This is part ten of my series on what psychiatric nurses do. You can read the other parts of the series here.
Personal physical care has got to one of the least popular aspects of a psychiatric nurse’s job, and the one that is most frequently delegated to healthcare support workers. It’s not supposed to be, but in reality it is. I personally found the personal physical care of patients awkward and embarrassing and avoided doing it if I could. (That’s not to say all nurses are as cowardly as me!)
On adult inpatient wards, physical care is not common, and you get out of the hang of doing it (which is why I always found it so awkward). But occasionally there are elderly or infirm patients; disabled people who might need some assistance with some aspects of personal care; patients with dementia or other cognitive difficulties; or patients who are catatonic. Staff might have to bathe patients, assist them with dressing or the toilet, give bed-baths, help with feeding, etc. It requires patience, professionalism and sensitivity to assist patients with personal care. It also requires experience, which is where I and other nurses struggle. The older, more experienced nurses and healthcare support workers have done this stuff for years and could dress a patient with their eyes closed. I, on the other hand, had little experience and felt nervous about it. Regardless, personal physical care is a part of the job and something all nurses have to do at some point.
It can be especially difficult with patients with cognitive difficulties who may resist attempts to help them. There is a duty of care to patients to maintain their physical health, and sometimes it may be necessary to restrain a patient in order to care for their physical state. This is very difficult and risky for everyone involved.
As well as personal care, nurses have numerous other physical health tasks to perform when required such as weighing patients, taking blood pressures, monitoring blood sugars, taking ECGs, etc. These are part of plethora of daily tasks that need doing. Psychiatric patients are at a very high risk of physical health issues such as obesity, high blood pressure, diabetes, etc: partly due to psychiatric medication and partly because of the poor lifestyle choices most psychiatric patients make. Nurses have to monitor physical health and refer any issues to the doctors.
(Are you getting to understand just what a diverse and busy job it is yet?)
Clerical duties take up a significant part of a psychiatric nurse’s working day. At the end of every shift an entry needs to be made in the case-notes of every patient on the books. The case-notes are mostly on computers now, which was a great development to those speedy typers like me, but many of the other staff struggled with this change and typing these entries takes an age for them. The entry made needs to give a description of how the patient has been throughout the shift; how their mental state has been, whether they’ve eaten, been off the ward, done anything risky, etc. Most of the decisions about care are based on these entries so they’re very important and need to be thorough. However… there are a number of problems with this. Firstly, not all staff make great entries. In fact some are downright illegible and say nothing useful. Secondly, it’s quite likely that the member of staff writing the entry hasn’t even laid eyes on their patients for the whole shift, being too busy. And thirdly, for some patients there is nothing at all to say as they’ve been exactly the same every single day for weeks. You might as well copy and paste the same thing day after day.
As well as making an entry at the end of every shift, staff are supposed to make an entry in these notes as soon as possible after any significant event. Someone rings about the patient, make an entry. The patient does something risky, make an entry. You spend some 1:1 time with a patient, make an entry. With 22 patients on the ward I was on and 5 staff per shift, I bet you can see that writing in case-notes takes up a lot of time, especially if you’re not very fast at typing.
The ward I worked on had a fantastic ward clerk. Without her the place would have fallen apart. But despite that, there was still a lot of clerical work to do, especially if it was her day off (usually falling to the shift leader). Numerous phone calls, filing, referral forms, etc. At least an hour of most days will be spent on purely clerical duties (not including the case-notes entries I just talked about). Just the general day-to-day things that need doing to keep the ward running smoothly.
Next time I’ll discuss the discharging of patients and mandatory training.