This is part two of the series on What Psychiatric Nurses Do. You can read Part One here.
A significant part of the training to be a psyche nurse involves learning to assess needs and plan care. It’s a tricky thing. In theory (and what you learn in training), a nurse is supposed to assess all aspects of a patient’s needs, including social needs, spiritual needs, physical needs, etc… In reality that rarely happens. There simply isn’t the time to go into so much detail, and ward-based nurses don’t have the time or resources to address things like social needs. These would be the remit of community psychiatric nurses (CPNs).
Assessment tends to be a fairly ad-hoc thing. Assessment tools are available, to assess things like depression, anxiety, withdrawal symptoms, medication side-effects, etc, but on a ward they’re rarely used. Again, there simply isn’t the time. Nurses (and support workers) simply use their knowledge and experience from day-to-day interactions with patients to assess what’s happening for the patient and what their needs are. Every interaction with a patient is a mini-assessment. To a casual observer it may seem like a nurse discussing with a patient what’s on the TV is just that, but in fact that nurse will be assessing the patient’s alertness, cognition, signs of depression or anxiety, signs of psychosis, any confusion, the presence of pressured-speech, thought disorder, etc.
In addition to these general conversations, the nurse will aim to spend dedicated 1:1 time with the patients they are assigned as primary nurse for. These sessions will be an opportunity to discuss what the patient’s needs are, how they feel about their treatment and progress, any issues they have, any symptoms they are experiencing. There is rarely time to explore issues in depth, and in truth most nurses have very little training in therapy and counselling. We can take courses on counselling and the like, but these tend to be available to more experienced nurses on the higher grades. Band 5 nurses (what I was) don’t tend to be trained in therapies.
Care-planning is supposed to take place together with the patient, based on what needs have been identified and assessed. And in an ideal world, that would happen. But when targets to have care plans completed within 72 hours of admission were brought in, this pretty much went out the window! Care-planning became a paper exercise, based on little, rarely with involvement from the patient, and simply to have them completed so it looks good on the ward stats. Nurses try to make the care plans as tailored to the patient’s needs as possible, but when you have to have the care plan completed before you’ve even sat down with the patient or you get hassle from managers, it makes it difficult.
Either way, care planning basically involves just that – planning the care. They’re all done on a computer form now, where you identify a need, decide what interventions you are choosing to address that need, and review the plan weekly to amend the interventions, close them if needs have been resolved, etc. So let’s say for example someone is suffering from a manic episode. Their needs would be to get some sleep, experience a reduction in symptoms, get some time out, etc. Interventions would be things like education on sleep-hygiene, administration of medication, addressing agitated states through de-escalation techniques, PRN (when required) medication, etc. Once the care plan has been devised, it can be discussed in review with the doctor where interventions will be decided by the Consultant and nursing team, and the nurse can put things like referral to community teams, therapies, etc, into action.
Assessment is a significant part of the role of a psyche nurse. The Consultant and other professionals rely on the day-to-day assessments of the nursing team. Discussions amongst the nurses about the presentations of the patients take place at staff hand-overs, where there won’t always be agreement about what’s going on for a patient and what the plan of action should be. Which leads me onto my next subject…. hand-overs and shift-leading.