Essentials of Advanced Nursing Practice Field Experience C157 Introduction and Overview of the Consultation Process One key concern in healthcare is management of change, which occurs continuously. Managing change is about handling the complexity of the process. It entails evaluating, planning and implementing new procedures, tactics and strategies and evaluating the relevance of the change. The purpose of change is to facilitate
people to adopt new ways of doing things. In a healthcare setting, change promotes better practices and result in better patient outcomes. The purpose of this consultation is to identify the strengths and weaknesses within Central State Hospital [CSH], a state psychiatric facility and use the data to propose a change to improve a process that has been identified as ineffective. This consultation provides an overview of the strengths and weakness within the facility and development of a change process to improve patient outcomes. For this consultation process, I will explore any gaps and weaknesses in the organization that would impact negative patient care. Data will be collected through website review, patient assessment and nurse leader interview. Organizational Analysis-Description of Organization CSH, originally known as the Central Lunatic Asylum, is a state psychiatric hospital in Virginia dating back to 1870. In the 1950’s a Maximum Security Forensic Unit [MSFU] was built to evaluate and treat patients referred by the court systems. A geriatric treatment center was also built to serve the chronically ill and bedridden. Over the course of time, there were five treatment buildings constructed and four adult treatment buildings were built. The Civil Adult Treatment Programs at CSH provide services to patients over 18 years old ranging from short term, quick re-entry to the community and long term intensive treatment for the most seriously mentally ill, often turned away from for-profit hospitals. CSH is Virginia’s only Forensic Mental Health Unit serving patients involved in the criminal justice system.
The facility can hold 495 beds and sees over 5,000 patients per year ranging in length of stay. Patients on the Maximum Security Forensic Unit (Building 39) are undergoing competency to stand trial hearings, restoration services to prepare them for trial or have already been found Not Guilty by Reason of Insanity (NGRI) and are serving their time at CSH. Everyone on this unit has a felony pending. Within this unit are six wards; five wards housing men and one housing women. On the Civil Adult Treatment Unit, (Buildings 94, 95 & 96) patients either have misdemeanor charges or have been sentenced to service their time in the state hospital. Overtime, these patients have progressed to receiving more freedoms (unlike MSFU) such as increased visitations, less restrictive rules and more liberties with activities and day passes. The typical length of stay for the civil unit can vary based on a patient’s progression to be restored back into the community and court mandates.
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- Spring '17