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- Mid-point
First weekYour initial discussion with your allocated mentor should take place within the first week of the placement. Within this meeting you will agree on an action plan, resources and support required to assist you to achieve outcomes during your placement. The date for your mid-point interview will be agreed at this meeting. Mid-pointLearning opportunities will be negotiated and supervision of activities will be carried out on an ongoing basis. Specific skills observed, taught or performed should be recorded in your clinical skills log. Further learning needs should be identified and a final assessment meeting should be arranged. This interview should be used as a forum to discuss any concerns either party may have regarding the progress of the placement and draw up SMART action plans detailing how to address them. Final point At this interview the student and mentor will meet to pull everything together and sign off the assessment documentation and supporting evidence. Progress and development will be discussed and identification of future learning needs and specialist areas of interest. This is also a time to reflect on and evaluate the placement highlighting positive aspects and possible areas for future development.
The level of nursing skills you have achieved will depend on what point you are in your course. However it is likely CAMHS will be new to you and you will have the opportunity to learn some unique skills here as well as developing some of your core nursing skills. You could think about incorporating skills development into an individual action plan that you could work on during your placement. Galaxy House will also provide you with the opportunity to enhance your core skills so as to become a more holistic and competent practitioner. The following are skills we would hope you develop here at Galaxy House;
INTERPERSONAL SKILLS AND COMMUNICATION SKILLS SHIFT CO-ORDINATION, ORGANISATIONAL AND DELEGATION SKILLS PROBLEM SOLVING SKILLS ADMINISTRATION OF MEDICATION SKILLS This is a practical skill you will have learnt about on other patients; however the medications used at Galaxy House are sometimes called “psycho-tropic medications” and have complex clinical indications and side effect profiles. Select 2 of these medications (e.g. and anti-depressant and a benzodiazepine) and list their indications, contra-indications side-effects, dosage range, adverse reactions and what the NICE guidelines are in relation to these medications used in CAMHS,
PHYSICAL OBSERVATIONS LIAISON WITH OTHER DISCIPLINES/MDT WORKING/TEAM WORKING
REFLECTIVE SKILLS/DEVELOPING SELF-AWARENESS
Galaxy House,
HOW TO CONDUCT AN EFFECTIVE HANDOVER
INCIDENT REPORTING ADVOCACY SKILLS
HEALTH PROMOTION SKILLS
These are skills that you will be introduced to during your time at Galaxy House. You may not observe all of them but through time spent with the young people you will have the opportunity to see some of these techniques being implemented. Below are a list and a brief explanation of some of these specialist skills. Think about how you can include development of these skills into your action plans and how you may be able to take them forward for use in the future in other practice areas. Special Observations Also called “specialling”, “1;1s” and “close observations”, or Level 1 observations. This is only used in exceptional circumstances when a patient is posing extreme risk to themselves, or other people, or is very vulnerable due to their mental health status/learning disability. It should only be used after thorough discussion and review by the team and after all other interventions have failed. It should not be used as a “knee jerk” reaction to risky situations or as a simplistic way of managing a “problem” patient. There are several levels of special observations; before implementing special observations the team must consider all the risk factors, ethical and moral issues involved. Progress plans should also be formulated as soon as an individual is placed on special observations, i.e. in what circumstances should the level of observation be reduced and the intervention and necessity for it must be reviewed daily.
There is a wealth of literature about special observations, representing different legal and moral standpoints. From a young persons point of view the most recent research suggests that although at first being on special observations can be a comforting and reassuring experience it soon becomes intrusive, ineffectual and burdensome and actually exacerbates the symptoms/behaviour the staff and young person wants alleviation from. The decision the implement special Obs should be multi-disciplinary, in collaboration with the young person and continually reviewed and evaluated. Therapeutic Groups
Observational skills related to monitoring mental state These skills can be picked up through observation of positive role models. They can be learnt both experientially and also by spending time with more experienced persons. Some of the cues that a young person may be experiencing deterioration in mental state are commonly mistaken for bad behaviour. Psychopathology, particularly in younger children presents as very “behavioural”. Through monitoring a young persons sleep, appetite, interactions, gait, non-verbal communication, tone of voice, role in the group, mood and behaviour you will learn a lot about psychopathology and how it relates to different conditions. You will also learn what indicates a young person may be hearing voices or having intrusive thoughts, such as them being easily distracted, vague and irritable. Preparing reports for multi-disciplinary reviews These reports encompass all the assessment and care activities that have taken place with a young person and often are focussed around the 5 different dimensions of the self. They cover issues such as social functioning, development, mental state, risk, family life, education and discharge planning. They also include a set of recommendations for future care planning with people assigned to each one within an agreed time frame. They need to be detailed, concise and relevant making sure all the main points are explored in enough depth without digressing or rambling and they need to be fairly tightly structured, a lot like an assignment! It is also important they are written in sufficiently enough of a scholarly style with good spelling and grammar. Parents, referrers and commissioners read these reports, amongst others. Organising social, recreational and therapeutic activities In addition to the groups, nursing staff are responsible for the overall milieu making sure the environment is a therapeutic tool in its own right. To achieve this there must be the correct balance of structured and unstructured time so the young people are neither bored nor over stimulated. Each young person will have an individual time table that will include a mixture of relaxation, education, free time, therapy and recreation time. Activities are achievement orientated and fun. They include cooking, games, pool, table tennis, art, music, going out for walks and more organised trips to places like Heaton Park or Knowlsley Safari Park. Young people have free time to read, listen to music or just chill. Tidying their bed spaces and doing their laundry and personal care is also incorporated into their daily routine. Organising de-brief following an incident De-brief happens following a particularly distressing, difficult or dangerous incident. It often occurs following acts of aggression, violence or self-harm. It also occurs following the discharge or a particularly challenging or difficult patient. Good practice indicates that time for de-brief should be protected time. Due to the emotionally and draining nature of working in CAMHS there is de-brief time at the end of each shift. This is facilitated by the shift co-ordinator and is a time and space for staff to ventilate their feelings, reflect on how the shift has gone and share their experiences and frustrations with their colleagues. Students can participate in de-brief but are not expected to lead on it as it is something that should be done by a more experienced facilitator. This opportunity to share and talk through things has been shown to ease some of the pressure staff may feel and go some way to ensuring staff don’t feel isolated or burdened, it also reduces the risk of burn out. It should not be confused with clinical supervision or the staff consultation group, which are other more formal forms of staff support. Research based outcome measures and assessment tools As part of the holistic assessment at Galaxy House and in line with clinical guidelines and evidence based practice the team use a number of standardised outcome measures and assessment tools. These are empirical measures that are used to evaluate the efficacy of care (outcome measures) and assist in gaining a deeper understanding of each Childs clinical picture and the severity of their symptoms. They are a very useful aid when “picking apart” the complex threads of a young person’s presentation. They are used alongside, not in place of the teams more ongoing qualitative observational assessment of symptoms. They are often presented in a questionnaire/multiple choice format. Some the young people can complete themselves unsupervised, some are observation only and some are for the young person and staff member to go through together. Afterwards they are scored to give an indication of the severity of the problem. Staff can train students to use these tools whilst on placement. They shouldn’t administer them without some form of training first and must be supervised when interpreting the results. Below is a table with some of the more frequently used tools.
Family work Working with family is an essential part of the treatment process as without this all the care planning and implementation would be futile. Family work is provided regularly by the child’s consultant and a consultant family therapist. Tom O’Neil. Individual Sessions One of the key tasks of the nurse’s role is to build a therapeutic relationship with the young people they are key nurse for and from this address specific therapeutic tasks such as social skills, expression of thoughts and feelings, confidence building, self-esteem work, anger/anxiety management, development of insight, self-monitoring of thoughts and symptoms and relapse prevention. The nurse will do this through individual sessions. A timetable for these sessions will be planned in advance in collaboration with the young person. At first the sessions are fairly unstructured and are focussed on development of trust and honesty, as they move on however and key issues and themes begin to emerge the sessions will become more structured and focussed and each one will have a goal and expected outcome. It is important the nurse demonstrates their commitment to the therapeutic relationship by adhering to the time table and being on time for sessions and protecting the time allocated for them. Failure to do so will lead to disengagement on behalf of the young person and a lack of trust in the nurse. Behaviour programmes The fundamental underlying principle behind these types of programmes is positive re-enforcement to reward good behaviour, therefore re-enforcing the appropriateness of this behaviour and hoping some social learning takes place. At Galaxy House we try to avoid negative approaches such as sanctions or punishments although at times we have to be fairly assertive in our limit setting due to the challenging and damaging nature of some of the behaviours. As far as possible we ignore the negative and reward the positive. Behaviour programmes identify target behaviours they want to increase or reduce. An activity is chosen that the young person really enjoys and the programme is geared towards them having access to more of that activity. For younger children it is usually sticker charts and is fairly visual and the activity may be something such as time on the play station or in the ball pool. Each sticker gained contributes to more time spent doing that activity. E.G. child x swears a lot, each half hour without swearing equates to 5 minutes on the play station, to be taken at 6.00pm. For older children (young adolescents) the reward may be a bit more substantial, not using stickers but verbal re-enforcement and may be something like a trip out or unescorted time off the unit.
This is essentially exactly what it says. Galaxy House is the main “hub” placement as the central or main placement and where all the action planning takes place. From Galaxy House there are a number of contextually related “spokes”. They are linked to Galaxy House by referral pathways, clinical similarity or interagency networking. By going on meaningful spokes the student will gain a deeper and more holistic understanding of the patient’s journey, where they have come from and where they may be going. It is also a very interesting experience for the student to find out more about the specialised nature of CAMHS. 
Please find a list of possible spokes around the Greater Manchester and wider North West region enclosed below. The list is not exhaustive however and you can do your own research to find relevant spoke placements that you may be able to access. It isn’t solely down to your mentor to sort this out for you, it’s a collaborative effort and you need to be proactive and take charge of your own learning. Initiative in doing so will be reflected in your final assessment documentation when your achievements are signed off. NORTH WEST CAMHS UNITS FOR POSSIBLE SPOKE PLACEMENTS Bolton CAMHS Eating Disorders Clinic 01204 390659 Gardener Unit, Forensic Adolescent Service Contact: 0161 772 3425 McGuiness Unit Contact: Tel; 0161 772 3678 Orchard Adolescent Unit, Cheadle Royal Contact: Ward Manager Mark Gilligan, Tel; 0161 4289511 Pine Lodge Young Peoples Centre, Chester Contact: Ward Manager Tracy Kempster 01244 364776 The Priory Hospital Altrincham Adolescent Unit Contact: Ward Manager Shepherd Nhariwa Tel; 0161 904 0050 Red Oak Child and Family Services, Lancaster, Lancashire Contact: Unit manager Terry Drake 01524 842266 LOCAL DISTRICT CAMHS TEAMS (TIER 3)
South Manchester - The Carol Kendrick Unit Contact Deborah Kay. Tel: 0161 291 3733 Hope Unit – Fairfield Hospital 0161 918 8505 Chronic fatigue service – Alex Woore 14517 Rochdale CAMHS - Contact Mark Wood Tel 01706 754349 Bury CAMHS contact John Henstock Tel: 0161 705 3526 In addition placements could be arranged with
These all count as spokes; you can find their numbers on the ward or by going through switchboard.
Your first 3 days will be 9-5s to allow for orientation and induction. Following this you will have worked out your shifts with your mentor. The activities you undertake will be dependent on your shifts, however below is a range of some of the activities you can do in your first week. Some of you may also need to incorporate a study day into your time-table (Manchester University BSc students).
This time table isn’t prescriptive but may help give some structure to the first week and an overview of Galaxy house. There may be other activities/ experiences going on that you can become involved with. So feel free to plan these with your mentor.
Galaxy House has an eclectic approach to treatment and care delivery. A variety of therapeutic approaches are used depending on the need and clinical presentation of each young person. There is no one all encompassing therapy that fits everyone so each programme of care is tailored to meet the individual’s needs. All treatment approaches have a strong evidence base and are empirically supported by clinical trials, case studies, audit, published guidelines and other forms of clinical evidence. The list below summarises the main therapeutic modalities that are used with young people with mental health problems. Cognitive Behavioural Therapy
Psychodynamic psychotherapy Less commonly used than CBT and also over a much longer timescale. There are various types of psycho-therapy including Gestalt therapy, person centred and transactional analysis. It originates from the theoretical schools of Freud, Rogers, Jung and Adler and became popular in the first half on the 20th Century. It is based on the premise that many of our desires, dreams, conflicts and motivations are governed by the unconscious mind which remains largely hidden to our conscious state. Where early issues and conflicts have not been resolved maybe as a result of trauma or neglect this manifests itself in problematic feelings and behaviour which interfere with our everyday functioning. Psychotherapy involves sessions with the client where the therapist encourages the client to talk freely about past experiences, thoughts and feelings. With skilled reflective techniques and questioning the therapist and client come to a greater understanding of the client’s internal world and hidden conflicts and can then look at ways to address them. This approach is often used with somatic disorders, phobias, pervasive refusal syndrome, dissasociative states and other complex states such as multiple personality disorder. It requires a long term commitment from the therapist and client often several months or even years. Creative Therapies This is an umbrella term for a range of therapies that involve creative activity, art, music, drama and play. All these mediums allow the young person to express themselves more freely and naturally. With the exception of the most articulate young person many struggle to ventilate their feelings verbally and may “act out” difficult feelings and conflicts through acts of aggression, self-harm or self-enforced isolation and withdrawal. Creative mediums give young people an acceptable outlet for these feelings and a therapeutic process is started from which the young person can explore coping strategies and work around building self-esteem and self-confidence. Young people do not have to be particularly talented at a particular artistic medium to benefit from it although through engaging in the process they often discover “hidden talents”! Art often gives the therapist a clue as to what the young person is experiencing in their internal world and how chaotic, intense and frightening that must be. Through drama a young person can role play a character safely i.e. a drunken angry man without fear of reprisals and this allows them to experience and create an outlet for these emotions. For many young people the use of creative therapies can be a cathartic and fun experience. Psychosocial Interventions Psychosocial interventions are a range of strategies that are used for people who are suffering from long-term severe mental illnesses such as schizophrenia and bi-polar disorder. They are mainly used in treating psychotic disorders. Symptoms are carefully assessed using a range of evidence based assessment tools and the nurse/therapist then works with the client and family around ways to alleviate and prevent symptoms from reoccurring. The work focuses on looking at triggers and working out someone’s individual relapse signature. The interventions are based on the stress vulnerability model of mental illness and attempts to make psychological environmental and social changes to increase a person’s resilience rather than just using medication. Once a relapse signature is identified the therapist and client will work together to on relapse prevention and a relapse “drill” of things to do when someone starts to deteriorate. They also look at coping strategies for hallucinations and fluctuating mood and how the client can adopt these independently. They are often simple things like listening to a certain type of music or spending time alone in a quiet low stimulus area. Family work is also essential with a lot of Psychoeducation around expressed emotion in the family environment, as high levels of this have been found to adversely affect those suffering from severe mental illnesses. Activity planning and social skills training is also part of the work. The approach has very successful treatment outcomes and due to it’s practical nature can be learnt and implemented by any practitioner working in mental health. Family Therapy Information about this approach is included earlier in the booklet. When young people are admitted family work is seen as integral to the treatment process and all other treatment will be ineffective if the family is not completely involved right from the beginning. Some families may just need support and education but others may need more formal psychodynamic input from a qualified family therapist. Multi-sensory Therapy This type of therapy is often implemented using a multi-sensory room or “snoezelen” room. This is a special space that has been equipped with a variety of sensory materials to stimulate and soothe all the senses. Usually they contain bubble tubes, projectors; glitter balls an array of cushions and fabrics of different textures, vibrating cushions/mats, hand held massage devices and fibre optic strands. The room may also have more interactive materials such as switches that activate lights and music. In addition to this many have aromatherapy burners to complete the sensory experience. Rooms vary in size and provision; some services even have sensory pool areas and large soft play rooms. As well as the multi-sensory room, other activities and environments are used to enhance the senses such as sensory gardens and ball pools. There are also numerous sensory learning materials available. Sensory therapy is often used with young people who have autistic spectrum disorder or learning disability with measurable success. These children are often sensory impaired and use of certain materials can enhance their sensory experience and encourage development of these senses. For other children the use of the multi-sensory room in particular can be a profoundly relaxing and soothing experience and can provide a safe haven where they can have therapeutic time away from the other young people. Staff always accompany young people into the room and use various guided relaxation techniques and exercises to encourage complete relaxation. The benefit of these environments cannot be emphasised strongly enough, in many cases proactive use of them can divert the need for more restrictive measures such as time out or PRN medication. The multi-sensory room should not be used indiscriminately, it should be individually care planned in every case. Care should be taken with some clients such as those who are hallucinating as if not used correctly it can actually worsen symptoms. The therapist should also be guided by the young person with regards to accessing the different types of sensory stimuli in the room, they may only want a couple of things or it could be over-stimulating it is important to check this out with them as you go through the different sensory experiences. The therapeutic milieu Milieu is a French word, the literal translation being “middle space” which we can interpret as middle ground, safe ground or safe space. The objective of using the therapeutic milieu is to provide patients with a stable and coherent social environment that facilitates the development and implementation of the treatment plan. As professionals we accept the responsibility for the management of the environment to create a safe space.
To provide physical and emotional safety.
Staff help the patients feel better and enhance self-esteem
Predictable organisation of time place and person
Patients actively attend to their environment and interact with it, having a sense of ownership
Individuality of staff and patients is recognised and accepted.
PSYCHOSIS Psychosis describes a persons lose of contact with reality or their perception of reality being distorted. When an individual cannot tell the difference between what is real and what is not they are said to be experiencing a psychotic episode (Stuart & Sundeen, 2002). The symptoms of psychosis can be divided into 5 main categories COGNITION This relates to the problems in information processing, these are often known as cognitive deficits. These can include aspects of memory, decreased attention & concentration, form & content of speech, decision making & thought content. This can materialise as memory problems, for example, pressured speech, incoherence, word salad, poor decision making, lack of insight, illogical thinking, lack of planning & problem solving, difficulty initiating tasks. Delusions can take many forms paranoid, grandiose, religious, somatic, nihilistic, thought broadcasting, thought insertion & thought control. PERCEPTION Refers to identification & interpretation of a stimulus based on the information received through the 5 senses. These include hallucinations auditory, visual, olfactory, gustatory, tactile, kinaesthetic (feeling bodily functions), and kinesthetic (sensation of movement whilst still). EMOTION Can be hypero/hyperexpressed in an incongruous manner. Mood may vary from hour to hour, from euphoria to suicidal ideation. MOVEMENT & BEHAVIOUR Responses can cause behaviours that are odd, confusing, difficult to manage and that can be distressing to others. Examples of odd movements are catatonia, abnormal eye movement, grimacing, apraxia, echopraxia, abnormal gait. Behaviours associated with psychosis are poor personal hygiene, aggression/agitation, repetitive behaviour & volition. SOCIALISATION Is the ability to form relationships. Effects seen in patients who are experiencing a psychotic episode are social withdrawal, isolation, low self-esteem, inappropriate behaviour, disinterest, gender identity confusion, ultimately, a decreased quality of life. It is vital important when communicating with an individual that is experiencing psychotic symptoms that all communication is simple & clear, & where required repeated, or even in written form for the individual to keep. It is common that the individual will need help to fulfil their daily activities of living whilst experiencing the episode. They will also need reassurance and support. Yüklə 233,88 Kb. Dostları ilə paylaş:
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