NURSING

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12 he is resting on his bed but it is difficult to ascertain if the desired effect has been achieved. The following shift I learn that Patient F has reported beneficial effect from this medication later that afternoon. Fifteen minutes later I sign over the safe and controlled drug cupboard key to the afternoon shifts assigned ‘nurse in charge’. My shift is complete at 2.30pm, so I change back into civilian clothes and make my way home. MHN Name: Donna Kemp Role/setting: Care Programme Approach Development Manager ‘‘ ’’ With two meetings scheduled in my diary, today is a day of catching up on emails and doing smaller pieces of work, interspersed with the two meetings. Today is a day of catching up The first meeting, from 10am to 12pm, is with a group of mental health clinicians who together form a review group. The work of the group is to review a trust-wide procedure. The second meeting of this group is intended to be one where we appraise progress since the last meeting and agree next steps. The procedure for review is ‘Procedure for the management of adult service users with a diagnosis of both mental health and learning disabilities’ and we have already decided that the title was too long and more importantly doesn’t have the right ‘tone’ – we feel the term management is outdated and reinforces the ‘being done to’ rather than ‘with’ mindset. We had agreed an alternative at the first meeting but since then, another alternative has been suggested, so this is for discussion again. The new procedure needs to reflect the changes to practice and direction of travel for learning disability services and mental health services working together. This is very current and outputs from the national group are emerging gradually, however, we are keen to progress the procedure and will aim to review the procedure early if the content is contrary to national directives. Working in partnership across both learning disability and mental health services is agreed in principle by all. Joint assessment and consultation are seen as achievable and reflect current practice. However, shared contribution to delivering the care plan is a discussion point as generally, beyond assessment, current practice is that someone’s care is with either learning disabilities services or mental health, not both, with finances being cited as the barrier. From this, it is agreed that discussions should be held with the service managers, to explore the scope of joint working. Discussions with the mental health service manager are positive, with the priority being about meeting the person’s needs in the best way possible rather than demarking service turf. A meeting with the learning disabilities clinical director is scheduled. Further refining is needed to the glossary – additional terms such as ‘reasonable adjustments’ and ‘inclusion’ had been added and these require explanation; and some slight amends to the wording are highlighted but otherwise, the procedure is about there. The role of the care coordinator and the lead professional are clear and specific as to their responsibility and expectation. Working on the procedure has brought up a number of questions that are not going to be resolved by the procedures existence – they are more strategic and concerned with the organisation’s culture. For example, should teams have both mental health and learning disabilities nurses within each service? We agree that as a group we will collate these issues as recommendations for consideration within services. Overall, the second meeting is productive, although there are more apologies than attendees. The content is taking shape and a clear next steps plan is articulated. There is an acknowledgement that there could be indefinite number of meetings but that really moving this forward is a matter of reading and discussion – and this can be done by email just as effectively. In the afternoon my meeting is cancelled at short notice, with plans to reschedule to be made on Monday. This leaves me with two hours to focus on the actions from the morning’s meeting – and this is my preferred way of working for a number of reasons. The information is still fresh in my mind and I can recall the detail. It helps keep the momentum of the piece of work going, and it means I am more likely to complete the work in the agreed timescale, and in taking the lead role in pulling this work together, it gives other members of the group time to focus on their contribution. Also this approach just feels efficient and means I can manage my workload better – spending less time worrying about what I forgot to do or haven’t done yet. MHN ‘‘ Name: Hollie Roblin Role/setting: Second year mental health nursing student placement I prepare to give handover. I am racked with nerves ’’ I am on my final placement of the year, with only three weeks left until summer begins. My placement is in a medium secure regional forensic unit, on one of the male wards. My day starts at 5am with a very large cup of coffee and a quick shower before I catch two buses and a train to placement. My commute provides me invaluable time to reflect, make notes and mentally prepare
myself for the day ahead. conflict as some take much seconds between calls. develop a rapport before I read The official shift starts at longer to wake than others. I answer a host of different about their index offence or listen 7.40am and continues until Luckily, today everyone was calls from concerned family to any preconceived ideas from 7.30pm. The trust has recently awake and ready for morning members, scheduling patient other staff members. moved to a 12-hour shift pattern medication and the first cigarette visits and liaising with pharmacy I always strive to practise in in all inpatient settings. of the day. regarding medication stock. a non-judgemental and person- I walk into the unit, filled with My mentor has asked that I In between answering calls, centered approach with all clients anticipation as to what has take charge of the shift today and unlocking the kitchen and laundry and patients, regardless of happened over the previous three complete the daily planning sheet. for clients and taking trips to the previous history. days. I am the first member of I start by double-checking levels vendor, I take ten minutes off Before I know it teatime staff to arrive and I greet two of observation and allocating staff the ward in search of a doctor medication is complete and the patients who are eagerly waiting to conduct the required task. who can rewrite four medication patients are either watching the for their first cigarette of the day. The ward had to lose one charts before teatime medication. soaps on TV or relaxing alone Once inside the nursing office, I male staff member as the acute Luckily, a senior house officer in their bedrooms, as the day is check the diary and leave book to admissions ward had an unsettled was available and happily took slowly drawing to a close. see if there are any appointments night and required a male for their the scripts and returned within 30 This period is quiet and gives or visits, or if a patient has day shift. Therefore, we did not minutes. me chance to reflect with my planned leave today. have enough staff members to I divide my afternoon by mentor about managing the shift. Handover officially starts at facilitate a patient’s leave and a spending time interacting I have thoroughly enjoyed the 7.50am. The night nurse provides family visit. and getting to know the new experience of assigning jobs, a substantial handover and I spoke with the two patients patients and accompanying the ensuring breaks are covered, starts by discussing the two new individually in the quiet lounge, horticulture therapist to the unit making sure the patients are ok admissions. only after I ensured my alarm was gardens. and most importantly thinking and Every patient’s condition is powered and my colleagues were I make an effort to speak and behaving as a staff nurse. discussed, covering current aware of my location. try to develop a therapeutic Fortunately, it has been a presentation and behaviour, One gentleman became very relationship with the two new relatively quiet day and nothing mediation amendments, recent upset and hostile, expressing individuals and find out their too chaotic has occurred. ward rounds and if any risk anger that this was the fourth interests and personality traits, However, just as we are speaking assessments or care plans have occasion where leave had been and explain the ward’s culture. the alarms are called for the been altered or new ones added. cancelled due to staffing levels. I find these interpersonal female ward. The nurse discussed the Mental I de-escalated the situation interactions with patients an One of the care support Health Act status of each patient by using distraction techniques invaluable experience. I aim workers whose duty is to attend and that of the new admissions. and insisted his leave would be to converse with patients and such emergencies is called away Following handover, the two facilitated as soon as possible. nurses and myself check the Together, we planned a day controlled drugs cabinet. While filled with therapeutic activities on this ward, the only drug that such as the gym, gardens and a was classified as controlled was game of bingo in the evening. Tramadol. I updated the patient’s notes This drug can only be with the recent developments administered if prescribed by and reflected with my mentor. I the doctor and checked by two expressed my concern, as this qualified healthcare professionals was not the first time leave was before dispensing, which is cancelled due to staff shortages. challenging when there is only one My mentor also agreed how qualified nurse on shift. periods of escorted leave are I ask if I can assist with the an invaluable mechanism for morning medication round so clients to reintegrate back into I can practise dispensing and the community and develop reading medication charts. meaningful skills that are person The patients all smoke and centred and aid recovery. cannot be let out to the courtyard The office phone continues to until medication has been ring throughout the morning and completed, which can cause into the afternoon, with barely 13
Page 1 and 2: A day in the life of mental health
Page 3 and 4: Editorial Contents Mandy Bancroft F
Page 5 and 6: News Data shows ‘negligible’ pu
Page 7 and 8: MHNA Update ever wish to take strik
Page 9 and 10: News feature Disparity shown in eme
Page 11: transfer paperwork. This led to his
Page 15 and 16: item, this then requires physical i
Page 17 and 18: and frailty, my role also includes
Page 19 and 20: work together for sessions and liai
Page 21 and 22: 24 hours in mental health nursing W
Page 23 and 24: Membership Join Unite/MHNA! As a tr

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