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Working Together as Agents for Change in Mental Health


Our Reflections on the Nightingale Challenge Northern Ireland Global Leadership Development Programme – ‘Working Together as Agents for Change in Mental Health’

Jennifer Jordan and Laura McLaughlin,
Mental Health Nurses

Firstly, may we introduce ourselves; we are Jennifer Jordan and Laura McLaughlin, both mental health nurses at Western Trust, Northern Ireland. Whilst we both work in mental health we did not work together until we joined the Nightingale Challenge Northern Ireland Global Leadership Development Programme (NCNI GLDP). We were both delighted to be selected in late 2019 to join a cohort of thirty young nursing and midwifery leaders from across Northern Ireland to participate in the NCNI GLDP, launched in January 2020 alongside the 2020 International Year of the Nurse and the Midwife. We were looking forward to representing mental health colleagues from the Western Trust on the NCNI GLDP and to broaden our knowledge about other areas of healthcare globally and locally, and leadership.

As a group of young nursing and midwifery leaders on the programme we were fortunate to have two face-to-face workshops (in January and March 2020) before we were forced to link virtually via Zoom, email and social media, due to Covid-19 restrictions. During each workshop we were both encouraged and motivated by the role-modelling of the leaders who contributed as speakers such as Rodney Morton, (Director of Nursing, Public Health Agency, Northern Ireland) Charlotte McArdle (Chief Nursing Officer, for NI), Mary Frances McManus (Director of Nursing, Public Health, NI) Howard Catton (CEO, ICN) and Dr Catherine Hannaway (Global Health Consultant). Much of our theoretical learning was by e-learning modules and we both managed to complete four Quality Improvement modules facilitated by the Institute for Healthcare Improvement (IHI, USA). This is really the motivation for writing this blog together as we wish to share the learning from how we collaborated on an improvement idea which was underpinned by our learning from the IHI Quality Improvement modules.

As part of the NCNI GLDP we were immersed in learning that encouraged nurses and midwives to lead from the front and to make sure their voice was at the table. A key requirement of the Nightingale Challenge Northern Ireland Global Leadership Development Programme (NCNI GLDP) is for participants on the programme to undertake a quality improvement (QI) project that requires participants to apply their knowledge and skills in practice. We initially had two separate QI proposals. However, given the potential pressures that the Covid-19 pandemic might place on mental health services, we felt this was an excellent opportunity to work together in order to represent mental health services across the Western Trust, both northern and southern sector. We are both very keen and passionate to try and introduce small incremental changes that will have positive outcomes for individuals in the community.

This is the story of our journey to date and the progress so far. In collaboration with senior nurses, the Quality Improvement team, the senior management team within the Western Trust and with expertise from the University of Ulster, we have undertaken some early work to develop the concept for potentially launching a co-produced, individualised, self-help mobile phone/tablet App named SHARA (Self Help Anxiety Reduction App) to help minimise and target early and mild anxiety in the local adult population. We believe the SHARA mobile App is an innovative approach which offers the opportunity for local people in need of support to have access to early self-help with mild anxiety from the safety of their home, or home-like setting to help prevent their symptoms from deteriorating.

The challenges of the Covid-19 pandemic coincided with the early launch of the NCNI GLDP in 2020. Like many other health and social care colleagues, it was obvious that we would need to look at providing mental health services in a different way to ensure patient and staff safety and wellbeing.

Using the IHI Model for Improvement, we collaborated with a range of stakeholders as part of the preparation for our improvement project. The overall aim was to develop and test a technology solution that may have the potential to enhance current mental health service provision across the Western Trust area (and possibly beyond). We used the Plan, Do, Study, Act (PDSA) approach from the IHI (USA), to scope out a robust plan that would support delivery of the overall aim. We formed an agile virtual team to agree who we needed to involve (key stakeholders including service users) and how we would test the concept and study the results for further improvement.

We then quickly established a project team which included ourselves, 2 doctors, 1 pharmacist and 1 occupational therapist to provide expertise for the SHARA mobile App project. Our initial audits highlighted that there were increased referrals for those presenting with anxiety currently, in comparison to pre Covid-19. Further audits were carried out from a sample of GP surgeries across the Western Trust to obtain data as to who was likely to make contact with symptoms of anxiety. It was evident through our audits that females were most likely to contact services, with the highest age group being between18-40. Virtual focus groups were held with patients, family members and staff members, all within the current Covid-19 guidelines where they were presented with the content of the proposed App for their feedback. This learning helped us as part of the PDSA improvement approach to adapt the information of the App, based on the views within the groups. During the planning/concept phase, we were invited to present the SHARA mobile App concept to a Senior Management Team meeting within the Trust, and the feedback was very favourable.

An important part of this improvement project was the learning from interventions that did not go well. For example, one setback which provided important learning for the project team happened when we applied for some grant funding as part of a ‘quick fire mental health challenge’ with a global company. Whilst we were unsuccessful, we received some positive feedback and recognised that to move forward we would need to fully identify cost implications for the launch of the SHARA mobile App as well as any ongoing costs in order to support the concept phase through to the development of the final product. As young nurse leaders working on the frontline, we recognise that the opportunity to apply for a grant would not have arisen without being made aware of it whilst on the NCNI GLDP. Fast forward to now and progress to date includes a further online focus group held recently with 3rd year nursing students within the Magee Campus of Ulster University. The feedback was very positive and encouraging. We also envisage having the content of the mobile SHARA App presented within an e-book format to help those who do not have access to a smart phone.

The NCNI GLDP has continued online with workshops and personal support. We began to form partnerships and a wider network with other young nurses and midwives both locally and globally. Laura had the opportunity to present at the NIPEC Conference in March 2020 and she has had her abstract accepted for the International Council of Nurses Conference for 2021, and Jennifer to do a radio interview to highlight mental health concerns within the community and the impact of Covid-19.

On reflection, we are both so thankful for the opportunity to actively participate in the NCNI GLDP programme. We remain motivated to bring the SHARA mobile App to life as a live product to help users access coping mechanisms safely and effectively from home.