SENIOR TRAINING FELLOWSHIP 1. Name
: Mrs. Santhi Lithiya Johnson
2. Department
: Psychiatric Nursing
3. Year of STF
: 2016
4. 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
5. Mentor
: Dr. Linda Redford
Center Visited for STF : Kansas University Medical Center – Geriatric Central Plain Education Center, USA
6. Short description of training: During the four weeks of Observational visit I was able to achieve the following objectives 1. Observe the physical set up of Geriatric Psychiatric unit 2. Observe and learn the skill in assessing the mental status with appropriate assessment tool 3. Learn the skill 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 patient
I had the opportunity to visit and observe the following services: 1. Geriatric – Psychiatric Inter-professional clinic, Center on Aging, Kansas University of Medical University, Kansas– The medical professional including the Psychiatrist, Pharmacist, Psychiatric nurse, Occupational therapist and Physiotherapist discuss and decides upon the treatment for the patients. 2. Nurse –Run Memory Clinic at KUMC, Kansas– Mental Health Nurse practitioner assess the new and review patients with Mini Mental Status Examination scale and prescribes the treatment plan at the Nurse run clinic. 3. Alzheimer Association support group at Kansas – The patients affected with Alzheimer’s Dementia are helped to meet twice a month and shares their experience of managing the activities of daily living. 4. Care givers support group of elders at Center on Aging, Kansas– once a month the care givers of older people meets to share their burden of taking care of the older people and their ways of coping with their difficulties. The psychologist guides them with suggestions during the process. 5. PACE programme (Programme of All-inclusive Care for the Elderly), Kansas – Assisted living community programme for Dementia – A day care center organization which admits the elderly population especially with memory problems assisted by the 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. The members in this programme visits the population to check their physical and mental status, checks their medications and teaches them with exercises, and assists care givers with problem solving.
I also have attended the following Lectures1. Functional Assessment and Gait treatment for elderly population 2. Ethics in Alzheimer’s 3. Dementia diagnosis 4. Long term care for the elderly
I have visited the following hospitals 1. GENERAL PSYCHIATRIC WARD AT KUMC – A 25-bedded Geriatric Psychiatric unit. It is a closed ward set up where the patients are aged 55 and above are admitted without family members for about one week to two weeks. The Center provides specialized psychiatric care. They focus on meeting the unique psychological needs of older adults who are with 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 the grand rounds and shared the importance of family therapy, which has been followed in our Mental Health Center, Bagayam, Vellore. It was an eye opener information for them to include family during 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 have observed the following:a.
Physical set up
b. Counseling given by the psychologist and nurses c. Admission procedure d.
Electro Convulsive Therapy
e. Group therapy done by the occupational therapist f. Protocols used for skin integrity assessment, prevention of fall and post fall assessment and care of violent patient. 3. Saint John Behavioral Hospital, Kansas The Center provides specialized psychiatric care to seniors aged 55 and above. They meet the older adults who are with Depression, Alzheimer’s and complications of memory impairment, confusion or thoughts of suicide. I have observed the following: a. Physical set up b. Nurses conducting recreational therapy for In - patients c. Electronic documentation system
7. 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 follow up 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 to conduct awareness programme on Alzheimer’s disease 5. Initiate and conduct research on the following aspects: a. Prevalence of Psychiatric morbidity among elderly population b. Predictors of care giver burden with elderly having Dementia c. Knowledge and Attitude of the care givers of older adults with mental illness d. Extent of burden and coping among elderly care givers of patients with mental illness 6. Discuss and plan with the Dean, Nursing Superintendent, HOD of Psychiatric Nursing and Psychiatric team to conduct 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 Medical Centre – Geriatric Central Plain Education Center, USA, under the supervision of Mentor Dr. Linda Redford, Director, Geriatric Central Plain 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, The 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, The Nurse Practitioner Ms.Carol Buller, Nursing Supervisor Ms. Cynthia Benbow at Research Psychiatric Center, Ms. Diana Khayat, The Nurse Manager at Saint John Hospital, Ms. Semachai, the Clinical Nurse Educator, Ms. Michelle Niedens at Alzheimer’s Association for their contribution. I thank Dr. Mani.M.Mani and Mrs. Rebecca Mani for their constant support during my stay at Kansas. My heartfelt thanks to Vellore 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