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How Kissing it Better can help the campaign to reduce pressure ulcers

Many elderly care wards provide a great deal of stimulation for patients but, sometimes, we are asked to visit a ward where staff are stretched to the limit, morale is low and where long-stay, mainly elderly, patients are washed and dressed and then sit in a chair or their bed for many hours. Their motivation to move or engage with others is often low. For a variety of reasons (illness, poor dental hygiene, lack of mobility), many of the patients may not have been eating well prior to admission which can affect their health and the quality of their skin. Busy staff may not be able to give them the quality time they need. If the patient is in a bed in a corner with no window or anything interesting to watch, they can become increasingly withdrawn, lacking the incentive to help themselves, including eating. It’s a downward cycle.

In order to maximize the opportunity to use our ideas on hospital wards, we engage well-led schools, colleges and voluntary groups in the local community, in our drive to push these ideas forward. Through their specialized engagement with patients and relatives (beauty treatments, singing, drama, reading groups, pet therapy, etc) these groups transform the way patients feel about their care. Energy levels rise whenever they visit and patients take a greater interest in their surroundings, become more inclined to move, and take more interest in their surroundings, including their diet.

Examples of these community led activities include…..

Student beauticians and hairdressers who, in many hospitals, through Kissing it Better, now offer free manicures, hand massages, make up and hair styling on the wards as part of their course. Visiting in groups of 8-10 students, always supervised by their tutors, they are bright and lively. Taught to smile and to listen as part of their course, they lift the mood of any room they enter. I have seen many frail patients sit up and lean forward to place their hands on a table for a simple manicure or make up session. I have watched how, after the manicure, they wave their hands to dry their nails as they admire them. This simple activity is also a form of simple exercise.

Musicians from sixth forms bring their instruments and their wonderful voices to the wards. Singing a selection of popular songs including music from the famous musicals, Abba, The Beatles etc, all in 2, 3 or 4 part harmony, the moment they arrive on the ward, patients , relatives and staff take notice. Singing a couple of songs in each bay, they encourage patients to join in. They then join the rest of their classmates, in groups of 6-7, to chat to patients and relatives in a bay before moving on to sing in the next bay. The music provides a wonderful trigger for conversation, whether it’s a patient turning to see what’s going on, or sitting up so that they can see better. We often see patients, who may not have moved very much all day, suddenly tapping feet and hands in time to the music or singing along. This all leads to improved circulation and a renewed enthusiasm to move about. This also helps to reduce the risk of frail and vulnerable patients developing a pressure sore.

School children often come and read popular poetry to patients. Whether its Shakespeare or Winnie the Pooh, the pupils find that the words always trigger a memory of someone who has had a stroke or who has dementia. Often poems learned at school are ‘hard-wired’ in our memories and many older patients do not realize that they can still recall the famous words until they hear then again. Pride in their ability to share this knowledge lifts spirits and prompts conversation. One lady asked a student to look up reading groups on her mobile phone. She told us that she feared her stroke would result in her sitting at home for hours on her own. A former teacher, she was delighted when , through our visit, she learned that her local library had a reading group that would welcome her.

We organize for dogs to visit acute wards through the charity Pets as Therapy. Leaning forward to pat or stroke a dog requires a change of position and arm movement. Moods lift instantly and pet lovers in the ward quickly start to engage with each other. The arrival of a greyhound on a male stroke unit resulted in a burst of chatter as so many of the men regularly visited the greyhound racing at the Perry Barr stadium. The consultant came to the ward while the dog was there and was so impressed by the buzz of conversation from his many patients, that he is now looking into buying a dog for himself that he can train it to come onto the wards.

Visits from Brownies, Cubs etc especially those who sing camp-fire songs with actions, prompt many older people to remember their time as cubs, scouts, brownies or guides. Most older people were a member of local pack when they were young. Joining in the songs, including the actions, or talking about the badges is a great way of stimulating a patient, improving their circulation and getting them to move position.

Through us, Drama groups of all ages often visit hospitals and perform in large communal spaces (day rooms, reception areas etc) . These events require patients to be moved from their bedside. All this helps with pressure area care.

Film (DVD) evenings in a day room encourage a few patients to move, or be moved, from their bedside to get together to enjoy a popular film. Famous musicals are ideal as everyone tends to know the storyline and the familiar tune always bring smiles of recollection and a chance to sing along or tap your feet to the music.

Bingo can be a great way of raising energy. With no memory or skill required, the most disabled patients have the same chance of winning as more able patients. It often requires a shift of position to play. Some patients are moved so that they can sit at a table. Again, the fun of the event is a great mood enhancer as patients, visitors and staff compete for simple prizes (donated by visitors and staff). Note: When my highly disabled mother won the bingo session, lots of people came to talk to her because the brightly coloured, large and hideous soft toy she won was a great conversation starter. My mum, who couldn’t speak, was smiling all evening.

At North Middlesex Hospital, we have made a link with Brettenham Primary School where many of the Somali and Turkish mothers do not speak good English. In an attempt to increase these ladies confidence, we plan for them to visit Somali and Turkish patients in hospital to lift their spirits. Under the supervision of school catering staff, they are also planning to make Somali and Turkish biscuits and cakes which they will bring to the hospital to encourage these patients to eat.

All these activities hugely lift morale of patients and energize them. Staff are also more fired up as a result of these events. Relatives are also delighted by the activities organized for their loved ones and start to think of ideas of their own. They become ‘better’ visitors when the surroundings are more stimulating and they are encouraged to visit more often. All this stimulation has to be good for the patient as it raises their morale and energy levels. This, in turn, encourages them to eat. All the activities increase their incentive to shift their position so that they get the best view of all that is going on around them. All of this helps pressure area management.

Jill Fraser

Jill Fraser

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