Shared learning database

Type and Title of Submission


Using national standards to develop aims, objectives and measurable outcomes for reflective practice groups on older peoples mental health wards (update September 2009)


Update on Criterion-based Reflective Practice Group Courses run in 2008-9 for staff in acute wards in older people's Services, West Sussex. The groups aim to increase psychological awareness through self-reflection. The group's objectives are based on criteria derived from twelve policies and documents in current use which have made recommendations for improved care standards in mental health services. Four main areas for development were identified from a review of the policies: 1. Improved communication between staff and service users/their families 2. Improved communication between different parts of a service-user's system 3. Increased understanding of a service-user's difficulties and strengths 4. A commitment to personal development and professional practice. Following the successful pilot, the need for further groups in acute wards for older people was identified, and a set of evaluation tools were devised to be piloted in each area of West Sussex.



Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG42 - Dementia

Category(s) that most closely reflects the nature of the submission:

Practice improvement and development project

Is the submission industry-sponsored in any way?


Description of submission


To build on the experience of the pilot group and establish Criterion-based Evaluated Reflective practice Group Courses initially on all functional wards for older people in West Sussex and then to establish additional groups in dementia wards and other settings such as day hospitals for older people in West Sussex by the end of 2009. To have demonstrated good results in terms of staff attending and completing the group courses, and to have promoted beneficial changes in the practice of both individual staff and of procedures and practices within the ward settings. To have evidence of the groups having raised essential care standards through raising psychological awareness, and to have developed a set of evaluative questionnaires for use as baseline and outcome measures for the groups.


1. To develop criterion standards against which changes could be audited. To focus on issues that relate to national and local standards for good care, to reflect on issues that are pertinent to staff's daily work and the development of services. 2. To effect behaviour change through developing and enhancing the psychological-mindedness of staff by encouraging: - A person-centred perspective that takes into account the context of the person's life, home, family, strengths, hopes and needs - Self expressed in reflective rather than reactive practice - An awareness of the surrounding system - A willingness to challenge different viewpoints - A capacity to make sense of complex difficulties and to formulate a recovery pathway 3. To develop competencies from the overall framework of standards in order to achieve: a) Improved communication with service-users by gathering their views and those of their families about how they understand the current difficulties and how they wish to address them, including service-users and their families at meetings where possible, considering issues of diversity when planning assessments or interventions, and making service-user satisfaction surveys an integral part of service development. b) Improved communication with other parts of the service-user's system through promoting the service-user's perspective, wishes and hopes when liaising with other professionals. c) Assessing difficulties and strengths, by seeking information on an individual's life and combining perspectives from different points of the care system, formulating treatment and recovery plans taking into account all aspects of a person's life including, physical health issues, nutrition, communication and cognitive issues, and assessing all interventions for outcomes, d) A commitment to personal development by seeking out opportunities for training, being aware of local and national documents and how they impact on their work.


Managers concern in 2007/8 that locality wide training days for staff had not resulted in the desired amount of observable increase in the quality of communication or in the amount of time spent talking to patients as part of a coherent assessment, care or recovery plan. Reported incidents revealed a range of learning needs and of the need for changes in service delivery linked to NICE and other relevant care standards. A pilot group was run to establish the process of repeated (at least twice) case presentations, with advice offered by the group facilitator and group members, and a re-presentation with discussion of successful interventions, blocks, barriers and learning points, and to derive helpful items for a manager's observation checklist to be prepared for the roll-out of the groups in as many wards as possible.


1. Following the pilot, six courses were provided. 15 staff completed the courses. A further 14 staff attended but were unable to complete due to Trust re-structuring, movement of staff into other wards and clinical areas. The staff will have the opportunity to complete the required attendance and case presentations at subsequent groups. 2. 5 groups are running. These include day hospital and specialist dementia unit staff, giving a total of eleven group courses by the end of 2009. Over 50 ward staff will have attended part or all of the courses. The main barrier now is lack of manpower. With only three psychologists and their trainees, there are limitations to the number of groups it is possible to provide. By giving the project the highest priority over the year, the achievement has been to show a small number of staff can provide a large number of groups. One group is now being run by a previous group member, the results of which could enable more groups to be run by facilitators who have been group members, trained by experience and supported by supervision, and achieving similar results. 3. Questionnaires were developed to evaluate learning in the group, and measuring changes in practice against specified aims and competences and for ward managers to record improvements in the overall ward culture. Both questionnaires were used by the completed groups as post-course evaluations, together with feedback forms in which group members reflected on their experience of the course and made suggestions for improvements. 4. The objectives stated were achieved, that is - Through developing the psychological mindedness of staff did change their behaviour to the benefit of patients and colleagues - Improved communications and information sharing - Improved assessment informed by multiple perspectives, including from the individuals life story and different points of the care system; and - A stronger commitment to personal development.

Results and evaluation

The current groups will have the advantage of the use of evaluative questionnaires both before and after the groups courses have run. The previous groups did not have these available until the groups were already running. By the end of 2009, completed sets of before and after outcome measures will be available for five further groups, and the ward culture questionnaires that were completed earlier in the year will form baseline measures with which to compare the next completed post-group ward culture questionnaires. Direct benefit to individual patients was observed as a result of the case discussions in almost all cases presented, as more psychologically informed understanding of difficulties and difficult behaviour was developed. This was evidenced in the detailed recording of the initial case presentation and of the follow-up presentation after putting into practice the suggestions offered by the group. This is the clear overall direction of the detailed results for the first wave of groups and this overall positive result will be able to be evidenced quantitatively as well as qualitatively in the second wave

Key learning points

Success of this project depends on the close partnership with service and ward managers. It is vital that ward managers arrange the staff rotas to allow designated course/group participants to achieve one hundred per cent attendance. With this level of co-operation, it has been made possible for the group courses to survive and to benefit patients even in adverse circumstances such as ward closure and frequent staff changes/ temporary staffing for protracted periods during which uncertainty prevailed. Without this partnership and engagement of managers, attendance falls away dramatically due to the day to day pressures of other ward tasks. Course facilitators have learned to give the maximum possible information to ward managers and to spend time explaining the need for close partnership involvement from ward managers at every stage. Where this was not able to be done because of frequent changes in ward management, fewer participants were able to meet the attendance and presentations criteria and so were not able to attain certificates without further attendance at future groups. Course facilitators have learned to provide clearer information such as a 'welcome letter' to participants emphasising that the identity of the group is held within the context of a 'course', and attaching an outline of the learning objectives, a description of what will occur in the group sessions and over the groups series of sessions, an outline of what is expected from the group members in terms of participation and attendance, and copies of the evaluative questionnaires which they are encouraged to use as a reflective tool with their manager before starting the group and then again when the group has ended. It cannot be over-emphasised that the evaluation component, based on NICE and other criteria, together with the active commitment of ward managers are the key elements in the success of this project.

View the supporting material

Contact Details

Name:Wendy Harlow
Job Title:NICE & SCIE Implementation Facilitator
Organisation:Sussex Partnership NHS Foundation Trust
Address:Aldrington House, 35 New Church Road
County:East Sussex
Postcode:BN3 4AG


NICE handles personal information provided to the Institute in accordance with the Data Protection Act 1998. Find further details in our data protection policy.

This page was last updated: 29 September 2009

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.