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Life as an Inpatient Adolescent Psychiatric Nurse

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Title: Life as an Inpatient Adolescent Psychiatric Nurse


1
Life as an Inpatient Adolescent Psychiatric Nurse
  • Jill Degen, BSN, RN, MHNP Student

2
Comprehensive Assessment Treatment Unit (CATU)
  • Characteristics of the Unit
  • 9 beds, soon to be expanding to 10
  • Length of stay generally is 6-8 weeks, more
    recently 12 weeks
  • Staffed with 4 for days and evening shifts
    combination of Nurses and Mental Health
    Counselors
  • Highly Structured Unit
  • Every minute of the day is accounted for,
    rules and expectations strictly enforced
  • RTS Response Training System
  • Connects the Unit to placements

3
Vision Statement
  • The Comprehensive Assessment and Response
    Training System (CARTS) of the University of
    Illinois at Chicago will strive to Provide
    innovative, optimal, and culturally sensitive
    assessment and treatment services to adolescents
    referred by DCFS who have had multiple
    intervention failures  Utilize a developmental
    approach to cultivate and maximize the
    adolescents inherent strengths and
    abilities Enhance the adolescents transition
    and integration into the community through
    collaboration with community-based providers and
    Provide leadership in the care of adolescents
    with serious emotional disturbances (SED) through
    education and research while serving as a
    resource to other providers.

4
Mission Statement
  • The Comprehensive Assessment and Response
    Training System (CARTS) of the University of
    Illinois at Chicago is dedicated to advancing the
    mental health and community integration of
    psychiatrically disturbed adolescent wards
    through innovative clinical services, technical
    assistance, education, research, and policy
    development.

5
Treatment Philosophy
  • We believe that normal adolescent development is
    characterized by the desire for self-mastery and
    the quest for autonomy and represents a potent
    force for health. We believe, therefore, that
    treatment for adolescents in the CARTS program
    should focus on helping them attain as normal a
    developmental progression as possible by helping
    their caregivers provide them with normative
    adolescent experiences including a stable
    placement, a consistent educational setting,
    involvement in age-appropriate community
    activities, and opportunities to learn the skills
    necessary to live independently.

6
Treatment Philosophy
  • We believe that in order for adolescents to gain
    the competency needed for self mastery and
    autonomy, they first need to feel that they are
    valued and that caregivers can be nurturing,
    empathic, trustworthy, and supportive. We
    believe that successful treatment occurs within
    the context of the relationship between the
    adolescent and the caregiver.

7
Treatment Philosophy
  • We believe that adolescents treated in the CARTS
    Program, like all adolescents, strive to master
    the skills required to care for themselves, to
    work, to play, to relate successfully to others,
    and to live independently. Their quest for
    mastery, however, is hampered by underlying
    psychiatric and emotional disorders, cognitive
    deficits, physical and medical limitations, a
    history of impaired relationships with
    caregivers, and limitations in their ecological
    systems.

8
Treatment Philosophy
  • We believe that in order to help our patients
    develop competency, self-mastery, and autonomy we
    must help them recognize and utilize their
    inherent abilities and develop effective
    compensatory skills for their deficits.
  • We believe that the treatment plan for patients
    in the CARTS program must be designed and
    implemented in cooperation with all systems
    involved in the adolescents life including the
    family, supportive friends, school, the church,
    the criminal justice system, recreational
    programs, and the adolescents placement.

9
Treatment Philosophy
  • We believe that all adolescents strive to create
    meaning in their lives, to develop a system of
    spiritual beliefs, to develop a sense of
    community and belonging.
  • We believe that the care we provide must be
    delivered in a culturally sensitive and
    culturally competent manner.

10
Patient Population
  • The age range of the children on the unit are
    11-17
  • All patients are DCFS wards of the state, time
    within the system varies from months to years to
    their entire life.
  • Custody was taken from parents due to abuse
    (physical, sexual, emotional, neglect, drug
    abuse, delinquency, suicidal attempts, in ability
    to care for the child due to mental/physical/medic
    al conditions of their parents.

11
Diagnoses of Patients
  • Pediatric Disorders
  • Pervasive Development Disorder, Autistic
    Spectrum, ADHD, Conduct Disorder, Oppositional
    Defiant Disorder
  • Schizophrenia and Psychotic Disorders
  • Schizophrenia, Schizoaffective Disorder,
    Delusional Disorder, Psychotic Disorder NOS
  • Mood Disorders
  • Major Depressive Disorder, Bipolar, Mood
    Disorder

12
Diagnoses of Patients
  • Anxiety Disorders
  • PTSD
  • Dissociative Disorders
  • Dissociative Identity Disorder
  • Personality Disorders
  • Borderline, Narcissistic

13
Criteria for Admission
  • All wards are admitted to CATU for the following
    reasons
  • Multiple Hospitalizations
  • Extreme Behavioral Changes (Aggression,
    Self Harming, Suicidal Ideation)
  • Medication washes, adjustments
  • Comprehensive assessment of the child
    required
  • Prior Admission to CATU Once a CATU kid
    always a CATU kid
  • ALL ADMISSIONS ARE CLEARED THROUGH THE DCFS
    GATEKEEPER

14
Presenting Behaviors
  • Many of the children present with extreme
    aggression, self harming, suicidal, psychotic
    behaviors prior to and during the admission.
  • The honeymoon period applies to all that are
    admitted, sometimes it is very brief minutes,
    or longer days to weeks.
  • Entitlement. When I lived with my family
    growing up I had to earn everything. Now that I
    am in DCFS things are just given to me, and
    thats what I now expect.

15
Tools to Pass Along
  • Structure, enforce rules
  • Clear Personal Boundaries
  • Empathy, Not Sympathy
  • Special treatment is not good treatment
  • Work part of a team
  • Communication
  • Advocate and consistency

16
Tools to Pass Along
  • Really listen to what the child is saying, how
    she/he is saying it but what she/he is NOT
    saying is just as important.
  • Trust your gut instinct.
  • Ask direct questions, clarification.
  • Be patient.
  • Allow the child to express themselves, but teach
    them how to be appropriate and respectful when
    talking with others.
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