The Patchwork Quilt by Valerie Douglas

A doctor once told me that I had a portfolio career.  As my working life as a nurse in the NHS draws to a close it seems to me more like a patchwork quilt, assembled from many knitted squares.  Beginning in a psychiatric rehabilitation ward, I moved to acute admission in the old Crichton.  I dipped in and out of that ward undertaking secondments: to the Clinical Research Department, a Lecturer/Practitioner role, Care of the Elderly, Patient Safety and Improvement.  Then full circle, I moved back to rehabilitation nursing, this time interwoven with forensic threads.  Knit one, purl one.

Recently I’ve been on a partnership working secondment, with seats on the IJB and the RCN Board.  I have needed to insert some elasticated fabric into my knitting, as this has stretched me in directions unlike anything experienced before.  

With retirement imminent it is inevitable that I reflect on the whole quilt, the completed work, and remember the dropped stitches, the unravelling I’ve seen, the piecing together, the mending.  Some squares have faded with time but others remain vivid.

The Quiet Man.  This inpatient was polite, smart, of late middle age.  He wore his depression like a waistcoat watch, well-hidden in a little pocket.  You could just catch a glint of it if you really looked.  One Friday he went home for the day.  This wasn’t unusual.  He would typically return before 9 pm.  When he didn’t appear, staff phoned him.  No answer.  They phoned his family.  No, he didn’t have plans to come home that day, he had informed them explicitly.  Alarm bells rang and rightly so.  He never returned.  He had chosen a way out of his deep, silent despair.  Our thoughts of course went out to his lovely family for their loss.  But today my thoughts are also for us, the staff who nursed him, the doctors who treated him, the domestics who cleaned his room, the ladies at medical records who received those final ward documents.  I wonder if they still mourn him like I do over twenty years later.

Miss M.  Mute, traumatised, psychotic, she hardly ate or slept.  I was on a spell of night duty and would sit by her bed, talking to her, after giving her medicine.  She would listen intently, not responding.  ‘Looks perplexed’ were the words used most often to describe her in nursing notes.  After about a week she was out of bed when I arrived for night shift.  She glided around the ward, keeping close to the walls, vigilant.  One evening I took chocolate éclair sweets in.  I gave three to the nurse and three to the nursing assistant, saying to Miss M as she passed, ‘I’m leaving these three sweets on the table for you.’  She neither slowed nor acknowledged me.  A short while later the nursing assistant bounded into the office, ‘She’s taken those sweets.’  In mental health nursing it is often not diagnostic tests that expose signs of improvement, but observation and engagement.  Nurses can usually pinpoint turning points – medication has started to work, trust has been gained – and I have never forgotten the night of the sweets.  Each Christmas I’m reminded of Miss M when I hang the tinsel angel she made for me before her discharge.

Nursing has presented me with many patterns to follow, using different weights and colours of wool, some challenging designs.  Although all secondments have been worthwhile, I’ve always chosen to return to hands on nursing, the role I rate the highest, the role I value, the one I will miss the most.  Knit one, purl one.

 Val Douglas RMN, DipN, BSc (Hons), MSc Research (nursing)

Take Two Bottles Into The Shower? Not me, I’m a Clinical Health Psychologist by Ross Warwick

Because you’re worth it

Bang! And the dirt is gone!

Eat fresh

I’ve been thinking a lot about advertising these past few weeks as September is a significant time for my team in Clinical Health Psychology. This month we will be making a concerted effort to promote our service, raise our profile and increase our contact with the people we aim to help.

As part of this, Ken has kindly allowed us to take over the blog for a few weeks. I’m kicking things off with an account of what the service does and I thought I would take inspiration from psychological tricks used in the world of advertising to help draw you in and get the message out there.

I’ll start, then, with a summary of the service that follows the advice of a Professor of Experimental Consumer Psychology at the University of Wales, Jane Raymond. Prof Raymond advises that rather than bombard the audience with information I should break it into chunks to allow the brain time to process each component:

• Chunk 1: The Clinical Health Psychology service helps people who have a psychological problem that is caused and maintained by a physical illness.
• Chunk 2: These problems usually involve unpleasant feelings and unhelpful thoughts about the illness that keep someone from doing things that matter to them.
• Chunk 3: This can cause distress, affecting overall well-being, medical treatment, self-management and health outcomes

An article in a social psychology journal showed that a wide range of people respond well and are persuaded by stories (Thompson and Haddock, 2012). So to illustrate chunks 1-3 here’s a fictionalised case based on real events:

“Jane is a young teacher who has type 1 diabetes. Her condition and the things she must do to keep on top of it are often accompanied by feelings of shame, anger and loneliness. She has frequent thoughts that her condition means she is abnormal and that it must be hidden from others. Because of these unhelpful thoughts and feelings she avoids testing her blood, guesses her insulin levels, is inconsistent with her diet and keeps problems to herself.

She has been absent from work and in and out of the DGRI several times within the past twelve months. Because of this she believes friends, family and colleagues are annoyed with her for not taking proper care of herself and landing them with more responsibility. As a result, she avoids seeing people and has become more and more isolated.”

The next steps for Jane are chunked below:

• Chunk 4: In therapy we would work with Jane to live well with her condition by addressing her unhelpful thoughts, feelings and avoidant behaviour
• Chunk 5: As therapy is all about collaboration, Jane’s most likely to have a good outcome if she’s motivated to participate and make changes to her life
• Chunk 6: Jane can be referred to Clinical Health Psychology by anyone who is involved in her care, be it her GP, Practice Nurse, Dietician, Diabetes Specialist Nurse or Consultant.

In Jane’s story, she’s in and out of DGRI because thoughts and feelings stop her from acting in a way that would help keep her well. So psychological therapy would add value by reducing her distress and unplanned contact with services (and by highlighting that sentence your attention has been focused on a key message about how psychology makes a difference to both the person and the hospital; Pieters and Wedel, 2004).

But would you believe that individual therapy expertly delivered by members of our experienced, compassionate, and, yes, attractive, team is but one feature of our service? In Clinical Health Psychology we also provide training, teaching, supervision and consultation because you don’t need to be a psychologist to provide psychological care (worth mentioning because (a) it’s completely true and (b) according to Goodman and Irmak, 2013, audiences are likely to prefer multi-featured products).

Already the Diabetes and Cardiac Teams are benefitting from increasing their psychological knowledge and skill through participating in Emotion Matters training, and a group of local GPs have recently completed training to introduce CBT techniques into their routine consultations. Recruitment of a second cohort will be underway soon.

Time for pictures of the product:

By now thanks to my evidence-based and scientifically informed techniques of persuasion, you will no doubt want to know how you can benefit from working with our wonderful service.

You can contact us by email or by calling us at the psychology department to talk about matters psychological, be it complex cases, potential referrals, or training your department. Find out more about making referrals by consulting our service leaflets which are available absolutely FREE through Beacon by searching for ‘Clinical Psychology’ or looking under ‘Documents’ after following the link below. And as the Patient Information Leaflet can also be found there, you enjoy a 2 for 1 bonus!

http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/?pageid=Sitesearch&searchCriteria=clinical%20health%20psychology

Keep your eyes open for opportunities to attend training events we’re delivering this month and enjoy the blog posts written by the Clinical Health Psychology team over the next few weeks. Finally, to eke this advertising ruse out just a little further, comment below to be part of a Clinical Health Psychology virtual focus group.

Just do it.

Ross Warwick is a Consultant Clinical Health Psychologist and Lead for Clinical Health Psychology at NHS Dumfries and Galloway

With occupational therapy you CAN… by Wendy Chambers

If I had a penny for each time during my career someone asked me “what is occupational therapy?” I wouldn’t need to be playing the lottery this weekend!

Next week is national occupational therapy week, November 7 – 13^th2016, #OTweek16 for those Tweeters out there.

So prior to its launch on Monday I’m offering you the opportunity to have an insight into this lesser understood, enigmatic profession. So pour yourself a contemplative cuppa and have a read.

Occupational therapy is a science degree-based health and social care profession, regulated by the Health Care Professions Council. It is one of the ten allied health professions. You can train to either degree or masters level, at any of three universities across Scotland.

Occupational therapy takes a whole-person approach to both mental and physical health and wellbeing, enabling individuals to achieve their full potential.

We work with children and adults across a variety of settings including health organizations, social care services, housing, education, re-employment schemes, occupational health, prisons, and voluntary organizations or as independent practitioners.

So what does that mean, what do occupational therapists actually do?

Well, as occupational therapists we think about “occupation” as any activity any of us does day to day, which is important, necessary or which we enjoy.

The range of “occupation” is endless. If I use myself as an example some of my daily “occupations” would be putting on my clothes in the morning, reading my emails at work, making a meal for my family, riding my bicycle.

The occupational therapists job is to consider how, if I was the service user, the changes in my mental or physical health are making it difficult for me to be able to do these “occupations”- the things I want or need to do day to day.

They need to understand what’s important to me in my life? What would allow me to stay in control and live my life my way?

Occupational therapists are adaptors; maybe that chameleon like ability is why people are often unsure what it is we do?

So for example in order to help me to keep riding my bike after an episode of depression the occupational therapist will problem solve and adapt either:

–the activity itself: maybe I should try going out for 10minutes, twice a week, with a close friend who also bikes, somewhere that’s easy to access and doesn’t take long to get there, with a nice coffee shop on the way back

–the surrounding environment and tools I use: maybe a tarmac cycle route would be easier, at a quiet time of day, and my bike could do with a service first so it’s working properly (they help me think through planning and organizing that)

–me: set SMART goals which I can achieve, to keep me motivated, help me think about what I value about biking and help me understand and make the link between doing an activity I enjoy and feeling better about and improving my mental health

So back to that question again “what do occupational therapists do?”

I guess the bottom line is it ends up looking different each time, as we are all different as people and what’s  an important “occupation” to me may not be important to you.

And we work in so many different settings, with different age groups of people, that that also makes what we “do” look different.

Ultimately it isn’t what the occupational therapist “does” that matters, rather what the person ends up being able to do that’s important.

So for occupational therapy week this year I’ll leave you with this thought,

“With occupational therapy you CAN….”

Wendy Chambers is Team Lead Occupational Therapist for Mental Health and Learning Disability Service at NHS Dumfries and Galloway

 

Top of the Pops (My Top Ten) by @gbhaining

This blog is to celebrate the fact that after twenty seven years I have taken the life changing decision to retire from NHS Dumfries and Galloway. I have had the honour and privilege of being the Alzheimer Scotland Dementia Nurse Consultant for the past two and a half years.

This is an effort to describe some of the work undertaken during my time as nurse consultant and I had an idea that I’d try to link it to popular songs thus the rather dated Top of the Pops theme.

I must say that I’ve gone with the titles in the hope that some of the lyrics reflect my comments.

So let’s begin. 

10. Another Brick in the Wall (Pink Floyd). I was delighted to be appointed as Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway in December 2012. This was a new post and with the support of others I pretty much developed and evolved the post in keeping with the national standards, strategies and drivers. I believe I have built the foundations required to take this agenda forward.

 

9. We are the Champions (Queen). In the past two and a half years I have had the absolute privilege of leading and supporting Dumfries and Galloway’s Dementia Champions. I have to say they work extremely hard advocating the best care for people with dementia when they have to be admitted to our acute and community hospitals. This is one of the pieces of work that I am extremely proud of and I want to thank each and every one of them for being so motivated, enthusiastic and most of all for engaging with me.

 

8. Long and Winding Road (The Beatles).This journey has been challenging however I have built up some excellent professional relationships. I have flown the flag for dementia and I truly believe there is a far greater understanding of the needs of this group of people. I believe we have turned some of the corners and I’m sure as an organisation we will continue to do so.

 

7. Feeling Good (Nina Simone).I think that there is a great willingness to work together to make services person centred and to deliver care at the right time and in the right place. This fills me with pride and optimism.

 

6. Funny How Time Slips Away (Willie Nelson).Personally it feels like yesterday I was starting my nurse training and trying to figure out how to put my nurses’ hat together! I’ve had a fantastic career and learnt so much over the years. I’ve worked with some fantastic people who’ve encouraged, nurtured and seen my potential. That’s something I will be eternally grateful for. We all need to do this and help people develop and reach their maximum potential.

 

5. 9-5 (Dolly Parton). Although it should read 8.30am – 5pm there will be no more “Working 9-5” for me!

 

4. 40 Hour Week (Alabama). Time now to rest, relax and enjoy my family life, catch up with friends and find time for all those things I’ve always put off.

 

3. It’s Five o’clock somewhere (Alan Jackson and Jimmy Buffet). Self explanatory I think!

 

2. When All Is Said and Done (ABBA).I hope that I have left the beginnings of a legacy for people living with dementia, their families and carers and that they will recognise a change as this work continues. We never know the time when we, our families and friends will require services and I’m sure we will continue to strive to deliver the best standards of care for all our citizens.

AND NUMBER ONE THIS WEEK IS !!!!!!

 

1. So Long, Farewell (Rogers and Hammerstein – The Sound of Music).I officially retire on the 28^th August. I wish all my colleagues and friends well and want to say thank you so much for everything!!

Gladys Haining is an Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway.

 

 

 

 

 

Mental Health Change Programme by Ian Hancock

Government policy, changing demographics, epidemiology, health inequalities and increasing public expectations services, requires NHS Scotland to flex and bend to meet healthcare needs of the Scottish public.

The challenges faced by NHS Dumfries and Galloway Mental Health Service Directorate are no different from the national perspective, and have required innovative thinking which have seen the development of better ways of working.

The demographic changes facing Scotland are well documented, with the number of people in Scotland aged over 65 projected to increase by 22% by 2020, and by 63% by 2035. The over 75 population is predicted to increase by 23% and 82% over the same period and the over 85 population will increase by 39% by 2020 and 147% by 2035. Our current service will need to adapt to meet the healthcare needs of this growing population

We all recognise the benefits of keeping people at home, or within a homely setting, as close to their family, friends and local community. The Mental Health Service works closely with patients, carers, statutory and third sector colleagues to provide services that, wherever possible, prevent unnecessary hospital admission. There are, however, times when admission to a hospital is necessary and with this in mind, we have been developing our services over a number of years, and have seen a huge shift from hospital based care to community settings. We need to capitalise on our previous successes and have identified ways in which we plan to move ahead over the coming years.

The Mental Health Service Directorate comprises of four large component service teams (Mental Health, Learning Disability, Substance Misuse and Psychology) and within these teams there are a range of individuals from different professional backgrounds (nurses, AHPs, administrative staff, HCSW, Medical Staff, Psychology, and workforce business partners from Workforce Directorate, Finance). We have 2 in patient units based in Midpark, and in Darataigh in Stranraer, and have numerous community bases across all 4 localities

Over the next few years, the Mental Health Directorate will continue to strive to provide care that aligns with contemporary healthcare policy and legislation, and do this in a collaborative way with our stakeholders. In order for us to ensure appropriate services are being delivered, and that will meet the health needs of the general public of Dumfries and Galloway, we will continue to focus on a number of specific areas.

We will consider ways in which our inpatient beds are configured and consider opportunities to improve individual’s experience of in patient care, whilst developing inpatient services in line with our changing demographics. Services will be based on patient need rather than age.

We will support and evaluate the current 24/7Crisis Assessment and Treatment Pilot Service (CATS), based in the Out of Hours/Accident and Emergency Unit

We will develop our IDEAS (Interventions for Dementia, Education, Assessment & Support ) Service, a team designed to enhance skills in statutory and non statutory services specifically for individuals with a diagnosis of dementia.

We will develop a model of care that takes into account the challenges associated with our more remote and rural areas.

We will develop services which provide early interventions for people with memory problems, and develop Health Care Support Workers to work with families living with dementia.

This is an exciting time with significant challenges to face. We think, however, that we can offer a modern and effective service, within budget, but that such successes will inevitably rely on continuing to build strong working relationships with our service users, carers, and families, colleagues from all health and social care settings, and third sector partners.

Ian Hancock is the General Manager for the Mental Health, Learning Disability, Substance Misuse and Psychological Services Directorate

The Home Based Memory Rehabilitation Programme by Emma Coutts

When I took up my post as an Occupational Therapist, within the Mental Health Substance Misuse and Learning Disability Service as a new graduate, I was unsure what to expect!! Having had a placement within the service I was familiar with the client group and the team however coming into this as an OT is very different to being a student! And my first initial thought was ‘what will I be doing as an OT?’

This is where the Home Based Memory Rehabilitation (HBMR) programme comes in! First suggested to myself and Corinna Sidebottom (OT, who started at the same time as me) back in 2012 as a possible piece of work we could develop within the service, who knew the success this would have?!

HBMR was originally developed in Belfast City Hospital in 2007 by Advanced Specialist OT Mary McGrath. It was developed as part of the cognitive rehabilitation approach for the treatment of people with acquired brain injury; however was found to be equally appropriate for the rehabilitation of cognitive deficits, including memory problems due to early stage Alzheimer’s disease.

It has been recognised that the main approach to helping people with memory difficulties to engage within their activities of daily living is to try to find ways to compensate for impaired memory, through memory rehabilitation strategies.

The idea of cognitive/memory rehabilitation interested me – we often associate rehabilitation with the likes of having had a broken bone and regaining the function within the specific limb, but we don’t commonly associate this in relation to Dementia (or at least, I didn’t!).

Cognitive rehab is defined as an individualised approach which should focus on real-life, functional problems a person experiences. Central to this is an understanding of the person’s strengths, abilities and deficits from a holistic approach, which as a profession, incorporates our core beliefs.

So what exactly is the HBMR programme? And how as new band 5s, were we going to develop this and pilot it within our service?

After various meetings we developed a modified version of Mary McGrath’s programme and we were then ready for a 6 month pilot.

Our HBMR Programme

The HBMR programme is a 4-6 week programme, delivered to the client, in their own home with caregiver/family support where appropriate. The pilot programme consisted of 4 sessions:

1. Remember where you have put something
2. Remember what people have told you
3. Remember what you have to do
4. Remembering people’s names and coping in social situations

Each session covered a range of memory strategies such as a memory book, memory board, post-its, safety checklist, using a calendar, medication checklist to name a few. These are all things any one of us could use within our daily lives to remind us of daily tasks.

The key to the programme is the structure and repetition of emphasis placed on the strategies and so each time a new session is delivered, all previous strategies are revisited to ensure the client is using these and is confident in doing so. It is this repetition that encourages new learned behaviours within people with early stage memory impairment and creates the habits that are more likely to be remembered as memory loss continues. 

 

 

 

 

 

HBMR Programme – Pillot Results

Following our 6 month pilot, we compiled our evaluation – which in my opinion not only demonstrated the effectiveness of HBMR but also highlighted that people with early stage Dementia, can learn new skills!!

The graph below clearly demonstrates that following completion of the programme, at 3 month review there was a significant increase in the number of memory strategies clients were using. And as a result, a slight decrease in the number of reported memory difficulties they experienced. 

Our Success!

Since completion of our pilot we have been working on promoting HBMR and how we can further develop this.

A key highlight of the whole process for me has to be winning ‘Best Community Support Initiative’ at Scotland’s Dementia Awards in Glasgow. Although probably the most daunting, as this involved making a small speech!! 

 

Our poster has also won at national events and was displayed within the poster presentation at last year’s Alzheimer Europe conference. 

The HBMR programme also features within Alzheimer Scotland’s ‘Allied Health Professionals Delivering Post-Diagnostic Support: Living Well with Dementia’ Publication which can be found at: http://www.alzscot.org/news_and_community/news/3197_three_new_publications_for_allied_health_professionals

The future of the HBMR programme

We are currently looking at how to develop the programme, with a view to sharing this locally and nationally. Since pilot completion, we have reconsidered the session topics and we have now created additional areas we feel are important to cover. The programme still takes place over 4-6 weeks however now covers the following areas:

1. Remember your priorities
2. Remember what people have told you
3. Remember what you have to do
4. Remember people’s names and coping in social situations
5. Remember to keep your brain active
6. Remember your bearings

We are also considering other possible ways to deliver the programme such as the use of technology.

We have also been looking into the branding of the programme and are looking to have our resources and manual ready within the next few months and as mentioned, we hope to share this both locally and nationally!

I am probably very bias about the programme as I have been involved from the beginning! but I hope reading about the effectiveness of HBMR, has encouraged you to think about the ability to learn new skills in early stage Dementia and how this may impact on future practice…..after all – Dementia is everyone’s business!!

Emma Coutts is an Occupational Therapist with the Mental Health and Learning Disability Service at NHS Dumfries and Galloway.

Climate Change – Can we make a Difference? by @DavidTheMains

INTRODUCTION

Having enjoyed a relatively warm and sunny summer for a change, there will inevitably be the usual speculation regarding possible climate change and the effect of human activity in warming the planet. Whether or not that is accepted depends on the individual’s point of view and most people are of the view that human activity can have some overall effect on the climate.

The difference between ‘climate’ and ‘weather’ of course is that ‘climate’ is the weather that you expect depending on long term averages, whereas ‘weather’ is what you actually get. What has this got to do with patient safety and patient safety in mental health specifically?

SAFETY CLIMATE

In the same way that the weather changes from day to day but follows an overall pattern consistent with the climate, how “safe” a ward or facility is can alter from hour to hour depending on the level of activity, the number of staff and the challenges that are being dealt with. The overall ‘safety climate’ ( on average how safe a ward or unit is in terms of the number of adverse events or the quality of care) is something which can be measured, and there is increasing evidence that it can be altered by interventions to change the safety culture, and therefore climate.

MEASURING THE SAFETY CLIMATE

Tools have existed for some time which gauge a staff group in an organisation’s assessment of how safe the facility feels. The sort of questions that staff are asked include whether or not they know who to report adverse events to, whether they would feel able to report such events, and how supported they feel by managers and others. Such tools have proven useful in identifying well functioning facilities across all industries including health, versus those where the climate does not support safe practices or encourage reporting of problems.

A search of the literature however revealed to us in the Scottish patient Safety Programme for mental Health (SPSP-MH) that no-one had previously developed a specific safety climate tool aimed at the users of services, specifically mental health services. 

The SPSP –MH programme has over the last eighteen months supported a group led by VOX (Voice of Experience) to develop and amend a patient safety climate tool for use by patients in mental health facilities. All Health Boards in Scotland have now used this tool to produce baseline information regarding how safe the participating wards feel to the patients within them. Again it asks similar questions to the staff climate tool about what they would do in the event of feeling unsafe, who they would report things to, whether they feel safe at different times of day or night, or in different locations, and how they feel when things are going wrong and if they are supported after upsetting events, such as witnessing an episode of restraint.

Already this has produced exciting insights into how variable this might be and the kind of things which seem to be important to patients using our services. For instance, a very small pilot here in Dumfries identified early on that patients did feel safe during the day when they had a named nurse who they could speak to but at night they didn’t have a specific named nurse and therefore this left them feeling more vulnerable in some instances. This led to a quick and simple change to address this. 

CAN WE CHANGE THE SAFETY CLIMATE?

Having identified that a climate of safety in a ward or unit can be measured usefully using such tools, including tools used by patients or service users themselves, the key question is can the climate or culture of a facility change and can that change result in improvement?. The answer seems to be a very definite yes.

One example is where colleagues in Greater Glasgow have been developing an amended patient safety walkround to include a more mental health specific slant and a specific’ safety conversation’ which aims to gauge the safety climate, and the level of any activity around the patient safety programme within that facility. Similar to feedback from the patient safety climate tool, early use of this approach has identified variation between units, with an apparent link to the units relative engagement in SPSP-MH work to address patient safety issues.

Essentially the more teams are committed to looking at their practice and processes and to making changes to try and improve safety, the safer the ward feels, both to staff and patients. 

CLIMATE CHANGE – FOR THE GOOD?

There is no doubt that the weather in Dumfries, as elsewhere, will continue to vary, and whether the climate alters such that we will have more of the pleasant summer weather that we enjoyed remains unclear. In terms of work around patient safety changing the safety climate and culture within our services, the Scottish Patient Safety Programme is producing increasing evidence that this is the case and that hopefully the climate change that we see will be one which we don’t need to worry about and which will be to the benefit of staff and patients. 

DR DAVID J HALL is Clinical Director & Consultant Psychiatrist at NHS D&G and National Clinical Lead for the Scottish Patient Safety Programme Mental Health