Wardipedia

About Wardipedia

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Contents list

  1. Introduction
  2. Whatipedia??
  3. Structure
  4. Ways of using Wardipedia
  5. Medium print
  6. Star Wards
  7. Big thanks

1.    Introduction

Mental health inpatient care rocks. This isn’t usually the message that’s out there, for a whole bunch of reasons including the reputational legacy of the asylums, dissatisfied patients being more actively vocal than the very content majority and crass campaigns by some charities. But despite regrettable inconsistencies in quality of care across the country, there’s no question that inpatient care is safe, therapeutic and gentle. In rating the quality of their care for the 2009 Care Quality Commission survey of mental health inpatients, 73% of patients said it was excellent, very good or good, 12% said it was poor.

We won’t go on and on here about what an incredible achievement it is that the majority of patients have positive experiences of inpatient care, including those who are there very much against their will and perhaps believing they aren’t even ill. (But it is an incredible achievement, along with impressive safety levels and falling suicide rates.) And these are particularly tough times on mental health wards, with service re-organisation, cuts in staffing and resources and patients’ stress levels being greatly exacerbated by the benefits’ cuts programme.

Wardipedia is designed to help! Mental health inpatient staff have generously shared their best practice ideas so that others can adopt and adapt these and have flung in some other information and examples. We’ve collected together:

  • almost 1,000 examples of great practice on wards
  • 200 articles, papers and other docs of research evidence and examples from and beyond inpatient care
  • links to useful resources, information and services
  • a few gags eg Reflective practice. A time to share.
  • opinions – unsolicited and occasionally deviating from the (current….) evidence base
  • revelations – Marion comes out as a user of transitional/comfort objects (i.e. she shares her hospital admissions with a fluffy rabbit.)
  • mini-campaigns – eg abolishing ward rounds
  • stuff that’s simply fun eg celebrating National Talk Like a Pirate Day

and haven’t held back with photos of Buddy. Here’s another one:

“We could do that.” We are regularly told by staff that when they read ways in which other wards are tackling problems or creating new opportunities for patients, this is their response. Wardipedia is a giant exercise in enabling ward staff to feel inspired and informed so that they can do that, or most often, do their own variation of it.

There’s some new stuff, some stuff you’ll already know but may perhaps find presented here in a refreshing way. Vast thanks to all the wards which have generously shared their great examples and ideas, and for letting Buddy and me visit. Wardipedia relies on practitioners’ contributions – the 959 examples are just the start!

We hope you enjoy using (and contributing your own great practice examples to!) Wardipedia. As with all Star Wards’ resources, we’ve collected and created a bunch of ideas, suggestions and possible solutions – but they’re just ideas. Definitely not standards!! They’re examples of what can be done, to use as a springboard for you to bring in your own expertise and for you to adapt to best meet the needs of your patients. Staff often tell us that it’s about doing things differently, not about doing more things. We’ve discovered there’s an Indian concept for this: Jugaad, or frugal innovation.

Jugaad – Frugal innovation.

Jugaad is a Hindi word meaning an innovative fix; an improvised solution born from ingenuity and resourcefulness. (Also known as DIY in the US, Gambiarra in Brazil, zizhu chuangxin in China, and Systeme D in France.) Frugal innovation embraces keeping things simple and making sure they’re what people need. For example, after the devastating earthquakes in Gujarat, a village inventor created a fridge made of clay cooled by water – fulfilling the frugal innovation criteria of products and services which are relevant, affordable, accessible.

The BBC’s Peter Day ended a programme on frugal innovation by saying it “turns innovation upside down by focusing on the things outside companies that perhaps people inside big business hardly notice. And then it uses cheap, cheerful and flexible ways to deliver the things that do the job without all the fuss that great big companies often apply to the rolling out of new ideas. Worth a try, this frugality.”

Honey Bee Network is a major hub (OK hive) of frugal innovation: “an organization which collects and disseminates traditional knowledge and helps facilitate and spread grassroots innovation throughout India and elsewhere. It is a crucible of like-minded individuals, innovators, farmers, scholars, academicians, policy makers, entrepreneurs and non-governmental organizations.” It’s also been described as providing “institutional support for scouting, spawning, sustaining and scaling up the grassroots innovations.” That’s pretty much what we aspire to do in Star Wards (with fewer farmers), and Wardipedia is where we’ve put everything we’ve found.

2. Whatipedia??

It took us ages to work out how to describe Wardipedia. An early attempt was:

It’s like the mental health inpatient care lovechild of Wikipedia and the Argos catalogue.

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In a nutshell, Wardipedia:

  1. Is an online, collaborative compendium of mental health inpatient care good practice
  2. Contains ideas, examples, information and evidence base
  3. Is structured around seven domains, represented by the acronym IMAGINE, and each domain has 11 Ideas. (Yup, 77 Ideas in total.)
  4. Could be referred to as a scatablogue – a slightly random yet evidence-based bloggy catalogue of great mental health inpatient care.
  5. Is an information and inspiration mash-up?Is most closely related to ‘good practice communities’ where experts share their knowledge and practical examples
  6. Is a collection. Compilation. Compendium. Constellation. Co-production. It’s more co than Coca-Cola.

So, Wardipedia is a set of ideas and examples about providing imaginative, therapeutic inpatient mental health care. Some are inescapably serious (eg not having anything resembling or being called a seclusion room) while others are enormous fun – and therapeutically beneficial (eg the now essential piece of ward kit, the Wii.)

3. Structure

The scaffolding for Wardipedia is provided by the seven domains of our IMAGINE acronym, inspired by the superb book If Disney Ran Your Hospital by Fred Lee.

Imagination – what’s it like for the patient?

Mindfulness – chilling out

Activities – social, recreational, physical

Generosity – sharing, kindness, giving  

Involvement –influence, information, independence

Neighbours – friends, family, fellow patients

Empathy – for self and others

Imagination

1. Consultant appointments – Time’s up for ward rounds

2. One consultant, one consultant – Go one better

3. Therapeutic liaison worker – TLC from the TLWs

4. Ladder of priorities – First things first

5. Relational security – Safety through trust

6. Animals – Furry, fluffy, feathery, finny friends

7. Mentalising – Mind awareness

8. Community meetings – A meeting of minds

9. Engagement is the thing – Time well spent

10. Creative communicating – It’s all improv

11. Peer supporters – He ain’t heavy

Mindfulness

12. Mindfulness – Silence spoken here.

13. Bingo and jigsaws – Gentle adventure

14. Multi-sensory – The sense of calm

15. Sanctuaries – Rooms that soothe not seclude

16. Spirituality – Keeping the faith

17. Musical – Can you kazoo?

18. Landscape painting – Bright outlooks

19. Gardening – Green fingers, green socks

20. Outdoor activities – Feeling good inside, outside

21. Art – For hearts’ sake

22. Smoking – Less of a drag

Activities

23. Media – Moving images

24. Wii – Wii-habilitation

25. Jobs – Work in progress

26. Ward newsletter – Making the headlines

27. Books – The great escape

28. Funnyness – Because wit happens

29. Food presentation – The icing on the cake

30. Indoor sports – Crazy golf and friends

31. Dance – Move with the groove

32. Football – The beautiful game

33. Men’s stuff – It’s a bloke thing.

Generosity

34. Appreciative culture – Well done and thank you!

35. Bring yourself to work day – Me, myself and I

36. Role flexibility – Shared interests

37. Arriving and leaving – All my bags are packed

38. Birthdays – Make a wish!

39. Cafe – Tea and empathy

40. Senior managers – From board to ward

41. Shopping – Buy in

42. Charities – Good feel causes

43. Going green – Thinking out of the refuse box

44. Gay patients – Somewhere over the rainbow

Involvement, influence, information

45. Patient involvement – Co-piloting

46. Patients’ views – Feedbackwards and forwards

47. Minority languages – Found in translation

48. Advance statements – Planning ahead

49. Graduated self-medicating – Managing my meds myself

50. Electronic access – Open sesame!

51. Personalising bedrooms – A room of my own

52. Physical health – Hearts and minds

53. Bank staff – Bank on us

54. Handovers – Me to you

55. Brain – Understanding brain pain

Neighbours

56. Mealtimes made special – Food for thought

57. Friends, relatives and carers – Since you been gone

58. Internet – Inpatients online

59. Social media – Keep clicking

60. Website – E-wards

61. Kids visiting – Hugs, Harry Potter and hoodies

62. Help with housing – Homeward bound

63. Volunteering – Giving, getting, gaining

64. Help with money – Poor no more?

65. Pointless National Days – Happy Pointless National Day

66. Good news – Media myth-busting

Empathy

67. Ward culture of empathy – Tea and empathy

68. Talking therapies – Beyond CBT

69. Therapeutic ward design – Easy on the eye, warm in the heart

70. Comfort objects – Touchy feely

71. Housekeeping heroes – Making hospital hospitable.

72. Complementary therapies – Hands on healing

73. Addiction support – Rehab.

74. Samaritans train staff – Listening at its finest

75. Reflective practice groups – Releasing time to share

76. Good night – Lightening the nights

77. Happy – Still smiling after all these shifts

Within each of the 77 Ideas, there’s:

  • A description of the Idea
  • Ward examples
  • The evidence base
  • Snippets – articles and extracts illustrating the Idea
  • Resources and references
  • At least one photo of Buddy. (The evidence base for this? It makes Marion happy. And judging from the number of photos of Buddy up on wards, she makes patients and staff happy.)

To give you a tiny preview of the collection of dazzling ward practice:

  • Football leagues, visits, stadium tours etc. The tour was to promote interest in local sport, active lifestyles and the importance of physical fitness.
  • The Catering Department  ‘Just for You’ where the patients are invited to design a meal themselves and the catering department will cook it for them.
  • There was a four week poetry workshop (also for community clients) in conjunction with the local BBC radio station
  • Holiday at home – bringing the beach to Birmingham!
  • Spontaneous paper plate Frisbee game
  • Nurse therapy assistants split their time between nursing and OT shifts, and work evenings and weekends.
  • Improvised space-hopper races using giant gym balls
  • Self-harm project run by a specialist nurse, including a camouflage clinic, support group, staff and training.
  • Repositioning a bed to give better view of outside
  • A family shabbos (Sabbath) room for orthodox Jewish patients and visitors, including a kosher kitchenette and prayer area.
  • ‘Virtual pets corner ‘ – a pet photo display of patients’ and staffs’ pets and wards sponsoring an animal e.g. a retired donkey or a guide dog
  • Podcast and music studio

Wow. Seriously wow. Wowza! How we admire inpatient staff!

4.    Ways of using Wardipedia

Here’s the thing. Wardipedia is lots of things, particularly suggestions and solutions from ward staff. You can use it in all sorts of ways, including:

  • Practical help for ward staff – its primary purpose:
  • For daily activities, approaches
  • For inspiration and feeling warmly about inpatient care and your role
  • For the “We could do that!” effect
  • A new batch of ‘challenges’ – structure, motivation etc for incremental changes (a follow-up set to Star Wards’ original 75 Ideas)
  • Training:
  • Ward staff and volunteers. It could be used in training sessions, or relevant chunks/chapters given to people. Especially useful for induction.
  • Qualifying and CPD training for nurses, doctors, psychologists, OTs, pharmacists  – clinicians that need to appreciate what’s possible on mental health wards
  • Support staff like security, catering, estates.
  • Campaigning – staff and patients can use the examples and evidence base to influence positive change
  • Service user organisations, especially those working collaboratively with wards
  • Academics, regulators, boards, commissioners, Clinical Commissioning Groups (til they’re replaced in yet another NHS traumatic upheaval)….. to inform expectations/standards – including in trusting staff and patients and arriving collaboratively at standards!
  • Contributing! Becoming part of a gorgeous compendium of great inpatient care, letting others know about the ways in which patients benefit from your care

You can:

  • read Wardipedia online
  • print off any page by clicking on the little grey Print icon and then the print icon at the top
  • save a page as a pdf by clicking on the little grey Print icon and then the pdf icon at the top
  • email the link by clicking on the little grey Print icon and then the email icon at the top

5.    Medium print

Sorry to be repetitious but – Wardipedia is full of ideas and suggestions, most of them from ward staff. Like all innovation, most of these are adaptations of others’ adaptations and we’re very grateful for wards generously sharing these with others, who can adapt and share them, for others to adapt and share. The ideas are simply springboards for other wards’ unique interpretation and implementation.

The 77 Ideas in IMAGINE are intended to apply to most wards, although we include extra information about patients with dementia as this seems a particularly challenging environment.

Whether any particular idea, example, approach and so on is appropriate (or strictly contra-indicated!) of course depends on loads of factors, not least:

  • patients’ ages, physical health and acuity of illness
  • patients’ skills, preferences, recovery goals, life aspirations, coping mechanisms (eg using safe products with patients who self-harm), specific risk issues (eg with leaving the ward), specific anxieties, energy levels, group dynamics and a zillion other factors that ward staff expertly and sensitively manage every shift.
  • ward design and purpose
  • staffing levels
  • funds available for resources, especially for activities
  • legal, ethical and other complications

We’re frugal innovators supporting frugal innovators so most of the ideas are low or no cost. The few daftly expensive resources we include are for broad illustrative purposes only and mainly to stimulate frugal adaptations by ever-resourceful ward staff. On the whole they’re small, easy, practical things that wards are or could be doing which make a huge difference to inpatients’ experiences. And we’re slightly obsessed with there being evidence of effectiveness before we recommend the sensible things.

What else? Most of the ideas are ones which ward staff can introduce with ease and without management needing to get involved. A few (eg replacing ward rounds with consultants appointments) are sadly usually outside of wards’ decision-making but ward staff and patients can be highly influential in instigating the changes.

Beyond the practical, we are particularly enthusiastic about practices which chime with Star Wards’ vision of all patients being on wards where:

  • talking therapies play as substantial a role as medication
  • patients are supported in our management of our symptoms and treatment
  • there is a strong culture of patient mutual support
  • patients benefit from a full programme of daily activities
  • patients retain and build on our community ties

and which focus on these aspects of patients’ daily lives in hospital:

  1. Recreation and conversation
  2. Physical health & activity
  3. Visitors
  4. Care planning
  5. Talking therapies
  6. Ward community
  7. Patient responsibility

Wardipedia isn’t intended to be comprehensive! We try to cite the major research/evidence and perhaps a few other findings if they’re distinctive. But we’re very parsimonious with your time and have tried only to include full articles, links, resources etc which we feel are pretty essential.

Occasionally Asked Questions

What is Wardipedia?

Wardipedia is a set of ideas and examples about providing imaginative, therapeutic inpatient mental health care.

What is a scatablogue and will the term go viral?
A slightly random yet evidence-based bloggy catalogue of great mental health inpatient care. Yes, we hope the term goes viral. #wardipedia for any tweeters out there!

What’s Imagine: 77 More ideas and what’s the difference between Wardipedia and Imagine?
Wardipedia is the overall web resource (or scatablogue.) Within this, the main feature is currently Imagine but there’s other stuff like the evidence base.

Is it really a follow-on set of ideas for wards who’ve got the Full Monty for having  in place all of the first batch of 75?
No, but it did start off as that and then mushroomed to a much more comprehensive and flexible resource. And we hope some wards will want to dive into this next batch of Ideas, including those with the Full Monty award for having the first set of 75 ideas in place.

Where can I find out more about some of the ward examples?
Details of most of the ward examples given can be found by doing a search on our website

Can I read it off-line?
You can:

  • read Wardipedia online
  • print off any page by clicking on the little grey Print icon and then the print icon at the top
  • save a page as a pdf by clicking on the little grey Print icon and then the pdf icon at the top
  • email the link by clicking on the little grey Print icon and then the email icon at the top

Copyright

Well, we’d be unhappy about anyone reproducing the whole website. But otherwise, the more circulation of the information, the merrier! The whole purpose of Wardipedia is for as many people as possible to access and share information about great mental health inpatient care.

Looking at copyright the other other way round, Wardipedia is very much part of the Web 2.0 revolution. To quote the mother of all co-productions, Wikipedia:

“Web 2.0 is a loosely defined intersection of web application features that facilitate participatory information sharing, interoperability, user-centered design, and collaboration on the World Wide Web. A Web 2.0 site allows users to interact and collaborate with each other in a social media dialogue as creators (prosumers) of user-generated content in a virtual community, in contrast to websites where users (consumers) are limited to the passive viewing of content that was created for them. Examples of Web 2.0 include social networking sites, blogs, wikis, video sharing sites, hosted services, web applications, mashups and folksonomies.”

In addition to all the examples, information and photos contributed by mental health wards, we have also included references, links, chunks of text and images we’ve found online. If any of these are yours and you’d like us to include more (eg we could include a full article instead of an excerpt), please do let us know. And if you feel we’ve included too much, we apologise and will edit/remove it if you let us know your preferences.

6. Star Wards

Wardipedia is a project of Star Wards….. which is the one and only project of the social justice charity Bright. Star Wards provides practical ideas and inspiring examples from and for mental health ward staff. About 600 wards are members and enjoying introducing small changes which make a massive difference to patients. Star Wards  was set up by Bright’s chief executive, Marion Janner, following her first stint as a detained patient. Marion is a devotee of inpatient care and the staff who frankly heroically provide it, and is deeply appreciative of the staff who care for her when she’s in St Ann’s, Tottenham.

7. Big thanks from Marion

Staff and patients who have so warmly welcomed Buddy and me to visit their wards. Sorry for any misbehaviour on either of our part!

Bright’s Trustees:
Ian Hulatt (heroic chair)
Jonathan Jenkins (heroic minder of all things financial, but not to be known as The Treasurer. Forget Treasurer. Don’t let it enter your head.)
Barrie Green
Kathryn Hill
Sue Stocks

Special mention to Jo Hill – our business development manager when we had a grant from UnLtd, wise and cherished trustee and pal of Marion and Buddy’s. Jo steered and valiantly supported us through our roughest times. We’re going to repay this kindness by Marion going on over-long visits to stay with Jo and family in their new home in India.

Charitable funding

It takes enormous courage (and nerves of steel!) to fund a charity run by someone with a debilitating, occasionally hospitalising and continuously ‘high risk’ mental illness. Most of Star Wards’ funding comes from charitable foundations, who are themselves charities and subject to strict legal requirements about prudent financial management. But charitable foundations are mercifully independent and have a strong tradition of social justice innovation. There’s no innovation without risk-taking and there’s no risk-taking without set-backs. A special thanks here to the Allen Lane Foundation who bravely took the plunge and gave us our very first grant, and to the John Ellerman Foundation for the first big grant which enabled Star Wards to really take off.

We’re deeply grateful to our funders, ‘not just’ for the grants but also for the trust that these represent – a faith that Bright and inpatient wards can indeed, despite considerable handicaps, continue to introduce small changes which transform patients’ experiences. Your independence and this trust means that Star Wards can operate in a very flexible, responsive way – including taking nearly a year to complete Wardipedia which we estimated would take 3 months! Thank you very very much for your understanding and patience with this,

Foundations marked in pink have given Star Wards a second grant. We seriously love them. We love and appreciate all our funders, who include private sector wards who pay for their annual subscriptions.

A giant virtual hug to our funders

Allen Lane Foundation
Comic Relief
Department of Health (and our adored National Health Service! And the late lamented despite being unhelpfully named s.64 Programme, which gave core funding to national charities contributing to DH priorities.)
Esmée Fairbairn Foundation
Javon Foundation
John Ellerman Foundation
Lankelly Chase Foundation

Big thanks also to New Philanthropy Capital for managing another grant from a family foundation.

UnLtd
Woman of the Year Foundation

Wise counsel

Henry Stewart and Happy

Prof Alan Simpson
Mark Beavon and the Royal College of Psychiatrists’ AIMS scheme
Andy Bell
Prof Len Bowers
Dr Joy Bray
Geoff Brennan
John Hanna
Paul Jenkins
Maria Kane
Simon Lawton-Smith
Sue McLaughlin
Malcolm Rae OBE (without whom Star Wards would never have happened.)
Mark Williamson and Action for Happiness

Star Wardsistas

Nic Higham
Star Wards (and mental health inpatient care!) is blessed to have Nic joining our little team. Nic has an incredible range of skills, not least his outstandingly creative and empathetic approach to inpatient care as a healthcare assistant. Joyously, Nic can stylishly translate his expertise into words, images, videos and music!

Tim Sharville
Big thanks
1. For being sooooo mellow about me postponing the launch from Oct to Dec 2011, then March and finally July 2012!
2. For being a genius designer.
3. For having the sort of improv humour I dream about developing.
4. For totally getting inpatient care and the quirky Star Wards
5. For formatting and uploading this and every other millimetre of Wardipedia

Michael Markham and Naing Moe Lwin at A M Accountants.
Our trustees, funders and everyone else who appreciates our financial robustness are very grateful to Michael and Naing for their meticulous attention. Marion is deeply grateful for their unshakeable patience, in particular for Michael’s ability not to sound even the most mildly of exasperated as he explains for the 10 zillionth time the difference between employers’ and employees’ National Insurance. (There’s only one letter difference so no wonder I find it baffling.)

Professional protectors of Marion’s sanity

Anthony Bateman and Patrick Doyle. Mere thanks don’t really start to do the job. But thank you.
Staff at St Ann’s Hospital, Tottenham
John Parkin and Gaia Pollini at The Hill that Breathes
Mick

Above all, the biggest of hugs to someone without whom none of this would be possible. No, not Marion’s ex who walked out on her, hence the madness, hence St Ann’s hospital, hence Star Wards, hence Wardipedia. (Hence is a funny word, isn’t it?) The accolade is of course for the national inpatient care celebrity:

Sagacity, compassion, style and snowflakes on the nose. Buddy’s been to Broadmoor, Brixton Prison and Buckingham Palace. She’s seen it all, And remains loyally and lovingly at my side – at least if she’s clipped onto the lead. Her travels to mental health wards across the country have brought deep pleasure to the hundreds of patients and staff she’s met, and a few close encounters of the very personal kind with PAT dogs. She loves a buffet or a meeting, and approximately 80% of her cognitive capacity is devoted to The Buddy League Table of Tasty Pastries, The other 20% is channelled towards resolving the conflict in the Middle East.

Marion Janner
June 2012

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