ACTIVITY FEATURE
From October , the team has worked on a rolling rota across the two wards , and has primarily been deployed to run groups .
Delivering group sessions Group work has been identified as the primary model for activity co-ordinators on the wards for a number of reasons . Human beings are social beings , but old age , and hospitalisation , can lead to isolation and loneliness ( Singh et al 2016 ).
Engagement in groups run by the activity co-ordinators on HCOP wards involve physical and social aspects , and increase nutritional intake , as described below . By offering groups , the number of contacts between activity co-coordinators and patients is increased , with more patients per co-ordinator seen than with purely one-to-one work .
Physical deconditioning for older people in hospital has been recognised as a factor in lengthening hospital stays and increasing frailty and disability ( Falvey et al 2015 ). In light of this , NUH has advocated the # EndPJparalysis campaign ( Oliver et a 2017 ; Dolan et al 2018 ), with the aim to get patients up out of bed and into their own clothes , to help promote individual identity , maintain mobility and facilitate discharge pathways through the hospital ( Oliver 2017 ).
A group session will require patients to get out of bed and mobilise to the table at the end of a bay . The activity co-ordinators encourage patients to put on their own clothes , or to have help to do so , before a session , in accordance with # EndPJparalysis principles ( Oliver et al ; 2017 ; Dolan et al 2018 ).
If the patient needs the toilet during the activity , the activity co-ordinator will walk with them to the toilet where possible , and facilitate independence with toileting . The group activity itself will involve upper limb movement , trunk stability , and manual dexterity .
Physiotherapists have fed back that the increased mobility practise patients are exposed to through attending groups has benefitted patients by increasing their mobility during their inpatient stay , which has helped prevent deterioration of mobility . Patient falls have also decreased on the ward .
Cognitive deconditioning has been studied less than physical deconditioning , but long stays in hospital have been associated with increased confusion and decrease in mood ( Krumholz 2013 ).
Cognitively , engagement in cognitive stimulation therapy , when run in the community , has been associated with improved mood , improved communication and language ( Spector et al 2003 ; Spector et al 2011 ).
Although CST is not traditionally run in acute settings , a feasibility study has found that this provision is possible ( Streator 2018 ). It has been used as a model at NUH because the sessions are described in detail , are replicable , and have been designed to have implicit cognitive challenges , which are presented in a non-threatening way , and which emphasise fun ( Aguirre et al 2012 ).
A session will involve a warm up activity to share names , a song , looking at the newspaper to analyse current affairs , and an activity , for example analysing laminated prints of art works and playing a game such as ‘ which ( picture ) would you put on your wall ?’ ( Aguirre et al 2012 ).
Patients have fed back that they have found the sessions interesting , that they have helped them to communicate with others , and that they have made their time in hospital more enjoyable .
Therapists have observed that the sessions help reduce daytime sleeping habits , that they stimulate patients , that they appear to make patients livelier than when they are sat at their bedside , and that they engage more positively with staff interventions .
Helping with nutrition Nutritionally , inpatient stays have been associated with decreased intake of food and drink ( Ross et al 2011 ). The activity co-ordinators integrate improving intake into breakfast , lunch and CST groups .
They start the day with a ‘ breakfast club ’ that involves group eating , which has been found to improve nutritional intake . Throughout the groups , they encourage independence , for example by asking the patient to butter their own toast , or pour out their own tea .
Drinks and biscuits are used in a break within the CST groups and a ‘ lunch club ’ is run at midday . Throughout , the activity coordinators will encourage intake of fluids . Ward sisters have fed back that they have noticed an improvement in the nutritional intake of patients supported by activity co-ordinators .
Increased patient contacts In relation to patient contacts , the activity co-ordinators have increased their number of contacts dramatically across the year . In April 2019 , they had 67 group contacts , 119 cognitive rehabilitation contacts and 72 psychological support contacts , a total of 258 contacts .
In October 2019 , they had 223 group contacts , 66 cognitive rehabilitation contacts , and 59 psychological support contacts , a total of 348 contacts .
Ward sisters have commented that the activity co-ordinators are routinely seeing most of the patients on their wards on a day-today basis , with the benefits to mobility , cognition , and nutrition as outlined above .
Overcoming the challenges There are a number of challenges to providing a service on a busy acute ward . Breakfast club can clash with drug rounds , which can lead to nurses having to locate their patients on other bays , increasing their workload .
Having a table at the end of a bay has to be carefully managed to allow access and exit routes , or therapists may have to interrupt the group to complete their assessments .
Patients are often too ill to engage in activity , or sometimes preoccupied with discharge planning , or disinterested in the activity at hand , for example saying : ‘ I ’ m just not interested in this at all ’.
Despite this , feedback from staff and patients is overwhelmingly positive , with comments including : ‘ increased mood of those who attend ’, ‘ activity co-ordinators often get people up and moving ’, ‘ patient falls have also decreased on the ward ’, and ‘ we see a real
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