What makes a good Behavioral Health Nurse? Behavioral health clinicians must have exceptional communication and relationship skills, including the ability to set boundaries and establish and maintain trust. Our veteran population at South Texas Veterans Healthcare System is cared for by a team of nurses who are passionate about improving and destigmatizing mental health care at the highest level of care.

Daily, inpatient mental health staff make special connections with our patient population. Staff demonstrate true compassion for our diverse veteran population including those who are homeless, transgender, and seriously mentally ill. Understanding how impactful respectful and compassionate care can be in preserving patient dignity, the staff have independently completed multiple acts of kindness. A few examples:  Staff washing a patient’s clothes by hand when the unit’s washer was broken to ensure this veteran was discharged with clean clothes. Staff purchased ethnic hair products for a female veteran, braiding her hair, and assisting her with other hygiene care which ultimately improved her mood and confidence. Staff purchased comfort foods identified by some of our veterans who had specific preferences and were not eating the meals provided.

Additionally, members of the care team must be flexible, demonstrate openness toward diverse lifestyles, and have a strong foundation in the behavioral sciences as well as medical science. They must be prepared to meet the complex needs of their patients and maintain a calm, caring demeanor in an environment that can at times be unpredictable. Nursing staff on GLA/B meet the needs of each veteran on an individual basis since they understand that each veteran’s experience is unique to their own perception.  Inpatient mental health staff demonstrated genuine care and concern when addressing a patient that seemingly escalated after being told he would be discharged midday. Staff learned he was refusing to leave because he wanted to wait to eat dinner first.  After learning the veteran was homeless and worried about food insecurities, nurses provided emotional support by relieving fear and anxiety by contacting nutrition care to request a hot meal prior to the veteran leaving, as well as a sack lunch for the veteran to take with him.  The veteran was educated on resources in the community for meals and shelter. This may seem like a simple feat, but the effects of this act not only met a basic need of the veteran, but it let the veteran know that we genuinely care.  

Additionally, the staff advocated for a transgender female who had gender-affirming surgery, had complications, and was experiencing pain and CAUTIs due to an indwelling catheter. Staff educated the patient on the importance of maintaining proper catheter care. Nursing staff raised concerns to the healthcare treatment team for the patient’s unique medical needs. Staff also reviewed other options for catheter placement that could potentially reduce the frequency of CAUTIs. The veteran was able to make an informed decision to request and ultimately receive a suprapubic catheter. This action improved the patient’s participation in their own plan of care. When this veteran was readmitted, the nurses who had developed a good relationship with her volunteered to visit her on the acute medicine unit.

Therapeutic communication skills are essential to empowering patients and promoting mental health. Psychiatric mental health nurses must become proficient in knowing not only what to say, but how to say it, with the right tone of voice, volume, and body language. The nursing staff on inpatient have time and time again demonstrated those skills establishing trust and facilitating medication compliance. An example was a veteran who felt marginalized by past experiences and homelessness. This veteran would historically no-show to his follow-up mental health appointments. During his inpatient stay the consistent actions from staff fostered a renewed relationship which was instrumental in this veteran’s follow-up care in the outpatient clinic and his recovery journey.  These are just a few examples of how the entire staff comes together to problem solve and use critical thinking to address the needs of our veteran population. The acuity of the unit can be such that patients escalate, become violent, and are volatile. The nursing staff consistently communicate to identify triggers and de-escalation tactics to preserve both the safety of the patients and staff in the most dignified and respectful way.

The nursing staff on the inpatient mental health unit understands the needs of our vulnerable population.  In addition to meeting Maslow’s hierarchy of veterans’ basic needs, GLA/B nurses and nursing assistants realize that veterans with mental health challenges also require specific aspects of care that in a collaborative effort, make up the elements for patient-centered care. Elements that make up patient-centered care are: 1) respect for the patient's values, preferences, and expressed needs; 2) information and education; 3) access to care; 4) emotional support to relieve fear and anxiety; 5) involvement of family and friends; 6) continuity and secure transition between health care settings; 7) physical comfort; and 8) coordination of care.

After a veteran transferred to the unit from an outside facility in paper pajamas without any of his personal belongings, the veteran asked if he could have a pair of underwear. Imagine having to ask if you could have your underwear, then being told none of your belongings arrived with you including your wallet and ID. The nursing staff purchased a pair of underwear for him and made it their mission to track down his belongings. Undaunted by the time-consuming and frustrating task, they contacted the other facility, the transport company, and finally the nurse who transferred him. Through persistence, they located the veteran’s belongings securing them for him. The veteran was so relieved and thankful. This is only one example of the time and effort the inpatient psychiatry nurses contribute to the mental well-being of our veterans in addition to their day-to-day nursing tasks and duties. As psychiatric nurses, they know by addressing the issues that matter most to our patients, their participation in their treatment planning and compliance improves.

We honor our veterans by demonstrating a level of understanding for what may seem like a small issue to others but are monumental to them. Recently, some of the veterans were discussing having to miss the Superbowl.  One veteran said “Football is an American pastime” that he always enjoyed.  Inpatient staff contacted hospital safety to get authorization to have a barbecue.  Staff contacted volunteer services and received a donation of $50 for food.  Staff brought in items and on Feb 12th, the veterans on the inpatient mental health unit had a barbeque and watched the Superbowl on the unit.  Veterans verbalized over and over how grateful they were to the staff and how much fun they had. One veteran said “This took me back. I felt like I was with my brothers again and for one day, I forgot about my problems.”

Special considerations for privacy and confidentiality place our unit in a unique position when it comes to including family members in the plan of care for our veterans.  However, the treatment team encourages each veteran with healthy family relations to include family members in their support system and plan of care. Our inpatient mental health nursing team demonstrates daily, respect, genuine care and concern, and emotional support for our veteran population.

Although not comprehensive, these examples serve as a small glimpse into how our nursing staff makes special connections with patients, including patients in their plan of care, educates patients, works as an interdisciplinary team, make patients feel comfortable, and goes above and beyond to preserve the dignity of our veterans.