Commonwealth Fellowship Report
Allen Nakibuuka
2006/7
Nominating organisation:EAST London NHS Foundation Trust
Host organisation:East London and City Mental Health Trust
COMMONWEALTH REPORT
ALLEN NAKIBUUKA
2nd September 2006 – 1st March 2007
Introduction
I am a nurse from Butabika Hospital and I came to the UK for a placement in
Psychotrauma for six months. I will start by giving my appreciation to the
Commonwealth for sponsoring me. I am also grateful to East London and the City
Mental Health Trust (ELCMHT) and the Tropical Health Education Trust (THET) for
the Link, which is helping us to develop our health services. I also thank all the heads
of department and other people who were so helpful to me during my placement in
the various places listed below including (1) The Institute of Psychotrauma (IOP) (2)
Topaz Ward at Newham Centre for Mental Health and (3) various Community Mental
Health Centres in Hackney, Tower Hamlets and Newham.
My placement started on 2nd September 2006 with an induction course for two weeks
at the ELCMHT Headquarters and we covered the topics including Nursing in East
London and the City Mental Health Trust, The Mental Health Act, Records keeping
and management, Infection control, Medicine Safety, Food Hygiene, IT training, and
general manual handling. It was useful because we were taught different topics,
which involved the daily nursing procedures on the wards.
After the induction course, I started going to the Institute of Psychotrauma where
people who are suspected to have Posttraumatic Stress Disorder (PTSD) are referred
for assessment and treatment. People who go to the institute may have experienced
Trauma like victim of torture, road traffic accidents, natural disasters, rape extra.
Initially I observed my supervisor when she was assessing clients but later I
participated in the same.
I also went to Topaz Ward where I have been working on one of the acute wards
where I was involved in admissions of patients, assessments, continuous nursing care,
giving medication and many other nursing procedures.
I visited various community mental health teams, which form the basis for provision
of secondary mental health care in the UK. They have an important integral role to
play in supporting service users and families in community centres. I was able to see
how their system works, how they follow up patients in the community and how some
of the patients are referred to the Institute of Psychotrauma if they are suspected of
having PTSD.
I also visited the Medical Foundation, which deals with victims of torture who can
also be referred to the IOP in case they have PTSD.Here I learnt about the different
kinds of torture that people experience, how they deal with them and how torture may
lead to development of PTSD.
I also went to the Child and Family Services in Newham. This service deals with
children and adolescents 0-18 years with mental health problems. Here I was involved
in assessment of children and Adolescents with mental problems and at times their
parents and teachers could be involved. I visited the Trauma Stress Department of
Child and Adolescent Mental Health in Newham. It aims to alleviate the
psychological distress of children and young people aged 0-18 years who have
experienced a traumatic event. The services deal with chronic, complex and crisis
cases.
I also did the Management and Prevention of Aggression (MAPA) course for five
days. This involved the management of actual and potential aggression where we
learnt to approach and handle aggressive patients in a mental health set up.
I did a post Traumatic Stress disorder one day workshop where I obtained the general
knowledge, the prevalence, diagnostic criteria used, risk factors, co-morbidity and
management of PTSD. I also did a Cognitive Behaviour Therapy (CBT) one-day
workshop, which was useful because it’s one of the main treatment for people with
PTSD.
I also went for some computer lessons and this added onto my computer skills and
experience. I also attended other educative workshops including the UK Trauma
Group, Caring for Psychological Injuries After Terrorism and Disaster Conference,
Welcome programme for 2006 intake for Commonwealth Scholars and Mental Health
Link Conference in Harrogate. All of the above helped me to improve on my
knowledge, experiences and skills.
I also attended a family therapy session. This was useful because it involved talking to
patients ‘s families about the patient’s condition or problems, which may hinder
his/her recovery.
Specific benefits
Institute of Psychotrauma
Its headed by a clinical psychologist who is an expert in the assessment and
management of clients with PTSD, so I was able to get knowledge, experience and
skills initially by observing during her assessments and later by also assessing some
clients and offering treatment which included CBT, exposure therapy grounding
exercises.
This is where I gained knowledge, skills and experience in assessment of people with
posttraumatic stress disorder. I learnt to use several clinician-administered scales for
assessment of PTSD which include,
1.Clinician Administered PTSD Scale (CAPS)
2.Beck Anxiety Inventory Scale.
3.Beck Depression Inventory Scale.
4.Impact of Events Scale.
5.Manchester Short Assessment of Quality of Life.
I also learnt skills and knowledge in the management of PTSD using therapies such as
CBT, EMDR, grounding exercises, relaxation exercises and in vivo exposure..
I gained skills and knowledge about general counselling and options for approaching
patients experiencing the effects of trauma.
I also attended Journal club meetings whereby we had discussions about different
topics connected to PTSD and how we can go about with them.
I had weekly supervision by the clinical psychologist concerning my placement and in
this I could get more knowledge skills and experience.
I had weekly study with a colleague whereby we could practice the techniques and
approach to be used when assessing and managing clients .We also practised skills
and knowledge about general counselling and options for approaching patients
experiencing the effects of trauma.
The experience gained from the Institute was of much benefit because I want to
specialise as a trauma Nurse, so this will help me to offer services to people with
PTSD back home.
Topaz Ward (Acute admission ward in Newham)
On this ward, I learnt about the inpatient services in the UK compared to those back
home. Here I was involved in admission of patients, medication, continuous
observations, counselling and attending major ward rounds. On the wards the work
was more organised mainly because they have enough resources.
All the teams co-ordinate from the time the patient is admitted to the time of
discharge i.e. nurses, doctors, social workers, psychologists, community nurses,
occupational therapists and the service user is involved at times. Before discharge the
community is involved so that they know where the patient is going. This was of
benefit to me because if some of these skills are practiced back home they can be
useful in terms of prevention of relapses.
I saw some of the different drugs used on the wards and I was told about the
uses, effects, and side effects.
I also had a chance to practice CBT with some of the patients who could benefit from
it.
Community Mental Health Teams.
I visited the various community teams and I saw how it helps the service user to
continue with treatment after discharge as the community nurses do a follow up. This
also prevents relapse as patients continue to get support from health workers and also
reduces the number of inpatients.
Challenges to transferring skills and knowledge
1.Shortage of staff, this may affect the performance on the ward.
2.Lack of transport in case you want to offer services outside the hospital.
3.Poor communication system
Transferable experience, skills and knowledge
Back home, we have so many traumatised people who need these specialist services
so we hope to open a unit, which will offer services to them. This may be as
inpatients, outpatients and in the community.
So my coming to the UK for a placement in Psychotrauma will be of much benefit
because I have got knowledge, skills and experience in assessment and management
of the same.
I have come to know the different assessment tools used and how they can be used
back home.
Weekly meetings where the Clinical Psychologist holds discussions are also useful
because it adds on someone’s knowledge; you may also have problems about any of
the patient, which needs a team discussion. So I also hope to transfer this system back
home.
My computer skills will be of benefit because some of the patient’s information has to
be fed on the computer so that even if the patient’s file is lost, you have access to his
information without disturbing the patient again.
Some of the clients need specialist therapy outside the hospital so since I was able to
carry out the therapy myself, it will be transferable in case we get a client who needs
the same.
I will be responsible for offering Psychotrauma services back home. I will teach my
colleagues the skills and experiences I have learnt and we shall be able to run the
service. While here I have been assessing and treating patients, I have been exposed to
different types of trauma presents by patients and I have had supervision by a
specialist in that area. These skills and experience will make me a good leader and I
will be able to head the trauma unit.
The placement has helped me to build relationships with experts in the UK, which
will continue upon my return, as they are willing to help me in case I need advice or
additional knowledge by use of email.
I hope also to visit various health centres where I can offer trauma services or carry
out workshops and teach about the knowledge and skills I have obtained in the UK.
PLANS
1.
2.
3.
4.
To head the Trauma unit when it’s opened and use the knowledge, skills
and experience to offer the services.
To teach other Nurses the knowledge and skills I have got.
Offer services to traumatised people outside the hospital.
Visit other hospitals or Health centres and offer the same services.