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Wellbeing Clinics: Addressing Wellbeing Needs of Clients within the Inpatient Setting
 

Jacqueline Garton
Charge Nurse
Submitted Date: 29/12/2012
Review Date: 30/06/2014
Overview
Promoting an enhanced patient experience when addressing the wellbeing of people admitted to an in patient setting.
Local Area
Dumfries and Galloway
Care Setting
In-Patient Setting
Care Group
Adults
Evidence Base for Practice
The projects delivers on targets set with the Mental Health Strategy for Scotland by providing safe, effective and person centred care. The project is also underpinned by commitment 5 of the delivering for mental health publication (2006).
“Commitment 5: We will improve the physical health of those with severe and enduring mental illness by ensuring that every such patient, where possible and appropriate, has a physical health assessment at least once every 15 months”
The project also achieves the patient wellbeing module of the releasing time to care initiative.
The project utilised the framework through the RTC initiative, the primary aim was to address wellbeing needs of clients, in return for an enhanced patient experience and empowering nurse teams to take ownership of a nurse led holistic approach to caring for clients.

The adult acute inpatient service works within the recovery model when delivering care to individuals experiencing mental illness. In October 2012 as part of a development senior role, the individual was given the responsibility to address an area of improvement within the remits of the quality cycle and also other national drivers.
It was decided through submitted proposals that a team of registered nurses and healthcare support workers would explore the topic of patient wellbeing and address these needs through the use of ward based clinics where patients could have their wellbeing needs addressed and appropriate referral pathways where developed to offer specialist support and follow up.

An assessment tool was developed and piloted over an 8 week period. The aims of the wellbeing clinics were linked into the RTC module which included:
• Establishing a consistent and reliable approach to wellbeing needs
• Seeing care through the patient’s perspective
• Empowering staff to take responsibility for a holistic approach
• Putting emphasis on quality
• Providing role structure
• To improve patient experience by addressing wellbeing needs as well as mental health needs.

Through the process the team carried out the following process with guidance from the RTC 6 phase process:
PREPARE – the project lead identified who would be involved and devised a proposal which was shared with the SCN and local quality group
ASSESS – Once the team was established they were given time to review current procedures and research evidence based practice.
DIAGNOSE – The team where able to identify where improvements had to be made by speaking to fellow colleagues and patient group
PLAN – Implementation plan was devised with a short pilot period and clear timescale and actions for each individual nurse involved. Referral pathways where developed.
TREAT - The pilot launched and male and female wellbeing clinics where held on a weekly basis and addressed all areas of wellbeing such as, Blood Pressure, Weight, Height & BMI, Cholesterol, Blood Sugar, Urine, Continence, Diet, Smoking, Alcohol, Sexual Health and Menopausal/Premenstrual status
EVALUATE – following project team evaluated progress, clinics demonstrated interest from clients, clients commented on how they felt their physical health needs where met at an enhanced level, staff found that this was a good forum for health promotion and have devised an action plan on how wellbeing needs can addressed and learning can be embedded and sustained as part of the service.
Quality assurance/impact of practice
Following the pilot period the team sought to evaluate progress, this was done through auditing the attendance, volume of referrals/intervention required following assessment and verbalised feedback.
Results are as follows:

ATTENDANCE:
From the 8 week pilot: Total of 10 attendees
7 female attendees
3 male attendees

REFFERALS/INTERVENTION:
50% of attendees required intervention or referrals to specialists.
2 physiotherapy referral
2 gynaecology referrals
1 required BP monitoring as highlighted increased BP

VERBAL FEEDBACK:
Client’s comments included:
“I feel my physical health issues are been addressed as well as my mental health"
“I felt listened too"
“I now recognise my mood instability may have something to with my hormone levels"

While initial pilot numbers are small, the period of time when the pilot ran, bed occupancy within the 34 bedded service was averaged at 61%. This equates to an average of 21 clients over the pilot period of which 50% attended the wellbeing clinics.
Following evaluation the % number of intervention/referrals would more than likely not have been addressed if wellbeing clinics had not been in situ.
Practice Summary
Addressing wellbeing needs of clients within the adult acute inpatient setting utilising a specific nurse developed assessment tool. With the aim of providing an enhanced patient experience and promoting nurse teams to take ownership of a holistic, recovery focussed approach.
Practice Detail
A group of registered nurses and HCSW developed a project based on addressing wellbeing needs of clients within the inpatient setting. The project consisted of nurse led gender specific clinics which where held within the wards on a weekly basis.
The adult acute inpatient teams developed and held specialised clinics within the acute wards; these clinics were held over an initial pilot of 8 weeks.
The clinics were identified as:
- Men’s health
- Women’s health
Staff were selected in regards to individual Personal Development Plans in accordance with the knowledge and skills framework to hold pilot clinics, staff were be paired to support collaborative working and allow for cover should there be any annual leave/sickness during project. Staff had protected time to hold clinics and were also be given a small amount of time for research and preparation in the month prior to project launch.

The project was defined as addressing wellbeing needs; these needs included Blood Pressure, Weight, Height & BMI, Cholesterol, Blood Sugar, Urine,
Continence, Diet, Smoking, Alcohol, Sexual Health, Menopausal/Premenstrual status
The aim of holding these clinics was to ensure that as a service we were encompassing all areas of wellbeing, in return for an enhanced patient experience. Patients had access to address needs in a way which is new and inventive for the adult acute inpatient service.
The teams developed an assessment tool to record and score data received from individuals, this was then relayed back to medical teams and if required referrals made to specialist services. The team discussed project with local specialist’s and developed referral pathways which could be accessed directly from nursing staff.
The project was well received locally by clients and staff and other services under the mental health directorate.
The project allowed nursing teams to contribute to delivering safe and effective practice to individuals experiencing mental illness.
CLINIC FORMAT:
- A range of health promotion material and information guides where available
- Clinics where held weekly, although varied in time from week-to-week to ensure target audience was available
- Assessment tool was developed and had a simple scoring sheet to highlight if further investigation/intervention was required.
- Clinics where held within the treatment rooms and an appointment system was available for clients.
- Clinics were promoted through the group discussion forum weekly and also posters were on display within ward areas.
Challenges
As clinics were gender specific, at times due to bed occupancy they was not great number of males/females available to attend at time of clinics, also noted that as clinics where held on a weekly basis that not all clients where able to attend due to personal commitments, i.e. pass etc.
Also due to patient length of stay clinics may have addressed initial needs at the start of the patient journey
Additional Comments
This is a nurse led appraoch to addressing wellbeing needs, this was an easy project which can be impemented in any area to achieve higher standards of care and treatment to individuals experiencing mental illness.
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