What the Swale Ward team have learned throughout the second wave of Coronavirus

Our Swale Ward team is based at the Humber Centre and is made up of Nurses, Psychiatrists, Psychologists, Healthcare Assistants, Social Workers, Occupational Therapists, Art Therapists, a Ward Clerk, and the Primary Care team, including GPs and Speech and Language Therapy.

The team is the regional gatekeeper for personality disorder patients requiring consideration of secure hospital admission or transfer to community care. They undertake assessments for Humber and Yorkshire patients that are placed in hospitals and prisons around the country, make recommendations and can offer hospital admission to our specialist unit. On the unit, we have both an acute assessment ward and treatment rehabilitation ward where we offer a patient-centred holistic approach with a number of therapy modalities.

The team’s focus is to help patients with their symptoms, which tend to be highly complex. To develop pathways on a patient’s journey, the team liaise early with families, other hospitals, prisons and community teams.

We spoke to Dr Mohammad Qadri, Consultant Forensic Psychiatrist and Medical Psychotherapist, specialising in Psychoanalytic Psychotherapy, about what life has been like on Swale Ward during the pandemic.

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In the very beginning, we had to respond very quickly and adapt to change almost overnight. Certain aspects of our service had to change, and our patients were no longer able to leave the ward for rehabilitation activities or enjoy visits with family and loved ones.

We quickly noticed that this could be a challenge, as the mainstay of treatment is based on relational factors and engaging in therapy. A loss of purposeful activity and access to therapies and positive relationships could result in potential relapse and thereby delays in progressing in their care.

It was important that we explained the reasons for this change to our patients and gained their understanding, whilst also ensuring that a high quality of care was met in different ways.

Our nursing staff in particular were phenomenal and really showed their dedication to the work they do. They picked up where others had to step away due to limiting staff access on the ward and ensured our patients were still maintaining a routine even without these additional interactions. They found new ways for patients to enjoy the activities they usually do and established new ways of working. It was really impressive to see how they rose to the challenge so quickly.

I think it’s also worth bearing in mind that, not only did we have to adapt quickly, but the situation was also moving quickly outside of the ward. As the government made quick decisions to respond to the pandemic we didn’t always have answers to the questions patients had, making it very difficult for us to set expectations with our patients. We didn’t always know how the ever-changing situation would impact patient pathways, and this was something we had to deal with carefully.

We were being led by government restrictions and had to work hard to manage and remove any anxieties both our patients and our staff were facing. It was all about working closely together as a team to ensure we put the right foot forward, and fortunately I think that is exactly what we did.

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As we moved into the second wave, we knew we had been here before. Lockdown was no longer an unknown concept and not only did our staff know how to better manage things, but our patients were much more understanding and adaptable. They continued to work closely with us which I think is a real testament to the hard work our staff put in the first time around, and the relationships they built throughout these uncertain times.

However, there’s no denying that staff were tired. The first wave was exhausting both inside of work and outside in our personal lives, and I’m sure we all felt that. In a lot of ways, you felt like you were just beginning to recover from the first wave when the second one arrived.

Our team again showed such incredible amounts of resilience, and they just got on with it. They ensured that patient care wasn’t interrupted and went above and beyond to ensure our patients were cared for during another trying period.

What we found really important was having a sense of community on the ward.  This was developed and adopted by the team and this is something we’re very proud of and will continue in the future.

Something which we do very well on Swale is that, when people come onto the ward, the first thing we do is work out together where the patient sees their pathway developing and in which community. We want to get a good understanding about what they want to do or talk about, and we want them to know from the beginning that they will be involved in their care, and that their voice matters.

From that point forwards, we involve them in all decision making related to their care. Transparency is key for us, we don’t hide things away from them and we keep them informed as much as we possibly can. There’s something to be said for this as I feel it makes them respect us that little bit more and enables them to feel comfortable that any decisions we do have to make, are in their best interests; that fundamentally we have the same goals.

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We introduced the early involvement of step-down community teams during this time, which is something we hope to carry on into the future as it’s working really well. Delays were, and continue to be, inevitable during the pandemic. Patient pathways are therefore affected, as accommodation arrangements and hospital transfers may need to be changed. We found that ensuring everyone was involved and on the same page from the very beginning helped minimise any delays from our side at the very least.

We prepare in advance, identify what challenges may arise, inform the patient of these potential eventualities and then, in the long run, expectations are managed more effectively and the patient ultimately feels like they are at the heart of their care.

Another way in which I feel we improved our overall service at this time was the introduction of increased reflective practice for staff, led by the Psychology team. We’re acutely aware that our staff need breaks and time off of the ward, but this was a chance for us to really show them that we cared about their emotional wellbeing as well. We began offering training every other week, which was a time for staff to step away from the ward and prioritise their own thoughts and feelings. It was also an opportunity for them to talk about difficult cases, get insights from colleagues, and participate in educational teaching about things like mental resilience.

This introduction was much appreciated by the team, who were now missing out on team days we used to host, and it’s something we will certainly continue post-Covid.

Consistent development and training are essential for staff, especially during the tough times as we noted in each of the lockdowns, but we hope our staff at Swale recognise that their work during this time has not only been appreciated but has been vital and surpassed all our expectations. I would like to thank them for that, they really have been inspiring in many ways.