A Walking Success

Mandy Trickett

Macmillan AHP, NHS Tayside.

Mandy and colleagues enjoying the Bronze route.
Mandy Trickett (PT), a PT RGU student, Rhonda Manning (DT) and Shannon Smith (Rehabilitation Assistant) enjoying the Bronze Route.

In respoWalksnse to patient feedback, new walking routes have been designed by patients, volunteers and staff at Macmillan Day Care to encourage physical activity in line with Macmillan Cancer Support’s national ‘Move More’ programme. ‘Move More’ recommends four interventions – circuit classes, walking programmes, gentle movement (tai chi, chi gung, yoga) and gardening; aimed at offering something for everyone to become or remain physically active. Following on from the findings of the 2013 NHS Tayside AHP Apprenticeship Practice Development Scheme, patients who attended Macmillan Day Care indicated that walking was their preferred choice of physical activity rather than a circuit class. Staff in Macmillan Day Care have responded to this by developing Medal Walking Routes, carefully designed with different levels, at bronze, silver and gold, to encourage patients to maintain or increase physical activity levels within their abilities.

Promoting physical activity is now considered beneficial all stages of the care pathway and NICE (2015) recommends that all patients should be informed of the benefits of physical activity. Losing the ability to walk is often considered the single biggest predictor of disability; often prompting hospital admission and preventing discharge. Regular focuWalking leaflets groups, continued informintree stumpg, engaging and consulting with patients and staff ensured everyone involved had a sense of ownership in the route development. Benches, signposts and leaflets were all designed by the patients in partnership with several outside agencies e.g. Paths For All, Ramblers Association, Dundee City Council, Macmillan Cancer Support, the Commonwealth Games Legacy Team and NHS Tayside. Inspiring walking-related quotes were also chosen by patients and these were engraved into the benches and added to some signage.

Staff from the physiotherapy team attended walk leader training, enabling staff to take small groups of patients out for walks and increase patient contacts within current resources. The rest of the AHP team supported the initiative as they understood the importance and impact of walking on health.

‘A walk in the fresh air may help to stimulate a poor appetite’
Rhonda Manning. Macmillan Dietitian

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Click on the image to find out more about how ‘walking works’.

The routes were completed in May 2015 and evaluation will follow the same processes used for the exercise class; continuing to provide information on patient preferences of physical activity interventions to enable more patients to access activities within the current resources. Finding purposeful and meaningful ways to engage patients in appropriate physical activity is key to facilitating long-term positive health behaviour changes. Patients who attend Macmillan Day Care appear to really enjoy ‘giving something back’ to help others and develop a person-centred effective and efficient service.

“I promote walking with my Palliative Care patients as it is an evidence based activity which has many benefits such as improving strength and fitness, improving mood ,especially when in a group, and it can allow a patient to achieve goals such as being able to walk to their nearest shop”.
Rosemary Brewster Macmillan Physiotherapist

Following on from the evaluation the next stages are to explore gentle movement activities. Gardening is available all year round with raised beds, hanging baskets and other various gardening activities. Patients and volunteers have recently planted a sensory herb garden in the Bronze walking areas which has encouraged patients to walk outside and explore.

The OT team enjoying the Silver route.
Lynn Sutherland (OT), Rosemary Brewster (PT) & Susanne Cook (OT) enjoying the Silver Route.

“Walking is an easy form of exercise. It is easily and often unknowingly incorporated into our daily routines. Walking is a purposeful and meaningful activity which can make us feel good physically, mentally and/or socially. Whether it is walking to the loo or to the kitchen to make a cup of tea or even to the top of a mountain, walking is an easily adaptable goal driven activity. “
Lynn Sutherland Macmillan OT

AHP Abroad Part 2

PeScreen Shot 2015-07-02 at 21.34.39rmission kindly given by Jane Reid to re-post this blog which she recently posted on AHPAbroad.

At the end of this week I will be travelling home to Scotland for the first time since I moved out to Qatar almost 8 months ago. In one way it seems a long time ago since I was AHP National Lead for Children and Young People, involved in so many different projects with so many different teams and great people. On the other hand I still feel “new” here in Qatar getting to understand the culture and finding out more about healthcare in the Middle East. It is however a great opportunity and I feel very privileged to be involved in the discussions about national standards for healthcare practitioners and their continued professional development, and establishing Sidra as a facility that can accredit continued professional development activities for all healthcare practitioners. I am also very fortunate to work with a great team both in education and simulation who are extremely enthusiastic and innovative.

From a paediatric AHP perspective the use of simulation is still in its infancy. This offers us great opportunities to explore and potentially begin to develop evidence around the use of simulation for this group of professionals. Traditionally simulation has been used within high risk/low volume scenarios and although AHPs may be involved they are generally not the primary professional. Our initial focus is to develop inter-professional scenarios that are pertinent to AHPs which will be used in the clinical orientation period. I am not aware of many publications detailing the use of simulation by AHPs in a paediatric setting but if you happen to be reading this blog and know of anyone who is using simulation for AHPs in paediatric settings, please get in touch.

Screen Shot 2015-07-02 at 21.38.23I was also privileged last month to attend the Institute of Healthcare Improvement’s (www.ihi.org) Middle East Forum which was held here in Qatar. It was fantastic to see and hear so many international speakers sharing their experiences and knowledge. It was incredibly exciting to also hear the likes of Don Berwick & Maureen Bisognano mentioning Scotland and the Early Years Collaborative (http://www.earlyyearscollaborative.co.uk/about-the-collaborative).

I thinks one of the things I am enjoying most about my adventure here in Qatar is the opportunity to try things out and be involved at the beginning of so many things. Later this year I hope to be able to participate in the first inter-professional conference in Qatar which is being hosted by Qatar University and share some of  the AHP inter-professional experiences.

Screen Shot 2015-07-02 at 21.32.25Although 8 months is not that long I do think I have had a great start to my journey both personally and professionally. It will be great to go home and catch up with friends and family but I will also be looking forward to the next steps in my AHP Abroad adventures.

Tackling Food Poverty

Tracy Moynihan

Health Promotion Dietitian, NHS Ayrshire and Arran

Cropped Toolkit 2In 2008 NHS Ayrshire and Arran’s Dietetic Team worked in partnership with Community Food and Health Scotland to produce the CAN (Cheap and Nutritious) Food and Health Toolkit. It was hoped that the toolkit would be used by those teaching cooking skills to low-income groups, and that as a result it would support local people to eat well on a limited budget. This goal has been achieved and the impact of the toolkit has surpassed all expectations; it is now used throughout Scotland by a range of individuals, groups and services, including learning disability services, children and young people and those with limited cooking skills and/or low literacy.

Last year the games section was reviewed and updated to reflect the reductions in fat, sugar and salt in some processed foods. In addition, more one-pot recipes and additional games provided by NHS Tayside were added.

Recent statistics show an increasing demand for food banks; and people from all walks of life utilise the service. Food banks are run by the community, for the community: non-perishable foods are donated and local volunteers sort, pack and distribute the foods to those-in-need. Every food bank user is referred; and to prevent dependency they are limited to three consecutive food bank vouchers.

CAN Toolkit RecipeWith the increase in foodbanks, NHS Ayrshire and Arran’s Nutrition and Dietetic Health Promotion team devised cards with simple meal ideas using common store cupboard /food bank ingredients. The aim was to produce a range of tasty, nutritious meals based around the Eatwell plate, which could be made quickly and easily with the ingredients on offer. To ensure our aim had been achieved all meals were tried and tested by our team and piloted within local community projects. Where necessary, tips were added to improve the flavour but all the finalised ideas were rated as “tasty”. Meals ranged from 50p to 92p per portion.

Some of these simple meal ideas have been incorporated into the regular CAN (Cheap and Nutritious) Toolkit training. All those who have attended the training feel these meal ideas may be the first step for some of their clients, before they move on to cook with fresh ingredients.

As a result of the above piece of work, these simple meal ideas are being added to our CAN toolkits as a hard copy which can be photocopied for individuals to take home, and in a poster format so that foodbanks can display them to the public and advise on suitable items for donation. They will also be made into a downloadable PDF for our NHS Ayrshire & Arran Health Improvement Resource Service catalogue, so that health, local authority and third sector partners can easily access them.
http://www.aahpcat.scot.nhs.uk/HPAC/BrowseSearch.jsp?subjectId=26&typeId=N&sort=dater&page=1&submit=true&dsn=hpayrshirearran

If you have any innovative ideas on how to tackle food poverty please share your approach in the comments section below; or if you are looking for support to develop services in your area or you simply want some more information on our resources, please don’t hesitate to get in touch: tracy.moynihan@aapct.scot.nhs.uk

We Need You!

A request from Paths for All

Calling all health profsCan you help us?

Paths for All is a Scottish charity. Our aim is to significantly increase the number of people who choose to walk in Scotland – whether that’s leisure walking or active-choice walking to work, school or shops. We want to create a happier, healthier Scotland, where increased physical activity improves quality of life and wellbeing for all.

How can you help?

We need you to tell us how we can best support you, and others in your profession, to encourage your patients to become more active by walking. By completing our short survey you will help to inform our planning and ensure we are responding to your needs. In return you will be entered into a prize draw to win an iPad Mini.

To complete our short survey, and be in with a chance to win that iPad Mini, please click here before the 30th July.

For more information on Paths for All please visit our website www.pathsforall.org.uk or email info@pathsforall.org.uk

Are your care home staff drinking enough fluid?

Introduction

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A small study into the drinking habits of staff in a Highland care home has indicated that Care Home Staff are not consuming enough fluids each day. [Have a look at our poll at the bottom of this blog to see if you are drinking enough fluid]

Urray House in Muir of Ord supported Karen Gentleman, a student dietitian from Robert Gordon Univeristy, to carry out a short study with staff to clarify whether dehydration might be an area of staff health which needed more focus. Staff volunteered to record their total daily intake of fluids over a 3 day period. These were compared with their calculated daily fluid requirements (weight x 35mls) and the results showed that care staff members were only consuming an average of 56% of what was recommended. This is shown on the slide below.

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Participants noted that they experienced the following symptoms of dehydration; thirst, passing light brown/yellow urine, lack of urine, tiredness, inability to concentrate, headache and light headedness.

Reasons given for such poor intake included:

“We know we need to drink, but it’s difficult to find the time”,

“When walking about it’s difficult to carry a drink with you”,

“Sometimes you make a hot drink, but are distracted by visitors, the phone, then the drink gets cold so you don’t drink it”

Denise Scott (Urray House Manager) said: “the staff members taking part in the survey were surprised at how poor their fluid intake was and this has really highlighted to them that they need to prioritise time to take drinks throughout the day. We will be sharing this work with other staff here and more widely to support our other colleagues in The Parklands Care Group, it is also an area that could be implemented as part of staff health promotion in the induction process”

Evelyn Newman (Nutrition and dietetics advisor for care homes in NHS Highland) said “this has been an excellent way of showing staff how dehydrated they are and how they can benefit from drinking more fluid at work. We can all benefit from this approach, as it is too easy to forget to drink, while doing other work and focussing on residents rather than ourselves. I hope that we can continue to build on this work and by sharing it with a wider audience”

Conclusion

Care home staff members are generally not meeting their daily fluid requirements. This is not because there is poor access to a range of fluid in the home; rather it is because it is not part of a staff routine to take drinks at every opportunity.

The member of staff with the highest intake took more regular opportunities to drink in smaller quantities. Even so, this was still not meeting their requirements.

Dehydration can have a negative effect on staff health and well-being and may promote symptoms such as tiredness, fatigue, low mood and contribute to increased staff absence. Working in a caring environment for vulnerable adults is a demanding role, making adequate hydration essential to perform duties effectively. Dehydration can also cause feelings of irritability and a lack of concentration which could cause trips and mistakes with medication etc.; this could be detrimental to residents. It is therefore in everyone’s interest to ensure that care home staff members remain adequately hydrated.

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Recommendations

Care home managers and staff are encouraged to assess their own fluid intake and to take steps within their own care environment to ensure that drinks are encouraged at every opportunity; for example taking tea with residents; having water at staff meetings/handovers; drinking fluids during teaching sessions.

Good fluid intake is also essential for residents and service users too, so support them to have a variety of drinks and flavours; offer ice lollies or chilled jellies; soups and milky puddings and use prescribed thickening agents for anyone with dysphagia and in need of texture modification.

Evelyn Newman RD and Denise Scott, Manager, Urray House Care home.

June 2015

Resources

Click on each image for a dehydration poster

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Poll. Do you drink enough fluid at work?

Notes and thanks

With thanks to RGU student Karen Gentleman, from Robert Gordon Univeristy who is currently finishing her B placement.

The attached flyers and posters have been rolled out to all care homes and care at home providers with full support of the Director of Adult Social Care, Joanna MacDonald.

Q&A with Tracy MacInnes; Dietitian and Associate Chief Health Professions Officer

Tracy MacInnes with Marjory MacLeod
Tracy with Marjory MacLeod, BDA Scotland Board Chairperson

Can you start by telling the readers a little bit about yourself and your professional career to date?

Yes, I qualified as a Dietitian from what was, Queen Margaret College, in 1986 and started my first job at Stoke Royal Infirmary. It was a rotational basic grade post so covered renal, paediatrics and community; which provided me with a really solid platform to build on. I then went to Stafford District General and worked as the Senior 1 dietitian where I again managed a complex and varied workload within primary and secondary care. I then made the decision to move back to Scotland in 1992 and was successful in getting the renal dietetic post at the Royal Infirmary in Glasgow. This was my first experience of working outside of a dietetic department and within a wider multi-professional team. This was when I really began to extend my scope of practice. My final dietetic post was as the Chief Dietitian within the Southern General Hospital in Glasgow, after which I moved to work as the Senior Professional Advisor at the Care Inspectorate. In this position I had responsibility for the regulation of independent hospital and hospices in Scotland. This was where my interest in integration started as I lead teams of officers who had professional backgrounds from education, social care, policy and health.

I was awarded the IBEX Award for Professional Achievement in 2003 by the BDA, and in 2005 I completed my Masters in Healthcare Management at Strathclyde University and my Postgraduate Certificate in Social Services Leadership, from Robert Gordon’s University – phew!!

In 2009 I had the opportunity to join the Scottish Government and I’m presently the Associate Chief Health Professions Officer.

How would you describe the work of a dietitian to someone who has never witnessed what we do?

Dietitians use the most up to date health and scientific information on food and health and interpret it in to practical advice so they can support people of all ages to make informed lifestyle and food choices.

With regards to profile, who should dietitian’s/the profession be engaging with and what should their key messages be?

Population health and reducing inequalities is a huge priority for us in Scotland. I believe that the dietetic workforce has a vital role to play by having healthy conversations at every opportunity and interacting with people who use our services, their families or carers, promoting healthy lifestyle choices and signposting to relevant health, voluntary and/or social care services.

In your opinion what makes a good leader?

Someone who can influence outside of their sphere of influence

How can dietitian’s/the BDA encourage leadership within the profession?

We need to build up an evidence base which illustrates the impact of dietary interventions, shows the added value of dietetic input and tells the story of what is the unique skills of a dietitian. I believe that building a dietitian’s knowledge of improvement methodologies and how to apply them is key.

What do you think are the key challenges for the profession over the next few years? And how do you think we can work collectively to address these?

We are living in a challenging economic time with real financial constraints whilst moving forward to working in a more integrated way. People are living longer now and demands on our services will become greater, so we need to deliver services differently and we need to spread and sustain good practice throughout Scotland

The incoming BDA chairman’s theme is ‘Workplace Health’ – why is this an important agenda item and how can dietitian’s lead the way/make an impact on this?

Building up and maintaining our own self resilience is important in maintaining good health; especially considering the pressure we all face. Again dietitains are well placed to sign post work colleagues & friends to resources which can help the person make a more informed decision about their lifestyle; they also have a great deal of practical knowledge and expertise which can be utilised to encourage behaviour change and enable people to adopt healthy lifestyles.

If you could give one piece of advice to a newly qualified dietitian, what would it be?

Remember you can do anything you want to do, as the skills that you have built up are transferable across the public sector.

Some of the Dietitians who attended the Scottish Parliament
Some of the Dietitians who attended the Scottish Parliament

You were able to attend the BDA Scotland Boards event at the Scottish Parliament on Wednesday, why was this important and what were your reflections from the evening?

I have to say I thoroughly enjoyed the Scottish Parliamentary reception hosted by the BDA Scotland Board, it was one of many activities being held throughout the country as part of the BDA’s International Dietitians Week 2015

It was a great opportunity to share with MSPs the vital role that dietitians play in dementia care, and to highlight the many examples of good practice from across Scotland. My congratulations to Marjory and the rest of the team for pulling the reception together

The BDA Scotland Board would like to say a huge thank you to Tracy and all of this week’s bloggers. We would also like to thank AHP Scot Blog for providing the platform and to all of our readers who stopped by and got involved in #DietitiansWeek 2015.

A Case Study In Dementia Care

As Marjory MacLeod told us at the beginning of the week, the BDA Scotland Board were hosting a Scottish Parliamentary Reception on Wednesday June 10th to showcase the role of Dietitians and their work in the area of dementia. Last night that event took place, and it was a great success wth key partners displaying resources and examples of good practice to dietetic colleagues and MSPs from across Scotland.

One of those illustrating her work was Sheila Riddoch Lead Dietitian, Acute Services, NHS Sheila RiddochGrampian, and now she has taken the time to share her work further through our blog.

As Marjory said in her blog on Monday approximately 90,000 people are currently living with dementia in Scotland and Dietitians play a vital part in their care.

Eating and having a good meal is part of our everyday life and important to everybody, not least to people living with dementia. However dementia can greatly affect a person’s relationship with food and eating. Whilst the difficulties experienced vary from one individual to another the result is often weight loss and deteriorating health. Undernutrition is common among older people generally; and the consequences include increased frailty, skin fragility, falls, hospitalisation and increased mortality. In people with dementia, undernutrition is particularly common. It also tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace across the disease course. However, whilst weight loss is a common problem for people with dementia, undernutrition can and should be avoided.

Sheila demonstrating the pictorial menus and illustrating colour contrast crockery and trays.
Sheila demonstrating the pictorial menus and illustrating colour contrast crockery and trays at the Scottish Parliament.

The cause of undernutrition in people with dementia is often multi-factorial involving the behavioural, emotional and physical changes which take place as dementia progresses. However one of the common problems which people with dementia encounter is a change in vision and a reduced understanding of what they are seeing. This led to research by a team at Boston University who showed that if we change what we do, and thereby allow people to see their food; they are much more likely to eat it. In context, what the team did was serve food to people with advanced Alzheimer ’s disease on standard white plates and then served the same food to the same client group on red plates. What they found was that people eating from the red plates consumed 25 percent more food than people eating from white plates. The simple reason for this improvement was that the contrast in colours between the food and the crockery allowed people to see their food more easily and subsequently they were more inclined to eat it.

With this research in mind NHS Grampian trialled the use of colour contrast crockery and coloured reusable drinking glasses in a local assessment unit for older people. When compared to the use of the traditional crockery and disposable white tumblers, positive feedback was received.

Since the provision of a good quality eating experience is an integral part of the therapeutic care provided in hospital and the results of the trial were so positive, a decision was taken to introduce the new crockery & tumblers to all hospital wards in NHS Grampian. This is seen to be a very positive move given the fact there is a high number of patients who could potentially benefit from high contrast crockery. This move also serves to ensure that there is a consistent approach across the Board and it supports equitable access whilst eliminating the ‘labelling’ of patients with individual needs.

Key Facts & Case StudiesFor more case study examples which illustrateNDRUK Resource how dietitians are working to improve nutritional care in dementia across Scotland click here.

For more practical information and advice aimed at carers of those with demenia click here.

Finally for more information on Dietitians and Dementia click here.

If you would like to share your case study examples, or your thoughts on the blog, please leave a comment below.