Educational training resource pack for staff Gemma Borwick

Educational training resource pack for staff Gemma Borwick Training Adviser in Health, Changing Faces

Why & how? • The National Burn Care Review (2001) highlighted poor practice in the levels of psycho-social care being provided in the UK • Working party set up to address these issues resulting in standards for Burns Care in England Wales (2008) which state every member of staff must be trained in psycho-social care • To demonstrate the London and South East Burns Network’s commitment to meeting the new standards, Changing Faces was commissioned to design and develop a resource pack for staff.

• 4 centres: – – – Chelsea and Westminster Hospital, London St Andrew’s Centre for Burns, Essex Stoke Mandeville Hospital, Buckinghamshire Queen Victoria Hospital, West Sussex Salisbury Hospital (South-West Network). • Worked in conjunction with the Centre for Appearance Research at the University of the West of England • Main aim: – to establish a training pack so all staff will receive training appropriate to their role in understanding the psycho-social aspect of living with burns, thus empowering the individual and their families to learn to live confidently.

1) Information gathering

• Lack of formal education and training in this area • Majority of staff feel they will benefit from further education/training (irrespective of their perceived confidence) • Varying degrees in confidence in addressing these issues • Requirement for greater clarification of terminology and education for all staff groups • Supervision/support for staff is variable across staff groups and sites.

Identified challenges: • Multi professional target group varying widely in skills, roles, needs, experience and patient contact (clinical/non clinical staff; levels of literacy and English) • Varying needs and priorities of 4 units • Different organisational structure across 4 units • Anticipate varying degree of ability to release staff for training • Provision of a suitable pack meeting the needs of children, young people and adults.

2) Set up advisory group

Advisory group: Patients Psychologists Psycho-therapists Nurses Social Workers Specialists at Changing Faces Therapists. 3 meetings to help inform, advise and develop strategy and plan way forward.

3) Draft questionnaire to measure existing staff knowledge and confidence and complete analysis

Addressing psycho-social needs as an integral part of the patient pathway is not consistent across all staff groups, some concerns expressed were: Insufficient time Understanding of terminology Variance in personal interest Competing professional agendas and priorities Not feeling sufficiently skilled Not feeling sufficiently confident Feel it is outside their job remit Clinical support and training has priority Environmental barriers Fear of causing further distress

I would benefit from education / training in: • Providing psycho-social education to normalise & thereby contain anxiety • Conducting simple problem solving; basic counselling skills • Basic screening & identification of psychological distress in all patients • Identifying symptoms of psychological distress & understanding when need to refer on to psycho-social specialist • Relationship building with patient/family, supporting expression of feelings & normalising common signs of distress.

4) Create and draft educational pack for pilot

Tier level • Split staff into 3 tiers according to expectation of understanding and providing psycho-social care within job role. Tier 1 – largely non clinical/unskilled staff Tier 2 – main bulk of clinical staff Tier 3 – staff who have additional training in psychosocial care and/or where it is a significant part of their job role. • Tiers do not correspond with NHS A 4 C banding • Tiers do not correlate with level of professional training • Done by questionnaire and discussion with manager.

Questionnaire example 5) Do patients ever confide in you or get distressed? a) No – this is not really part of my job and/or I am not sure what I would say if they did. b) Yes, occasionally. I might listen but it is not part of my job to help with these kinds of issues and I would suggest they went elsewhere for advice or help. c) Yes, this is an inevitable part of my job but I would usually suggest they go to someone else for specialist help. d) Yes, this is a part of my job. I am a good listener but if I thought someone needed further help or more time I would suggest a more specialist person. e) Yes, I am often called upon to help patients and families if they are experiencing strong or difficult emotions. I feel confident that I have been trained appropriately for this role. f) Yes, handling these kinds of situations is a major part of my role in the unit.

Modules • 5 modules • Increasing in complexity • 1 hour learning time per module Tier 1 Module Module 1 2 3 4 5 x x Tier 2 x x Tier 3 x x x

Modules 1 and 2 (Tier 1/2/3) Understanding and awareness of a patient’s psycho-social needs. Modules 3 and 4 (Tier 2/3) Exploring the impact of burn injuries on the patient and their family and investigating factors that can predict adjustment. The role of the health care professional in providing day to day psycho-social support. Module 5 (Tier 3 only) Specialist aspects of psycho-social care in burn injured patients – case studies and further reading.

Providing the training • We suggested the training was delivered flexibly to meet the varying needs of the units • Can be used as taught components or self directed study if necessary A separate ‘workbook’ for each tier Modules are broadly the same for each tier but the expectation of level of response increases throughout the tiers A mixture of tasks, reading, guided case discussion and reflection. • • •

Training materials • Set aims and objectives that must be met • Taught components (training leaders from each unit can use the materials provided as much or as little as they like) • Can therefore be taught in multi professional groups across tiers • Students’ workbook • Teachers’ notes and workbook with ‘model’ answers • Available electronically or hard copy • DVD of first hand patient and staff experience.

Pilot • Pilot was undertaken in 5 units during May 2010 involving 4 LSEBN Units and 1 South West Unit • Evaluation of pilot (with the Centre for Appearance Research at UWE) • Questionnaires (including qualitative and quantitative measures) designed to measure baseline confidence, awareness and appreciation prior to training (Tier 1 and Tier 2/3), with a retest after training and additional questions about the training itself. • 30 participants, with 25 valid responses • 6 tier 1 staff, and 19 tier 2/3 staff.

Significant increase shown in: • Knowledge of why psycho-social care should be provided • Knowledge of how psycho-social care should be provided • Knowledge of own role in providing psycho-social care (T 1, 2 and 3) • Ability to recognise own responsibility for psycho-social care (T 2/3) • Ability to respond appropriately to psycho-social needs (T 2/3) • Understanding of how coping strategies can affect recovery/behaviour (T 2/3).

Significant increase shown in: • Understanding of factors that predict positive or negative coping in patients (T 2/3) • Knowledge of strategies that can be used to support patients (T 2/3) • Skills and abilities to help patients deal with a sense of loss (T 2/3) • Ability to use strategies to support patients and their families (T 2/3) • Ability to make appropriate referrals for psychological therapies (T 2/3).

Staff in units that received group training (3) rated training as being more enjoyable than those completing self-directed study (2) (p<0. 05) Majority of staff rated the training as being: – Appropriate (“about right”) – Easy to understand – Relevant – Enjoyable – Motivated to complete – Useful – Able to influence practice.

Not significant, but majority showing an increase pre and post test: • Ability to communicate routinely with patients and families (T 2/3) • Ability to talk to patients and their families about distress and emotional issues (T 2/3) • Ability to recognise patients’ psycho-social needs (T 2/3) • Ability to problem solve when addressing psycho-social needs (T 2/3) • Confidence speaking to patients and their families (T 1)*

Trainers felt the materials were: • • Useful Relevant Raised staff awareness Confident when using the materials The materials enhanced delivery Enabled appropriate training A desire to continue using the materials • Practicality was a concern (hospital logistics/time allocation).

5) Refine pack as a result of pilot, print and disseminate

• Individual interviews were carried out with trainers highlighting areas for development • Authors addressed some of the ‘non-significant’ points in more detail • Long proof-reading process checking for grammatical and academic accuracy • Designed, illustrated and printed professionally • Final packs delivered w/c 8/11/10 • DVD to be completed.

Dissemination • • • To the London and the South East Burn Network To other UK burn networks At BBA conference 2011 Through academic literature Had international interest and will follow it up.

Where next? • Children and young people pack – seeking funding and a network to take the lead on this • Further research into effectiveness of training pack and its longer term benefits • Any Questions?

For further information please contact: • Gemma Borwick, Training Adviser in Health, Changing Faces • 0845 4500 275 (direct dial: 0207 391 9255) • gemmab@changingfaces. org. uk