All of us deal with difficult patients on a regular basis, even more so for our psych consult liaison team.  RV was a patient who had a prolonged.  His behaviors were rooted in his intellectual developmental delay, OCD, and intermittent explosive disorder. Although his cognitive function was at the level of a toddler, the toddler was housed in the body of a grown 30ish-year-old man.   His needs were multilayered.  The kind of needs that aren’t easily met in an acute hospital setting.  This led to two admissions over six weeks with some aggressive behaviors.  

RV needed structure and routine.  A big piece of establishing a routine for him came from Jennifer.  She saw RV on a very regular basis, not just when required to do so for her job.  She sought out his behavior plan from Metrocare and communicated this to staff, so that all the sitters and nurses could start to know and understand RV. This directly led to a successful de-escalation of his behaviors over the many weeks he was housed on the 12-400 unit.  

More importantly, Jennifer established a personal connection with RV. Through her regular visits, she established trust with RV.  He had a positive reaction when seeing her.  After much maneuvering through the legal system, his family was able to secure a place for him at the Austin State School.  On past attempts to place RV in other settings, his behavior would escalate, leading to his hospital stays.   Jennifer laid the groundwork with RV about his discharge, communicating to him in a way that he could understand.  She let him know that this was a good change, and one to be happy about.  She came in early to be at the bedside when the EMS transport team arrived to help smooth the path with the transition.  She helped serve as a point person regarding his behavior plan, and helping the nurses get the right PRN orders from the psych team to help with the discharge.   

I was moved to tears watching RV's face beaming and saying “yea! State school, I’m leaving!”.  He reached his arms out to Jennifer over and over for many hugs of happiness as the teams prepared for his departure. Jennifer walked RV down to the EMS dock to make sure RV had a friendly face he could trust as he was leaving.

There were many involved in RV's care.  Including so many kind and caring staff from dietary, nursing, and EVS who participated in his care.  I was lucky enough to be one of his providers for a short time. However, a patient like RV needs someone to lead by example. Jennifer did this.  Many followed her example, and this gave RV what he needed to make this crucial transition in his life. 

Jennifer demonstrated the I-care values.  Her Integrity was demonstrated by establishing a trustworthy relationship with RV.  She demonstrated compassion in the extra lengths she took to make sure that RV knew that someone cared about him.  Collaboration was demonstrated by taking the responsibility to get his behavioral plan in place so that excellent care could be delivered.  RV's intrinsic worth was made clear in her efforts to show Respect.  Even difficult patients deserve equity, RV found a voice in Jennifer that helped ensure his equity.