None listed
Conditions
Brief summary
Failure to recognise and appropriately respond to clinical deterioration in patients admitted to mental health units has been highlighted as a significant factor in a number of adverse events within these settings. Reasons for this are multifactorial but likely related to the relative infrequency of acute physiological deterioration in mental health settings, for example, deterioration in cardiovascular and respiratory function, evidenced by changes in blood pressure and respiratory rate. As a consequence, staff lack experience in recognising signs of physiological deterioration and responding effectively. Evidence also suggests staff commonly undertake observations from a distance (for example, shining a torch through a window during the night while undertaking observation rounds) and on the basis of appearances only (as opposed to what has been learned through direct engagement with a patient). This is reflected in medical records and during verbal handover with comments such as ‘patient appears settled’, ‘patient appears to be resting’ and ‘no change observed’. These actions by staff have been implicated in and heighten the failure to detect clinically-deteriorating patients. Further, evidence suggests managing physiological deterioration in mental health settings is often suboptimal due to poor communication between multiple healthcare providers from more than one team, and across different locations. In the proposed study setting, 32% of Medical Emergency Team (MET) calls (due to clinical deterioration of patients) result in the transfer of patients to critical care, with some of these patients dying. In most cases, earlier recognition of deterioration could have prevented these outcomes. The aim of this study is to evaluate the effectiveness of a positive workplace culture program designed to develop effective workplace cultures and nursing leadership within adult inpatient mental health units. This culture change program aims to (i) ensure the delivery of compassionate, safe, patient-centred care through the early recognition of, and response to, clinical deterioration and (ii) build on the work undertaken as part of the Productive Mental Health ward by increasing the amount of time nursing staff spend engaging with patients.
Interventions
An organisational change consultant will work with nurse leaders and nurses to collectively identify the type and style of strategies that will support them in achieving key objectives. The positive workplace culture program will focus on assisting staff to develop strategic self-awareness of their leadership style, strengths, motivations, drivers, and potential weaknesses particularly in the context of leading and co-creating culture change. Two programs will run concurrently – one for the nurs
An organisational change consultant will work with nurse leaders and nurses to collectively identify the type and style of strategies that will support them in achieving key objectives. The positive workplace culture program will focus on assisting staff to develop strategic self-awareness of their leadership style, strengths, motivations, drivers, and potential weaknesses particularly in the context of leading and co-creating culture change. Two programs will run concurrently – one for the nurse leaders, which will focus on leadership capability and cultural transformation and a program run ‘at the coal face’ with Nurses. The Positive Workplace Culture Program will be tailored to the individual sites based on findings from baseline focus groups and questionnaires. The program will be delivered by an organisational change consultant in Phase 2 (3-15 months) of the study. The program will be delivered to nurse leaders in group sessions during professional development time, and to nurses in groups during in-services. Phases 1, 3 and 4 consist of the collection of both quantitative (surveys and audit) and qualitative (individual interviews and focus groups) data. Baseline data will be collected during Phase 1 (0-2 months). The Positive Workplace Culture Program will be implemented during Phase 2 (3-15 months) and is briefly described above. The immediate impact of the Positive Workplace Culture Program will be measured during Phase 3 (16-18 months), while the sustainability of the Positive Workplace Culture Program will be assessed during Phase 4 (19-21 months).
Sponsors
South Western Sydney Local Health District
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
All nursing staff (mental health nurse leaders and nurses) working in the adult in-patient mental health units at Bankstown, Campbelltown and Liverpool Hospitals will be eligible to participate.
Exclusion criteria
None.
Outcome results
None listed