Insight into Adult Nursing for Mental Health Nursing students

Faculty of Health, Social Care & Education
BSc (Hons) RN
Insight into Adult Nursing
for
Mental Health Nursing students

INTRODUCTION:
Welcome to your adult insight placements.
“Adulthood is a period generally characterised by self-reliance which centres on occupational and family interests. There
is, of course, great diversity in the lifestyle and behaviour exhibited by individuals in this stage of life” (Alabaster, 2006).
The Specialist Area of Adult Nursing
This insight package is designed to introduce you to the specialist area of adult nursing and to help students studying
other fields of nursing to develop the knowledge and clinical skills that will help them to meet and understand the physical
care needs of their patients whilst taking a holistic approach to care. It is aimed at increasing your knowledge and
awareness of what services are provided in the adult sector both within acute and community settings. Use this workbook
alongside your clinical skills learning log.
In many areas of adult nursing you may find that the emphasis of care is placed on the physical needs of the person
being nursed. However, a more holistic approach that promotes individualised, seamless care for patient and family is
widely used.
As with all fields of nursing, caring for the ill adult takes place in many settings. Nearly all of us have, at some time, been
‘consumers’ of health care. This workbook follows a patient’s journey through the health care system and includes
activities designed to help you gain insight into the adult field of nursing.
Whilst on placement work with your mentor to select 1 and ideally 2 patients to follow their journey from
admission to discharge (these are referred to as patient 1 and patient 2 in the activity boxes). This will enable you
to enhance your knowledge and undertake many of the skills in your clinical skills learning log on a number of occasions.
Try to undertake at least 2 different skills in your skills learning log, each week. Make notes to reflect upon what
you have learnt and discuss them with other students in your tutor group so that you can learn from each other. Do not be
concerned if other students have undertaken skills that you have not been allowed to do (since this will depend on the
individual organisation’s policies) or if all of the skills in your skills log cannot be completed on your adult placement. If
there is something that you particularly wish to achieve on a placement include this in your action plan (appendix 2) and
ensure that you have your mentor’s agreement that this is a skill that you can undertake on that placement.
Using this workbook
Each section will include a number of activity boxes:
ACTIVITY BOXES
These are sections in which you are asked to undertake a specific activity
or reflection. Your answers should ideally be discussed with your mentor
and included in your portfolio where appropriate.
Each section identifies a list of resources that you will need to undertake the activity(s).
NB. Many of the activities require the use of the Internet.
Boxes with red borders relate to the first patient identified.
Boxes with blue borders relate to the second patient.
Adult Insight Sept 16 2

SECTION 1:
Beginning the journey
This section looks at the beginning of the patient’s journey into an adult setting.
To help you complete this section you will need:
 Internet access
 Discussions with patients and staff
If patients are admitted to hospital, they reach the start of their admission by many different routes.
ACTIVITY BOX
List the routes by which patients are admitted to an acute hospital; does this differ to admissions into in-
patient mental health services?
 Encounter with the general practitioners
 General practitioner outside office hours
 112 ambulance
 Self –referral
Emergency department Admission / Geriatric rehabilitation care.
Student Signature.........................................................
Mentor Signature..........................................................
Some patients need longer-term physical nursing care, which often takes place in the independent sector.
ACTIVITY BOX
List the routes by which patients are admitted to a longer-term nursing care setting e.g. Nursing home;
does this differ to admissions into longer-term mental health services?
Which route of admission was used for the patients you have identified?
Patient 1: (dementia) Community
Adult services Acute care Liaison
Memory assessment
Adult Insight Sept 16 3

Patient 2 (cardiovascular accident)
Student Signature.........................................................
Mentor Signature..........................................................
SECTION 2:
Assessment and care planning
To complete this section it will be useful for you to have:
 This workbook, you will find a nursing care plan form for you complete at Appendix 1.
 An anatomy and physiology textbook
 Access to the Internet
 A foundation nursing practice book with a section on pain assessment.
 Pharmacology textbook
 Research articles
ACTIVITY BOX
At this point you should revise:
The anatomy and physiology of the musculo-skeletal system.
The anatomy and physiology of the pancreas.
Pain assessment.
People require healthcare for a variety of reasons and initial contact with health services may be via a number of
routes. Regardless of the mode of entry to the healthcare system it is important to reassess the patients holistically to
allow for individualised care planning.
Assessing a patient with a physical condition is equally as complex as assessing those with a psychological or mental
health difficulty. People do not fit neat categories. All branches of nursing need to consider the physical, psychological
and social dimensions of those in their care and to recognise the strong interrelationship between mental and physical
health. People with mental health issues have a vulnerability to physical illness and those with physical disease are
susceptible to mental health problems.
‘It is common to feel sad or discouraged after a heart attack, a cancer diagnosis, or if you are trying to manage a chronic
condition like pain. However, there are some risk factors directly related to having another illness. For example, conditions
such as Parkinson’s disease and stroke cause changes in the brain. In some cases, these changes may have a direct
role in depression. Illness-related anxiety and stress can also trigger symptoms of depression.’ (National Institute of
Mental Health) https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml
Adult Insight Sept 16 4

ACTIVITY BOX
Explain what the terms ‘Holistic Care’ and ‘Individualised Care’ mean to you.
Holistic care- Holistic care involves assisting the patient in the healing of the mind, body and souls of the patient.
Individualised care- An individualised care is the care planned to meet the individual or the specialised needs of
each patients (Morgan and Yoder 2012).
Student Signature.........................................................
Mentor Signature..........................................................
Many adult nursing care settings use the Activities of Living model developed by Roper, Logan & Tierney (2000) to guide
assessment.
The Activities of Living (ALs) are:
 Maintaining a Safe Environment
 Communicating
 Breathing
 Eating and Drinking
 Eliminating
 Personal cleansing and dressing
 Controlling body temperature
 Mobilising
 Working and Playing
 Expressing Sexuality
 Sleeping
 Dying
ACTIVITY BOX
Consider each of the ALs and how they relate to a patient you are caring for on the ward (Patient 1)? Use
this to identify patient focused problems on the attached care plan (appendix 1)
Patient 1- This patient had been suffering from progressive dementia and has poor mobility having high risk of
falls.
 Maintaining a Safe Environment- Provision of environment modifications to prevent falls
 Communicating- Communicating using simple and short sentences that can be understood by the
patient.
 Breathing- Encouraging deep breathing exercises and teaching relaxation techniques.
 Eating and Drinking- Encouraging the patient to consume nutritious food and fluids timely
 Eliminating- Providing physical assistance during bowel clearance.
 Personal cleansing and dressing- Assisting the patient in self care activities
 Controlling body temperature- Daily check up of the body temperature
 Mobilizing- Assisting the patient with physical exercises to improve mobility.
Adult Insight Sept 16 5

 Working and Playing- assisting the patient in incidental exercises.
 Expressing Sexuality-Allowing the patient to spend quality time with her partner. Cuddling and
affection are sometimes considered as the basic needs of the elderly people.
 Sleeping- Assisting the patient to maintain sleep cycle by exercises or by medicines.
 Dying- Respecting the wish of the patient while in a palliative care
ACTIVITY BOX
Consider each of the ALs and how they relate to a patient you are caring for on the ward (Patient 2)? Use
this to identify patient focused problems on the attached care plan (appendix 1)
Patient 2 : Patient 2 had undergone a cardiovascular accident and is now under rehabilitation.
The Activities of Living (ALs) are:
 Maintaining a Safe Environment- Providing side rails in beds and accompanying the patient in the
bathroom to prevent fall.
 Communicating-Communicating the patient in a comprehensive, culturally safe language.
 Breathing- Assisting the patient is shallow breathing exercises.
 Eating and Drinking- Providing in the patient with semi solid food and abundant fluids.
 Eliminating- Assisting the patient in bowel clearance, laxatives can be given.
 Personal cleansing and dressing- Assisting the patient in self care, dressing , grooming
 Controlling body temperature- regular checking of the vital signs.
 Mobilizing- Mobilizing the patient to prevent venous thrombosis.
 Working and Playing- promoting no work or playing.
 Expressing Sexuality- Allowing the patient to spend quality time with her partner. Cuddling and
affection are sometimes considered as the basic needs of the elderly people
 Sleeping- Relaxation exercises and providing calm environment to facilitate sleep.
 Dying- Providing a culturally safe care, respecting patient’s wish or the religious or the spiritual
beliefs to facilitate a dignified death.
Study the assessment documentation used at your placement to admit a patient and note if all of the ALs are
included. Reflect on how this compares to assessment carried out in your own discipline.
Student’s reflection
What ?
In my own discipline of mental health sector and other sectors, less importance is given on maintaining the
Adult Insight Sept 16 6