Psychiatric Nurses Please Help.

Mr Ian · Jan 28, 2009

How are units divide up in a true psychiatric hospital, like acute hospitals have med./surg., tele., ICU, ER, IMU, etc. Also do psychiatric facilities use Per Diem Agency? Any help is greatly appreciated. Thanks

Oddly enough I was discussing this today with my own guys.

Generally (and this is limited to UK and Australia experience - but I've not heard it's much different in USA) - psych ward is a psych ward. If it's psych it goes to psych. That's it.

The only diff is patients are placed on 'acuity' rather than diagnoses.

ie

Those with ongoing low grade mental health issues go to "MH rehab" where they learn functional skills to so they learn to "live with the illness".

More acute go to ... err... Acute In-patient unit. If you're not coping well at home because of depression or anxiety or if you're running naked up the street - if you're 'manageable' you go to the acute ward. Most get well here and go home. Some don't get well enough to go home and go to MH rehab/LTC. Some get worse and go to PICU.

If you're out of control - you go to PICU - psychiatric ICU (other names available on request).

If you're out of control and dangerous - you go to a secure MH facility

(this may be diff in USA - someone will let me know I'm sure)

In all these there is no diganostic difference. It's all measured on 'risk'.

The conversation we had today was how general hospital has med - surg - maternity - ICU - CCU - etc; yet in MH wards it tends to mix all the diagoses together and utilise the skills of the nurses generically across all diagnoses.

Personally - I think the 'acuity' model is sensible but only up to a point - it would also make sense to have patients diagnostically sifted. Too often I've seen very deranged or hypomanic patients on a ward with little old depressed ladies. Or I've seen perpetrators of abuse on wards with abuse survivors - very wrong.

I'm waiting for the day where an in-pt sues the hospital after getting assaulted by another in-pt. It happens frequently (not ALL the time - but often) and really, are we putting these people in a place of safety if they're exposed to other less self-controlled individuals?

Be interesting to see how/if the USA model differs.

Whispera, MSN, RN · Jan 28, 2009

Where I've worked there has been a three-four unit model. The extremely ill, the functional, and the chemically dependent (and the elderly). All were locked units. There was some intermixing between the units too. Add to those the nearby hospital that took patients who only had Medicaid--all diagnoses were mixed there. It was on the same campus but independently incorporated.

sbyramRN · Jan 28, 2009

The hospital I did my Psyche rotation at had a PICU, Dual Diagnoses (usually substance abuse + depression), geriatric, adolescent. There might have been one more, but I forgot. Maybe just a substance abuse.

whodunit · Jan 28, 2009

Alas, in the hosp where I work, we have an inpt psych ward where everyone/anyone goes so its a odd mixture at times. I agree there needs to be a seperation of depressed from just psychotic etc but don't see it happening, especially with the mess health care is in.

bookwormom · Jan 28, 2009

Several years ago I worked at a state psych facility with these units:

-Forensic admission (mentally ill men who were facing criminal charges)

-Long term forensic (men and women "Not guilty by reason of mental illness")

-Male unit (like long term, but men who would not do well in a mixed sex unit)

-Young adult unit (mostly general psych patients over 18 who were court committed)

-Neuro-psych unit (mostly elderly)

-They have a new transition unit now for forensic patients preparing for discharge.

I worked as a PRN nurse. They didn't use per diem from agencies .

Katnip, RN · Jan 28, 2009

Our hospital has two residential units divided into boy and girl adolescents.

Our three adult acute units are based mainly on acuity, but one of them is strictly for mood disorders, not psychoses. We also have a children's unit for ages 10-13, and an acute adolescent unit where all our adolescents tend to go regardless of acuity.

LeavingTeaching4RN · Jan 28, 2009

The hospital where I completed my clinical rotation had three sections - cognitive disorders, thought disorders, and geriatrics which was a mixture of both.