Do mental health nurses have the appropriate skills and knowledge to look after patients’ physical health needs?
This has been brought into question by fitness to practise cases involving mental health nurses who have failed to undertake essential monitoring of patients’ vital signs.
At the age of 17 I started my career in general nursing, then going on to become a mental health nurse. I have used my general nursing skills everywhere I have worked in mental health settings.
I firmly believe, to care for a patient, a holistic approach is needed and that physical and mental health needs go hand in hand. As practitioners, we need to be knowledgeable and skilled in all areas that any patient may present with in order to deliver high standards of care to patients.
Yet in my experience, mental health nurses often lack confidence in managing the physical health needs of their patients, often due to a lack of education.
Students training to become registered mental health nurses need to have education in physical health in order to become competent practitioners in their future roles.
So how can physical health care be effectively delivered in mental health wards?
I believe every nurse starts their day aiming to care for and deliver the best practice they can, even if their day begins with staff shortages and a multitude of tasks to problem solve, organise and manage for the day.
Some things just don’t get done. The cliché ‘I didn’t have enough time’ is all too frequently heard on wards.
But what are the consequences of not measuring patients’ vital signs, particularly on acute mental health admissions wards? Not taking patients’ vital signs, meeting patients’ basic physical healthcare needs is, in my opinion, negligence. It could result in severe consequences that are harmful to the patient.
“I believe every nurse starts their day aiming to care for and deliver the best practice they can”
Over the past three weeks I have personally escalated physical health alerts which have resulted in three patients being transferred to a general hospital. One of these three was a patient with an eating disorder, emaciated, refusing to eat or drink, which undoubtedly required frequent monitoring of vital signs. The consequences of not attending to her physical healthcare needs could have been fatal.
Any nurse could find themselves in front of their professional body answering questions at any point in their career. Everyone is rightly concerned about safeguarding. Basic physical health monitoring of patients vital signs is ‘safeguarding for nurses’. I frequently find myself saying to staff: ‘If in doubt obs it out’.
In order for physical health to run well in acute psychiatric wards, there needs to be a physical health champion/lead for that area. Physical health systems should be based around trust policies but adapted to meet the service area.
In my view, it does not matter what recording systems your trust/ward uses, as long as it works for that area and is streamlined to purpose. In my experience of championing/leading high standards of physical healthcare within several acute psychiatric hospitals, the simpler the process is the better the results.
If a bank or agency nurse comes to the ward, they may not be familiar with normal ranges of blood pressure. If a service has this data at hand, in the physical health file or on a wall, the allocated member of staff on physical health duty for that day will be alerted to what is expected.
Having an algorithm for physical healthcare at easily accessed in a ward is helpful, as is nurses taking and scoring vital signs using a clear record showing alerts.
“Nurses need to have a good working knowledge in both physical and mental health”
A MEWS (medical early warning scores) chart will alert scores that give false alerts in an adolescent ward, therefore, adapting forms to make them work for your area is important. Having blanket policies for all areas in a trust will not work, adapting paperwork to be fit for purpose to use in your area works.
It is worth investing in thorough training for regular staff on the ward in physical healthcare, this training should be specific to that area.
Remember, if your ward looks after anorexic patients then staff should be competent and aware of parameters of concern for anorexic patients. All staff should have medical competencies training.
Job satisfaction comes from helping patients through their issues whatever that issue may be, whether it is high blood pressure or depression.
In order to be a competent practitioner and give our patients the best care, nurses need to have a good working knowledge in both physical and mental health.
Vonnie Robertson, senior staff nurse, Sussex Partnership NHS Foundation Trust