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PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL

Reflective Journal Psychosocial Rehabilitation Regional Treatment Centre Abbotsford. Student Name Dermot Connolly Stenberg College

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL

Monday July 22nd 2013 I was quiet excited to start today, I had never being to a prison before and didnt know what to expect. Surprisingly I wasnt nervous, I guess I was too caught up trying to anticipate what to expect. As today was orientation day, I didnt get to start my clinical experience as I spent most of the day being orientated, watching training videos and getting accustomed with the facility. I met with Steven, the clinical team lead in the morning and it was he that I reported to for almost all of today. Not a lot happened today that I feel I could journal about; hopefully I will have more to write about tomorrow. Towards the end of the day I did get to spend some time with my assigned nurse, Allen an RPN who I will be working more closely with over the next few weeks. One thing that did strike me that I hadnt considered before was how stable the environment was. In such an environment, its unlikely that I will see new intakes, prisoner releases or calls for additional assessments, but I am hopeful there will be plenty of other learning opportunities in the coming weeks. Tuesday July 23rd 2013 Today was my first real day on the ward with my assigned RPN. Much of the responsibilities of the RPN role within the regional treatment center revolve around the administration of medication, vital signs and assessments surrounding escalations such as violence and suicide attempts. Scheduled charting and client assessment as it pertains to rehabilitation is not a common function of the RPN. While many of the community resource competencies do not fall within the responsibilities of the RPN, I was not concerned as I had

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL already arranged several visits within different departments that were directly involved with community rehabilitation. Instead, I availed of the opportunity to learn some new competencies as they arose during the day. In the afternoon for example I had the opportunity to carry out my first intramuscular injection on two patients. The first was a vitamin B12 shot into the clients deltoid and the second was the preparation and administration of Risperdal Consta into the clients right dorsogluteal. I felt both injections went well, I was not nervous and my RPN reported no concerns with my technique. Wed July 24th 2013 I spent today with one of the regional treatment centers clinical coordinators. He was an RPN with over 30 years experience and I felt I learnt a lot from him. We started the morning by supervision the methadone clinic which involved watching each client take their methadone and water and ensuring they each stayed in the holding area for 20 minutes to ensure proper absorption. One thing I learned from my RPN was to watch for clients attempting to regurgitate the methadone and hold it in their mouth. To prevent this, client interaction in conversation is

encouraged and for those who are silent, we tried and engage them in some form of conversation. Not only does this prevent morphine regurgitation, but it also helps with the absorption process. In the late morning I sat in on several treatment team meetings with my assigned RPN. The purpose to these meetings is to assess the progress of the clients against their assignment rehabilitation goals. With 96 clients on the unit, each one is scheduled over a period of a few weeks. One thing I noted today was the fact that there are two types of rehabilitation planning for forensic clients. The first relates to the traditional model where the client is assigned treatment needs and goals designed to help facilitate their return to the community. The second type targets

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL those who are serving life sentences with no eligibility for parole. While there is a lot of cross

over between both types of rehabilitation planning, the definition of community is different for client serving a life sentence. The client looking to be rehabilitated into the community for example may look to being placed in a halfway house while having other ADLs such as money management and employment also assessed. The definition of community for the client serving a life sentence, would address such issues as their ability to do their time without aggravating other clients. This would involve maintaining personal hygiene, the invasion of personal space and their ability to adjust to new environments if they were transferred to other institutions. In the afternoon, I was also very pleased to have the opportunity to sit in on some clinical assessments with my RPN and the resident psychiatrist. The purpose of the clinical was to address medication requests from the clients and review their current dosage and side effects (if any). Many of the clients request this meeting to discuss modifications to their medications which are reviewed in detail by the psychiatrist. I found these meetings also very interesting as it allowed me to witness many of the strategies used by the clients to remove themselves from certain medication such as anti-androgens or to be prescribed higher doses of others such as Seroquel. I felt I got a lot of worthwhile experience today and learnt a lot about psychosocial rehabilitation as it pertained to the forensic community. Thurs July 25th 2013 I was pleased to be working with the same RPN as yesterday and was even more delighted to learn that our list of agenda items was different from yesterday. I again spend the early morning helping with the supervision of the clients methadone and after that I participated in the transportation of a client offsite to an optician appointment with my RPN and two

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL correctional officers. Prior to this clinical, I would have viewed this as a simple escort off site, but I realized this week that the psychosocial tasks assigned to many of these clients while basic and simple to most people, are highly complex to the client. For example, todays offender is serving a life sentence for multiple sexual assaults and has a violent history of attacks on both correctional officers and nurses. Yet today he was accompanied offsite without restraints to his appointment. This was a result of years of participation in rehabilitation programs designed to treat his assessed needs.

In the afternoon I attended another treatment team meeting with my assigned RPN where we discussed in great detail the rehabilitation treatment plan of the same client I accompanied in the morning. The meeting concentrated on the clients desire to be moved away from the regional treatment center to a minimum security facility and his eventual movement to a half way house. As with yesterdays treatment meeting, a multifunctional team was in attendance and I was impressed with the amount of strategy and forward planning that went into the meeting ahead of time. The treatment team was aware of the clients request for transfer to a minimal security prison was denied and the strategy centered around how the client would be informed of this news without triggered a negative response such as self harm, with which he had a long history. The strategy planning worked well with the option of a second medium security facility being proposed and accepted. One thing that struck me from todays meeting was the childlike conversations held between the client and the meeting facilitator. As he is considered a low functioning client, he was spoken to in a manner that was similar to that of a child. Once the client agreed to consider movement to another medium security prison, the focus of the meeting next turned to addressing the clients goals towards self sufficiency to help him adapt in his new environment. Many of

PSYCHOSOCIAL REHABILITATION CLINICAL REFLECTIVE JOURNAL these goals would seem simple to a fully functioning individual but not to a low functioning client. These goals included maintaining personal hygiene and reducing the need for meetings with psychologists or nurses. In addition, I was also very encouraged with the level of recognition and encouragement shown towards the client where he had recently received an increase in pay and his wiliness to consider other treatment options. I was also pleased to be asked about my thoughts on the meeting during the debriefing which made me feel very much part of the team.