Zonal Nursing at the Ayr Clinic Hugh Hill & James Dalrymple Movember 2012

Introduction Meaningful involvement Effective and evidence based practice Embedding and delivering a recovery model Busy, active and engaging wards Person centred care Getting the balance right between safety and freedoms

The Impact of Enhanced Observations Up to 6 patients 1:1 or 2:1 Increased stress levels Motivation levels reduced General lack of hope Similar experiences of mental health settings they had been in before

The Teams Mission? To explore viable alternatives to traditional observation methods To examine related research and good practice articles and visited other hospitals that were operating alternative engagement strategies To develop a proposal and project plan To consult and develop a new system To work with patient and the MDT to find a better way for patients and staff.

What is Zonal Nursing? Staff are allocated to specified zoned areas in the ward rather being assigned to an individual patient Via an established ‘Zoning’ system patients are allocated an individual risk assessment Patients can move between areas and be monitored discretely A security nurse and floor walker manage and monitor the zones

Changing Culture Improving communication at every level on the ward Testing trust and confidence in each other and teams Ownership and commitment to the process Putting patients front and centre Flexibility in roles and approaches Getting the patients to work with us Supervision and support

After 10 months? The environment is less restrictive It is conducive with delivering better therapeutic intervention Activity has increased allowing staff to develop protected time and introduce structured programmes for people in the ward Culture of positive risk taking Supporting recovery

Specialing

Less is more? Staffing numbers Supervision Morale Meaningful week – 25 hours minimum Therapeutic environment Greater freedoms, responsibility and options Incidents Fun

What next? RCN and MWC Nominations Presenting the work – articles, workshops, posters Full evaluation – February 2013 Extend across the hospital Share practice – (Thanks to Dykebar and Leverndale)

Conclusion Drivers for change Evidence base Ownership at team level Involving patients Substantial improvements in ward experience Substantial improvements in nursing opportunities A positive step for change. References: STEEL, M., Breaking with tradition. Activate, 6(10), pp. 5 CARR, P., Using Zonal Nursing to Engage Women in a Medium Secure Setting. Mental Health Practice, 15(7), pp

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