Journal of Psychiatric and Mental Health Nursing, 1996,

Clinical notice board

June Andrews Scottish Board, Royal College of Nursing, 42 South Oswald Road, Edinburgh EH9 2HH. Scotland

A national helpline needs your help SANELINE was set up by the charity SANE in 1992. It is the first out-of-hours national telephone helpline providing accurate and up-to-date infor- mation to enable callers to develop informed options for action; and to offer emotional support to people suffering from mental illness, their fami- lies, friends and interested professionals. SANE- LINE is currently being run from the charity’s London base, but early in 1996 the first satellite helpline operation to SANELINE was launched in Macclesfield with the approval and help of South Cheshire Health Authority. Eventually, SANELINE hope to start up satellites countrywide so that the helpline will be even more effective.

SANELINE’s helpline is staffed by volunteers who are able not only to listen and offer emotional support, but also to use the charity’s database to offer relevant information.

SANELINE’s unique database offers information in the following areas:

mental health services on both a local and a

medication, treatments and side effects psychological treatments and other therapies illnesses and symptoms mental health law and sufferer and carer rights. SANELINE volunteers are essential to the

running of the helpline and each volunteer receives very rigorous training. Volunteers need to be caring, non-judgemental and empathetic to mental illness. The selection programme consists of an introductory evening to which all applicants are invited to learn what it means to be a SANELINE volunteer and the commitment that is expected. Interested people will then complete a detailed questionnaire which is followed up by a telephone interview. Successful applicants are then invited to a selection day when applicants will join discussion groups, join in role plays and individual interviews,

national basis

and both staff and volunteers have the opportunity to discuss areas of concern. A five-day training pro- gramme follows, designed to ensure that volunteers will have an understanding of the nature of the calls SANELINE receives and the ability and confidence to deal with the calls in an appropriate manner. At the end of the training programme, which includes lectures from professionals, talks from both suffer- ers and carers, and training on difficult calls and manipulative callers, volunteers will be able to use the information database, have a knowledge of the Mental Health Act and the roles of the various pro- fessionals in the mental health field. They also will have a greater awareness of mental illnesses, their symptoms and treatments. A two month probation- ary period follows, when each volunteer is closely monitored and supported throughout their shift. SANELINE operates from 2 PM until midnight every day of the year, including Christmas. Each of the four-hour shifts is managed by a member of SANELINE staff and this coordinator is there to give support to the volunteers.

SANELINE requires certain commitments from their trained volunteers. All volunteers must commit to working one four-hour shift per week. They must make a commitment to attend on-going training which involves lectures, refresher days and residential weekends. They must also keep all infor- mation about the calls that they receive strictly confidential.

SANELINE needs your help. If you think that you would like to be a volunteer on SANELINE, and you live within a 25-mile radius of London or Macclesfield, please contact Philippa on 0171 724 6570 for further details. We look forward to hearing from you.

VI GILLMAN Media Relations

SANE 199-205 Marylebone Road

London NWl S Q P

Q 1996 Blackwell Science Ltd

B a h t prize for the field of health and nursing care

To promote relationship-orientated care based on the Ascona Model of the World Health Organ- ization (WHO), prizes will again be awarded in 1996.

This model originates in the work of Michael Balint, in whose honour a prize has also been donated and awarded yearly since 1990 in the field of health- and nursing care in Ascona, Monte Verith.

The award of 8000 Sfr. has been offered by the Foundation for Psychosomatic and Social Medicine in Ascona and by the Swiss Red Cross.

Papers of maximum 20 pages (30 lines per page and 60 letters per line) will be judged according to the following criteria. 1 Exposition. Papers presented give an account of

a personal experience within a nursing care rela- tionship with a patient and its possible develop- ment. The author’s experience and the degree of empathy are especially important.

2 Reflection. The author analyses hidher own behaviour as well as that of the patient and the relationship to co-workers and to the patient’s people of reference. Referring to this situation analysis, personal feelings, fantasies and percep- tions, which are all often supressed, should be taken into consideration.

3 Action and Progression. The author describes what he learned and which experiences he/she made. Helshe shows in which way the experi- ences have been integrated into everyday care.

Closing date for entries: 31st May 1996

Three copies of each paper in German, French, Italian or English accompanied by a short profes- sional record should be submitted to: SWISS RED CROSS Department of Vocational Education Pro Balint Werkstrasse 18 P.O. Box CH-3084 Wabern

The awards will be presented on 26th October 1996 in Ascona, Centro Monte VeritA, during the 29th International Ascona Meeting on the theme ‘The depressive patient - psychosocial and thera- peutic perspectives’.

The meeting is directed by Professor Dr Dr H.c. Boris Luban-Plozza.

The management of wandering in older people with dementia

Background

Of all the many changes in behaviour shown by Alzheimer’s patients, wandering both night and day can be one of the most disturbing and difficult to cope with. Together with other symptoms it pre- sents major problems for both patients and carers and frequently means that patients have to be taken into institutional care (Argyle et a/. 1985).

Risks associated with wandering include encoun- tering hazards, falls, fractures, missed treatments and diversion of nursing staff from other duties (Mayer & Darby 1991). It challenges the skills and patience of both the hospital and home carer. Historically, the most popular way of coping with wanderers relied heavily on restraint, physical as well as pharmacological (Snyder et al. 1978). This relieved staff members from dealing with the behaviour, but such practices are now largely viewed as inappropriate as, ethically, the use of restraint violates the rights and dignity of patients who exhibit wandering behaviour.

Research studies suggest that assessing the differ- ent types of wandering seen is essential if appropri- ate nursing intervention is to be planned (Hope & Fairburn 1990). Several approaches to the manage- ment of wandering are known, including the use of mirrors (Mayer & Darby 1991), visual barriers (Namazi et af. 1989) and structuring the wan- derer’s day (Stokes 1988).

The project

The unit I work on provides support to people, both in the hospital and community setting, who exhibit wandering behaviour. Often I have felt frus- trated that we are unable to manage this behaviour effectively and promote dignity and freedom of movement in the patient. Following a major litera- ture review, I found that a great deal of research has been undertaken in this field and the main aims of this year long project are listed below. 1 To understand more fully the variety of behav-

iours observed during wandering. 2 To introduce a more systematic method of

assessing wandering behaviour by using the

0 1996 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 3,137-140

‘Descriptive Typology of Wandering’ tool (Hope & Fairburn 1990). To plan care more effectively as a result of this assessment and incorporate appropriate strate- gies into the plan of care of individual patients. To test each of the methods previously described, both in the hospital and community setting, in an attempt to find the most effective method of reducing the incidence of wandering. To incorporate techniques used in the manage- ment of wandering into a booklet designed for use by carers. To share the results with nursing colleagues in Powys and throughout the country to achieve widespread good practice in the management of patients who wander. The project has now been in action for two

months and 1 am currently working with six patients and their carers and I am already observing some interesting results.

If you would like to hear more about the project, please contact me at the above address given below.

CAROL ROBERTS Tawe Ward,

Powys Health Care NHS Trust, Ystradgynlais Community Hospital,

Glannant Terrace, Ystradgynlais, Powys, SA91AE

References

Argyle N, Jestice S, Brook C.P.B (1985) Psychogeriatric Patients: Their Supporters’ Problem. Age and Ageing,

Hope R.A., Fairburn C.G. (1990) The Nature of Wandering in Dementia: A Community Based Study. International ]ournu1 of Geriatric Psychiatry 5 ,

Mayer R. Darby S.J. (1991) Does AMirror Deter Wandering in Demented Older People? International Journal of Geriatric Psychiatry 6,607-609.

Namazi K.H., Rosner T.T., Calkins M.P. (1989) Visual Barriers To Prevent Ambulatory Alzheimer’s Patients from exiting Through An Emergency Door. The Gerontologist. 29,5, 669-702.

Snyder L. Rupprecht T.R., Brekhus S, Moss T. (1978) Wander ing. The Gerontologist. 18,272-280.

Stokes G . (1988) Choosing The Path To Guide The Wanderer Geriatric Medicine Community Nursing Supplement. July 13-14.

14,355-360.

239-245.

Clinical Diaries: a compelling necessity

I have long fostered the view that a mechanism is required that promotes the recording of experiential

Clinical

data and facilitates its availability for evaluation at a more convenient time (reflective practice). My inten- tion here is to outline the potential uses of clinical diaries by ward-based nursing staff; introduce their use, and report the outcome in terms of qualitative comment following a period of six months.

A number of questions stimulated an interest in the use of clinical diaries by ward-based nurses (the term clinical diaries is used in describing diaries that record specifically clinical and professional infor- mation, perhaps as a narrative or key-word format.

These questions are listed below. How do nursing staff manage without the use of individuals’ diaries when community staff find them indispensable? Why does their need diminish with organisa- tional status? (‘G’ grade staff use them but less so ‘F’ grade staff and their use is rare by junior staff) How do staff make individual appointments to see outpatients or relatives, or to perform out- reach work during their span of duty? How is the fallibility of human memory dealt with? In addition to these more general questions was

the need to generate a range of agendas. The need exists to generate agendas in relation to

clinical supervision, individual performance review, professional portfolios and in stimulating reflective practice.

Clinical supervision

A common method of identifying the agenda for clinical supervision sessions is by way of negotia- tion at the beginning of each session. Whilst some staff may have little difficulty in recalling incidents or bringing ‘appropriate’ material to supervision, the very use of a clinical diary facilitates the review of clinical work and it’s presentation for joint con- sideration.

Individual performance review

Like clinical supervision, some staff can have diffi- culties in identifying what they consider to be suitable material that will form the agenda for an individual performance review. (It should be remem- bered that these meetings are an opportunity to influence in a significant way the direction of one’s clinical work and the objectives related to it.) Also within individual performance review is an oppor- tunity to agree objectives related to career develop-

0 1996 Blackwell Science Ltd, journal of Psychiatric and Mental Health Nursing 3 , 137-140

ment plans. It therefore makes sense as the year pro- gresses to note areas of interest, frustrations, and barriers to achieving objectives. It should also be noted that this is an opportunity to engage the assis- tance of senior clinicaYprofessiona1 staff and managers in ensuring that one meets one’s objectives and in many cases, assists staff in achieving them.

Professional portfolios

Some mechanism is necessary to assist in tracking information and experiences that will go toward producing a professional portfolio. At it’s simplest level it may act as an aide memoir, at it’s most complex as a template for accredited prior experien- tial learning (APEL). As the need to demonstrate ongoing professional development unfolds as a result of post-registration education programme (PREP) and periodic registration, nursing staff will increasingly need a means of identifying their devel- opment and it seems likely that this will increasingly focus upon reflective practice.

Reflective practice

Clinical diaries offer an opportunity to record in an immediate way those clinical issues that emanate from practice upon which we might reflect. Whilst reflective practice is in danger of being seen as the panacea for nursing’s ails, it does have a valid contri- bution to make to clinical practice and supervision.

Many researchers would report their research diaries as being indispensable in looking at the route that they travelled in their exploration of their chosen area of study and that this formed a signi- ficant part of the learning process. Likewise from a quality and audit perspective, it might usefully con- tribute to identifying an audit trail in evaluating nursing intervention and identifying outcome measures (notoriously difficult in psychiatry)

Whilst clinical staff may have reservations about recording their personal experiences in the light of confidentiality and senior personnel checking their use, it would seem appropriate and sufficient to ob- serve that they are in everyday use and await the com- ments of staff on their use after a six-month period.

BARRY JACKSON Senior Nurse

Mental Health Division, Newcastle City Health Trust,

Newcastle upon Tyne, England

Special Care Unit: audit of time out, enforced segregation and seclusion, St Nicholas Hospital

How nurses respond to aggression from patients is the litmus test for staff attitudes. If nurses are gentle, respectful and professional towards patients who have tried to hit them, then nurses model good anger-control methods and preserve the therapeutic relationship.

The Special Care Unit at St Nicholas Hospital, Newcastle, is about to repeat the audit on all episodes of time out, enforced segregation and seclusion (only used once in the last four years). Information will be collected on the level of aggres- sion shown, the identity of the victim (if any), demographic details about the patient, details about staffing levels at the time, and the grade and sex of the staff member who made the decisions. Finally, what were the outcomes for the patient? Was required medication given? Was physical restraint used? If so what type? Also, were there any other repercussions?

Why? First to test our performance against our standard that physical restraint should be used only when absolutely necessary. There should be docu- mented evidence of other approaches having been tried previous to the use of restraint, or that restraint was immediately necessary to prevent injury.

Secondly, if we can identify patterns, we may be able to identify preventative measures, or trigger factors or stressors for patients. We may identify training needs for staff, and possibly room for improvement in the current policies and guidelines.

Finally, every episode is audited and a copy of the audit report is circulated to the Local Clinical Policy Group. At this meeting other nursing col- leagues, other professions, and a representative from the User Group may all comment and suggest possible improvements to practice.

We aim to audit this every year and learn from the findings to improve and refine practice.

ANN WIDDAS Senior Clinical Nurse

GARY O’HARE Ward Manager

Special Care Unit, St Nicholas Hospital,

Jubilee Road, Gosforth, Newcastle upon Tyne

NE3 3 XT

Q 1996 Blackwell Science Ltd, ]ournu/ ofPsychratrrc and Mental Health Nursing 3,137-140