Inside Adult Psychiatry
The nursing staff on the adult inpatient unit which is specially designed to accommodate the needs of the developmentally delayed/mentally ill adult population (DD/MI), have had a successful experience during this first year of the unit's operation. The patients who are admitted to this unit are at risk of losing their existing community placement due to aggressive, assaultive, impulsive behaviors. The nursing staff is in the pivotal position of implementing and supporting the goals of the unit, which focus on the timely return of the patient back to the community-based living arrangement.

Much of the work for the multidisciplinary staff is based on a highly structured behavioral model whereby patients and family are educated regarding acceptable behaviors and resulting consequences. In this regard, the nursing staff have benefited from extensive and comprehensive education on crisis intervention techniques, behavior modification models, family dynamics, and group therapy interventions for this very specific population where the cognitive level of the participants is very low functioning. For this reason, the nursing staff has had to introduce and implement creative methods to communicate with the patients in order for the patient to understand and achieve their individual behavior modification goals.

In addition, the patients on this unit present with multiple medical needs along with their psychiatric needs, which necessitate a comprehensive approach in planning. The complex medication regime, for example, presents a challenge to the nursing staff who must be attuned to the physiologic impact of multiple medications which may have negative interactions. As the 24-hour caregiver, the nurse has the important responsibility to collect the relevant data for continued planning by the physician and the team. This information, which includes the understanding of lab values as they relate to the individual need, medication indications and possible side effects, evidence of behavioral changes, alteration in physiologic status, and newly acquired information from the family is presented to the team by the nurse, to support a holistic plan for the patient and for the family.

The first year data regarding the outcomes for this patient population suggests that 95% of the patients discharged were, in fact, returned to a community placement, thus avoiding admission to a state sponsored developmental center. In addition, the zero percent turnover of nursing staff during the past year on this unit is a testament to the level of commitment to the patients treated on this unit.

The Two North D service is the only one of its kind in the state and serves as a model for future state planning initiatives for the developmentally delayed population. The Department of Behavioral Health and Psychiatry is proud of the dedication of the nursing staff and the entire team working with this very special and challenging population.