Date of Submission

Spring 4-25-2022

Document Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Mary Bittner

Second Advisor

Dr. Nicholas Webb


An adolescent pediatric patient who presents with psychiatric and medical conditions is subject to a pediatrician's diagnostic acuity, experience with pediatric psych patients, and existing constraints on providing an appropriate course of care. Too often, the psychiatric DRG becomes the pediatrician's single story of the patient, accompanied by subtexts of aggressive behavior, and the pediatrician's own biases about psychiatric patients. The novelist Chimamanda Adichie warns of the dangers of a single story. As a child in Nigeria, Adiche devoured stories. The children were fair-skinned and blue-eyed in the books available to her. As Adiche began to write her own stories, her characters reflected the narrative of her childhood stories. Adiche's experience demonstrates the impact of a single story. Without adequate placement for inpatient pediatric psychiatric patients, the quality of specialty psychiatric care in health care systems falls short, with stark inequities for pediatric patients. The consequence of the single story is that it robs people of dignity. Implicit biases are prejudices that impact understanding, decisions, and actions unconsciously. Stop telling the story of young people's psychiatric histories with the words aggressive, hostile, and unpredictable. Our healthcare system needs to embrace new models of care that offer equity, inclusion, and diversity to the least heard voices in pediatric care: minority, transgender, and homeless youth. We need inpatient medical-psychiatric services to address the growing issue of pediatric dual diagnosis patients.