to us
and talked to very excitedly. He requested us to free him from the captivation of the hospital.
We also found a patient there who wan drug addicted named Shakel Ahamed. We talked to
him and he told us that he want to recover and lead a normal life. We asked him about the
reason of taking drugs. He told us about his depression, stress and anxiety about his life that
was the reason for taking drugs. We inspired him to lead a normal life and encouraged him to
take medicine regularly. And provided counselling to all the patient we interviewed.

P-4: Patient requested us to free them from the P-5: provided counselling to the patient
captivation of the hospital.
The History Sheet and Mental State Examination of the patient who was suffering
‘Substance related psychotic disorder’ is given below:

HISTORY SHEET

1. Name and : TAJUL ISLAM

2. age : 28
3. Sex : Male
4. Marital Status : Married
5. Occupation : employed
6. Education : Secondary
7. Reliable Informant : Father
8. Source of referral : Self
9. Chief Complaints : i) Sleep
ii) out going
iii) Odd behaviour
10. Total Duration of the illness : 2 years
11. Present Duration & episode : 1 month
12. Mode of onset : Sudden
13. Precipitating Factors : Stress at home or work
14. Family History of Mental Disorder : Absent
15. Premor bid Personality : Extroverted
16. Social & Family life : Well adjusted
17. Birth History life : Full Term
18. Treatment : taken
19. H/O Substance abuse : yes
 MENTAL STATE EXAMINATION

1. General Appearance and behavior : Abnormal

2. Speech : Irrelevant
3. Mood : Irritable
4. Thought : Flight of ideas
5. Perceptual disturbances : Hallucination Present
6. Cognitive Functions :
a) Consciousness : Stupor
b) Attention and Cone : Impaired
c) Orientation for time place person : Impaired
d) Memory : Impaired
e) Abstract Thought : Concrete
f) Intelligence : Average
7. Judgment : Impaired
8. Insight : Absent

The counselling’s are as followed –

1. We attentively listened to the patients about their problems, complaints, depression,
and anxiety etc.
2. We encouraged them to cope with daily problems and stress of life.
3. We improved their self-confidence share their opinion with others.
4. We told them different & coping methods to lessened the anxiety and depression such
as; - meditation, exercise etc.
5. We encouraged them to maintain daily schedule of taking drugs and diet properly.
6. We also encouraged them to continue the treatment regularly.
7.
At last we greeted the nursing officer of the ward and left the ward with proper
documentation.
Then we went to the outdoor of the hospital and met some doctors who were giving treatment
to the outdoor patients. Doctors were very friendly and explained us about many common
mental patients with whom they regularly deals. They also showed us some files of patients
and the treatment methods of mentally ill patients and we noted some of information.
Although the hospital was well organised but there was no facilities of ECT for the patient
with severe mental illness and number of doctors and nurses were insufficient according to
the number of patient. So we hope these problem will be solved soon by taking necessary
measures.

Conclusion: In the end of psychiatric field visit we learned about-

 The proper way of establishing interpersonal relationship with psychiatric patient by
effective communication.
 The process of providing counselling to the mental patients.
 The way of developing many necessary skills of a psychiatric nurse such as identification
and treatment of psychiatric patient.
 The administration of psychotropic drugs in proper method.
 The management of the patient with severe psychiatric illness.
 Education of the patient and their family for better outcome.
The whole visit was very effective for us to collect necessary information and gain
knowledge about mental illness and management of psychiatric patient. We also experienced
a good hospitality from the hospital Authority. Then we thanked them and left the Pabna
mental hospital with our honourable teachers.