Nursing Department
Marcia Lipper Michaelson, R.N., M.S., C.S., C.N.P., Director
The NYS Psychiatric Institute Department of Nursing’s mission includes clinical
care, research, and education of trainees. Departmental clinicians strive to
provide the highest quality care and treatments in the least restrictive
environment possible; to generate, support, and participate in research
protocols; and to train a new generation of healthcare providers in both
traditional and newer therapies. Health promotion, maintenance, and
rehabilitation are viewed as essential in meeting the needs of patients, their
families, and significant others. Interactive education of recipients is
incorporated throughout all phases of contact.
Registered nurses utilize the nursing process: assessment, planning,
implementing treatment, and reassessment to determine nursing care needs and
provide care to patients. Primary nursing, an assignment method by which each
inpatient nurse is responsible for a specific number of patients, and
participation in therapeutic groups are but two of the ways in which nurses
participate in patient treatment. Nurses also serve as individual therapists,
case managers, and educators concerned with a variety of health issues. Others
are active in performing diagnostic tests and in gathering essential data for
studies. Mental hygiene therapy aides, working with patients under the
supervision of registered nurses, provide care on an individual and group basis
including such services as assistance with activities of daily living,
observation of behavior, and provision of support and encouragement.
Units and Clinics in which Nursing Care is Provided
Nursing care is provided by registered nurses and therapy aides to patients on
an inpatient and outpatient basis. The inpatient units (Schizophrenic Research,
General Clinical Research, and Washington Heights Community Service) provide
round the clock care. Nursing services are also provided in the Child and
Adolescent Day Program, as well as in the outpatient units of the Washington
Heights Community Service, i.e., Inwood and Audubon Clinics. In multiple
research areas at the Institute, nurses also participate in protocols and
treatment.
New Initiatives
Services for Victims of Trauma Following the 2001 World Trade Center bombing and
American Airlines crash, Nursing Department personnel in conjunction with
members of other disciplines responded to the immediate crises by providing
crisis intervention (to outpatients, inpatients, residents of the community, and
other staff). Nurses assigned to inpatient units and outpatient clinics have
continued to provide therapy to those adversely affected by these events.
Additionally, clinical nurse specialists provided education to staff about the
effects of traumatic experiences and various interventions to facilitate
recovery. The Assistant to the Director of Nursing for Quality Improvement was
also involved in determining and distributing literature concerning how to
assist children and others in processing such traumatic events, so as to
mitigate adverse future outcomes.
Disaster Drills Nursing Department personnel participated with
multi-disciplinary and administrative staff in disaster planning and drills. As
a result of the events of September 11th, Nursing took on increased disaster
response responsibilities, e.g., Nurse Administrators carry a list of
inpatients’ significant others’ telephone numbers, so that in the event of
disaster they could be readily contacted as to where patients are being
hospitalized (e.g., Bronx Psychiatric Center) or conditions permitting to take
them home. Additionally, the NYSPI Pharmacy has made available disaster
medications, which inpatient nursing personnel are responsible for transporting
in the event of disaster/drill and evacuation.
Bioterrorism Nursing staff were instructed by the NYSPI Infection Control
Department as to how to respond in the case of possible bioterrorism (e.g.,
anthrax). Staff was taught whom to notify and how to secure the area until it
was determined to be safe for return.
Safety-Falls Prevention In conjunction with the NYSPI Quality Assurance
Department and the Department for Education/Training, the Nursing Quality
Improvement Committee focused on falls prevention. With members of these
Departments, lectures were given concerning precautionary measures; posters in
English and Spanish were placed on units for both patients and staff delineating
how falls could be prevented; bells were purchased for those who needed
assistance in rising from bed or sitting position. Information was incorporated
into the Nursing Assessment Form to assist in identifying patients at risk for
falls, so that they could be placed in the fall prevention protocol. Related
documentation was then required on the Nursing Assessment Form and in the
Multi-Disciplinary Treatment Plan (as a separate goal with related objective and
methods). This information was pre-determined and printed with a checklist for
possible methods to be utilized.
Continuing Focus on Preventing Behavioral Restrictive Interventions Nursing
personnel continued to participate with the multi-disciplinary treatment team to
prevent and reduce the need for restrictive interventions such as seclusion,
restraint, quiet room. Nurses are required to complete a coping agreement with
all patients upon admission (or shortly thereafter, if the patient is unable to
focus on this information at time of entry to the hospital). The agreement
serves to incorporate those interventions which assist the patient in reducing
stress and agitation. It further serves as an opportunity to educate patients in
appropriate alternative ways to manage disturbing feelings and events. Such
agreements are also found to be empowering for patients and families who may
also have input into these interventions.
Protocols Involving Patients with Substance Use Diagnoses As both the General
Clinical Research Unit initiated additional protocols (e.g., lofexidine study)
and the Schizophrenia Research Unit admitted patients with a primary diagnosis
of alcoholism, Nursing Staff Development instructors were instrumental in
teaching nursing personnel how to fulfill duties related to such studies.
Computer Skills Assessments and Training In conjunction with the
Education/Training Department, Nursing continued to assess staff skills in
utilizing computers to document patient information and interventions. The
Informatics Nurse met individually with nursing personnel for evaluation
purposes and to provide individual training. This education is crucial to the
implementation of the Mental Health Automated Record System (MHARS), which was
introduced at NYSPI in 2002.
Nursing Implications in the Care of Patients with Bipolar Disorder The Assistant
to the Director of Nursing for Staff Development initiated reviewing with all
inpatient nursing personnel the signs, symptoms, treatment, and other
interventions with patients who are diagnosed with having a bipolar disorder. In
addition to lecture material, video-taped segments were shown, so that symptomatology could be more graphic and thus identifiable.
Ongoing Initiatives
Continuous Quality Assessment and Improvement Program The Nursing Department has
an active Continuous Quality Improvement Program to insure quality care for
patients/subjects and foster the professional development of nursing staff. The
many aspects of nursing care and related documentation monitored included:
nursing assessment, coping agreement process, patient education, suicide risk
evaluation, emergency cardiac care, treatment of patients receiving
electroconvulsive therapy, medication administration, patient rounds, and
progress notes. A major focus has been on patient safety issues, currently
including communication between shifts and increasing involvement of patients in
a collaborative process to reduce risk.
Staff Development Courses With regard to the education and training of Nursing
personnel (i.e., registered nurses and mental health therapy aides), Nursing
Staff Development has core responsibilities involving orientation of new
employees; provision of a Basic Life Support Course; an annual up-date in
preventing and managing crisis situations; Mock Codes (Cardiac Arrests);
assessment of competency; and identification of training needs which are
addressed at unit-based in-services and other forums. In addition, new resident
physicians are oriented to the emergency medical system and related equipment.
Training includes the procedures to activate the emergency system; the potential
types of medical crises; and the expected staff response.
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In May 2001, the PH/PI Psychiatric Nursing Council, which is comprised of
representatives of the Nursing Departments of NYS Psychiatric Institute, The New
York-Presbyterian Hospital, and the Columbia University School of Nursing,
sponsored annual Nursing Grand Rounds. The topic this year concerned Diagnostic
and Treatment Issues in Transcultural Psychiatric and Mental Health Care.