Clinical Reflection

N360-PMH
Tami Watanabe

During our clinical rotation, I was able to work with both adults and adolescent; males
and females. I found that many patients throughout the units were diagnosed with a type of
schizophrenia and comorbid conditions. Each individual experienced stressors and managed
stressors in various ways. At Kahi Mohala, I believe the goal of each patient is to educate the
individual in coping skills. The structure of each unit differed in how it was managed.
The first two clinical rotation I was able to remain in the adult forensic unit with patients
who were court ordered. In this unit I found that all patients were diagnosed with some type of
Schizophrenia. My patient is diagnosed with Paranoid type and as we conducted our interview I
observed the patient feelings of interrogation. I was also able to observe patient reacting to
internal stimuli to self. It was difficult to keep the attention of the patient for a prolonged period
of time.
I noticed that patients that did not comply with medication treatment for their mental
illness was often agitated walking with rigid body movements or with negative interactions with
others. This was controlled by having patient separated from the others.
I found that the general appearance of the patients was often disheveled but hygiene was
encouraged. Most need direction or redirection in order to follow rules of the unit. It was difficult
to hold linear conversations with adult patients often times needing to be refocused. The
adolescent units, the patients were willing to communicate with a focused interview. It was
difficult for the staff at times to keep these patients in order, some defiance was noted by a few
patients and in order to take control of the situation, the individual was often restrained.
Depression with suicidal attempts or suicidal ideation was most noted in the adolescent units.
Comorbid conditions were often found in both adult and adolescent units. Anxiety with
depression or bipolar with both mania and depression.

Many individuals suffer from a type of mental illness. One out of four is a
significant amount. The Department of Health, public health nurses go out to the community to
try and assist those who are willing to receive treatment. To my understanding home visits are
also completed by PHN. The various resources that we have been able to volunteer at will help
me as a nurse, to inform the patients I interact with, the services available to them. The Waipahu
Club House program offers services that will improve independent living. The River of Life that
not only provides meals but also encourages independent living is another great resource.
The treatment received at Kahi Mohala, I believe encourages the patients to learn coping
skills and encourage positive interactions with others. The management of the adolescent when
out of control may not be the most effective.
Homelessness, polysubstance abuse, and legal actions seems to be what many with
mental illness are faced with. Finding positive coping skills with stressors, anxiety,
hallucinations, etc. are important to stress to these patients and those that I will in the future as a
nurse need to educate.
This clinical rotation along with the volunteer work has opened my eyes to the large need
of assisting individuals with mental illness inside of these units and in the public. My story of
my own child as an adolescent and observing the adolescent in the units has broadened my
knowledge. I believe that some are necessary to be at Kahi Mohala, while others are sometimes a
form of neglect on parenting. My own child had been a handful and multiple times I wanted to
send her to a lockdown unit to find a way to control her negative behavior. Now that she is older,
I have a better relationship with her than ever before. Had I sent her to a lockdown unit I would
have destroyed her youth and self - esteem. Some are in need of the services provided, the

psychiatric counseling, the medication treatment, and the redirection to improve; some would
benefit greater with the services and resources outside.