Overview

• Qatar National Mental Health Strategy states that, “Good mental health is a sense of wellbeing, confidence and self-esteem.

Often referred to as mental or emotional well-being, it is a positive state arising from a sense of connection with people,

communities and the wider environment.”

• There is well-documented evidence supporting that promoting diversional activity (e.g. activities that encourage leisure,

physical activity and recreation) among psychiatry patients, not only has physical health benefits but also has a positive impact

on self-esteem and personal fulfillment while emphasizing on holistic, client-centered care.

• In the Female Psychiatry Unit, occupational therapy and physical therapy are currently available only during the morning shift.

Nursing staff have observed that the lack of therapeutic interactions with and between patients during the evening hours

resulted in increased patient boredom, escalating patient tensions, and decreased social interaction. It has been also noted

that these seemed to be the time when patients’ symptoms are amplified and acute outbursts occurred leading to a higher

number of aggression and violence episodes.

• Previously, staff nurses in Female Unit are organizing activities for patients but not on a regular basis. Activity conduction

depends on availability of staff, availability of activity materials and acuity of the unit. Ensuring that diversional activities are

conducted on daily basis can improve patient engagement by supporting patients in relieving stress and anxiety, reducing

isolation, and increasing morale.

Model for Improvement

Results

Challenges

• Lack of nursing staff secondary to increased patient acuity

• Lack of activity materials

• Monthly budget for activity materials

• Patient interest (different cultural background, language barrier, acuity of illness)

Conclusion

• Results showed a positive trend in patient participation except for some months (Ramadan season) or when the patient

census was low (August 2019)

• Monthly patient feedback indicates participants in general are satisfied with the activities, perceive it as beneficial during

hospital stay and want it to be continued.

Recommendations

• Collaborate with the Mental Health Services Nursing Education team to have additional educational opportunities for the

nursing staff to learn more about structured group and individual activities.

• Collaborate with other members of the MDT such as physical therapy and occupational therapy.

• Spread the program towards other mental health inpatient units.

1 2 3 4 5

Strongly disagree Disagree Neutral Agree Strongly Agree

93.5%96.4%

100.0% 100.0%93.5% 93.3%

97.0%94.0%

100.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19

Co

mp

lian

ce

Months

Monthly Percentage of Diversional Activity Conduction

Compliance Target

76.0%78.6%

81.6%86.7%

77.1%

83.4%80.7%

74.7%

82.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19

Co

mp

lian

ce

Months

Monthly Percentage of Patient Participation

Compliance Target

Ramadan

1

1.5

2

2.5

3

3.5

4

4.5

5

Jun-19 Jul-19 Aug-19 Sep-19

Patient Feedback

Patient Satisfaction Activity Benefit Continuation of Activity

Low Census

References: • Lara Fenton, Catherine White, Karen Anne Gallant, Robert Gilbert, Susan Hutchinson, Barbara Hamilton-Hinch & Heidi Lauckner (2017) The Benefits of Recreation for the Recovery and Social Inclusion of

Individuals with Mental Illness: An Integrative Review, Leisure Sciences,

Diversional Activity Program:

Improving Patient Engagement in

Female Psychiatry Unit

Authors: Monyeen Cholette Vinluan, SN; Kavitha Chakrapani, SN; Elsa Paul, SN; Day Monnique Velasco, SN; Agustina Paat, SN Team Leader: Abier Khamis, HN

Team Members: Abeer Tawfik, CN; Jincy Philipose, SN; Anna Leah Yap, SN; Jeetu Jacob, SN; Ruby May Barquilla, SN Jayanthi Soundarajan, SN, Eman Zidan, SN

Executive Sponsors: Iain Francis Tulley, CEO; Deborah, Nelson, EDON; Hoda A Salam, DON; Wesam Smidi, AED Clinical Services

Unit Consultants: Dr. Abdul Moneim Abdul Hakam; Dr. Ehsane Gad Advisors: Dr. Ameera Al-Kharaz, QI; Mohamed Hamideh, QI; Pauline Grace Cadampog, QI

AIM

• Our aim is to increase patient participation in the diversional activities in the evening shift to 85% in Female Psychiatry Unit for the year 2019.

MEASURES

• Percentage of days diversional activity is conducted in the evening shift per month

• Percentages of patients participating in the daily diversional activity.

CHANGES

• Educating the nursing staff in conducting diversional activities.

• Ensuring activity nurse is allocated every evening shift.

• Documentation of patient’s participation in the Progress Notes.

• Educating patients about the benefits of having diversional activities.

Changes Tested

AIMPRIMARY

DRIVERS

SECONDARY

DRIVERSCHANGE IDEAS

To increase

patient

participation in

diversional

activities to 85%

in Female

Psychiatry Unit

for the year

2019

Patient

Participation

Daily Activity

Conduction

Patient

Involvement

Patient Education

Nurse

Documentation

Nurse

Compliance

Patient Feedback/

Activity Preferences

Patient Activity Board

Budget Allocation

Activity Nurse/PCA

Allocation

Staff Feedback

Staff and PCA

Education

Education upon

Admission

Logbook/Cerner

Documentation

Driver Diagram

PDS

A

PDS

A

PDS

A

PDS

A

Activity Nurse Allocation

Patient Preferences Survey

Patient Activity Board

PCA Allocation and Education

Education upon Admission

Logbook and CERNER documentation