Korero Hauora Health Talk - Taranaki District Health Board

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Shifting Clinical Practice and Critical Thinkingin Mental Health NursingBy Donna Gush, RN, PGCertHScHi, my name is Donna and I work in Acute Mental Health.Sometimes that is greeted with a certain amount ofpreconceived ideas and stigma… Mental Health Nurses aren’t“real nurses”, “what’s wrong with you that you want to workthere?”, and the old jokes about you can’t tell the nurses fromthe patients.Well, nursing in mental health is a highly skilled specialisedfield, and doing post graduate study has helped me to bothwork more effectively and to value what I and those I work withdo. We make a difference to people in distress – and isn’t thatwhat nursing is about?While I was working on my most recent assignment I found a quote which mademe stop and think about what it is we do: “Inpatient psychiatric nursing requiresconsiderable expertise in assessment and treatment of severe forms of psychiatricillness, with psychodiagnostic and psychopharmacological skills, psychotherapeuticinsights, knowledge of group and family dynamics, psychosocial and culturalawareness and an ability to relate to other professionals and relevant outsideagencies. And this list is not exhaustive” (Leonard Fagin, Psychiatrist).I returned to study after a lengthy break (about fifteen years) and had some anxietyabout whether I could still study. I can. I also started working in Mental Healthsometime after I did my nursing training and there had been a few changes. Focus ofcare to a recovery model with management of mental health clients in the communityas much as possible – the main role of Acute Inpatient Care was now to stabilisepeople in as short as possible time so people can be returned to community care,meaning that often people in Inpatient Units are more unwell than they were in thepast (as they remain in the community longer). As someone said clients are oftendischarged at a level that ten years ago they would have been admitted at … also,since I had last had any contact with mental health nursing the “big bins” had closedand those who would have been sent to them for treatment are now nursed here. TheMental Health Act had been updated and was quite different from what I had learnt. Itwas a different world.There is a lot of training provided through the hospital for those who work in mentalhealth, but after a while I wanted to learn more than was offered, to augment it.Post graduate study has helped me to feel more confident about things such asmental health assessments, working with patients to help them understand the linkbetween their thinking and behaviour, recommended approaches towards peoplewho self-harm and to challenge in myself why I do things the way I do – is my practiceactually the best for benefiting that patient? There is much more. It has been said thatInpatient Mental Health nurses are poor at articulating what they actually do – I feel Ihave barely skimmed over what I have learnt and gained, and I believe my practice isnow at a higher level due to what I have learnt.So, if you’re on the edge of deciding and not sure – I encourage you to go for it, you’llbe challenged and grow in skills and confidence… one assignment at a time.172011 Korero Hauora - Health Talk
Clinical Practice continues to develop in Aged & Residential CareNursing By Bronwen Pepperell, RN. on final pathway to Masters of Nursing 2011,NurseConsultant Aged CareThe Nurse Consultant AgedCare role was implementedin 2007 to support ongoingprofessional educationand development for theresidential aged sector inTaranaki.Key areas of work for thisrole include facilitatingclinical education days forRegistered and EnrolledNurses (RN) (EN)s from thissector. For example, in 2011,a clinical refresher study dayhas been held with a varietyof relevant clinical topics.Access to Taranaki DHB studydays continues and nursesfrom this sector have beenable to attend many differentstudy days, for example,wound, respiratory, mentalhealth, and pharmacology.Uptake of ProfessionalDevelopment RecognitionProgramme (PDRP) inthe sector continues tobe popular with nineteenfacilities participating in theprogramme. Many ENs inthis sector have transitionedto the new EN scope ofpractice by completing theirportfolio and meeting thenew competencies.The Aged Care ClinicalEducation and Leadership(ACCEL) programmehas been developed inconjunction with Dr MichalBoyd, (Gerontology NursePractitioner and SeniorResearch Fellow, Auckland),and delivered in Taranaki.Fifteen RNs from residentialaged care participatedin this programme whichfocused on advanced clinicalskill development. Nursesensitive quality indicatorswere collected prior tothe programme andagain following ACCEL.There were significantimprovements noted incompleted skin, falls andnutrition risk assessmentundertaken by the RN.In addition presence ofskin breakdown was alsorecorded with resultsindicating decreases innumbers of skin tears, lowerlimb ulcers and pressureinjuries. Further ACCELprogrammes are planned for2012.An example of clinicalpractice development andquality improvement initiativeis highlighted by Dr Boyddescribing Albert Lim whoworks in the sector: “I hadthe pleasure of teachingAlbert as part of the ACCELprogramme through TaranakiDHB. Albert was a joy towork with and he is clearlypassionate about being anurse and about.He significantly developedhis physical assessmentskills with mentorship byBronwen Pepperell. He alsomade an impact throughthe implementation of astandardised handoversystem in his aged carefacility. He collaborated withthe GP and staff to adapt it tothis environment. He reportsthat the GP was very happywith the tool and found itvery helpful for reporting ofresident issues.I was also very impressed thatAlbert has used the researchliterature to inform and shapehis clinical practice. He hasshared this literature with hisnursing colleagues and withthe GPs he works with. Hehas demonstrated excellentinitiative to improve practice.Albert is a shining exampleof how upskilling nurses inaged care can translate intochanged practice”.Concurrent to the ACCELprogramme, Albert hassuccessfully completed twopost graduate papers thisyear as well.Albert, Michal and Bronwen and‘hand held friends’ mourn therecent loss of Steve Jobs providingexcellent care for older people inresidential aged care.2011 Korero Hauora - Health Talk
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Page 33 and 34: Time to CareBy Kareen McLeod, Nurse
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