Improving Inpatient Care the Issues Challenges. Considering Advanced Practice for Adult Inpatient Care Alan Howard Con

1. Improving Inpatient Carethe Issues & Challenges. Considering Advanced Practice for Adult Inpatient Care Alan HowardConsultant Nurse Adult Acute Care

2. “Improving inpatient care is key to the Government’s drive to reform and improve mental health services” Jacqui Smith, Minister for Health 2002

3. National Service Framework Standard 5 Each service user who is assessed as requiring a period of care away from their home should have: Timely access to an appropriate hospital bed or alternative bed or place, which is: In the least restrictive environment consistent with the need to protect them and the public. As close to home as possible.

4. Acute Concerns A Survey of the quality of care in acute psychiatric wards Sainsbury Centre, 1998 No individual approach is offered, sensitive to the needs of patients Hospital care is a non-therapeutic intervention

5. Acute ConcernsA Survey of the quality of care in acute psychiatric wards Sainsbury Centre, 1998 There needs to be a overhaul of the care & amenities on acute psychiatric wards Staff are currently poorly equipped in terms of numbers, roles & skills to offer effective care Acute 24 hour care should be viewed as one component of a comprehensive & integrated service

6. Current Trends in Use of Inpatient Service in England 1991 - 2001 Reduction in available beds greater pre NSF (1999). No significant decline in admissions. (95 – 2001). No significant decline in length of stay (95 – 2001). An increase in formal admissions.

7. Purpose of Adult Acute Inpatient Care “It’s where people go when other services cannot cope” “It’s when people are in need of the most help and understanding”. Service User, Exeter Oct 2002

8. Purpose of Adult Acute Inpatient Care The purpose of an adult psychiatric inpatient service is: To provide a high standard of humane treatment and care in a safe therapeutic setting for service users in the most acute and vulnerable stage of illness. For the benefit of those service users whose circumstances or acute care needs are such that they cannot at that time be treated and supported appropriately at home or in an alternative, less restrictive residential setting.

9. Inpatient Nurses: Changing Images

10. Inpatient Nurses: Good Hats!

11. Changing Systems

12. Inpatient Nurses: Challenging Times Posing the Problem – Process of engaging in action and reflection requires asking new questions. Pablo Freire

13. Strengthening the Nursing Contribution to Inpatient Care Nurses vital to Inpatient provision Need a modern career path Review systems of care Strengthen education and training Enhance quality Focus on fundamental aspects of care Patient & Carer focused care Active contribution to evidence base

14. Advanced Practice for Acute Inpatient Care

15. “Working on an inpatient unit, I feel like a jack of all trades and master of none!”

16. “I spent years learning these specialist skills, but never have the time to use them properly”

18. Four Key Areas of Capable Practice (SCMH 2001) Ethical Practice – respects the rights & dignity of all service users, and is informed by values & attitudes necessary for modern mental health practice Knowledge – that underpins effective practice – and includes knowledge of policy & legislation, mental health and mental health service delivery

19. Four Key Areas of Capable Practice (SCMH 2001) An understanding of the process of care – including effective partnerships with service users & carers, care co-ordination and effective team working Expertise in interventions which are known to be effective in promoting stability and recovery

20. In-patient Values Treat individuals living with mental health problems with dignity & encourage their full involvement in their care Respect diversity, acknowledge similarities across cultures & confront discriminatory practices Respect the roles & skills of carers, acknowledging them as partners in care &supporting them in this role

21. In-patient Values Promote positive mental health and take effective steps to reduce stigma & discrimination Make the best & most effective treatments & interventions available, when & where they are needed Respond appropriately to need & ensure we provide a comprehensive package of care Emphasise Safety

22. Advanced Practice Job Purpose Nurse Consultant Provide better outcomes for individuals referred for assessment and treatment within the Hospital, the aim being to strengthen clinical and professional leadership within the service. Provide expert clinical practice for individuals within Adult Acute Inpatient Services. Develop and maintain multi-agency and inter-professional relationships and networks to influence and develop current systems of care delivery.

23. Advanced Practice Job Purpose Nurse Consultant Facilitate service and multi-professional practice developments in relation to Acute Inpatient Care, based on relevant research, clinical audit and educational activity. Enhance the education and capability of Nurses and other mental health care professionals working within Acute Inpatient Care Services

24. Expert Clinical PracticeNurse Consultant Acute Care Take direct referrals and hold a caseload of patients with more complex needs Carry out detailed assessments, formulate care plans and advise on interventions for specific problems/needs Co-work with other team members on specific patient’s problems/needs using evidence based interventions Provide supervision and mentoring to nurses & other professionals

25. Expert Clinical PracticeNurse Consultant Acute Care Develop nurse led innovations in clinical practice which can be disseminated to nursing and other colleagues to improve patient care Champion Patient & Carer involvement Practice Development Unit status Hearing Voices Group Early Psychosis & Psychosis Support Inpatient Dialectical Behavioural Therapy Real-time ward based CBT training SHO CBT training

26. Leadership & Service Development Nurse Consultant Acute Care Act as champion for Acute Inpatient Care within Hospital and Trust, and at Regional & National level Provide leadership by setting a clear direction on service planning, ensuring that an innovative and high quality service is delivered Practice Development Lead for Hospital to facilitate the development of an environment that encourages continuous service improvement and practice development by all practitioners

27. Education, Training & ResearchNurse Consultant Acute Care Development & contribute to educational programmes at pre-registration and post-graduate level Acute Inpatient Care Medication Management. Disseminate research & evidence based practice and advise colleagues of the impact upon practice and implementation Conduct clinical research Understanding Voice Hearing Experience Medication Management Training (RCT) with IOP London

28. Professional DevelopmentNurse Consultant Acute Care Seek appropriate supervision and peer support for clinical practice. Attend relevant training, conferences and study days. Maintain an individual professional profile as direct evidence of clinical practice at an advanced level. Disseminate good practice through national and international conference presentations Prepare relevant material for publication in appropriate professional journals

29. Good Luck! Remember Some Key Improvement Principles

30. Key Improvement Principles See things through service users’ and carers’ eyes Find better ways of doing things Look at the whole picture Take small steps as well as big leaps Measure improvements made Work with front line staff, provide both the time and tools to tackle problems

31. Key Improvement Principles Influence service development & work with senior management to improve the inpatient environment Motivate others and take ownership of inpatient agenda Share information and good practice - and support each other e.g. through networks, learning sets, collaboratives etc.

32. Contact Details Taunton 2 Tower Lane Taunton TA1 4AR Ph: 01823 337879 St Ann’s Hospital 69 Haven Road Poole Dorset BH13 7LN Ph:01202 492082