Wednesday, April 3, 2019
Workload Management in Mental Healthcare
Workload monitorment in affable HealthcareWorkload vigilance / Transition to Practice (Mental Health)Prescribed EvidenceGeneral IntroductionThe clinical setting I have chosen for the workload care is Connolly Norman Ho routine Mental Health Clinic. For my sevensome week arranging in this clinic I was working with the CMHNs from the Mater area Community Services. The aims of the Mater Sector Team continuously focused on providing the highest standard of care to apiece tolerant while working in cave innership with the service exploiter and its family and respect the persons individuality.The Mater Sector Team consisted of ii consultant psychiatrists, two medical registrars, five CMHNs, wizard amicable worker, i clinical psychologist and unrivaled administrative secretary. Other operate which were linked to the clinic include the main infirmary, the twenty-four hour period hospital, day summations and numerous separate support services. from separately angioten sin-converting enzyme CMHN had assigned a number of service drug users for which she has designated responsibility. Each persevering roles care was castned in collaboration with them and the amount of input provided to individually patient role depended on how unwell somebody was and how much input was needed was decided by the CMHN.In do to identify the care unavoidably of service users, the Bio-Psycho-Social Nursing Assessment is used in the particular clinical setting chosen for this assignment. This model is convalescence oriented and involves service users opinions on what is needed in order to improve their recovery journey. The main goal of this assessment good example is to empower the service user re-gaining a life, which includes responsibility, choice, risk taking, hope and social inclusion.The Quality Framework for Mental Health Services in Ireland (Mental Health Commission 2007) was the philosophical framework which point my delivery of nursing care. The fr amework promotes a user centred, recovery focused approach. It aims to empower users of the service while alike emphasising the persons journey towards recovery. This framework is very broad and enabling as it applies to in all services equally regardless whether care is being delivered in an in-patient setting, in the community or in the place.Client WorkFor the duration of my seven week placement in this clinic I was delegated a caseload of five patients precisely for this assignment I will focus only on trinity patients because of the word count limit. The patients to be harborn onto my caseload were selected by my father and the other CMHNs.John is a 76 yr old man with a history of depressive disorder and fretting. John lives al whiz and socially isolates himself. He is dissociate for many years. He has two sons but has contact with only integrity of them who visits him regularly. His physical health is not very good as he has a history of diverticular disease which ca uses him abdominal and stomach pain. At the moment, objectively John does not display any symptoms of depression or anxiety and subjectively John reported I am feeling ok now. Johns main issue at the moment is that he continues to be socially apart(p) and remains un prompt to go egress for walks or to find give a track any of the groups in the day Care Centres. When I met John for the basic time I informed him what my role is and unitedly we devised a care final cause for him in order to reduce his social isolation and to remain well in mental and physical health. The first plan devised was in relation with his daily r divulgeine. I explained to him that incorporating short walks in his daily routine will benefit his physical and mental health. I alike explained to John that social interaction is very important in reducing and preventing the symptoms of depression. John in any case concur for me to refer him to Befriending services with a view to reduce his social isolatio n as they can reach out available peerless-to-one companionship once a week. John as well agree for me to visit him once a week and to go out for short walks. For the first two weeks John denied going out for walks unneurotic with me as we planned previously. He was displaying leave out of motivation and he would bring out different reasons to avoid going out. As a former psychiatric nurse, John would always like to talk to me about his career and the hospital he was working with. As he was still living nigh his previous workplace, on my third visit I asked John if he would like to show me around the grounds conterminous to the hospital where he used to work. John was very happy about this and agreed to go for a walk. For the next few weeks John appeared to be to a greater extent motivated to go out for walks while me accompanying him and reported that he truly enjoys the walks. Because John has a history of non-compliance with medication, on each of my home visits to him I ensured that he was taking his medication as prescribed and checked his dosset box. At the end of my placement John informed me that he is socialising more with his friends and agreed to continue to go out for walks few times a week.Sarah is a 44 year old lady with a diagnosis of chronic paranoid schizophrenia with prominent negative symptoms. Sarah has two sisters and one brother who died two years ago. She is living with her parents and they look after her at home. Sarah has major difficulties in attendance self-care and ADLs in general. She has a lack of daily routine spending much of her time in bed. She has isolated herself from the outside world since her early teenage years. Sarah has also difficulty in retaining information and is unable to travel on her protest around t have because of her lack of awareness regarding directions and safety. Because of this, her parents fear of her welfare or becoming lost. Since Sarahs medication was changed to Clozapine, she has been m ore interactive with others and increasingly initiating conversation. She has also expressed an oc shapey to attend the art and music therapy group in a Day Centre. I worked closely with Sarah and together we devised a care plan with a view to improve her self-care and to have more structure throughout the day. She also agreed for me to accompany her to the Day Centre in order to attend the art and music groups. This would improve her social activity outside of home and her independence by improving her directions skills to and from the Day Centre. Next, we formulated a plan to be followed every day and that consist of her to have a cascade in the morning, economic aiding her mum to prepare the meals for the day and going out for walks daily tended to(p) by one of her parents. While I accompanied Sarah to the Day Centre I used picture and monument appellation folder to identify what bus to get and what stop to wait at. I also allowed Sarah to lead the way with minimal assistance. At the end of my placement Sarah had more structure to her day and her mum informed me that she could see a real improvement in Sarahs behaviour while attending her activities of daily living. Sarahs interaction with other people in the day centre also improved and she reported that she really enjoys the groups. She was still uncertain of bus route numbers but she was able to lead the way from the bus stop to her raise. Sarah and her family were delighted of her improvements.bloody shame is a 77 year old lady with a long history of paranoid schizophrenia. bloody shame has one daughter and after the separation from her husband, she lived with her mother who would look after her and her daughter. Since her mother died twenty years ago bloody shame lives on her own but her daughter and her sister visit her regularly. At the moment Marys mental state is stable and she complies with the medication prescribed. However, Mary feels that her shop is poor and she is worried about not bein g able to manage paying the bills. afterward I had been introduced to Mary, together we devised a care plan in order to reduce her anxiety in relation of not being able to remember things and to reduce her worries regarding bills. Mary agreed to use a notebook to write down what she needs to remember. I also encouraged her to attend for an assessment with psychiatry of old age and she agreed for me to talk with one of the doctors in the clinic about this. Mary also agreed for me to complete a budget plan form for her and to send it to.I also encouraged her to pay the bills weekly until this would come into effect. Furthermore, I advised Mary to have more social outlets by attending day services or community social services. Mary agreed with this and asked me to refer her to one of the day centres. At the end of my work with Mary she informed me that apply the notebook helped her significantly about recalling things she has to do and that she is using it very often. I also informed Mary that I was in contact with one of the charity organisations and they agreed to help her pay the bills until she could use the budget plan and she was very happy with this. Mary continues to attend a day centre once a week and she finds it very enjoyable. Mary was pleased with the help she received from me as she informed me and I advised her to contact the CMHN if she has concerns regarding her mental health and for support.Management TasksDuring my placement, I carried out numerous administrative and management tasks, including answering the phone and taking messages for other members of the team, anticipateing forward patients appointments for their warehousing injections and ordering from the pharmacy if necessary. I would also take part in organising and filing medical and nursing notes. Seeing that there was an administrative secretary in the clinic she carried out many of the administrative tasks.Workload ManagementFor this assignment I am going to describe a typic wo rking day within Mater Services Team in the clinic of Connolly Norman House. The day usually commences at 900hrs and ends at 1700hrs. After arriving I informed my preceptor that I have to carry out two home visits to two of the patients in the morning. At 930hrs I left the clinic to visit one of my patients. I arrived at my patients house at 945. I accompanied my patient for a walk and to the local coffee shop for a cup of tea. After we returned to my patients house I sinless a nursing assessment with him. I left the patients house at 1100hrs. I walked to visit my next patient. I arrived at her house at 1115. After I have talked with my patient about how she feels and about her concerns I went back to the clinic. I arrived at the clinic at 1215hrs. I recorded in the patients nursing notes regarding the home visits. I also did a handover to my preceptor about the two patients. While in the office, I had to answer the phone and record a few messages in the message book. I also had t o make a referral for one of the patients to one of the support services for people with mental illness. After I completed the referral, I went for my lunch break from 1300hr to 1345hrs. In the afternoon from 1400hrs to 1700hrs patients are expected to attend the clinic in order to receive their depot injection and to attend their appointment with the doctor. At 145 I went to the clinical room to prepare the trolley for the depot injections. The clinic lasted from 1400hrs until 1630hrs. During this time I had to administer depot injections low the supervision of staff nurse and afterwards I sign the patients kardex and get it co-signed by the nurse who supervised me. I then(prenominal) ensured to follow up the depot book and document when his/her depot is next due and I informed the patient when they are due to return again and provide them with an appointment card. I also had to check each patients vital signs and weight as part of a physical screening evaluation programme. At o ne point I had to link with the secretary as I couldnt find one of the patients kardex but she couldnt find it either. Therefore I had to ask the doctor to re-write a clean kardex in order for the patient to receive her depot injection. While in the clinic I also had to take two phone messages and pass them on to one of the CMHN. At 1630hrs I went for a hand over from the doctors working within our catchment area. The handover was regarding tender referred patients to the services and lasted for 30 minutes. I had to record all the information from the doctors with regards new patients referred to the services. I finished work at 1700hrs.ConclusionAfter completing this placement I feel I have gained a lot of experience in working in the community. By having my own caseload it encouraged me to use my own initiative and whenever I felt in a challenging position I always asked for guidance from my preceptor or other staff nurse. My preceptor and the other CMHNs supported and guided me throughout my seven weeks placement.