Week Four

"15 Minute Checks for SI/SIB..."

January 27th, 2008 - February 2nd, 2008

ACTIVITIES:

• Perform Psychosocial Evaluation on newly admitted patient
• Ask questions
• Have January time sheet signed

REFLECTION:

I can't believe January is over! It's been a much quieter week after last Tuesday's treatment team planning meeting with patient K. I am getting to know my patients a little bit more each day. I'm also getting used to all the fast talking done by nurses and doctors. During report, the nurse gives the "pass status" of each patient. Each newly admitted patient will automatically be placed on unit restriction for approximately 2 weeks. After they complete 2 weeks of good behavior, they can earn their next level. Pass privileges may be taken away as a result of bad behavior. I asked Floy what all these terms and abbreviations meant.

One-to-One- This is the most restricting pass there is. These patients have nearly no privacy whatsoever. A staff person must be within arms length of this patient at all times (this includes restroom and shower privileges).

ICST- Incompetent to Stand Trial- This isn't really a pass. Rather, it is just an abbreviation I see after many patients' names during report. These patients usually have open criminal charges against them, but the court has agreed that they are not mentally healthy enough to stand trial. They are here, in the hospital, trying to get well enough to stand trial. Sometimes, time served in the hospital may count for time they would have spent in jail. Other times, this is not the case. Each case is court and judge specific.

15 Min. Checks (indication specified)- Patient is checked on every 15 minutes by staff for one or more of the following reasons:

• SI- Suicide Idealization
• SIB- Self Injurious Behavior
• Other indications for 15 minute checks include assault, escape, sexual precautions, etc.

UR- Unit Restricted- Every patient starts here. These patients may leave their room, to go to the med line or the lounge, but may not leave his or her unit.

ESC- Escort- These patients have permission to leave the unit to travel inside the hospital if and only if accompanied by staff personnel. One staff member may be in charge of escorting multiple patients to dining room, gym, chapel, etc.

B- Buildings- These patients have permission to come and go freely from their unit and around the hospital. This pass is highly respected and coveted among patients, due to the fact that this is the necessary pass one must have to go out to the smoking area for cigarettes. This pass also allows some patients to find hourly minimum wage jobs within the hospital.

B&G- Buildings & Grounds- This is the highest pass offered at Larue Carter. With this pass, patients may come and go off their unit, and in and out of the hospital. They may not leave hospital grounds, but are allowed to walk about outside, play volleyball, basketball, or other outside activities.

With spring just around the corner, it should be a goal of many patients to earn that B&G pass, so they can enjoy the great outdoors. However, earning passes is hard work, and takes much time and commitment. We'll see how it goes...

INTEGRATION QUESTIONS:

HBSE/micro: Where do you think personality develops in terms of someone’s physical and emotional growth?

Personality is developing as soon as, and as rapidly as, everything else in the human body is developing. In terms of physical and emotional growth, I believe personality is constantly growing and developing. I strongly believe that in (especially in the younger years), a person's personality is growing as a result of the environment they are in. I.e. If a person is raised in a nurturing, supportive environment, positive personality traits will be encouraged, and shine through in the individual in following stages of life. Just as a person growing up in a less than supportive, maybe abusive environment may show more negative personality traits. These negative personality traits can be due to many factors (abuse, neglect, etc). And if left untreated, can manifest into a wide array of personality disorders. However, this is just my opinion. I know there are cases out there to disprove my theory. In fact, I see it in my patients at Larue Carter. I believe the mind and body to be very interdependent. I.e. If a person feels physically healthy a person will be physically healthy.

Practice/micro: How does your personality reflect and influence how you work with clients and coworkers?

I think, especially in the field of social work, attitude is everything. I have received multiple compliments about my positive attitude at work and at my practicum, and I think it can make everyone's life a little easier, just to be in a better mood. Smiling, making eye contact, actively listening, and engaging clients when you see them about the unit (not only when you're looking specifically for them) will make you seem more approachable, and clients will feel more comfortable talking with you. Also, smiling is contagious. Work is not always easy. When doctors, nurses, and other staff are having a long and hard day of work, remaining upbeat and cheerful can more often than not, help relieve some stress. If you appear to be stressed, bogged down, too busy, or upset with outside things, (all together presenting a negative affect) those you are communicating may tend to view things you have to say more negatively, or else, speak what they have to say in a more negative manner. I have found this to be very true working in a state funded psychiatric hospital. Having a good (and professional) sense of humor helps take your mind of the days stresses sometimes, and helps everyone get along a little bit better.

Weekly Hours: 14
Hours to Date: 29

Week Three

"Now that's what I call team work..."

January 20th, 2008 – January 26th, 2008

REFLECTION:

Floy warned me that this week we would be a having a very interesting Treatment Team Planning Meeting. She could not have been more correct in her warning. Today I was introduced to a very famous patient on the unit. (For confidentiality purposes, I have renamed him K*) As I walked into the report room to take a seat for the meeting, I looked around at the plethora of support persons all interested in the treatment and care of patient K. Just take a look at this roster:

• Dr. Helio Perez, MD (an expert in medicines of mental health)
• Medical Student #1
• Medical Student #2
• Kursar, the dietician
• Susan, the chaplain
• Michael Kura, from the psychology department, but currently filling in for a social worker on extended medical leave
• Med Nurse, RN
• Floor Nurse, RN
• Galean, the drug/alcohol counselor
• Floy Hodson, LSW
• Me, Social Work “Student Intern” (ß that’s what it says on my badge!

And that’s just the staff! Patient K also had some family members attend this meeting:

• Mom
• Aunt (mother’s sister)
• Uncle (mother’s brother-in-law)
• Grandfather (mother’s fater)

All of these people came together to sit around one table and discuss what is and isn’t working for patient K. The meeting opened with Dr. Perez asking K to introduce/explain himself, why he’s here, and what he needs from the treatment team.

K opened by unfolding and reading a small crumbled piece of paper he had previously scribbled on. In this letter, K expressed tremendous concerns about the medicines he was taking. He was fearful of permanent psychiatric damage, and went into great detail explaining his concerns. Dr. Perez thanked him when he finished, and jokingly stated that he would “put it in the box” where he kept a stack of letters almost identical to the first one, all authored by K.

We spent almost 30 minutes listening to K express his immense anxiety, fears, worries, frustrations… things started to get very repetitive. His family would interrupt him, telling him that he just worried way to much, and the staff agreed. This was a 21 year old, white male, with a very loving and supportive family. A little part inside of me just wanted to yell, “Whoa, chill out!” to this boy I saw sitting across from me. But I know his problems are deeper than that. I maintained good eye contact, and listened very attentively to what he was saying. At times, I felt like I was listening harder than anyone in the room… and then I realized why. Patient K has been a patient at Larue Carter for nearly two years now. Floy tells me each Treatment Team Planning Update meeting has been around these same fears and worries of patient K…

Patient K sounded almost hopeless by the end of this interview, but he was reminded today of what an awesome strength he has... SUPPORT. Above, I listed 15 people who are actively looking for any way they can be of help. I thought support like this was amazing, and I let patient K know it. :)

INTEGRATION QUESTION:

Policy/macro: What Indiana Bills & Resolutions for the Spring 08 Legislative Session are of interest to you personally? What Indiana Bills & Resolutions are of interest to you professionally? Describe their significance to you, your agency, & your clients.

Personally, I take interest in bills pertaining to issues such as womens health, education, health care (for all persons), mental illness and the mentally impared. As a female student born and raised in a very "medical" family (many relatives work in the hospital setting), these topics are of particular interest to me, and I have cared about many of these issues for years now.

After researching bills and resolutions that may be of particular interest to my future career in social work, I would still need to stay current with bills regarding mental health care. If I were to find a position at Larue Carter, or any other state agency, I would be very interested in learning more about House Bill 1095, which discusses living wage contracts for state agencies, as this bill could directly affect my earnings and wages. A similar bill, Senate Bill 0350, discusses funding for mental health centers- I think this one would be equally important to me as well.

One bill I need to study up on, which will directly impact my practicum would be House Bill 1266, which explains eligibility for medicaid, and seeks to set up priorities for services provided. I think this is very important, as two cases we are currently handling could have been done weeks ago, had the medicaid eligibitiy been cleared sooner.

Weekly Hours: 13
Hours to Date: 15

Week Two

"I am starting to get the feel of things..."

January 14th, 2008 - January 16th, 2008

REFLECTION:

I am starting to get the feel of things around the hospital now, and am starting to understand what needs to be put into my learning plan, and how I can accomplish those things.

I understand that every morning we have “report” in the conference room. The purpose of report is so that doctors, nurses, and social workers can be updated on patient health and behavior each morning. The report is usually given by a nurse who has communicated with the night staff nurses. I was given a sheet of paper with each patients name on it, and told to “jot down important notes.” I am still pretty new at this, and everyone seems to talk so fast! The nurse reads off a patients’ name, tells their “pass status” (which is where in the hospital the patient is allowed to go… I still need to grasp understanding on this concept) then the nurse reads off their vitals, and mentions any behavioral problems the patient might have had in the last 24 hours. This gives the doctor a chance to write new orders in the chart, and any of the “treatment team” a chance to communicate ideas.

Tuesday mornings are special. Every Tuesday on our unit, after regular report, we have a TTPU, or Treatment Team Planning Update. This meeting is similar to report, however, the patient in focus, as well as any family member or support person, is invited to attend. I found this meeting to be very beneficial for everyone involved, and plan to report more on these TTPUs later...

INTEGRATION QUESTIONS:

Research/Micro: How could doing research for classes impact your relationship with your clients?

Research is so important, especially in the field of social work. Working with mental illness, I have learned to love researching. When I am introduced to new clients, I am respectively introduced to new diagnoses and other histories. Making myself knowledgeable with these concepts will not only help me work better with my clients, but it will also help me become a better teammate to my colleagues.

For example, during a practicum visit, my instructor was dealing with a difficult situation surrounding a clients Medicaid applications. I knew a little bit about welfare and the basics of Medicare/Medicaid, but found myself much more comfortable talking to her about this situation and asking questions after I came home and googled the different Medicaid options our client was exploring.

Another example of research being very beneficial in respect to clients and co-workers within the agency comes to mind. This patient has long been diagnosed with schizophrenia (among other illnesses). Each morning, a staff meeting is held with the social worker team, doctors, nurses, and any students to discuss (in an interdisciplinary fashion) the patients progress. Dr. P highly recommended that any med/nursing/social work intern interested attend the schizophrenia seminar being held by one of his colleagues, who is an expert on the subject. Having a better understanding of the diagnosis/illness helps the entire staff communicate better, and ultimately provide better care to the patient.

Policy/Macro: What is the agency policy about relationships at work? What are the consequences of infraction of the policy?

Although teamwork and professional relationships are highly encouraged among the Larue Carter staff, there are strict policies regarding inappropriate relationships between patient and staff. No staff member may engage in any relationship past the professional/acceptable relationship with a patient. This means, as staff, you may not date or have intimate relations with patients. It also means you may not accept money or gifts from a patient. Infractions are taken very seriously and consequences will be severe (i.e. immediate elimination).

Weekly Hours: 1
Hours to Date: 2

Week One

"What have I got myself into?!"

January 7th, 2008 – January 9th, 2008

ACTIVITIES:

• Meet Floy
• Meet other staff
• Orient myself to unit

REFLECTION:

Tuesday was my first day at Larue Carter Memorial Hospital. I parked out front, and walked through the main entrance promptly at 7:50AM. A security guard stopped me, asked for my name, and told me to wait in the waiting area for my field instructor, Floy Hodson. What an experience that was. I waited patiently, watching patients, patient’s families, and staff walking in and out of the building. I saw an older woman signing (sign language) to a younger deaf man in a wheelchair. I smiled at a few passers-by, and they smiled back. Then I nodded at another individual standing by the security window. He was rocking backing and forward and apparently did not like my smiling and head nodding in his direction. He moaned back at me. “I have had a little bit of experience in the mental health field,” I thought. But from day one, I knew I was in for a crazy ride…

INTEGRATION QUESTION:

After meeting your first client, can you tell what stage of development they are at, according to the theories you have learned in human behavior?

I haven’t really been “assigned” any patients just yet. I am working with Floy, just getting oriented to her unit, 3E- Adult Unit, and getting to know some of the patients there. But of the patients I have met, and had a chance to sit down and talk to, I still think this question is a little difficult to answer. Working with mental health, precise developmental stages may be ambiguous, due to the nature of the patient’s mental illness.

Because it is an adult unit, all patients here are over the age of 18. However, some are performing at the developmental stage you would typically associate with a 7 year old. For example, one patient, Jessica, is 18 years old, but insists on sucking her thumbs, carrying dolls, and throwing temper tantrums (actually, I hear temper tantrums are common with a lot of our patients).

I would say, due to the nature of their illnesses, many patients at Larue Carter are developmentally behind typical development of their peers. However, there could be many exceptions. I guess I’ll find out… in time.

Weekly Hours: 1
Hours to Date: 1