Critical Care admits the vast majority of behavioral health patients requiring medical admissions, not yet medically cleared for inpatient psychiatric treatment. Christy received a lateral transfer for psychiatric safety; a 22 year old female admitted for dehydration, poor nutrition/intake, and altered mental status who happened to be COVID+. Speaking Swahili as her native language, it was challenging to assess her mental status despite using an interpreter. The previous assessment identified her to be agitated, uncooperative, crying frequently, and repeatedly asking to go "home to Africa". She arrived with a coretrak feeding tube; identified as a High-Suicide risk patient requiring constant observation.
Christy took the time to try to learn this patient's preferences and understand the root cause of her behaviors. Seeing her as a Person, Christy found the patient to be understanding of the care plan and cooperative; and was able to establish a trusting relationship. She concluded that the patient's concerns were valid. She wanted to eat food and have the coretrak removed, she wanted to walk around the unit because she was bored in her room and she missed her boyfriend in Africa, expressing unhappiness that her family moved to America.
Overnight, after Christy had ended her shift, the patient attempted to elope from the unit, citing she just wanted to go home. She also complained she was uncomfortable sleeping in our hospital bed, as she was accustomed to sleeping on a mat on the floor when she lived in Africa. Security had to respond to help de-escalate her, and during this event, she lied down on the floor and pulled out her coretrak. With collaboration, the care team decided to obtain a mattress for the floor to allow her to sleep as she is used to sleeping. She was then able to obtain uninterrupted sleep while sitting on the mattress in an upright position as was her preference.
In the morning, Christy was again assigned as her nurse. She found the patient to be alert, oriented to self, to the year, and to her situation saying she was not "sick" anymore, recovered from Corona. She was refusing to eat other than French fries, due to cultural preferences. However, Christy influenced her to eat some of her pancakes and eggs for breakfast. Christy collaborated with nutrition and food services to try to find culturally appropriate foods based on her preferences. Despite not being able to provide anything for lunch, the patient again ate most of her French fries with Christy's coaxing.
Christy truly felt the patient was probably immature for her age and was behaving as appropriate for someone who may be closer to a teenager or adolescent. Christy felt the patient's request to return home and eventually go back to Africa to be with her Fiancé/Boyfriend was understandable. Christy established trust and encouraged the patient to do activities that brought her happiness, life performing African dance and singing. The patient became more cooperative and seemed to trust Christy, in a way nobody else could connect with her. She even sat at the Nurses' station for a time for a change of scenery outside of her room, humming and singing quietly or coloring.
Because Christy went above and beyond to learn this patient's preferences and see her as a person, the discharge planning moved quickly. Christy collaborated with psychiatric services, the patient's family, and the attending to facilitate discharge home. The care team agreed that this patient was not suicidal and could safely return to her home under her parents' supervision with resources for outpatient behavioral health services. The patient was so happy and successfully discharged home later that evening. She even hugged Christy goodbye when her family picked her up to take her home. Imagine how much longer this patient might have been hospitalized if it had not been for Christy's commitment to serving this patient.