Ward revamp boosts both patient care and nurse team
Ward manager Debbie Chown talks about her involvement with an award-winning project to improve her ward’s environment for patients
Working on an older people’s mental health admission ward is always challenging. Our patients have either functional or organic illness and are only admitted on the ward when they cannot be safely managed in their home setting. They may present with agitation, aggression, cause harm to self or others, self neglect, have mobility issues, or a combination of all of these.
When nurse consultant Geraldine Rodgers first approached me, as ward manager, about improving the ward as a fellowship project, I had doubts about how much we would be able to achieve.
There had been an increase of aggressive behaviour and the ward, which is actually quite spacious, felt cramped. Some patients preferred to spend time in their bedroom rather than being out on the ward where we could encourage them to socialise with others and attend groups. Some relatives and carers needed reassurance that the ward was safe. Staff felt they weren’t always able to give their time fairly to all patients and morale was sometimes low.
Both Geraldine and I felt strongly that we included not only all the professional teams on the ward but the patients and carers too. Through focus groups and looking at safety crosses (from Productive Wards), we identified an increase in violence/aggression on the ward and talked about how this could be reduced.
The focus groups were completely multidisciplinary and staff were encouraged to give honest feedback. Geraldine spent time getting to know staff, patients and carers on the ward in a very unobtrusive way so she got a true reflection of our experiences - the challenges we face on a daily basis and our strengths.
We then consulted with staff, patients and carers and it was identified that nature/outdoors was something that initiated calmness and relaxation. The staff felt involved throughout the process, from the more formal focus groups to extremely informal voting for toilet door colours and choosing which lavender themes we wanted.
Not all of our patients can always go outside so the idea of the ‘garden room’ [video to come] - where people can experience the outdoors through sight, touch, smell and sound without leaving the ward – began to take shape. It has made the biggest difference of all the changes. How great that we can provide music, bird song, different garden smells, books about gardening and nature, the fabulous wallpaper, the artificial grass.
On a daily basis I see the patients, relatives and staff enjoying spending time there and benefiting from getting a glimpse of outdoors, indoors, especially when the weather is bad or the patient is too unwell to go actually go outside. Comments include that ‘it makes coming the ward less intimidating’, ‘it shows that staff care about their environment and care about making things nicer for the patients’ and usually ‘oh, it’s so lovely!’
It’s a great place for patients to have one-to-ones with staff in a non-clinical environment where they are not going to be disturbed. The sensory aspects of the rooms are utilised and a great favourite is having a lavender scented hand massage.
Having the opportunity to give the patients a completely different experience, whether it is someone is restless, wandering around at risk of falling over, someone who is confused and wants to leave the ward to see a relative who has long since passed away or someone who just wants to sit quietly or talk to staff away from the daily noise of the ward, is very rewarding to us as staff.
One of our staff nurses regularly takes a small group there in the evenings to chat about whatever the patients want. I’m not sure who enjoys it most.
Having coloured doors for the toilets has made a positive impact in reducing incontinence for patients that may be confused. Now toilets are easily identified. We have also found patients are no longer rushing to try to find the toilet in time, reducing the risk of falls.
The changes made across the ward have created a homely, less clinical, more familiar, calmer environment for our patients and the impact to both patients and staff has been amazing (statistics below).
The project has provided the staff with more tools to use in managing challenging behaviour and reducing aggression on the ward. The results speak for themselves.
Staff see that change is possible, they have confidence to give their ideas to improve the quality of our patients care, knowing that they will be listened to, whether they are ‘quick wins’ – changing all the patients’ laundry baskets to smarter ones that don’t easily get broken, or longer term projects – getting new chairs on the ward that reduce risk of pressure sores.
Although the patients that were on the ward at the time have long since been discharged, I feel it was extremely important that we had their involvement throughout. They were listened to and they have left their legacy to help new patients’ experience be a positive one.
Personally, it has helped me realise how many ideas and innovations are out there to help our patients’ experience in hospital be more positive and less limiting and that we can access and achieve change. The ward team is looking forward to being part of many new projects.
I would definitely recommend other wards or clinical areas to get involved with a similar quality improvement project. The involvement of everyone from staff of all disciplines to patients regardless of how unwell they were to our relatives and carers made it the success it is. It was a brilliant opportunity to work together and make change happen.
Debbie Chown is ward manager of an older people’s mental health ward at NEFLT
Impressive benefits of improving the ward environment for patients with dementia
Nurse consultant Geraldine Rodgers’ project to create a more homely environment on the older people’s mental health ward has led to a fall in aggressive incidents, the use of restraint and antipsychotic medication, as well as staff sickness levels.
The money saved on agency spend has already more than funded the changes.
The impact on violence and aggression has been impressive and the 20 per cent reduction target significantly exceeded. There were 81 incidents of verbal aggression and 47 of physical aggression in the six months before the environment improvements. This fell to 28 (a 40.4% decline) and 33 (a 59.3% reduction) incidents respectively.
Before the project, less than 30% said it was ‘extremely likely’ they would feel safe on the ward. This has more than doubled to 64% of patients.
The project’s balancing measures - including confidence in staff, use of anti-psychotics, staff sickness and use of restraint – also showed a marked improvement.
The average monthly number of episodes of staff sickness fell from 3.8 days to 2.2 days per month, a 42% reduction. Days lost to sickness fell 64% from 26 a month to 9.3.
Her achievements were last month recognised at the prestigious RCNi Nurse Awards, where she won the Hallmark Care Homes-sponsored Nursing Older People category.