DRAFT

The Role of the Registered Mental Health Nurse (RMN) in Acute Hospital Settings

There is often a requirement for RMNs to provideadvice and support to both patients and staff within acute health care settings. The role of the RMN involves specialist observation and the provision of safeand therapeutic interventions during periods of distress when patients are at risk to themselves, others around them or both. This information leaflet will provide you,in your capacity as an RMN, with useful information about what is expected from you and what you should expect in return from the acute ward that you are working in.

Arriving on the ward – responsibility of ward staff

  • To orientateyou to the ward environment including instructions on how to summon help especially in urgent or emergency situations
  • Provide identification of the nurse in charge to the RMN and inform them that this nurse will be the initial point of contact for support, advice and information
  • To provide a full handover including background history, presenting physical and mental health issues and current symptoms
  • To provide access to any relevant documentation in use
  • To advise youof break times/relief times and how to access these

Mental health observation – what the RMN will monitor

You will be expected to monitor the patient’s presentation, overall mental healthand be alert to any deterioration. This may include(but is not limited to):

  • Mood – including low mood, elevated mood or suicidal ideation/self harm
  • Anxiety – to include supportive measures and de-escalation
  • Psychotic symptoms including delusions, hallucinations and thought disorders
  • General presentation including: speech, eye contact and whether the person is overly sleepy/hyper-alert or has problems sleeping
  • Monitoring symptoms of stress and distress in dementia (including but not limited to aggression and agitation)
  • De-escalation of distressed behaviours using a therapeutic approach
  • Advising ward staff when psychotropic PRN medication is required
  • Management of acute behavioural disturbance in accordance with ‘Guidelines for the Observation of Patients with Behavioural Disturbance in Acute Division Wards’
  • Identifying any triggers that may escalate behaviours
  • Identify methods that de-escalate distressed behaviours
  • A full written and verbal handover to the nurse in charge at the end of the shift to include all mental health observations
  • When the patient is distressed and relief is required then rotation with ward staff will be considered and arranged by the nurse in charge. During these times you will assist ward staff but only within the limits of your competence
  • Work with security staff when required in accordance with local hospital policy

Other interventions for RMN

You may be required to participate in the following:

  • Restraint in accordance with NHSGGC Restraint Policy
  • Personal care including toileting and assistance from ward staff will be provided when required
  • Nutritional support
  • You will not be asked to administer any medication that you have not dispensed yourself and have not signed the Kardex for
  • You will not be required to obtain blood samples, attend to intravenous infusions or cannulae.

Therapeutic interventions implemented by RMN

Although it is important to recognise that patients require and are entitled to privacy, it is expected that when appropriate the time spent with a patient should be utilised for therapeutic engagement. You should consider the following:

  • Utilising the ‘What Matters to Me’ bed board and gathering information from family and other people who know the patient well
  • For patients with dementia commence, or further develop, the patient’s‘Getting to Know Me’ document
  • Compassionate practice
  • Reminiscence
  • Provide comfort and reassurance
  • Person-centred care and meaningful activity

Privacy and dignity

All people must be treated with dignity and respect. Patients may require periods alone to rest or attend to their own personal care and where possible this should be respected. However, depending on the level of observation this might not always be possible, especially during special observations.

Family and carers

The RMN will be required to discuss the purpose and nature of the observation level with the patient (where possible), their family and carers. There will also be an expectation, where possible, that the patient will be involved in decision making processes.

Documentation to be completed by RMN

As a registered nurse you are expected to complete all relevant documentation during your shift which may include:

  • Nursing notes including ABC charts
  • Bowel charts
  • Pain scales
  • Risk assessment: NEWS (National Early Warning Score), PUDRA (Pressure Ulcer Daily Risk Assessment), 4AT /TIME Bundle and falls risk. Psychiatric risk assessment.
  • Food and fluid charts

NB: Ward staff will support the RMN to complete any documentation that they are unfamiliar with.