HEALING TOUCH Fiona Geiger, Matron S. R. N; Dip HEALING TOUCH Fiona Geiger, Matron S.R.N; Dip. Nursing Siobhan Doolan, Clinical Educator R.G.N; BSc (Hons); PG Cert; FHEA Welcome, thank you for choosing to attend this workshop today, in which we will be focussing on care and compassion in Nursing. We would like to share our story on how we introduced trained Volunteers to deliver hand rub therapies within the division, to improve the patient experience.

DRIVERS Healing Environments Project Nursing and Midwifery Strategy 2012 (Central Manchester University Hospitals) Compassion in Practice (DoH 2012) 1 The Mid Staffordshire NHS Foundation Trust Public Inquiry - Francis Report (2013) 2 HEALING ENVIRONMENT/ACTIVITIES PROJECT- Initially borne from the Kissing it Better national initiative, introduced to the Trust in 2012. The Trust developed the healing environments project which focuses on bringing various activities to wards and out patient areas – to engage with patients, to relieve stress and boredom, to distract and entertain patients, and to, ultimately bring a smile to patients faces, which will improve the patient journey. JANE TILLEY OFFERED HAND RUB THERAPY AT ONE OF THE MONTHLY HEALING ENVIRONMENT MEETINGS. LOCALLY, within CMFT, the Nursing and Midwifery Strategy was launched in 2012. This underpinned a set of values of how CMFT nurses and midwives want to deliver care and how patients, families and service users want to receive care. DIVISIONALLY- we chose to identify Compassion, Dignity, Respect, Consideration, Empathy and Pride, as our values. COMPASSION IN PRACTICE - 6C’s- Care, Compassion, Competence, Communication, Courage and Commitment. These are the values that motivate us want to work within healthcare. These are powerful words, are they words, or are you transferring them into practice? As frontline staff we are the people who can and will make a difference FRANCIS REPORT -Briefly mention poor standard of care, patients suffering whilst in hospital care, management failing to respond to patient complaints effectively. Meeting targets, but as a trust, allowed themselves to become complacent and naively assumed that targets = high standard of care. Despite being informed by staff, the warnings were ignored. In reality the care was far below the level of acceptable which should have been delivered. As health care professionals, we should learn from this drastic mistake and question the care we are delivering, directly or indirectly. There is no room for complacency, Mid Staffs proved targets do not = quality of care, we can and should always strive to improve!!!

BACKGROUND Supporting patients Ageing population Extended roles Nurturing of Intelligent Kindness Service user’s expectations Patient Experience We are privileged to support patients at the most memorable and possibly their most vulnerable times of their lives, highest highs, e.g. children being born to their lowest lows – major trauma, serious illness/loss of friends/family and sometimes death of a dearly loved husband, wife, son, daughter, grand ma, grand dad. Divisionally, we support patients when they undergo minor surgery, resulting in a short stay in hospital to major surgical interventions, which may be life changing or severely affect the quality of their lives.. People are living longer, with many complex health needs, remember these patients are often frightened, vulnerable and sometimes enduring prolonged hospital stays. Within an ever changing working environment, we are required to utilise our skills to include extended roles, following complex surgical interventions. Eg IV therapies, VAC dressings, Tracheostomy care. Some of sciences within nursing are indeed being celebrated today. This results in patients who require intense support and high quality nursing care to recover. These are difficult times for our patients who endure longer stays within a hospital setting. Prolonged hospital stays can lead to episodes of depression, mood swings, poor nutritional intake, change in their own identity-lack of confidence, lack of motivation, isolation, feelings of lonliness, fatigue. These are whilst patients are dealing with trying to recover both physically and psychologically from serious illness/trauma. From an educationalist perspective, it is essential that the workforce is equipped with skills to be deemed as competent practitioners. Whilst this is important, we emphasise the importance of ensuring care and compassion are high priority for our patients. Within Surgery, we are striving to balance competency, compassion and kindness – intelligent kindness. Service Users now have high expectations of care they would like to be delivered, Patients can even choose where they would like to receive their treatment/surgery. As a Trust we are closely monitoring the patients journey, asking them via several methods, if they were happy with care being delivered. This may be via the patient Tracker, Quality care rounds or via the friends and family test? Would you recommend our Trust to your family and friends? The feedback reflects, that it is the “little things”, which make a massive improvement to the patient experience, whilst in our care here at CMFT. I ask you to take a couple of seconds to think about when you or one of your family are poorly, we want our husband, mum, partner/ to be kind to us, this may be by holding our hands, rubbing our back if we feel sickly, mopping our brow, or even simply holding our hands. The power of touch should never be underestimated.

TOUCH PATIENTS: BARRIERS: Elderly population 3 Living with Dementia 4 Language barriers Disabilities BARRIERS: Lack of consent Cultural Lack of authenticity TOUCH As we have agreed, when we are at the most vulnerable times in our lives, we need touch. eg hold hand, rub back if feeling sick. It is such acts of kindness which patients remember, as being shown this kindness and compassion when feeling sick, frightened, sad, anxious, suffering. This is also true for patients whoa re living with DEMENTIA , touch is soothing, calming, reassuring when unsure of surroundings and strange people. LANGUAGE BARRIERS- we can smile and rub their hand as reassurance and support (non verbal communication). How would you feel if you were admitted to hospital whilst abroad, when you may not speak the same language, but you are very ill? If you were shown this act of kindness, would you feel reassured? DISABILITIES – blind patients, who may be very sensitive to touch, deaf patients who cannot hear us or lip read, special need patients with multiple communication deficits. BARRIERS Culturally, this may be a sign of disrespect to touch patients. eg Muslim Men or Orthodox Jewish Men Always seek consent, this may be implied. If patient not responsive, do not carry out procedures, as this could potentially offend the patient. Lack of authenticity- Touch MUST be authentic and coupled with the appropriate verbal and non verbal body language I would like to show you a very short DVD of an interaction between a volunteer and a patient. This Volunteer has undergone Hand Rub Therapy training, which is offered by the Volunteer leaders. Please look at the various communications which are taking place within this interaction. SIT DOWN!!

LINK I am sure you will agree, this patient enjoyed the therapy and we saw some of the benefits of the hand massage. This lady when asked how she felt prior to the hand rub scored herself 3/10. on completion she scored herself 8/10 and reported even her headache has eased!!!

BENEFITS OF TOUCH Distraction Decreases the sense of isolation Physiological changes (lower blood pressure and lower pulse rate) 5 Reduces stress levels 5 Increases the production of endorphins Promotes the feeling of well being Reduces tension Promotes relaxation Increases the range of motion for patients with arthritis 6 BENEFITS OF TOUCH Sometimes patients who live alone, may go for long periods without being touched, this can lead to an increased feeling of isolation. This may change whilst in hospital; however, we should stop and think about the care we are delivering. Do we only touch patients during care delivery? eg, to change a dressing, to give IV Therapies etc. Alters Blood pressure and Pulse rate refer to referencing on slides, which will be available after the conference. ITA in neighboring Trust had hand massage therapy whilst recovering from major surgery. I saw first hand, the difference it made to her as a patient. I was driven by my mums experience, to pursue this fgurther for the benefits of patients undergoing surgery and treatment within this division

INTRODUCTION TO SURGERY Challenges: Environment Diversity of patients Scepticism Raising awareness with Division: Utilisation of Lewin’s Change Model Agenda item at Senior Nurse Meeting Scoping Exercise Volunteer services Vision to reality: Piloted on Ward 7 Volunteers allocated Challenges: Busy environment,, emergency admissions, structured routine, ward rounds, theatre schedules, acutely unwell patients, not trialled before, may not be well received. LEWINS CHANGE MODEL: UNFREEZE –Preparing staff accept change is necessary, it is working within other Trusts, it can work here!! My MUM CHANGE – Staff to believe this would work within their areas and want this for their patients. TIME AND COMMUNICATION PARAMOUNT for this stage to be successful REFREEZE When change is taking place and staff are embracing of this, then RE FREEZE NOW!!! Roll out: Asked for support at Senior Nurse Meeting, from all ward managers for their areas. Personally scoped areas, asking if staff felt this therapy would make a difference to their patients, Dilemma women only? or to include men All areas registered interest – pilot area chosen Ward 7, longer stay patients within division. 2 x volunteers weekly. (I hour session x 2). Liaised with Volunteer services. Limited volunteers trained. Were added to waiting list. Patient and staff feedback very positive Rolled out divisionally in conjunction with Voluntary services. LINK FORMALLY EVALUATED THE HAND RUB THERAPY SESSIONS WITH EVALUATION FORMS, WHICH Ward 7 were instrumental in collating the evidence.

FEEDBACK “I didn’t expect to have a hand rub. It was heaven” “It was so relaxing” “My hands felt so good, it was a lovely experience” “After having the hand rub, I noticed a difference in my arthritis pain in my hands” “I don’t feel like I have been in hospital” “I really enjoyed chatting with the young lady” “It was 7 minutes of uninterrupted time, by someone other than a nurse” The acceptance of alternative therapy in conjunction with traditional treatment , was adopted by all managers within Surgery. The Art of Nursing is enhancing holistic nursing “where ALL nursing practice that has healing the whole person as it’s goal” . This embraces the use of all agencies, including the Volunteer services, to improve the patient experience. The pilot on Ward 7 was so successful, we rolled the hand rub sessions out Divisionally

HAND RUB ACTIVITY January – June 2013 ESTU - 31 patients Ward 7 - 135 patients Ward 8 - 75 patients Ward 11 - 93 patients Sourced from the Healing Environments Annual Report, 2013 The therapy has been a widespread success having delivered over 334 hand rubs to our patients within the division of Surgery. Each of these interactions will have had an effect on the patient within the Surgical ward environment and as you have seen the feedback has been very positive. Unfortunately, in some areas the demand has outweighed the supply of volunteers. So the areas, in which patients endure a shorter hospitalisation, have less volunteer visits. More volunteers have been re-trained in July, so we are hoping to be allocated more to Wards 9/10, Ward 15, and ETCS. Each quote in speech bubbles, will be added and one tap on the mouse for each quoteis to be added individually and “jump into the screen) The therapy has been a widespread success having delivered over 521 hand rubs to our patients within the division of Surgery. Each of these interactions will have had an effect on the patient within the Surgical ward environment. Lets see if the patients thought the hand rub therapy were

MOVING FORWARD Ongoing projects Entertainer Music Therapy Communal games Beauty Therapists to be introduced DVD film nights Hand rub volunteers Manchester Academy Student visits The hand rub therapy is only one work stream of the Healing Environment project. Barrington - Magician /Entertainer, who not only works individually with patients, but works so hard to build a community spirit on the ward, by introducing patients to each other via his activities. MUSIC THERAPY _ Childrens Choir in Main OPD, both patients, families and the choir had a fantastic time. The choir were given a fruit hamper to take away and they sent a thank you card to the manager, as they had a fantastic time. WARD 9/10, Rev Peter Gomm, played guitar within the ward setting Communal Games – donated by RMCH via the healing Environments group. To encourage communication with patients Dementia, patients who could engage with each other. Beauty Therapists – Sept 2013 looking at introducing therapy students form Openshaw college, to volunteer services for our patients, hairdressing, nail painting. DVD Themed nights- Donated DVD’s …. Currently scoping Division with a view to introducing Themed nights within dayrooms. Eg ROM COM/ action/ thriller nights for patients to go to the dayroom (Plan to advertise film being shown, date/time) College Student Visits favourable visits, young people chatted about being 17 today and patients about when they were 17!! Students felt like they had made a difference.

We would like to thank you for your time and beg, could these therapies be introduced within your area. If it is possible in Surgery, it is possible anywhere!!! As our patients told us IT IS THE LITTLE THINGS THAT MAKE A BIG DIFFERENCE.

ANY QUESTIONS ? Barrington our Entertainer/Magician will be in the foyer downstairs and at lunchtime, there will be a demonstration of hand rub therapy being performed by one of our trained volunteers(? DIV SURG STAND!!!) in the Post graduate centre. Please accept a little gift from us, as you leave.

REFERENCES 1 Compassion in Practice. Nursing Midwifery and Care Staff Our Vision and Strategy Department of Health Commissioning Board 2012. 2 Final Report Of The Independent Inquiry Into Care Provided By Mid Staffordshire NHS Foundation Trust Chaired by Robert Francis, QC, February 2013 3 Baldwin, L. (1986) The Therapeutic use of touch with the elderly. Physical and Occupational Therapy in Geriatrics 4 : 45 – 50. 4 Kim, E.J. & Buschmann, M.T. (1999). The effect of expressive physical touch on patients with dementia. International Journal of Nursing Studies 36, 3, 235-243. 5 Lindgren, L., Winso, O., Lehtipalo, S. et al. (2010). Physiological responses to touch massage in healthy volunteers. Autonomic Neuroscience: Basic and Clinical. 2010; 158: 105 – 110. 6 Field, T., Diego, M., Hernandez-Reif, M., & Shea, J. (2007). Hand arthritis pain is reduced by massage therapy. Journal of Bodywork and Movement Therapies . Vol 11, 1, p21-24. *Music composed by Mark Fisher and performed by Ros Hawley and Mark Fisher Lead Musicians for Music for Health at LIME.