Handover | Issue 39 - July 2017

By Lois Boyd and Caro Swanson

In terms of accessing inpatient services, supporting people to develop a sense of comfort and wellbeing can be really important.

In the middle of a mental health crisis or overwhelm, it’s really easy to end up totally in your own head space and unaware of both your body and any physical feelings. If you ask people how they feel it is likely they will tell you about current mental health issues but miss any other sources of pain or discomfort. However, like a dull roar in the background any physical discomfort will start to erode gains made in finding peace, stability or grounding.

Helping people identify any physical discomfort and then ensuring there is treatment available to alleviate this can be overlooked in the urgency of treating mental health crisis and distress. At times like this, ensuring people are physically comfortable can make a huge difference towards decreasing agitation and preventing escalating situations. Examples of common physical discomfort that is often overlooked include toothache, flu, poor fitting shoes, foot care/ingrown toenails, ear infections, headaches and substance withdrawal syndromes.

Are people too cold? Too hot? Hungry? Thirsty? Tired? Headachey? Tummy ache? Muscle aches? In pain? Constipated? Are physical discomforts preventing the person from sleeping? This is an important aspect of care.

Checking these things and caring about a person’s comfort tells people you care and want them to feel better. Alleviating physical discomfort also allows any sensory modulation approaches to be more effective.

We often hear from you, and say ourselves, that it’s the little things that make the big difference and paying attention to the whole person supports their wellbeing and contributes to a positive service culture. When we visit services we see some great examples of practice innovation and 'thinking outside of the box’, that from our perspective we would love to see integrated into ‘business as usual’ everyday practice. Examples include:

  • units that provide care packs for people who don’t come in with their own toiletries
  • providing choices and preferences wherever possible
  • focusing on welcoming practices - taking extra care to consider how people are welcomed into the unit, what that first impression looks like and how initial engagement is approached.

Some staff that we have talked with identified that simple misunderstandings can build up and trigger anger and frustration if they are not addressed. As one aspect of welcoming a person into the space, making sure that at an appropriate time, a person does get an orientation to the unit and its routine is really important. Staff also often talk to us about the need to revisit this with people, acknowledging that when distressed, all this information may not be heard the first time around. Sometimes a trigger for resentment and anger is being told off for something that you didn’t know was a unit rule.

One unit we have visited did a ‘walk through’ of a person being admitted, using two nursing students to give a first impression perspective. These students commented on a number of things that horrified the staff but that they had ’not seen’ because they are in the space every day. This fresh set of eyes approach can be challenging and useful in promoting change. They have decided that their next step will be to repeat the exercise, inviting service user and family representatives to give feedback.

Another unit made a challenge to staff to greet people in their own language whenever possible, and to make an effort to correctly pronounce people’s names. This has been reflected and supported in some artwork and become a great engagement tool. Again a seemingly small thing, but if you are showing that it’s important to you to pronounce someone’s name correctly and the person can support you in getting this right, that person is more likely to engage.

Increasingly we are seeing units that are focusing on welcoming practices, include key cultural aspects when people enter and leave the inpatient space. Ora is the closest word to ‘wellbeing’ in the Māori language, so greeting people with “Kia ora” is a very welcoming beginning to a conversation.

As you are aware, there is huge concern regarding the high rates of seclusion experienced by Māori people and we are seeing services working to understand and address the reasons for this. We are currently revisiting the recommendations in Reducing Māori Seclusion, which was released in 2013. This research-based report provides a range of practical and useful guidance, based on the Six Core Strategy© model, to support Māori wellbeing. If you haven’t already, we would encourage you to read it and apply it in practice.

As nurses, a quarter of our Nursing Council professional competencies focus on how we demonstrate cultural competence and this is such a key component of people’s wellbeing, so please consider, on the basis that small actions make a big difference, what are you doing as a nurse to address the high rates of seclusion experienced by Māori people?

If your service includes cultural practices that you believe are having a positive impact on reducing Māori seclusion, we would really appreciate hearing from you. A key focus of our team is to enable networking and sharing of positive practice stories to support change and we are keen to keep working with you all to keep reducing and eliminating restrictive practices.