Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, April 29, 1990 TAG: 9005080036
SECTION: NURSES PAGE: N7 EDITION: METRO
SOURCE: Sarah Cox
DATELINE: LENGTH: Medium
The may be true even more so in adult psychiatric programs, since adults are responsible for themselves, work toward getting back into the workforce and standing on their own.
Unlike children or the elderly, they often don't have others to take care of them. They are under no one else's supervision, and the amount and weight of decisions facing them can be greater.
For nurses in this field, that can be both the challenge and the love.
"I see that population as the one that needs the most support, and that I find most enjoyable to work with," said clinical nurse specialist Barbara Kolarik of Catawba Hospital. "I feel the most affinity with this age group. It's the widest range, in terms of age (18 to 64) and growth and development issues."
"They are more likely to have more control over their lives, and therefore can handle and take more responsibility for themselves," said Mary Lou Holland, an R.N. on the adult program unit of Roanoke Valley Psychiatric Center.
"It's more interesting to plan - there are more options open to them. The elderly more often can't be on their own; they have to have supervision. If they haven't had education, it's too late. Young adults still can make that decision - they still have everything open to them."
There are a number of options for adults needing psychiatric help in the Roanoke Valley.
Catawba, a state hospital, established its adult program July 1, 1981 as an alternative to psychiatric patients having to travel to 150 miles to the Southwest Virginia Mental Health Institution in Marion.
"When you have to travel that far away, you lose the family contact," said John Plichta, assistant director at Catawba.
Among the patients in this hospital are those who have no insurance or no means of payment. Length of stay can vary from an average of 45 days to a maximum of 180 days. It is a full-service facility, offering the conventional modalities "with good track records," said Kolarik. These - group, individual and music therapy, medication and stress management, assertiveness training and family support groups - also are offered at private hospitals such as the Roanoke Valley Psychiatric Center.
The latter also offers an alternative to in-patient care: its Adult Day Treatment Program, which allows patients to continue their normal, daily lives, while receiving regular psychiatric therapy.
In addition, Mental Health Services in Roanoke offers a Community Support System for adults suffering from mental illness.
"This program model is designed to strengthen client skills and the ability to function in the community," said Helen Dasse, R.N., the program director. The Community Resource and Counseling Center section of this program involves case management, community resource access, psychiatric consultation, medication management and counseling.
Its psychosocial rehabilitation section, centered in Mountain House, is a clubhouse established in 1984 and modeled after a similar program called Fountain House, developed in the late 1960s in New York, according to Dasse.
"Its purpose is to work with the membership - adults with mental disabilities - in socialization and peer support, developing strengths and skills."
These skills are living, learning and working abilities. "They set a goal when they come to the program," said Dasse. For instance, that they eventually want to live in their own apartment. When Mountain House was first established, membership was about 20; now, said Dasse, there are about 80 active and 140 members on the role.
Dasse is no longer solely involved in the clinical side, but tries to maintain patient contact as much as possible. She said she didn't really pick her job - "it sort of picked me. Because I was a parent, I didn't want to work with children or adolescents - I was parenting at night. And I found a natural affinity for seriously disabled adults. I get a lot of satisfaction out of the growth that I see."
Many nurses say that teaching is a large part of nursing. In this field, hands-on teaching is most important.
"When you work with seriously disabled adults whose functioning is limited, they need someone who is willing to work with the patients and show them how to do things. And that's what you're supposed to do when you're a nurse. You don't stand back and tell them to change their dressing. You don't tell them to get up and walk. You help them. I'm not real good at telling - I need to show and do it," Dasse said.
And there's the social services aspect, which goes hand-in-hand with mental and physical nurturing.
"I'm not only responsible for medical things, but I'm responsible for and enjoy talking to patients about the problems that brought them into the hospital," Holland said.
by CNB