4 Dec 2008

SW Newsletter #46

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Welcome to the Star Wards’ newsletter and a warm welcome to the new members of the Star Wards’ community. The last newsletter raised considerable interest about great practice in elderly people’s wards, and we hope that this fortnight’s newsletter about some of Kent’s working age adults wards will similarly stimulate discussion and replication.

Arundel Unit, William Harvey Hospital, Ashford, Kent

Scarburgh

Although for younger adults, they are flexible, for example having youthful older people or those who have a strong relationship with the ward consultant.

The current activity greeted us even before we walked into the ward (having carefully cleaned our hands… it was Clean Hands Week.(Buddy wasn’t with me but anticipates future Clean Paws’ Week). Loud pop music was flowing out of the door, and inside there were a group of patients sitting in comfy chairs around a table littered with music CDs. The activity was a brilliant example of how a ubiquitous feature of ward life, music, could be made participative. Patients took it in turns to choose a track to be played by the enthusiastic OT/DJ, while others danced, chatted about the tracks or just sat and enjoyed what was going on.

There were lots of posters and notices on all the walls which felt very dynamic and also contemporary and connected, eg the Fairtrade poster.

Edgehill

Walking into the ward, we enjoyed a series of strikingly beautiful photographs reproduced as canvas prints. The photos were taken by patients and staff on a visit to Wye Downs, using cameras borrowed from staff as well as the OT department.

The ward had benefited from a fabulous make-over courtesy of the King’s Fund’s Enhancing the Healing Environment. The overarching themes were ‘warmth and calm’, although one of the improvements was to make the ward less stiflingly hot in the summer. (Clearly not this ‘summer’, despite global warming…) An increased sense of space was achieved by knocking three rooms into one lovely, open plan space, with dining, lounge/TV, hot drinks and pool table areas.

Everything is glamorously colour co-ordinated, suffragette green and purple, including the deeply hip, curvy (Bonio-shaped) dining tables and matching padded dining chairs. These were custom-made by the building contractor, and are cleverly designed to enable people to sit together but with more personal space than on traditional tables. I was told this is particularly helpful for many psychotic patients who find it hard to sit too close to others, and also conducive to people doing different activities (eg one person reading and another painting) at the same time.

There’s a fantastic solution to so many of the fiddly and risky problems of patients making their own hot drinks. The same hot drinks machine the canteen has. There’s also a milk machine, which avoids milk in cartons left out of the fridge gently turning into cheese, or those yucky little cartons of white liquid vegetable fat masquerading as milk.

There were two stunning embroideries, one which featured the first hand-sewn DH logo I’ve seen. Doesn’t sound too promising, but this certificate celebrating the newly Enhanced Healing Environment was magnificent partly because of the bold, incongruous, post-modern fusion of officialdom and art. The artist, former patient Louise Jessup, also contributed a large, long landscape (predominantly in green and purple of course), combining embroidery, quilting and other fabric techniques.

The visit to Edgehill was a taste as well as visual treat. Neil the OT had been working with patients in the OT kitchen downstairs, making a wonderful Italian meal. The dining experience was a triumph for me as well as the patient cooks – I managed to place every delicious morsel in my mouth, rather than the inevitable Jackson Pollock tomato sauce creation that usually ends up all down my clothes.

Newington

This was a very rushed visit as we were by now waaaay behind schedule because it was all so interesting and enjoyable that I delayed leaving each ward. But there was time for a quick chat with a nurse and to appreciate that the central area in the ward has a computer and electronic keyboard.

St Martins Hospital, Canterbury

Anselm Ward

This is a triage ward, taking up to 4 new patients a day, with a purpose-built 136 suite, separate but next door. Te average stay is up to 2 weeks, then patients move to one of the admission wards.

Leonie the OT runs a 9.00 Start the Day group and it was good to hear that there’s good attendance because  people are curious about the day. Sometimes they have an add-on to meeting eg a Buddhist chaplain did a meditation session the day I visited and they’ve had keep-fit and Rethink giving a talk.

There are 1.5 OTs on Anselm and Dudley Venables House, and they run a group activity a day. Their Steps to Recovery weekly group has constructive activities, recovery, goal-setting. This was described to me as a ‘two way assessment’ so patients can decide what’s helpful for them. How cool is that?

It felt like the dynamic, positive nature of the ward stimulates

patients being (unfortunately unusually) supportive to each other. Community meetings, Steps to Recovery groups and walks are good opportunities for patient bonding. Start the Day groups also provide the chance to talk about expectations and emphasise that there are other people on the ward with similar experiences and feelings as you’ve got. Leonie the OT made the interesting observation that people arriving on the ward are still half in the outside world so have the same social skills and willingness to listen and be supportive, illness allowing.

They buy in sessions for yoga, fitness and music. There’s a shop on-site, and shop also ‘visits’ ward, which isn’t always the case and is such an obviously helpful service for ward-restricted patients. PALS and volunteers run the on-site social centre, with its lovely activities like aromatherapy and music recitals. They’re recruiting for an activities’ coordinator and housekeeper.

Dudley Venables House

There’s a PICU and a forensic LSU.

Lou, the lovely, enthusiastic, caring NA who told us about the ward, did OT activities course which Katherine and Leonie ran for qualified and unqualified nurses. It’s much harder to motivate patients to get involved than in Anselm ward.

The courtyard is large enough for playing Frisbee or badminton and doing some gardening. There’s a Victorian walled garden next to the unit which is a very pleasant place to include in the  morning walk. The OT runs a cooking session once a week, and patients often make meals for other patients.

Wed is ward round day and very busy so they have groups which are easy to come in and out of. And get this! They’ve got a big circus skills box! Sam, a staff nurse, juggles and does other popular twizzly things. Wake and shake is popular including among patients who wouldn’t be expected to be motivated to take part.

Anselm

A mixed ward. When there are women patients, they have beauty sessions, Foot spa very popular with the men.

Some people go from DVH straight home (often with support of AOT) or to an open ward in Ashford, Thanet or other local unit. People have overnight or day leave before discharge to get prepared for return home.

I liked the concept and actual ways of using their de-escalation suite. The large main room is primarily a lounge but has a bed if the patient needs to sleep overnight there. (Also bathroom and loo.) Staff and patients bring books, games, crosswords, and when the patient is sufficiently settled, a radio.

A seclusion room is at the suite entrance but is rarely used. There are always 2 staff with a patient in the de-escalation suite and patients usually spend a very short time in there, eg half an hour but one patient needed to be nursed there for 2 weeks and then had careful, phased return to his bedroom and the rest of ward.

Elmstone

This was an admission ward, now a treatment ward. Innovatively, their volunteers include not only psychology students but also law students. A Rethink advocacy volunteer helps with benefits fortnightly. The art room is used by OTs but open at all times. The ward has an OT working with patients on the ward and an ex-136 suite is now used for ward rounds freeing up the TV room for TV. Part of recovery treatment is the OT’s involvement morning and afternoon.  It’s felt important that patients get out of bed in the morning, so the bedrooms are shut during the day. The programme of activities includes a sports group, art, activity outing, shopping, meditation, games, music and pampering sessions.

 

Pampering sessions are a good point to wrap up this final episode of the Legendary Kent Trilogy. Many thanks again to Janet Hatch, Katherine Lees, colleagues and patients for their time, hospitality and patience. If you’d like to know more about any of the exceptional wards described in, you can contact the wonderful Janet Hatch for further details:[email protected]

 

All the best

Marion

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