Stage set for patient care
Nurse Brigid Reid had an unfortunate experience once when a relative was in hospital.
"The treatment he received was at best neglectful, at worst abusive," she says. "I had to get involved. I met with some senior people at the hospital and voiced my concerns.
"The nursing officer said 'Clearly we need to improve our customer care'. I said, 'No you're missing the point. This is about essential nursing skills'."
Brigid is a consultant nurse with the East Lancashire NHS Trust at Burnley General Hospital. Her relative's experience inspired her to set up Being With Patients, a staff-training programme which uses professional actors to play patients.
The Health Foundation has now given a grant which will enable Brigid to measure the effect of her programme on patient care and to develop her leadership skills.
She started Being With Patients through CragRats, a West Yorkshire training company, which works with a range of clients including ASDA, Manchester Airport, BT and American Express.
CragRats works with health trusts throughout the UK. For example, a CragRats project in Leeds gives student nurses and doctors a chance to practise their consulting skills on people acting as patients.
Brigid advertised for patients to come forward with their hospital experiences, both "heart-warming and heart-sinking". After sifting through the material common themes emerged and she was able to respond to training needs.
An awareness day was held for 50 nurses. They took part in drama and workshops in small groups. Then came some day-courses on interpersonal skills for up to 10 nurses, each with a mentor, using people acting as patients.
"We cannot care for patients unless we feel cared for ourselves," says Brigid. "Nurses need to feel cared for. Before they come on the day, I ask them to suggest their ideal lunch, a piece of uplifting music, their favourite flowers. And we try to cater for them.
"Each is given a goodie bag when we finish, and there is a handwritten CragRats postcard with a message: 'If you found today special in some way, how can you recreate that for the people you work with (staff and patients). You as a nurse are your best resource - look after yourself.'
Many of them look at that message during their working day. It helps them if the culture they work in is difficult."
Nurses practise their interpersonal skills in a mock-up area in a deserted ward. There's even a soundtrack of typical ward noises.
Only the simulated patient and the actor are in the mock-up area. Brigid and the nurse's mentor are behind a screen.
Brigid cites some examples of what can be learned in a scenario. Putting an operating gown on a bed, saying "put that on" and walking off makes the patient feel even more vulnerable. Nurses introducing themselves by their first name assume that the patient will want to be known by their first names. It then takes great courage for the patient to insist on being called Mr, Mrs or Ms.
A fundamental is getting nurses to accept that patients are experts in their own conditions.
Brigid talks of the body language of nursing. She sets great store on facial expressions, warmth and contact.
Brigid reads an extract from a nurse's letter: "I'm horrified that my actions, which I don't think about normally, could have such an effect on patients. I shall recommend the course to my colleagues. It's excellent."
The feedback has been enthusiastic. Nurses have talked of gaining professional courage. Other health trusts are showing interest.
"There is a clear correlation between the participants' own views, the views of their mentors and the views of myself and the patient-actors," says Brigid. "What we don't have yet is evidence that it actually makes a difference to patient care. I am constructing a research project to look at that, funded by the Health Foundation.
"I have a strong instinct that it will be seen to make a difference - provided that it's seen as integral to care. A trust that just bought this work in but paid no attention to the needs of the staff, would find that it did not work."