Overview
The aim of introducing a more structured group work program was to improve access to staff and increase the amount of therapeutic activity/interventions available in the ward.
Local Area
Greater Glasgow and Clyde
Care Setting
In-Patient Setting
Care Group
Adults, Later Life, Children and Young People
Evidence Base for Practice
The data prior to, during and after the pilot provided an ideal opportunity to map views and progress on group work. The study highlighted improvements and issues during and after the pilot. The pilot commenced on the 24th November 2008, for fifteen weeks (excluding two weeks over Christmas and New Year). The ward was closed to visitors and other disciplines on Tuesday and Thursday mornings between 10.30am and 12.30pm.
The data was collected on each shift of the type of group work that took place, frequency and the patients and staff that attended the group. The staff also completed a questionnaire prior to and after the pilot study to give their experience of the group work. The results from the pilot are very positive and are contained in the report.
Comments from other disciplines and service user highlighted the positive aspects to patients, staff and the general ambience of the ward.
Quality assurance/impact of practice
Prior to the pilot there were approximately three or four groups per week occurring on the ward, but these were mainly at weekends. The ward timetable set out an aim of twelve to fourteen groups a week: the report highlighted that during the pilot, nine to fifteen groups were carried out per week. These results indicate that the pilot has been overall successful as most planned groups did occur.
Out of the thirty programmed ‘protected sessions’ over the fifteen weeks; only two were cancelled. This was due to the clinical activity on one occasion and on another occasion this was due to group room being decorated.
The staff involved has given very positive feedback. Comments such as, they feel more motivated, confident in their practice, and it has enhanced the nurse/ patient relationship whilst breaking down barriers.
As part of the research patients also completed a questionnaire on the group activities, the feedback was very positive. Some of the areas they highlighted was that groups gave structure their day, encouraged socialisation, found them enjoyable and that they improve relationship with nursing staff.
It was worth considering from the results that the increase in groupwork may have an impact on the amount of patients on raised level of observations on the ward.
There is clear evidence in the chronological account of care that patients are being offered and are participating in the groups. Certainly the documentation on patients on raised level of observation displays evidence that they participate and are offered the opportunity to engage in the groups.
Practice Summary
Overview
A pilot study was commenced in November 2008 and ran for fifteen weeks; this involved closing the ward at specific times for group work to be carried out without any clinical interruptions. A structured timetable for the groups was compiled and closing the ward to allow ‘protected time’ for therapeutic intervention and group work with the ward based nursing staff and patients. Previous attempts to provide groupwork on a daily basis had been unsuccessful, although groups were occurring randomly during the week and at the weekends.
There was existing group work occurring approximately three to four times per week. The aim of the pilot was to increase this amount and ensure that all staff were facilitating the groups as part of their practice.
Practice Detail
This pilot was carried out in an extremely busy acute admission ward, which covers Glasgow city centre. In psychiatric admission ward it is often considered that there are many obstacles preventing staff carrying out such therapeutic groupwork. Indeed, group work is often viewed by nurses themselves as something that other disciplines carry out and specialist training is required before any groups can be facilitated.
This pilot aimed to try to dispel these views and challenge some of these issues. Efficient forward planning such as utilising ward diaries and allocating the staff responsible for therapeutic group work for each shift had a positive impact on the pilot’s success. The main aim was to improve therapeutic groupwork in an in-patient setting, enhance the in-patient experience and improve patient access to staff. Another aim was to enhance nursing staff’s skills, competence, knowledge and confidence in groupwork.
Since the pilot a four week programme has now been compiled, which was influenced by comments and suggestions from patients and staff during the pilot.
The protected time has now been increased from 9am-1pm every Tuesday and Thursday mornings. This allows more time for therapeutic contact, group preparation and clinical supervision for staff.
A multi agency approach has now been incorporated into the programme. Services and disciplines such as crisis, advocacy, occupational therapy, pharmacy, physiotherapy, and addictions have been invited and have accepted the invitation to talk to staff and patients in relation to the services that they provide.
By periodically repeating the patient’s questionnaires ongoing feedback will be continually assessed and where appropriate changes will be incorporated into the group program.
In closing the ward at ‘protected times’, this has released time for staff to provide therapeutic contact with patients. This pilot has promoted a recovery based approach and successfully improved the in-patient experience.
Challenges
Prior to commencing the study the ward manager met with all the nursing team, medical staff and other disciplines. A copy of the proposed pilot paper was sent for feedback to all concerned. This gave all involved the opportunity to discuss and be involved in information sharing prior to the pilot commencement and the report was circulated afterwards.
Most of the time other staff and disciplines adhered to the ward being closed for therapeutic group work, but on occasions some of the medical staff had to be reminded. Due to the nature of the ward if an emergency admission occurred during this period then an exception was made. In these circumstances the group was only cancelled on one occasion during the pilot.
Additional Comments
The pilot did not have any additional human resource or financial implication. It was carried out by utilising the existing allocated resources and skills of the ward team.
Comments often heard by nursing staff, is that they do not have the resources to carryout therapeutic group work or that it is other disciplines ‘job’ to carryout group work. The positive outcome of this pilot was it proves that nursing staff can deliver values based training, as part of their everyday practice. This it doesn’t always mean you have to increase staffing resources