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Provision of therapeutic activity and the activity culture

 

Activity is essential to an individual's health and wellbeing.It has the potential to restore, maintain and improve physical and mental health.Our individual personality, life history, interests, values and beliefs influence our choice of activity.In short, what we do says a lot about who we are.

If an individual experiences disruption of daily routines, or has access to only a limited range of activities, physical and psychological health will suffer.

Why we are interested in this

Although the ability to perform basic activities is important, the need to enable social engagement and purposeful activity are key to encouraging a sense of self worth and well-being.Staff with the relevant knowledge and skills to provide appropriate activities can enrich the relationships within the ward to keep the activity culture vibrant and alive.

What we would expect to find

We would expect all staff to share responsibility for ensuring there is a culture that promotes and includes activity for individuals in all aspects of their daily life. We would expect individuals to be free to engage in personal and social activities of their choice in a relaxed and friendly environment.

We would expect the range of activities for each individual to reflect their choice, their social, cultural and religious preferences, and to be available at frequent and regular intervals throughout the week.

We would expect there to be sufficient financial and other resources, such as transport, equipment, materials, training and facilities, and effective use of the available environment and local community. We would expect that people are supported to participate in activities of their choice.

We would expect the need for "quiet time" and quiet space to be recognised and respected.

What we found

In wards where there was an activity culture, we saw individuals participating in a variety of leisure and daily interests that reflected their hobbies and interests that matched their level of ability.

Activities we found took many forms such as:

Daily living activities e.g. washing, dressing, managing medicines, eating, laundry, snack/meal preparation, budgeting, taking buses and taxis, going out to the shops and meeting friends for coffee.

Health and wellbeing activities used to address individuals cognitive, sensory and physical needs e.g. singing and playing musical instruments, dance classes, reminiscence groups, crosswords, quizzes, baking, art, crafts, therapets, snoezellen, massage, walking, swimming and gentle keep fit.

Lifestyle management activities including learning how to live with depression, anxiety management, healthy eating, smoking cessation, community education and leisure activities.

Person centred activities to improve the quality of the individual's life e.g. staff taking the time to sit and chat socially on a one to one or small group basis with individual patients and carers, facilitating patients to visit spouses who may also be in hospital or a care home or have transport difficulties, ward visits by relatives, friends, neighbours, outings to local parks, museums and the cinema, going to watch football, eating takeaways, the provision for "quiet" time and privacy.

Wards with a culture of activity provision supported individuals to do these things throughout the whole day, not just the organised groups in traditional activity programmes.This culture was underpinned by regular meetings between the patients and staff to plan the week's activities.

Some wards had developed meaningful social and community connections for individuals through the introduction of volunteers, befriending services, local churches, artists and musical groups visiting the ward throughout the day, in the evenings and at weekends.

However our visitors came across many missed opportunities to use activities therapeutically for the benefit of the individual.On meeting one individual and reading the last review in her case file, a visitor commented,

"This lady's mental health has improved but she remains physically frail.There is no mention to even suggest that activities of any sort have been considered, let alone been offered and adapted to meet her capabilities."

Individuals told visitors: "The only activity on offer is relaxation - every morning.That is it!"

"I enjoy painting water colours.I spend a lot of time doing that at home.I was told by staff that they don't do water colours on the ward."

"There isn't much going on in the ward.It all depends on who is on duty."

One visitor observed a lady playing dominoes with staff on the day of our visit.At interview she told the visitor that she did not like dominoes yet felt pressurised by staff to participate.On examining this lady's care file, the visitor found this lady's dislike for dominoes documented.The visitor highlighted this anomaly to a member of staff who did not appear to take this matter seriously and was dismissive of the individual's activity preferences.The individual told the visitor she felt fed up and frustrated.

Visitors spoke to some staff who believed that individuals were not interested in taking part in activities.In one ward, a gentleman repeatedly told staff that there was nothing wrong with him and at his age he didn't want to do anything.There was very little in the way of planned activity on the ward.The visitor gained no sense from staff that their lack of knowledge about his past and current hobbies and interests, the poor activity provision on the ward generally and the gentleman's refusal, and lack of motivation, to do anything could be clinically important in terms of his assessment, treatment and preparation for moving beyond the ward setting.

We found the consistency of staffing and frequency of activity provision to be easily sacrificed when the wards were busy. Variable staffing levels and lack of access to other disciplines like Occupational Therapy were also cited by staff as undermining the therapeutic value of activity in preparing people for life beyond the admission ward setting.

Good practice

One individual spoke very highly of the staff saying that when he was admitted to the assessment ward he didn't feel like speaking to anyone or participating in anything.The staff supported him through this difficult time providing him with a variety of his favourite reading materials which he felt helped his concentration.They also spent time with him, "just being around".As he began to feel better he took them up on the offer of walks around the hospital grounds …."Before I was admitted I hadn't been going out at all.The opportunity to get outside really boosted my confidence."