santhi-lithiya-johnson

SENIOR TRAINING FELLOWSHIP REPORT Mrs. Santhi Lithiya Johnson, Psychiatric Nursing 2016

Objectives stated in the application for STF •

Establish a nurse-led geriatric psychiatric center

•

Formulate nursing protocols for maintaining standards of care including triage, admission, discharge and managing psychiatric emergencies

•

Educate and train nurses to provide quality care

•

Conduct short courses on geriatric psychiatric nursing

•

Conduct research in the field of geriatric psychiatric nursing

Mentor: Dr. Linda Redford Center Visited for STF : Kansas University Medical Center – Central Plains Geriatric Education Center, USA

Short description of training: During the four weeks of Observation I was able to achieve the following objectives 1. Observe the physical set up of geriatric psychiatric unit 2. Observe and learn the skills to assess the mental status with appropriate assessment tool 3. Learn the skills to identify the level of depression among elderly patients using the Geriatric Depression Scale 4. Observe and learn the protocols for admission, discharge, skin integrity assessment, prevention of fall and post-fall assessment and restraints protocols of geriatric psychiatric patients

I had the opportunity to visit and observe the following services: 1. Geriatric-Psychiatric Interprofessional Clinic, Center on Aging, Kansas University Medical Center (KUMC), Kansas– The medical professionals including psychiatrists, pharmacists, psychiatric nurses, occupational therapists and physiotherapists meet to discuss and decide upon the treatment for patients.

2. Nurse-Run Memory Clinic at KUMC, Kansas– Mental Health Nurse Practitioners assess the new patients and review existing patients with Mini Mental Status Examination scale and prescribe a treatment plan at the nurse-run clinic.

3. Alzheimer’s Association support group at Kansas –Patients affected with Alzheimer’s dementia meet twice a month and share their experiences of managing the activities of daily living.

4. Care givers support group of elders at Center on Aging, Kansas– once a month the caregivers of older people meet to share the burden of taking care of their older loved ones and their ways of coping with their difficulties. The psychologist guides them with suggestions during the process.

5. PACE (Programme of All-inclusive Care for the Elderly), Kansas – Assisted living community programme for dementia – A day care center which admits the elderly population especially those with memory problems. They are assisted by team members consisting of doctors, nurses, social workers, occupational therapists and physiotherapists.

6. Shepherd’s Center Companion Programme at Kansas –A community programme for people affected with dementia. Trained volunteers 55+ visit the population at home several hours a week to check their physical and mental status, check their medications, teach them exercises and assist care givers with problem solving.

I attended the following lectures 1. Functional Assessment and Gait treatment for elderly population 2. Ethics in Alzheimer’s 3. Dementia diagnosis 4. Long term care for the elderly

I visited the following hospitals 1. General Psychiatric Ward at KUMC – A 25-bedded Geriatric Psychiatric unit. It is a closed ward that admits patients aged 55 and above, without family members, for 12 weeks. The Center provides specialized psychiatric care. They focus on meeting the unique psychological needs of older adults who have psychiatric conditions such as depression, anxiety, grief reactions, psychosis, mood disorders, violence and attempted suicide.

I had the opportunity to meet the psychiatric team during grand rounds and share the importance of family therapy, which has been followed in our Mental Health Center, Bagayam, Vellore. It was interesting for them to hear about including family during the hospitalization of mentally ill patients.

2. Hospital Corporation of America (HCA) – Mid-West Health Research Medical Center at Kansas– Geriatric Psychiatric Unit. A 125-bedded hospital designed for senior adults who have maintained a high degree of functioning prior to the onset of psychiatric symptoms. These patients are admitted from their homes, nursing homes or assisted living facilities, and usually require only a brief hospital stay. The most common diagnoses are anxiety, bipolar disorder, psychotic disorders and dementia.

I observed the following: a.

Physical set up

b. Counseling given by the psychologists and nurses c. Admission procedure d.

Electroconvulsive therapy

e. Group therapy given by occupational therapists f. Protocols used for skin integrity assessment, prevention of fall and post-fall assessment and care of violent patients.

3. Saint John Behavioral Hospital, Kansas The Hospital provides specialized psychiatric care to seniors aged 55 and above who have depression, Alzheimer’s and complications of memory impairment, confusion or thoughts of suicide.

I observed the following: a. Physical set up b. Nurses conducting recreational therapy for in-patients c. Electronic medical records system

Plans to implement objectives on return to CMC: 1. Discuss with Dean, Nursing Superintendent and HOD of Psychiatric Nursing to prepare the following protocols and policy for Geriatric Psychiatric patients: a. Admission b. Discharge c. Falls prevention, and post-fall assessment d. Skin integrity assessment e. Assessment of violent patient 2. Train and sensitize nurses in Mental Health Center to understand and use the various protocols to provide comprehensive care and help them to use various clinical evaluation tools for geriatric psychiatric patients.

3. Empower Nursing students to provide comprehensive care to geriatric psychiatric patients.

4. Discuss and plan with the psychiatric team and administration establishing an awareness programme on Alzheimer’s disease 5. Initiate and conduct research on the following aspects: •

Prevalence of psychiatric morbidity among elderly population

•

Predictors of caregiver burden with elderly having dementia

•

Knowledge and attitude of the caregivers of older adults with mental illness

•

Extent of burden and coping among elderly caregivers of patients with mental illness

6. Discuss and plan with the Dean, Nursing Superintendent, HOD of psychiatric nursing and psychiatric team establishing workshops on care of patients with geriatric psychiatric disorders.

From, Mrs. Santhi Lithiya Johnson Reader, Psychiatric Nursing

07.11.2016

Through Head of the Department Psychiatric Nursing, CMC, Vellore Through The Dean, College of Nursing CMC, Vellore To The Director, Human Resource, CMC, Vellore Respected Sir, I thank the Institution for awarding me the Senior Training Fellowship for the year 2016.

As part of Senior Training Fellowship I had an opportunity to visit Kansas University Medical Centre (KUMC) – Central Plains Geriatric Education Center, USA, under the supervision of mentor Dr. Linda Redford, Director, Central Plains Geriatric Education Center, Research from 22.08.2016 to 16.09.2016. During this period I also visited General Psychiatric Unit at KUMC, Saint John Senior Behavioral Health Unit and HCA Research Medical Center at Kansas. This opportunity has given me new knowledge on Geriatric Psychiatric Nursing.

I thank God Almighty for helping to achieve my objectives. I would like to thank our administrators and members of the selection committee and Dr. Selva Titus Chacko, Dean, CON and Dr. Premila Lee, Nursing Superintendent for the opportunity given to me and Dr. Manoranjitham Sathyaseelan, HOD, Psychiatric Nursing for her constant support.

I also would like to extend my gratitude to administrators, international officers of Kansas University Medical Center, my mentor Dr. Linda Redford, Nurse Practitioner Ms. Carol Buller, Nursing Supervisor Ms. Cynthia Benbow at Research Psychiatric Center, Ms. Diana Khayat, Nurse Manager at Saint John Hospital, Ms. Wichulee Semachai, Clinical Nurse Educator, and Ms. Michelle Niedens at Alzheimer’s Association for their contributions.

I thank Dr. Mani. M. Mani and Mrs. Rebekah Mani for their constant support during my stay at Kansas. My heartfelt thanks to Vellore CMC Foundation, USA for supporting me financially and giving me the opportunity. I am grateful to my Institution for the opportunity given to me. The report of my visit is herewith attached.

Thanking you, Sincerely, Mrs. Santhi Lithiya Johnson