Community nursing at South London and Maudsley NHS Foundation Trust

Thursday, October 19, 2017

Community nursing: guiding people to recovery

Seeing patients successfully living at home and interacting with their families is one of the many immensely rewarding features of being a community nurse. Find out how the role works at the South London and Maudsley NHS Foundation Trust.

“Being a community nurse is a unique role, because you are often seeing the individual in their own home and their own surroundings,” says Elaine Rumble, deputy director for nursing, quality and assurance at South London and Maudsley Foundation Trust.

“When people sometimes talk about community nursing, the vision is that all they do is nip out to Sainsbury’s to help [individuals] with their shopping. But you are responsible for a group of patients – it could be up to 25 patients on your case load.”

At the trust, community nurses work as part of community mental health teams (CMHTs), providing assessment and treatment services and helping support people’s recovery.

The trust’s CMHTs operate across a large part of south-east London – Croydon, Lambeth, Lewisham and Southwark – and provide patients with treatment, diagnosis and specialist assessments. A large part of the role of community nursing is treating people in their homes and guiding people through the next steps – such as GP access or recovery groups.

As well as community psychiatric nurses (CPNs), the teams are also formed of psychiatrists, occupational therapists, social workers, psychologists, mental health support workers and administration staff.

Rumble says nursing in the community can really help speed up recovery for some patients.

“Sometimes on a ward you are going to focus on a service user’s symptoms. But in the community, you often seek this information through conversations and people’s behaviour in their own homes.”

Rumble says this could include behaviours such as hoarding. The type of food in the fridge could also be a clue, Rumble explains, helping community teams recognise if people are managing well with the daily routine, and are staying healthy.

Encouraging people into the role

The trust is also at the forefront of development in community healthcare, and team leaders are looking at ways of encouraging more people into the role.

“We are beginning to pioneer preceptorship,” Rumble says. This involves a structured support for newly qualified healthcare professionals under a preceptor. In particular, Rumble says, the trust is “looking at how to really help band five nurses or band six nurses transfer into the community. We want to really support new community staff and help people understand what it is really about.”

One of the major reasons community nurses find their work so fulfilling is that they can witness people recovering and getting well. “You see individuals with their families, with their children, with their parents – all these normal things you don’t see when you’re on the ward,” says Rumble. “You also get to work collegiately with other providers – when it goes well, it goes really well.

“However, the main positive of working as a community psychiatric nurse is that you have the opportunity to really make a difference to the individual’s recovery – and get them to their optimum level of functioning at that time.”

CMHTs work with carers and relatives, hospital liaison teams and GPs to ascertain how care and support can be given when patients are discharged from hospital. It also includes overseeing the transition of care back to GPs, or changing medication.

Andrew Tapfumaneyi is team leader of the primary care enhanced mental health service. The team works with people who require more mental health support than they can get through their GP, but do not require secondary mental health services.

“We are working and supporting people who have psychosis – people who have been well or out of a hospital setting for a period of time,” says Tapfumaneyi.

“One of the things we have been trying to support people to do is navigate their way through the welfare system – which can be complex. This also includes access to employment.

“A lot of people will still be on medication. We try to support moving people from specialist care to working within primary care services.

“We are working beyond a medical model of care and an acute phase of illness – which means treating people in the community as individuals.

“We are looking at the needs people have beyond the mental health label – and looking at people’s talents, strengths and capabilities. We are also often the first point of contact if someone has a query.”

Tapfumaneyi says working at the trust can bring further benefits for employees.

“There are lots of opportunities to train and develop professionally. There is also access to the Institute of Psychiatry and the latest research available. I think you become part of a very rich staff complement.”

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This article was supplied by South London and Maudsley NHS Foundation Trust for The Guardian. 



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