A day in the life of a mental health nurse

The CHOC Children’s Mental Health Inpatient Center is an inpatient psychiatric center exclusively dedicated to the treatment of children ages 3-17 with mental illness who are in immediate risk of hurting themselves or others. It is the only inpatient facility in Orange County that can treat patients younger than 12. Our doctors and care team are all specially trained to treat children and provide the very best patient- and family-centered care 24 hours a day, seven days a week.

During a child’s stay, he or she engages in daily multidisciplinary therapeutic groups and receives individual therapy, family therapy, brief psychological testing and psychiatric care.

In observance of Mental Health Month, follow along for a day in the life of Madeline, a clinical nurse in CHOC’s Mental Health Inpatient Center.

5:15 a.m. – After fighting my snooze button, I wake up, shower, and drink some much-needed coffee.

6:30 a.m. – My cat yells his goodbyes to me as I give him a treat and leave for work. On the way, I vibe out to music to get pumped up for the day. I’ve worked at CHOC for over a year now. Last year, I was accepted into CHOC’s Registered Nurse Residency program. As a new nurse, I felt called to work in a mental health setting. I am beyond proud to stand alongside the brilliant CHOC team on the frontlines of mental healthcare.  

7:00 a.m. – I join my team in our conference room for a daily briefing report. Together, we review any newly admitted patients, our current population of patients, and any safety concerns. One of the ways we keep kids safe is through trauma-informed care. Upon admission, we work with patients and their families to determine any triggering situations or actions the patients may have, and then learn how strong emotions may manifest outwardly; such as pacing, shaking, or becoming very quiet. This information helps us to rapidly identify when patients are struggling and may need extra support or encouragement to utilize their coping skills. One of my favorite environmental adaptations we can provide for patients is our sensory room. It helps stimulate a few of our five senses to help kids cope and be more present in the moment. Sometimes, just hearing the rhythmic movements of the bubbles can be soothing and have a great calming effect.

7:30 a.m. – Once I have an understanding of our environment, I walk the unit to check on the patients. Most are still asleep, so I then look up my patient’s medications, while verifying medication consents. All pediatric psychiatric medications need parental consent obtained by the patient’s psychiatrist.

8:15 a.m. — Our medication room has a barn door, so I can efficiently and safely administer patients’ morning medications, preform a quick mental status check-in, and obtain vitals.

9:30 a.m. — One of my patients is currently taking a new medication. In order to better understand her body’s acceptance and tolerance of the drug, we need to run labs. Before drawing her blood, I numb a small area of her skin using a J-Tip®. During the blood draw, a child life specialist and I help the patient cope by offering her modeling clay and a hide-and-seek activity book.

10:00 a.m. — Throughout the day, our patients are divided into groups based on age to attend group sessions. This creates a structured environment that promotes the development of coping and social skills they can utilize when they go home. The sessions focus on our various themes of the day that can range from problem solving or emotional regulation to nutrition and wellness. These sessions are led by our team of nurses, social workers, child life specialists, plus art and music therapists. This morning’s group session is focused on gross motor skills. Our group leaders soak up some sunshine in our beautiful outdoor area while supervising patients socializing and joining in on a game of handball.

11:00 a.m. — I sit down with one of my patients to discuss their day so far and check in on any thoughts of self-harm that we can work through together. Afterwards, as part of the patient care team, I meet with that patient’s psychiatrist Dr. Lavanya Wusirika, and social worker Gaby, to discuss the patient’s care plan.

12:30 p.m. – It’s time for the patients to have lunch. Our patients eat together, so I assist with passing out lunch trays and pouring drinks. One of our licensed vocational nurses, Brenda, has become our unofficial DJ, and she plays music during lunch to help create a fun, therapeutic environment.

1:00 p.m. – I receive a call from a patient’s parent. After addressing their questions, I update them on their child’s plan of care, medications and current temperament.

2:00 p.m. – I use my own lunch break to catch up with my coworkers. We spend a lot of time together, and I’m lucky to have such an amazing work family.

3:00 p.m. – It’s time for one of our patients to head home. Upon admission to the unit, our team begins organizing outside resources and planning ways to increase safety and support at home. This information is built upon throughout their stay and is incorporated into an individualized safety and coping plan. After our social workers discuss the plan for home with the patient and their parent, I review current medication information and additional discharge instructions. Staff members and fellow patients send off their peer with warm wishes and words of encouragement.

4:30 p.m. –As a nurse, it’s my turn to lead one of our nursing groups. After the patients participate in a discussion about favorite coping skills and we do a check-in of their current emotions, we follow a painting tutorial to practice our theme of the day, mindfulness.

6:00 p.m. – I spend time updating my patients’ charts, including their mental status assessments and treatment plans. This way our whole team can see the patient’s progress and any concerns.

6:45 p.m. – During daily community meetings, all of our patients join together, and our staff leads a check-in to summarize what has been learned from our theme of the day. Patients take turns sharing their high and low of the day and how we can build on these experiences for tomorrow.

7:00 p.m. – As our night shift nurses arrive, we take turns giving a report of their patient’s day and mental status. We share new triggers that we have learned from the patients as well as new coping skills that were helpful. Knowing how we can best care for patients before, during and after a crisis or stressful situation is fundamental for trauma-informed care. By caring for every patient as a whole, not as a diagnosis or as someone defined by their trauma or maladaptive behaviors, we are able to better understand and care for them.

8:00 p.m. ― Get home and share a delicious meal with my husband. A long hug and many kisses are bestowed unto my cat Boots. The three of us will cuddle up and watch a show before we head to sleep and start again.

CHOC Psychologist Encourages Mindfulness Through Flower Therapy

Long before Dr. Carlos Konishi was a seasoned pediatric psychologist at CHOC Children’s, he understood firsthand the healing effects of flower therapy.

As a psychology intern at CHOC more than a decade ago, he would create flower arrangements for the psychology department in his spare time, and quickly noticed the positive impact it had on the wellness of patients and his colleagues.

Dr. Carlos Konishi, pediatric psychologist at CHOC Children’s

Inspired largely by his Japanese heritage, known for its deep appreciation of nature, Dr. Konishi had always enjoyed working with flowers and plants as a pastime, and even used it as a therapy technique with patients in another facility.

As part of his dissertation, Dr. Konishi studied the possible impact of nature settings on people’s physical and emotional health.

“Our appreciation for nature is cross-cultural. At a very basic level, we are drawn to nature and how it makes us feel,” Dr. Konishi explains. “Think of a favorite vacation spot for instance; you often think of a place tied to nature. There’s something about nature that makes us feel reconnected and refreshed.”

In 2016, Dr. Konishi returned to CHOC to work as a full-time psychologist, and he continues to use the art of flower arranging today to encourage mindfulness and wellness among his colleagues. Every Monday, he sets up a flower therapy station in his department’s break room, including a variety of fresh flowers and colorful vases, which his fellow colleagues and students can use to create arrangements for their individual offices and therapy rooms where patients are seen.

Psychology department staff members creating flower arrangements at a recent retreat.

The physical act of arranging the flowers and concentrating on the soothing task stimulates mindfulness, Dr. Konishi explains. Like with other mindfulness activities, the task allows you to focus on the present moment and acknowledge your feelings, thoughts and sensations.

One of the many flower arrangements found throughout the hallways in the psychology department at CHOC.

He also enjoys creating flower arrangements for the hallways in the office like he once did as a student. He and his team often hear from patients and their families who comment on these beautiful touches of nature and how uplifting it makes them feel when they come in for an appointment.

“It’s part of your emotional health. When you see things that are aesthetically pleasing, you feel good,” Dr. Konishi says. “Flowers are a representation of the beauty of nature.”

Dr. Konishi’s commitment to his mental and emotional health and that of his colleagues does not stop with flower therapy, however. He and a few colleagues have formed a wellness committee in their department. Throughout the year, they organize activities such as Smoothie Day, pet therapy, yoga and flower arranging with the goal to help staff reset and be more present for their patients’ care. The committee has also organized Tea for the Soul through CHOC Spiritual Care as well as Healing Touch therapy and Reiki sessions for the department staff.

“Wellness and mindfulness programs can be beneficial for everyone and can play a very important role in decreasing burnout and increasing engagement,” Dr. Konishi says. “I strongly recommend creating a small team of individuals who share an interest in wellness to ensure sustainability and allow for a variety of activities. These activities don’t have to be very long and can provide a reprieve from the daily stressors people face and can help them recharge and refocus throughout the week.”

Mental Health Nurse Manager Shares How Nursing is the Art of Caring for People

CHOC Children’s wants its community providers to get to know its staff. In recognition of National Mental Health Awareness Month, meet Lisa Schneider, nurse manager in CHOC’s new Mental Health Inpatient Center.

Q: What is your education and training?
A: I have a degree in nursing from The Ohio State University, and I am in the last semester of completing my master’s degree with a focus on Nursing Administration. In addition, I am a board-certified psychiatric-mental health registered nurse.

Q: What are your special clinical interests?
A: I am very passionate about pediatric mental health. I have a strong interest in trauma-related diagnoses and crisis prevention, as well as serving as an advocate to de-stigmatize mental health.

Q: How long have you been on staff at CHOC?
A: I am new to the organization and so excited to be here! I have been with CHOC since January 2018.

Q: What diagnoses are most common among the patients you care for?
A: As the community is beginning to recognize mental health disorders sooner, children and adolescents can present with a wide range of diagnoses such as depression, anxiety, eating disorders, psychosis, autism, PTSD, and ADHD, among others.

Q: What myths about mental health would you like to dispel?

A: Many people believe that talking to kids about suicide can put the idea into their heads. However extensive research has shown that this is not the case. Suicide is currently the second leading cause of death in children and young adults ages 10-24. Start the conversation now and talk to your kids about suicide – it could save their life.

Q: What excites you most about the Mental Health Inpatient Center?

A: The opening of the Mental Health Inpatient Center is so exciting because we will be providing innovative care and services to children and their families. The unit will consist of private rooms, group activity rooms, an expansive outdoor play area, along with daily programming such as music therapy, art therapy, pet therapy, and classroom education. The Center is designed around aspects of nature to promote a holistic and healing environment.

In addition, every child will receive a comprehensive treatment plan which will include individual and family therapy sessions while inpatient, and care continuation at discharge. I am so excited for the positive impact this Center will have on the kids in our community, especially since we will be the first to offer inpatient mental health services to children under the age of 12 in Orange County.

Q: What inspires you most about the care being delivered here at CHOC?
A: I am inspired by the tremendous amount of dedication that CHOC has shown in our mission to provide quality healthcare to children. Specifically, we are taking a leadership role and setting a high standard through our commitment to de-stigmatizing mental health and expanding services. It is important to remember health does not solely rely on physical health, but strongly depends on mental health as well. In order to achieve overall health and well-being, mental health must be cared for with the same emphasis that is placed on physical health.

Q: Why did you decide to become a nurse?
A: I chose to become a nurse based on the philosophy of nursing. Nursing is known not only as a science, but also as an art in caring for people. I have a passion for creating strong nurse-patient relationships, which can promote the healing process. I chose pediatrics because I’m inspired by the resiliency I see in children, and mental health specifically because I strongly believe in the concepts of prevention and early intervention.

Q: If you weren’t a nurse, what would you be and why?
A: If I wasn’t a nurse, I think I would probably be a police officer. I enjoy serving others and building strong relationships within the community.

Q: What are your hobbies/interests outside of work?
A: Outside of work, I love spending time with my husband and 4-year-old son. We are new to California so we have been spending a lot of time exploring this beautiful state!

Learn more about CHOC’s mental health services at www.choc.org/mentalhealth.

Dr. Hoang Nguyen Appointed Medical Director, CHOC Children’s Mental Health Inpatient Center

A psychiatrist with a long history of service in Orange County, Dr. Hoang “Wayne” Nguyen has been appointed medical director of the CHOC Children’s Mental Health Inpatient Center. He will also serve as medical director, child and adolescent psychiatry and chair of the psychiatry section of CHOC’s medical staff.

Dr. Nguyen earned his medical degree at Texas A&M University Health Sciences Center, followed by additional training at University of California, Irvine and University of Utah Health Science Center, where he served as chief resident. He is a diplomate with the American Board of Psychiatry and Neurology in child/adolescent psychiatry and general psychiatry, as well as being board certified in psychosomatic medicine.

Dr. Hoang “Wayne” Nguyen, medical director, CHOC Children’s Mental Health Inpatient Center

In addition to seeing patients in private practice, Dr. Nguyen has been a consulting psychiatrist for Fairview Development Center. There, he also served as chief of medical staff for five years. He was director of undergraduate medical education for psychiatry at University of California, Irvine, where he still holds an appointment as associate clinical professor.

Having joined CHOC’s medical staff in 2000, Dr. Nguyen has been integrally involved in the development of the Center. When it opens in April 2018, the 12,000-square foot, 18-bed facility will be the only one in Orange County to treat patients younger than 12. It is the only facility in California to offer all private rooms, as well as an option for parents to stay overnight with their children, as appropriate.

“I am extremely proud of CHOC’s commitment to creating a mental health system of care, including the Center as its centerpiece,” says Dr. Nguyen. “A child’s mental health is as important as physical health, and we are committed to making sure children and adolescents with mental illnesses receive high quality services without stigma or barriers to access.”

With Dr. Nguyen as its medical director, the Center will serve patients ages 3 to 17, with specialty programming available to children 12 and younger. Patients will participate in therapeutic programming seven days a week, which is unique among inpatient facilities. During their stay, typically five to seven days, patients will also have access to medical specialists if assessments suggest a relationship between the mental health condition and an underlying health issue.

CHOC’s broad and robust pediatric system of mental health care has been built to facilitate early diagnosis, intervention and treatment of pediatric mental health problems.

The system’s components include the ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s, designed to prevent psychiatric hospitalization and re-admission; mental health screenings in primary and specialty care settings; pediatric mental health training for community health care providers, school personnel and therapists; and a co-occurring clinic for patients with mental health challenges complicated by physical illnesses.

Other aspects include mental health triage at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital; an early childhood mental health initiative set to begin in spring 2018 that is aimed at reducing behavior-related suspensions from child care and preschool settings; and faith community partnerships.

Learn more about CHOC’s mental health services.

CHOC Children’s Celebrates Completion of Mental Health Inpatient Center

CHOC Children’s leaders joined with mental health supporters today to celebrate the completion of our pediatric health care system’s Mental Health Inpatient Center, which will provide the first psychiatric inpatient beds in Orange County for children younger than 12 years old.

Set to open in April 2018, the 12,000-square foot, 18-bed facility will serve children ages 3 to 17. It is the only facility in California to offer all private rooms, as well as an option for parents to stay overnight with their children, as appropriate.

One in five children experience a diagnosable mental health condition during childhood — about 150,000 children in Orange County alone. Previously, the absence of designated space to treat young patients and a shortage of beds for adolescents in Orange County meant that often children with serious mental health episodes remained in emergency departments for days at a time waiting for a bed in an outside county.

One of the Center’s activity rooms.

“For the first time, Orange County children younger than 12 experiencing a mental health crisis will have a place for care close to home,” CHOC President and CEO Kimberly Chavalas Cripe said. “The Center’s completion is evidence of CHOC’s commitment to ensuring that every Orange County youth receives the mental health care services they need in a safe and healing environment.”

The Center’s other unique features include two sensory rooms – one sensory-rich and the other low-stimulation to help children learn to manage strong emotions and calm themselves. In addition, the facility includes a 3,600-square-foot outdoor play area with sensory activities and a basketball court.

The Center’s innovative floor plan was designed with guidance from national experts and incorporates elements of several exemplary programs observed by CHOC staff. It was built with two primary goals in mind: patient safety and creating an optimal healing environment. The facility incorporates safety features such as shatterproof glass, special high-density materials, doors that open one at a time, and many other measures. The design includes elements of nature, curved features and a soothing color palette to promote healing and relaxation.

With pediatric psychiatrist Dr. Hoang “Wayne” D. Nguyen as its medical director, the Center will offer specialty programming to children 12 and younger. Patients will participate in therapeutic programming seven days per week, which is unique among inpatient facilities. During their stay, typically five to seven days, patients will also have access to medical specialists if assessments suggest a relationship between the mental health condition and an underlying health issue.

CHOC broke ground on the Center in September 2016. The Center was announced in May 2015 as the centerpiece of a pediatric system of mental health care that would be scalable and replicable by other health systems nationwide.

“CHOC is committed to the truth that mental health is as important as physical health,” Cripe said. “Put simply, health is health. We want to create a system that others can replicate and help empower health systems across the country to support children’s mental health.”

CHOC’s broad and robust pediatric system of mental health care has been built to facilitate early diagnosis, intervention and treatment of pediatric mental health problems.

The system’s components include the ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s, designed to prevent psychiatric hospitalization and re-admission; mental health screenings in primary and specialty care settings; pediatric mental health training for community health care providers, school personnel and therapists; and a co-occurring clinic for patients with mental health challenges complicated by physical illnesses.

Other aspects include mental health triage at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital; an early childhood mental health initiative set to begin in spring 2018 that is aimed at reducing behavior-related suspensions from child care and preschool settings; and faith community partnerships.

“While the Mental Health Inpatient Center at CHOC Children’s will support children and families while in crisis, we cannot meet all the needs for pediatric mental health care alone,” Cripe said. “By joining with our community partners, we are working together to ensure that children get the help they need when they need it and where they need it.”

Learn more about CHOC’s mental health services at www.choc.org/mentalhealth.