Description of the Unit
Unit 52 Psychiatry, also known as the Brain Stimulation Unit, is a locked 10 bed inpatient unit located on the 5th floor of the North Tower, Patient Services Building. The unit typically treats adults requiring acute psychiatric care and who may benefit from brain stimulation in the form of electro-convulsive therapy (ECT) and/or would benefit from other services available in an academic medical center. Adolescents may be admitted if no comparable services are available elsewhere. Unit 52 is designated as a private Baker Act Receiving Facility by the State of Florida. Patients may be voluntary admissions or involuntarily admitted for evaluation and treatment.
The unit consists of all private patient rooms. There are two day rooms, a staff office and staff lounge, a conference room, and a seclusion/restraint suite including a lobby area, quiet room and a bathroom. There are also two procedural rooms, a treatment area and a 4 bed recovery room. This suite is used for the administration of electroconvulsive therapy (ECT).
Monitoring capability is restricted to non-invasive vital signs monitoring. There is no telemetry capability on the unit itself. Continuous direct non-invasive cardiac and vital signs monitoring occurs during the ECT procedure and recovery phase.
Care is provided 24 hours per day 7 days a week on the inpatient unit.
Unit 52 is also the setting for the ECT program. Both inpatients and outpatients are served in the program. Patients from UF Health Shands Psychiatric Hospital also come for ECT. ECT is a form of brain stimulation. The ECT suite is described above. One or both of the day rooms are used as waiting space for outpatients and their escorts during ECT days. ECT is given Monday, Wednesday and Friday mornings.
Description of Patient Populations
Patients are admitted to Unit 52 from the Emergency Department, by direct admission, by physician referrals, by referral via the consult team from other UF Health Shands hospital units, and by hospital-to-hospital referrals and transfers. The unit attending physicians must approve the admission.
The care focus of the inpatient unit is treatment of individuals with psychiatric diagnoses who may require electroconvulsive therapy, persons with co-occurring unstable medical or surgical problems or persons requiring neuro-psychiatric evaluation. Diagnoses most commonly treated include mood disorders such as major depression and bipolar disorder, schizophrenia, and psychosis NOS. Co-occurring substance dependence is also treated. Concurrent medical -surgical problems may include post suicide attempts, infectious diseases, diabetes, heart disease, hypertension, renal failure, respiratory problems, epilepsy, Parkinson’s disease and other movement disorders.
Individuals treated in the ECT program typically have a mood disorder including depression, schizoaffective disorder, bipolar disorder. These individuals may be inpatients on Unit 52, inpatients at UF Health Shands Psychiatric Hospital which is a distinct part of UF Health, or they may be outpatients. Occasionally patients from other UF Health units come for ECT. The patients are usually adults. Adolescents may be treated with additional psychiatric consultation required as per the unit and ECT policies.
The nursing care model used is that of total patient care delivery by the assigned RN with assistance from coworkers, including mental health techs (MHTs) and support techs. The RN focus is assessment, diagnosis, treatment planning, interventions, and evaluation of care. The ancillary staff including MHTs, support techs, and occasionally CNAs work under the direction of the registered nurse. Other nursing staff who work on unit may do so after requesting a Best Shift or they may be assigned by the Central Staffing Office.
The unit staff is very involved in maintaining a therapeutic milieu for patients and families. This includes providing an environment that is safe, secure and therapeutic. Empathy, therapeutic listening, and de-escalation skills are practiced. For those patients with dementia, a ‘no fail’ approach is used.
As required the nurses may call upon the expertise of others in the Department of Nursing, e.g. Stat nurses, the SWAT Team, Lift Team, nurse specialists, nurse educators. UF Health Shands Healthcare, UF Health Shands Hospital general and nursing policies, plus unit specific policies help guide practice.
The Nurse Manager of the unit is a Master’s prepared RN (MSN in Psychiatric-Mental Health Nursing). An RN is designated each shift to be the Charge Nurse. Nursing Team Coordinators serve in an advisory and assistive function to the unit. In the planned absence of the Nurse Manager, another Nurse Manager is designated to be available for administrative assistance.
Health Care Team
The Medical Director of Unit 52 / Brain Stimulation Unit is board-certified in psychiatry, has a background as a neurosurgeon and has fellowship level experience in addictions. He is privileged to provide ECT. The College of Medicine Department of Psychiatry physicians and residents provide 24 hour per day, 7 days a week medical coverage on the unit. The Department of Psychiatry schedules rotations for this coverage. Other members of the health care team are a social worker, nursing staff, recreation therapists, and a unit assistant. Medical students and PA students do rotations on the unit. Other members of the multi-disciplinary team are Rehab Services (PT, OT, Speech), respiratory therapists, Nutrition Services including a dietitian and , dietary aides, pastoral care staff, pharmacy staff, diagnostic services. Other medical specialists, teams from the College of Medicine, such as Internal Medicine, Cardiology, Neurology, Urology, Nephrology, and Infection Diseases may be consulted.
Recreation Therapy (R.T.) staff on the unit contribute to patient care including assessment of leisure skills, coping skills, identification of problems in these areas, development of treatment approaches and provision and evaluation of R.T. strategies. Safety risk factors and the prevention of injury are factors taken into account in the implementation of approaches. Therapy approaches include leisure education and activities, coping skills groups, life maintenance groups, exercise. Walks on hospital grounds provide patients with an opportunity to leave the unit and get fresh air and exercise. The skill level of the R.T. staff include certification as therapeutic recreational specialists, with a Bachelor’s Degree from an accredited program. The R.T.’s report to the Nurse Manager on the unit. The Senior R.T. supervises the other R/T. staff.
In the ECT procedure area, a separate cost center, there are designated unit nurses who coordinate the patient flow and provide pre and post procedure care. RNs from the PACU staff come to the ECT recovery area to provide PACU level recovery care. Medical team members in the ECT program include a psychiatrist who is credentialed to administer the ECT treatment. Also present are an anesthesiologist and one or more resident anesthesiologists, Anesthesia Assistants, or nurse anesthetists. Students, including residents, fellows, and medical and nursing students, may observe or assist.