How to turn your outpatient department into a health promotion hub

Staff nurse Anne Thomas, winner of the Community Nursing category at the RCNi Nurse Awards 2017, created a model of care for rural areas that reaches out to men. As well as taking health education to farmers’ markets, colleges and pubs, she encourages men to use the outpatient department as a resource for self-care

A staff nurse has turned her outpatients department into a health promotion hub, reaching through her community hospital and beyond to provide a model for proactive, preventive and integrated services in rural areas.

Anne Thomas, who works at Dolgellau Hospital in Gwynedd, north west Wales, won the Superdrug-sponsored Community category of the RCNi Nurse Awards 2017 for her work addressing health inequalities among men. Her team has made health education central to all care and is breaking down barriers between the hospital and the local community.

‘We work together with commitment and enthusiasm, going the extra mile to make a difference,' says Anne. 'We work in a small, rural community hospital and this achievement will hopefully encourage other nurses to feel that small initiatives are just as important as larger projects.’

Inequality

The team identified that men in particular were failing to access services, and in 2014 developed a concerted approach to health education that was accessible, acceptable and effective.

‘Inequalities of health for men, particularly in rural areas, are often due to the socioeconomic factors and expected roles and attitudes within that community,’ says Anne. ‘Nurses know their own communities and must be creative in reaching out, shifting services away from hospitals to be more preventive and community-based. 

‘As well as taking health education to where men work, study and socialise, we wanted to encourage them to use the outpatient department as a resource for self-care.’

Feedback suggsts that going ‘where men are’ has improved engagement.

Working faster

‘They are reporting symptoms earlier, accessing health services more readily and are more willing to talk about their health needs, hopefully improving individual and community health and reducing gender health inequalities,’ says Anne.

Her research identified barriers experienced by the community in accessing health education, and with her team of two healthcare assistants (HCA) she consulted individuals and groups. They developed plans with colleges, workplaces and GPs before deciding to assign one member to work on their own community projects for an afternoon each week. 

‘Men are reporting symptoms earlier, and are more willing to talk about their health needs'

Anne Thomas

Anne presented the initiative to her managers. ‘They thought it was great but there was no money to fund it,’ she recalls. ‘So we work harder and faster to cover that person out in the community, because we feel it is so important.’

Initiatives include prostate symptom drop-in clinics and awareness sessions for community groups in pubs. There is also a  Healthy Heart programme – six sessions of one-on-one support and ‘male friendly’ lifestyle advice.

Worrying symptoms

Testicular cancer awareness sessions are provided in schools and colleges, and sun awareness sessions for farmers are held at cattle markets. College students with special educational needs are invited to visit the hospital and familiarise themselves with the environment; this means if they need to return as a patient in the future, it will be less stressful. 

The health awareness sessions sometimes have an immediate impact.  ‘Following a presentation, two young men are being investigated for worrying symptoms,’ says Anne. ‘We have supported them by arranging appointments – this is a small community and they don’t want to bump into an auntie in the waiting room.’

Drop in for advice

‘Patients can face up to a 140-mile round trip to the nearest district general hospital,’ says Anne. ‘Men report that they are more likely to attend for tests or advice if services are local. They also tell us that they like the fact that they can drop in for advice without an appointment.’

Health promotion opportunities for inpatients are also maximised. ‘Some staff did not have the materials, confidence or knowledge to advise inpatients on improving their health and preventing avoidable ill health, such as discussing healthy eating with an obese patient with cardiac problems,’ says Anne.

Following discussions with ward staff, she set up a mentor scheme linking outpatient staff with a member of the ward team (see box). 

Anne has found that men respond well to opportunistic health education in clinics. One patient wrote to her matron to praise Anne for the advice and encouragement she had given him in a cardiac clinic. ‘I had been aware of the need to get down to a more sensible weight, but doing something about it had not been a priority for me,' revealed the patient.  He added: 'I could not have asked for better advice and I am now inspired to follow that advice!’ 

Links with charities

The team links with charities at every opportunity, including the British Heart Foundation (BHF), Macmillan Cancer Support, the Alzheimer’s Society and Cancer Research UK. Each organisation has provided training, materials and support.

‘We promote the Farming Community Network to provide support for depression, isolation, illness and stress,’ says Anne. ‘Carers Outreach provides instant access to support in the Parkinson’s or older people’s clinic, for example. It helps carers who have often not acknowledged they are a carer or sought support.’

‘Anne demonstrates a great awareness and understanding of her community’s needs'

Jo Bosanquet

Anne has set up a system of linked nurses for Parkinson’s, Macmillan Cancer Support and Carers Outreach. ‘It is working very well,’ she says. 

Healthcare assistant Barbara Hunt works with a Parkinson’s charity. She says: ‘The outpatients team helped me create a resource file with all the information leaflets that patients and staff might need. For Parkinson’s Disease Awareness Week we put together a display in the waiting area with balloons and posters. I used to be a carer and I wish there had been a similar scheme then. Patients just don’t know what information is out there and how to get hold of it.’

A shining star

Public Health England’s deputy director of nursing Jo Bosanquet says: ‘Anne is a shining, impressive star. She identified that health outcomes are worse for men than women in her area. In addition, health-seeking behaviours are different, which presents a real challenge, especially among the farming community. 

‘Using the national and local policy drivers, population level data and conversations with the local community, Anne and her team established a tailored and acceptable way for men to access the health care they need. All this is focused around prevention, which is brilliant. It is a superb initiative and shows how a local community hospital can be a leader in their community.’

Superdrug’s national nurse manager Louise Gordon was on the RCNi Nurse Awards judging panel. She says: ‘Anne demonstrates a great awareness and understanding of her community’s needs. She has made a real impact on patients’ lives and presented an idea that could be rolled out into other rural communities.’

Used as a model

Anne's  successful Parkinson’s clinic and virtual ward round are being used as a model in Mid-Wales and she is now advising on the use of telemedicine for clinics in rural areas.

In the community, she is about to launch a partnership with district nurses. Outpatient department staff will go out with the district nurse to patients they identify would benefit from their health promotion expertise.

What advice would Ms Thomas give to nurses who might want to replicate her approach?

First and foremost, she says, nursing staff must get to know their community. ‘They need to go out and make contacts with different groups and talk to them to find out their health education needs.

Willing to listen

‘As hospital nurses we must all be aware that patients live their lives in the community and only use hospital services for a very short time.

‘We understand that a farmer is unlikely to come to us for sun protection advice, but he may be willing to listen in the sheep market. Every community is different, and if the approach is not acceptable or appropriate then even the best health education initiatives will not be effective.’

Once a health education opportunity has been identified, she says, start small and plan every detail, talking to community groups and accessing materials before presenting it to your line manager.

‘The most important factor, however, is enthusiasm and good humour. No one likes to be lectured or judged for their lifestyle choices. Smiles, kindness and understanding go a long way to breaking down the barriers that nurses will experience in encouraging people to make healthy choices.’