Our unit received a transfer from the Ross Heart Hospital, a 33-year-old female who had been at Harding (mental health) for three weeks. The patient was transferred to the Ross due to chest pain and subsequently to University Hospital. The patient had a complex medical history including multiple mental health issues with suicidal ideation. This patient required a sitter from the day she was admitted.
The patient was quickly medically cleared and it became apparent that the obstacle to discharge was placement in a facility where she would be safe from a behavioral perspective. Placements were set up several times and when the patient was notified, she would act out and make attempts to harm herself, thus sabotaging her release. The staff was compassionate but frustrated with the one step forward and two steps backward dance occurring with this patient.
Staff devised reward systems in conjunction with the psychiatry team to encourage positive behavior and to help the patient use better coping skills when she felt like harming herself. The patient was treated to adult coloring books, crayons, colored pencils, painted nails by the sitter and card games. She loved to play UNO and rummy and this made the hours pass more pleasantly for her.
Attempts were made to trial her without a sitter on several occasions and we would have her sit in the hallway by the nurses' station. She was in the middle of the action where staff could engage her in conversation. Staff made every attempt to engage her in a normal routine and to keep her from being withdrawn and alone. When we realized she was using eating as a negative coping mechanism and she was gaining weight, we worked with her primary physician and the dietician to devise a healthy eating plan and exercise. We encouraged her to get up and required her walk around the unit several times a day and to be as active as she could be. She lost over 50 pounds in a short amount of time and was proud of her accomplishment!
The planning continued for her to be transitioned to a facility. When a facility was located the team of providers determined the best course of action was to wait until her discharge date to notify her to prevent her sabotaging her discharge. The day arrived for discharge and all the staff on the unit were apprehensive about how the plan would unfold. Prior to the discharge day, the multidisciplinary team had met and decided to put together a care package to send off with the patient to let her know that we cared about her and to make her discharge a little easier for her.
The ambulance arrived and the team was assembled. The multidisciplinary team entered the room with balloons and presents and smiles on our faces. Dr. Klisovic took the lead and announced with great joy that we had found a great place for the patient to live and that all the patient's hard work to be ready to leave had paid off and that day had finally arrived. Krystal Renz, 11 E Rhodes Manager, presented the patient with a gift from the facility the patient was going to, a teddy bear and a brochure for the facility and a welcome from them and the news that they were excited she was coming to their facility.
The mood was joy, excitement, encouragement and support for the patient. She was overwhelmed and began to cry tears of joy and said she was ready to go. Everyone breathed a huge sigh of relief. We were grateful that she was accepting and that we could help her transition to the next stage of her treatment.
She left with the ambulance drivers and the last contact she had was with Krystal, she told Krystal she was happy and was smiling. This was more than we could have hoped for after months of her being depressed and threatening self-harm and worrying about her safety.

Not only did the staff on 11 E Rhodes invest a great deal of time caring for this patient but the multidisciplinary team did as well. We believe this is an excellent example of how effective collaboration results in positive results for patients.
The staff members that played a direct role in the ongoing care of this patient include the following:
Valerie Tiu - RN, assigned to take care of her frequently however even when not assigned to care for her visited with her often and offered support to J by stopping by her room and visiting with her. She helped to organize bringing in various things for J-nail polish, games, coloring books.
Keborah Thompson, Joely Henriquez -PCA/Sitter was assigned to care for her frequently. Was able to help J maintain a positive attitude, engaged in activities with her, played games, walked with her, painted her nails and talked with her when she sat with her. J liked when her sitters were "companions" and interacted with her and she tended to have better days when her sitters treated her with compassion and tried to make her situation as "normal as possible".
Maggie Shaw - RN/Clinical Coordinator-she motivated her when she was having difficult days and tried to help keep her focused on her treatment plan, she was supportive and was able to set good limits and boundaries with J which J responded to.
Laura Schimmeyer - RN-Charge Nurse-in her role as Charge Nurse Laura would frequently intervene when J was having a bad day and was able to help J with coping skills. Laura was a core group of nurses that J would respond to when she was withdrawn and difficult to communicate with.
Phoebe Nelms - RN-Phoebe is a night shift nurse that was often assigned to care for J, she spent countless hours at her bedside talking with her when she was having difficult nights, she painted her nails, braided her hair and listened to her when she was struggling with negative thoughts.
Bridget Thongsavanh - RN-Charge Nurse-Bridget brought in a deck of cards for J and it was the best gift she could have given her- she loved to play cards and this helped pass many hours of her days.
Dr. Sikic-Klisovic - Psychiatrist-saw J on an ongoing basis during her hospitalization. Was one of the only constants since the attending rotated on a regular basis. Was able to help her set goals and reframe her negative thinking.
Carrrie Stegall - Social Worker-Worked closely with Dr. Silkic-Klisovic's team. Was also a constant in J's life. Talked at length on a regular basis with her, offered support.
Marlena Richards - worked with psychiatry to find placement for J
Becky Short - worked with the team to find placement for J
Krystal Renz and Colleen Gains - nursing leadership on 11 E Rhodes -checked in daily with J, offered support, boundaries and helped negotiate conflict with staff.
Lauren McGlade - Registered dietician-worked closely with J to help adjust her diet and helped reduce her caloric intake.