320 likes | 517 Views
E N D
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