1. The Sit & See Tool
Capturing care and
compassion in any care
setting
Lynne Phair
Independent Consultant Nurse Older People
and Adult Safeguarding
lynne@lynnephair.co.uk
07802229715
Sit & See TM Lynne Phair 2014
www.sitandsee.co.uk
3. What is the Sit & See tool?
• Developed with Brighton & Sussex University
Hospital Trust and piloted in acute hospitals
and care homes.
• Captures evidence of positive, passive or poor
care and compassion, in a simple way with
agreed standard descriptors
• Observation sessions are 15 minutes – 50
minutes in total.
• It does not matter how much or how little you
see
• A tool that captures the tiniest things that
make the biggest difference
5.
A tool to measure care and compassion
in care settings
• It’s the small things that make a difference to a
person’s hospital or care home stay
• What patients and their families remember the
most, may not be whether their operation was
successful, but whether the staff were kind
helpful, understanding, supportive or showed a
sense of humour and had a little banter
• The healthcare professional must not only be
concerned with the technical medical treatment
but whether the person feels cared for and
understood.
6. Why is the Sit & See tool
different?
• Anyone can be an observer, staff, families,
patient representative groups, Managers,
Directors, care staff, admin staff
• Used to observe care and compassion
regardless of their diagnosis
• Only a few hours of training and is quick and
easy to use
• Staff learn to see things from the patients
point of view
• It builds pride in staff - because it celebrates!
7.
Key benefits of the Sit & See Tool
• Safeguarding adults is about prevention, the
absence of care and compassion can be the first
sign of a failing environment
• Celebrate compassionate care by highlighting it
• Identify shortcomings within the context of positive
practice
• Staff see and understand care through the eyes of
the patient
• It does NOT audit clinical skills - its not what you
do but the way that you do it!
• High quality nursing care requires the use of the
head, the heart and the hands
8. Changing hearts and minds
Many staff who work in general care settings
justify dispassionate treatment of patients
because of pressures on them and on the
services.
The tool is helping nurses see beyond the
rituals, routines and systems.
Reasons cannot justify poor care - they can
only mitigate and help find solutions
The tool is helping staff to see care from the
patients point of view.
9. Sit & See is like finding your way
in the dark - at the beginning
you see nothing - and then you
start to see everything as the
patient and their family does
11. What the tool captures
• Vital Signs of fundamental care, divided into
three domains.
• Observations are graded positive, passive or
poor.
• Domain A and B have three grades of evidence,
positive care, passive care and poor care.
• Domain C only has positive practice or poor
practice (patient safety either happened or it did
not)
• Each domain has a care component and a
statement which should be used to reflect what
the observer witnesses.
12.
The Domains - General care
• Patient centredness
• Rest and Sleep
• Food and fluids
• Supporting the patient who may be
disorientated
• Managing pain and distress
• Supporting continence
• Supporting the small extras a patient
may need
13.
The Domains - Patient and visitor
engagement
• Demonstrating dignity
• Communication
• Anticipating care (includes wound care and skin
integrity – as well as in ‘Supporting anxiety and
distress’)
• Patient empowerment
• Supporting anxiety and distress
• Responding to the small things
• Participation in care
14. The Domains - Patient safety
• Patient hand hygiene
• Use of clinical waste bins & spillages
• Laundry
• Gloves and protective clothing
• Clinical equipment and the patient’s
personal space. Infection Control.
• Bed rails
• Manual handling
• Continence equipment
15.
Descriptors of the level of care
and compassion
Positive care and compassion
• Staff demonstrate that they respect the
patient/visitors; they use opportunities
to engage with and/or solve difficulties
without giving any impression that the
task is too much or not their job, that the
patient is treated first and foremost as a
person and their medical condition is
treated within that context. The 5
principles of the Mental Capacity Act are
observed.
16. Examples positive of care and
compassion
• Anxious lady comforted/patient hand held during
conversation
• Offered an extra blanket when patient was feeling
cold
• Visitors greeted by staff on arrival
• Pain relief given quickly
• Wound treatment given whilst comforting person
through talking and reassuring.
• Telephone obtained for a patient who requested
one.
• Housekeeper encouraged frail patient to drink
• Person centred interaction between patient and
Doctor
17. Descriptors of the level of care
and compassion
Passive care and compassion (business
like)
• This is when staff attend the patient/
visitor but are business-like or
impartial, showing no emotion or
visual signs of caring or respect for
the patient as a person, but they are
not treated as an object or a medical
condition
18. Descriptors of the level of care
and compassion
Poor practice and compassion
• Staff either do not attend or attend the
patient/visitor but are abrupt, negative
in tone and body language, or do not
talk or attend to the patient at all.
Staff may talk over the patient. The
person appears to be treated as an
object or as a medical condition
19. Domain example -
Food and drinkPositive
• Food delivered in a courteous way. Choices are offered. Food
served and left accessible. Menu and food explained to
patient in a manner they understand. Help is offered and
given if required
Passive
• Choice or assistance offered with food and drink but it is done with
no emotion and patient not referred to by name.
• Patient told what they have. Food put in reach but patient not helped
to start eating or drinking
Poor
• Unable/experiencing difficulty in eating or drinking and help not
forthcoming
• Food or drink available but put out of reach.
• Helped to eat and drink but food or drink is cold as help is too late.
• Leaving food or drink out of reach of the patient.
20. Domain example -
Responding to the small things
Positive
• Staff member responds to request for help that is not directly
associated with the role of the worker (but is not outside their
competence to undertake). The staff member responds helpfully,
demonstrating a kind manner and that they are pleased to help (e.g.
helping find a channel on the radio, repositioning a pillow).
• Apologises for any delays, explains reasons and keeps patient
informed.
• Staff ask if there is anything else they can do to help before they
move on.
Passive
• Responds to request for help not directly associated with the role,
but done so in a business-like way, with little visual or verbal
evidence that they are happy to help.
Poor
• Staff member ignores requests for help or tells patient it is not their
job, but does nothing to find someone who can help.
22. How to use the tool
• Agree with the care area - no
surprises
• Inform staff, patients and visitors what
you are doing
• Sit or stand out of the way (move
during time frame if you wish)
• Use first 5 minutes to acclimatise and
relax – observe for 15-50 minutes
• See, hear, feel what is going on
23. Seeing and hearing different things
• Remember you are sitting and
listening or watching as you would
when visiting a relative - or sitting in
the waiting room, or an out patients
department.
• Your attention will get drawn to things
happening.
• Concentrate on the way things are
done not what is done.
24. Recording
• 1 intervention may only last a short time (e.g
25 seconds).
• Capture as many aspects of what you see as
possible.
• More than 1 domain may be observed in a
short space of time, or the same domain may
be observed being done positively and then
poorly in the same intervention.
• Record as much as you can - not just an
overall impression.
• The record should reflect all you see, not just
an overall picture.
25. Recording
• Put a tally mark in
the relevant box, as
many times as you
feel right
• Make notes of
specific examples
of positive or poor
care
• Record if you have
to intervene
26.
27.
The training-how it helped
• Helps to give structure to aspects of
care that they have hitherto found
difficult to define
• Helped them to celebrate compassion
• Will be helpful in giving feedback to
staff in positive ways and ways that
would not make staff feel that
managers were "getting at them”.
28. And what the participants said
• "I never spent any time considering care and
compassion. I will now be looking at myself and
staff even if not actually sitting and seeing. it has
made me think about how I am"
• "It has made me consider how we can make our
domestic and catering teams more inclusive in
care"
• The course has influenced my thoughts about
care and compassion very positively"
• "I will now make a conscious effort to step back
to see what is going on from the resident's
perspective
• "Will encourage me to look deeper at what is
going on"
