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Should nursing education be branch-specific from the very beginning?

  • Comments (8)

At my university, the first year for all nursing branches, paramedics and ODPs is called a common foundation programme. It provided us with the fundamental skills needed for working in healthcare and introduced us to anatomy and physiology, psychology, sociology and healthcare law.

I felt like I had covered very little mental health in my first year and whilst the things we were learning were important, it felt like it was all geared towards the adult branch students. I understood that that first year was just forming a basis for nursing practice, but at first I felt somewhat disadvantaged.

Despite the first year being a common foundation, all branches had the entirety of their placements in their chosen areas. At first glance of my portfolio, I was concerned that it would be difficult to meet all of the requirements to enter second year. For example, a lot of the portfolio seemed focused on physical care. In mental health settings, there wasn’t the same opportunity to practice vital signs or moving and handling as there may have been on a medical ward. Eventually we were told that we didn’t have to necessarily carry out the portfolio requirements, but just be able to talk it through with our mentors. I couldn’t help but feel that if the separate branches had separate portfolios, it would be more relevant to our practice.

A requirement for our portfolio is that we visit services associated with our placement as well as arranging visits to services in different branches. I decided that, rather than feel like I was at a disadvantage, I would use opportunities such as these to develop skills that I may not have been able to in my mental health setting.

It used to be that nursing training would start off with eighteen months of general training before you chose a branch to specialise in. By the time you chose your branch you’d have a firm grasp of clinical nursing skills. Some universities arrange insight placements - rather than spending just a day in a different branch, you had a good few weeks there to experience it. Whilst I have found that spending a day in different services has been really beneficial, it is not enough to be able to really get involved.

I know that regardless of how the degree was structured I would still be a mental health nurse, but it would be beneficial to my practice if I was able to really understand how other branches work. We are expected to work in multi-professional teams so having a good understanding of how others work would greatly improve teamwork, communication and - subsequently - patient care. Now that I am in my second year I feel much more confident with all aspects of care thanks to the common foundation programme.

It occurred to me as I was writing this blog that it wouldn’t matter how nursing training was structured, as even when I qualify there will still be things to learn. There will always be those who think that students should focus on their particular branch and others who think that training should be better-rounded. Regardless, nursing is a career that requires continual education and there will always be more skills to develop.

Natalie Moore, mental health student nurse editor

  • Comments (8)

Readers' comments (8)

  • Anonymous

    I train staff in a mental health Trust in physical health care management and resuscitation. I am appauled at the level (or lack) of understanding regarding physical health needs. This is not the staffs fault but is more to do with the way the training is structure, as you have pointed out. We are now in a situation were we are trying to train staff in physical health issues whilst they are trying to manage a full time job. mental health staff, especially those working with older adults, are looking after more patients with more physical health issues for longer periods of time. Something needs to be done regarding basic training, and it has to happen now. I would urge all mental health staff to take a small part of their CPD time and allocate it to physical health. Think of those patients that make you uncomfortable, because of a physical health issue, and look at that first. Remember it's all about hollistic care.

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  • Anonymous | 15-Oct-2012 9:33 am

    I have just got hold of a great book called Physical Health & Well-Being in Mental Health Nursing by Michael Nash. I'm definitely going to pay attention to physical health in my placements, like you say something needs doing about it. Thanks for your comment!

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  • tinkerbell

    the first rule of psychiatry is to eliminate a physical cause.

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  • Tinkerbell, maybe so but none of the nursing training focuses on this. This would also depend on the service - most patients will already be diagnosed unless it's their first acute episode.

    This fits in well with my point that not everything can be squeezed in to 3 years of training.

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  • tinkerbell

    Natalie Moore | 16-Oct-2012 9:10 pm

    of course it should natalie, otherwise we're putting the cart before the horse.

    But i would urge every student nurse to question 'have we eliminated a physical cause?' first before we start trying to treat someones mind when in fact that person may have a brain tumour, cancer, toxic confusional state, or some other physical cause affecting their mental state, as i have witnessed so often when the basic physical causes haven't been properly investigated properly.

    Check out for yourself that these investigations have been done and if they haven't ask for them to be done, basic bloods and urinalysis before we start off down the 'mental therapies' road.

    I am a mental health nurse by the way and i still rely heavily on my knowledgeable colleagues to advise me but i never stop questioning 'what tests have been done so far?'. When i am satisfied that we've covered the basics first then i will move forward to do my interventions with gusto, but not beforehand.

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  • I am a recently qualified nurse, who studied the combined Mental Health Nursing and Social Work course. In our first and second year, we each had a placement that was outside of our mental health remit. One was a clinical placement, and the other was with learning disabilities.
    I can honestly say, that from having these placements that were not necessarily specific to my branch, I learnt so much, and that there can be a lot of cross-over from one field to another, particularly between LD and MH.
    Whilst I can understand your concerns, in having these additional experiences, you will most certainly find that the knowledge you learned here will crop up later on in your career as it already has done on mine a number of times.

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  • I do believe that you should go straight into your chosen branch at the beginning x

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  • tinkerbell | 16-Oct-2012 8:38 pm

    "the first rule of psychiatry is to eliminate a physical cause."

    Natalie Moore | 16-Oct-2012 9:10 pm

    ".... most patients will already be diagnosed unless it's their first acute episode."

    I'm neither a nurse nor a student, but am currently going through the ucas application process (for mental health branch). However, for the last 10 years I've worked with people with so-called 'multiple & complex needs' and this discussion took me back a few years...

    A woman, who had already been diagnosed with a psychotic illness, was experiencing an increase of her symptoms (persistent delusions; paranoia; behaviour changes; poor self-care/body odour). Over a period of around 10 months, she had two hospital admissions (psych) and contact with community teams. After all this, she eventually showed me her breast, which had a large (2" diameter) open wound, which tests showed to be cancer - turns out that her unpleasant smell & presumed poor hygiene, was in fact down to the big hole in her flesh - a physical health condition.
    Arguably, her leaving it for so long to disclose was influenced by her mh, but that doesn't excuse all the many professionals (myself included), who came into contact with her for automatically assuming it was mh related and failing to explore potential physical causes.

    I would prefer to go straight into my chosen branch without the common foundation year, as this is where my interests lie, I'm enthusiastic and of course, I just want to get started - but, I just have to remember this case and I'm reminded of its necessity. We're multi-layered beings, it's only right that we approach care and treatment with an awareness and understanding of alternative but interlinking health systems.

    Apologies for the lengthy response: whenever I remember this client, I just feel totally awful. I guess it was a steep learning curve for me, which has benefited my practice since, but just should never have happened : (

    Helen Donnachie | 19-Oct-2012 11:05 am

    I do believe that you should go straight into your chosen branch at the beginning x

    Helen - do you have any reasons for this? Would be interesting to hear the other side of the argument :)


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