Meet the RCN Nurse of the Year 2017
When Melanie Davies joined ward G at Morriston Hospital in Swansea, an investigation into the death of a patient with severe learning disabilities was underway. Now, thanks to her determination and commitment, the ward is leading the way in quality care for patients with learning disabilities.
'Never again on my ward, in my hospital, in my health board: that's what I resolved and I felt it in my heart,' says RCN Nurse of the Year 2017 Melanie Davies. 'I have driven it and made it real. I made a promise to Paul's family that no other patient or family would experience the poor care that he sadly received.'
An ombudsman's 2011 report criticised the care received by Paul Ridd, a happy, much-loved brother in his fifties, as 'dire'. He died on ward G, a surgical ward specialising in upper gastrointestinal and pancreatic complaints, in January 2009. Melanie joined as ward sister in December 2010.
'I was horrified,' she says. 'I grew up with my uncle who has a learning disability. I was determined to make sure people with learning disabilities got the best possible care and experience. I wanted to change attitudes: helping staff to understand and see the person behind the learning disability and involving patients, their carers and families in all planning and decision-making.'
Commitment to change
Paul Ridd died after being transferred from intensive care. Poor care and a lack of training contributed to his death (see box). For six years after joining the ward, Melanie advised colleagues, developed information packs, delivered training and developed a network of champions, mostly in her own time. Now her achievements, passion and commitment, have been recognised with the nurse of the year title, the profession's top accolade.
'It wasn't easy working in that environment,' she recalls. 'I didn't actually believe it could have happened until I read all the documentation.'
Melanie was not naïve about the kind of care people with learning disabilities often received in acute settings, having previously complained about her uncle's care. 'It was the whole culture on the ward though,' she says. 'This was someone who was completely dependent on us and it sickened me to hear what had happened to him.
'I was determined to make sure people with learning disabilities got the best possible care and experience'
'I am a general nurse, so I thought about how I could proactively challenge other general nurses to take this on. In the beginning, without a learning disabilities nursing background, it was difficult, but I knew little things could make a huge difference.'
She set about addressing attitudes on the ward and developed an information pack to make it easier for staff to meet the needs of people with with learning disabilities. The information pack has communication and traffic light assessment tools, as well as magnets and stickers with helpful contact numbers, which enable reasonable adjustments to care.
Traffic light assessment
For Melanie, the pack's traffic light assessment documentation is crucial. 'It is completed by someone who really knows the patient,' she says. 'It includes things we should know, things we need to know and things the family would like us to know,' she says.
'Everything is in there for whoever is caring for that person, including vital information as well as instructions on what the person likes and doesn't like. This might be loud noises or bright light, or perhaps a female patient might not like being treated by a male nurse.'
Melanie started delivering informal training sessions on the wards, explaining the packs and its tools and firmly establishing herself as the hospital's go-to person for advice when a patient with a learning disability arrives on the ward. 'I built relationships and shared good practice ideas with staff whenever I could.' Staff rang her on and off shift – 'if they were stuck, they knew they could call me any time'.
The packs and the training were rolled out across the hospital, and then spread to the Abertawe Bro Morgannwg University Health Board. 'It grew from there, and more and more people came on board,' Melanie says.
The pack has been used as the foundation for the care bundle developed as part of the Welsh assembly's 1,000 Lives campaign, which is being promoted across NHS Wales. In addition, a fundraising ball for the Paul Ridd Foundation raised enough money to cover the costs of 1,200 information packs, enough for every ward and department in Wales.
'The information packs are so important, because learning disabilities is not part of mandatory training,' says Melanie. The bundles are used and can be audited. 'We had no clear documentary evidence on the care of people with learning disabilities.'
Melanie has implemented a procedure to ensure patients are assessed before their care begins, which involves meetings with the lead nurse and care manager. Family and carers have the chance to relay valuable information to the ward team, and a personalised care plan is developed to meet all the patient's needs. There is a logo on all patient documentation, alerting staff to make reasonable adjustments. 'The logo is in a speech bubble, to highlight that communication is the key.'
She also arranges for patients with learning disabiliities and their carers to visit the hospital before planned admissions so they can familiarise themselves with the environment. Before discharge, the multidisciplinary team who have been caring for the patient in hospital also meet with the patients' carers. 'We now tell parents and families what to expect at every step,' says Melanie.
Network of champions
Changing the ward culture 'took a long, long time', she says, but there is now a network of 170 trained learning disabilities champions across the health board's four sites. Their names are on ward noticeboards, so that staff know who to turn to with any questions or issues about learning disabilities care.
Melanie now wants to work more closely with parents, carers and families and to see learning disabilities training made mandatory. Also on her to-do list is delivering teaching sessions to nursing students, and the ongoing development of an e-learning platform for learning disabilities training.
'She has done something many would not have: developed a collaborative relationship with the sister and brother of the patient who died'
Morriston Hospital's lead nurse Tina Smyth says: 'We are so proud of Melanie. She has been a pioneer in changing attitudes and behaviours towards patients with learning disabilities from passive to passionate. Her own passion for patient-centred care and her willingness to go the extra mile is abundant.
'She has worked hard to ensure staff have a better understanding of how to care for patients with learning disabilities, and that individual needs are acknowledged through improved communication with patients' carers/family. Her work makes a huge impact on the experience of patient relatives, who know they are listened to, and the patients themselves and their comfort on the ward. Patient stories highlight the progress made under Melanie's leadership.'
RCNi editorial advisory board chair Caroline Shuldham, who was on the nurse awards judging panel, highlights Melanie's empathy and 'great determination to effect change'.
'She has used personal and professional experience and persistence to make improvements to the care of people with learning disabilities,' she says. 'And she has done something many would not have: developed a collaborative relationship with the sister and brother of the patient who died, worked with them to improve care, and become a trustee of the charity they created in their brother's name. The panel were really impressed by her.'
There has been a fall in complaints related to learning disabilities care since Melanie started her work, which has been evaluated qualitatively through patient stories and carer/relative feedback.
'If we can get it right for a person with a learning disability, we will get it right for everyone'
The mother of a 21-year-old patient who had negative experiences on previous hospital admissions had been anxious on her son's admission to the ward. She later offered the following feedback: 'Mel has shown great care, compassion and understanding during our experience as a family in hospital. This has been reflected by the nursing staff on the ward and demonstrated by the care provided to my son, which is a very different type of care as he has a profound learning disability.'
Others will benefit from Melanie's work too; her mantra is 'if we can get it right for a person with a learning disability, we will get it right for everyone'. She is proud of the feedback she has recently received: 'I had a letter from a lady whose mother spent some time with us. She was nervous as her previous admission was on ward G nine years ago, about the time that Paul was here. She couldn't believe it was the same ward – the care was exceptional and the nurses happy.'
Paul Ridd's legacy
'Paul wasn't properly observed when he was on the ward and he didn't receive the treatment he needed to allow him to stay alive,' the public service ombudsman said in his report. 'The care he received actually contributed to his death. It is clear that the individual needs of Paul were not addressed and the fact that Paul had physical and mental disabilities was not taken into account with this in mind. It greatly concerns me that the dire level of care that Paul was subjected to on the ward could happen in the 21st century.'
Given this damning conclusion, the endorsement of RCN Nurse of the Year 2017 Melanie Davies by Paul Ridd's family is perhaps the most important of all.
'Not always easy'
'It was not always easy working with the family,' says Melanie. 'Hearing them tell the story of Paul's care in person was even more difficult than reading the report.'
The first time she met Paul's sister Jayne, Melanie was presenting a story of care for a patient with a learning disability.
'We had failed Paul but had got it right this time and wanted to shout it from the rooftop,' says Melanie. 'After the presentation I met Jayne, who told me she knew a friend whose relative with a learning disability had been on the ward and said we hadn't really changed. I came home in floods of tears but absolutely determined that I would prove to her we would get it right and that I was going to make a difference.'
Sometime later Jayne and her brother Jonathan visited ward G. 'It was very difficult for them because it was where Paul had died,' says Melanie. 'I wanted to tell them the changes we had made and the care we give but I got really emotional. So did my lead nurse and ward manager. It was a turning point. The family could see we were genuine about making a difference.'
Jayne and Jonathan Ridd applaud the 'fundamental change' Melanie has led at the hospital and beyond, and acknowledge the support she has given them professionally and as a volunteer for the foundation set up in their brother's name.
‘Melanie guides and inspires other NHS staff with her high standards and values. By following her example, the standard of care for patients with learning disabilities is increasing enormously throughout the hospital', says Jonathan.
'Her outstanding communication skills enable her to connect with individuals and deliver clear information. As the brother of someone who had profound learning disabilities, I know this is essential. Her genuine care for others sees her following patients' journeys throughout their hospital stay, ensuring any requirements are met, securing a safe and stress-free discharge, and that continued plans are in place for their healthcare once they leave hospital.
'Her energy, enthusiasm and compassion are to be commended. She is an amazing lady, whose dedication to her patients is exceptional. If Paul had been nursed on ward G today, we believe he would still be alive.'
The RCN Nurse of the Year award is sponsored by Royal College of Nursing