Making the Healthy Choice

Western State Hospital initiates a special program to promote nutrition and activity for staff and patients

By Sandy Keefe, MSN, RN

Beautifully landscaped grounds, walking paths, open courtyards and educational malls with gymnasiums.

The 300 acres that encompass Western State Hospital, Staunton, VA, a mental health facility located in the Shenandoah Valley, offer the perfect venue for physical activity. However, despite these advantages, healthcare professionals at the facility were seeing an alarming trend toward weight problems among patients and staff.

"In addition to all of the issues that are contributing to obesity in this country, our patients face special challenges," said medical director Mary Clare Smith, MD. "Almost all of the newer and older anti-psychotic medications can cause weight gain. Some stimulate the appetite and some cause sedation that makes activity difficult, so we needed a dual focus on nutrition and physical activity."

And, since many patients are at the facility for longer stays due to forensic reasons, they are prime candidates for a long-term health project, said Diane Pavalonis, MSN, MBA, RN, APRN, clinical nurse specialist.

That's when Debra Vought, performance improvement coordinator, and a multidisciplinary team rose to the challenge — the Healthy Choices Challenge, a comprehensive, hospital-wide initiative to combat the weight issue.

"We wanted it to be about making healthier choices, because everyone — patients and staff — has to choose to exercise and eat healthy," she explained. "And a challenge made sense, because our nursing staff have anted up with enthusiasm and active involvement in past competitions."

IN THIS TOGETHER

To meet the challenge, 11 wards and eight departments have developed an array of programs to meet the diverse needs of patients and staff.

First, to generate interest, hospital leaders produced a video about weight gain and specific information about the facility's population. Although many of the wards already had healthy initiatives in place, the Healthy Choices Challenge really pulled things together, Smith said.

"Healthy lifestyles and healthy choices are not just a patient problem," she noted. "It's great to address an issue that patients and staff have in common. When patients and staff join together, it really breaks down the barriers.

"The focus is to have fun, with a bit of a competitive element," Smith continued. "There are prizes for scientifically sound projects, the best participation and the best-planned program. People are getting into the good spirit of the Healthy Choices Challenge."

To visualize the "fruits" of their labor, administration tracks staff and patient intake of fruits and vegetables, consumption of water, and number of miles walked through a drawing on a big poster representing the new Western State Hospital and landscape that will soon be built.

"For every day that an employee eats five fruits and vegetables, we fill in a leaf on a tree," Smith explained. "When you drink a bottle of water, you add to the lake. And for every mile of walking around the grounds, you add a brick to the building."

STEAMBOATS ON THE MISSISSIPPI

Walking the grounds could, in theory, add up to the distance of the Mississippi River from New Orleans to Minneapolis. On one nursing unit, staff members and patients have each chosen a steamboat name and are involved in earning points that "move" them along the river.

"There are points for eating five fruits and vegetables a day, as well as exercises in the day room," said Ann Davis, LPN. "Patients who are chair-bound can earn points for doing range-of-motion exercises with their arms, and those who use walkers get points for walking around with those devices."

Ambulatory patients may choose to walk around the grounds, or they may join in the day room exercise sessions.

"At 20 points, patients and staff each receive a pedometer or something of equal value, such as a stress ball, for those who can't walk around," Davis explained. "When someone earns 40 points in a month, they can get a salad shaker, foot lotion, a water bottle, or a food scale. After 90 days of participation, they'll earn a baseball cap commemorating their trip on the river."

90/90 LOSE PROJECT

Martha Sparks, RN,C, nurse coordinator on an all-male unit with longer-term patients, has found a unique way to promote healthy choices on the unit through the "90/90 Lose" project. Given their lengths of stay, the 28 participants in the 90/90 Lose project are committed to losing 90 pounds in 90 days, collectively.

"[Patients are] here with us anywhere from several months to several years, with the majority having some type of schizophrenia," she noted. "The ages range from 18-65, but the average age is in the 30s and 40s."

"To tell you the truth, the patients tend to be doing better than the staff," admitted Dianne Ford, LPN. "Everyone wants to lose weight and get fit, so we've made some changes such as replacing our weekly doughnuts with fresh fruit, and choosing diet drinks instead of regular sodas."

During the first 26 days of the program, the group was more than halfway to their goal, so they needed to extend the top of the weight loss chart.

"When a patient is upset because family members aren't visiting, or when someone has excess energy, we encourage them to do some power walking outdoors," said Ford. "Staff members are finding more opportunities to take groups for walks, so the patients can socialize while they exercise. They feel better physically, and they feel better about themselves after they've lost some weight."

On Monday morning, patients participating in the wellness challenge weigh in, and receive positive feedback for weight loss and healthy behaviors.

"The patients crave structure, and we see problems when they don't have that in their days," Ford said. "By identifying common goals and working toward them, and by receiving praise for their healthier behaviors, the program provides that much-needed structure."

WESTWARD BOUND FOR WELLNESS

Shannon Conner, LPN, is involved in another weight loss project, Westward Bound for Wellness. Spearheaded by occupational therapist Clay Huie, OTR/L, the program's goal is to travel the same distance as it would take to go from Virginia to California by walking or cycling. "Some of our patients go out on the grounds with pedometers to record the miles they've walked, and others who can't leave the unit participate here on stationary bicycles," Conner explained. "We also have a supervised walk once or twice a day outside on the grounds."

Even patients who pace to reduce agitation or anxiety can earn points for that activity, Conner said. "One gentleman who used to just pace aimlessly is now focused on getting his miles in, and that's an improvement."

The group consistently exceeds their cumulative goal of 180 miles per week, Conner reported, and progress is recorded with little footprints placed on a wall map.

"The best three walkers and the best three cyclists each week receive a granola bar and water as a treat," she said. "The top walkers and cyclists at the end of the 12 weeks will receive a $25 gift certificate to Dick's Sporting Goods, so they can purchase wellness-related items."

SPREADING THE WORD

John Beghtol, director of community services, characterizes the challenge as a natural extension of the psychosocial rehab program at the hospital.

"It makes perfect sense to teach healthy lifestyle options as part of integrating the patient back into the community," he noted.

Each year, Western State Hospital discharges more than 750 individuals back to 13 community service boards in the northwestern quadrant of Virginia, encompassing a large area from Lynchburg to Arlington.

Western State Hospital administrators are confident that the Healthy Choices Challenge program will influence the lives of individuals with mental illness across the nation. In fact, the U.S. Department of Justice has recommended that other state hospitals in the U.S. visit Western State Hospital to learn about the psychosocial rehab program.

"As staff from those programs visit us they'll learn about the Healthy Choices Challenge component of our psychosocial rehab program and take our ideas back home," Beghtol said. "It's certainly a worthy idea whose time has come."

Sandy Keefe is a frequent contributor to ADVANCE.

A Wellness Wheel for Lifestyle Learning

As coordinator of an extended care unit at Western State Hospital, Jody Wagner, RN,C, jumped at the chance to participate in the facility's Healthy Choices Challenge. Wanting to make a lifelong difference in the health status of patients on her unit, she and her team rose to meet that goal.

"The highest percentage of our patients have a diagnosis of schizophrenia along with some having borderline personality and bipolar disorders," Wagner explained. "We have about 25 men and women at any given point in time and quite a few of those individuals are NGR [not guilty by reason of insanity], so they're with us for many years. It's a real challenge to get many of them motivated with physical activity and nutrition, because they're bored and want to be free on the outside. Because our patients are pretty high-functioning, we wanted to help them think about the entire scope of wellness."

After consulting with her daughter, a college student who is a fitness/wellness major, Wagner decided to implement a Wellness Wheel, a visual wellness tool that demonstrates the need for "balanced" or "well-rounded" lives.

"We researched and looked at a lot of literature, incorporating elements of intellectual, emotional, social, spiritual and physical well-being into the wheel," she said.

EARNING POINTS

Today, patients carry a "Healthy Lifestyle Point Card" and use the honor system to earn points for various activities listed on the wheel.

"Our patients can earn points for a wide variety of activities, so that everyone has the chance to succeed," said Yana Kerschke, LPN. "On the physical health portion of the wheel, for example, they earn points for everything from doing their own oral care to walking around the grounds."

Kerschke particularly enjoys taking patients from the ward to swim at the local YMCA every Friday. "They have the chance to get away from the hospital, exercise, participate in water aerobics and socialize," she said.

Within the domain of nutritional health, patients can earn points by drinking 8 glasses of water a day or by eating five servings of fruits and vegetables.

"We also have many patients who don't eat enough, so they get credit for eating 85 percent of the food on their meal tray," Kerschke explained.

Vocational and occupational goals include everything from changing their sheets to gardening and cooking. "These activities are important, because they keep our patients active, alert and oriented," Kerschke said.

Spiritual and emotional needs also are addressed in the wheel by attending Western State Hospital's chaplain program, church, or going to Alcoholics Anonymous or Narcotics Anonymous meetings off the grounds, Kerschke said.

"Even something like getting a haircut counts, because looking good is part of feeling good," she said. "Patients can earn points by initiating a conversation or telling a joke as well."

MOTIVATING PATIENTS

Wagner and her staff kicked off the Wellness Wheel activity with a special showing of the hospital's healthy lifestyle video. To demonstrate how tasty healthy snacks can be, staff members served low-calorie angel food cake with fresh fruit. With small monetary prizes for winners and weekly drawings for kites, jump ropes and bottled water, the program is enjoying a high participation rate.

"We're helping our patients learn about healthy activities that they can carry with them after discharge," said Kerschke. "We want them to be well-rounded individuals with interesting lives."

–Sandy Keefe