The old age ward: Investigation into the effects of training sessions with junior medical staff

Annabel J McDonald 
Ananth Puranik 
Baytree House, Maidstone

Abstract

Aims

To stimulate and teach nursing staff to increase confidence and extend skills Improvement of team working between nurses and doctors.

Background

Retention of psychiatric ward staff is an ongoing problem in the UK. Staff development has been cited as a potentially retentive factor. These seminars were designed to pique the interest of nursing staff. There can be a weak interface between nursing staff and continually changing junior doctors. It was felt that this project could augment communication and effective team working as nurses and doctors developed a better mutual understanding of their skills and knowledge bases.

Method

Two older people wards were identified at neighbouring psychiatric hospitals. One ward (n=15) received twice-weekly training sessions with a junior doctor for four months. The other ward (n=12) served as a control. The staff filled questionnaires at start and finish to evaluate changes in their confidence with both doctors and patients, enthusiasm for their jobs and plans to take further qualifications. Changes in responses were tested for significance using student t-test.

Results

The average score for all questions increased on the intervention ward.  There was a fall in all average attitudes on the control ward.  Student’s t-test showed a significant improvement in scores following intervention (p=0.04)

Conclusion

This small study indicates that such seminars can increase nursing confidence and interest.  We feel that the results justify extending the project to a larger sample and suggest that similar findings would justify building such teaching into the role of junior ward doctors.

Keywords

nursing, ward staff, training, teaching, doctor nurse relations,psychiatric, psychogeriatric

Financial Support

This research received no specific grant from any funding agency, commercial or not-for-profit sector

Conflict of Interest

none

Background

Retention of trained psychiatric nurses is recognised as an ongoing problem1,2 and the 2006 UK Chief Nursing Officer’s review of the issue considers a number of areas where change could be of value.  These include increasing public respect for the profession and improving the remunerative package as well as enhancing intrinsic job satisfaction. The review suggests that improvement in nursing skills and knowledge with an increased challenge could support the latter aim1.  Other studies have commented on the high significance, to nurses, of their relationships with physicians and their perception of a relatively low level of respect for their input by doctors3.  Nurses describe this as significantly affecting their levels of job satisfaction while suggesting that further collaboration and communication could be helpful in combating the problem.  Fagin and Garelick’s interesting analysis of the relationship similarly suggests that an improved understanding, by doctors, of nurses’ roles and skills would be of value4.  They add that there could be value ‘in arranging for doctors to train junior nurses in aspect of clinical assessments, diagnosis and treatment.’

This study examines the introduction of training seminars, run by junior medical staff, for nurses on an old age psychiatric ward.  It was felt that this could nurture confidence and job satisfaction by increasing the skills and knowledge of nursing staff whilst developing a better mutual understanding, by both nurses and doctors, of their complementary roles and knowledge. 

Method

Two old age wards were identified at neighbouring Kent psychiatric hospitals.

Staff on each ward were asked to fill out a questionnaire (figure 1)  which recorded their attitudes to their work and their doctor colleagues on Likert scales.  It was noted, on the intervention ward, whether the information was provided by qualified nursing staff or health care assistants.  There were no refusals.

Figure 1: Questionnaire

 

Twice-weekly training sessions were set up on the intervention ward.  There was no intervention on the other ward which therefore acted as a control.  Each session lasted 30 minutes.  One session was aimed primarily at qualified staff while the other was directed toward healthcare assistants.  Sessions were held at shift-crossover time to maximise staff availability.  There was no compulsion to attend.

After four months, the staff on the two wards were asked to fill in the same questionnaire again.

The mean before and after values were calculated for each question on each ward. Student’s t-test was used to examine the before and after values for significance. The results from the intervention ward sub-cohorts were examined to establish whether changes primarily reflected attitude alterations in trained nurses or healthcare workers.

Results

A summary of recorded responses to the questionnaire appears in Table 1.  Student’s t-test showed a significant improvement in scores following intervention relative to the control ward (p=0.03).  The intervention ward results suggest that changes in the views of qualified staff accounted for the majority of this improvement.

Table 1:  Mean Likert Scale Responses to Questionnaire Items on Intervention and Control Wards

 

INTERVENTION WARD

CONTROL WARD

Question

1

2

3

4

5

1

2

3

4

5

Number respondents (n)

Start/end

18

15

18

15

18

15

18

15

18

15

12

12

12

12

12

12

12

12

12

12

Mean value, start

7.3

6.6

7.1

6.4

4.4

8.4

9.3

8.2

6.3

7.3

Mean value, end

1.8

1.3

7.4

6.4

5.5

7.8

8.6

7.6

5.4

6.5

Change, %

+6.9

+10.4

+4.2

+0.2

+25.8

-7.0

-7.7

-7.2

-14.4

-11.3

HCA  % change

+5.64

-1.0

-6.7

-4.4

+8.0

 

not differentiated on control ward

Nurse % change

+14.7

+41.8

+32.3

+122

+75.8

Table 1:  HCA = health care assistants            Nurse = Qualified Psychiatric Nurses

Questions

1: How confident do you feel in dealing with an ill patient?

2: How confident do you feel in talking to a strange doctor?

3: Do you feel excited or a little frustrated with your work?

4: Do you feel that on-call doctors are usually helpful?

5: Are you intending to take any further qualification?

Discussion

The results indicated significantly increased confidence and satisfaction on the ward where training seminars were instigated.  This was further emphasised when compared to the control ward where attitudes showed a decline.

Further examination of the results suggested that the most positive effects were apparent in the qualified nursing staff rather than the healthcare assistants.  This may have reflected the fact that the qualified staff chose to receive a more practical series of sessions.

The sessions with the healthcare assistants covered topics such as types of dementia, diabetes, urine dip results, physiology of patient observations, etc.  The results from this group showed a positive improvement in confidence when dealing with an ill patient and an increased interest in taking further qualifications.  It did not improve confidence with doctors or increase enthusiasm for their work.

The sessions with the qualified nursing staff tended to be more practical.  They included sessions on reading an ECG, taking ECG’s, interpreting blood results, using the online pathology reporting system and practical phlebotomy as well as some of the topics covered with the healthcare assistants.  The responses to these sessions indicated increased confidence in dealing with both sick patients and doctors.  There was also a reported rise in enthusiasm for the job and greater desire to take further qualifications.

The staff on the ward displayed an enthusiastic response to the seminars with good attendance.  The project received firm support from the Charge Nurse.

A number of practical gains were made by the qualified nursing staff.  Two nurses have now returned to active phlebotomy work.  All qualified staff now use the hospital Pathology system with confidence.  Six qualified staff can now take ECG’s with a broad understanding of the resultant traces

Limitations

This was a small study with a number of further limitations.  The nearest old age psychiatric ward (to act as a control) was 12 miles away and thus subject to different local influences.  Attendance at the seminars was variable according to duty rosters and ward requirements on the day.  Changes to staff and rostering also meant that fewer final questionnaires (15) were obtained than starting questionnaires (18).

Conclusion

Seminars from general medical staff were welcomed by ward staff and appear to have fostered confidence and enthusiasm as well as the acquisition of practical skills.  This was a small pilot study which would support extension to a larger population .  Confirmation of observations would support the incorporation of such sessions into the role of junior ward doctors.

References

  1. Department of Health. Recruitment and retention of mental health nurses: Good Practice Guide, The Chief Nursing Officer’s Review of mental health nursing, 2006, http://www.nacro.org.uk/data/files/nacro-2006042401-349.pdf (last accessed 14/2/15)
  2. Karlowicz, K. A., & Ternus, M. P. (2009). Issues influencing psychiatric nurse retention during the first year of employment: a case analysis. Journal of Nursing Management, 17(1), 49-58.
  3. Rosenstein, A. H Nurse-physician relationships: Impact on nurse satisfaction and retention. 2002 AJN The American Journal of Nursing, 102(6), 26-34.
  4. Fagin, L., & Garelick, A The doctor–nurse relationship. 2004 Advances in Psychiatric Treatment, 10(4), 277-286.