Hints and Tips for achieving Practice Learning Outcomes in Mental Health Nursing Practice (Semester 2, year 1)

Transcription

1 Hints and Tips for achieving Practice Learning Outcomes in Mental Health Nursing Practice (Semester 2, year 1) In the CAP Document for all years undertaking the BSc(Hons)Nursing programme the Practice Learning Outcomes [PLOs] are skills based and match the Essential Skills Clusters that the Nursing and Midwifery Council [NMC] state must be achieved at the different progression points in programmes they validate. The NMC have identified that ALL nurses need to achieve these as they progress, whatever their field of practice. As you are aware this represents a change in culture for our students and mentors and at first glance it is difficult to see how they can be achieved in many mental health practice settings, particularly those in the community. To try to help students and mentors understand how these may be interpreted in various practice environments I have made some suggestions below. Some of this is based on recent discussions with students and mentors. This is a new challenge and we hope to add to this resource in future. All questions, suggestions and feedback is therefore most welcome, please don t hesitate to get in touch. Neil Burton; Lecturer, Module Leader Mental Health Practice 3 Module n.burton@hull.ac.uk Hints and Tips for interpretation of specific PLO activities Page numbers refer to the CAP Document : a pdf of this is available to everyone from the following URL (cut and paste it into your browser) ielddocuments.aspx If you are looking for a specific PLO activity number (e.g. 1.5), type this number into the find field in the edit menu above. Level of performance Please remember at this level to achieve the outcomes the student is required to observe others undertaking the activity, accurately describe it and/or act as a helper demonstrating acceptable performance under direct supervision as a knowledgeable observer (page 10). This competency level (4) allows some flexibility in the way it is written as there are two possible levels of performance. This suggests students should ideally practice the skill under supervision but if the opportunity to do this is not available there is the scope to accurately describe it. Please note: There is nothing here to prevent the activity being simulated if necessary and/or described. Many clinical skills can be observed using the resources available to students via the University VLE ebridge. For example using ClinicalSkillsNet or, for intramuscular injection practice the videos and elearning package via It is also very appropriate for students at this level to explore the resources and policy documents available in the Trust to support safe practice (e.g. for infection control). Many Trusts now have access to equipment to simulate clinical skills and these can be borrowed by teams and mentors (e.g. a injection

2 site model). The student can be asked to talk through a procedure or asked questions about what they would do in a certain practice situation or scenario. 1.5 Demonstrate an ability to engage effectively with a range of people and build caring professional (p65) This PLO provides a list of the full range of people the student has engaged where all types must be achieved by the end of Year 1. This does not mean individually on separate occasions. For example maybe the student will visit a patient at home where there are children and/or young people in the family they interact with. A person with a diagnosis of schizophrenia has a long-term condition. There may need to be some thought given to how the student can achieve the PLO in relation to Pregnant and/or Postnatal Women. This may require facilitation of a visit to an antenatal clinic but could involve a visit to the perinatal mental health service. It would be better if some students achieved this in semester 2 to avoid clinics becoming overwhelmed with requests in Semester 3. Please liaise with the PLF if you are not sure how to go about this. 3.3 Adjust ways of communicating where a person's hearing, vision or speech is compromised. (page 67) Think creatively about this one. A person senses may be compromised because they are experiencing hallucinations that are distracting or because they have difficulty attending to stimuli. 9.2 Respond appropriately when faced with an emergency or sudden deterioration in a person's physical or psychological condition (e.g. abnormal vital signs, collapse, cardiac arrest, self-harm, extremely challenging behaviour, attempted suicide) (Page 73) The key phrase here is sudden deterioration. The examples given are just examples, any sudden deterioration in a persons physical or psychological condition is appropriate as an example. If not witnessed during this placement, discussing and answering question about how to respond to a given scenario described by the mentor and taken from his/her previous practice would be appropriate. 9.3 Seek the assistance of appropriate others in such a situation (page 74) See 9.2, the same applies Participate in aspects of care planned to keep people safe by: These all need to be signed off but don t have to be taken too literally and again scenarios could be used. Consider how you would minimise the risk of falls when administering an injection in a patient s home, when there is a risk of sedation from medication (or postural hypotension), when agitation or insomnia impacts on function increasing the risk of accidents.

3 How do you make sure pain is not the cause when assessing levels of anxiety and agitation in any patient Signs and symptoms of infection may be observed in all settings. dysfunction Constipation is a potential anticholinergic effect of many medications and GI disturbances are also common from both prescribed medicines and substances of abuse, The increased prevalence of bowel cancer in people with serious mental illness provides a rational for asking questions about bowel function and exchanging information about when to act, the impact of poor diet or fluid intake as a result of mood or delusions may require intervention. Think about interpreting this one relating to skin integrity, personal hygiene, obesity, sedation Accurately measures and records weight, height, temperature, pulse, respirations and blood pressure using manual and electronic devices. (page 74) ers Equipment should be available for this in all settings. If no patient is available or willing to consent, practice on the staff. Staff themselves may have become deskilled through a lack of opportunity to practice and welcome an update from the student. Students can share the resources on ClinicalSkills.net via ebridge and the Trust training or clinical development departments should be able to help Participate in maintaining a person's personal hygiene where they have identified they are unable to carry this out for themselves (page 74) This may involve supporting a patient to improve their self-care skills Engage in communication with a range of members of the team (page 78) To achieve this you MUST include evidence recorded on the INTER PROFESSIONAL LEARNING LOG on page Demonstrate safe manual handling techniques (page 82) This does not just apply to people, maybe there is a box or item of furniture that has to be moved Apply principles of asepsis to aspects of patient care where there is actual or potential danger of infection being introduced Consider how you would prepare an injection in dirty a home environment. Or advise a carer how to store and prepare medication for self-administration by a child or older person (e.g. liquids, inhaler, eye drops) Ensure dignity is preserved when collecting and disposing of bodily fluids and soiled linen (page 90)

4 This may require a scenario but consider how bodily fluid is present on used needles and gloves when administering an injection and the patient may bleed post injection. Any patient in any given service or situation may vomit, what would you do about it s disposal? 27.1 Assist people to maintain independence in choosing what they eat and drink 27.2 Report any information gained from discussion with the person or their carers about food preferences/requirements/difficulties (both page 91) These two activities are about the overarching PLO about meeting needs for an adequate nutrition and diet. There are many issues to do with poor nutrition in all sorts of client groups and situations in mental health services. For example where there is weight gain and obesity, in eating disorders, where delusions or compulsions impact on diet and fluid intake Participate in accurately monitoring and recording fluid intake and output 29.2 Identify indicators of dehydration and fluid overload (page 93) These are similar to 27.1 and 2 above but are likely to require a scenario discussion and questions. For example if a patient discloses to you they think the water in their flat is being poisoned, what signs of dehydration would you look out for and what would you advise the patient was a reasonable fluid intake a day and how many times a day would you expect them to pass urine. How could you convert what they report to you as having drunk into an assessment of an adequate fluid intake and output. At what point would you become concerned about the safety of the patient and what would you do next? 31.1 Recognise and report when people have difficulty eating and/or swallowing; 31.2 Observe and seek out information on alternative methods of maintaining adequate nutrition (page 95) Think about situations where people s dietary and fluid intake is restricted due to substance or alcohol use, where it is impacted on by their behaviour, symptoms or mood (e.g. in hypomania or mania, in depression, in an eating disorder, delusions) or where medication, poverty, life skills and lifestyle leads to an inappropriate diet and weight gain or loss Observe infusion sites for signs of inflammation/infection and report findings; 32.2 Observe the process of administering intravenous fluids and describe their specific role within that process (page 96) NB: Please note; as a change to the previous document these outcomes are not allowed to be taught and assessed in simulated practice in the clinical skills unit at the University nor signed off by a member of the academic staff. (THE NMC SAYS IT MUST HAPPEN OUT IN PRACTICE) we are negotiating with the trusts how this might best be addressed but please make all efforts possible to address this if you can.

5 33.1 Demonstrate competency in (page 97) I suggest you devise some of these from the BNF using the information available in the main CNS medicines sections as well as different product entries e.g. identifying how many tablets of a certain dose and frequency will be dispensed from the pharmacy for 7 days, calculating a certain dose in millilitres where the concentration of a liquid is given in the BNF, similarly calculating how much to draw up for an injection in millilitres where the concentration is known, converting tablets to liquid or drops, demonstrating how to use drug equivalence tables when switching IM medication or when calculating the maximum dose of a prescribed oral medication plus prn of the same class. The BNF can be accessed online at using an Athens username and password Demonstrate knowledge of local and national policies governing ordering, receiving, safe storage and disposal of medicines; 37.2 Demonstrate safe disposal of medicines (page 101) If medicine administration does not take place in the placement, talk through the process and answer questions about the policy as this activity says demonstrate knowledge of Use prescription charts correctly and maintain accurate records; 38.2 Utilise and safely dispose of equipment needed to administer medicines e.g. needles, syringes, gloves; 38.3 Demonstrate competency in medicines administration Injections 38.4 Reports any adverse reactions to medicines administered (all Page 102) For these try to facilitate access to an area where the student can undertake medicines administration. If some of these are impossible in Semester 2, please make sure this feeds through into the action plan for the placement in Semester 3 and use simulated practice and scenarios in Semester 2. Jacquie has a number of scenarios mentors can use, should they need to (send an ) and make use of any available equipment for simulation in your Trust.