Zonal Nursing at the Ayr Clinic

1. Zonal Nursing at the Ayr Clinic Hugh Hill & James Dalrymple Movember 2012

2. Introduction • Meaningful involvement • Effective and evidence based practice • Embedding and delivering a recovery model • Busy, active and engaging wards • Person centred care • Getting the balance right between safety and freedoms

3. The Impact of Enhanced Observations • Up to 6 patients 1:1 or 2:1 • Increased stress levels • Motivation levels reduced • General lack of hope • Similar experiences of mental health settings they had been in before

4. The Teams Mission? • To explore viable alternatives to traditional observation methods • To examine related research and good practice articles and visited other hospitals that were operating alternative engagement strategies • To develop a proposal and project plan • To consult and develop a new system • To work with patient and the MDT to find a better way for patients and staff.

5. What is Zonal Nursing? • Staff are allocated to specified zoned areas in the ward rather being assigned to an individual patient • Via an established ‘Zoning’ system patients are allocated an individual risk assessment • Patients can move between areas and be monitored discretely • A security nurse and floor walker manage and monitor the zones

6. Changing Culture • Improving communication at every level on the ward • Testing trust and confidence in each other and teams • Ownership and commitment to the process • Putting patients front and centre • Flexibility in roles and approaches • Getting the patients to work with us • Supervision and support

7. After 10 months? • The environment is less restrictive • It is conducive with delivering better therapeutic intervention • Activity has increased allowing staff to develop protected time and introduce structured programmes for people in the ward • Culture of positive risk taking • Supporting recovery

8. Specialing

9. Less is more? • Staffing numbers • Supervision • Morale • Meaningful week – 25 hours minimum • Therapeutic environment • Greater freedoms, responsibility and options • Incidents • Fun

10. What next? • RCN and MWC Nominations • Presenting the work – articles, workshops, posters • Full evaluation – February 2013 • Extend across the hospital • Share practice – (Thanks to Dykebar and Leverndale)

11. Conclusion • Drivers for change • Evidence base • Ownership at team level • Involving patients • Substantial improvements in ward experience • Substantial improvements in nursing opportunities • A positive step for change. References: • STEEL, M., 2012. Breaking with tradition. Activate, 6(10), pp. 5 • CARR, P., 2012. Using Zonal Nursing to Engage Women in a Medium Secure Setting. Mental Health Practice, 15(7), pp. 14-20

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