In the last 2 weeks of my nursing home placement, I had the opportunity to spend a day at a mental health inpatient unit for elderly patients with dementia, and sit in on a Consultant Psychiatry clinic afternoon. The deputy manager of the home had asked if there was anything I wanted to do specifically since my formative assessment had been completed, and I said I wanted to ‘get out and about’ to learn more about the background of our residents such as some of the services they may have had to come through before reaching us at the nursing home. I felt it was important not only to understand them, but also how the dementia pathway works in my area.
I was incredibly nervous. It was like starting a new placement except, in a speciality I had never really experienced before. I’m not a student mental health nurse, and yes, my adult nursing degree had taught me about dementia, but I was yet to have training on other mental illness and complex conditions. I was confident in my communication and interpersonal skills but still got heart palpations when situations escalated, or residents were particularly agitated and aggressive.
However, I need not have worried so much. The staff, particularly the Nursing Assistants at the inpatient unit, explained things thoroughly and dispelled worries pretty quickly. From there I was able to learn a vast amount in such a short space of time.
The dementia inpatient unit is a facility for patients who have deteriorated and need specialist input to stabilise their mental health, in order for them to be settled and looked after in a more permanent residence, often an EMI nursing home. I was surprised at how chilled out everything was, and the patients seemed happy to be there. Yet, like most NHS mental health services, they were almost at full capacity and this meant that the day was spent hurrying along discharges, so they would have space to accommodate anyone over the weekend. At the nursing home, we have found this can lead to residents arriving who are unstable, their medication hasn’t taken effect or needs reviewing, and their unsettled behaviour can affect other residents. However, good relationships between the lead nurses, psychiatry teams and nursing home managers means that often things are managed well.
The Psychiatry clinic was a complete whirlwind of new experiences. The Consultant really involved me in the process, getting me to read the case notes before the consultation, including me in the discussion with the patient and explaining anything to me afterwards. We had 4 cases: anxiety related anorexia with low sodium and blackouts caused by medication, a dementia diagnosis, a dementia patient whose spouse wanted to get on and do his own thing but the patient was agitated in his absence and therefore he wanted the patient medicated, and a reported depression due to family issues that actually presented as an ego-centric personality disorder. In the space of 4 hours, I learnt about medication, how often you are treating the family as well as the patient, how good relationships with other professionals can facilitate continuity of care, how a memory test and the dementia diagnosis pathway works, and a myriad of other little things.
These 2 days were such valuable experiences for me as a student adult nurse. Without formal mental health training, we are often ill-equipped to be able to communicate with and understand the perspectives of some patients which can be frustrating and daunting. Mental health services have their own set of problems in today’s NHS, but this doesn’t detract from the fact that they are a wonderful place of learning and not as unnerving for a student as you first may think. I want to be the best nurse I can be and for that placement it meant broadening my knowledge of the journeys some patients go on and having a good understanding of other services. Take every opportunity as a student to learn about your patients and their journeys as the freedom to pop in and out of places can be limited upon registration. Just ask! You never know what may lie ahead.
Rachael Palmer (@PUNCrachpalmer)