Evaluation of a pilot Masterclass for dermatology nurses in psychosocial aspects of care

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1 Practitioner Perspectives Evauation of a piot Mastercass for dermatoogy nurses in psychosocia aspects of care Poy Buchanan, Barbara Page, Karen Stephen, Janice Bianchi, June Gardner & Zoë Chouiara Objectives: To deiver a Mastercass to eight dermatoogy nurses focusing on the bio-psychosocia aspects of care for peope iving with skin disease; utiise psychosocia assessment toos avaiabe for Hoistic Needs Assessment (HNA); increase participant nurses understanding of eves of psycho-socia intervention; evauate course impact on participants confidence in HNA; evauate course impact on participants competence in HNA and record changes in practice foowing course competion. Method: A pragmatic action research approach was undertaken, utiising standardised pre- and postconfidence and competence questionnaires and refection (free-text and verba feedback). A two-day interactive earning programme was deivered with a haf-day feedback debrief session at three months. Resuts: Overa confidence eves increased with mean tota confidence scores increasing from 43.1 to 58.3 (range 0 to 90). Greatest percentage increase was demonstrated for: use of screening toos and discussing suicida ideation. Overa competence eves increased with mean tota competence scores increasing from 43.1 to 85.1 (range 0 to 130). Greatest percentage increases in competence were demonstrated for: use of the Distress Thermometer (386 per cent); use of screening toos for anxiety and depression (139 per cent); educating the patient about mechanisms of anxiety (129 per cent); structure and organisation of psychoogica practice (85 per cent) and assessing for suicida ideation (85 per cent). Concusions: This Mastercass improved participants confidence and competence eves in assessing psychosocia aspects of care. It met participants expectations and course objectives. Deveopment of an additiona mentorship programme for participants foowing course competion is recommended to sustain change in practice. Introduction ADDrEssiNG the psychosocia needs of patients is essentia to the success of any dermatoogica intervention and can improve patient experiences and outcomes. The scottish Dermatoogica Nursing society (sdns) deveoped a Mastercass for dermatoogy nurses wishing to enhance their practice and address patients psychosocia needs. The sdns received an educationa grant from LEO Pharma UK to support the deveopment, impementation and evauation of the Mastercass. Dermatoogy represents a cinica speciaty where the psychoogica and socia impact of disease can affect individuas experiences and cinica outcomes (A Party Pariamentary Group on skin, 2013). A recent sdns audit (Bianchi et a., 2014) highighted itte or no psychosocia assessment or interventions are being undertaken in scottish dermatoogy departments. This is of concern as nationa recommendations ceary state that psychosocia impact of skin disease can be profound and assessment must be undertaken (report of the A Party Pariamentary Group on skin, 2013). Further to this, the Nursing and Midwifery Counci (NMC) aso recommend that nurses are hoistic in their approach and address the physica, psychoogica and socia aspects of care (Nursing & Midwifery Counci 2015). Heath Psychoogy Update, Voume 25, Issue 2, Autumn The British Psychoogica Society

2 Poy Buchanan et a. The sdns recognised a gap in knowedge and skis of nurses and proposed to deveop and deiver a Mastercass on the psychosocia aspects of care for sdns members. rationae for undertaking this initiative was identified as: Dermatoogy nursing practice in scotand faied to demonstrate adequate psychosocia assessment of patient needs (Bianchi et a., 2014). Yet there is strong evidence of increased eves of psychoogica distress and psychosocia needs of patients with dermatoogica conditions, which is often independent to the objective cinica disease severity (Affeck & Chouiara, 2015; Affeck et a., 2015; jones-cabaero et a., 2007). Furthermore, there is evidence inking psychoogica distress and progression of skin conditions (Zoubouis & Bohm, 2004). Dermatoogy practitioners in scotand indicated a ack of knowedge, skis and time to undertake hoistic assessment in daiy practice with patients psychosocia needs not being met (Bianchi et a., 2014). NMC requirement for a hoistic approach is integra to the code of professiona practice (Nursing & Midwifery Counci, 2015) Benefits of psychosocia needs assessment According to the Word heath Organisation (WhO) heath is: A state of compete physica, menta and socia webeing and not merey the absence of disease or infirmity (WhO, 2014). heath protective factors incude individua coping skis, psychosocia support and access to resources and services (Myers et a., 2005). Given the prevaence and severity of psychoogica distress and psychosocia needs of patients with skin conditions, a systematic assessment of psychosocia needs can have key benefits for patients, practitioners and organisations. Addressing the psychosocia needs of patients matters because: it heps patients understand and cope with their condition (Affeck & Chouiara, 2015; Affeck et a., 2015). it represents a more hoistic approach in assessing the physica, cognitive, emotiona, spiritua, socia and financia aspects of care which are important to persons iving with skin conditions (Affeck et a., 2015). it improves physica heath and webeing. (hurey et a., 2014). it can enhance patient consutation and improve adherence to treatment/ management programmes (snyder et a., 2014). it can improve patient experiences and outcomes (You et a., 2012). Practitioners attain greater knowedge and skis to improve practice, identify psychoogica morbidities prompty, enhance communication and improve cinica outcomes (Myers et a., 2005). Practitioners demonstrate greater job satisfaction (hurey et a., 2014). Organisations fufi Nhs scotand Quaity objectives (scottish Government, 2011) in ensuring assessment and interventions are patient focused, safe and effective. Aim of project The main aim of this piot initiative was to up-ski dermatoogy nurses in order to increase confidence and confidence to undertake psychosocia assessments and be famiiar with appropriate psychosocia interventions avaiabe to enhance care. Objectives were to: 1. Deiver a two-day Mastercass for dermatoogy nurses focusing on the psychosocia aspects of care of persons iving with chronic infammatory skin disease. 2. Utiise psychosocia assessment toos for hna: swift Too (Nhs Education scotand, 2013) Distress Thermometer (O Donne, 2013) Genera Anxiety Disorder Questionnaire GAD-7 (spitzer et a., 2006). 34 Heath Psychoogy Update, Voume 25, Issue 2, Autumn 2016

3 Evauation of a piot Mastercass for dermatoogy nurses in psychosocia aspects of care Patient heath Questionnaire PhQ-9) (Kroenke et a., 2001). 3. increase participant nurses understanding of eves of psychosocia interventions. 4. Evauate course impact on participants confidence (a feeing of sef-assurance arising from an appreciation of one s own abiities or quaities) in hna. 5. Evauate course impact on participants competence (the abiity to do something successfuy or efficienty) in hna. Method and Mastercass deivery A pragmatic action research approach (Muha 1999) was undertaken, utiising: a. Pre-course Assessment, comprising two questionnaires. Pre-course questionnaires reated to confidence and competence in psychosocia needs assessment (Nhs Education scotand, 2011). A reading ist and a programme were aso sent to participants. b. Mastercass deivery comprised 15 hours interactive earning (two study days) for eight deegates. The course was deivered within an Nhs educationa estabishment. Experienced sdns nurses faciitated the Mastercass sessions and workshops. These incuded bio-psychosocia aspects of skin disease, motivationa interviewing techniques, heath iteracy, psychosocia assessment toos (swift Too; Distress Thermometer; Genera Anxiety Disorder Questionnaire GAD-7; Patient heath Questionnaire PhQ-9) and eves of intervention. Coeagues from dermatoogy, psychoogy and psychiatry aso contributed to the deivery of the programme on speciaist topics such as psychoogica morbidity, use of anguage, suicide ideation(incuding risk assessment), sef-care for heath professionas, and reaxation techniques. c. Post-course evauation was undertaken using standard course evauation forms and post course confidence and competence questionnaires at three months after competion of the Mastercass. d. Participants were aso invited to a hafday feedback debrief session at three months to refect and share accounts of any change in cinica practice. The emotiona webeing of nurses is integra to their success in recognising, assessing and addressing psychosocia needs of patients. A cinica psychoogist faciitated the debrief session on this important aspect of sef-care. Participants The course was aimed at experienced dermatoogy nurses with a minimum of five years experience in dermatoogy nursing. Eight successfu appicants were seected based on experience and cinica speciaty. Ethica considerations As an action research project, with participants being heath professionas and using questionnaires oca ethica committee approva was not a requirement. The sessions were deivered in a sma group forum within a safe istening environment. Participants were assigned a study number for questionnaire anaysis and reporting of findings to maintain anonymity. Confidentiaity was respected at a times during a sessions. No identifiabe patient detais were mentioned during cinica discussions and feedback. Data coection and anaysis: Sef-report confidence and competence questionnaires Data were coected pre- and post-course (with permission) using standardised sefreport questionnaires for confidence and competence (Nhs Education scotand 2011). Deegates were asked to indicate on a numerica rating scae the eve of confidence and competence against specific criteria. 1=Not very confident/competent to 10=Very confident/competent). A further open question was asked regarding participants main concerns about discussing psychoogica issues with patients. A space to write any other comments was aso provided. Heath Psychoogy Update, Voume 25, Issue 2, Autumn

4 Poy Buchanan et a. Using Microsoft Exce software package, confidence and competence questionnaire data were anaysed using simpe descriptive statistics. This incuded the range of scores for each criteria (pre and post), mean scores for each criteria (pre and post), percentage (per cent) change in scores for each criteria and tota pre- and post-mean scores and percentage (per cent) change. This piot programme invoved sma numbers of participants which is a imitation in terms of statistica anaysis. Refective practice Foowing the Mastercass, participants were invited to keep refective diaries of one to two case studies. Feedback from these case studies was attained at the three-month foow-up debrief session and reported in reation to changes in practice, impementation of psychosocia assessment toos and psychosocia interventions undertaken. Resuts: Course evauation forms One-hundred per cent of participants reported that their expectations were met and there was sufficient time for networking. The question of sharing earning with coeagues eicited responses which ceary indicated their intention to share knowedge and earning with others, for exampe: I wi share the information about open questioning, assessment toos, reaxation and meditation techniques. Through discussion we can incorporate the toos with appropriate patients during consutation. We wi aso make sure the information from DLQI* questionnaire is acted on rather than just fied in patient s notes. (*DLQi=Dermatoogy Life Quaity index, Finay & Khan, 1994) Confidence and Competence questionnaire scores Confidence questionnaires identified nine criteria on which to measure confidence. The questions (1 9) are detaied in Tabe 1 as are pre- and post-mean confidence eves. Competence questionnaires identified 13 criteria on which to measure competence. The questions (1 13) are detaied in Tabe 2 as are pre- and post-mean competence eves. 36 Heath Psychoogy Update, Voume 25, Issue 2, Autumn 2016

5 Evauation of a piot Mastercass for dermatoogy nurses in psychosocia aspects of care Tabe 1: Pre- and Post-Mean Confidence Scores. Question Confidence Questionnaire Mean Range Mean Range % (scae 1 10) Score Score Increase How confident do you fee Pre- Post- Mean in/about: Course Course Score 1. Discussing psychoogica probems % with patients 2. Eiciting worries or concerns from % patients 3. Using specific screening toos to % detect psychoogica probems 4. Recognising symptoms of % psychoogica disorders 5. Managing a patient who is % describing symptoms of psychoogica distress 6. Providing information to patients % about how to manage their psychoogica distress 7. Discussing concerns about a % patient's psychoogica distress with other members of your team 8. Discussing suicide ideation with % patients and famiies 9. Managing your own feeings when % deaing with patients with psychoogica distress Tota Mean Confidence Score % Heath Psychoogy Update, Voume 25, Issue 2, Autumn

6 Poy Buchanan et a. Figure 1: Bar chart: Mean Confidence Scores Pre- and Post-Mastercass. Figure 2: Bar chart: Pre- and Post-Mean Competence Scores. 38 Heath Psychoogy Update, Voume 25, Issue 2, Autumn 2016

7 Evauation of a piot Mastercass for dermatoogy nurses in psychosocia aspects of care Tabe 2: Pre- and Post-Mean Competence Scores. Question Competence Questionnaire Mean Range Mean Range % (scae 1 10) Score Score Increase How Competent do you fee Pre- Post- Mean in/about: Course Course Score 1. Understanding what the % psychoogica aspects of your current practice entai? 2. Understand how to structure and % organise your psychoogica practice? 3. Creating a good istening % environment? 4. Using open and cosed questions % and refective istening? 5. Acknowedging, vaidating and % normaising what your patients are discussing? 6. Informing patients? % 7. Assessing how peope cope? % 8. Using scaes to assess % psychoogica issues? 9. Using the distress thermometer? % 10. Educating patients about the % mechanisms of anxiety? 11. Using reaxation techniques with % your patients? 12. Using screening toos for anxiety % and depression? 13. Assessing for suicida ideation? % Tota mean scores % Heath Psychoogy Update, Voume 25, Issue 2, Autumn

8 Poy Buchanan et a. Open question responses: Pre- and Post-course Open question responses Pre-course: Pre-course, participants main concerns about discussing psychosocia issues with patients reated to perceived ack of confidence and competence, for exampe: (P001) The approach and wording. Knowing what to say without distressing them more. (P008) Not having confidence using the screening toos avaiabe and having ony a basic and ife experience knowedge of psychoogica issues. Open question responses: Post-course: Post-course responses to the open question regarding their main concerns about discussing psychosocia issues reated to time constraints and gaining experience in using toos. (P003) That I know the principes but need to buid confidence in practica experience. Participant vaidation at three-month foow-up debrief session Participants attended a three-month foowup debrief session and provided group feedback and refective notes reating to the course content, case histories and changes in practice. in the group feedback and refective notes participants reiterated the questionnaire information, that is, that the course provided appropriate eve of chaenge, instigated a profound change of approach in addressing psychosocia issues with patients and increased eves of knowedge about these issues. Discussion Meeting expectations Overa the Mastercass appeared effective in meeting the expectations of the participants. From the quantitative and quaitative anaysis, the resuts demonstrate achievement in our overa aim. The course content was reported as appropriate and met our origina objectives to increase the confidence and competence of participants in assessing psychosocia aspects of care for patients and participants intention to change practice. Confidence eves resuts from the sef-report questionnaires indicated that overa confidence eves were increased foowing competion of the course for a nine criteria identified, with tota mean confidence scores rising from 43.1 to 58.3 (scae range: 9 90) indicating a 39 per cent increase change in confidence eves. Before commencing the Mastercass, participants fet most confident in discussing their concerns about a patient s psychoogica distress with other members of the team and managing their own feeings when deaing with patients with psychoogica distress. Likeihood is one action serves the other, discussing patients psychosocia issues with coeagues can be reassuring and enhance/support confidence as we as acting as a porta for deaing with one s own feeings. Before commencing the Mastercass, participants fet east confident in using specific screening toos and discussing suicide ideation. This is understandabe as participants reported itte knowedge of assessment toos. Lack of confidence in discussing sef harm and suicide ideation is commony reported as uncomfortabe for the heath care professionas and regarded as a no go area for fear of opening up a can of worms (Dazzi et a., 2014; Morriss et a., 2013). This was demonstrated in the precourse confidence and competence questionnaires with participants stating main concerns are: not being abe to dea with the issues, being out of their depth or not being abe to provide hep. Lack of knowedge and skis to manage an uncomfortabe or potentiay emotiona situation reinforce this ack of confidence. Three months foowing competion of the course, mean scores for confidence in using screening toos increased from 3.5 to 6.2 (77 per cent change increase in confi- 40 Heath Psychoogy Update, Voume 25, Issue 2, Autumn 2016

9 Evauation of a piot Mastercass for dermatoogy nurses in psychosocia aspects of care dence). This is an encouraging finding as it represents a core ski in hoistic needs assessment. simiary, mean scores for confidence in discussing suicide ideation increased from 3.1 to 5.5 (77 per cent change increase in confidence). Greater confidence to have such a discussion with patients indicates the course content addressed fears and concerns of participants about suicide ideation. These sessions were ed by a cinica psychoogist, with input from a psychiatrist and a dermatoogist, and reinforce the need for a mutidiscipinary approach in deivering a programme of earning. Carification of the specific psychosocia issues, motivationa interviewing techniques and anguage used provided new insights and skis for participants to fee more confident in exporing thoughts and feeings with patients. Competence eves resuts from the sef-report questionnaires indicated that overa competence eves were increased foowing competion of the course for a 13 criteria identified, with tota mean scores rising from 51.9 to 85.1 (scae range: ), a 64 per cent change increase in reported competency eves. Before commencing the Mastercass participants fet east competent in using the Distress Thermometer with a reported mean score of 1.4 on a scae of Foowing the Mastercass the mean score was 6.8 (386 per cent change) demonstrating a much higher eve of competence. Before commencing the Mastercass participants fet most competent in creating a good istening environment. This is interesting as the participants beieved themseves capabe of creating a good istening environment yet prior to the course were not taking the opportunity to assess psychosocia needs. There appeared to be a wiingness to create an environment and aso a ack of skis to assess psychosocia needs which perpetuated avoidance behaviour. in the post-course comments, respondents commented on the need for support to practise psychosocia assessment and practise using the toos. The impementation of a mentorship programme for participants foowing course competion may enhance confidence and competence to faciitate sustained change in practice. The argest percentage (per cent) increases in competency scores post-course were reported for: a. Using the Distress Thermometer (386 per cent change increase); b. Using screening toos for anxiety and depression (139 per cent change increase); c. Educating patients about the mechanisms of anxiety (129 per cent change increase); d. Assessing suicide ideation (85 per cent change increase); e. how to structure/organise their psychoogica practice (85 per cent change increase) Limitations of this pot work incude sma participant numbers and ack of contro group. in future, with arger cohorts of participants, potentia statistica anaysis of findings wi be as foows: A pre/post t-test anaysis of competence and confidence eves to identify whether the Mastercass has made any difference in confidence and competence for individua participants. A three- to six-month t-test anaysis of the same variabes to see if there is any difference between these two points in time, that is, whether the differences are ong asting. The same anaysis can be between pre-course data and six months data. A correation matrix to check for associations between a variabes. Checking whether years of experience in dermatoogy makes any difference in confidence and competence. With numbers over time, repeated measures anaysis for a three time points and a variabes can be undertaken. Heath Psychoogy Update, Voume 25, Issue 2, Autumn

10 Poy Buchanan et a. Concusions and recommendations This two-day Mastercass received a positive evauation from a participants, meeting course objectives. such objectives are rooted into evidence on the extent and severity of increased psychosocia needs of dermatoogy patients and the potentia benefits of psychosocia assessment and management of such patients. Despite such evidence, psychosocia training has been imited so far for professionas working in dermatoogy (Keyworth et a., 2014). This Mastercass programme aimed at addressing this gap, therefore faciitating better and more costeffective management of such patients within the Nhs. The mutidiscipinary and interactive approach served we in creating a usefu earning environment. The action research approach provided a robust framework for evauation. The course content was appropriate and met the expectations of the participants. The sma group forum served as a safe, non-threatening, supportive environment to discuss potentia uncomfortabe or distressing cinica experiences and situations. Limitations of the project incude a sma cohort of participants and absence of a contro group. Ongoing evauation of change in practice wi be undertaken. This Mastercass can faciitate psychosocia assessment of patients needs which in turn may enhance patient consutations to improve experiences and patient outcomes. A strong recommendation is for this course to be made avaiabe to a wider range of dermatoogy practitioners and roed out across scotand and the UK. An additiona mentorship programme woud be usefu to support practitioners consoidate and sustain change in practice foowing course competion and most importanty to consoidate and embed into cinica practice psychosocia earning obtained through the training. Key points/take home messages: Traditiona modes of care in dermatoogy often fai to provide an environment which encourages meaningfu hoistic needs assessment of patients. This paper documents a psychosocia approach, in using a Mastercass to change the environmenta, working practice and cuture within dermatoogy settings. The Mastercass proved successfu in increasing confidence and competence of dermatoogy nurses in assessing psychosocia aspects of care. The Authors Poy Buchanan Lead Nurse, research and Deveopment, Nhs Fife. Barbara Page MBE independent Nurse Advisor. Karen Stephen Lead Nurse Dermatoogy, Nhs Tayside. Janice Bianchi Medica Educator, Gasgow University. June Gardner Cinica research Manager, University of Dundee. Zoë Chouiara Practitioner heath and Counseing Psychoogist & Psychotherapist/Counseor, reader in Person Centred Care, Edinburgh Napier University. Correspondence Poy Buchanan Emai: pbuchanan1@nhs.net 42 Heath Psychoogy Update, Voume 25, Issue 2, Autumn 2016

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