What was the impetus for developing the Spa Team?
In our previous model, four PCAs jointly assisted RNs with the needs of about 40 patients in a typical day shift. But PCAs were being pulled in so many different directions that patient baths often fell through the cracks.
For example, a PCA preparing to deliver a bath may have been interrupted by another patient’s call light. Of course, it was appropriate for the PCA to prioritize answering the call light for patient safety, but this model often resulted in patients not receiving their baths.
The Spa Team sounds expensive. Is this a team of massage therapists?
No, Spa Team members are not massage therapists. Rather, they're PCAs who focus on bathing patients and changing their linens. We want the bathing experience to be as comfortable as possible for patients, so we use the "Spa Team" name to evoke relaxation.
How did you develop and pilot the model?
The Spa Team model was piloted on a 38-bed medical/surgical unit. We converted two of the four day-shift PCAs on the unit into the Spa Team, which has the exclusive responsibilities of bathing patients and changing linens. The remaining two day-shift PCAs are the "hallway PCAs" who perform all other work, including answering call lights and running labs.
Do all patients receive the same services from the Spa Team?
The Spa Team visits all patients on the unit but scales its services based on patient needs. Non-ambulatory patients receive a full bath, while ambulatory patients receive a brief foot bath and five-minute massage. The team also divides responsibilities appropriately: while both team members bathe non-ambulatory patients together, they can work one-on-one with ambulatory patients.
How did you roll out the model across the hospital?
A few months into the pilot on my unit, nurses from other units started asking their managers for their own Spa Team. Physicians were also noticing the special treatment patients received on the pilot unit. After six months, our executive team reviewed the cost and outcomes. When they saw what a positive impact the program was having on pressure ulcers and patient satisfaction, they asked me to expand it to all units across the hospital.
How did the Spa Team impact the hospital's budget?
The initiative was full-time equivalent neutral: each unit converted two existing PCAs into the Spa Team. Other costs are minimal and include:
- A cart the team uses to transport their supplies
- A CD player and spa music CD, which could be replaced by an MP3 player and speakers
- Massage tools, including neck wraps, massage knuckles, foot cream, and bath salts
- Vests, which cost less than $25 each and which Spa Team members pay for as part of their uniforms
How do PCAs sign up?
PCAs inform their unit manager if they would like to be considered for the unit’s Spa Team. Then, a unit-based, staff-led panel interviews and makes selections from those PCAs.
What training do they undergo?
A massage therapist trains the Spa Team members in back massages and foot baths. They also attend annual, mandatory PCA trainings on skin conditions.
Are there any male members? If so, how are they received?
Males have been some of the most successful Spa Team members, and we have several male-female pairs. The only difference in care is that the female team member completes more private aspects for female patients.
What were some of the implementation challenges you faced?
One of the main challenges was ensuring that members were able to focus exclusively on their Spa Team responsibilities. At first, nurses and hallway PCAs often tried to enlist the team to help with other tasks, such as lifting patients and answering call lights. I used a few strategies to signal the distinct role of the Spa Team to other care team members:
- First, during the roll-out period, I had team members start their shift 30 minutes later than the hallway PCAs so that they would not be assigned additional tasks
- Second, each team places a sign that says “Spa Treatment in Progress” on the patient’s door to prevent disruption during a bath
- Finally, each member wears a vest to signal their unique role to other care team members
What results have you seen since implementing the Spa Team?
Facility-acquired pressure ulcer rates have decreased by 2.2 percentage points on the pilot unit since implementation. Patient satisfaction surveys also show numerous positive comments about the services, and the comments often mention the team members by their individual names.
What advice would you give to nurse leaders interested in implementing the model?
Appoint a nursing director as the Spa Team facilitator. They should serve as the "go-to” person for the entire program, advocating for all of the Spa Teams and helping them navigate any barriers across the hospital.
I also recommend assigning specific Spa Teams to one unit as opposed to dispatching members out of a float pool. Having consistent members for each unit helps create a sense of unity between the Spa Team members and other caregivers on the unit.