​New Era for Eastern State Hospital

10/30/2014 – A number of national events and conversations in the past decade have demanded that we reexamine how we address mental health in our country. The stigma of mental illness is beginning to be overcome, and research is beginning to outline the severity of the connection between mental and physical health. There is a movement toward recovery-focused care in which the whole person is treated and not merely the symptoms.

Nursing is key to this holistic, team-centered approach to patient care.

The historic Eastern State Hospital recently entered into a partnership with UK HealthCare under which UK operates and manages Eastern State Hospital. This partnership has opened the door to an innovative collaboration with the College of Nursing including a psychiatric nursing internship program and the stronger presence of advanced practice nursing and research.

“It is a tremendous opportunity for the College of Nursing to play an active role in the transformation of psychiatric mental health services at Eastern State Hospital,” Patricia B. Howard, PhD, RN, NEA-BC, FAAN, professor, Executive Associate Dean for Academic Operations and Partnerships, and the Marion E. McKenna Professor of Nursing, College of Nursing.

Mental health care today is no longer merely about patients who are admitted or are being seen primarily for that reason. Many patients who enter the emergency room doors have dual diagnoses. Increasingly nurses are expected to be able to screen for behavioral health concerns in a way that can allow patients to recover from medical conditions and begin to get the attention they need for their mental health situation.

In the mental health world, a nurse not only has a very pointed role in medication management, overall unit and patient safety, but also in the team dynamic which is often complimented by the mental health associate, the social worker, the psychiatrist and other advance practice providers.

“The role of the psychiatric nurse has changed because of the change in the model of care,” says Colleen Swartz, DNP, MBA, RN, NEA-BC, chief nurse executive, UK HealthCare. “The expectation is for the patient to have an acute hospitalization as a moment of stabilization in the mental health continuum. But then there is the transition of the care to the outpatient team and managing those care transitions has become the work of the nurse, the social worker, and the physician provider.”

“Psychiatry is a specialty that is most effectively provided by a team,” says Joanne Matthews, DNP, RN, APRN-CS, clinical instructor, College of Nursing. She holds a dual position as course coordinator for the psychiatric/mental health nursing course in the undergraduate program and psychiatric clinical liaison nurse for UK HealthCare. “At UK HealthCare I’m seeing a much greater focus on the team approach to medicine across all medical specialties. But psychiatry has always been a leader in the team approach to health care. Quality outcomes rely heavily on nursing contributions to this health care team.”

The first priority for Dr. Matthews in training undergraduate nursing students is to reduce previous misconceptions and cultural stigma about persons with mental illnesses. She emphasizes seeing the individual as a person first with individual goals and dreams, then as a person with a mental illness, always with a focus on optimal wellness promotion. All nurses need to learn how to meet the needs of patients with psychiatric illnesses because they will care for patients with these illnesses in all health care settings.

“A psychiatric nurse can no longer focus only on the mental health care issues of the person, but just like every other nurse they have to look at the patient holistically,” states Dr. Matthews.

“The comorbidity of medical illnesses and psychiatric illnesses are an increasing challenge for the psychiatric nurse. The medical and the psychiatric components are often closely tied together. For example the psychiatric nurse may care for psychiatric patients who also have diabetes, cardiac or kidney disease, or problems with mobility. Conversely, the psychiatric nurse must understand how the physical or psychological aspects of cancer or heart disease contribute to the development of the mental illness.”

Over the years UK has developed a number of nurse internship programs in particularly complex practice areas such as perioperative and cardiovascular ICU nursing. Focused internships like these have proven to reduce staff turnover and benefits both patients and the overall health care environment. UK HealthCare now offers a psychiatric nurse internship based out of Eastern State Hospital open to newly graduated baccalaureate nurses as well as experienced nurses from a non-psychiatry practice setting.

“We’ve already heard from students who have interned at Eastern State Hospital who hadn’t considered a career in mental health until their exposure to it through the internship. We’re excited about the potential this collaboration holds for the future, including the training of the next generation of caregivers,” says Mark Birdwhistell, vice president, Administration & External Affairs, UK HealthCare.

With a proactive approach to psychiatric health care, Eastern State Hospital opened an innovative, state-of-the-art new facility in September 2013, equipped with 239 inpatient beds and a long list of amenities including a “recovery mall” for restorative activities like pottery, gardening and crafting. They are working to make sure their clinical services are state-of-the-art as well.

“One of the challenges in behavioral health is looking at the array of services that we have in our existing ecosystem and deciding what parts are redundant, what parts are lacking and where can we best perform particular services,” says Andrew Cooley, MD, chief medical officer, Eastern State Hospital.

This is where advanced practice nurses are able to really step up to the plate: to facilitate the implementation of the best evidence-based practices in a field with so many behavioral and medical variables. Lillian Findlay, PhD, RN, APRN, assistant professor, College of Nursing, is the point person at Eastern State Hospital to ensure this happens. 

“That’s one thing that doctorally prepared nurses are ideally suited for,” says Dr. Findlay. “We are a conduit for instituting research-based ideas into the clinical setting. Instead of doing things because it’s the way we’ve always done it, now the role is to make sure we’re doing what is actually supported by research.”

Much of this innovative research is taking place within the halls of the College of Nursing. Chizimuzo T. Okoli, PhD, MPH, RN, assistant professor and director of the Tobacco Treatment and Prevention Division of the Tobacco Policy Research Program describes the discipline’s approach to psychiatric research: “Nursing is unique from medicine in that we want to look at a patient not only as an organism that has all these things affecting it, but rather as a person within the context of what it means to be a person,” says Dr. Okoli. “We look at a person from a bio, psycho, social, spiritual perspective.”

In his research, Dr. Okoli is examining the role of tobacco use among behavioral health patients that often leads them to have the complicating medical conditions that ultimately result in their demise such as cardiovascular disease, respiratory illnesses and cancers. “Most of those illnesses tend to be related to first-hand smoking or second-hand smoking exposure,” explains Dr. Okoli. He is working now to develop patient-centric smoking cessation programs among patients who are also suffering from schizophrenia.

This patient-centric approach is also mirrored when training the next generation of advanced practice psychiatric nurses. “What doctorally prepared psychiatric-mental health nurses uniquely bring to the table are very refined skills in assessing psychiatric disorders, developing an accurate diagnosis and looking at how the mental illness influences functioning in all aspects of the patient’s life,” says Peggy El-Mallakh, PhD, RN, assistant professor and coordinator of the Psychiatric-Mental Health Nursing Track in the Doctor of Nursing Practice Program.

In her role at the college, Dr. El-Mallakh pays close attention to national trends in mental health. UK was one of the first to sign on to a joint White House/American Association of Colleges of Nursing (AACN) initiative to improve the curriculum for training nurses specifically in areas related to military mental health including suicide, post-traumatic stress and depression.

“Some veterans do not get their mental health care within the VA system,” explains El-Mallakh. “A lot of them are seen in the private sector so the likelihood of an advanced practice nurse treating a veteran is pretty high even if they are in private practice.” Eastern State Hospital itself will open an acquired brain injury unit later this year with this population group in mind.

The collaborative partnership between the College of Nursing and Eastern State Hospital is ripe with potential. At every level – baccalaureate and doctoral, research and practice—the opportunity is here and the door is open wide to a brighter future.