KMPT recognised the importance of physical health to patients affected by mental health disorders and introduced Band 5 physical health nurses to all acute wards following a pilot at Boughton Ward, in Priority House, Maidstone. This successful pilot led to the roll out of physical health nurses across all acute wards at KMPT in 2016.
Poor mental health can negatively impact on physical health, leading to an increased risk of some conditions. Schizophrenia is associated with double the risk of death from heart disease and three times the risk of death from respiratory disease. Depression has been linked to a 67% increased risk of death from heart disease with a 50% increased risk of death from cancer.
People with mental health conditions are clearly vulnerable to poor physical health and often need additional care and support. For example some of our patients may have wounds as a result of self-harm and therefore will need support with wound care etc.
KMPT recognised the importance of physical health to patients affected by mental health disorders and introduced Band 5 physical health nurses to all acute wards following a pilot at Boughton Ward, in Priority House, Maidstone. This successful pilot led to the roll out of physical health nurses across all acute wards at KMPT in 2016.
Our physical health nurses are based in our acute wards across the trust and set up physical healthcare plans for patients as well as providing training for staff e.g. the human body which includes education around how to be aware of health symptoms such as sepsis and diabetes. As a result each patient has a physical health folder and an ‘at a glance’ board which features key information such as when a patient needs to get blood tests done etc. Nurses train staff in identifying issues such as fluid balance and also carry out audits to ensure quality remains of a high standard.
One powerful example of how a physical health nurse has supported staff is when a patient was admitted to KMPT with Huntingdon syndrome. People affected by the syndrome have abnormalities including muscle atrophy, cardiac failure, impaired glucose tolerance, weight loss, osteoporosis, and testicular atrophy. This particular patient had swallowing difficulties as a result of Huntingdon syndrome and staff lacked confidence to know how best to support them with eating and drinking. The nurse put together a PowerPoint presentation which was delivered to frontline staff on how to support patients affected by swallowing difficulties. This training tool and new knowledge empowered staff to more effectively support this group of patients.
We seek feedback when we send patients to acute hospitals to see if our physical care has been appropriate. We have also had verbal feedback from LPS colleagues that their acute medical colleagues have noted physical health care records show an improvement in patients attending from KMPT mental health wards.
Patient centred care is vital to KMPT and we strive to involve patients in care planning wherever possible.
One of the challenges that faced us was educating more experienced nurses to understand the link between physical and mental health. This challenge was overcome through peer to peer support and training although this has involved significant time.
To help retain our Band 5 physical health nurses we have developed a clear structure in partnership with our HR team that provides career progression for nurses to reach Band 6 roles.
We also capture and share best practice e.g. via internal communication channels such as our ‘one minute read’ that is distributed electronically to all staff and made available on our intranet called ‘i-connect’. We ensure that our processes are all documented and succession plans are in place to capture key information, should key staff move on elsewhere.
The service also has a link RGN nurse based within the nursing directorate and a trust wide group for the PHNs to attend so they can get peer support and look at good practice in all the areas where it has been introduced.
We proactively seek feedback from colleagues across service lines to help us evaluate service models.
The physical health nurses are having a pivotal role in improving the physical health care of service users. There has been a reduction in the number of deaths on our wards which may partly be attributed to the additional knowledge that staff have around physical health.
Within the inpatient units there has only been one sudden death within 18 months whereas previously there were 15 within a 24 month period. Deteriorating physical health is being recognised and with patients being treated much earlier particularly around conditions such as sepsis, chest infections and urine infections. Patients with chronic lung conditions are also being well monitored.
The physical health nurses support the organisation’s trust wide objectives to improve physical health within mental health. This not only includes recognising the symptoms of the patients who are physically unwell but also by working closely with the service users to provide health education and health promotion.
The physical health nurses have also supported the staff within the wards by being a resource to ensure they have the knowledge to care for patients who are physically unwell and also to screen the patients for risk factors regarding physical health. Some of the physical health nurses have instigated training sessions for staff and also support wards that haven’t got their own physical health nurse.
As a result of these nurses our patients’ physical health has improved, particularly around diet and lifestyle. By working with these specialist nurses patients are able to identify risk factors to their physical health that may be impacting on their mental health recovery.
There is now much more awareness of the importance of physical health amongst staff and patients. Staff, for example healthcare assistants are more empowered and confident to support patients with their physical health.
The Care Quality Commission has recognised the value that physical health nurses have brought to the trust. The trust’s CQC inspection report in April highlighted that ‘patients received ongoing monitoring of their physical health needs. Wards employed registered general nurses who had improved the service’s ability to recognise patients’ physical health concerns and respond accordingly’. Overall KMPT received a ‘Good’ rating in April 2017 with an ‘Outstanding’ for Caring.
The work has been shared across the trust using service line meetings and the interface between these and wider nursing directorate meetings, and other trust wide communications.
This project came out of Boughton ward, where the ward manager was having issues recruiting registered RMS, she realised that employment of an RGN would support the RMN nurses in generic nursing tasks but also bring a focus and development in terms of physical health care being recognised as an issue that should have parity of esteem with mental health on the ward. The RGN proved to be an asset in terms of improving physical care on the ward this was then looked at more widely and it was decided that each ward should have an RNG post available.
The RGN started on Boughton ward 10 years ago but the benefit of her work there become recognized and three years ago she was officially recognised as a PHN. (This was in advance of the national drive to have such care available in mental health services) This role was quickly seen as key to delivering physical health care in parity with mental health care on our units, thus this then lead to the decision to for such posts to be initiated in all Inpatient services offered by KMPT.
