From my last post, I began the countdown to graduation … My cohort and I have finished 2/5 items on the list and are now ‘resting’ before that final push. Left on the list are simulated practice (simprac); dissertation and final placement. Over the weekend (someone must have been paid overtime!) I was notified of my final placement – it’s at a PICU. Psychiatric Intensive Care Units, better known as PICUs, are wards where service users who are in the most acute phase of a mental health condition (usually bipolar disorder or schizophrenia) and require more intensive care are admitted. So why a PICU for me? The two broad areas I haven’t had the opportunity to ‘work’ in have been CAMHs and PICUs – CAMHs was my first choice but I have been given a PICU instead but still happy overall.
Acute Male/Female Ward Newham:
– shift handover from Night shift
– waking service users up and ensuring they get breakfast (?0830)
– morning medications (most service users on the ward attend this)
– Ward round (dependent on day)
– escorting service users for short breaks or longer (permanent staff led but students can shadow) usually off site to smoke or do errands
– community meeting (dependent on day and could be in the PM)
– lunch time (good opportunity to sit and chat with service users) ….1200
– afternoon meds (few service users have these)
– OT led activities (pampering; gym; walks; cooking)
– more escorting off the ward if required
– continuation of ward round if required
– Dinner (1700)
– evening meds
– write up of notes
– handover to Night shift
– tea & toast 2130
– night meds
– audit patient records (ensure care plans up to date; notes for ward round; tribunal reports; this is me; etc … student will assist as required)
-check crash bag (ensure contents all there and items in date)
– check fridges are at right temps
– ensure equipment in operating limits (BM machine, etc)
– write notes
– handover to day staff
John Howard Centre Rehab Ward:
– similar to the above, differences captured below
– some service users administer there own meds, so they will not be part of the meds activity
– some service users have ‘jobs’ on site which they need escorting to
– most of the service users have psychology and groups which they have to attend so again they are required to be escorted there and back
– service users with leave need to be risk assessed before they go out and a number of forms need to be filled in – as a student you get to do the first part and feed this back to permanent staff who will complete the form side
– on return from leave, service users have a post-leave interview which students can do
– good learning area for physical health morbidity – T2DM; hypertension; EPSEs
RAID Newham
– Night shift hands over any cases they haven’t dealt with
– Referrals from A&E as and when they happen – you can have a shift where there are none at all through to having multiple patients with all the clinical staff (usually 2 xRMNs; 1 x SHO; 1 x ConPsyc) assessing service users with more on the books!
– Handover any outstading cases to night shift
– The Drug and Alcohol nursing team had ceased to exist in Summer 16, thus there were requests covering this area also
– placement focuses on mental health assessments, so you attend the interviews and over time if staff are happy you can take the lead on an interview – usually you start up with family members getting collateral
– you gain a good insight into all the mental health services available in Newham as you will refer the service user to these and range from acute ward admissions through to referral to GP
– you gain an insight into how the sectioning process works
– good for a short placement or final year placement to gain an idea of the services offered by the Trust
– drawbacks are starting posts are at Span 6, so you not an actual job you can go to when you graduate
RAID Tower Hamlets Older Adults
– 0915 – daily (except Weds) review of patient list regarding actions for that day and allocation of new referrals
– alternatively on Weds – MDT full patient review; focus on complex cases requiring in depth team input
– Tuesday visits to Jubilee Ward at Mile End Hospital where physical rehab occurs for some service users
– gain collateral for any new service users
– visit wards to assess any new service users or to follow up with existing ones
– provide advice to General nursing on wards where they do not traditionally have dementia/elderly patients (this is driven by the Winter pressures, which means patients are placed wherever there is a free bed)
– Administer cognitive assessments (ACE III; BAMSE – Bengla adapted MSE; MoCA – Montreal cognitive assessment)
– Opportunities to work with OT/SHOs/Psychologists/Dementia and Delirium team
– 1700, go home
– same drawbacks as above for Newham’s RAID
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