My second week in the community is now complete, and I am now half way through this short placement of just four weeks. It is a great shame that this placement is not actually the longer one of ten weeks, which is later in the year, as I absolutely love it and the time is going far too quick.
As being a community mental health nurse is rather like being a social worker too, the role is sufficiently varied to keep it interesting and challenging. Part of the time is spent in client’s homes, maybe delivering a specific talking intervention over a cup of coffee, giving them their two-weekly depot injection, or just making sure that everything is generally okay with them.
Another part of the time is spent seeing clients at the mental health centre. Clients may be visiting to have their depot injection or to get their bloods checked, or they may be attending for a six or twelve monthly review of their treatment. If it is the latter, the resulting paperwork is extensive. The review has to be written up, and copies are sent to the client and their GP. The client’s risk assessment and care plan are updated, and an essential care cluster review and a SALT are carried out. I can’t remember what SALT stands for, but I know it is not the acronym that I am usually familiar with – speech and language therapist – and is instead something to do with the social work side of assessments. Of course, if clients have got better and have stabilised, reviews sometimes end in them being discharged from the service. It must be so rewarding for the staff to see a previously poorly client regain good mental health once more. It can often be a long journey, and this is what must make it all the more worthwhile.
As inferred above, another part of the time is spent in the community mental health office, catching up with all the paperwork. After a couple of client visits, this does tend to pile up rather quickly, and I can see that if you are not very careful, paperwork could potentially take over from actual client contact. It is therefore essential to be organised and to get ahead as much as you can.
Yet another portion of the time is spent being on duty triage. Unwell clients or concerned family members phone up for advice, and if a person is deemed to be in need of further help, they may be asked to visit the community mental health centre, in order to have an assessment. The assessment may be booked for a future date, but if really urgent, will be carried out that day. Assessments are a hugely time consuming exercise, but are essential for nurses to get to know their clients, what might be wrong with them, and how they can be helped.
I took the notes during an assessment last week, and it took about two hours in total. Information needed to be gathered under various headings, such as presenting problem, past psychiatric and physical health history, medication, family history, personal and social history, appearance and behaviour, speech, mood, and so forth. The resulting array of information was massive, and of course, all had to be typed up once the exercise was completed.
The process that I witnessed was not just an information gathering procedure. The community psychiatric nurse, that conducted the assessment, spent time to build a good rapport with the client, and used appropriate opportunities to teach the client about the identified problem, and to persuade them to see how the likely diagnosis was justifiably applicable. The nurse was extremely skilful and managed to normalise some of the client’s concerns by sharing a little about her own personal life experiences. This shared human element was extremely effective, and helped to put the client at ease, and to help the client to address the next stage of her treatment journey.
The experience with the community team is proving to be both enjoyable and educational. I can hardly wait for week three to begin, but for now I will enjoy what is left of the weekend.