By Brent White,2014-06-28 12:36
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    1. ATTITUDE: All Duties contribute to the therapeutic environment. Included are observation assessment, treatment, 1:1 interactions, activities, meeting immediate patient need and housekeeping.

    Attitude toward visitors, patients and staff is also important. Factors that make a difference are:

    - Being courteous

    - Providing adequate response…being timely, making sure the response is

    understood, and follow-up.

    - Providing adequate explanations and reassurances. Examples of occasions

    when explanation and reassurance may be helpful: when admitting a

    patient, when performing a level II search, when asking a visitor to turn

    over knifes cigarettes, etc., when denying a request, and any interaction

    with the public.

    When incorporated into your daily routine these guidelines require minimal effort.

    2. RESPONSIBILITY: In addition to assigned patient and duties staff is responsible for:

    - Completing, appropriately labeling and/ or informing the oncoming shift of any assignments or other tasks that have not been completed due to busy shift etc. It may also be appropriate to inform the charge nurse. Examples of tasks

frequently incomplete but not labeled are patients’ laundry, cleaning bathmats,

    and disposal of used utensils.

    - Notifying appropriate personnel of forms needed, broken equipment, linen need, contaminated linen pickup needed etc.

    - Maintaining an awareness of the mental and physical status of patients, of unit safety issues and other potential problems.

    - Participating in unit duties. Examples: maintaining therapeutic milieu, MAB, emergency response. When appropriate, assisting other staff: Assistance with total care of patients; rounding patients for groups; meals, medications, etc.; helping out with assigned duties on an as needed basis.

    - As appropriate removing, cleaning and storing personal items such as coffee cups and other items used such as pens B/P cuff, and charts. Do this before change of shift and as needed during the shift to maintain a functional workspace. - Continuing education. In-services in the in-service binder and in-service videos provide a way to do this at slow time in the shift. Doing these in-services is one way of getting in-service credit. It is useful to review skills, policies and procedures on and as needed basis. The relevant manuals and some psychiatric, medical and nursing information are kept at the nursing station.

    - Using initiative in performance of duties and when encountering new situations. - Balancing obligations to others with adequate self-care.


    Admission and Discharge: Refer to policies and procedures for completion of

    admission/discharge process. Attempt to complete all processes and paperwork; make a note on each form that is not completed.

     It is especially important to provide reassurance, be aware of special fears/paranoia and to provide care for patient and his/her property. The patient may be tired, hungry, and/or afraid. Treat him/her accordingly with care. Be familiar with policies and procedures for Level I, II, and III searches.

     Wash clothes on with the permission of the patients. Label clothes, shoes, valuables, property, washer and drier loads. Make a record on the patient’s property, list all items brought on or taken off the unit at admit/discharge and other times. Services: ADL's assistance and education as needed; 1: for reassurance and reality orientation to the unit, its schedule and services provided by Sempervirens, County Mental Health and the community; working with patient’s needs and requests; limit

    setting, redirection and MAB.

     Treatments and medications are provided by licensed staff. Special services may be indicated for minors, D.D., and geriatric patients.


    - Introduce yourself to your assigned patients early each shift.

    - Change of shift report and the patient’s admission status, progress and

    problems. The treatment plan shows the diagnosis, problems, symptoms,

    etiology, goals and planned interventions.

    Tailor you actual interventions according to the planned interventions in

    the treatment plan, the goals and the patient’s current status.

    - A brief 1:1 with carefully considered intervention is essential to provision

    of current data on the patient’s status. The 1:1 may be done casually or

    formally and as part of a 1:1 for reassurance, orientation and education

    or separately.

    Other sources of information on the patient’s current status are: casual

    observation and interaction; 1 hour rounds; observations by other staff;

    Attention to report, chart review and planned intervention improve the

    effectiveness and completeness of observation, assessment, intervention,

    and charting.

    Charting: Be familiar with the policies and procedure for charting, the P-I-R format etc.

    - Chart in reference to the problems. Chart only the actual interventions

    done and the result observed.

    - Place all significant information that is not directly related to a

    problem/goal/intervention in a narrative section.

    Patients on Suicide Precaution or in Seclusion and Restraints

     Be familiar with policies and procedures for these patients. Make sure that all the safety and patient care interventions are done with the specified frequency.

     Patients on Level I S/P (suicide precautions) will be checked for safety every 30 minutes; patients on Level II will be checked every 15 minutes; Level III S/P patients are on observation at all times.

    S&R (Seclusion and Restraint) patients are observed every 15 minutes for safety and respiration and receive fluid and restroom offers every hour (while awake), and receive (if in restraints) range of motion exercise and circulation check for extremities every fifteen minutes. Meals will be provided to S&R patients at usual meal times. Patients will be positioned to facilitate swallowing. The bathroom for an S&R patient will be locked unless there is a M.D order to keep it open.

    Access to Property:

    Patients in regular rooms have clothes and non-valuable, non-dangerous items stored in the lockers in their rooms. These lockers are to be locked except when there is a problem (ex: confused patient who changes clothes numerous times a day…) patients’ requests for access to property in the in the lockers should receive prompt attention. Access to razors for shaving and other objects that could be used to do harm is only with staff supervision. Such supervision should be provided on a 1:1 basis or as part of and ADL’s group. See policies and procedure for special care to be taken for patients on suicide precautions.

     Valuables, cigarettes, money, ID, sharp objects etc. are not placed in the lockers in the patient’s rooms. A search/check of all property placed in patient lockers or given to patient should be done. The purpose of this search is to prevent inadvertent access to dangerous/counter-therapeutic items.

     If the patient is in a seclusion room locked or unlocked their clothes should be

    labeled and stored in the utility room. If the patient does not have a duffel bag or other adequate container place the clothes in a labeled plastic bag and store in the utility room.


    A. Nursing Station:

QS Each shift: PRN As Needed:

    - Clear debris -Maintain organization of drawers

    - Maintain function & organization and cabinets for forms and references.

    - clean with cleaning fluid Replace the posted information at the desk.

    B. Medications Room: QS. The person responsible for maintaining the med. Room,

    maintain extra restraint sets and the exam room supplies and equipment

    Medications nurse is also usually responsible for securing the rand(s) in

    case of a fire or other emergency.

    C. Staff Kitchen:

    QS PRN

    - Clean coffee machine - Clean: coffee dispenser, shelves, - Brew coffee for next shift. Under coffee machine, cupboards, - Wash dishes, cups etc. and place in refrigerator.

    cupboard. - Discard stale food from the fridge

    - Clean countertops - Replace towel under dishrack

     - Stock with cleaning supplies

    Clean refrigerator

D. Linen and Utility Room:


    - Bring out/remove/stock linen cart as scheduled.

    - Remove soap, cups, towels and other items from shower and bathrooms. - Remove debris from counter tops. Clean counter tops

    - Make sure there is access to all points in the utility room.

    - Take out linen bags at change of shift or if more than 1/3 full and during shift as needed.


    - Label all unlabeled clothes “unlabeled.”

    - Check with patient and or against their property list to see if there are claims on unlabeled or unclaimed items.

    - Label unclaimed items “unclaimed” and date the label.

    - When clothes are donated to the unit sort them, wash those which can be used and place them in the unit clothes locker. After clothes have been unclaimed for a sufficient period of time and adequate attempts have been made to return them to the owner, they may be treated as donated items.

    - Label unit cloths that have been loaned to patients returned as “unit clothes.” Wash these clothes before replacing them in the unit clothes locker

    - Stack linen in the closet.

    - Maintain a functional level of organization.

E. Meal Monitoring, Snacks, Dining Room:

    Monitor patients during meals and note food intake for all patients. Monitor fluid

    intake for patients on I/O.

    Be alert to:

    - choking

    - Intrusive behavior; set limits and redirect as needed,

    - Situation with actual or potential for isolative behavior and any other

    situations which require “MAB” intervention.

    Solicit other staff as needed.

    Ensure that all patients receive a meal.

    A.M.’s: Prepare coffee for community group.

    P.M.’s: Prepare coffee for dinner and snack. Take out snack, and round up patient for the snack. Coordinate with video group/popcorn. Begin video if requested by activities therapist.

    ALL SHIFTS: Clean tables and counter after all meals, snack and coffee. Return coffee carafes and condiments to staff kitchen and rags to linen cart.

    F. Making Beds:

    Preference is to assign two staff members for this task especially on day shift.

    Beds are made for patient who are discharged or have a room change. Patients are generally expected to make their own beads each day. Patients are given fresh linen as needed.

    Check for beds that need to be made at the beginning of each shift.

Making Beds:

     - Take linen carts to room. Remove dirty linens. Use gloves.

     - Spray with disinfectant fluid. Turn mattress and spray again.

     - Remove all discarded items and paperwork from the area of the bed. Disinfect

    sink, B/R, closets.

     - Make bed.

    All staff: assist assigned staff with beds for total care and incontinent patients. G. Trash: Nursing station, Med. and Exam rooms.

    H. Rounds:

    A.M.’s and P.M.’s:

    Q 1 hour rounds:

    R.N. makes rounds at change of shift to check unit status.

    - Early in shift: check on patient concerns; provide brief reassurance and/or

    orientation as needed.

    - Check on patient location, activity, status, and specified medical/psychiatric

    concerns (agitation, threats, intrusiveness, any unusual behavior, EPS…) Notify

    Med. Nurse, Charge Nurse as appropriate of any unusual items or changes.

    - Unit safety check: all rooms, offices including bathrooms.

    - As appropriate spend a few minutes at places where patients’ comfort and access

    to unit facilities and resources entertainment and therapeutic.


    Q 30 minutes.


Respiratory status and other specified concerns.

    Safety check.

    I. Community Group:

    Community group will be held when specified and as assigned. A of 1/1994 this group is regularly held at 0800 Q day.


     Have coffee, cups, and condiments ready. Have scheduled and meal menu for lunch and dinner. Have staff assignment sheet.

     Inform M.D.’s and other personnel who will attend. Have other staff round up patients as they approach the dining room or other venue.

    Group agenda:

    1. Introductions all present

    2. Staff assignments

    3. Meal menus for the day

    4. groups to be held that day

    5. Expectations: part of the discharge process is that patients will have an

    adequate level of self-care. This includes: ADLs including grooming; care of

    room and making the bed; cleaning up after self (bathroom, dining room etc.)

    Encourage patients perform these activities and to take part in cleanup after

    meals, snack and groups

    6. Encourage patients to come to staff with personal problems and conflicts with

    other patients

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