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On the 22-bed inpatient psychiatric unit at St. Marys Hospital and Medical Center in Madison, WI, the census can vary from eight to 19 patients, according to staff nurse Therese Kroll, RN. With the advent of new antidepressants, the patient population has shifted from geriatric depressed patients to young schizophrenic patients. The challenges of care have evolved as well.
Surveys indicated that patients did not have enough to do, and they wished for more structured activities.
A team of a nurse, occupational therapist, recreational therapist, and social worker reviewed literature on the needs of the schizophrenic. They compared findings to the unit’s daily offerings: Individual patient goals, group therapy, occupational therapy, and relaxation classes. "Really, the structure was there," Kroll says, "but the patients were not participating in it."
As of January 1999, each patient receives a daily goal sheet. "It may seem simple, but these are things a schizophrenic has trouble with," Kroll explains:
1. Getting out of bed, grooming, and hygiene.
2. Attending group sessions.
3. Starting a conversation with another person.
"We observed patients carrying the sheets in their back pockets and sitting around the table talking about them," says Kroll. Nurses collect and discuss goal sheets with patients in 20-minute DART (Daily Activities Reinforcement Therapy) meetings Monday through Friday (M-F).
In group therapy, patients more often respond appropriately to each other instead of making unrelated remarks. Second-quarter 1999 patient survey results:
1. 67% learned about their illness and acquired better coping skills (improvement target: 85% to 90%).
2. 83% thought the unit program offered enough structure and activity (up from 62% in the first survey).
3. 85% made progress with problems and symptoms during hospitalization (up from 60%).
Plans for continued improvement: Increase regularity of M-F DART meetings from 73% to nearly 100%.
Keys to success
1. Consistent emphasis on goal completion.
2. Goal sheets direct patients’ efforts toward skills required for normal functioning in the community.
Therese Kroll, Inpatient Psychiatric Unit, St. Marys Hospital and Medical Center, Madison, WI. E-mail only: Therese_Kroll@ssmhc.com.