In a packed seminar room, clinicians from Northern Health listened intently to nearly a dozen presentations on practical projects implementing the principles of the Best Care for Older People Everywhere: The Toolkit (The Toolkit)1. What made this day different from many other study days, however, was that the presenters were also clinicians from Northern Health. Most had never previously undertaken project work, or presented to such a large audience. This was one of the outcomes of Northern Health’s (NH’s) Staff Capacity Building Initiative.
The initiative provided successful applicants from NH’s clinical staff with training in project management, leadership and presentation skills. Those undertaking the program then used these skills to develop and implement a project in their clinical area based on the domains and principles of The Toolkit. A Project Mentor was also available to help throughout the period.
Applicants were from a variety of allied health and nursing roles. Most were ward staff who had not previously had the opportunity to do this type of training or project work. Projects undertaken were quite diverse, from no lift techniques to be used with resistive patients, to trialling an exercise group in a secure dementia unit, to reducing falls in a short stay unit.
"If we know the name of their football team or their granddaughter’s name it can help calm them – it doesn’t always work, but when it does work it’s really, really good."
One participant was Jan Thomas, an experienced Enrolled Nurse in a secure dementia unit. Jan undertook a project to revise The Key to Me, an information form about the background and personal preferences of dementia patients, and champion its use. She initially thought taking on the project “was out of my depth, but I like to push myself… so I thought I’d give it a go.” Her project involved developing a questionnaire and distributing it to staff and some family members of patients about what they would like to see from the new form. She simplified and shortened the existing document to make it more relevant and easier to use. Involving staff and family also helped foster a sense of ownership.
Jan found the process challenging, but ultimately rewarding. She says having information about a person with severe dementia can often help to manage some of the behavioural and psychological symptoms of dementia. “If we know the name of their football team or their granddaughter’s name it can help calm them – it doesn’t always work, but when it does work it’s really, really good.”
The program also had a personal impact on Jan. She says it was valuable creating connections with staff members outside of her area, and has also sparked a desire to undertake further education. Having the support of her team and finding others who are continuing to champion the use of the form have been other bonuses of her involvement.
Angela Ruzzene, a Clinical Nurse Consultant who coordinated the education program, says that several of the projects are having an ongoing impact at the ward level, such as a delirium screening tool that was introduced in a dementia ward. Others are having an impact more broadly through the organisation. Perhaps the widest reaching of these is nurse rounding for falls prevention. Nurse rounding involves each patient being regularly checked by a nurse and asked several basic questions about their needs, such as whether they need to use the toilet, whether they have pain and whether they need to be repositioned. This was piloted by one participant as her project and is now being refined and will be rolled out across the organisation.
"I’ve been nursing for a long, long time and sometimes you forget that [patients] had lives, they’re not just a patient… I think that did me the world of good."
While some projects are having a lasting and tangible impact, the initiative was not without its challenges. Recruiting staff, particularly ward-based nurses, was challenging, and not all who undertook the program were able to complete it. The program required a detailed application, support from the participant’s manager as well as a significant time commitment, factors which Angela thinks may have limited the number of applications. Some projects participants began were too large scale and ambitious to be realistic and some were constrained by the need for costly equipment purchases.
Nonetheless, Angela says the initiative has had a positive impact in spreading the principles of person centred care and of The Toolkit. She says the most successful projects were those that were small scale, contained and had tangible results. In many cases these projects have continued to have an impact and the participants continue to champion them. For several, being involved in the initiative has also led to moving into a more senior role within the organisation. Others have been able to utilise their new skills in their current roles.
However, the most lasting impact may be the way the program allowed those involved to see their role, and their patients, in a different light. As Jan says, “I’ve been nursing for a long, long time and sometimes you forget that [patients] had lives, they’re not just a patient… I think that did me the world of good.”
1. The current edition of this resource is Older people in hospital.