Hospital life and illness are stressful for patients and staff. Being in hospital can bring back traumatic memories of previous visits and the death of loved ones. It also exposes one to the suffering of others.
Patients are understandably distressed about operations or other invasive procedures, changes or losses of bodily function and resulting changes in their way of life, and concerns about their families.
In this vulnerable situation, it is not uncommon for hospital patients to complain that they are not being treated with sensitivity and understanding by staff. For their part, hospital staff struggle to fulfil public expectations while performing tasks that are inherently stressful, dealing with the extremes of human experience.
King's College Hospital trust, London, has responded to this by establishing a counselling team which serves patients and staff.
The hospital has had specialist counsellors to support patients with particular needs, such as those facing renal transplant, for several years. And in 1998, the trust employed a bereavement counsellor to support patients and relatives across the medicine and neuroscience care groups.
Soon, ward staff in these care groups started referring patients and relatives with issues other than bereavement or terminal diagnosis. Doctors, nurses and professionals allied to medicine also began requesting the counsellor's input for issues such as patient motivation, treatment compliance, anxieties about patient discharge, breaking bad news, communicating with difficult patients or families, and staff support sessions. Referrals also came from wards outside the designated ones. A subsequent needs assessment confirmed that a hospital-wide counselling/psychotherapy service would be used. It showed more than a third of patients and relatives identified as needing support were already asking for counselling.
A trust-wide service was established in September last year. The team, comprising three registered psychotherapists, provides psychotherapy support across the entire hospital except in those areas, such as haemato-oncology, which already has a counsellor. The team also provides training for staff, reflective practice groups and multiprofessional debriefing sessions after difficult and distressing incidents. The cost for the first year has been£100,000, which includes computer and recruitment costs.
In January, a clinical placement scheme was established for 12 students in advanced training toward their registration as therapists. These students work with approximately three clients a week on a voluntary basis, with the team providing clinical supervision of their client work. This allows the service to respond, usually within 48 hours, to any request for counselling or staff support.
In the first 10 months, the team was able to provide 679 sessions for patients and relatives. The length of counselling contract has varied from one session, to regular sessions over eight months. Each session lasts up to an hour and are held at the patient's bedside, the counselling room or a nurse's office.While the patient is in hospital, the client (patient or relative) is usually seen once a week or more. After hospital discharge, clients are offered six follow-up sessions at the hospital. Though the service is open to self-referrals, most referrals are made by nurses. The next largest group of referrals comes from professionals allied to medicine, followed by doctors.
Improving the patient experience is inexorably linked to the training and personal awareness of hospital staff. The staff, including counsellors and psychotherapists, need to acknowledge the emotional impact their work has on them. Since the team's inception, we have facilitated reflective practice and debrief sessions and provided training in bereavement, listening skills and dealing with difficult patients.
We have proposed, in co-operation with the dean of the postgraduate medical school at King's, the development of 'self-awareness' groups (similar to the Balint groups for GPs) for pre-registration house officers to offer emotional support and practice development, in terms of building relationships with patients and their relatives.
King's is interested in exploring how this model may be of value to hospitals. One possibility is that a service could be provided for hospitals which recognise the importance of these needs but do not have the resources to establish their own team.
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