Introduction:

Mental Health Nursing is a specialised field of nursing which focuses on meeting the mental health needs of the consumer in any setting and in partnership with family, carers and the community. It is a specialised interpersonal process embodying a concept of caring, which is designed to be therapeutic by;

• Supporting consumers to optimise their health status within the reality of their life situation.
• Encouraging and empowering consumers to take an active role in decisions about their health care.
• Involving family/carers and communities in the care and support of consumers.

Registered mental health nurses recognise the need for flexibility, adaptability, responsiveness and sensitivity as they continually shape practice to the dynamically changing needs of the consumer, family, carers and the community.

The Rural and Remote Mental Health Service of South Australia recognises that Mental Health Nursing is a speciality area of nursing, and values the contribution that Mental Health Nurses provide to the Multi-disciplinary team.

Modular Nursing:

Modular Nursing is a composite clinical nursing model, informed by a variety of other nursing models, including; primary care nursing, team nursing, progressive nursing care, allocated care, and task oriented nursing. Underpinning Modular Nursing is the concept of comprehensive care. As Modular Nursing is a composite model it allows for the positive aspects of the various models previously mentioned to be blended into an eclectic model that emphasises the positive aspects of all of these models.

Modular nursing promotes professional practice, high levels of autonomy and accountability, whilst also promoting continuity of care, a cohesive nursing team as well as a multi-disciplinary team structure.

Modular nursing enables various combinations of staff mix and gives nurses the opportunity to provide individual, team or supervised nursing care where and when required. Furthermore it allows those nurses with particular and specialist areas of training, eg family therapy, drugs and alcohol, grief counselling, not only to utilise those skills but to assist other nurses to gain those skills through the direct supervision of another nurse.

Modular nursing promotes professional practice. By working as a group, nursing staff energies can be pooled and the knowledge skills and expertise of each nurse can be concentrated into the provision of high standards of care. The model offers flexibility to accommodate changes in client needs while ensuring continuity of care to each client.

The allocation of clients to nurses in this framework ensures that a particular nurse is responsible for individual clients throughout the entire admission. It enables the nurse to work cohesively with the multi-disciplinary team from admission to discharge of a specific group of clients. In the absence of the primary nurse, the members of the multi-disciplinary team are familiar with and can relate to the relieving nurse, and more specifically the Clinical Nurse.

Description of Modular Nursing Clinical Practice:

All clients are assigned within a module and to a particular nurse when they are admitted.

Each module is made up of a group of nurses and their allocated clients.

Nurses are consistently assigned to a module, as are the clients. Whilst nurses are assigned individual clients, they are also expected to be familiar with all clients in the module.

The number of clients per module and the number of modules are determined by the overall ward occupancy at any given time.

Each module will have staffing, comprising an allocated Clinical Nurse, mental health nurses and a student nurse. The student nurse must work under supervision and as such, cannot be allocated primary clients. This in essence means that each mental health nurse including the Clinical Nurse will have a caseload of both primary clients and those clients for whom they provide comprehensive care in the absence of the primary nurse. The student nurse is teamed with the Clinical Nurse and as such works with the Clinical nurse throughout the entire placement.

Each nurse provides comprehensive care to those clients directly assigned to the nurse, support and expertise to other nurses in the module and undertakes tasks according to skill level, client problems and the general needs within the module.

Nurses working on night duty do not work as module nurses, but are assigned to specific modules to provide support to the modular nurses in line with the nursing care plan and comprehensive nursing in the absence of the modular nurse.

Roles within Modular Clinical Nursing Practice:

All nurses have a role to play within the Modular Nursing Model and it is vital that all nurses understand their role.

• has accountability and responsibility for the standards of client care within the service and as such is the coordinator and processor of all nursing care within the unit;
• provides clinical leadership, direction and supervision to the Clinical Nurses;
• meets with Clinical Nurses to evaluate the progress of clients within the module and within the unit.
• has a role centred on assisting the Clinical Nurses as module leaders and in their absence, the module nurses to render appropriate client care;
• ensures client care and services are continually evaluated and improved by maximising the participation of staff and customers to achieve optimal client care outcomes;
• is responsible for the cost effective management of nursing care and client services, as well as human, material and financial resource issues at unit level;

• is accountable to the Clinical Nurse Manager for the standard of nursing care within the assigned modules;
• coordinates the activities of the assigned module;
• communicates with the Clinical Nurse Manager and the multi-disciplinary team with regard to the progress of all clients within the module;
• ensures that client care is implemented in line with the outcomes of the multi-disciplinary team clinical reviews;
• meets regularly with nurses assigned to the module to monitor the progress of all clients;
• assigns responsibility of all new clients to Level 1 nurses according to their level of expertise and when necessary arranges the transfer of clients between modules or nurses within the module;
• provides direction and supervision to the Level 1 nurses.
• ensures that client care is provided according to the individual care plan and in line with the multi-disciplinary care plan;
• works directly with and supervises student nurses assigned to the module;
• provides feedback to the student nurse regarding individual progress and assists the student in meeting required learning objectives and competencies, while assigned to the unit;
• assesses competency and completes written appraisals of module nurses;
• provides orientation to all new staff assigned to the module;
• evaluates the need for assistance within the module and communicates it to the Clinical Nurse Manager.

Registered Nurse:

• is responsible for the providing comprehensive care, from admission to discharge, of those clients allocated by the Clinical Nurse;
• communicates with and reports to the Clinical Nurse regarding the progress of, or concerns relating to all assigned clients;
• provides an explanation of and ensures patients/carers understanding of rights and responsibilities;
• ensures that patients are aware of, understand and are involved in their treatment plan;
• undertakes assessment of, plans care for, implements, coordinates and provides comprehensive nursing care for allocated primary clients;
• at daily reviews and ward rounds, informs the Clinical Nurse and the multi-disciplinary team, of progress or concerns relating to assigned clients;
• ensures that all nursing care is delivered according to the individual patient’s nursing care plan, which is in line with the multi disciplinary teams planned outcomes for the individual client;
• ensures appropriate brokerage of services for the assigned clients;
• negotiates individual daily counselling sessions with primary clients to identify and problem solve various issues;
• liaises with the Community Mental Health Teams to gather information on admission or regarding discharge planning;
• administers medication as prescribed;
• maintains safe environment for the client based on the Risk Assessment;
• ensures that all necessary information is gathered and documented to enable nurses who provide care to do so without compromising themselves or the client;
• ensures that all planned care is reviewed, updated and documented, as required;
• remains familiar with all clients within the module.
• facilitates the daily Therapeutic Group Program.
• Assists in the care of other patients in the module in the absence of other module nurses when required.

Summary:

Modular nursing effectively combines many models of nursing care, enabling comprehensive care of individual clients. It promotes professional practice, high levels of autonomy and accountability. By working as a group, nursing staff energies can be pooled and the knowledge, skills and expertise of each nurse can be concentrated on the delivery of optimal standards of client care.

The model of care ensures that nurses are able to work at their level of skill and competence in providing care to meet the varied needs of individual clients. It allows for appropriate supervision of student nurses and ensures that the student nurses are not placed in situations for which they are not adequately trained or that will compromise the student or the client.

The division of clients into modules means that the Clinical Nurses and the module nurses can concentrate their efforts to care for those clients assigned, and not be required to focus on all the clients in the ward. Essentially it means that each nurse will have a comprehensive knowledge of those clients assigned rather than some knowledge about everyone.

The Modular framework can be broadened to include all members of the multi-disciplinary team. In essence, the allocation of the multi-disciplinary team to modules achieves smaller, comprehensive modules of service provision and client care.

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