Two articles have been published about the successful delivery of a QI project at a female inpatient mental health ward by Nursing Times, a leading research and best-practice magazine for the nursing profession.
Staff at Bow Ward, which is the only female adult mental health forensic ward at the Trust, were aiming to improve service user experiences and staff satisfaction by over 40% across a full year by implementing trauma-informed care.
As those who experience traumatic childhood experiences may experience poor physical and mental health, this can in turn result in poor levels of staff retention due to episodes of physical and verbal abuse.
To understand staff better, the multi-disciplinary team (MDT) and senior managers on Bow Ward completed a cause-and-effect (fishbone) diagram and identified several factors that were causing staff to feel burnt out. The team believed staff had to be in a more positive position before they could facilitate trauma-informed care, so started by addressing staff issues before moving on to improving care for inpatients.
The MDT followed the Trust’s sequence of quality improvement, including:
- Identifying the quality issue.
- Understanding the problem.
- Developing a change strategy.
- Testing.
- Implementation.
The Ward’s use of quality improvement methods created the following outcomes:
Staff bullying and burnout
- Staff reported difficult dynamics and bullying in the team; these were addressed through anonymous surveys and feedback, increased supervision with a specific check-in on bullying, focused team building and personality-type group work.
- The team used trauma-informed principles to get to know each other as individuals, and consider their own backgrounds and how they influence working.
Decreased racism
- Occupational therapists held a focus group with service users to discuss how racism makes them, and might make others, feel.
- They used an anti-racism board with inpatients’ pledges on how to reduce racism and reviewed this weekly in ward community meetings.
Improved physical health
- The ward consulted with the local sexual health service for outreach cervical smears, meaning women could be screened without handcuff restrictions.
- Staff used accessible groups to raise awareness and improve knowledge, for example ‘menopause bingo’, a game devised by the ward in which symptoms of the menopause were used instead of numbers.
Improved equity
- The team successfully campaigned for free period products to be provided on the ward, and the hospital shop agreed to display feminine hygiene products on the shelves, not hide them behind the counter.
- All of the above contributed to staff turnover rates decreasing from 32% to 5%. It was noted that amendments created a more “harmonious environment” for effective engagement between service users and clinical staff.
The links to the two articles about the Ward’s project can be found below:
- Trauma-informed care at a forensic mental health ward
- Improving women’s health and female equity at a secure unit
If you don’t have a Nursing Times account, are unable to view the articles online and would like to find out more information about Bow Ward’s QI project, contact Elizabeth Hearn at elizabeth.hearn1@nhs.net.
List of staff involved in the project:
- Team leader – Elizabeth Hearn, Consultant Nurse
- Team coach – Emma Furlong, Independent Sexual Violence Advisor
- Ward Manager: Hortence Tchonang
- Occupational Therapist: Sidrah Babar
- Counselling Psychologist: Dr Erin Vignali
- Consultant Psychiatrist: Dr Paula Murphy
- Consultant Psychiatrist: Dr Sumi Ratnam
- Service users
- Nursing staff