The Sit & See ToolCapturing care and

compassion in any care setting

Lynne Phair Independent Consultant Nurse Older People

and Adult Safeguardinglynne@lynnephair.co.uk

07802229715Sit & See © Lynne Phair 2013

www.sitandsee.co.uk

What is the Sit & See Tool?

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

Who uses the tool?

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.

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!

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

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.

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

What does care and compassion look like?

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.

The Domains - General care

• Patient centeredness• 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

The Domains - Patient and visitor engagement

• Demonstrating dignity• Communication • Anticipating care• Patient empowerment• Supporting anxiety and distress• Responding to the small things• Participation in care

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• Bed rails• Manual handling• Continence equipment

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 MCA are observed.

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• Telephone obtained for a patient who

requested one.• Housekeeper encouraged frail patient to drink• Person centred interaction between patient

and Doctor

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

Descriptors of the level of care and compassion

Poor care 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

Domain example -Food and drink

Positive• 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 drinkingPoor• 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. 

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. 

How to use the tool

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

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.

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.

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

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”.

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"

Thank you for listening

Lynne Phair Independent Consultant Nurse Older People and

Adult Safeguardinglynne@lynnephair.co.uk

07802229715Sit & See © Lynne Phair 2013

www.sitandsee.co.uk