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Nurse profile: healthcare for women at a low-secure unit

Lisa Roberts
Hospital Practice Nurse
Farndon Unit, Nottinghamshire

What is your background in the NHS?
I qualified in 2004 and worked at an ENT, maxillofacial general surgical ward at Lincoln County Hospital for about three years. I then worked at a female prison, HMP Morton Hall, for three years. Around 90% of the prison population were not from the UK, so I was working with quite a varied group of women. I was employed by Raphael Healthcare at The Farndon Unit in August 2010.

What made you decide to apply to work at The Farndon Unit?
At the time, HMP Morton Hall was being converted into an immigration and deportation centre, and I was looking to expand my role to working with females in different situations. Working in a prison is very different to working in a hospital or community setting, and the work looked really interesting and prompted me to apply.

How does the unit work?
The Farndon Unit is an independent, low-secure mental health hospital in Newark, Nottinghamshire. We care for a wide variety of patients, aged 20 and older, from all sorts of backgrounds. The women have been in prison or may have had problematic backgrounds. Some have been stepped down from other medium-secure units. We have direct admissions from the community, through the Ministry of Justice or from other units.

Which conditions do you treat?
I see all the usual physical conditions that nurses see in the community, such as asthma, obesity and cardiovascular disease. I don't get involved in the care of patients' mental health, but can refer to the mental health team if necessary. I monitor bloods, for example, in patients who are on antidepressants such as lithium, making sure blood tests are carried out at the correct time. I also monitor patients who are on antipsychotic drugs. Every patient has at least an annual health check-up where observations are taken. This might include blood tests or ECGs, for example.

I am available for women to come and talk to about their general health at any point. I may triage them and, if necessary, point them in the right direction, such as A&E or the GP. I will arrange appointments for them if needed. My role is to maintain the physical health of the women. I have become a bridge between the GP and the hospital, so I speak to the GP and arrange appointments if necessary. A good partnership is important and they find it useful to have me in the role.

Who are the members of the team?
I work closely with the mental health team, occupational therapists and social workers. If the mental health team have any issues they come and talk to me; for example, if they have any concerns or are worried about administering treatments, such as wound dressings, I will prepare a care plan for them to follow. If they feel there are any training needs I will give them advice about physical healthcare. In return, if I have issues with a patient who may have behaved inappropriately, I can go to them and ask if we need to do anything about it. We all need to be singing from the same hymn sheet.

Do you see many cases of self-harm?
Yes, we see quite a bit of self-harm and it's quite a big part of my job, including maintaining wounds and monitoring the patient, and advising colleagues about how to dress wounds.

Do you raise the subject of self-harm with a patient you are treating for an unrelated condition?
I make it clear to all patients that whatever they divulge I have to tell the team. I can't keep that secret. We work as a team and the patients know that. Anything they show me or declare to me I have to go back to the team, as obviously that will impact on their care and their care planning. I have to make sure we aren't leaving them in a vulnerable situation, where they may attack staff if given the opportunity. Anything a patient tells me I will report back, if it is appropriate, to get extra help.

Have you ever been faced with the threat of violence at work?
No. I have never been put in that situation, and I have never felt I can't be alone with someone. I do check beforehand whether or not it is safe to be left alone with a patient, but I have never felt the need for a chaperone.

What is the most challenging thing about your job?
Some of the women can be very demanding and needy of physical healthcare, and as part of their mental health problems they can dwell on physical health issues. It is a fine balance and I have to decide if they really need to see me or if it is part of their illness. I need to make sure patients are aware of why I am there and that they use me appropriately. I do remind them that they don't need to see me for every ache and pain they have. It is also part of my role to educate them about how to use healthcare services appropriately in the community when they leave the unit. I am sure we have all seen GPs getting harassed by patients, and it is my job to make them aware of how to manage their own illness properly. The patients see me around most days and they often ask to see me when it may not be needed or appropriate.

Do you think there are any ways in which the service could be improved?
It's a fairly new role and there were no physical healthcare nurses at the unit before I started in August 2010. I am developing the service, and looking at involving more community initiatives, such as smoking cessation groups, and building relationships with them. I plan to arrange time to visit a service myself and then, when it is appropriate, the women can go out to the group to get further education - I want the unit to be more engaged with the community. We are a private hospital but we want to encourage the women to use all the services that people in the community would. There is a lot of scope for improvements in the unit, more care planning and more staff education, but it's an ongoing process. I make autonomous decisions about whether or not the patient needs to go out to use other services or whether they can remain at the unit and be treated there.

Do you see many patients with drug and alcohol problems?
Some have a history of drug and alcohol abuse, but by the time they come to us they have been through a detox programme. A lot of my training at the prison was on blood-borne viruses, such as HIV, so patients come to see me and may have concerns about their history and whether or not they are at risk, and I can give advice about testing. Most of their drug and alcohol issues have already been dealt with but I can offer counselling on viruses if they need it.

Does your patients' gender affect the way in which you care for them?
The women I see can be vulnerable and may have been in difficult or abusive relationships, which can cause issues. You have to be aware of their backgrounds and why they might be needy of healthcare or why they might reject healthcare because of past experiences. You have to be aware that they may find it hard to see male GPs or healthcare practitioners and have physical examinations. Communication skills are key and it is hard work. It can be a challenge but I have to make sure patients are feeling at ease and comfortable with approaching both us and outside services. I can try to ensure they see a female GP but they may need to see a doctor who is available at the time, and it can take a lot of persuasion to do so, and its my job to challenge their beliefs.

I can't assume that everyone has come from an abusive background, but in the prison we had a lot of women from difficult circumstances and I think the prison was a good learning opportunity to improve my communications skills to work with women. Men tend to be more direct about their problems and will get straight to the point, whereas women may talk around the problem. Trying to wheedle out what the patient is trying to explain to you and what the problem is can be hard. I do think women are more complex than men when it comes to healthcare needs.

Are you aware of the offences your patients have committed?
No, I feel that would cloud my judgement and I have never made it my business to find out. I want to treat someone as an individual and not have their background affect that.

What do you enjoy most about your job?
I enjoy the challenge of working with such a variety of women. They have their ups and downs and their behaviour can be erratic as they can be quite unwell with their mental health issues. I do find it enjoyable working with women and it's unusual for a general nurse to be working within a specialist mental health unit.

Would you recommend other nurses to do your job?
I think it would suit other nurses who enjoy working with a different variety of patients and are looking for a new role, and find mental health of interest. There are lots of challenges in this area, for example, integrating physical healthcare with a mental health service, and if nurses are ready for that then I think it would be a great career option.