Infection Prevention and Control/Physical Health Nurses (IPCPHNs) at North Staffordshire Combined Healthcare NHS Trust (NSCHT) developed and led innovative physical health training sessions for staff. This has raised the profile of the inequality of peoples’ physical health within the mental health setting, ensuring that this is considered alongside the patients’ mental health.
Where to look
One of the key priorities identified within The Five Year Forward View for Mental Health (2016) was to address the inequalities of peoples’ physical health within the mental health setting. It highlights that “people with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people – one of the greatest health inequalities in England.”
NSCHT provides mental health services across Stoke-on-Trent and North Staffordshire, England. The Trust are committed to providing high quality services, as well as creating a learning culture to continually improve, encourage, inspire and implement research and innovation at all levels. This supports them to maximise and use resources intelligently and efficiently. The IPCPHNs identified an opportunity to develop their physical health offer to reduce unwarranted variation being seen nationally and locally.
What to change
In May 2017, a newly integrated IPCPHN team was formed. From here, the infection control and physical health team merged. The focus of this team was to identify patients that may potentially be at risk of acquiring infections and with support from staff minimise this risk. A further function of the team was to provide physical health advice and training. The team identified unwarranted variation where, before the merger, input into the physical health advice/ training for teams was limited and there was no formal physical health training delivered by the Trust. This variation highlighted an opportunity to standardise assessment and practice in relation to physical health across the Trust by providing staff with the skills they need to support patients effectively.
How to change
Two Infection Prevention and Control/Physical Health Nurses (IPCPHNs) with the support of colleagues within the IPCPH team developed new and innovative training sessions for staff, which involved the setup of ‘Fundamentals of Physical Health’ (FoPH) training, which was devised to enable staff to feel more confident in identifying a deteriorating patient and offers guidance on next steps for that patient. The IPCPHNs deliver the training over a full day, which is provided to all clinical staff including staff nurses and health care support workers. A Tissue Viability Specialist Nurse supports delivery of the tissue viability training and an Occupational Therapist (OT) and Physiotherapist support the delivery of the falls awareness training.
The training session provides information on:
- The Lester Tool (2014);
- Completion of vital signs and National Early Warning Scores (NEWS);
- Falls awareness;
- Drug and alcohol awareness;
- Continence care;
- Pain management;
- Nutrition and hydration;
- Smoking cessation.
Staff are also provided with a ‘physical health in mental health and learning disability competency workbook’. The training day is mainly facilitated by the IPC/PH team and experts facilitate some elements of the day, e.g. Smoking Cessation Advisors and Diabetic Specialist Nurses. The training is devised to build confidence in staff in dealing with potential IPC risks and raises the profile of both sepsis and anti-microbial resistance (AMR) stewardship.
In April 2018, the IPCPHNs reviewed the FoPH training and made changes to the day based on staff needs and feedback. Many core elements to the training remain in place, for example falls awareness. The IPCPHNs will review the training again in April 2019. Venepuncture and electrocardiogram (ECG) training for staff commenced in May 2018 with positive feedback and full attendance at each training session.
Better outcomes – The ‘Fundamentals of Physical Health’ training had a compliance rate of 69% within the first year which is positive. The training has considered patients’ physical health needs alongside the patients’ mental health to address the unwarranted variation. It is anticipated that this work will lead to an improvement in the number of physical health checks, which could increase earlier identification of nutrition and hydration concerns and a reduction in falls or other incidents.
Better experience – The feedback from staff has been very positive across the training enhancements that have been introduced. Specific feedback regarding the ‘Fundamentals of Physical Health’ training includes:
- ‘Very enjoyable day, set at the right level. Changeable subject kept pace good’;
- ‘Well delivered and interesting. Thank you’;
- ‘Very good and enjoyed all aspects of the training’;
- ‘Good day and well-presented full of information’.
Better use of resources – Staff feel more confident in caring for patients whose health is deteriorating, which has had a positive impact on the transfers to UHNM. It is anticipated that this work will also lead to an increasingly personalised approach to patient care.
Due to the success of the programme, it is planned that in the next 12 months the training support and education offer will be enhanced further. This is likely to include recognition of sepsis, recognition and possible causes of the deteriorating patient and tissue viability assessment and support.
Challenges and lessons learnt for implementation
Staff are well equipped, keen to learn and already have a vast knowledge around caring for a patients’ psychological needs. This is coupled with a great interest in gaining new knowledge and caring for patients’ physical health needs too. This has ultimately had a positive impact on the care that staff deliver on a day to day basis.
Releasing time for staff to attend training is sometimes seen as a barrier; to combat this, the ‘Fundamentals of Physical Health’ training has been placed in the inpatient mandatory training week alongside extra training sessions for other services, e.g. Community, Child and Adolescent Mental Health Services (CAMHS) and Learning Disabilities.
For more information contact
Infection Prevention/Control and Physical Health Nurse
North Staffordshire Combined Healthcare NHS Trust
Julie Anne Murray
Deputy Director of Nursing, AHP and Quality
North Staffordshire Combined Healthcare NHS Trust