|Welcome to the Star Wards’ newsletter and a warm welcome to the new members of the Star Wards’ community. It’s episode two of the legendary Kent Trilogy, which would be the legendary Kent Decimology were I to restrict each episode to the newsletters’ usual length. So a nice long version this time, including photos of the incomparable Ramsey Ward.
St Martins Hospital, Canterbury
St Augustine, the local asylum which closed 15 years ago had 2,500 patients!! Let’s hope, but not expect, that it had lots of activity co-ordinators (or entertainment officers). St Martins has a strong focus on appropriate activities for its elderly patients and 3 years ago they decided to appoint an activity coordinator for each of the 3 elderly wards by, wisely in my view, converting an existing HCA post into an activity coordinator role.
Acute admission for elderly people with functional impairment, and some overlap with organic and physical health problems. The ward manager Bob has a wonderful dry sense of humour. Just before the Start of the Day meeting when he was wondering how many patients would participate, he said: “Let’s see what we’ve got in the way of a coalition of the willing.” And he referred to a very athletic elderly patient who managed to scale the garden wall as an ‘escapologist’. Such an inspired, almost admiring alternative to the awful term ‘absconder’.
In the garden for my semi-illicit (as an under 65 year old) fag break, Bob enthused about ferrets as pets and told us about Maurice, their 94 year old gardening volunteer. Maurice was a university lecturer and while no longer able to do the planting and weeding, his advice informs and motivates the gardening enthusiast patients who keep the borders looking beautiful.
It was unusual and heartening to find PALS closely involved pro-actively with a ward. Pam from PALS comes to the weekly community meeting and transforms these notes into a lovely newsletter with pics.
The ward is inspiredly set up with a very strong reminiscence theme. Peter, the extraordinary ward manager, told me that the elderly patients with dementia feel they’re living in the past and so the surroundings he and his team have created are familiar and reassuring for them. There are beautiful pictures everywhere, from the entrance to the ward right through to the magnificent seascape mural in the bathroom. The photo shows part of the mural, which the nursing team not only painted but meticulously cut out the birds, penguins etc for and arranged these on the scene. (The whole mural was then glazed to meet infection control requirements.)
It is of course possible (although unlikely!) to have created wonderful surroundings for patients but for daily life to be sterile or untherapeutic. But not on Ramsey Ward! Sleeping is obviously a very big occupation for elderly people with dementia, but those patients who were awake were absorbed in activity with staff and visitors. A game of giant dominoes was underway, and two patients were putting together large, chunky, colourful Duplo pieces. The whole issue of ‘age appropriate’ activities is complicated but my take is that we should use the most age-appropriate resources that meet individuals’ needs. If this is a teenager listening to Eminem, great. And if it’s an elderly person with highly impaired cognition enjoying playing with Duplo, great. (While I write this, my 8 year old learning disabled foster son Matthew is playing simultaneously with his games console and a talking doll.)
You won’t be surprised to learn that Peter and team have put similar energy into creating a lovely garden. For example, they managed to get B&Q to donate garden furniture through their wildlife scheme, by pointing out that this would enable patients to enjoy the visiting rabbits, partridges and birds.
Ward manager Amanda is pregnant with twins, but that hasn’t reduced her energy. The staff celebrated the NHS’s 60th anniversary by resourcefully borrowing nursing outfits from the 40s, creating a fabulous atmosphere for the day’s activities. The ward is decorated with glamour pictures of ladies’ fashion from the 30s and 40s and staff were actively involved with those patients who were awake, doing jigsaws or looking through magazines together.
There’s a conservatory looking onto the pleasant garden, and like the other downstairs’ wards, there’s a (semi-prefab?) ‘pod’ extension for extra bedrooms and bathrooms. (Til 2006 they had 18 people in one cramped dormitory, with one bathroom between them!!)
William Harvey Hospital, Ashford
We joined in with the session being run by music therapist Ian was with 4 elderly people. It was amazingly moving, both with the patients who were enthusiastically and rhythmically joining in with their maracas and xylophones, but particularly with a lady who was hunched over for most of the time. One lovely moment was when she was looking at Ian and he gave her a very warm smile. It reminded me that patients gain different sorts of benefits from being part of a group even if this is relatively passive. But in fact when Ian began playing and singing Blue Moon, the lady sat up and joined in the singing, word perfect.
The ward also has art therapy and gardening groups. The ward manager said that they use everything as an activity, eg washing and dressing are opportunities to compliment patients. Carers are very involved with the ward, eg can help at mealtimes if their relative needs help eating.
The oldest patient on the ward is… 101!!
“Fucked if I know.” For once it wasn’t me swearing, but the very good-humoured elderly patient showing us around, in response me asking the name of another patient. He’s one of a trio of patient gardeners. That is, 3 gardeners who are patients. And probably patient.
The light, spacious-feeling ward has an unusual, very open plan, modern design, with the communal areas in the centre and (ensuite) bedrooms around the edge. The most impressive feature was in the open plan kitchen in the central area of the ward – a Zip Tap. The water it produces is hot enough for tea/coffee but not riskily boiling.
Those patients who want their beverages hotter and/or poured by someone else and/or in a more high street-like setting, just outside the ward’s entrance is the Forget Me Not café. The good-sized room is brightened by the Big French windows and jolly table cloths on round tables. The need for a funky pink mini-fridge is met through the prominent placing of a funky pink mini-fridge. The café is lovely and informal for visitors as well as a more ‘conventional’ but still special venue for patients. I still have a clear, touching image in my head of the gentle, softly-spoken, very aware and responsive nurses.
There’s a new shop run by volunteers 2 days a week in the reception of this modern, multi-purpose, ‘community care’ building. Volunteers and staff run an ambitious fund-raising programme with monthly special, fun events.
I enthused in a previous newsletter (#41) about the Club Endeavour beach holiday at Highcroft Hospital, Birmingham. The coast is considerably nearer Margate but still too far for inpatients. So staff brought the beach to the unit! Tescos donated playsand, they created Punch & Judy, an old-fashioned Edwardian bath hut, an Olde Worlde Sweet Shoppe (trolley with popcorn, rock etc), made one of those boards with cut-outs to stick your head through for a ‘new’ body…., had games, songs, sandcastle competition. fish and chips supper, BBQ, hot dogs and ice-cream…… There was a different special activity every day and the day centre made wonderful papier-mâché seaside creatures to add to the atmosphere (eg donkey and seagull). Many of the activities intentionally had a sensory aspect eg touching sand, listening to music. They had an ‘old crooner’ performing one day, and the nostalgia factor was continued with a bonnet-making competition for patients. It was a fantastic opportunity for relatives to visit and to share the enjoyment.
The ward is a member of the National Association of Activities for Older Patients’ Providers (www.napa-activities.co.uk). NAPA set a challenge for all their members to get all patients outside the ward that week, even if just to the local shop or to post a letter. The beach week was rather more ambitious!
Two adaptations that impressed me were armchairs that double as nice comfy wheelchairs (also avoiding patients having to transfer from one to the other). And a bath which not only has a seat which raises and lowers, but itself can move up and down to save nurses’ backs.
Unusually, the ward has 5 younger and 10 older functionally impaired patients, the benefits being that older adults feel less stigmatised and stimulated by the younger patients, who can feel useful and appreciated by helping older people.
Impressively, they have an activity chart for the 7 days of the week, with clip art illstrating each activity. These include producing a ward newsletter, a community access group and a baking group. The smoking room was turned into a group room.
The word game on a whiteboard in the centre of the ward is popular with everyone – patients, nurses, domestics, visitors. Such a simple, clever, inclusive, involving idea. Another good stimulus for conversation is the display of historic local photos.
Each ward has a service user champion. A network of forums and meetings feed into the Trust’s service users and carers steering group. There was a Star Wards’ presentation and workshop for this group.
When we visited the staff were particularly stretched caring for the patients, who have organic impairments, but we did have the chance to see the lovely sensory garden. Not only scented plants but carefully chosen shapes and textures.
Frank Lloyd Unit, Sittingbourne
Hospital management was taken on by Kent and Medway in 2007, having previously been run by PCT. I was told that one ward had lots of bed-bound patients and the Transition Project team worked to help nurses provide stimulation and appropriate physical care eg introducing hand massage, repositioning a bed to give better view of outside and physios advising on appropriate seating.
The League of Friends (interestingly of the community hospital where the unit is based) donated a plasma screen TV and the activity room includes a piano as well as a library. The reception has a small poster advertising visits by Spot the PAT dog and his human, Val.
The ward manager, has a lovely name badge, with Jayne in nice big font, embroidered by a Women’s Institute contact of a colleague. There are 3 OT techs who can provide activities evenings and weekends, and part-time music and art therapists. They’re building up the therapy team and have done lots of fund-raising for activities. Music is very much a feature of ward life and the Start the Day group is valuable for basic orientating.
The ward imaginatively involves carers to help patients create their life history using scrapbooks, with the therapy technicians taking the lead. Although many patients have relatives visiting regularly, other patients don’t have any visitors and staff are taking up Star Wards’ suggestion of arranging visitors for the visitorless. They’ve found Star Wards fits well with the ward’s strong philosophy and practice of individualised care. They use Validation Therapy – valuing the context of what person is saying and acknowledging the emotional component (www.vfvalidation.org). There are memory boxes for patients and a sensory room, including a disco carpet which lights up!! They’d like to have a ‘wandering path’, a route around an inside or outside area which is continuous rather than having an end as this ‘block’ can be distressing for confused patients.
Staff are very conscious of the importance of patients having a positive purpose and identity. One patient goes out to make tea at a local community group. The physio is keen to get an allotment for patients’ use as it’s great exercise for fitness, suppleness, stimulation, flow, pleasure…. They’re applying for raised borders, trees and astro-turf for the garden.
If you’d like to know more about these exceptional wards, you can contact the wonderful Janet Hatch for further details: [email protected]
All the best