Clinical placements

Monitoring fluid intake in mental health patients

A new system for monitoring fluid intake helped nursing student Daniel Taylor address the physical health of mental health patients. 

A new system for monitoring fluid intake helped nursing student Daniel Taylor address the physical health of mental health patients 

During my second year of nurse training, I had a clinical placement on an acute male psychiatric ward. 

Daniel Taylor, who created a fluid chart for mental health patients

There were around 20 patients on the ward with a variety of mental health conditions, including depression, bipolar affective disorder and schizophrenia.

Quite a few patients were restricting their fluid intake and therefore not drinking enough to maintain their physical health. There were various reasons for this, not all of which were tied to the patients’ mental health disorders, but some of the patients had delusional beliefs around drinking, others had command hallucinations – such as voices telling them not to drink – and some had body image issues.

Although the ward had a food and fluid chart system in place, this was not adequate or appropriate for the patients who were severely restricting their fluid intake. It enabled staff to monitor fluid intake but did not address the reasons why the patient wasn’t drinking, or what the nursing staff could do about this. 

The ward also had a location check system in place, where a member of staff was allocated to check where patients were on the hour. It was clear that a new fluid monitoring system was needed, so I decided to construct a fluid chart which could be used by staff when doing their hourly checks. 

Picture: iStock

I devised a check sheet which allowed staff to offer patients fluids hourly and record whether they were accepted or refused. If patients refused fluids, the staff member could note on the chart the reasons why. 

Staff could record how much was consumed roughly, such as half a cup of tea, or by a more specific amount, such as 200mls. Another crucial option added to the chart was for staff to record whether they had observed the fluid being drunk or whether this was self-reported by the patient.

I hoped that the new chart would maximise the accuracy of the recorded fluid intake of these vulnerable patients and alert staff to those who were not drinking enough so they could address this. When I ran the chart past the nursing staff, they all agreed it was a good idea.

Sustainable initiative

Working with these patients made me realise how quickly physical health can deteriorate as a result of decisions made while experiencing poor mental health. It has made me aware of how vital it is to screen for nutrition and hydration in mental health patients, and observe and record food and fluid intake to try to ensure good physical health. 

Constructing the hourly fluid chart to a high specification, with the input of the nursing team, increased my confidence in putting ideas forward and showed me how important it is to work as a team.

After I finished the placement, I worked on the ward through a healthcare agency and was very pleased to see that the chart I had made was still being used.

Daniel Taylor is a second-year mental health nursing student at the University of Leeds and a finalist in the Andrew Parker Student Nurse Award category at the RCNi Nurse Awards 2016 

This article is for subscribers only