Psychiatric Intensive Care

Rent a copy of Clockwork Orange and watch it on fast forward.

People go to psychiatric intensive care when they present a severe risk to themselves or others (generally others): people who are aggressive and violent, those who are sexually disinhibited, those who are extremely suicidal - this is a selection of people you might find there. What they’ll share in common is that the acute ward will not have the resources to manage them safely. Most of the time, patients are referred there from the acute wards. People might spend a spell in PICU awaiting transfer to a more secure unit.

PICUs have small numbers of beds, large numbers of staff, increased security and should have a high turnover of patients. It will be very different from your dementia care unit, but of course the basic principles of nursing don’t change whatever the setting. You may think it sounds a scary place to work, but in fact, it’s often a lot safer than the acute wards because admissions are controlled (no sudden admissions pitching up from A&E for instance), you know who you’re getting in advance and what they’re capable of, there are lots of staff about and they’re usually well trained in such things as the management of violence and aggression.

Should be interesting and enjoyable!

Yes, I meant to say what beakie said.

One further point in your posted Q to add to beakie’s response:
“what sort of stuff the staff do on them…”

Altho the terminology of ‘do on them’ may be somewhat politically challenging - I think I know what you mean.

Pretty much every PICU will also be a locked ward - can’t think of one that wouldn’t be. This means access protocols and keys/cards etc. It’s a pretty simple procedure but an important one nevertheless.

In regards the treatment, if you haven’t been on an acute unit yet then PICU is going to be literally, like my facetious post above implies, acute mental health on fast forward.
Medication alterations, MDT staff assessments and use of restrictive practices are higher in PICU than other areas might be. The high risk nature of the patients and the urgency to help bring someone back to a point where they are in more control of themselves and in touch with reality requires some fairly competent clinical skills from all disciplines. Mostly it will be nursing and medics - you’re unlikely to see OT, psychology or social workers, unless there is specific reason to engage with a patient on there, as the patient is not really well enough to undertake structured activities or those requiring concentration.

Having said that, it’s not generally as fast paced and constantly demanding as a busy A&E dept can be (given competent RMN staff) but it does have its moments.

Mr Ian - do you think that the OP meant ‘do on them’ as in ‘do on these wards’ rather than ‘do on these patients’?

hmm… yup.

oops

Ow ow ow ow ouch.

“. . . but since my current placement is dementia care I have a feeling it’s going to be pretty different.”

What?!

Does your current placement in dementia care have a dedicated PICU? I know of no Older People units in our region that do, happen you’ve a different set up where you’re training, though. Why does this matter? Well, most Mental Health Services for Older People take on board dealing with challenging behaviour. Managment of behavioural and psychological symptoms of dementia (BPSD) is about patient centred care, focussing on their needs and behaviours (that arise through their dementia).

This should give you a lot of translatable skills. I’d expect you’re already getting some familiarity with triage, risk assessment, formulation, care planning, mitigating risk, de-escalation of arousal/distress and manageing care in the least restrictive fashion.

PICU has younger patients, generally with functional problems, often with “dual diagnosis” too. Management varies. One hospital I worked in was very nurse lead, medics were shunned and hardly ever called. Another was very medication lead, with medics and nurses (and managers) generating pathways of care around medication and assessment of effect and repeated dose administration. As such, PICUs can have very different cultures so don’t assume the experience you gain is universal!

An important point here: as noted above, PICUs are locked environments, therefore to be a patient on one requires detention under the Act. I have to disagree, though, about not seeing OT on there: I’ve witnessed good stuff being done on a PICU in the name of “structured activity”. From the patient perspective, one of the biggest problems with this type of environment is boredom.

“. . . therefore to be a patient on one requires detention under the Act”

Technically not, although practically often yes. Technically you could provide the necessary care in the best interests of an incapacitated adult under section 5 of the Mental Capacity Act 2005 without use of the MHA 1983, if they’re not making repeated efforts to leave.

You can find out more about Psychiatric Intensive Care via the http://www.napicu.org.uk website. Providing the unit you are going to is well run, you should definatley see all members of a multi disciplinary team working in the unit. In therory the whole purpose of the units is to provide intensive interventions therapeutic interventions. There are national minimum standards that units should be achieving.