Mental Health Graduate Nurse Program

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Mental Health

Graduate Nurse

Program

2013

Conducted in collaboration with

The Royal Children’s Hospital

Integrated Mental Health Program (IMHP)

© 2008 NWMH Nursing RMH Royal Park Campus, Building 5 Parkville VIC 3052 Tel: (03) 8387 2730

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CONTENTS

Welcome ________________________________________________________________ 2 About NorthWestern Mental Health ____________________________________________ 2

Working Together__________________________________________________________ 2 Consumer and Carer Participation ______________________________________________3 NWMH locations ____________________________________________________________3 Services across the lifespan___________________________________________________4 Youth Mental Health Services – ORYGEN _________________________________________4 Adult Mental Health Services __________________________________________________5 Aged Persons' Mental Health Program ___________________________________________5 Specialty Services __________________________________________________________6 Overview of Graduate Psychiatric Nurse Program_________________________________ 7

Philosophy ________________________________________________________________7 Aim _____________________________________________________________________7 Objectives ________________________________________________________________8 Timeframe and Structure_____________________________________________________8 Theory development ________________________________________________________8 Clinical development ________________________________________________________9 Program Calendar (SAMPLE) ________________________________________________ 10 Academic Assessment and Clinical Appraisal Requirements ________________________ 11

Written and oral assessment __________________________________________________11 Clinical Appraisal ___________________________________________________________11 Annual Leave and Accrued Days Off (ADOs) ____________________________________ 12 Study Day Protocol _______________________________________________________ 12 Study Block Timetable (SAMPLE)_____________________________________________ 13

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WELCOME

Welcome to NorthWestern Mental Health and to the Mental Health Graduate Nurse Program 2013. The program is conducted in collaboration with The Royal Children’s Hospital Integrated Mental Health Program (IMHP_ and we welcome graduates of that program to our service.

NorthWestern Mental Health is committed to the provision of the highest quality mental health care to clients of the North Western metropolitan regions of Melbourne. The Mental Health Graduate Nurse Program is designed to facilitate your transition toward contributing at a confident and competent level toward this goal and a future in mental health nursing.

This booklet provides you with a summary of the program, and other information to assist you. The staff of NorthWestern Mental Health look forward to working with Graduates each year and are pleased to assist you in any way possible. We pride ourselves on our supportive culture and trust that you will feel a part of the team.

ABOUT NORTHWESTERN MENTAL HEALTH

NorthWestern Mental Health (NWMH) is one of the largest publicly funded providers of mental health services in Australia.

It is an organisation that has evolved primarily out of the closures of stand alone Psychiatric Hospitals and the re-development of Health Care Networks in Melbourne in the mid-late 1990s. A clinical division of Melbourne Health, NorthWestern Mental Health operates in partnership with Northern Health (Northern Hospital, Broadmeadows Health Service and Bundoora Extended Care) and Western Health (Sunshine, Williamstown and Western Hospitals) to deliver a comprehensive range of specialist, community and hospital-based mental health services to the communities of northern and western metropolitan Melbourne.

NWMH acute services are integrated with mainstream health services. NWMH aims to ensure that the people who live in the northern and western regions of metropolitan Melbourne are provided with high quality mental health services that are responsive to their needs, based on best practice and delivered by highly skilled and experienced clinicians.

NorthWestern Mental Health provides crisis assessment and treatment, rehabilitation, community-based treatment, ongoing case management, acute inpatient, residential and specialist services as well as consultation and education to a population 1.2 million people and a wide range of health and welfare organisations.

NWMH has a total of 449 beds: • 175 acute psychiatric beds • 152 aged care residential beds

• 80 community based rehabilitation beds • 26 secure extended care rehabilitation beds

• 16 specialist beds for eating disorders and neuropsychiatry

Working Together

Vital partnerships with the psychiatric disability support services (NGO) sector, consumer and carer organisations, the community health sector, General Practitioners, Private Psychiatrists, local government and universities all assist NorthWestern Mental Health to achieve its goals.

NorthWestern Mental Health’s 1,700 person strong multidisciplinary workforce is primarily comprised of the disciplines of medicine, nursing, occupational therapy, clinical psychology and social work. Multi-disciplinary teams of clinicians work in acute and rehabilitation inpatient services, community mental health services, and residential services including community rehabilitation units, hostels and nursing homes.

A strength of NWMH is the combination of a regionally organised grouping of specialist services, together with strong academic partnerships, that has proven to be the best way of providing sustainable high quality services and attracting and retaining high quality staff to work in the north and west regions of Melbourne. This also ensures that psychiatry, as a speciality, remains robust, stable and relevant.

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Consumer and Carer Participation

NWMH has a strong commitment to the involvement of consumers and carers in the development, delivery and evaluation of mental health services. Consumer and Carer consultants are employed across NWMH to provide advice and input into improving the quality of care provided to people with a mental illness and their families. They are also routinely involved in the staff selection process. NWMH has an active Consumer & Carer Advisory Group, and a comprehensive Consumer and Carer participation strategic plan.

We Value "Passion for Caring - Achieving the Extraordinary"

 Respect  Caring  Unity  Integrity  Discovery. NWMH locations

NorthWestern Mental Health operates out of all hospitals in northwest metropolitan Melbourne and a number of independent locations. The formation of NWMH has seen the redistribution of inpatient mental health facilities from the inner city to meet the needs of the growing populations in the outer west and north - a catchment area of over 1.2 million people. Major sites serviced by NWMH:

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SERVICES ACROSS THE LIFESPAN

NorthWestern Mental Health provides services to people across the lifespan who live with a serious mental illness. These services can be split into three streams:

 Youth (15 - 25 years*)

 Adult (18-64 years*)

 Aged (65+ years)

The overlap of the age groups between youth and adult services promotes a continuum of care for those with a serious mental illness who may enter the service for the first time e.g. first episode psychosis.

Youth Mental Health Services – ORYGEN

ORYGEN Youth Health provides mental health services to young people between the ages of 15-25 years, and their families, who reside in western and NorthWestern metropolitan Melbourne. ORYGEN Youth Health has an early intervention focus, and comprises:

Early Psychosis Prevention and Intervention Centre (EPPIC)

 EPPIC Personal Assessment and Crisis Evaluation (PACE) Clinic - provides a service to young people, aged between 15-25 years, who appear to be at high risk of developing a psychotic disorder. The Clinic plays a key role in the early detection of psychosis - the aim being to delay its onset, and hopefully prevent its development.

 EPPIC Continuing Care - community case managers coordinate young people’s care and involvement with other aspects of the EPPIC program. The community case manager team has the capacity to provide home-based treatment and crisis intervention in collaboration with the other key elements of the EPPIC program.

 EPPIC Statewide Services - provides mental health agencies throughout Victoria with access to expert clinical knowledge in the area of first episode psychosis. Clinical staff conduct secondary and tertiary consultation, staff training, site visits, workshops, community and professional education, resource development and a Graduate Diploma in Mental Health Sciences (Young People’s Mental Health).

Youthscope (non-psychotic disorders)

 Intensive Mobile Youth Outreach Service (IMYOS) - provides an intensive outreach treatment, case management and support service to young people and their families and wider system.

 Mood Disorders Program

 HYPE Clinic (helping young people early) - offers assessment and treatment to young people who may be experiencing a range of specific psychological emotional and behavioural problems that have usually been present for a long time.

ORYGEN Youth Health

 Youth Access Team (YAT) - a multi-disciplinary, mobile assessment, crisis intervention and community treatment team which is the first point of contact for the Early Psychosis

Prevention and Intervention Centre (EPPIC) and Older Adolescent Service (OAS). It provides a triage service, assessment for new referrals and community-based treatment.

 Inpatient Unit - aims to meet the short-term treatment needs of young people experiencing an episode of psychosis, who reside in western metropolitan Melbourne. The Service provides specialised assessment, treatment and care and aims to reduce the severity and promote the remission of symptoms of psychosis.

 Group Program - aims to empower, inform and help young people feel good about

themselves and recover from their mental health issues by assisting them to work on their personal goals and enhance their strengths in a supportive peer group environment.

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Adult Mental Health Services

NorthWestern Mental Health provides mental health services to adults aged between 16 and 65 years who have, or are at risk of developing, a severe mental illness, through four adult Area Mental Health Services: Inner West AMHS (cities of Melbourne and Moonee Ponds), Mid West AMHS (cities of Brimbank and Melton), North West AMHS (cities of Moreland and Hume) and Northern AMHS (cities of Darebin and Whittlesea)

Each Adult Area Mental Health Service comprises the following programs:

Acute Inpatient Unit – specialist treatment for people experiencing an acute episode of

mental illness who require treatment and care in a hospital in-patient unit setting.

Crisis Assessment and Treatment Team (CATT) – a 24-hour service which acts as a

‘triage’ point for all referrals and provides assessment and referral to the most appropriate service. The CATT also provides short-term treatment for people experiencing an acute episode of mental illness, as an alternative to hospital admission. In addition, CATT clinicians are located in the emergency departments of the Royal Melbourne, Northern and Sunshine hospitals where they provide assessment and consultation services for patients presenting with mental health issues.

Continuing Care Team – provides community based assessment, treatment and case

management, as well as community consultancy and liaison services.

Mobile Support and Treatment Service (MSTS) – provides assertive outreach,

longerterm treatment, rehabilitation and support for people with serious mental illness who are living in community settings, including special residential services and boarding houses.

Community Care Unit (CCU) – provides treatment and rehabilitation for people with

serious mental illness and psychosocial disability, in a community-based residential setting, with 24-hour nursing support. The aim of the CCU is to equip individuals with the daily living skills they require to live independently.

Primary Mental Health Team – provides psychiatric assessment and consultation to

people (all ages) with high prevalence mental health disorders who are receiving treatment or support from a General Practitioner or Community Health counsellor. PMHTs also provide secondary consultation and education on high prevalence disorders to a range of primary care service providers.

The Adult Mental Health Rehabilitation Unit at Sunshine Hospital is a regional service, managed by Mid West Area Mental Health Service, and provides intensive treatment and rehabilitation in a secure in-patient setting, for adults with persistent psychosis who are at risk to themselves and others.

Aged Persons' Mental Health Program

The specialised area of aged persons’ mental health is one which is continually growing in terms of demand for service - reflecting both the nation’s ageing population and incidence of mental illness and mental health problems in the community.

The interaction of two key factors within this sector – the frailty and lack of independence that comes with age, and the additional complexity of mental illness - means that people being cared for in this program have extremely high needs.

NorthWestern Aged Persons’ Mental Health Program provides a comprehensive range of services to people aged 65 years and over. It is a highly specialised and comprehensive service and includes three aged psychiatry assessment teams, three acute inpatient units and five residential

accommodation facilities (including psychogeriatric nursing homes and hostels).

Aged Psychiatry Assessment and Treatment Teams - provide assessment, treatment,

rehabilitation and case management, helping to prevent unnecessary hospitalisation and minimise the length of stay in acute inpatient facilities.

Inpatient Care - provides voluntary and involuntary short-term management during an

acute phase of mental illness, until recovery enables the person to be treated in a community-based setting.

Residential services - inpatient services for people with high levels of persistent cognitive,

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The specialist multi-disciplinary Aged Psychiatry Assessment and Treatment Teams (APATT) service the entire NorthWestern and South Western regions of metropolitan Melbourne. They are key components of the Program and operate within geographical

boundaries:

 Mid West and South West APATT - Cities of Brimbank and Melton (including Sunbury), Hobsons Bay, Maribyrnong and Wyndham.

 North West and Inner West APATT - Cities of Hume, Moreland, Moonee Valley and Melbourne.

 Northern APATT - Cities of Darebin and Whittlesea.

These teams are the first point of contact for elderly people who have been referred to the program for assistance. They work with the individual and their family to assess the severity of the person’s mental illness and recommend an appropriate form of treatment and/or support. In keeping with the charter of mental health service provision, the individual is referred to the least restrictive service or facility possible. In all instances, there is a shared care arrangement with a general practitioner. Supporting people with less severe mental illness to live in Commonwealth run, community-based residential settings has become an important priority for NorthWestern Aged Persons’ Mental Health Program. A multi-disciplinary team of specialist staff work in partnership with community-based nursing homes to equip staff with the skills necessary to manage the challenging behaviours often associated with mental illness in the elderly.

Specialty Services

Within NorthWestern Mental Health, a number of regional and state wide programs have national and

international renown for innovative approaches to service delivery and for pioneering work in clinical research. These include:

 ORYGEN Youth Health ORYGEN Research Centre

 Substance Use and Mental Illness Treatment Team (SUMITT)

 Secure Extended Care Unit at Sunshine Hospital

 Telepsychiatry

 Eating Disorders

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OVERVIEW OF THE MENTAL HEALTH GRADUATE NURSE PROGRAM

***The program is also available by arrangement to graduates employed by services other than NWMH. Collaboration is in place to include graduate nurses from the Royal Children’s Hospital Integrated Mental Health Program (IMHP).

Philosophy

The Department of Human Services – Public Health Division [DHS-PHD](1998) document “Graduate Nurse Program Guidelines” recognises the need for a program to ease the transition into practice. It states:

The graduate nurse enters the clinical practice environment having met the theoretical and competency requirements of the educational institution and registering authority: accordingly the graduate therefore has accumulated a significant body of knowledge prior to beginning independent practice. It is assumed however that a fair proportion of this knowledge remains conceptual and awaits transformation (Kolb 1984) in direct clinical experience for meaningful learning to occur.

This program extends beyond the aims of the DHS guidelines in that the guidelines pre-date the development of graduate nurse programs specific to practice in psychiatry. Notwithstanding this, NWMH undertakes to pursue, as far as possible, the values statement within the guidelines.

The philosophy underpinning the Graduate Psychiatric Nurse Program recognises clinical practice and theoretical development as the central foci in the development and implementation of meaningful experience, augmented by an adult life-long learning approach. Values of the program also encompass:

 Theory development is aimed at providing a sound basis for competent practice in the field

 Clinical performance objectives being used to measure performance and areas of development;

 Clinical expectations of the field of practice being clearly identified;

 Identifying the graduate as being a valuable and respected team member who is encouraged and nurtured by more experienced nurses;

 Allowing individual graduates to be recognised for the experience they bring as individuals whilst acknowledging their role as beginning practitioners.

Finally, the individual should uphold the values of the profession in achieving quality nursing care, promoting client advocacy, demonstrating the required level of technical competency and developing communication, problem solving and conflict resolution strategies within the workplace.

Aim

NorthWestern Mental Health is able to provide clinically based theoretical and experiential learning in a supportive environment in which clinicians and educators work together to ensure that the

graduate nurse’s potential is encouraged, valued and rewarded. The course has been developed to account for the need to provide a sound theoretical and clinical education and incorporates formative and summative assessment of knowledge and continuous competency-based assessment to promote the development of the necessary skills and knowledge to function as competent practitioners in psychiatric nursing.

The program is relevant for all new graduate nurses and those who are recently graduated but new to the mental health area. The course of study and clinical experience builds on existing knowledge, serves as an introduction to the specialty of psychiatric nursing and encourages lifelong learning that may lead nurses to further postgraduate studies in the area.

The overall aim of the GNP is to build upon the undergraduate program and facilitate the transition of the graduate into clinical practice by providing the requisite professional support and education to graduate registered nurses entering mental health nursing.

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Objectives

 Encourage the transfer of existing theoretical and clinical knowledge into quality client care outcomes in a psychiatric care setting.

 Develop an understanding of major mental health disorders with particular emphasis on the seriously mentally ill.

 Develop appreciation of the subjective experiences of people with mental health problems  Enable the graduate to develop proficiency in context related competencies particular to mental

health nursing

 Encourage reflective practice.

 Encourage collaborative relations with the wider health care professional team.

 Assist graduates to articulate the rationale of specific mental health nursing interventions.  Encourage the graduate to explore and develop strategies in clinical situations with which they

may not be familiar, thereby broadening their range of clinical skills.

 Assist the graduate to identify individual strengths and weaknesses with a view to developing strategies for further development.

 Enhance professional development.

 Further develop critical thinking skills in relation to clinical practice.

 Encourage independent/collaborative nursing practice designed to meet the client's mental health and well-being

 Consolidate clinical practice within the context of Ethical Practice and in keeping with ANMC Competency Standards and the National Practice Standards for the Mental Health Workforce (2002)

 Develop an appropriate level of competence to fulfil position requirements of Registered Psychiatric Nurse Level 2 (RPN2)

 Develop an awareness of the clinical, community and other resources available to support clinical care.

Timeframe and Structure

The course is 13 months duration, graduates being employed by NWMH for that period under contract. NWMH has a six-month probationary period.

The theoretical component of the program is delivered in mixed mode of study blocks, study days, workshops and online learning.

Three clinical rotations of approximately 15 weeks are undertaken for clinical development.

Theory development

Graduates are inexperienced in mental health and most are newly registered as beginning practitioners in nursing. Adult learning promotes the recognition of individual learning needs in a learner-centred environment. This program embraces adult learning to further develop critical thinkers who are self-directed, responsible and accountable for their learning and with an emphasis on continuing to develop expert clinical skills. At the same time the program recognises that the organisation in which graduates are learning will also determine a framework for minimum learning areas.

Theoretical studies are undertaken in four discrete Units of study: - Models Supporting Psychiatric Care

- Psychopathology and Interventions

- Assessment, Interviewing and Therapeutic Skills

Additionally there are experience-based components allowing the graduate to present and discuss his/her own work in a supportive critical environment. The teaching of conceptual models as principles that guide practice takes place in lecture/symposium sessions.

Graduates must complete a range of mandatory assessment tasks designed to evaluate knowledge and attitudinal development.

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Clinical development

NWMH provides a supportive learning environment in which optimal learning may occur throughout a variety of clinical placements. Each graduate nurse is allocated a preceptor to facilitate and support work-based learning in each clinical setting. A collaborative approach to identifying learning needs promotes a learning dynamic that is relevant to the learner, the venue and the organisation as a whole. Graduates experience formative clinical assessment through the Graduate Appraisal Tool, Clinical Competency Tools and Orientation to Safe Medication package.

Each graduate nurse has three areas of clinical placement of approx 15 weeks duration each. Graduates are allocated according to the preference requests supplied by the graduate upon application. Every effort is made to cater for graduate requests. However, the Graduate Nurse Program Co-ordinator has the discretion to allocate Graduates on a service needs basis and according to availability of places.

This may result in Graduates being allocated to clinical areas other than their highest preferences. The options for placements within Adult services will include the Acute Psychiatric and Community Care Units and within the Acute Assessment Units of the Aged Care Mental Health. Quotas for placement are determined in consultation with the Managers, Senior Nurses and Clinical Nurse Educators.

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ACADEMIC ASSESSMENT AND CLINICAL APPRAISAL REQUIREMENTS

Written and oral assessment

Graduates’ theory development is evaluated through a range of tasks throughout the program.

Assessment tasks may include: attendance, examinations, essays, assignments, presentations and case studies or other work.

Assessments will be marked in a timely fashion, and results returned to the Graduate within 21 days of the submission date, unless otherwise notified by the Co-ordinator.

CLINICAL APPRAISAL REQUIREMENTS

Clinical Appraisal

There are three forms of evaluation of clinical skills that contribute to the satisfactory completion of the Graduate Nurse Program.

1) Orientation to Safe Medication Administration

Prior to independently administering medications, Graduates must satisfy the requirements outlined in the Graduate Nurse Program Medication Safety Package (see separate booklet for details)

2) Graduate Nurse Appraisal Tool

The appraisal tool is based on National Practice Standards for the Mental Health Workforce (2002) This tool is to be completed on each rotation of the program. The tool is designed to provide guidance to the Graduate regarding learning needs and tasks that will enhance their practice (formative assessment). It is also designed to provide outcome assessment of the graduate’s development over the rotation (summative assessment). The appraisal is to be commenced by the Graduate Nurse, in collaboration with the Preceptor within the first week of the rotation.

There are three parts to the tool:

a) Each Graduate Nurse is required to identify and record individual priority learning objectives. Satisfactory progress toward these objectives will contribute to the Graduate Nurse’s overall evaluation. Fortnightly review of these objectives is required as the graduate progresses through the placement.

An evaluation of learning outcomes and overall performance is undertaken four weekly throughout the placement. The frequency of recording progress is critical in the monitoring of graduate performance. As a result, strategies to address deficits can be identified, positive and constructive feedback can be provided and opportunities for future professional development identified.

b) The form also indicates twelve standards of practice and includes performance indicators toward competent and safe practice in these areas. A progress rating is designed to give Graduate Nurses an opportunity to self evaluate their performance and to be provided with feedback regarding their clinical development at the half way point in the clinical placement (approximately 8 weeks). The final rating is to be completed at the end of the clinical placement by both the Graduate nurse and Preceptor

c) A final summary and evaluation of the Graduate Nurse’s clinical performance in this clinical rotation.

ALL areas must be completed at the end of the clinical placement.

The completion of this form is a shared responsibility between the Preceptor and the Graduate Nurse. Graduate Nurses are required to keep a copy of this form for their own records.

The completed form must be returned to the Graduate Program Co-ordinator within one week after completion.

(This tool is adapted from National Mental Health Education and Training Advisory Group (2002) National Practice Standards for the Mental Health Workforce , National Education and Training Initiative National Mental Health Strategy. Commonwealth Department of Health and Ageing, Canberra ACT.)

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3) Clinical Skills Competency Tools

Designed to provide a guide to the Graduate regarding specific skills that are seen as measures of safe competent professional practice in psychiatric nursing, these tools are a compulsory component of assessment.

The following must be completed to a satisfactory level on each rotation:

 Orientation To Clinical Agency

 Conducting A Mental Status Examination

The following must be completed to a satisfactory level at least once throughout the program:

 Orientation to Safe Medication Administration (see 3 below)

 Discharge Planning

 Needs For Service & Individual Service Plan

 Interview Skills: Individual

The following may be completed at the discretion of the graduates preceptor/supervisor:

 Leadership And Management

 Client Care Presentation To Peers

The forms for these competencies can be found in the sections allocated to each rotation.

ANNUAL LEAVE AND ACCRUED DAYS OFF (ADOS)

Graduate nurses undertaking the program are employed full-time 40 hours per week and receive six (6) weeks annual leave. During each of the rotations, the graduate nurse will be eligible for and required to take two (2) weeks annual leave. All leave must be taken by the completion of the contract.

The dates for annual leave are determined by service needs and in negotiation with the service manager. Graduates are eligible to take leave in advance of having accrued leave thus allowing leave to be taken at any time throughout each rotation according to roster suitability.

Graduates working full-time accrue a day off per month. Graduates will take these in accordance with the rostering policy of the Unit as they accrue each month. ADOs are identified on the timesheet submitted for the period in which it is taken.

STUDY DAY PROTOCOL

The Graduate Nurse Program delivers theoretical support through paid study days. These are organised either in blocks, study days, workshops, conferences and online learning.

ALL STUDY DAYS AND ACTIVITIES ARE MANDATORY

Study Days are paid time. Graduates must arrive on time, return from breaks as directed and stay for the duration of the Study Day.

If Graduates are unable to attend due to illness or other contingency, he/she must report the absence to the Graduate Nurse Program Co-ordinator and ensure that their time sheet indicates the sick leave taken.

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STUDY BLOCK AND STUDY DAY TIMETABLES

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