Registered nurses utilize the nursing process: assessment, planning, implementing treatment, and reassessment to determine nursing care needs and provide care to patients. 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.

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.

Additionally, nurses and mental health therapy aides participate in Institute-wide forums which benefit patients and their families, for example, the Patient Family Resource Center Committee, as well as task forces concerning policy development. Nursing personnel also lead diverse therapeutic groups and provide structured activities. On the Schizophrenia Research Unit, a nurse co-leads the Multi-Family Group in conjunction with a member of the Social Work department. Other staff lead health and recreational groups, as well as participate in a weekly sale (proceeds benefit patient activities). On the Washington Heights Community Service, members of the Nursing department lead groups on topics such as medications, grooming, and discharge planning. Staff on the General Clinical Research Unit convene groups involving orientation to the service, medication education, eating disorders, body image, and discharge. Other personnel hold discussions of cultural topics and oversee arts/crafts activities.

Enhanced Pain Management While management of physical pain/discomfort has always been a concern, greater emphasis has

been placed on this aspect of care. During the Nursing Assessment Process, specific questions have been formulated which trigger the practitioner's generating and completing a specific Pain Assessment Form. This information is in turn discussed with physicians and other members of the team, so that symptoms can be targeted, controlled, and, as much as possible, eliminated. It is of course imperative that medical illnesses with associated painful symptoms be treated. Pain affects one's well-being by causing psychological distress in the form of anxiety, depression, restlessness, insomnia, agitation, or other distressing consequences. In addition to medications, other complementary treatments may be utilized and consultation is sought from those in other specialties.

Coping Agreement Preventing psychiatric crises has also been of the utmost importance. More recently, however, the department revised its Stress Management Survey into a Coping Agreement. Upon admission, the patient is queried as to ways in which they have learned to calm themselves. Additionally, the admitting nurse utilizes a prepared list of self-soothing and other techniques which may be of assistance in decreasing the urges to act out when experiencing disturbing thoughts or faced with provocation from others. Examples of ways that enhance relaxation include music, medication, reading, and exercise. Patients can initiate these calming techniques or may ask others to participate with them. Similarly, nurses and mental health therapy aides may adjust the environment, so that stimuli are decreased or provided as necessary. Every effort is made to avoid utilizing more restrictive interventions such as quiet room, seclusion, or restraint. If, however, this is necessary, debriefing sessions are held with patients and staff to elicit feelings and minimize restrictive measures in the future.

Preventing and Managing Crisis Situations In harmony with the Coping Agreement, the Nursing Staff Development department and Department of Education and Training have initiated more frequent staff up-dates concerning methods to prevent and manage crisis situations. Vignettes, videotapes, and other educational materials are utilized to keep teaching sessions realistic, engage the learner, and incorporate valuable staff input. Having both scheduled and unannounced mock psychiatric crises enables instructors and staff to evaluate functioning in such situations.

Missing Person Drills Missing Person Drills were also instituted to insure the correct steps to take in such an event. This enactment and response to patient(s) not being present in the institution as required assists personnel of a variety of disciplines to locate patients as swiftly as possible.

The Nursing department maintains an active continuous quality improvement program in order to insure appropriate and effective care for patients and foster the professional development of nursing staff. Ms. Gretchen Seirmarco, Assistant to the Director of Nursing, chairs the Nursing Quality Assessment and Improvement Committee, and encourages input from all levels of personnel, which is integral to the quality assessment/improvement process. The many aspects of nursing care and related documentation monitored over the past year were: 1) nursing assessment of patients on admission; 2) nursing progress notes regarding patient data, nursing staff's actions, and subsequent patient response; 3) nursing care of patients receiving electroconvulsive therapy (ECT); 4) nursing documentation of the coping agreement; 5) medication administration; 6) patient education; 7) notation of patient rounds; 8) emergency cardiac care; and 9) suicide risk assessment.

Under the direction of Ms. Kathleen Ibrahim, Assistant to the Director of Nursing, comprehensive staff development programs are provided for personnel. In planning for educational offerings, aggregated competency data concerning staff, as well as the findings of Self-Assessment of Education and Training Needs Surveys were utilized. This year, in addition to orientation of new employees, educational programs included: 1) basic life support and instructor courses; 2) orientation of resident physicians to NYS Psychiatric Institute's emergency medical system and related equipment; 3) critical skills up-date for registered nurses, 4) mock cardiac arrests, 5) medication administration review, 6) missing patient drill; 7) utilization of centrifuges, and 8) new and essential policies review. With the Education and Training department, age-specific presentations were held: Working with the Older Adult and How to Run a Behavior Program for Adolescents within an Adult Milieu. Additionally, the Informatics Nurse, Ms. Christina Nakraseive, taught a number of computer-related classes: Introduction to Windows and Excel, as well as File Management. In conjunction with representatives of New York Presbyterian Hospital and Columbia University School of Nursing, the department also sponsored Nursing Grand Rounds entitled, "Mental Health Advocacy: Consumer, Policy, and Practice Perspectives."

Nursing personnel were also professionally active in the community. Ms. Christina Nakraseive, RN, gave a poster presentation, "Preparing for the Information Super Highway: Learning by Doing," at the Annual New York State Directors of Nursing Conference. Ms. Yvonne Singletary, RN, who works with the New York Coalition Against Depression was quoted in the media concerning recognition and treatment of depression in minority populations. Mr. Paul Tricarico, RN, a Certified HIV Counselor, provided several programs on that topic.

The Nursing department continues to provide essential services to patients, their families, and the greater community. Provision of quality care and related education ameliorates the problems of patients, their families, and the greater community. Patients are assisted in returning to healthier states and treatment mitigates possible relapse in the future. Participation in research is vital in assisting endeavors which prevent illness and provide enhanced treatments for those with mental disorders.

From left to right, Ms. Kathleen Ibrahim, Ms. Marcia Michaelson, Ms. Ruth Corn, Ms. Amy Bennett-Staub, Dr. Mary Bongiovi-Garcia, Dr. John Oldham, and Mr. Steven Papp (standing), and, seated, Dr. Sandra Rosenblum and Mr. Kyle Evans at the Nursing Recognition Day celebration