Journal of Psychiatric and Mental Health Nursing, 1996,

Clinical notice board Editor: Submissions address: June Andrews Scottish Board, Royal College of Nursing,

42 Zouth Oswald Road, Edinburgh EH9 ZHH, Scotland

Substance abuse

A common sight in our local area of Airdrie and surrounding villages is that of a group of people, especially the young, standing in public places drinking their ‘Buckfast’ wine. Therefore, it did not take Lanarkshire Health Board ‘Strategy on Substance Abuse’ to signal the existence of a major health problem. It was an established fact.

We felt that a multidisciplinary approach at this stage was the best way forward.

Our initial aims were: to improve the lines of communication between all concerned; and to discuss the possibility of attempting some form of initiative. It was unanimously decided to set up a pilot

scheme to target selected ‘primary seven’ groups for specific health education on drugs, solvent abuse, alchohol and smoking.

For the pilot study, the group decided to choose two schools of different social backgrounds, feeling that it would allow for more effective evaluation. Two such schools were chosen, and the official ‘go ahead’ was given. Following this, we divided into two smaller ‘core groups’ which provided a closer individual affiliation with each primary school.

It was interesting to note how substance abuse was initially perceived by parents and staff of the two participating schools.

On one hand, the attitude of the predominantly middle-class catchment area school (school A) was one of reticence and apprehension - even doubt as to whether any such problem existed for them. On the other hand, attitudes emerging from the school within a more socially deprived setting (school B) was one of ready acceptance and awareness of problems within their area.

School B had the advantage of an ongoing statutory input from the Community Education Department and strong parental involvement was

already well-established. It was interesting to note that these parents, although aware of all the issues, saw alcohol as the main problem, and were, at that stage, opposed to a teaching programme on drugs, feeling that it might encourage experimentation. As for solvent abuse, they considered it to be much less of a problem.

School A relied solely on the teachers input, aided by members of the core group. The teachers were one hundred per cent willing for teaching on all aspects of substance abuse, although interest- ingly, it later emerged that their initial apprehen- sion stemmed from fear of, and lack of knowledge about drugs. In many cases, this tended to lead to a denial of the whole possibility of their children’s involvement. They simply wished to feel that it did not really apply to them.

The teaching programme proved a sucess in both schools and the children responded with interest and enthusiasm.

On evaluation of the questionaires, it was evident that parents and children gained information and awareness on the subject and felt able to make informed choices.

It was interesting to note that the parents of School B now felt the need to include solvent abuse, drug abuse and smoking in next year’s pro- gramme.

Conclusion

It seems to us that a structured, coordinated pro- gramme of substance-abuse awareness should be expanded to a wider area in order to bring the opportunity of informed choice to a larger number of children.

BETSY FERGUSON HELEN DALE Health visitors

Airdrie Health Centre Airdrie,

Scotland.

0 1996 Blackwell Science Ltd

al notice board

Discharge planning - Leanchoil hospital

Leanchoil Hospital is a 35-bedded GP Unit, with acute and long-stay patients. The project developed as a result of staff feeling that arrangements for dis- charge planning could be improved.

The aims of the audit were to: establish the current discharge planning arrange- ments; highlight good practice and areas for improve- ment; develop discharge guidelines for Leanchoil. The initial stage of study involved a literature

review and discussions with all the care profession- als involved in the discharge and follow-up care of patients. This resulted in the development of an interview schedule for use with patients and ques- tionnaires to be completed by care professionals.

The study involved the follow up of 25 patients, all aged 65 or over, discharged from Leanchoil Hospital. Twenty five discharges represents 20% of the average total number of discharges from the hospital per year.

Each of the study patients were invited to be interviewed at home following the discharge. In addition, each care professional involved in the dis- charge or follow-up care of a patient completed a questionnaire.

The main issues highlighted by the study were: the value of the already established multdiscipli- nary discharge-planning meetings, held fort- nightly; the need to establish clear guidlines on the refer- ral procedures to various care professionals; the need to improve communication between staff and patients and their relatives. Results of the project are the following: discharge guidlines and a checklist have been developed for use by ward staff with a measure of confidence that discharges are being organized effectively; the referral procedures to some care profession- als have been modified and better defined, increasing efficiency; patients and their relatives are routinely involved at the start of the discharge-planning process, promoting a better exchange of information; printed information on medication is given to patients to reinforce the verbal explanation given prior to the discharge. Several patients have com- mented on the value of this; patients being discharged to residential or private

nursing home care are accompanied on the day of transfer by a hospital nurse. This has been found to be of benefit both to patients and all staff concerned. The findings of the audit have resulted in several

changes to discharge planning at Leanchoil. To establish the effectivness of these changes there will be a re-audit of the discharge procedure in one year.

MARGARET ROBERTSON Sister

Leanchoil Hospital, Forres.

Rehabilitation - functional independence measure

In April of last year, our multidisciplinary team set out to measure functional ability in our patients with functional impairment and/or disability.

The rationale being to have documented evidence of the effectiveness of our intervention and rehabili- tation. After thorough research of various tools that have been or are being used in Great Britain, it was decided to use the Functional Independence Measure (FIM) (1990) developed by the Research Foundation in New York. As it was developed in the United States, the terminology may be different and some of the data collected does not apply in Britain, but, with practice, these small hurdles are easily overcome.

The FIM is intended to include a minimum number of items and is a basic indicator of severity of disability, not impairment. It always measures what the individual does, not what they ought to do. Performance is measured on a numerical scale and the sections covered apply to all members of the multidisciplinary team,

The FIM assesses all factors that may measure changes in a patient’s motor function. These are: self-care, sphincter management, mobility, locomo- tion, communication and cognition.

A seven-point scale was used, the point ratings are given below. An example could be the rating of bladder management.

7 = complete independence; 6 = modified independence; 5 = supervision or set up; 4 = minimal contact assistance; 3 = moderate assistance; 2 = maximum assistance; 1 = total assistance.

Q 1996 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 3, 327-329

Clinical n

Other categories are recorded in the same fashion on admission and discharge. The reference book is a necessary and useful aid. The FIM is unmanage- able without it. It must be used as it stands - it cannot be changed. If changed it is no longer a vali- dated audit tool.

A teaching video is also available and perfor- mances are measured on the numerical scale, which all members of the team must use. No one profes- sion owns it.

We are planning to carry out our first six-month audit at the end of December. More often would be inappropriate owing to the low turnover of admis- sions and discharges in Belhaven. Comparisons will be made between admission and discharge scores and the FIM should prove to be a useful tool when auditing the effectiveness of nursing and therapeu- tic interventions. Most importantly it will again stress that we are all individuals with different ways of coping with, and adjusting to, changes in our lives.

NORMA GREEN Staff Nurse

Belford Hospital, Fort William,

Scotland.

Dementia care planning - Highland

For a considerable time there has been a core group of staff within ward 13 who have felt that there is more to caring for persons with dementia than ensuring they are washed, fed and toileted.

This, in conjunction with observing continually high apathy scores in the Clifton Assessment Procedure for the Elderly (CAPE) assessments of our residents, led us to develop an extensive activi- ties programme, in an attempt to provide stimula- tion for our residents.

Having read some articles by Tom Kitwood on Dementia Care Mapping (DCM) myself and a staff nurse were able, with the aid of funding, to attend a course on DCM at Stirling University. We returned with a sound theory base and the ability to assess care from the person with dementia's standpoint using the DCM tool.

Our management team embraced the concepts with enthusiasm and we were then given funding to attend further training to become evaluators. The ultimate aim being for us to train staff, to assist in mapping.

We then 'spread the word' about DCM by talking to staff, providing literature and asked for volunteers who were willing to be trained. This was met with an overwhelming response and we found ourselves in the position of having to select who we would train. Once the training was completed, we mapped all the wards in the unit.

We met witb varied responses, but most staff were receptive to discussing their care and finding solutions to the problems. To date, wards have been looking at shift patterns and the way in which staff are utilized, and some have been looking at education for staff in relation to attitudes. We have also been asked back to remap two wards in three months time.

For ward 13, DCM has been an exciting and worthwhile development. It has fostered more open communication between staff and has enabled people to become more innovative and to suggest ideas to improve care.

DCM has certainly proved itself to be more open than just another-evaluation tool, we believe that it is a contribution to the removal of the terrible suf- fering that individuals undergo when their person- hood is denied.

We still have a massive challenge ahead, but we believe that DCM will help us to move forward and provide the quality of care that we would like to have for ourselves if we were handicapped by dementia.

Our spirits are not dampened, and we are deter- mined to succeed.

HELEN NAIRN Sister

Craig Dunain Hospital, Inverness, Scotland.

Present address: Deputy Matron,

Cradlehall Nursing Home, Inverness.

Q 1996 Blackwell Science Ltd, /oumal ofl'sychratric and Mental Health Nursing 3,327-329