Focus assessment of injury in a long-term forensic hospital setting

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Keeping patients from harm is paramount to professionals in health care. In Psychiatric Mental Health Nursing, patients causing self-harm is the usual, but in a long-term care facility there are far more injuries sustained than those of self-harm. The facility where I work has a very active Recreational Therapy department including activities of basketball, volleyball, ropes course, weight training to mention a few. In addition to this the campus is sprawling across approximately 10 acres with some of the patient living areas (cottages) lying quite a distance from the main building where most of the programming and meals occur. This setting and therapies set the stage for many diverse injuries than for those of self-harm including sprains, bumps, bruises, falls during inclement weather and the like.
Nurses in this setting must have great competence in assessing for musculoskeletal injuries. Performing problem-focused assessments are a reality in this setting. The nurse must have skills in assessing each and every joint, skin lesions, edema. This is compounded by assessment for chief complaints of syncope episodes, and a whole inventory of other complaints.
The psychiatric patients (some with co-morbid mental retardation) are not always reliable in their reports, or are unable to describe their signs and or symptoms. With this being said it is imperative that Psychiatric Mental Health Nurses remain competent in their assessment skills, whether it is a comprehensive admission health history and physical assessment or a problem-focused assessment.
I challenge administrators in psychiatric facilities to offer continuing education to their Registered Professional Nurses in an on-going fashion to keep their skills current. I would be interested to learn how other facilities maintain the competence of their nurses.

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