Debra Kay Balido knows that she works with patients many others choose not to-the mentally ill. She is aware that she is taking care of people others might not want to do business with or even walk next to.

"I feel that we are their champions. Someone has to give them a voice. We try to connect them with the channels and avenues available to the mentally ill in this country.

"I think it is every nurse's job to be a patient's advocate, and the job of every member of the team. If you keep your care patient-focused, it is a natural progression to be a patient advocate."

With that kind of attitude, Montevista Hospital has been a restraint-free facility for the past two years, even while it maintains the highest acute census in its nationwide organization. Balido said accomplishing that required a philosophical change and a different approach to situations. In other words, it meant looking at patients differently.

Another manifestation of that attitude is the hospital's system for inventory and tracking of patient belongings, a system refined by Balido.

"Mentally ill patients have a hard time with things, getting them together and labeling them correctly. Then they are so anxious to leave that they forget half of what they bring in. So I devised a system to successfully reunite people and their belongings. That is important to them. I think it is just part of my job." She went above and beyond that job by finding a site for the system and making sure it happened, rather than telling someone else to do it.

Balido also identified, recruited and trained inhouse patient advocates, available as per policy at Montevista, to ensure that patient concerns were handled consistently. She used role-playing and other methods to make sure staff felt comfortable with skills review, and enlisted different team members to add objectivity to advocacy.

She also spearheaded a project to create a video on patients' rights for families and visitors. The hospital had a handout, but Balido knew that not everyone took the time to read it, or even could. The video seemed an easy way to capture the highlights of safety concerns, confidentiality and other issues specific to mental illness and behavior. The video makes it easier for the nurses, too, she said.

"From a quality perspective, my job truly is patient-focused, so it was a natural integration to formalize some of those advocacy concerns. We have a much clearer communication avenue for patients and staff-and communication is an important part of patient advocacy."

Patient advocacy is little more than keeping an open mind and truly listening to the content of what a patient says and the feelings behind it, Balido said.
"Working with this population, patients' rights are such a strong focus. Psych nurses truly understand patient rights and the importance of hearing the patient." Mentally ill patients and those with behavioral problems will be more successful, she said, if they feel that they are supported.

"We find some common ground and move forward together."