Life Beyond the Cubicle Project report

Life Beyond the Cubicle

Executive Summary May 2024

Background

Making Families Count (MFC) in partnership with Oxford Health NHS Foundation Trust developed the Life Beyond the Cubicle (LBC) learning resources. The aim of the resources was to enhance healthcare professionals knowledge and skills in order to work collaboratively with carers ensuring that, where possible, they were involved in the care of their loved one during mental health crisis. There is literature that underpins the involvement of carers within the care of their loved one particularly at times of mental health crisis (Bradley & Green, 2018; Murphy et al., 2015; Warrender et al., 2021), however there is no consensus on effectiveness of the different interventions to educate and empower healthcare professionals in developing authentic collaboration with carers/families. Similarly, The Triangle of Care (Carers Trust, 2019) originally launched in 2010, highlighted the important role of carers and the need for healthcare providers to work collaboratively with carers in shaping the care and treatment of their loved one. The Triangle of Care provides a framework for embedding carer involvement within healthcare services and consequently should be adopted to enhance outcomes for service users and their carers.

The LBC resources were co-produced by clinicians, people with lived experience of mental health crisis and carers, supported by an Advisory Group. The co-creation of the resources was essential for ensuring that the materials reflected the experiences and aspirations of those with lived experiences as well as the learning needs of clinicians.

The Life Beyond the Cubicle Resources

1. Five e-Learning modules plus an Introduction and Resources for family carers.

These were designed to enable healthcare professionals working with adults to reflect on effective ways to

engage families/friends when assessing and treating a service user during an acute mental health episode. The emphasis was on encouraging and helping healthcare professionals to work collaboratively with carers. The modules used short films and audio recording from people with lived experiences and actors as stimulus materials to bring the lived experiences of patients and families to life.

E learning Modules

• Introduction (includes guidance on how to use this resource)

• Module 1 Why do Families and Friends matter?

• Module 2 Assumptions and Expertise

• Module 3 Feelings and Fears

• Module 4 Confidentiality and Information Sharing

• Module 5 Safety Planning

• Resources for Family and Friends

2. A Handbook to support facilitated group-based training.

The handbook incorporated film and A Handbook to support facilitated group-based training.

The handbook was designed for use by clinical practice educators, ideally co-facilitating with a trained and supported family carer. This aspect of training enables richer dialogue and discourse between healthcare professionals to promote deeper reflections on experience and consideration of the facilitators and barriers to effective and authentic family involvement, with a view to taking positive action when back in practice

Purpose of Study

Aim

A mixed method study to assess the potential of the LBC learning resources to enhance the skills and knowledge of mental health professionals by evaluating the effectiveness of the e-learning modules.

Objectives

1. To explore the experience of healthcare professionals working with carers when their loved one is experiencing mental health crisis.

2. To identify healthcare professionals’ views on their readiness to engage and participation in LBC learning resources.

3. To explore the experience of engaging with The LBC learning resources and outcomes for the participants personally and professionally in terms of their mental health practice.

Study Population

Methods

1. Pre and post-questionnaires were embedded in all the e-learning modules. The pre-questionnaire was designed to assess the level of current perspectives in working with carers during times of mental health crisis. The post-questionnaire assessed the participants perspectives of completing the modules, any lessons learnt and any subsequent impact on clinical practice.

2. Participants who completed the questionnaires were invited to join an individual interview. The aim of the interviews was to gather in-depth information on the participant’s experience of completing the e-modules, as well as any lessons learnt and impact on clinical practice.

Questionnaires Pre - Questionnaire 175 responses Post - Questionnaire 184 responses Interviews Interviews 4 x individual interviews

Study Findings

• The study participants completed the modules as part of their continuous professional development and whilst there were mixed reviews about making the training mandatory, there was consensus on the importance of the content.

• The resources supported staff to identify strategies for engaging with carers, which may not have been explored due to fear of breaching professional boundaries in relation to consent and confidentiality or due to lack of time or physical space to adequately discuss key information with carers.

• The evaluation found that whilst healthcare professionals were keen to involve carers within the care of their loved one, particularly during times of crisis but they recognised that this was influenced by several factors including family dynamics and level of engagement of carers with their loved ones.

• The e-learning modules were pivotal in creating a new interest in carers and provided the participants with opportunities for reflection which inadvertently triggered a new sense of motivation to ensure that carers were identified and actively sought for involvement in the care of their loved one.

• The LBC e-learning modules offered participants an engaging and empowering approach to exploring the role of carers within the safety of personal reflection and group peer learning.

• The presentation of the content provided a balanced approach to supporting staff to identify with the content and through reflection develop strategies for enhancing their professional practice.

• The presentation and accessibility of the content was viewed as adequate and the main gaps highlighted were relation to in-patient care and young carers.

• The data demonstrated that participants appeared to follow the logical order of the modules for completion which was beneficial but there may be a need to review the order of the modules as the participants predominately shared the challenges of navigating their professional role when dealing with confidentiality and knowing what to share/not share with carers.

• The e-learning modules supported staff to be emotionally attuned to the experiences of carers which ‘opened the door’ to enhancing care delivery for patients and their families/carers.

Significance of the Study

The finding of this research has informed best practice for healthcare staff training on the importance of involving families wherever possible during mental health crisises to improve care, avoid harm and reduce fatalities. This study has also highlighted best practice for the implementation of The LBC e-learning resources.

Limitations

The e-learning modules were piloted across different healthcare providers. The application of the modules were individualised to each provider as some used them for Learning and Development training, whilst others used them for staff training or both. The inconsistency in approach means that at this stage the results cannot be generalised.

The e-learning modules were solely piloted with NHS staff. In the future this could be piloted with pre-registration health and social care students. Pre-registration students are the future workforce, and it is important that family/ carer involvement is included within their curricula.

Recommendations

The following recommendations are informed by the findings from this evaluation;

LBC: Module Implementation for Healthcare Providers and Universities

1. Healthcare providers to incorporate the LBC e-learning modules within their Triangle of Care Action Plan with strategic objectives on measuring impact on patient care.

2. Healthcare providers should work in partnership with their staff and carers to identify relevant information, advice, and support required to promote engagement and collaborative working.

3. Healthcare providers to incorporate carer involvement within all areas of their service delivey and governance monitoring processes. Embedding carers in all apects of the Trust will foster a culture that champions the family/carer voice and influences more meanginful engagement with carers.

4. Healthcare providers should have identified carer involvement lead roles for promoting the carer voice and championing good practice through targetted training and events for staff and carers.

5. To include LBC modules/ materials within the curricula for health and social care pre-registration students with the aim of emdedding principles of carer involvement within the future workforce.

LBC Module Development

6. The LBC modules to be reviewed to ensure that reptition of content is removed and to enhance the sense of progression in terms of completion time and learning outcomes.

7. To review the content of LBC modules to consider in-patient and young carers case scenarios and modelling for some of the clinical scenarios to demonstrate good practice.

8. The LBC module order to be reviewed with consideration given to the professioal barrers experienced by staff when dealing with confidentialy and complex family dynamics.

9. The LBC content to include more informaton on promoting equaltiy, diversity and inclusion with a focus on learning about different faith communties and role of faith within care dellivery.

Conclusion

In conclusion, the LBC modules had a positive impact by raising the profile of carers and supporting healthcare professionals to champion and involve carers, particularly during crisis. The e-learning modules were engaging, accessible and clinically relevant which made it conducive for staff to engage in the training. The use of the resources within staff training and supervision was valued as a postive way of sustaining the good practice of championing the carer voice. This research has evidenced that the workload and time pressures within the clincial environments could hinder full engagment with the modules or involvement of carers. This research has evidenced that carers are central to supporting their loved one during crisis and that involving carers in care decisions can unlock the door to