The Role of the CPN

By Lucy Clark

Role of the CPN

• Assess patients cognitive and mental state.• Consider and identify any physical issues.• Report any concerns to consultant.• Monitor medication.• Provide education, support and advice to

patients and their families.• Promote and encourage empowerment,

recovery and resilience.

Role of the CPN• Support patients in the community and reduce

hospital admissions.• Identify existing support• Give practical advice to allow patients to manage day

to day life.• Make professional decisions in relation to the

management of care and support and refer and sign post to the appropriate agencies.

• Liaise with fellow professionals via telephone, reviews and MDT meetings.

Role of the CPN

• Work in relation to national frameworks and strategies as well as legislation.

• Give patients the opportunity to voice anxieties and explore coping strategise.

• Respond to crises situations.• Facilitating groups to encourage self help.

Case Study 1

• Asked to see a 78 year old gentleman with a diagnosis of Alzheimer’s dementia. He had been admitted to a care home for respite from ARI. His wife had been admitted to ARI following a decline in her physical health.

• Staff at care home raised concerns regarding patients behaviour (agitated and attempting to leave).

Case Study 1My assessment

• On arrival the care home staff informed me patient had been assessed at ARI to have no capacity. Patient down as NOK, Son abroad on business and daughter in England.

• On assessment the patient was able to recall the events leading to his admission to the care home but was slightly confused in some area’s which he stated was due to some information not being communicated to him. He was able to give a full history and contact details for his son which he was aware was abroad at that time.

Case Study 1My assessment

• He agreed to complete an MMSE in which he scored 23/30.

• He appeared appropriately anxious regards to his concern that he could not leave the environment to see his wife and she may not be aware of his whereabouts.

• He voiced his wishes to return home and visit his wife in hospital. He told me his plan was to go home and then visit his wife. He declined to stay in the care home.

Case Study 1My concerns following assessment

• I felt from the information given by the care home staff, my observations and MMSE score. This man would be able to function at home with some support and therefore respite was not the least restrictive option to meet his needs.

• I felt this man’s presentation was a rational reaction to his situation and therefore the use of medication would not be ethical in this instance.

• The patient had planned to see his wife in hospital and was to achieve this by driving there. I was concerned about him driving and that he may be unable to sequence the events to utilise public transport.

Case Study 1What were my actions

• I contacted the consultant and explained the patients situation and my concerns. The consultant kindly agreed to an emergency outpatient appointment and therefore I took the gentleman to RCH.

• The consultant carried out an assessment and agreed it would be appropriate for him to go home but was advised not to drive.

• As it was important to this man to see his wife, I organised transport to ensure his wishes were met.

• I took the man home to ensure he was safe and arranged to see him the following day.

Case Study 1The outcome

• This man remains at home and his wife has now been discharged home from hospital.

• His family have now been contacted and made aware of the situation and given support and advice.

• Care Management have become involved and have offered support.

• The DVLA were notified of this man’s diagnosis of Alzheimer’s dementia and the gentleman has independently decided to give up driving.

• He receives regular input from myself.

Case Study 2• I was asked to see a 75 year old man with Lewy Body

Dementia.• The patient experiences visual hallucinations and

episodes of misidentifation which do not always cause him distress.

• He was prescribed Rivastigmine medication which required monitoring.

• He was prescribed as required antipsychotic medication if required for periods of aggiatation and distress.

Case Study 2The crises

• Received a phone call from patients wife stating he had not tolerated the Rivastigmine patch due to the side effects of skin irritation. He was prescribed Rivastigmine tablets in which he was declining to take. He also had been experiencing visual hallucinations and misidentifation at that time which were causing him distress.

Case Study 2On my arrival

• I visited the patient at home that day. He recognised me and my role. He spoke openly about his hallucinations and appeared to have some insight so some of the things he was seeing. He told me the lady next to him (his wife) was his mother-in-law and was concerned as to where his wife was and her safety. He told me his plan was to go to the police station to inform the police.

Case Study 2My concerns

• I was concerned about this man’s safety if he chose to go to the police station. Due to his physical I health I felt him to be at risk of falling.

• As this man appeared scared and anxious anout his wife and her safety. I felt may become a risk to others if he was tried to stop acting on his plan to go to the police station.

• If this man continued to present in this way and refuse medication, he may require admission to the ward.

Case Study 2My actions

• I allowed the patient to discuss his concerns and beliefs and offered reassurance.

• I spoke with him about the risks I felt there were and possible outcomes and that I felt taking his as required antipsychotic medication would be of benefit to his mental state at that time.

• I fully explained the purpose of the medication, it affects and side effects. The man agreed to take the as required medication and I reviewed him the following day. I gave his wife advice as to who to contact if there was no change in his presentation

Case Study 2The outcome

• The patient had a good effect from the medication and agreed to take it again when required.

• We discussed the Rivastigmine medication and the patient has now agreed to take this.

• The patient has agreed to continue with CPN support.

Any Questions?