DSH Nursing Service

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DSH Nursing Service
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Integrating Services for People Who Engage in
Deliberate Self Harm (DSH) A Nursing
Initiative
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Introduction
What Presentation Will Offer

• An oversight of the background to setting up the
  project as a Clinical Nurse Specialist
• DSH remains high risk factor for suicide
• The day to day practice of the role
• Role evaluation ongoing learning

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Identified Service Need

• National Task Force on Suicide (1998)
• Suicide in Ireland (2001)
• Quality and Fairness Health Strategy(2001)
• Commission on Nursing (1998)
• National Goals include Programmes to promote
  positive attitudes in mental health will be
  introduced, suicide prevention programmes will be
  intensified

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Factors Influencing The Project

• NEHB Suicide Steering Committee impetus behind
  post
• No national model and work varied, but service
  was keen to respond to local needs
• Being integrated into Community Mental Health
  Team
• Welcome by Louth County Hospital
• Awareness and experience of UK models of service
  and ongoing contact

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A UNIQUE ROLE

• Setting Nursing Practice Out - Scope of Practice
• Protect and Enhance the Nursing Role
• Trying Not To Be All Things To All People
• Clinical Nurse Specialist
• Range of Psychiatric Nursing Interventions
• Patient and Nursing Centred (Castledine, 1991)

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Why CNS ?

• National Council Of Nursing and Midwifery 2001
• The post has arisen from an identified service
  need.
• The area of specialty is a defined area of
  nursing that requires application of specially
  focused knowledge and skills, which are both in
  demand and required to improve the quality of
  client care.
• The role will encompass a major clinical focus
  and will involve working closely with medical and
  paramedical colleagues.
• The post involves participation in audit and
  research and serving as a consultant in clinical
  practice

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• Clinical focus
• Advocacy
• Education and Training
• Audit and Research
• Consultancy

• Core Concepts of the CNS

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CLINICAL FOCUS

• Specialist Practice Will Encompass a Major
  Clinical Focus (National Council)
• Direct Care
• Indirect Care

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Direct Care

• Named nurse for all admissions to LCH with DSH
  
• Psycho-social assessments with safety plans
• Working closely with and maintaining effective
  communication with family/friends or other MDT
  members..
• Use as a turning point

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Direct Care

• I felt a lot better after each sessionWithout
  it I would not be here today..Makes every aspect
  easier to cope with.. Talking about
  problems-boosting confidenceSay what you want
  whereas the Psychiatrist changes wordsCan put
  episode behind me and look forwardMore like a
  friend than a nurse
• Professor Phil Barkers Tidal Model
• One to One and/or Family Work

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Indirect Care

• Attempts to influence the quality of care in
  general working with relatives or friends
• Safety plans and early access to services in
  future
• Education and facilitation

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Advocacy

• DSH Disempowering
• Promoting self-advocacy
• Negotiating for and representing
  individuals/client groups at MDT meetings or
  other decision-making forums
• Alienation from services

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EDUCATION Client Family

• Ambivalence towards suicide
• Crisis as an opportunity
• Clients empowering selves through education
• Provide relevant information, guidance and
  support to clients families.

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EDUCATION Staff Development

• Involvement in learning-needs analysis.
• Involved in developing delivering educational
  programmes to meet those identified needs ie
  Mental Health Matters Programme in Louth County
  Hospital
• Work with nurses, Simon Community, Local Suicide
  Action Group
• Communicating research findings related to my
  practice area to other nursing staff.
• Presentation of audit and quality initiatives to
  colleagues.

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EDUCATION Self

• One to one coaching
• Shadowing
• Mentorship
• Reading
• Visits to other sites
• Clinical Supervision
• In-service training
• Formal training courses

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Audit Research

• Clinical Supervision as Basis
• Local Quality Steering Group
• Statistics
• Service Plans
• Audit of Role and Service Delivery
• Research Utilisation
• Primary Research

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Consultancy

• Act as a Consultant in Education and Clinical
  Practice to Nursing Colleagues and the wider
  Multidisciplinary Team (National Council)
• Internal Consultant -- Influence and effect
  change within the organisation
• Outside Consultant GPs, Outside Agencies
• Reducing Stigma

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Working In Partnership

• Focus needs to be placed on promoting and
  facilitating the delivery of health care through
  inter-professional partnership for the benefit of
  the patient. For a partnership model to be
  effective the old hierarchical thinking in
  relation to the professions must disappear, along
  with the turf wars which are a barrier to patient
  care...

Public Consultation in Health Strategy
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RolePurpose

• Lack of joined up thinking.
• Clients feeling disconnected.
• Tidal Model helps frame care.
• To co-ordinate follow-up and after care plans.
• Aim to form link for future help, screen for
  psychiatric disorders, assess safety, focus on
  past strengths, past coping and clarify future
  options and vision.

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A Day In The Life...The Role Of The Liaison Nurse

• Assessments
• Care Management
• Discharge Planning
• Family Work
• Liaison With A Range Of People
• Education and Training
• Research and Presentations on Developing Practice
• Involvement in Local Community Groups

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Ready, Willing But Able?

• Management and Organisational Skill
• Role strain
• Proving the role
• Support for the role i.e. resisting demands and
  creating opportunities
• Patients want conversation and not QA
• Not a problem saturated assessment but a
  conversation that is in itself useful and
  incorporates psychiatric nursing skills

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Project Evaluation Recommendations

• Immensely challenging and rewarding experience
  due to the broad range of skills and diversity of
  experience gained
• Uniquely placed to provide cohesion between acute
  and psychiatric care
• New venture and needs to be sensitive to demands
  of other areas Our Lady of Lourdes, Drogheda
  project
• Highlight nursing practices that need
  standardising
• Take opportunities to reduce stigma and give
  people outside the profession a better
  understanding of the nature of mental health
  problems.The gift of time from the friendly
  professional..
• Further research and training

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Despite our current emphasis on medical
diagnosis, sophisticated technology, economic
cutbacks and quick fixes, What patients need
most in the midst of this health care maze is
sensitive and caring individuals who are willing
to enter into interpersonal relationships that
foster hope and prevent hopelessness.Peplau
1995
Transfusions Of Hope