Developing

1

• Developing
• Acute Inpatient
• Services
• in
• Greater Glasgow Clyde

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Developing Acute Inpatient Services

• Change Drivers
• Service user carer concerns
• Professional concerns
• National reports - inpatient care struggling
  peoples needs not being met poor environments
• Risk averse, defensive practice prevailing
  culture of clinical observation rather than
  clinical engagement
• Stifling effect on practice development
• Undermining attempts to meaningfully engage with
  people and their carers
• National directives

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Developing Acute Inpatient Services

• The Perceived Role of the Ward Nurse
• Prevention of untoward incidents and physical
  harm increasingly being seen (by some) as the
  sole focus of the role.
• Perception that the role is not as dynamic as
  that of community colleagues
• However
• Mental Health Nurses have a critical part to play
  in supporting people towards recovery.

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Developing Acute Inpatient Services

• Gartnavel Royal Hospital New Build
• Guiding Principles
• Care will be person-centred.
• Single room accommodation.
• Flexible use in terms of gender specification
  enabling single sex segregation
• Must respect the individual and recognise their
  full rights and responsibilities as a citizen.
• Promote a personal sense of safety and security
• Vulnerabilities will be managed by the least
  restrictive means necessary

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Developing Acute Inpatient Services

• Gartnavel Royal Hospital New Build
• Guiding Principles
• A sense of safety will be promoted by a range of
  approaches including
• Appropriate levels of staffing
• Effective engagement and involving people in
  their own care
• Informed clinical judgement
• Safe systems of work
• Environmental and physical security integral to
  construction requirements
• People will have access to information on their
  care
• Care plans will promote self determination,
  informed choice and equity.
• Each person will be viewed and treated as a
  unique individual and not pre-judged.

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Developing Acute Inpatient Services

• Recovery
• A personal, collaborative process which seeks to
  overcome the negative impact of diagnosed mental
  illness / distress despite its continued
  presence.
• About self-determination, recovering control over
  ones life, feeling valued as a person, feeling
  heard, contributing to the community, helping
  others
• Not just about symptom control.

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Developing Acute Inpatient Services

• What Would be the Key Attributes of a New and
  More Effective Approach?
• Acknowledge the central role of people in
  assessing their needs and planning, implementing
  and evaluating their care.
• Respect people, value their contributions and
  preserve their dignity.
• Empower people to take control of their lives and
  instil hope.
• Bring structure and clarity to the role of the
  mental health nurse.
• Provide a platform for further practice
  development.

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Developing Acute Inpatient Services

• Principles of Care.
• Professional curiosity what makes this person
  different from every other person with the same
  diagnosis.
• Harness the persons natural resources work
  with the persons assets and strengths inner
  and environmental / situational
• Respect value the persons wishes and
  aspirations, recognise the person is the expert
  in their personal situation. (The wisdom that
  comes from the lived experience)
• View crisis as an opportunity as a natural
  signal that something has to change.
• Think small and simple achievable highly
  specific goals are best - look for
  straight-forward uncomplicated interventions
• Work with the person caring with caring about
  but not caring for

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Developing Acute Inpatient Services

• Key Questions
• How do we ensure that we really listen and
  respect the persons story.
• How do we balance the professional perspective of
  the persons needs with their perspective?
• What is the persons personal theory? How does
  the person understand their problem, what is
  their experience of it?
• How do we seek to limit restrictions? Aim to
  use the least restrictive means of helping the
  person resolve their difficulties.

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Developing Acute Inpatient Services

• Suggested Components of an Inpatient Recovery
  Model.
• Multi-disciplinary assessment
• Persons personal assessment of their situation
• Planning the joint management of vulnerabilities
• One-to-One Sessions
• Group-work

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Developing Acute Inpatient Services

• Aims of the Personal Assessment
• Gives the person the opportunity to describe,
  discuss and examine their experience of illness
  and health.
• Focused on the persons needs as s/he sees them.
• Identifies their chief problem(s) - problems are
  rated
• Written in the persons own words and signed off
  by him/her.
• Demonstrates the nurses understanding of the
  persons situation
• Sets the agenda for the ongoing one-to-one
  sessions
• Ensures that the careplan addresses the persons
  concerns as well as professional concerns

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Developing Acute Inpatient Services

• PERSONAL ASSESSMENT
• Beginning of Problems When I first noticed or
  became aware of things.
• Past Effect of Problem(s) How this affected me
  at first.
• Past Emotions How I felt at the beginning.
• Developmental history How things have changed
  over time
• Situation, Relationships and Practical
  Resources/Problems How this has affected my
  relationships / Other aspects of my life e.g.
  finances, family/friends, others, housing,
  employment/unemployment
• Thinking My view of things or what I think about
  them. What I think about- My present situation /
  My memory and concentration / My view of myself
  / My life generally / My view of others / The
  future
• Emotions, Mood and Feelings How I feel now
  within myself

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Developing Acute Inpatient Services

• PERSONAL ASSESSMENT
• Physical feelings, health and symptoms My view
  of my Physical Health e.g. known physical
  conditions or illnesses, weight, appetite, bowel
  habits, sleep, pain, mobility, smoking and
  drinking/substance use habits.
• Behaviours / activity levels My view of how I am
  behaving and coping, organising my life and
  getting on with things. My involvement in
  interests and hobbies socialising and meeting
  people
• What all of this means for me.
• What all of this says about me as a person.
• Needs, wants, wishes What needs to happen now,
  What I want or wish to happen.
• Expectations What I think the ward team could do
  for me.
• My Signature Nurse Signature

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Developing Acute Inpatient Services

• Planning the Joint Management of Vulnerabilities.
• Integral to the careplan
• Requires to be reviewed and updated regularly.
• Linked to a planned process of engagement
• Identifies what (exactly) the person might be
  able to do for themselves to reduce the
  likelihood of untoward events occurring and help
  them feel safe
• Monitoring promotes engagement

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Developing Acute Inpatient Services

• Benefits of Jointly Managing Vulnerabilities.
• Not just about keeping the organisation safe.
• Person is actively contributing to their own
  careplan
• Identifies the kind of support the person might
  need from the clinical team to help self-manage
  their own vulnerabilities not what is going to
  be done to them.
• Clearly sends the message that the clinical team
  recognises that the person has strengths and
  potential to recover
• Less paternalistic approach, promotes self-esteem
  and instils hope

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Developing Acute Inpatient Services

• Example of an Individual Vulnerabilities
  Management Plan.
• I have discussed my specific needs with my
  keyworker and we have agreed that I will
• Read over letters from my family everyday to
  bolster my self esteem
• Make a note in writing each day of the people who
  have demonstrated that they value me for who I am
• Listen to music on my walkman and talk to people
  as a means of distracting myself and dealing with
  my voices
• Seek out my Named Nurse if I am feeling
  vulnerable
• Attend the Recovery Groups in the mornings
• What can others do that I might find helpful?
• The nurses will spend time with me to find out
  how I am coping at least 4 times every day and
  will be happy to talk to me over and above that
  whenever I feel the need.
• -

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Developing Acute Inpatient Services

• Focus of the One-to-One Work.
• Addressing the immediate needs of the person and
  the continuation of the personal assessment and
  problem solving process.
• Jointly identifying simple achievable goals
• Encouraging the person to become aware of the
  part they can play in identifying needs and
  working out potential solutions.
• Instilling hope by developing the persons
  awareness of change however small or gradual.

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Developing Acute Inpatient Services

• Aims Of The Group-work.
• Share experiences of difficulty, distress and
  disability.
• Obtain support from other group members.
• View problems from a different perspective and
  learn from the experiences of others.
• Experience helping others.
• Share information
• Explore new options for resolving problems.
• Develop assertiveness, social skills and
  problem-solving skills

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Developing Acute Inpatient Services

• Engagement not just Observation
• Engagement level 4 Everyone is offered at least
  one therapeutic session per day one-to-one,
  group meeting, family meeting etc.
• Engagement level 3 Nurse makes formal contact at
  least 3 times during the day
• Engagement level 2 Nurse makes frequent
  enquiries throughout the day to assess persons
  wellbeing
• Engagement level 1 Nurse in constant attention
  throughout the day to offer support

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Developing Acute Inpatient Services

• Key Messages.
• Listen to the persons story listen intently,
  listen, enquire, listen again dont assume.
• First question - what is it that makes this
  person different from other people I have met
  with the same illness?
• Work in partnership with the person do with
  not for.
• Demonstrate understanding - use the persons own
  words to describe their situation and support
  them to address their chief problems - as they
  see them.

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Developing Acute Inpatient Services

• Understanding the Person.
• Be professionally curious
• Never assume you know everything about the person
  (or about nursing).
• If the nurse acknowledges they dont know
  everything they need to know it encourages
  humility.
• Cultivate a non-judgemental approach / attitude
• Let go of preconceptions - if we pre-judge a
  person as good or bad we will fail to understand
  them.
• There is no such thing as good solutions or bad
  solutions what works for one person might not
  work for another.
• If the nurse is non judgemental then respect for
  a wide diversity of opinion, thought and culture
  should follow.

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Developing Acute Inpatient Services

• Key Leadership Messages
• Listen to the concerns of staff and service users
  / carers and explore potential solutions with
  them.
• Communicate the new approach as a solution not
  another task on top of everything else.
• Plan - prepare the ground visits, meetings,
  consultation events, highlight the potential
  benefits
• Be able to communicate the vision but be flexible
  - ensure scope for local input and innovation -
  dont tell people precisely how to do things
• Dont get obsessed with documentation

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Developing Acute Inpatient Services

• Key Leadership Messages
• Invest in training at all levels
• Identify, invest in and support practice
  development champions
• Ensure effective collaboration steering groups
  / local implementation groups with input from all
  stakeholders
• Be brave enough to try new things but big enough
  to admit when things are not working and learn
  from the experience
• Evaluate locally more evaluation less routine
  audit!
• Dont just invest in the pilot areas and expect
  things to work elsewhere without the same level
  of support.