Nurse’s Reforms Help Manage Psychiatric Patients in Crisis
One in an ongoing series.
The unit where Timothy Daley works at Einstein Medical Center Philadelphia is locked. The patients are there, not always voluntarily, because they have psychosis or schizophrenia or depression and some of them may want to hurt themselves or someone else.
Until recent years, it had been routine practice in the behavioral health setting to physically restrain psychiatric patients when they hit an emotional bottom – when they kicked a door or punched a wall, when they lashed out at another patient or a member of the staff.
Since Daley became nurse manager of the 30-bed adult inpatient unit two years ago, that hardly happens at Einstein anymore.
“I’m not a big proponent of putting patients in restraints,” Daley said. “Every one of our patients has endured some kind of trauma in their lives that has brought them to this point. Putting them in restraints is anti-therapeutic. It can be retraumatizing.”
Now, when patients need medication to calm down, they’re escorted to the “quiet room” and a nurse sits and talks with them while the meds take hold. The number of incidents of physical restraint has dropped to one a month; the unit recently went nearly 100 days without any at all.
Daley has initiated other reforms, as well. He helped co-found the hospital’s Therapeutic Response Team to educate staff how to understand and manage difficult patients. He created a meditation room on the adult psychiatric unit with a mural, comfortable furniture and religious reading materials available to patients. He revamped crisis de-escalation training for behavioral health staff by abandoning the lecture format presented to large groups and substituting smaller, interactive workshops.
“He has certainly helped move the needle with how we provide care to psychiatric patients who often are marginalized in their communities,” said Shamit Chaki, LSW, director of Einstein’s Crisis Response Center.
For Daley, it’s about respecting and understanding every patient, a philosophy which has been tested under extraordinary circumstances. As a nurse in the U.S. Navy active reserve, he spent nine months at Guantanamo Bay providing medical treatment to people held in the military detention center after 9/11.
“That was very challenging,” he said. “I treated everybody with humanity. I didn’t want to know what they were about prior to coming to Guantanamo Bay. That philosophy served me well.”
Daley’s efforts at Einstein are propelled not only by compassion, but by pragmatism, too. His reforms have been instituted with an eye on patient satisfaction scores – which have improved under his tenure – because they determine in part how the hospital, and he, are evaluated.
But motivation comes naturally to Daley. On the first day of seventh grade, for instance, he took home his English and spelling workbooks and completed the lesson plans for the entire year. He still laments the fact that the teacher wouldn’t give him the next grade’s workbook but made him follow the lessons he’d already completed.
Daley always wanted to go into medicine and the military – his father and uncles served in Vietnam — but he delayed both goals because he and his wife had two sons while they were in college and he didn’t want anything to detract from raising them. “Time is the one thing you can’t get back,” he said.
But he eventually went to nursing school and joined the navy at the age of 37. Now he’s making up for lost time.
Daley has one-year, five-year and 10-year plan for his professional and military careers and he reviews his goals once a month.
He’s assistant officer in charge of his Naval unit and will become Officer in Charge in December. He’s completed half the courses at Penn State to receive his MSN and will then pursue his MBA. He has a part-time job at a children’s residential home, to obtain necessary Navy nursing credentials. Oh, and he’s training to run his first marathon.
“I’m a doer,” Daley said. “I like to get things done.” Daley is certainly getting things done at Einstein, to the benefit of the hospital and the vulnerable patients in his care.