Tools of the Trade – Mental Health Nursing

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Assessment or screening tools are key to gathering a whole wealth of information from a client and they can often lead to them opening up about other or underlying issues that may be impacting on their health. How and what they answer can give you insight into their current feelings about things as well as provide a baseline of presentation to record any future changes and used to point towards treatment required. Being able to monitor someone’s recovery progress can help staff encourage and motivate a person, just as being able to monitor someone’s deterioration can help staff adapt treatment and interventions appropriately.

Tools are not always perfect and we have to work with them openly and carefully using them as a guideline to help support the treatment or diagnosis we provide. Below is a short list of the some of the assessment tools you might come across on placement;

The Hospital Anxiety and Depression Scale (HADS) – Used for Anxiety & Depression can be used in community as well as hospital. It is a 14 question Psychological screening tool assessing the severity of symptoms.

Generalised Anxiety Disorder Questionnaire (GAD-7) – Screening tool used to measure the severity of Generalised Anxiety Disorder. 7 questions that can be administrated by a health care professional or self-administrated by the client themselves.

The Mini Mental State Examination (MMSE) – Commonly used short assessment used for screening for any dementia or cognitive impairment concerns are suspected. It measures cognitive functioning, and can be used to monitor change. 11 item tool taking around 10 minutes to administer making it a quick and useful tool to use.

The Addenbrooke’s Cognitive Examination (ACE) –  Well validated assessment tool for clinic setting assessment of cognitive functioning. This measures cognitive domains including language, visuospatial, memory and attention.  Usage is usually in part with other screening tests such as blood test, ECG and MRI scan to inform a diagnosis.

The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) – Is a self-assessment tool for measuring the side-effects of antipsychotic medications. Red herrings are included to check the accuracy of the results. The 51 questions are based on true side effects with 10 being false  ones aim to help patients Identify, understand and gain awareness of side effects they could be experiencing.

The Alcohol Use Disorders Identification Test (AUDIT) – A basic screening tool used to pick up the early signs of hazardous and harmful drinking and identify mild dependence and highlight if a need for assisted withdrawal is required.

There are many varied tools assessing risk used by health care professionals in all fields and in  a wide variety of settings. It is important practitioners should take care to always explain what is involved,  how long it will last and how they can help a patient and their treatment.

Using an assessment tool can help uncover more information about a patients situation and help to encourage conversation that could provide valuable information to inform their care is more personalised and help reduce risk.

Keep your assessment tool box handy and help patients access all areas in health care support.smile

A moment of CALM: de-stress with new wellbeing workshops for student nurses and midwives

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It’s well known that in order to properly care for others, we must first take care of ourselves. I’m sure many of us have shared that advice with our friends, family, patients or their carers, yet how good are we at following it ourselves?

As the term progresses and the list of assignments builds up, it is tempting to put our health and wellbeing on the back burner. There are so many competing demands, especially as many of us juggle uni work with part-time jobs, family commitments or other personal issues. It can be overwhelming at times: every student nurse I have spoken to has felt the pressure at one time or another, yet you can often end up feeling quite isolated, thinking ‘is it just me?’ Believe me, it’s not.

Don’t fear – help is at hand! After feedback from previous students, a brand new project has been set up to support students throughout the year. CALM has been designed been designed specifically for student nurses and midwives, aimed at tackling some of the regular issues we might face during the course.

On offer is a four week Mindfulness course starting this afternoon which will give an introduction to mindfulness and share techniques to cope with anxiety and stress. Mindfulness is about being present in the moment, switching off from the endless distractions and learning to calmly accept the emotions and thoughts that fill our minds. Over the four weeks you will be given an introduction to acceptance and be taught some simple stress-busting tips including how to carry out a body scan and breathing exercises. You will also learn how to recognise stress cycle and ways to build mindfulness into your everyday routine.

On top of that are drop-in sessions on money management, for practical tips on how to make your bursary and student loan go further, and a session on housing for anyone who wants advice on finding accommodation that fits our hectic schedules. A series of free sport and fitness classes are also in the works, so watch this space!

meditation-1000062_960_720Starting this afternoon, the Mindfulness course will run every Wednesday for the next four weeks between 1-2pm and there are a couple of one-off money management and housing sessions planned for the rest of this semester. You can book a place on any of the sessions here or contact Eve Foster at sso.intern@manchester.ac.uk – and if you’re interested in the Mindfulness course, it’s fine if you can’t make the first session today.

Don’t forget that the university also offer a fantastic counselling service and a massive range of wellbeing and relaxation courses, from daily meditation sessions to longer courses on low mood and self esteem. There are also plenty of online resources and apps like Headspace that can help you unwind and de-stress.

You don’t have to become a incense-burning zen master to build mindfulness into your everyday life. Mindfulness expert Andy Puddicombe says in this TED talk that we only need to spend 10 minutes doing absolutely nothing to feel the transformative effects of mindfulness.

So kick back, switch off and just breath.

Suicide is everyone’s business

There were 6, 122 registered suicides in the UK in 2014 (ONS, 2016).

Today is National Suicide Prevention Day. This got me thinking about my experiences of suicide attempts in placement and what I have learned, which I wanted to share with you.

I am a student children’s nurse… I know, suicide in children’s nursing?! Yes, children and young people take their own lives. Notice I didn’t say ‘commit suicide’? Well-spotted. This was intentional. Now, it’s not easy to break our language habits, but I’ve found that a good start in communicating with people who have attempted suicide (or any vulnerable person, or, well… people) is to think carefully about what I’m saying. The word ‘commit’ is commonly used in reference to criminal activity, which ties it to negativity, so I prefer not to use that word. I recognise I used the word ‘attempt’ above. Is this word associated with failure? I don’t know. I’m still learning.

During my time on placement, I have observed how well staff respond to these children and young people in a clinical sense, and how they are still learning how to provide emotional and psychological support.

My first experience was with a young person with diabetes who intentionally missed insulin doses and miscalculated insulin doses in an effort to end her life. The nurses were open about their discomfort in communicating with her. I respected their honesty and, from this point, made it my objective to build my knowledge of communicating compassion in these situations. I started by sitting and talking with her. More importantly, I listened.

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Fast forward a few months and I am with a girl who has taken an overdose on the ward. This was an emergency. The charge nurse raised his voice and forcefully asked what she had taken. She stayed silent. Another student and I took a different approach. She held her hand and I asked people to stand back.

We introduced ourselves, explained she wasn’t in trouble and that we cared about her.

Somehow, we got to a point where we were singing and dancing to Justin Bieber in her bay, with the curtains closed enough to give her some privacy and open enough for staff to monitor. We listened to her and gave her our time. She disclosed to us what she had taken and she was treated. She was referred to CAMHS (Child and Adolescent Mental Health Service). She thanked us sincerely.

Following this incident, I asked staff which they felt was the best approach, given it was an emergency. Opinion was divided. What do you think?

I could write on and on about suicide prevention, but for now I have listed some of my top tips:

  • Refrain from judgement. If you can admit to yourself that you can be a little judgemental, that shows great level of self-awareness and highlights an area of self-development. For now, try to disguise your judgement. Think about how eye-rolling, tutting and slumping your shoulders whilst turning your back (yes, I have observed these in practice) could make somebody feel – Remember the first standard of the Code ‘treat people with kindness, respect and compassion’
  • Actively listen. Show you’re listening; make eye contact, nod with understanding…
  • Sometimes there are no ‘right’ words, but think about how your language could make someone feel.
  • Don’t be afraid to ask. ‘Are you feeling suicidal?’ ‘Would you like to talk?’ ‘Is there anything I might be able to do to help?’…
  • Don’t make promises you cannot keep. If you feel someone is at risk, make it clear you will need to share information confidentially with appropriate colleagues/services.
  • Know who to refer to and what support is available. You are a student, so at this stage it would be your mentor you would raise concerns with, but learn trust safeguarding policies and national and local services. Here are some resources to get you started:

SamaritansMindStamp Out SuicideMaytree, Male-specific: The Calm Zone,

Young People: Papyrus, Children: Childline

  • Be open to learning ways to help vulnerable people who are considering suicide. One small action you make could save somebody’s life. Keep learning. Keep reflecting. As always, I recommend Twitter as a useful starting point:

#WSPD16 #WorldSuicidePreventionDay #ItsOkayToTalk #TalkThroughTheTaboo

Suicide is everyone’s business and you can make a difference.

Supporting Patients with a Learning Difficulty

 

Between 25 and 40% of people with learning disabilities also suffer from mental health problems, with dementia and schizophrenia showing a higher prevalence. Standards of care for those with an identified learning disability have been under the spotlight since appalling levels of care were highlighted in the media relating to a specialist care home – somewhere that should have been a safe haven for those in need of support. Questions were raised about in-patient services for those with a combination of a learning difficulty and a mental illness who presented with behaviours that were challenging and what care options should be provided. It must be highlighted that not everyone presenting with these combination of diagnoses will present with challenging behaviours. Everyone is different but we all deserve the same level of care.

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In placement as a mental health student I have observed patients being brought onto a general mental health acute ward who have a diagnosed learning difficulty. I have seen both good and poor practice observed. I have seen staff gain a real understanding of a patient’s condition and how the patient see’s and understands the world. I have seen other patients on ward stand up for and support a patient with learning difficulties and sadly seen others exacerbate the patients current mental state. Knowing how to support and care for the patient as an individual in this situation is crucial as well as manage the others in your care in the same way.

Learn more about the patient’s condition just as you would a standard mental health patient. Asking the patient directly can also be a great way to gain understanding of they view their situation. Asking a carer or family for advice, again in the same manner you would with other admissions helps to promote equality and improves the care you can provide. Find out if they have any extra physical or communication needs that need support as it can help relieve some stress and anxiety about settling into the new environment.

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Providing an individualised person centred approach to care during an admission is vital. The Royal College of Psychiatrists (2013) recognise the complexities involved in service provision of this kind and confirm the importance that communication between a multi-disciplinary team plays. Some hospitals have a learning disability liaison nurse so it’s worthwhile finding this out too. It maybe that a learning difficulty is undiagnosed in a patient as cognitive impairment is often found in those with schizophrenia; the consultant should be able to provide support on this when made aware. Either way, care provision should be treated with the same respect, care and dignity as it is to all.

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Reference:

The Royal College of Psychiatrists (2013). People with learning disability. London: Royal College of Psychiatrists

 

 

Life on a Mental Health Mixed Acute Ward

It’s a roller coaster ride

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Some people like them some people don’t but life on an acute ward is often up and down. Some days are busy some days are – dare I say the word…. Quiet!

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But no two days are the same, which for some people is what attracts them to work the acute life.

Acute wards in mental health are designed to be a place for assessment and or treatment for people experiencing a severe episode of mental illness. Admissions can come at any time in the 24 hour period and with varying degrees on urgency.

Some patients are informal and choose to be admitted as they may recognise they are unwell, others are brought in on a 136 section from police custody due to concerns for their welfare or that of others. All will need risk assessing and care plans put into action straight away.

On top of the new admissions there are the often another 20 or so patients on the team-upward (depending on the size of the units). These patient’s presentations may vary day to day depending on how their treatment is going and how they feel it is going. Whilst mentally unwell, patients may have little or no regards for others on the ward so balancing out everyone’s needs can be hard. Team work is essential.

Some patients may be restless all night so keeping the disturbance for others to a minimum is another challenge. Flexibility and thinking on your feet for solutions is another necessity for a mental health nurse.

However there is nothing more rewarding than escorting a discharged patient calmly off the ward knowing they are now thinking  and feeling a lot more clearly and will hopefully be able to manage their illness out in the community and regain their place as part of  their family or community.

As a student nurse a mental health ward is one of the best places to really understand what someone experiencing a mental health illness can be like. Every kind of illness could be admitted, from depressive or manic behaviour, thought disorders and post-partum psychosis to severe self-harm and aggressive behaviours. To match the variety of illnesses you may encounter there are the medications to match.

The medication trolley will be your nemesis as a student nurse. Trying to remember your anti-depressants from your mood stabilisers and your anti-psychotics becomes stressful as you are under the watchful eye of your mentor as well as the patient themselves. You probably won’t remember them all so don’t try too.

Always ask if you are unsure – the patient is an expert in their own medication usually as well so there is no harm in asking them if they are stable in their presentation to assist you. This also helps to check the patients understanding of what they are taking their medication for; which is part of the NMC Code.

Talking to the patients can seem daunting at first but just being around canbe helpful for some as a piece of mind that someone is there is they need them. As a student nurse you may often find during your shift you have more free time than the qualified nurses so you can become extra support and provide more vital one to one time with a patient. Just don’t forget to document it afterwards.

Love it or loathe it acute wards can throw anything at you at any time of your shift they really are a roller coaster!

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Blue Monday?

Its Blue Monday today! Apparently the third Monday in January is supposed to be the most depressing day of the year. So are you feeling depressed? How do you know? 

What does it mean to be depressed?         Feeling sad, miserable, fed up?      

How can you tell if you are depressed or just a bit down in the dumps – a bit blue?

Depression can mean different things to different people. What may seem simple and straightforward to one person may just have been the straw that broke the camel’s back for another. People often carry on with daily life often hiding the struggle they face. This can make things harder to cope with and accept or spot. Depression can affect anyone at any time it is not exclusive or discriminative.

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There are many different types of depression such as seasonal affective disorder (SAD), postnatal depression and bipolar disorder (manic depression).  Symptoms can range from low spirits, feeling numb, helplessness or isolation to name but a few. You may find you’re not enjoying activities you usually would. You could be funding it hard to concentrate on things, difficulty sleeping or have lost your appetite. Again symptoms may vary from person to person and you may not even realise yourself. It could be that they reoccur or are just persistent.

The cause of these feeling may not be transparent, it could stem from a loss you may have experienced, life changes that are everyday occurrences in general but may have just impacted on you significantly. It may be something that happened a long time ago but feelings have only just resurfaced.

So what can you do if you feel this way or you think someone you know may be suffering with depression?

Self-help – reconnecting with people and talk to someone if possible, you’d be surprised how many people out there are ready to listen and help you if they can.  As they say …

timetotalkttclogo       It is good to talk!

As a friend you can help encourage your friend to seek the right kind of help for them.  Show them you care and be there for them when they need you. Again little things can make a big difference and being patient with them can be important. As a friend or carer you too can seek support and advice from a GP or other appropriate organisations (some of which are listed below). 

Keeping busy is important as breaking the negativity cycle and keeps your mind occupied on other more positive things. Take time to care for yourself. Every little helps and each step no matter how big or small can be a step in the right direction.

Alternative therapies are recommended to medication such as mindfulness or talking therapies. These can be accessed via your local health authority or via your GP or often at community/library centres.  Art or music groups, community volunteering or the new popular colouring books are a great way to help you focus on the here and now.

It is important you seek advice from your GP if possible, they can help you monitor your situation and support your recovery. They may also discuss medication if they or you feel it is necessary. 

For more information please seek professional help, below are some organisations that can also help;

www.mind.org.uk

www.time-to-change.org.uk

www.samaritans.org

https://friendsinneed.co.uk/

www.depressionuk.org

www.sane.org.uk

Useful YouTube

Have you checked out Manchester University on YouTube? Subscribe to their channel and find out from the staff and students direct what life is like.

There is always something going on in different departments too so you can enhance your social awareness of what everyone else attached to the university is up to. This can provide extra learning opportunities and ideas, encourage a wider social involvement and a better understanding of university life outside that of the school of nursing.
The school of nursing has some great collaborations with outside agencies and generate ways to aid public awareness of topics and promotions going on in the area. A recent example is;

Use these ideas to be creative during your time here at Manchester University and beyond into your nursing career and stay involved with those around you.