Going the extra mile for psychiatric patients
Going the extra mile for psychiatric patients
Staff Builders creates modular program
(Editor’s note: This is the second part of a series on psychiatric home care. In the December issue, Home care Education Management featured articles on psychiatric services and training mental health aides. In future issues there will be more articles on specific mental illnesses, such as depression.)
Staff Builders in Lake Success, NY, goes the extra mile in training psychiatric nurses. The national home care company has created an extensive psychiatric nurse competency program that accompanies its mental health aide training.
"We want to provide a safe patient-care setting," says Carolyn Scott, RN, MS, national coordinator of the behavioral health program for Staff Builders Home Health Care in Chicago. She says the company has had difficulty finding psychiatric nurses because many believe insurers are unwilling to pay for mental health benefits and so are leaving the field. "But that is not true anymore. That’s why we’re showcasing mental health at Staff Builders because it’s an opportunity for us to meet this mental health need."
Staff Builders offers its psychiatric nursing training only to nurses who have met Medicare’s minimum criteria for psychiatric nurses:
• an associate of arts degree and two years of experience in a mental health treatment center, either outpatient or inpatient, or a psychiatric hospital;
• a bachelor of arts degree and one year of recent experience;
• master of arts degree in psychiatric nursing or counseling.
"We also look for seasoned psychiatric care nurses who have three to five years of experience, no matter what their degrees are, because of the high degree of autonomy required in home care," Scott explains.
The company also evaluates psychiatric nurses for these two qualities:
• Caring: This is evaluated through an interview, supervisory visits, reference checks, and ongoing clinical supervision.
• Compulsiveness: This is evaluated through the nurse’s timeliness, completeness of documentation, and care management efforts on a patient’s behalf. "We try to find the most well-balanced, seasoned, mature individuals," she says.
All potential psychiatric nurses must pass a competency test with a score of 80% or higher. "If nurses pass the psychiatry exam with 80% or better, they don’t need to go through the psychiatric written training program," Scott says. "It’s assumed, based on their test scores, that they know the material and have a basic level of expertise to see psychiatric patients."
About three-fourths of Staff Builders branches have at least one nurse who has met all the requirements to become a psychiatric nurse, she says. The chief incentive for nurses who undergo the competency program and training is that it will broaden their horizons. "If you are a professional, you have to keep your personal and professional growth continuing no matter what."
Nurses are given three chances to pass the competency test. These are among the competency areas included (for more details, see Staff Build ers’ psychiatric nurse competencies, p. 7):
• maintaining appropriate boundaries;
• teaching assertiveness, problem-solving, and thought-stopping techniques;
• offering supportive interventions;
• safely handling psychiatric emergencies;
• communicating therapeutically;
• setting up a behavioral plan;
• accurately administering, scoring, and interpreting assessment tools;
• performing venipuncture safely and competently.
Nurses who fail the test may study Staff Builders psychiatric nursing manual, which includes self-learning modules in these areas:
• behavioral modification with children;
• thought-stopping techniques, a type of cognitive therapy (see related story, p. 13);
• assertiveness training;
• how to solve problems;
• how to deal with difficult or violent patients;
• medication management;
• communication and interpersonal strategies;
• various mental illness diagnoses.
Nurses may study only the modules in which they did poorly on the test and then can take that portion of the test again.
Psychiatric nurses also are encouraged to refer to Staff Builders’ manual on psychiatric drugs, so they can look up any medications they have questions about. The manual includes patient education with clear, easy-to-understand wording. Nurses may copy these materials to give patients when appropriate. (See sample patient teaching medication guide, inserted in this issue.)
For example, Scott says, suppose a patient has been diagnosed recently with schizophrenia, and he and his family know nothing about his illness. The psychiatric nurse may refer to the manual and pull out the pages on schizophrenia medication, including a list of side effects. Those materials supplement the nurse’s own medication instruction.
"By teaching people about their illness and medications, the hope is they won’t stop taking their medications prematurely," Scott says. "Many psychiatric patients don’t like the side effects. They stop taking the medication and get sick, ending up back in the hospital."
Looking for consistency in training
The psychiatric program includes additional patient teaching literature as well. Any of the materials can be copied and given to staff, patients, or caregivers when needed. (See insert for patient teaching tips on coping skills and memory loss.)
Staff Builders’ rationale for creating the comprehensive psychiatric nurse competency program was to make sure nurse training was consistent at each of the more than 200 Staff Builders agencies, she says. "If you’re going to try to have a standardized high-level program nationally, then you have to draw the line somewhere of what will be the minimum standard. Otherwise, you have 200 different versions."
Because inservices and specialized training can be expensive, the company created the nurse education modules as self-learning tools that could be used only when necessary, such as when psychiatric nurses fail the competency exam. This saves time and money because agencies don’t have to put aside several hours of a nurse’s time to provide psychiatric training.
The modules serve a dual purpose. They provide all the information a staff educator might need for a staff an inservice on a particular subject. If an agency has had a rash of patient-staff problems, the education manager can pull out the inservice on dealing with difficult patients and teach staff that material. Although it is part of the psychiatric program, its information might work as well with a general patient population.
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