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77. Happy

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Still smiling after all those shifts

Introduction

Being happy working on a mental health ward. We’re not being trite or in any way under-estimating how super-demanding it is working in this environments at the best of times. Which these are definitely not. Here’s how our good (and much-mentioned in Wardipedia!) pal Henry Stewart from Happy puts it:

Jobs don’t come more demanding than working on a mental health ward. But (on good days!), they also don’t come more rewarding and satisfying. From what I’ve read and from my visits to Marion when she’s in hospital, mental health ward staff do an incredible job, one that most people would readily accept they don’t have the patience or compassion to do.

Is it legitimate to be happy when working with people going through the darkest of times? Absolutely. Being happy at work doesn’t mean uninterrupted joy. It can be about relief, cheerfulness, small moments of satisfaction and so on. But it’s definitely about being fully involved and having some level of ownership over what happens on your ward. It can be about seeing even small improvements day to day and knowing you have played a role in enabling that.

 And looking at it from the patients’ perspective, I know if I was on a ward I’d want staff who are positive, upbeat, cheerful – i.e. happy! All the research shows that staff work best when they are happy and feel good about themselves. The main thing is, you do amazing work and you deserve to be happy!

The other 76 Ideas in Imagine are a mixture of quick wins and incremental steps on the way to long-term, highly ambitious goals. One of the best quick fixes we’ve come across is that even faking a smile can almost instantly make us feel a bit better!

Action for Happiness is warmly recommended in both #42 Charities  and Idea #46 Patients’ Views. They have great resources, are practical, pragmatic and very collaborative. They describe themselves as:  “….a movement for positive social change. We’re bringing together people from all walks of life who want to play a part in creating a happier society for everyone.”

 

Ward examples

Feeling appreciated and cared about, having a sense of satisfaction and plenty of fun, and being oneself. Here’s a sort of encore for the fabulous ward practices that have the additional benefit of feeling affirming, morale-boosting and generally happiness-generating.

 29. Funnyness

  • Juggling
  • The ward has a big circus skills box! A staff nurse juggles and does other popular twizzly things.
  • Kite-flying
  • Balloon modelling
  • The Great Chilli Off 2007! Each patient was given a chilli plant to love and nurture in their room, or wherever else they wanted to keep it. Prizes for First Ripe Chilli, Most Chillies and Biggest Chilli.
  •  ‘Theme days’ either based on special days or events, or just for fun.
  •  An extensive dressing up cupboard covering a range from Christmas to pirates, and things to hand are turned into props.
  • Patients spending their birthdays with us can choose (within reason!) how they would like to celebrate. eg a sixties night included non-alcoholic cocktails, lots of sixties food favourites (yes, we even had Spam sandwiches!), groovy music and lots of black eye-liner and back-combed air, with a prize awarded for the most fabulous outfit!
  • Regular social evenings on and off the wards, with events such as BBQs, Caribbean
  • Evenings (with themed food) and very popular DVD concerts, including special Elvis and ABBA nights!
  • A Come Dine With Me evening!
  • Holiday at Home – inner-city hospital imported sand, ice-cream vans and other props and gave their rehab patients a fabulous seaside week!
  • Patients visit the annual local scarecrow festival.
  • Hairy head day to raise money for Children in Need. Patients and staff wore fake eyelashes, wigs, plaits, false moustaches, hair y chests.
  • Oxleas House comedy room!

30.  Indoor sports

  • Paper plate frisbee
  • Indoor hockey
  • Improvised space hoppers!! Perfect for the exercise-reluctant patient (or member of staff). They use giant gym balls for corridor races and, creatively, had a competition to see who could drink best while balancing on these. When Marion and Buddy visited, staff were messing around on the ‘space hoppers’, one fell off, and a person with learning disabilities who hadn’t spoken since being on the ward roared with laughter and said “You must get that on the Internet!”
  • Spontaneous Frisbee game, using a paper plate!

34. Appreciation

  • The ward has a ‘thank you tree’ on the wall. Staff, patients and visitors are invited to stick post-its of thanks to the tree. Anyone can show their appreciation to know whoever they like. Patients can thank each other, nursing staff can thank the house-keeping staff, consultants can thank the nursing staff and so on…
  • All wards at the unit have ‘time out days’. They take place off the ward and all staff attend. These happen once a year and cover all aspects of the ward. They sometimes include fun activities, team building, and talks etc. So these are great opportunities to show a bit of love.
  • Regular team meetings are a good place to tell colleagues that they’re doing a good job. They don’t just have to be about discussing problems.
  • Acknowledging what works well.  Having a thank you board or positive comments board including staff and patients and management comments.

35. Bring yourself to work day

  • There’s an item on Job Descriptions that asks what additional skills the member of staff can bring. For example, music, arts, languages etc. This is also an essential question to ask a recruitment interviews.
  • “One HCA (who is also a brilliant artist) has been doing stunning pencil drawings for years for staff and his friends and family. Now he’s offering his services to patients (free of charge), who absolutely love his work. They bring in photos of their children and pets etc for him to sketch. The HCA has protected time to do this work.”
  • “Forget job titles, even for a few planning minutes. Focus on staff skills and personal qualities.”

36 Role flexibility

  • A receptionist runs drama sessions for patients and a  guy from the mailroom runs music jamming groups. The patients benefit from the groups and the members of staff have a much more enriched working life and increased understanding of patients’ strengths, needs and aspirations.
  • No matter what their role is all staff take turns chairing ward meetings.
  • “One HCA (who is also a brilliant artist) has been doing stunning pencil drawings for years for staff and his friends and family. Now he’s offering his services to patients (free of charge), who absolutely love his work. They bring in photos of their children and pets etc for him to sketch. The HCA has protected time to do this work.”
  • A Housekeeping Assistant who is fluent in 5 languages happily puts her translator hat on and helps with patient assessments and interviews on the ward.
  • One Housekeeper also has a nursing assistant role, which includes going to patients’ homes. This seems to increase staff retention because it’s a more enriched role.
  • Nurse Therapy Assistants split their time between nursing and OT shifts, and work evenings and weekends.
  • A staff nurse is liaising with the local college’s ‘enrichment’ officer who has offered to be a volunteer herself! She’ll be carrying out activities such as jewellery making, photography and pottery.
  • There’s an item on Job Descriptions that asks what additional skills the member of staff can bring. For example, music, arts, languages etc. This is also an essential question to ask a recruitment interviews.

40 Senior managers

  • The chief executive runs one of their hospital book clubs.
  • The very Modern Matron runs a fabulous weekly Prepare and Share evening meal.(Tim please link to this feature in Idea #35, BYTWD)
  • The Modern Matron visits patients a fortnight after they have returned home.
  • Managers have an open door policy if patients wish to see them
  • The Modern Matron facilitates patients’ breakfast each morning.
  • There are signs up in the hospital about monthly meetings with the modern matron, and PALS co-ordinator. And nice posters with a photo of the modern matron, explaining his role.
  • A growing number of hospitals have social groups consisting of both patients and staff, such as choirs, rock bands, book clubs and football teams. We gather that senior managers can be the vital drummer or goalie in these crews.
  • Each year this hospital puts on an incredible Christmas extravaganza. Staff and patients throw themselves into costumes, carols and elaborate ward decoration competitions.
  • The chief executive works shifts with staff groups ranging from domestics to healthcare assistants.
  • The chief executive and the Director of Nursing each work a shift a week on the wards.
  • Following an invitation from ward staff , the chief executive, enjoyed working a morning shift on the ward to find out more about the demands faced by ward staff.  He worked as a nurse on acute admission wards earlier in his career, and the shift back on the ward reminded him of some of the joys as well as the challenges of the work.
  • Each ward sister has a Trust board mentor, generally see monthly. Chief executive is also a mentor. Get different perspective, from government, through strategic health authority. Board now getting much more immediate feedback about patient experience. Looking at accreditation with RCN.
  • Some wards involved with the excellent Productive Mental Health Ward initiative have found that senior managers spend time on the wards as part of their commitment to the process.

42. Charities

  • Staff and patients on one ward were in the pink for a good cause when they supported Breast Cancer Awareness Day. Wards were festooned with posters and balloons, all staff wore pink and patients got involved by making cakes and dressing up for the day. Donations netted an impressive £200 for the charity.
  • International Book Day was celebrated with cakes and donated books and magazines and a group discussion on everyone’s favorite book.
  • International Women’s Day. Cakes and talks about what women have inspired each patient. The chance for patients to write either a poem or just something to express their feelings towards this.
  • A Hairy Head day for Comic Relief, with staff and patients adding fake eyelashes, wigs, plaits, false moustaches, hairy chests for the cause.
  • Disability gardening charity Thrive has begun to collaborate with Bethlem Hospital in SE London to develop a programme for long-stay patients working towards their release.

53. Bank staff

  • The ward display photos of their regular bank staff on the staff photoboard. This makes these staff members feel a valued part of the team and helps patients identify who’s who.
  • A regular bank staff support group is facilitated by a clinical psychologist.
  • Each bank staff reads a handover sheet about each patient before commencing the shift.
  • All bank staff read and sign a ‘observation competency’ booklet before commencing observations.
  • One member of staff is ‘Bank staff link worker’. They look after bank staff and help with any issues that occur.
  • New bank staff have an experienced ‘buddy’ for the first few weeks of their work.

67. Empathy

  • Empathic (and therefore effective) leadership: Not simply telling or instructing staff but showing, role-modelling and coaching. For example, the ward manager does the patients’ breakfast each morning.
  • We can’t give what we don’t get. (Staff need to have caring, supportive management.)
  • Seeing in patients stuff that’s very painful in ourselves. Being able to use this therapeutically.
  • The displays a large poster displaying a list of emotional words which helps broadens everyone’s emotional vocabulary.

71. Housekeeping heroes

  • As the domestic staff are ward-based and are present on a daily basis, they are part of the multi-disciplinary team
  • Housekeepers play an active part in ward meetings, briefings, nights out and fund-raising events.
  • Housekeeping staff attend and contribute to handovers.
  • Photographs of domestic staff are displayed along with other ward staff on the ward photo board.
  • Housekeepers are recognised as an important part of the ward team.
  • Members of the housekeeping team attend ward community meetings to gain feedback about food etc.
  • Cleaners, domestic and housekeeping staff attend the food focus group.
  • The weekly community meeting involves all staff and patients including domestic and catering personal. It’s an inspired idea to involve not just domestic staff, who often have very positive, relaxed relationships with patients, but catering staff as well, given how important the meals are to patients.

Role Flexibility

  • One of the housekeeping staff contributes to the ward newsletter.
  • One of the cleaners is also a ward activity volunteer. He helps out in the art group. This helps build up relationships with the patients.
  • Housekeeping staff maintain a board in the ward detailing menus, food facts, dietary specifications, as well as cleaning information and schedules.
  • Impressively and imaginatively, the housekeeper also has a nursing assistant role, which includes going to patients’ homes. This seems to increase staff retention because it’s a more enriched role.
  • The housekeeper liaises with estates, catering, linen services and ensures appropriate stock levels, including avoiding excess stock which helps keep the wards within budget.
  • The ward displays posters explaining that if patient need help in the kitchen or laundry room they can approach one of the housekeepers for assistance.
  • The housekeeper welcomes new patients and gives them a tour around the ward.

Training, support and acknowledgement

  • These staff attend basic listening skills courses, for example TalkWell.
  • GNVQ and other professional development courses are offered.
  • These staff attend a customer care workshop.
  • A very basic mental health session takes place in the induction. This gives staff some understanding of what to expect on the ward and some reassurance.
  • Service users are involved in training non-clinical staff – eg domestic, cleaners and housekeepers.
  • A regular support group takes place for these members of staff.
  • One of the housekeeping staff was nominated as ‘unsung hero’ in the yearly celebration of achievement ceremony.

Part of the Therapeutic Environment

  • The ward harness the positive, informal relationships domestics often have with patients.
  • These staff are an “information gateway” for particular matters between patients and nursing staff.
  • The domestic staff, when less busy, spend a considerable amount of time on the ward talking to patients.
  • The housekeeper role has been tailored to reflect the needs of the patients and this is shown in the interaction they have with patients.
  • It is a common sight to see the domestic staff playing games of table tennis with patients on the wards or board games.
  • The word game on a whiteboard in the centre of the ward is popular with everyone – patients, nurses, domestics, visitors.
  • While chatting with patients isn’t a formal aspect of the role, it’s flexible enough to be integrated if recommended by the nursing team.
  • Patients sometimes tell housekeeping staff things they wouldn’t tell other staff. There’s perhaps less sense of pressure, expectation or authority.
  • Cleaners, domestic and housekeeping staff have time to speak with patients who have little or few visitors.
  • These staff are positive role models of hospitality, cleanness and tidiness.
  • Housekeeping staff understand and are awareness of boundaries and explain to patients that if they want to talk about something that is distressing them to talk to the nursing staff.
  • Domestic staff can form particularly good relationship because of intimacy of working environment, i.e. cleaning a patients’ room.
  • Domestic and other non-medical staff are involved in providing informal support to patients.

75 Reflective practice

  • Case formulation group is forum for qualified nurses to get support re: clients emotions and behaviour.
  • Clinical psychologist runs drop-in consultations for staff.
  • “We have a fortnightly reflective group on our ward. It’s facilitated by a Senior Psychotherapist from our Therapeutic Community. It is an hour long and takes place after the midday handover while more staff are around. It’s utilised to reflect on the challenges we have with our patients with personality difficulties. It’s useful to have a space to reflect on our work (including our own responses and reactions) and to gain a fresh perspective. It’s good that the group is facilitated by someone who isn’t based on the ward, especially when we can’t see the wood for the trees. Both qualified and unqualified staff attend.”

Happy Star Wards

Nothing makes us at Star Wards HQ (aka Marion’s attic office) happier than hearing about how being involved in Star Wards makes staff and patients happier. This sort of thing:

“Before Star Wards, I was bored. Everyone was bored. Now, all the patients are happy, everybody is happy, the patients are enjoying themselves. We sit and gather everybody, we involve the domestics because they interact with patients, and everyone talks. Everyone gets to know each other and each other’s interests. We’ve bought a lot of games and movies for the evenings.” Nursing assistant, forensic ward.

“Staff on Regency ward have enthusiastically and creatively been implementing Star Wards. The results have included better client feedback, increased staff satisfaction, less aggression and violence and more therapeutic contact.” Nicky Lambert, Clinical Development Nurse, Sussex Partnership Trust

patient examples

  • Feeling disconnected is my most dreaded emotion. It is lonely and scary and feels like it is never going to end. Just having a smile from someone at a time like that helps.
  • When people around you believe in you it is motivating and inspiring. It kept me going.
  • It’s hard to commit to something you can’t see an end point to. So at the end of each day I sit down with my key-person and we talk about one thing I have achieved that day on my path to recovery. We write it down and sometimes we illustrate it. I have over 60 now and I can see a future.
  • I feel most hopeful when I feel connected to those around me.
  • Thinking about my family gives me hope
  • I wrestle everyday with the idea that there is hope. But each day I get through, hope grows stronger.
  • I didn’t believe hope existed. Some days I am still not sure. But I look back and realise hope got me this far!
  • Taking each day as it comes. That’s all you can do. 
  • It’s easy to feel hopeless on the ward but there’s a way out of the black hole: hope. 
  • Having a healthy but realistic expectation in mind that I would get better. 
  • A speck of hope is the only thing that’s keeping me going. At least there’s now some light in the dark.
  • The ward helps you take stock and helps you realise the things that matter to you. 
  • Upon getting my diagnosis I had to get my life back together again and re-establish my own identify. I lost so much but eventually gained so much more. 
  • When you’re at rock bottom sometimes all you can do is count the so-called small positives. There are always some if you look hard enough. 
  • I look at my friends who haven’t been where I have been and I sometimes feel sad for them because they haven’t had the opportunity to get to know life in its rawest form. They haven’t had the opportunity to properly get to know themselves and I know how important it is.
  • I am most hopeful on Sundays. I don’t know why. Maybe it is the idea of a fresh start on Monday.
  • Every time I make someone a cup of tea on the ward I feel like a part of me is smiling.
  • I feel so much more rounded as a person for going through what I’ve gone through. 
  • Life felt so shallow before I was ill. Even though it can be terrifying there is something extremely liberating about being aware of the depth of human emotions. I will always be grateful for that.
  • The journey of recovery has enabled me to really connect with people. It has given me insight I never had before.
  • I was so impatient to be ‘recovered’ that I didn’t realise when I had got there!
  • When I’m feeling particularly low on the ward I find just having a smile from someone helps so much 
  • I might not have always enjoyed the journey but I love my destination.
  • Knowing that my time on the ward is short compared to my entire life. 
  • My key-worker was positive and realistic – it was this balance that helped me the most.
  • My lack of confidence meant I had very little self-belief. I had to put my faith in those who said ‘you can do this!’….turns out they were right!
  • When I was first admitted onto the ward I kept wanting to know when everything would be better and when I could leave. After a while I found that I could sit with the understanding that ‘some things just take time’ to heal. Now I don’t feel as anxious and take each day as it comes. 
  • The ward is like a no man’s land. Everyone’s trying to find a way to make sense of it all or look for a way out. I followed the threads mainly given by Dad and the staff until found recovery. Putting your trust in others, I guess. 
  • I am ambivalent about recovery because I don’t fully believe I will ever get better. But I put my trust in those who have faith in me and I think we are getting there together!
  • I kept thinking ‘this isn’t how my life is supposed to go’… I had to put my faith in those around me to believe that I had a future worth fighting for.
  • Sounds simple but constantly asking staff if I was going to get better was my way of holding onto some hope
  • I have learned to accept that I can achieve things and my self-esteem has risen with it.
  • I reminded myself that I would not always feel like this and would visualise myself being well.
  • Whilst I was getting better I tried to never look back, concentrated on the here and now to get better in the future.

 

Categories: Empathy, Wardipedia
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