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Student Editor Blog

‘Why isn’t physical assessment a bigger part of mental health nurse training?’

I’ve come to realise that your nursing training is what you make of it and everybody’s experience will be different.

One thing that does concern me is the lack of physical assessment skills that student mental health nurses are taught at university

Just because you don’t cover something at university, you might encounter it on placement, and vice versa.

But one thing that does concern me is the lack of physical assessment skills that student mental health nurses are taught at university.

I have seen very little physical assessment in practice and although it should be, it’s not routine practice

After two physical assessment skill sessions with a tutor who is both an RMN and RGN, our cohort requested more as we found it invaluable.

In all honesty I have seen very little physical assessment in practice and although it should be it, it’s not routine practice.

Let’s say, for example, you are a CPN who sees a patient once a fortnight. The patient is on medication and suffering from side effects, although doesn’t really mention them. You may well be the only professional contact this patient has.

Why shouldn’t physical assessment be a routine part of mental health care?

If a patient has a physical complaint than they are more often or not sent to the GP. But if we are to give holistic care, more consideration needs to be given to the physical implications of mental health care.

It wasn’t until after these sessions that I realised how awful it was that I didn’t have these skills before.

During my next placement I will give more consideration to physical health and try to develop these skills further.

Do other mental health student nurses feel that physical assessment falls by the wayside during their training? Have any mentors placed an emphasis on physical assessment in your placements?

Natalie Moore is the mental health student nurse editor for studentnursingtimes.net.

Readers' comments (11)

  • What a valid point. I trained in mental health pre project 2000 (pre 1980s to be precise). during my training we had a specific 6 week block on physical/assessment and observations. I am sure some elements of physical health is covered in todays training however I find that some of todays post grad students are fixated on the theory and lack the observational skills of nursing

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  • Anonymous | 4-Jun-2013 1:43 pm
    Thanks for your comment. We do cover physical health but not in great detail. I certainly wouldn't feel confident carrying out a physical assessment. There are of course avntages to being branch specific but I know that a lot of student MH nurses would appreciate more focus on physical asssessment, even a placement in a general service.

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  • I would have to support this comment. As a general nurse, with some mental health knowledge from CFP but mainly as a carer/involvement in MH advocacy, I strongly suspect that repeating the research re: longer length of stays/care issues for patients with dementia, & patients with learning disabilities in general hospitals for 1) patients with MH issues in general hospitals & 2) patients with physical conditions receiving psychiatric care would mirror the results.
    I've lost track of the number of patients with MH issues who've had their meds stopped as nil by mouth & then acute withdrawal misdiagnosed as reaction to pain medication or dismissed as 'just because they're mad' (yep, discrimination is alive and well in nursing). I've also heard of e.g. an insulin dependent diabetic admitted voluntarily to a psych hospital who was threatened with sectioning for refusing to take the dose of insulin he'd been prescribed (when he adjusted dosage to food intake & knew meals in hospital far smaller so he'd have a hypo on that dose). Aside from lack of knowledge of sectioning (even as an RGN I know that's only for treatment of MH condition, if you had concerns re: validity of consent/refusal of physical treatment you'd be looking at assessing capacity), thank goodness for the most junior doctor who 1) remembered their FY1 medical experience & spoke up & 2) remembered the organisation has a diabetic registrar on call 24/7.
    When I was doing placements in the 4 branches in CFP it was all down to the 'new fangled P2K' (then). But even those 4 week placements in 8 areas have had a career long impact on my ability to look beyond my speciality.

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  • snowy_owl | 5-Jun-2013 4:29 am

    why are patients with MH disorders not treated with respect the same as any other?

    re the diabetic patient, the fact the doctor had to call the diabetic registrar means the patient's word was not taken for his dose of insulin and administering his own treatment. why? did the patient request this consultation with the registrar?

    I am ashamed of the lack of education, lack of applied intelligence and poor behaviour of some nurses and especially those who call themselves 'specialists'!

    Looking beyond your speciality must apply to all nurses who must, in effect, all be both generalists and specialists.



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  • tinkerbell

    Please remember this as you go forward in your training students, that

    Eliminating a physical cause is the first RULE of psychiatry.

    You don't want to be treating a patient for mental illness when in fact they are physically ill. Wasting their time and yours and preventing them from getting the treatment they really need. That is why routine bloods MUST always be done and then some.

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  • tinkerbell | 5-Jun-2013 8:06 pm
    I think you posted something similar when I wrote about nursing education being branch specific. Eliminating physical causes is of course important but I am thinking more in terms of people who have already been diagnoses (such as in the community) when physical health checks can quite often go without being done.

    I know that LD patients have annual check-ups and wonder if this could be helpful for our client group as well.

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  • Natalie

    Please, what is an LD patient?

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  • tinkerbell

    Natalie

    i now work in the community. Whenever I am asked to assess a patient it is the first thing I ask, what physical checks have been done and where's the evidence?

    It is more than important, it is vital that i can work from a baseline that has already determined there is no underlying physical cause for the patients presentation.

    I could give you a few stories where patients have been misdiagnosed and treated for mental health problems and then died because they had a physical illness.

    Be mentally prepared when you qualify that you will be acting as the patients advocate to ensure these checks have been done.

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  • Anonymous | 6-Jun-2013 6:52 am
    Learning disabilities. Sorry, shouldn't abbreviate really.

    tinkerbell | 6-Jun-2013 7:39 am
    If I work in the community I will always make sure that physical health checks are part of my role as an RMN. Your point about advocating to make sure they're done is really vital.

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  • Natalie Moore | 6-Jun-2013 8:33 pm

    Anonymous | 6-Jun-2013 6:52 am

    thank you Natalie. some of us readers are abroad and are not always familiar with all the abbreviations used in the NHS.

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  • tinkerbell

    i can't access why Niall felt overwhelmed as don't subscribe, but an easy way to remember a mental state assessment is you are assessing

    thought
    perception
    mood
    and
    behaviour.

    Hope this helps. I have always tried to break everythig down into its simplest compnents as i think sometimes we are blinded by jargon and then become overwhelmed. You have to have a starting point and then work upwards.

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