Empowered Partners in Mental Health Care
Summary
1 in 5 Canadian children and youth experience a mental illness and those with a disability or chronic illness are 2-3 times more at risk. As a pediatric rehabilitation hospital which cares for children and youth with disabilities and chronic illnesses and their families, the need for integrated health care, inclusive of mental health care has become a priority at Holland Bloorview Kids Rehabilitation Hospital. Staff on our inpatient units care for children and youth and their families after they have experienced trauma and those with chronic conditions who often experience stress associated with hospitalization and co-morbidities. Our outpatient clinics witness the prevalence of anxiety and depression among youth with disabilities and chronic illnesses on a regular basis. Holland Bloorview launched a Mental Health Strategy in August 2017, with the aim of targeting stigma reduction and identifying needs through a staff survey. The important work of the mental health strategy has promoted a curiosity among direct care staff to build their capacity to support clients in their mental health and wellness journey. I partnered with stakeholders and leaders to ensure alignment with the Mental Health Strategy and recruited a network of champions from across inpatient units, ambulatory care and allied health to identify priorities, resources, and facilitators for this project. Stakeholders highlighted the opportunities for improved communication and role clarity for nurses in supporting the mental health of clients. Often formal supports are implemented for children experiencing challenges with their mood and coping such as counselling with a social worker or a referral for assessment by an external consulting psychiatrist. After this happens, nurses wonder about the outcomes and how they can support a client’s mental health and coping throughout their rehabilitation journey, 24 hours a day and beyond structured appointments. This led to the development and delivery of a mental health education program focused on using validation and empathy, re-embracing the role of the therapeutic nurse-client relationship and including mental health in nursing care.
Through this fellowship, I was able to enhance my knowledge of mental health resources, implementation science and adult education skills through planning, delivering and evaluating education sessions with nurses to support the holistic care of children and families at Holland Bloorview. I participated in a variety of mental health educations throughout the fellowship such as through the Mental Health Commission of Canada and Applied Suicide Intervention Training. I had the opportunity to meet weekly with my mentors to grow and build my learning. I conducted a needs assessment with stakeholders and found this identified a variety of directions which could be followed throughout this fellowship. It also highlighted the research of prevalence of mental illness in youth with disability and the commonality of challenges across the healthcare system. The experience and expertise of my mentors helped to focus and direct my objectives. I was also able to build my implementation science and stakeholder engagement skills with feedback and idea review to navigate the structures required for organizational alignment. I was able to pull from the experiences and expertise of my mentors to learn about external practices and successes that helped nurture and form the mental health education in this fellowship. The learnings from education initiatives at allied hospitals helped launch the development of a powerful adult education program here including applicable case base learning and applying relevant skills like validation. I was also able to apply the concepts I’ve learned through strengths-based and solutions focused communication theories.
Outcomes
Since completing this fellowship, management and senior leaders shared an observed increase in assessment of client and family mental health. It has been reported that mental health and coping is more consistently brought forward by nurses to the interdisciplinary team in bedside rounds discussions so that the holistic needs of clients and families can be supported through collaboration. Prior to the fellowship, I’d heard from children and their families that they feel they need additional support around their mental health and coping especially when they are physically recovered from a trauma and haven’t had an opportunity to acknowledge their grief and adjust to a new normal. Through this fellowship and the inclusion of mental health care, we will demonstrate to children and their families that their mental health is as important as their physical health in their rehabilitation journey. Through the education in this project, knowledge of the tools and resources available to support clients was also further disseminated so that when children and their families are struggling, more team members will be able to help them navigate the system to receive mental health services and respond to their emotions throughout their hospitalization. At Holland Bloorview the Mental Health Strategy is ongoing and will continue to evolve and grow to meet patient needs and the fellowship has allowed us to take an important first step towards a more enhanced connection between physical and mental health.
Outcomes experienced among colleagues/staff, organization, and stakeholders as a result of the fellowship:
Mental health education was delivered to 50 nurses through several small group sessions, which represents 40% of the full time and part time workforce.
Outcomes of the education session were very successful.
97% of nurses agreed they would be able to integrate increased consistency of mental health assessment into their practice
95% reported they had increased their comfort in asking about the mood and mental health of their clients
94% agreed they learned skills and resources which would be helpful in their nursing care.
Nurses enjoyed exploring case studies to illustrate relevant and practical skills to support the mental health of the children and families we care for. They reported and demonstrated engagement through discussion and participation, bringing communication tools to life and exploring examples of how to use empathy and validation with clients. The presentation improved knowledge of the statistics regarding the prevalence of mental illness and nurses shared the education was eye opening and informative. They valued the opportunity to become more familiar with the mental health resources available to the children and youth we care for. This illustrates the benefit of nurse-led and nurse-tailored education using mixed and flexible modalities to integrate education into direct care and reaching staff members who work varied shifts and may not have been able to receive prior information via traditional modes.
Overall experience
Overall, the fellowship experience was incredibly rewarding and impactful. I am grateful to have had this opportunity to grow and develop as a nursing leader. The opportunity to learn with and from my mentors was amazing and inspiring. The networking with nurses from other practice settings and learning how they are leading change in their organizations to improve health care and to see the shared commonalities of needs across our populations was invaluable. It was an inspiration to share this experience with them and build our community of nurse leaders advocating and improving together towards a common goal. The experience in education was also very positive and surprising. I wasn’t expecting the level of support and appreciation I received from my nursing colleagues who were incredibly engaged in the project and shared in the passion for advancing mental health at Holland Bloorview. I also heard from allied health staff that they’d love to be included in this work. The opportunity to build a network of champions was rewarding and it is great to have allies on this journey as well as to provide mentorship to emerging leaders who are growing in their careers as well. It was a great experience to put into practice the concepts I’ve learned at RNAO Best Practice Implementation workshops and the Summer Institute in the past and be able to develop a project charter, engage stakeholders, deliver education and evaluate outcomes.
