Lasting Improvements to Acute In-patient Settings: LIAISE part 1 of the BETTER PATHWAYS project Jo Evans and Caroline Laker

Method Aim: To develop new measures of service user and staff perceptions of inpatient care, using a participatory research model pioneered by Dr Diana Rose (SURE, IOP). Reference Groups: Identified major themes from their experiences of either delivering or receiving services. These were incorporated into a flexible topic guide for the focus groups. Focus Groups 4 focus groups of 5-8 people met twice to discuss their views and experiences. Analysis & Measure Creation: Throughout the focus group process, data was analysed using NVIVO to identify key themes. The items which the groups considered most important formed the content of the questionnaires. Final Consultation: The draft measures were presented to 2 expert panels and the reference groups for their comments. The measures were adjusted, refined and reduced.

Main Issues Thematic analysis of the data revealed the core domains: Themes were counted by NVIVO. Those that had the highest number of references were included as items on the questionnaire. STAFFSERVICE USERS InterventionsAdmission CPD (training)Care and Treatment Patient CareMedication Management (bed management)Staffing SafetyTherapy and Activities Team WorkingEnvironment (safety) Diversity

Safety Physical and verbal abuse are common place I had somebody who was from my country as well as an inpatient just was telling me off in my language saying, I will head butt you, I will smash your glasses into your face. And all so I said to him, go on, you say that so that others can hear you, just go on threatening me because Ive got channel I can actually go to and report you and make sure that something is done. But the thing is, I was only just saying that for the sake of it… its not going to work. I think acute wards are quite stressful places to be. Because like youve got people with all different kinds of illnesses. You might have someone with depression in with someone with paranoid schizophrenia or really aggressive and the two dont match. Both staff and service users feel unsafe and unprotected

Staffing Staffing Levels and Interaction As nurses we get qualified and we do years of whatever and were enthusiastic about what we want to do and then we get into the real world of acute working wards where youve got maybe two qualified nurses on shift then you have very limited time to spend one to one time with your patients and I think that often nurses start losing some of the therapeutic skills. A:A lot of the time you had to go to them to say I need to talk and theyd say five minutes and half an hour later youre getting worse and worse and worse. Youre spiralling down, you need that person to talk to and they finally decided to turn up. B: By which time you think about cutting your wrists and fucking off. Staff and service users want the same thing: time to interact with each other

Bed Management & Admission High turnover, little explanation, powerlessness You take this up in clinical supervision, you take it up with your colleagues, and you say what are we doing here? This lady is saying Im 8 over10 suicidal and youre saying, Well if you cut your wrists, go to A&E and were putting you on leave. Its very difficult on you having to make that balance. You feel youre letting down the patients. I was plonked down in a chair and I was left there for nearly an hour, not knowing what was going on and watching the patients, you know, both aggressive and very, very withdrawn. You know, it literally frightened the living daylights out of me because I was there for nearly an hour, without anyone coming up to me. Both groups want less emphasis on turnover and more individualised care

In Summary It is crucial that service users and staff work together to shape improvements to inpatient services. Because of your involvement, we have been able to create questionnaires which reflect the issues that staff and service users think are most important. Both questionnaires are now being used in BETTER PATHWAYS A big thank you for all your help so far. We wouldnt have been able to do this without you.....