|In eating disorders there is a high risk of heart failure as a result of patients being underweight. As such, when people first come to our service we have to monitor their physical health closely, including ECG’s and bloods. At present young people and parents have to attend blood clinics to have their bloods checked which results in long waits. In relation to ECG’s we have to ask GP’s to complete these which often results in a delay due to availability of time slots at the GP and then in results being returned to us.
One of our Support Workers – Lauren, qualified as a Nursing Associate (NA) this year. The course itself is specifically designed to integrate physical and mental health. Throughout her training Lauren has developed numerous skills around management of physical health concerns, which we are now integrating into our service. The whole team has embraced the Trainee Nurse Associate role and have worked hard not only to support all the Trainee Nurse Associates coming into the team for placements, but also embracing the new skills developed to enhance our service.
Service Users will be able to have ECGs carried out by our Nurse Associate at the clinics in one hour slots, twice a week. There will be an online booking system, so any patient attending for an Eating Disorders assessment can be given a slot to attend for an ECG before they leave. We have arranged with the Adolescent Unit on site that we can utilise their ECG and clinic room to complete this. The Nurse Associate will complete an ECG which will then be passed the same day to a Doctor within our team for review and follow up as needed. As part of this project we are also hoping a nurse will be present who can take bloods so everything can be completed at the same time.
This project will result in an increase to patient safety as the wait to complete an ECG and have the results reviewed by a specialist doctor will be dramatically reduced and the risk will be held solely within our team which means we can action concerns sooner.
In addition we have created a ‘Trainee Nurse Associate Lead’ role to support our Nurse Associate and the other Trainee Nurse Associates (TNAs) through the service. This has been taken on by Della O’Donnell who has been shortlisted for a mentor of the year award as a result of her inspirational leadership and great passion and understanding for the implementation of the TNA role.
Also, as a team we spent time developing an experience checklist as below in order to facilitate the best learning experience possible for our trainee nurse associates within the context of their four week placements:
Trainee Nurse Associate Experiences in the Eating Disorders Team:
||Date of Completion
|Assessments – observe initially and then progress to asking some questions
|Attend follow up sessions for those you have participated in assessments for
|Shadow Support Workers including mindfulness sessions
|Experience meal support:
|Visit other community Teams:
· Targeted Team
· CAMHS Team
· Adult Eating Disorder Team
· Assessment Reports
· Paris Entries
· Risk Assessments
· Care Plans
|Outcome Measures (supported by Sarah):
· Adding to tracking sheet
· Attaching to Paris
|Join reflective teams with Family Therapists
|Join Consultations between us and CAMHS
|Attend Ward Round at Forest House
|Attend medical reviews with team Doctor’s
|· Shadow a variety of clinician’s within the MDT
· After shadowing spend some time with that clinician reflecting on what you learnt and asking any questions
|· Give assessment feedback in the team meeting
· Handover relevant information in ward round, team meeting and/or CPA meetings
|Complete physical investigations i.e. weight, height, BP, Pulse, Temp
· Parent Pack
· Young Persons Pack
· FBT Manual
· CBT-E Manual
· Hunger for Understanding (Shared Drive)
· Think Good, Feel Good
· Motivational Enhancement Therapy Presentations (Shared Drive)
|Attend CEDS team meetings (1st Tuesday of the month at 13.30)
|Spend some time in Forest House School
|Attend Professionals Meetings
|Medication at Forest House
Any direct interaction with young people & parents, documentation and phone calls will be done with the supervision of a nurse who will countersign and check any written documentation. The nurse will also ask you to reflect after experiences to help with your development.
Our Nurse Associate has also developed a welcome pack as below for all students and trainee nurse associates on a placement with the team. This helps orientate them to the team and enhance their learning experience:
Welcome to the
CAMHS Eating Disorders Team
Student Information Booklet
Hello and welcome to our team.
We are a Specialist Child and Adolescent Mental Health Service (CAMHS) which covers the whole of Hertfordshire. We have a high referral rate and work hard not to have a waiting list for our young people. The nursing team is separated into 4 quadrants to manage the service. Within each quadrant we have an Advanced Practitioner, Eating Disorder Nurse, Support worker/ Trainee Nursing associate and Family Therapists. We also have various clinics within Hertfordshire that we can see our young people, in addition to doing home visits:
- Saffron ground –Stevenage
- Waverly road – St Albans
- Roseanne House- Welwyn
- Hoddesdon Health Clinic
- 15 Forest Lane
Meet the team:
Manager: Penny Smith
Consultant Child and Adolescent Psychiatrist: Linda Zirinsky
Trainee Consultant Adolescent and Child Psychiatrist: Dr Mufti
Speciality Doctor: Jenny Hill
Family Therapists: Brid O’Leary and vacant post
Advanced Practitioners: Tina Fisher & Charmaine Clarke, Ellen Mulroy
Eating Disorder Nurses: Della O’Donnell, Cathy Godfrey, Rachel Williams, Katie Plummer, Abi Johnson and 2 vacant Posts
Trainee Nursing Associate: Lauren Caruana
Support worker: Kerry O’Brian
Assistant Psychologist: Sarah Dunstan
CBT Therapist Lauren Bloom
Team Secretary: Suzanna Anderton
We also have 3-4 beds in Forest House Adolescent Unit (FHAU) which are allocated for the Eating Disorders team when inpatient admissions are required for young people. FHAU is an inpatient unit for young people between the ages of 13-18 years. It has 15 beds in total. Forest House can also accommodate 72 hours admission for medical monitoring.
What do we do:
We know that recovery at home is the best option for young people, so we aim for this if possible. We foster a Family Based Treatment model and try to include families as much as possible. Families are not responsible for young people developing Anorexia Nervosa, but they are very important in the recovery. We try to help families support their young people to recover at home.
When is inpatient admission required:
Sometimes it is not possible to support young people at home any more, and we need to arrange an inpatient admission. Deciding when admission is required is something we generally discuss as a team in our weekly team meeting. We then attend the CPA meetings arranged by the unit and see the young person at these meetings.
If a young person is not in agreement of the admission we may need to arrange a Mental Health Act Assessment.
Example of a recent admission
We are all experienced to carry and manage a certain level of risk but we aim for recovery, and if we can see a young person is not able to be engaged in the treatment program, and if health is at risk we may decide on an inpatient admission. Eating Disorders have the highest mortality rate of any Mental Illness, and as such we are very careful to manage the risk associated with the illness. Deciding on an inpatient admission is not a decision made just on weight. For example a young person may be exercising for several hours a day and restricting eating. This example is of a case we had recently who despite her weight not being particularly low was exercising for several hours each day. She visited us and said she had been waking in the morning in a sweat. We sent her to the GP and her blood sugar was around 2, resulting in hospital admission and then an inpatient admission. The morning sweat was a hypo and left untreated she could have died. If we had just looked at her weight we would not have reacted the same way.
Building a rapport:
The most important initial part of what we do is engaging the young person and building a rapport. While getting to know the young people and you may find they ask you personal questions, therefore we would recommend that you never discuss your own weight, shape or diet with the young person. We also advise that you do not comment on how they look. Working with Eating disorders we have to be sensitive with the language we use when communicating. Phrases like “you look well” can often be heard as “you look fat”, but don’t worry, we will support you to learn what is helpful and unhelpful to say. Never be afraid to ask us.
On your first day you will be allocated a mentor who will be responsible for your learning outcomes and experiences during your placement. You will work closely with your mentor to ensure you gain support and guidance. They will help you to facilitate your learning in Eating Disorders and to understand our treatment pathways for the young people in our service.
There may be times when you will be unable to work with your mentor as young people and their families may not consent to you attending their sessions. However we have other clinicians in the team who can help to facilitate your learning and experiences in the team.
Additionally on the book shelf we have various Eating Disorder books which you can use to increase you knowledge and understanding of Eating Disorders when you are unable to attend a clinical session.
As a community team we are mostly Lone working, facilitating visits in homes, schools and in clinic. Therefore please ensure you read the Long Working Policy and familiarise yourself with this.
Clinicians will aim to include you in the initial assessments of young people and our expectation is that you will then continue to follow those cases throughout their treatment during your placement, attending their regular clinical sessions to see a continuation of care.
Other learning experiences available:
- Attend and participate in assessments, including report writing, documentation, care planning and risk assessments
- Attend CPA’s, professionals meetings, safeguarding meetings and transition meetings when possible
- Work alongside Support workers and observe mindfulness sessions and meal support
- Observe Family Therapy sessions
- Provide Assessment Feedback and Handovers
- Learn about Outcome Measures
- Attend medical reviews
- Attend ward rounds at FHAU.
During your placement you will also have opportunities to experience other specialist teams:
- Forest House Adolescent Unit
- Targeted team
- Perinatal Mental Health Team.
- Adults Eating Disorder Team
You are entitled to a break each shift which is 30 minutes. We have a kitchen in Forest Lane where you can use the facilities provided to heat food, store food in the fridge and make hot and cold drinks. There is also a café in King Fisher Court which is where adult wards are located. This is only a short walk away.
If you are unable to attend placement due to feeling unwell, please call and leave a message on the office number provide to inform us, in addition to informing your university.
If you have vomiting or diarrhoea symptoms then you should only return to work 48 hours after the last symptom episode. This is to prevent the spread of infection.
We are 9am-5pm service, which is available Monday- Friday only.
Wednesdays are when we have our team meetings and it will be important and highly valuable to your learning for you to attend these.
||09.30 – 11.30
||1st Wednesday of the month
|Peer support Meetings
||2nd Wednesday of every month
||2nd Wednesday of every month
||3rd Wednesday of every month
|Team Lunch & Case Discussion
||4th Wednesday of every month
Ongoing preparation discussion
|5th Wednesday of the month
Thank you for taking the time to read this information we hope it has been helpful for you. We look forward to having you in our team for the duration of your placement and hope you have a happy learning experience with us.
Within our service we have a strong belief in parity of esteem (integration of physical and mental health) in order to protect our patients from harm caused by their illness and this is demonstrated by our new initiatives to offer integrated care for our service users.