Supporting Staff and Patients to improve our wards

Transcription

1 Supporting Staff and Patients to improve our wards Claire Blount (Clinical Psychologist), Gwylfa Therapy Service, Aneurin Bevan UHB Hanka Roudnicka (Ward Manager) Belle Vue Ward, Aneurin Bevan UHB

2 Context - Belle Vue Ward, St. Cadoc s Hospital, Caerleon - Locked 6 bedded psychiatric rehabilitation ward for women with complex needs. - Diagnoses of Personality Disorder, Psychosis, PTSD, Substance Dependence, Anxiety, Depression... - Histories of abuse, neglect, poor attachments (many ACES) and often difficult (or ill fitting) experiences in mental health services. - High risks to self and others. - Referrals from Low secure hospitals and acute wards - Average length of stay: 18 months - Gwylfa Therapy Service (specialist personality disorder service), joined with Belle Vue Ward in 2014.

3 Context 2014 Transitioning from a forensic Ward to collaboration with the Personality Disorder Service. Women reporting feeling misunderstood, penalised, invalidated. Staff reporting feeling burnt out, tired, attacked, unsupported, going through the motions, powerless to help. Gwylfa service keen to help, but not invalidate and intrude.

4 What we did

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6 Model of Care Attachment model of nursing care (Barber et al, 2006) recognising that positive change comes through caring, respectful relationships. Person centered care, respect individuality Reflective approach Positive risk taking Motivation Empowerment Being good enough

7 Building a thinking, supportive culture Consultant Nurse and Consultant Clinical Psychologist role of Responsible Clinician Appointed Deputy Nurse Manager to strengthen ward management & Staff support. Focus on formulations, therapeutic relationship and psychological therapies Developed a role of an Activity coordinator Changed the physical environment dedicated room for groups / meetings. Improved recruitment and mentorship Established weekly reflective practice Supervision and support Provide DBT, MBT, Mindfulness, Hearing voices groups Individualized management of self harm plans Provide teaching sessions / 3 day training program for the Health Board

8 Staff training Alongside encouraging staff to engage in training such as DBT / MBT, we designed an inhouse training for Ward staff: 3 day training course: Working on Wards with people with Personality Disorder and Complex Needs. Co-produced the design and delivery of the course with the Gwylfa team, service users and Ward staff. Also, invited other experts to help deliver sessions. Focus on respectful, caring, hopeful relationships being the agent of change. Gave questionnaires pre and post training (at the end of the course and then several months after return to work).

9 Something has changed!

10 Pre-training comments Very, very timeconsuming and tiring Post-training comments It has changed my views about this client group I find it challenging and upsetting at times Reminded me of the reasons I came into nursing. Worried I will say the wrong thing. all staff should get this training as we often lose sight of the person and focus on their behaviour

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12 Patient focus group Qs. - What is good about Belle Vue? - What could be better? - How does it compare to other Wards?

13 Questions: Responses: What is good about Belle Vue? Having an activities coordinator Having groups Staff give you time for 1 to 1s The staff. They are: nice, caring, want to help, know their stuff, understand, funny, want to help, care about how you are doing, want you to do your best. I feel safe. The staff are always there to talk to, give advice, check on you. I feel safe because there are cameras. What could be better? Sometimes there aren t enough staff so leave gets cancelled. The food. Not enough drivers / cars to go on leave sometimes. Better planning for leave. Can feel locked in, like caged animals. Need more freedom. Should be able to go out more. How does it compare to other Wards? Better than PICU, as you are allowed your stuff in your rooms, makes you feel happier. We have our own space to chill out in. Some facilities are better elsewhere, but the staff are nicer here. Staff are more caring here, they are more available to support. Feels safe that you can lock your doors when you re getting dressed. It s quieter here. Staff are nicer it feels that staff on other wards don t care they shout at you if you self-harm. I have mixed feelings. I don t want to be locked up, but it s nice here too.

14 Staff focus group feedback Q. Why do you think that Datix incidents have improved so dramatically?

15 Theme Ward team is stronger Comments The team now gels better. More tight. Leadership is better. Used to be more top down. Experience has been built over time. When there are new and bank staff it is more unsettled. Positive risk taking / less restrictive environment More time to plan. Now more accepting of risk. More confident to take risks. Means less conflict with patients and gives them responsibility. Better able to predict and manage incidents. Ward environment is less restrictive and more relaxed than elsewhere we give them more responsibility. They know they have to take some responsibility to stay safe. Patients are different Now more thought to what is a good combination of patients. Maybe 2014 incidents were high due to certain patients who have now left. Patient population are now more stable. Better relationships with patients Less confrontational and restrictive with patients. Patients know we care. Patients are given more time. Different/ better culture has developed. Everyone has a voice More therapeutic activities Attitudes are different more positive to the patients. Everyone is now more involved in planning. Helps to understand decisions and feel safer. Felt chaotic in the past which was scary. More therapeutic activities on this Ward. Less of a focus just on medication.

16 Enabling Environments Measures The Enabling Environments Questionnaire pack comprises 5 psychometric measures. Staff and patients on Belle Vue ward in January 2017 were invited to complete these questionnaire packs. 13 staff questionnaires and 2 patient questionnaires were returned.

17 General wellbeing measures Oldenberg Burnout Inventory (OLBI), Demerouti and Bakker (2007) Oxford Happiness Questionnaire (Brief version) Hills and Argyle (2002) Satisfaction with Life Scale (Pavot and Diener, 2013) Measures indicated that staff were in the normal range for satisfaction and happiness. Staff did not score as burnt out and scored more positively than other caring profession norms.

18 Essen Climate Evaluation Schema, Schalast and Tonkin (higher scores = a more positive appraisal of the environment) Belle Vue staff av. Score Belle Vue patient av. Score Medium Secure Staff norms Medium Secure patient norms Social Cohesion Experienced Safety Therapeutic Hold Total Essen Score

19 Enabling Environments measure (1= strongly disagree 7=strongly agree) Factor Average staff score Average patient score Belonging Boundaries Communication Development Involvement Safety Structure Empowerment Leadership Openness Total Average

20 What did we get right?

21 We re not sure! But here are some ideas: A change in culture: More truly biopsychosocial. Staff feeling more supported / included (without this, nothing can change). More space to think. More curiosity about people s struggles and the way they show them. Attachment model of care promoting relationships, not discouraging them. Offering trust, respect and hope.

22 The Future Questions: How can we find out what made the change? How can we transfer our learning to other wards? Ideas for future development: Use the insight, learning and ideas of our service users more. Repeat the measures for 2017.