A Capability Framework for Working in Acute Mental Health Care

Transcription

1 A Capability Framework for Working in Acute Mental Health Care The values, skills, and knowledge needed to deliver high quality care in a full range of acute settings

2 ACKNOWLEDGEMENTS NHS Education for Scotland would like to sincerely thank everyone from across Scotland, and the UK who contributed to the development of this Framework. We would also like to acknowledge the contributions of the project group and working group and thank them for their time and enthusiasm. Members of the Project Group commissioned to develop the framework and the Working Group who guided the project are shown in Appendix I

3 Contents Introduction What is a capability framework? Why develop this framework? Who is the Framework for? How should the framework be used? The structure of the Framework How does the framework relate to other mental health capability and career frameworks? Key legislative and policy drivers that have informed the development of the framework The Framework Rights, values and recovery focussed practice Supporting recovery from acute crisis Making a difference in acute care Sharing positive risk taking Supporting Implementation Learning to support the development of the capabilities Activities and initiatives to support a positive change agenda in acute care services in Scotland Generic capability frameworks on which this framework builds Useful References/Sources Useful Websites Appendices Appendix I Members of the Project and Working Groups Appendix II Four Overarching Themes for Advanced Practice Appendix III Underpinning Principles for Advanced Practice Appendix IV The Knowledge and Skills Framework (KSF) Dimensions, Levels and indicators relating to the Acute Care Capability Framework Page 3

4 Introduction What is a capability framework? Capability (or ability) frameworks describe the values, skills and knowledge that people should have to help them to do high quality work. Whilst the framework was principally developed for nurses, a range of disciplines and workers, working in acute care settings could also use this framework. Why develop this framework? Recent national policy documents, such as Rights, Relationship and Recovery - The Report of The National Review of Mental Health Nursing in Scotland and Delivering for Mental Health, have highlighted the important role of acute mental health services and care. This has led to a positive agenda for development providing a welcome move away from merely identifying the problems and shortcomings of acute care, towards providing guidance, support and targets that will have a positive impact for those who use and provide acute services. Acute care in Scotland is developing to provide a full range of services including crisis resolution teams, crisis centres and intensive home care and treatment. These services are provided by a range of agencies including health and the voluntary sectors, and operate alongside in-patient care settings. Delivering for Mental Health outlines a range of future developments including Acute In patient Forums and Crisis Services Standards and HEAT targets 1 for mental health services. This framework supports this policy drive and aims and in a later section we outline a range of activities and initiatives that have been put in place by the Scottish Government and other organisations to support this positive change agenda. HEAT target from Delivering for Mental Health Target 3. We will reduce the number of readmissions (within one year) for those who have had a hospital admission of over 7 days by 10% by the end of December 2009 There are also a number of other training developments that have complemented the development of this framework including the Ten Essential Capabilities Training Materials (Scotland) and Realising Recovery- A National Framework for Learning and Training in Recovery Focused Practice. 1 What is a HEAT target? HEAT (Health Improvement, Efficiency, Access, Treatment) targets are a core set of Ministerial objectives, targets and measures for the NHS. There are four mental health HEAT targets in Delivering for Mental Health. Page 4

5 Who is the Framework for? In developing the capabilities that are specific to acute care, close attention has been paid to what makes acute care different for nurses, service users, and other mental health workers in comparison to other areas of mental health care. In particular the framework pays close attention to: The purpose of acute care The impact of the environment in which acute care is provided (whether this is in hospital or community) The impact of acute care on peoples rights, recovery and relationships This framework aims not to duplicate other general capability frameworks that inform the work of pre and post registration mental health nurses and a list of other relevant mental health capability frameworks is presented in the references section. This framework sets out a range of capabilities for all nurses working in acute care and then a further set of capabilities as nurse s progress their careers. However this framework does not intend to limit people s development, indeed many practitioners may be aspiring to and achieving capabilities beyond their particular career stage and this should continue to be encouraged. How should the framework be used? For nurses and service managers: to guide personal development planning by highlighting the support and development needed to promote effective working, and career progression in acute care, which maps with the NHS Knowledge and Skills Framework (see Appendix IV) For service users and their families/carers: to explain the key skills, knowledge and attitudes that they should expect from nurses in acute care settings. For education and training organisations: to guide the development of training and educational activities and programmes specific to acute care. Page 5

6 The structure of the Framework The framework is divided into four key areas. Under each of the four areas the key capabilities are in bold with further detail about each capability bullet pointed underneath. The Four Areas Area 1 Rights, values and recovery focused practice As well as having knowledge of legislation and associated guidance that relates to acute care, nurses must be capable of recognising how legislation and principles inform values, and safeguard the rights of all service users and carers/family members. The capabilities in this area are also informed by the knowledge, values, and skills necessary for developing recovery focused acute care and treatment. Area 2 Supporting recovery from acute crisis This area includes capabilities about the nurse s role within acute care in supporting people s recovery journeys by forming positive and optimistic relationships, which build on people s strengths. Area 3 Making a difference in acute care This includes capabilities about developing skills in prioritising time for face-to-face contact, offering therapeutic interventions - including social, psychological and pharmacological interventions, and providing a therapeutic environment. Area 4 Sharing positive risk taking This area includes capabilities that help nurses to actively and meaningfully involve people in a shared responsibility for assessment of risk, risk management, and risk taking. Page 6

7 The table below shows how the capabilities are first set out as the core capabilities for all mental health nurses in acute care, followed by specific capabilities for nurses working at Advanced and Consultant level. Core Capabilities Nurse Title Consultant Practitioner level Advanced Practitioners level Senior/ Specialist Practitioner level Descriptor Staff working at a very high level of clinical expertise and/or have responsibility for planning of services. Experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard - make high-level clinical decisions and will often have their own caseload. Have a higher degree of autonomy and responsibility Specific Capabilities Practitioner level Most frequently registered practitioners in their first and second post-registration/professional qualification jobs Advanced Practice in Acute Care A number of activities have been, and are currently underway, to describe core standards for Advanced Practice. For example, the Nursing and Midwifery Council defined the Advanced Nurse Practitioner and has outlined draft competencies for the role (NMC, 2005). Modernising Nursing Careers (MNC) was launched in 2006 as part of the overarching Modernising Healthcare Careers Strategy. It is a joint initiative involving the four UK countries and Scotland is taking the lead on advanced practice. An Advanced Practice Toolkit is being developed by the Scottish Government informed by work undertaken during the Senior Charge Nurse Review and NMC regulation. As part of the Toolkit the over arching themes that are main components of advanced practice have been defined alongside the underpinning principles for Advanced Practice (these are outlined in Appendices II and III). The Advanced Practice capabilities described in this framework are in addition to these general components of the role and are specific to the acute mental health care context. Page 7

8 How does the framework relate to other mental health capability and career frameworks? The framework does not stand alone in offering guidance to nurses working in acute care. The diagram below shows how this framework links with other frameworks. It also shows how it relates to the NHS Knowledge and Skills Framework (KSF). The capabilities can have a direct application to the KSF by guiding the evidence required and development opportunities to support career progression (See Appendix IV) 10 Essential Shared Capabilities (ESCs) O t h e r R e KSF Core Dimensions l e v a n t N H S F r a m e w o r k s a n d P o Rights, Values and Recovery Focussed Practice Making a Difference in Acute Care Acute Capability Areas Supporting Recovery from Acute Crisis Sharing Positive Risk Taking l i c y D r i v e r s Key legislative and policy drivers that have informed the development of the framework The Mental Health (Care and Treatment) (Scotland) Act 2003 The Adults with Incapacity (Scotland) Act 2000 Rights, Relationships and Recovery the Report of the National Review of Mental Health Nursing in Scotland (SEHD, 2006a) Delivering for Mental Health the Mental Health Delivery Plan for Scotland ( SEHD, 2006b) Better Health, Better Care: Action Plan (Scottish Government, 2007) Page 8

9 Rights, Values and Recovery Focussed Practice As well as having knowledge of the relevant legislation and associated guidance that relates to acute care, nurses must be capable of recognising how legislation and principles inform values, and safeguard the rights of all service users. These capabilities are also informed by the knowledge, values, and skills necessary for developing recovery focused acute care. CORE CAPABILITIES All mental health nurses working in acute care: A1. Can apply the principles and safeguards of legislation, including the Mental Health (Care and Treatment) (Scotland) Act 2003, the Adults With Incapacity (Scotland) Act 2000 and the relevant parts of the Criminal Procedure (Scotland) Act 1995 to support the care and treatment of service users and carers in acute care. A1.1 Practice in a way and in an environment that ensures the least restriction on the lives of service users. A1.2 Provides care in a way that demonstrates respect for the rights of service users, carers, and significant others A1.3 Gives verbal and written information to service users about their rights and safeguards (when informal or detained) and named persons as outlined in the Mental Health (Care and Treatment) (Scotland) Act A1.4 Identifies if service users have sufficient information and capacity to consent to any aspect of care or treatment and when additional assessment, input or safeguards may be required if consent cannot be given. A1.5 Takes steps to gain informed consent as an on-going process rather than as a one off event at times of crisis. A1.6 Provides service users and carers with a range of support and information to ensure that they can participate as fully as possible in decisions about their care, for example through creating crisis plans and planning for the future. A1.7 Provides care that takes into account the past and present wishes of the service user. A1.8 Is able to provide information about, and promote, the use of advance statements The Principles into practice network has been developed by the Mental Welfare Commission in Scotland. The network aims to promote care and treatment that is in line with the principles of Scottish mental health law by sharing practical tools; best practice; opinion; and experience of what works in the delivery of principles based care. principlesintopractice.net/ principlesintopractice/home/ principlesnethome.asp A1.9 Can support service users to prepare for and attend Mental Health (Care and Treatment) (Scotland) Act 2003 tribunals and support them in accessing independent advocacy. Page 9

10 A2. Can apply values based practice principles to inform decision making in all aspects of care and treatment. A2.1 Demonstrates respect for the service user s expertise and unique knowledge gained as a result of having experienced acute care and mental health crises. A2.2 Works to maximise social inclusion when people access acute care by promoting awareness of and supporting service users to access community organisations and supports. A2.3 Reflects on how ethnicity, age, gender, sexuality, religion or spiritual beliefs and disabilities can impact on people s specific needs and experiences in acute care. A2.4 Can assess, protect, support and work in partnership when people who need additional support and protection access acute care, e.g. young people, and people with learning disabilities A2.5 Provides care and treatment that takes account of individuals beliefs, abilities and backgrounds and works to ensure that the service responds appropriately to diversity and promotes equality. A2.6 Understands anti-discriminatory legislation and is able to act (with service user s permission) where discrimination, harassment and abuse occurs. A2.7 Can assess and act in finding effective aids to ensure effective communication, particularly for people with sensory impairment. A2.8 Develops own skills and use signposting (where this is not possible) in addressing barriers that hinder communication- including translation and interpreting services A2.9 Understands the role of independent advocacy (individual and collective) and local provision and facilitates service user s access to local advocacy workers and organisations. A2.10 Actively engages with service users and carers to involve them in the on going audit, evaluation and development of the acute care service through informal (e.g. day to day feedback) and formal methods (e.g. complaints and audit tools). The Edinburgh Crisis Centre, run by a Partnership Group, is a twenty-four hour nonmedical crisis service which is the first Centre of this kind in Scotland. At the centre of staff job descriptions is the ability to maintain positive relationships with key contacts in underrepresented groups including Black Minority Ethnic, Lesbian Gay Bisexual and Transgender and Disabled Communities who access mental health services. Joint training and planning activities are also delivered with agencies working with groups at risk of marginalisation. A3. Is able to identify and carry out recovery focused approaches to care within an acute care services including using respectful, recovery focussed language. Page 10

11 ADVANCED PRACTITIONER Adv A. Facilitates decision making within a values based practice and recovery ethos through team building and review activities including effective staff appraisals, clinical supervision, staff development and other strategies for enhancing staff support. AdvA.1 AdvA.2 AdvA.3 AdvA.4 Develops and implements formal policies to promote meaningful service user involvement in acute care services. Shows personal courage in leading a team that challenges practice and manages change in a constructive and productive way in line with feedback about the service. Is able to audit and assess the acute care service using equality-auditing tools and lead the development of practice that ensures that diversity is valued and equality promoted. Has a high level of knowledge about the Mental Health (Care and Treatment) (Scotland) Act (2003), the Criminal Procedure (Scotland) Act 1995 and the Adults with Incapacity Act (2000) and is able to join up the professional, ethical, clinical and legislative framework to ensure the least restrictive practice and to guide staff on the impact of legislation on individual care in acute services. CONSULTANT PRACTITIONER Cons A. Has expert knowledge about the professional, ethical, clinical and legislative framework in relation to acute care and inputs into the development of National policy and legislation. Page 11

12 Supporting Recovery from Acute Crisis This area includes capabilities about the nurse s role within acute care in supporting people s recovery journeys by forming positive and optimistic relationships, building on people s strengths. CORE CAPABILITIES All mental health nurses working in acute care: B1. Works alongside service users, carers and other health, local authority and voluntary sector organisations during the immediate acute care period (for example first 72 hours) to facilitate a sensitive transition into acute care. B1.1 Contributes to Multidisciplinary Team discussions about referrals to the acute service to ensure that access to the service is timely, will benefit the person and reflect their wishes expressed in any crisis plans and/or advance statements that exist. B1.2 Demonstrates genuineness, sensitivity and empathy in providing relevant verbal and written information about the purpose, philosophy, staffing, safety, and facilities of the acute service as a continuous process rather than a one-off event. B1.3 Takes an active role in ensuring that advance statements are identified, discussed and carried out as per the principles and requirements of the Mental Health (Care and Treatment) (Scotland) Act B1.4 Gathers, exchanges and acts on information to help make early assessment and care planning possible, including any immediate needs, risks, and concerns service users and families may have. This may include making arrangements for child care, pet care, security of home and valuables, notification of significant others, the availability of medication and suitable meals. B1.5 Demonstrates a values base that recognises the key role of relatives and carers in the recovery of service users, values their involvement in the recovery process, and is able to provide appropriate information and support while respecting confidentiality and the choices of the individual. Page 12

13 B2. Supports service users to plan their recovery journeys using person centred assessment and care planning and approaches. B2.1 Demonstrates an ability to relate to service users who may be highly distressed in a way likely to engender trust and reduce their distress, and to meet their physical and safety needs in the immediate term. This would include, for example, the ability to help someone manage their agitation, anxiety, low mood, suicidal thoughts, and intrusive experiences. B2.2 Engages with service users to explore what has been happening in their lives in the lead up to contact with acute services, and to explore their needs and strengths in a range of areas that will promote recovery, including: Core needs such as shelter, nutrition, physical health, entitlements, personal care, and religion/belief. Significant relationships and events Employment and social activities Alcohol and drug use, prescribed medication, carers needs, and physical health care. Discharge planning The Tidal Model builds upon the nursing profession s core concepts of caring about people and is based on collaborative working that promotes people s strengths and attributes to bring about change in their own lives. Focused individual and group work promotes recovery-centred working. B2.3 Facilitates and supports service users to access local community resources that provide volunteering, employment and education opportunities. B2.4 Actively works alongside service users to provide opportunities to maximise purpose and meaning, for example, through creating formal opportunities for self-expression of creativity and spirituality. B2.5 Shows awareness of the Integrated Care Pathway Standards and monitoring process and how this applies to acute mental health care practice. B2.6 Forms relationships with service users, carers and others, which support people to explore and make sense of their distress and their experiences of acute mental health services. Page 13

14 B3. Is able to work with the challenges substance use brings in acute care services and how this impacts on peoples needs. B3.1 Provides people with individualised information and education (through discussions and written information) about the effects of substance use on physical and mental health. B3.2 Recognises the psychological and physical effects of drug use on service users health and well-being and is able to liaise and make referrals to outside agencies as appropriate B3.3 Demonstrates a knowledge of routine drug and alcohol screening in an acute care and can respond when confirming illicit substance use by being open and honest and sharing concerns for the person s health as well as the effects on others B3.4 Promotes the principles of and acts within the requirements of the Mental Health (Care and Treatment) (Scotland) Act 2003, and local guidelines/policies/protocols about substance use in acute care settings especially when gaining consent to search person or belongings, or obtain samples. Page 14

15 B4. Reflects on the emotional impact on self of working with crisis and high levels of distress in acute care, and is able to recognise stress levels and potential burnout B4.1 Continuously works to develop emotional intelligence and shows emotional resilience when coping with own sensitivities and emotions during times of stress, uncertainty or change 2. B4.2 Can outline and reflect on different models of causation of acute mental health problems and crises, including the impact of traumatic experiences (for example childhood abuse or previous compulsory admissions). This should include a working knowledge of the medical model and of relevant social and psychological models as well as the role of inequalities, social and discrimination on acute mental health problems and recovery. B4.3 Is aware of own abilities and limitations when disclosure of traumatic experiences takes place in an acute setting and recognises when and how to refer to another person or agency. B4.4 Demonstrates an awareness of own mental health and well-being, and shows a willingness to share aspects of their own lives to inspire hope and recovery in others. B4.5 Actively participates in reflection and supervision activities to explore own and others values, practice, and interactions in acute care. B4.6 Proactively creates opportunities to see people at all stages of the recovery process including rotation into a range of care settings. B4.7 Mentors learners and other staff within the team to reflect on achievements and challenges in working with people in acute distress. 2 Emotional Intelligence can be defined as a person s ability to monitor their own and others emotions, and to use emotional information to guide thoughts and actions. It is often divided into skills in the areas of: Self-awareness, Self-management, Social awareness, and Social-skills. Page 15

16 ADVANCED PRACTITIONER Adv B1. Provides expert knowledge and skills in working with people in person centred care through direct work with service users and by coaching and mentoring other staff. Adv B2. Can clearly communicate the role, purpose and ethos of the acute care setting through written communication, mentoring, coaching, and role modelling. Adv B2.1 Arranges the acute service so that help is offered in a manner that nurtures (rather than disrupts) personal roles and relationships beyond the service system Adv B3. Develops ways of working in partnership with relevant services and agencies to ensure that people are supported when care arrangements change. Adv B3.1 Adv B3.2 Adv B3.3 Adv B3.4 Adv B3.5 Implements and monitors procedures to record and feedback referral, care, discharge and follow up outcomes to service users, carers, and other agencies. Is capable of telephone consultation in crisis situations Leads Multidisciplinary Team discussions and decisions to ensure that all transitions through acute care are timely and purposeful, ensuring that bed occupancy or caseloads within acute care are managed at a service level and that consideration of in-patient or caseload mix is given prior to admission. Puts clear systems in place to ensure that all relevant information, both verbal and written, is available within 24 hours of admission to the acute service Uses methods of structuring care delivery (e.g. Integrated Care Pathways) to systematically evaluate processes, the outcomes of care delivery and identify training needs. Acute services in Scotland are increasingly developing staffing rota, secondments and joint appointments which aim to break down the traditional barriers between in and outpatient services. These schemes allow staff to see the whole system of services, to provide seamless follow-up for people discharged from hospital, to support the person at all stages of their recovery journey, and to motivate staff to develop autonomy, skills and therapeutic interventions which can enhance the care they provide. Adv B4. Facilitates the workforce to deal with the emotional impact of acute and crisis care and to actively seek ongoing support and supervision. Adv B5. Develops new ways of working that enable staff to experience a range of acute care services and support people during all stages of their journey, through for example post discharge follow-up and staff rotation between impatient and community based care settings. Page 16

17 CONSULTANT PRACTITIONER Cons B1. Advises and plays a leadership role in the Multidisciplinary/Agency Team by providing expert knowledge and skills in the acute care of people with complex needs. Cons B2. Contributes to strategic planning to ensure that acute services develop in line with service user and staff feedback, policy, legislation, and evidence based drivers. Cons B3. Leads multidisciplinary team discussions around referrals to the acute service and offers expert knowledge to ensure that all admissions are timely and purposeful ( Triage ) Cons B4. Develops and delivers training in all aspects of acute care with service users and others Page 17

18 Making a Difference in Acute Care This area focuses on developing skills to maximise therapeutic contact time with service users and their carers/families through person centred care and treatments, including psychological and pharmacological interventions. CORE CAPABILITIES All mental health nurses working in acute care: C1. Can manage own time and workload to maximise the face-to-face time spent with service users and carers in acute care. C2. Can offer a range of helpful interventions that meet the individual needs of people experiencing acute mental distress. C2.1 Uses counselling theory and skills, such as active listening and problem solving to support people. C2.2 Uses brief interventions such as solution focused therapy, and psychosocial interventions such as coping strategy enhancement and relapse prevention to support people. C2.3 Is able to organise and facilitate short term goal focused groups (when appropriate) in an acute services for example service, community or partnership meetings, admission and discharge groups, physical health and well-being groups, gender sensitive, and social discussion groups. C2.4 Able to work alongside people receiving Electro Convulsive Therapy, providing emotional and physical support. Ensures that Human Rights and the requirements of the Mental Health (Care and Treatment) (Scotland) Act 2003 are observed and the principles promoted. Protected engagement time (or zoning ) enables the staff office to be closed and the ward shut down to phone calls, paperwork, visitors, and other professionals, for a specific regular period of time in the day while the staff engage with the service users. The engagement can take many forms including, individual one-to-one time, group work, games or activities, escorted leave, and meal time supervision. Evaluation of this initiative has shown it to be an effective way of redirecting staff time and attention. Page 18

19 C3. Is able to share information that allows service users to make informed choices about prescribed medications used in acute mental health care including consideration of both the benefits, costs and unwanted effects C3.1 Understands the commonly encountered issues around medication in acute care including: advance statements, supporting people taking medication for the first time, changes to the type/dosage of medications, associated benefits/unwanted effects. C3.2 Understands Rapid Tranquillisation protocols and is able to inform and discuss these with service users and their carers. Understands the need to review protocols regularly, and for increased engagement with service users after rapid tranquilisation to offer support and to monitor adverse effects. C4. Can work with service users to assess their physical health needs and provide them with information and support on a variety of physical health and well being issues C4.1 Can carry out a physical health assessments and when appropriate support and enable people to access physical health care practitioners or services. C4.2 Understands the need to ensure that all service users are registered with a General Practitioner and have information about the health promotion, screening and other services available through their local health centre. C4.3 Assists service users and their carers/families during crisis or acute distress in meeting needs such as food & fluid intake, and personal hygiene in a way that protects service users dignity. C4.4 Delivers health improvement support and advise through individual or group work activities, for example smoking cessation, the impact of non-prescribed drugs on health, physical activity, diet, and social prescribing. C4.5 Can advise people about local sources of information and support in relation to housing, benefits and other aspects of welfare support. Page 19

20 C.5 Is capable of promoting the therapeutic environment of the acute care setting C5.1 Is motivated to provide innovative and creative ways of offering interventions to help people on their recovery journey, through involvement in a range of activities (see Star Wards for examples). C5.2 Appreciates and promotes the benefits of formal and informal peer support and facilitates service users and family members/carers to access this. C5.3 Develops and maintains links with local communities and selfhelp resources (including those beyond traditional mental health services) to create a wide spectrum of opportunities for people in times of crisis. Star Wards works with mental health hospitals to enhance acute inpatients daily experiences and treatment outcomes. Wards can choose from 75 practical ideas.. The ideas span: talking therapies, recreation and conversation, physical health and activity, visitors, care planning, ward community and patient responsibility. These activities are divided into tweaking activities (minimum changes to staffing and resources) to transforming (which require a bigger investment). ADVANCED PRACTITIONER Adv C1. Supports and leads the implementation of creative approaches towards providing a therapeutic, interactive, and stimulating environment in acute care settings Adv C1.1 Adv C1.2 Adv C1.3 Adv C1.4 Adv C1.5 Adv C1.6 Adv C1.7 Uses expert skills to provide role modelling, supervision and coaching to a range of staff. Effectively manages the balance of activity to reflect the crucial importance of face-to-face contact as a therapeutic tool in acute care. Effectively manages the service and staffs workload to maximise building relationships with service users and carers, and enables access to the level of clinical supervision recommended to maintain therapeutic skills in practice Builds working relationships with local self-help and collective advocacy groups to ensure access for people in acute care settings. Supports and fosters best practice in acute care through clinical audit, reviews of published material, attendance at conferences and other local and national events. Disseminates this to staff and is proactive in putting new initiatives into practice. Models expert skills when working with specific client groups, for example people who self harm or have substance use problems, or using specific evidence based psychological therapies such as Cognitive Behavioural Therapy Can carry out a full assessment of peoples needs and offer expert skills that enhance the choices, access to treatment, and speed of response, e.g. nonmedical prescribing Page 20

21 CONSULTANT PRACTITIONER Cons C.1 Cons C1.1 Cons C1.2 Cons C1.3 Is capable of delivering expert skills and interventions in acute care Is involved in designing and delivering training in acute care and specialist areas with local Higher Education Institutions and other training providers. Can develop and lead research proposals and studies into acute care. Facilitates access to staff rotation, exchanges and placements in other organisations providing acute care services. Page 21

22 Sharing Positive Risk Taking This area includes capabilities that help nurses to actively and meaningfully involve people in a shared responsibility for assessment of risk, risk management, and risk taking. CORE CAPABILITIES All mental health nurses working in acute care: D1. Can sensitively apply procedures and practices in the prevention and management of violence and aggression by actively and meaningfully involving people in a shared responsibility for assessment of risk and risk taking. D1.1 Able to work alongside people to share information and complete risk assessments to develop and regularly review safety plans throughout all stages of the care pathway. D1.2 Engages in observation with service users in a way that maximises therapeutic engagement, as described in the Clinical Resource and Audit Group Good Practice Statement (2002) Observation and Engagement. D1.3 Works with service users and others to plan care and regularly review care using the principle of least restrictive care. D1.4 Works with service users in a way that enables and promotes their role and personal responsibly to ensure acute care services provide a safe environment for all. D1.5 Recognises and responds to service users early indications of distress that could lead to increased risk to self and others, taking necessary actions e.g. by reviewing the level of engagement D1.6 Sensitively uses verbal de-escalation and therapeutic management techniques and practices in the prevention and management of violence and aggression, including effective communication and seeking acceptable solutions with people. The refocusing work conducted in Bradford (Dodds et al 2001) aimed to shift the balance away from observation of service users, toward engaging them in meaningful activity that had a therapeutic value. Positive results were noted in terms of service user satisfaction with the service and in morale of ward staff. D1.7 Understands and uses child protection procedures, policies and best practice frameworks to guide their work in acute care. Page 22

23 D2. Recognises when people are at risk of suicide or self-harm and can work with people to assess and understand their situation and jointly agree a safety action plan to minimise risk. D2.1 Understands how attitudes, culture and professional barriers can inhibit open discussion about suicide and potentially lead to suicide being missed, dismissed or avoided. D2.2 Recognises when someone might be having thoughts of suicide, and, engage them in discussions about this in a confident, direct and open manner to make sure levels of risk can be reviewed and actions taken to increase safety. D2.3 Uses evidence based models and methods of suicide prevention and interventions to reduce peoples risk of suicide and self-harm. Self-Harm Project. At the Royal Edinburgh Hospital, a Specialist Nurse in Self Harm offers expert advice and support to nurses in acute care which includes co-working with clients, cofacilitating a support group for service users who self harm, and offering support and training for Carers coping with those who self harm. In addition the project delivers a 2-day Working with People who Self Harm Workshop. (Contact Merrick Pope merrick. pope@lpct.scot.nhs.uk.) D3. Works with people who self harm in a non-judgemental and sensitive way D3.1 Displays an extensive knowledge and understanding of why people self harm when experiencing distress. D3.2 Works positively and in partnership with people who are at risk of, or do self harm using a problem solving approach with jointly agreed goals addressing their potentially complex situation. D3.3 Understands harm reduction approaches to self harm and applies them to supporting people. Page 23

24 ADVANCED PRACTITIONER Adv C1. Supports and leads the implementation of creative approaches towards providing a therapeutic, interactive, and stimulating environment in acute care settings Adv D1.1 Adv D1.2 Adv D1.3 Adv D1.4 Adv D1. 5 Adv D1.6 Adv D1.7 Adv D1.8 Adv D1. 9 Adv D1.10 Provides whole team training, facilitation and support to enable to positive risk taking is understood and practiced Contributes to the development of positive and efficient systems of verbal and written communication and team/service mechanisms for regular short-term reviews of progress, and to foster information sharing, decision making and care planning in relation to positive risk taking. Fosters a climate in acute care where creative approaches to risk taking are encouraged and systems are in place to discourage defensive practice and a blame culture. Takes a lead role in planning for complex situations where risk has been assessed as a significant issue and multi agency coordination is required. Takes a lead in implementing and monitoring evidence based risk assessment tools and methods. Ensures that on-going high quality supervision and support is available to staff. Leads and facilitates post-incident support and reviews for staff, service users and others involved Facilitates the teams understanding of Prevention and Management of Aggression & Violence Policy and training schedules. Ensures all new staff attends as part of induction programme. Leads reviews and decision making about changes to individual service user s levels of observation as per the Clinical Resource and Audit Group Good Practice Statement (2002). Ensures that there is a written policy on restraint that adheres to best practice, and that reporting and monitoring processes in relation to restraint are in place. Introducing STORM to New Craigs Hospital In 2006 four nursing staff at New Craigs were trained as STORM trainers. STORM (Skills based Training on Risk Management) is a University of Manchester validated course offering skills based training in risk assessment and management of suicide prevention. Training for registered nurses started with nurses in the acute wards followed by all in-patient wards. By November 2007 all registered nurses and some students in the hospital had completed the course and NHS Highland are now starting to train Allied Health Professionals and nursing assistants. The STORM assessment has also been incorporated into the admission/ discharge integrated care pathway ensuring appropriate care is available for people at risk of taking their own lives. Page 24

25 Adv D1.11 Adv D1.12 Adv D1.13 Adv D1.11 Ensures that there is an operational policy on searching, based on legal advice, which complies with the requirements and principles of the Mental Health (Care and Treatment) (Scotland) Act 2003, and that there are agreed protocols in place with local police that ensure effective and sensitive liaison about incidents of criminal activity Adv D1.12 Ensures that a policy on Rapid Tranquillisation is in place and regularly reviewed and monitored and that the requirements of the Mental Health (Care and Treatment) (Scotland) Act 2003 and notifications to the Scottish Mental Welfare Commission are met Adv D 1.13 Ensures that the service has child protection procedures and policies in place and has links to child and family support services CONSULTANT PRACTITIONER Cons C1. Demonstrates positive risk taking in planning and developing services that have rights, values and recovery focussed care at the core Cons C2. Provides an expert critical voice in the continuous development of services providing acute care. HEAT target from Delivering for Mental Health Target 2 Commitment 7. We will reduce suicide rate between 2002 and 2013 by 20% supported by 50% of key frontline staff in mental health and substance misuse services, primary care, and accident and emergency being educated and trained in using suicide tools/suicide prevention programmes by Page 25

26 Supporting Implementation Learning to support the development of the capabilities This section details some of the learning activities that acute care mental health nurses and other workers can undertake to develop their practice against the capabilities in this framework. Many of the activities are work based and activities that support learning such as supervision, reflection and review are essential. The learning activities are split into four main areas: Structured educational, training and learning activities Individual work based learning Whole team learning activities Rights, Values and Recovery Focussed Practice A3. Can apply the principles and safeguards of relevant legislation. A4. Can apply values based practice principles. A5. Is able to carry out recovery-focused care. Mental Health (Scotland) Act 2003 Education for Frontline Staff - Web-Based Resource. Adults With Incapacity (Scotland) Act 2000 and Care Programme Approach training. The 10 Essential Shared Capabilities Learning Materials (Scotland) Flying Start NHS Equality and diversity training, Leaning activities signposted in Realising Recovery: A National Framework for Learning and Training in Recovery focussed Practice (NES/SRN 2007) Supporting Recovery from Acute Crisis B5. Can work with service users and others during the immediate acute care period. B6. Can support service users plan their recovery journey. B7. Is capable of working with the challenges of substance misuse. B8. Can reflect on the emotional impact of working in acute care. Training and activities that promote networking and connections with the community. Person centred planning training Working with people who hear voices training Forum discussions between service user and carer organisations and service staff Substance misuse and mental health problems training Maintains regular contact with specialist services Training to use supervision and reflection effectively. Secondments and rotation to other care settings. Page 26

27 Making a Difference in Acute Care C1. Can maximise face-to-face time. C2. Can offer a range of therapeutic interventions. C3. Is able to share information about the main medications including unwanted effects C4. Can assess and provide basic information on physical health. C5. Is capable of promoting the therapeutic environment. Supervision and reflection activities Counselling and Brief Interventions training Psychosocial Interventions Training. Group work training Pharmacology training Non medical prescribing training Making links with specialist physical health care and health promotion services and staff. Visits and sharing best practice with other areas. Partnership meetings with service users and carers. Sharing Positive Risk Taking D1. Can promote positive risk taking and least restrictive care. D2. Capable of recognising a person at risk of suicide and jointly agree a safety plan. D3. Can work in a non-judgemental and sensitive way towards self-harm. Supervision and reflection activities individual and whole team. Safety planning, de-escalation and positive risk taking training. Prevention and therapeutic management of violence and aggression training Child protection training. Positive Risk taking training Suicide awareness and prevention workshops and training Suicide assessment and prevention training - Applied Suicide Intervention Skills Training (ASIST); Skills-Based Training On Risk Management (STORM). Self Harm Awareness Training and Workshops Page 27

28 ADVANCED PRACTITIONER Rights, Values and Recovery Focussed Care Training in cultural assessment/audit of services and developing a culturally competent service Training in the use of recovery environmental audit tools e.g. the Scottish Recovery Index Forming networks and working relationships with other mental health and non-mental health agencies Supporting Recovery from Acute Crisis Leadership and management skills including: change management and service development; the meaningful involvement of service users and others; negotiation and influencing skills, and audit and appraisal skills. Understanding the political context of care through involvement in Local and National forums and networks. Understanding and promoting whole systems approaches to care through joint training with other relevant hospital/community services and sharing best practice. Developing skills as trainers and developers of other people including integration of skills into practice and assessing the development needs of others. Making a Difference Training to develop personal, and other staff/organisational time management skills. Training to develop expert skills for working with specific client groups or using specific intervention frameworks including non-medical prescribing. Sharing Positive Risk Taking Supervisor training to support staff in formal and informal reflection and supervision. Leadership training in de-escalation and critical incident reviews. Developing skills in organising and delivering whole team training and review workshops. Consultant practitioners Training to develop in-depth knowledge about the legislative/ethical/clinical frameworks and expert skills in using these to guide acute care. Developing expert skills in evaluation, using evidence based approaches, and identifying and developing research opportunities in acute care. Develop skills in developing and delivering teaching and training through personal development and developing links with education providers. Training in strategic workforce planning, and be responsible for supervising and supporting the acute inpatient workforce. Develop links and networks to influence acute mental healthcare policy, practice and education within national and regional networks. Page 28

29 Activities and initiatives to support a positive change agenda in acute care services in Scotland Delivering for Mental Health - The Mental Health Collaborative The Scottish Government will launch the Collaborative in April 2008 to support the implementation of delivering for Mental Health. Its work will include driving the HEAT re-admission target will be a crucial re-design support nationally and regionally and locally. For more information see Standards for integrated care pathways for mental health NHS Quality Improvement Scotland (QIS) published standards for integrated care pathways in mental health in December QIS will be supporting the implementation of the standards through regional co-ordinators. For more information see Acute Care Learning and Practice Development Network NHS Education for Scotland is supporting the development of Regional Acute Care Learning and Practice Development Networks and will appoint Regional Co-ordinators to support development of these networks in For more information see Database of positive practice NHS Quality Improvement Scotland Practice development unit will start to establish a database of positive practice in mental health services in Scotland in 2008 to enable sharing and learning from innovation nationally. For more information see Crisis Standards The Mental Health Foundation and the Scottish Association for Mental Health are developing a learning network for mental health practitioners on behalf of the Scottish Government to share practice around implementation of the crisis standards. For more information see and Page 29

30 Generic capability frameworks on which this framework builds Sainsbury Centre for Mental Health (2001) The Capable Practitioner Framework. London. Sainsbury Centre for Mental Health Sainsbury Centre for Mental Health (2004) Ten Essential Shared Capabilities. A Framework for the Whole Mental Health Workforce. London. Sainsbury Centre for Mental Health. SEHD (2006) Rights Relationships and Recovery- Report of the National Review of Mental Health Nursing in Scotland. Role focus, capabilities and contribution of mental health nursing to service delivery in relation to service tier and community and population needs Edinburgh.SEHD Skills for Health National Occupational Standards for Mental Health Page 30