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Areas for improvement

 

Locked doors

For many of the people we visited it is still common to have to negotiate locked doors in wards. Individuals are often unable to control access to their own personal space. People in hosptial should be afforded the same courtesy and right to privacy and dignity as anyone else. Staff should knock and seek permission before entering somone's private space.  To be constantly seeking staff assistance to unlock doors is also a barrier to gaining a sense of autonomy, especially in relation to internal locked doors.

Feeling safe

A feeling of safety and security is a fundamental human need. That a majority of the people we saw had been threatened or subject to aggression by other patients may be related to the lenght of time they have spent in hospital. However, people in such a vulnerable position should feel confident that they can ask for help and and receive support following such incidents. They should also be informed or action taken and how this should help them to feel safer in future.

Admission criteria for wards

Clinical need, not service expediency should determine who is placed in rehabilitation and continuing care wards. A wide age difference alone presents enormous difficulties for staff and is not supportive of individual recovery.

Meaningful activity

There is increasing evidence of staff being employed to promote access to activity and recreation within wards and in the wider community. While opportunities for activity and recreation are better than five years ago, for some there is little evidence that this is being translated into meaningful, individualised programmes. This is confirmed in the care records we reviewed.

Physical healthcare

Smoking, diet and exercise were highlighted as areas of concern. Many recognised the problems associated with their lifestyles but did not feel they were receiving the necessary support to make the changes they wanted, in order to improve their health.

Capacity to consent to treatment

Although nursing staff are generally aware of matters of consent in relation to those subject to compulsion, for others issues remain in upholding the rights and evaluating the capacity to consent to all forms of treatment. Awareness of the Adults with Incapacity Act may be just as important for this patient group as the Mental Health (Care & Treatment) (Scotland) Act 2003.