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Reforming dementia care

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Jeni Bell was always a bit sqeamish but found caring for those with mental ill health was nothing to be afraid of

Jeni Bell never had any intention of becoming a nurse. She wanted to be a cookery teacher. To her, nursing involved too much “blood and stuff” - she’d never witnessed a whole operation during training as she always fainted.

It wasn’t until she did her placement on a psychiatric ward that she really felt she’d found “her bag”. She excelled at discovering what made people tick, supporting carers and understanding patients’ behaviour.

Since then, she’s always wanted to make a difference to patient care, so, almost 30 years later, when the money for a project at Southampton General Hospital was confirmed, she had to get involved. Now, she’s the first hospital-based clinical specialist Admiral nurse on a dementia-friendly ward.

Designed to cater for those with memory loss when admitted with other conditions, the ward features brightly coloured doors and large lettering to help patients remember which bay they’re staying in. Beds aren’t numbered but images, such as umbrellas, lighthouses and starfish, work as a visual aid to help patients find their way back to their space.

Rooms that staff would prefer patients to avoid, such as cleaning stores and offices, have doors the same colour as surrounding walls so they go unnoticed, while the nurses’ station has been renamed “reception” and lowered to improve accessibility so it’s more approachable for both patients and carers.

Even the flooring has changed, a battle of which Ms Bell is particularly proud. “If you’re going to do something, you need to do it properly. I was passionate about getting matt flooring down as it didn’t appear wet to patients, but it wasn’t seen as a priority. To change minds, I used optical illusions - pictures that look different to different people - to demonstrate how a shiny floor looks to patients.”

But the main focus of this project isn’t aesthetics. Ms Bell is working to change staff mindsets towards patient care. “It was never bad care here, it just could be better. The way face-to-face contact was dealt with needed to change as it was becoming more and more medical; the sense of having a relationship with a patient was lost.

“In producing the chief nursing officer’s 6Cs for nursing care, commitment, competence, communication, courage and compassion, I can’t help but feel as though ‘creativity’ has been missed. I sometimes worry that we no longer think outside the box.

“If you can sit and have a cup of tea with a patient, and it means they’re drinking tea too and getting their fluid levels up - that’s good care. But nurses don’t feel they have permission to do that.

“We need to change that so nurses can interact with patients in the social situations of eating and drinking. The attitude of ‘not on my ward’ or ‘not on my shift’ is one that still exists and prevents nurses from sticking their neck out and saying something.”

Once, Ms Bell was called for a referral because a patient had started throwing things at staff. “It turned out they were throwing Maltesers. How can you be aggressive with Maltesers? You ask them to stop throwing them and give you one instead.”

She believes that by taking 15 minutes out to spend time with a patient and find out what makes them tick, you can save yourself a referral - and hours of trouble.

“Nursing isn’t rocket science. A lot of it is about communication and building relationships with people.”

When patients sit in bays there’s no sense of community. They will wander off or fiddle with things that don’t belong to them, causing upset. So, Ms Bell asked for a table to be put in the middle for patients to gather around with tea and biscuits. When she didn’t get one, she found one herself.

It wasn’t long before the woman who spent most of her time in distress, banging her head against the door trying to get out, and the one who packed a bag every day to go home started gossiping together. Then the lipstick came out.

Just don’t ask Ms Bell where she got the table from.

Katherine Bannon

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