Zonal Nursing at the Ayr Clinic

Hugh Hill & James DalrympleMovember 2012

Introduction

• Meaningful involvement• Effective and evidence based practice• Embedding and delivering a recovery model• Busy, active and engaging wards• Person centred care• Getting the balance right between safety and

freedoms

The Impact of Enhanced Observations

• Up to 6 patients 1:1 or 2:1• Increased stress levels• Motivation levels reduced• General lack of hope• Similar experiences of mental health settings they had

been in before

The Teams Mission?

• To explore viable alternatives to traditional observation methods

• To examine related research and good practice articles and visited other hospitals that were operating alternative engagement strategies

• To develop a proposal and project plan • To consult and develop a new system• To work with patient and the MDT to find a better

way for patients and staff.

What is Zonal Nursing?

• Staff are allocated to specified zoned areas in the ward rather being assigned to an individual patient

• Via an established ‘Zoning’ system patients are allocated an individual risk assessment

• Patients can move between areas and be monitored discretely

• A security nurse and floor walker manage and monitor the zones

Changing Culture

• Improving communication at every level on the ward• Testing trust and confidence in each other and teams• Ownership and commitment to the process• Putting patients front and centre• Flexibility in roles and approaches• Getting the patients to work with us• Supervision and support

After 10 months?

• The environment is less restrictive• It is conducive with delivering better therapeutic

intervention• Activity has increased allowing staff to develop

protected time and introduce structured programmes for people in the ward

• Culture of positive risk taking • Supporting recovery

Specialing

Less is more?

• Staffing numbers• Supervision• Morale• Meaningful week – 25 hours minimum• Therapeutic environment• Greater freedoms, responsibility and options• Incidents• Fun

What next?

• RCN and MWC Nominations• Presenting the work – articles, workshops, posters• Full evaluation – February 2013• Extend across the hospital• Share practice – (Thanks to Dykebar and Leverndale)

Conclusion

• Drivers for change• Evidence base• Ownership at team level• Involving patients• Substantial improvements in ward experience• Substantial improvements in nursing opportunities• A positive step for change.

References: • STEEL, M., 2012. Breaking with tradition. Activate, 6(10), pp. 5

• CARR, P., 2012. Using Zonal Nursing to Engage Women in a Medium Secure

Setting. Mental Health Practice, 15(7), pp. 14-20

Movember Facts• The average life expectancy for men in the UK is four years less than

women• Prostate, colon, lung and breast cancers account for over half of the

cancer diagnosis in the UK• Prostate cancer is the most commonly diagnosed cancer in men in the

UK. Over 40,000 men are diagnosed with prostate cancer ever year and there are 250,000 men currently living with the disease

• 1 in 9 men in the UK are likely to face prostate cancer in their lifetime. This is comparable to the 1 in 9 women that are estimated to get breast cancer

• 2,209 men in the UK were diagnosed with testicular cancer in 2009• 47% of testicular cancer cases occur in men under 35 years and over

90% occur in men under 55 years• 42% of men were classified as overweight in 2010 (in England)

compared to 32% women• Obese men are 5 times more likely to develop type 2 diabetes and 3

times more likely to develop cancer of the colon

It’s not all bad news – see Health is for Life at Movember.com

Movember – changing the face of men’s health