VOL: 96, ISSUE: 43, PAGE NO: 42
Carol Cooper, BSc, RMN, is practice development nurse, Community Health Sheffield, Older Adult Mental Health Care Group
Joanne Doherty, RMN, is staff nurse, Community Health Sheffield, Older Adult Mental Health Care GroupAs nurses working on an admission and assessment ward for older people, we decided that there was a lack of structured activity for patients with functional mental illness. So we looked at simple ways of using activity groups to enhance our assessment and support. This was a change from just working with patients individually.
As nurses working on an admission and assessment ward for older people, we decided that there was a lack of structured activity for patients with functional mental illness. So we looked at simple ways of using activity groups to enhance our assessment and support. This was a change from just working with patients individually.
We felt that such groups could be relaxed and fun while also giving the patients another arena for exploring their thoughts and feelings.
Nurses facilitating these groups gained a much deeper understanding of their patients' mental health problems. Combined with the more formal tools already in use on the ward, this resulted in improved care planning. The patients described feeling better able to take an active role in their care and to negotiate their preferred methods of interaction with the nurses. To demonstrate this in practice we present the stories of three of our patients.
Ms Smith was admitted to the ward with symptoms of depression and appeared to function quite well. She joined in a discussion group and in the icebreaker section it was evident that she was struggling to remember the names of the other five group members. We offered appropriate prompts and encouraged the other group members to help her out. She managed to cope with the difficulty.
Later Ms Smith was able to contribute fully to a general discussion on healthy eating. She enjoyed reminiscing about cooking for a large family. In short, she got to share some of her strengths.
Informality allowed humour to diffuse any tension. We followed this up with more formal assessment of her cognitive abilities. It assisted in integrating Ms Smith and helped us to understand her problems and strengths. She also said she had made some new friends.
Mr Healey had been on the ward for some time and usually found the community group an acceptable forum for discussion. He had previously found it extremely difficult to relate to the nurses in a one-to-one setting. This compounded his sense of isolation. As the groups took place wherever the majority of patients were sitting, it was easier for Mr Healey to design his own involvement. He had sat in many previous groups without talking but his non-verbal behaviour clearly indicated that he was engaged with what was being discussed.
This group aimed to encourage participation by asking patients to identify problems and offer suggestions on how the running of the ward could be improved. After several weeks he felt able to make some comments and suggestions. We listened and responded.
Mr Healey acknowledged he had made a contribution to the environment. In the following weeks he appeared able to participate more readily and became more trusting of the nurses.
Ms Rogers was an anxious woman, who participated in a papier mache craft group. She was initially in need of constant reassurance. She had, naturally enough, never done anything like this before in her life, and had little confidence in her own abilities. She showed obvious signs of anxiety and talked about her negative thoughts surrounding her capabilities. As the group progressed, her level of anxiety decreased and she gained support from the facilitator as well other group members. On this occasion Ms Rogers did not finish her piece of work, but was able to stay for the full duration of the group and offered to return again to finish it. She acknowledged that she had been able to control her anxiety through group support. Also as a result of the support in the group, Ms Rogers developed a more therapeutic relationship with one of the nurses and subsequently approached this nurse to discuss more personal problems.
At the end of each group all members were asked to comment on what they felt they had gained. They were also encouraged to give constructive criticism to the facilitator. These views were recorded and helped in the planning of future groups.
Although we have not carried out any formal evaluation of these groups the information gained from the patients suggests that they have many benefits. Patients described an improved relationship with both fellow patients and nurses. They particularly liked feeling involved in their care and enjoyed helping each other in the problem-solving activities. They stated that they felt better able to support each other outside of the groups and felt that nurses in the groups really listened to them and therefore achieved an increased understanding of their needs.
The nurses involved reported that their skills had been enhanced by facilitating the group work. Their assessment of patients was also enhanced by being able to observe verbal and non-verbal communication. The nurses enjoyed having a more formalised joint approach to care-planning through increased patient participation. Our original objectives were good foundations and we are still building on these.