Reminiscence Interactive Therapy Activities (RITA)

Everyone has a story to tell and our colleagues at NHS Lothian are helping their patients tell theirs.

Thanks to funding from NHS Lothian Charity, ward teams across NHS Lothian have been able to provide digital reminiscence technology to help enhance the quality of life of patients on their wards.

Reminiscence Interactive Therapy Activities, or ‘RITA’, is an innovative digital therapy system that allows patients to access entertainment, games and other leisure activities as part of their day to day care and recovery.

From music and films to comforting images and soothing sounds, this system helps to make hospital stays more enjoyable, reducing anxiety which in turn helps reduce negative and aggressive behaviours.

RITA can also help to spark memories and conversations with patients and their families which helps staff to build up a picture of a patient’s likes and dislikes, and an understanding of what they enjoyed doing prior to their hospital admission. This not only encourages communication and social interaction but also helps staff to deliver better, and more personal, care.

When patients come to hospital, we can give them the medical treatment they need, but we want to give more. We want to give comfort, a sense of homeliness. This is what the MAC [Meaningful Activity Centre] and the RITA machines are trying to do.”

Activity Coordinator, Roselane ward, Midlothian Community Hospital

Wards and meaningful activities centres can host bingo, quiz nights and even the odd karaoke night to help bring some joy and entertainment to patients who are staying in hospital, often for weeks at a time. Group activities are great to reduce the feeling of isolation and boredom, and to encourage people to socialise and share their memories.

Our patients love music and musicals so when we put a musical on using RITA you see the patients dancing, tapping their feet. Getting them up and moving is so much better than lying in a bed.”

Activity Coordinator, Roselane Ward, Midlothian Community Hospital

Where in the hospitals is RITA being used?

As RITA is attached to a trolley, it is fully mobile and easily cleaned so it can be used in the MACs, in communal ward areas and by a patient’s bedside. Predominantly, RITA is used with older adults with cognitive impairments such as dementia. The specially selected list of pre-loaded programmes has been shown to calm patients who may be experiencing symptoms of dementia such as anxiety or restlessness.

As most of my patients have dementia, I use the reminiscence images with them in a small group, this then leads on to the group reminiscing and sharing stories. It really got everyone together chatting and alleviated the feeling of loneliness and isolation they can face.”

Activity Coordinator, Ward 51, Western General Hospital, Edinburgh

Each patient can also have a bespoke folder that contains all their favourites in one place, making it really simple to use, and because they don’t then need to have to access the internet, families can be assured that their loved ones remain safe.

For those patients who are unable to leave their beds, RITA also has a number of interactive games which stimulate hand and finger exercises to support rehabilitation.

How is RITA supporting our mission of having a positive impact on health in the Lothians?

RITA is supporting NHS Lothian Charity to achieve its mission of having a positive impact on health in Lothians in a number of ways:

Improved clinical outcomes for patients

The interactive gaming elements in RITA have been used to support the physical and mental rehabilitation of some patients.

We had a young male patient with a brain injury on our unit, he was very fit and had been a gym instructor. He used RITA to play games which rehabilitated the dexterity and motor skills in his hands and fingers. We saw that this speeded up this rehabilitation and, as a result, his anxiety levels came down as he felt a bit more in control of his recovery. This helped reduce his length of stay in hospital.”

Lead Dementia Nurse in Stress and Distress, St John’s Hospital

Patients experienced less stress and distress

RITA has shown to reduce agitation in patients and help staff manage behaviours that challenge, taking pressure off staff.

The Oaktree ward in East Lothian Community Hospital saw the number of incidents and adverse events drop from an average of 14 a month to 7 with the introduction of using RITA on the ward.

One lady came on the ward and was very restless to the extent she was crawling around the ward. This was very distressing for the patient, the staff and other patients on the ward. I wondered what would calm her, she mentioned yoga so I found some yoga music in RITA and took it to her room. She would listen to the yoga music and be so calm and settled, it was like she went to another place. When I chatted with her family, I found out she had been a yoga teacher. This made life so much easier for staff and made things on the ward so much calmer for the other patients.”

Activity Coordinator, Ward 73, Western General Hospital, Edinburgh

Patients experienced increased connections and reduced isolation

RITAs are being used to facilitate group activities in wards in Midlothian Community Hospital and Western General Hospital, Edinburgh. Patients who spend time in individual or smaller shared rooms have been able to connect with other patients across the ward, alleviating feelings of isolation that some long stay patients can experience.

COVID still presents issues in hospitals, RITA can support patients to feel less isolated when wards are limiting visitors.

I wasn’t able to bring patients to the MAC as per my normal activity schedule and visitors were not allowed in so I took RITA to a safe berth with 4 patients and we played bingo for the afternoon. This alleviated feelings of isolation for those patients and brought a bit of fun and normality to a stressful situation for staff and patients.”

NHS Lothian staff member, Western General Hospital

Patients experienced improved mental and physical wellbeing

Staff reported how RITA positively impacted the wellbeing of patients and contributed to improved quality of life while on the ward.

Staff on Oaktree ward in East Lothian Community Hospital witnessed an increase in nutrition intake during the times they put on film and bingo nights for the patients on the wards.

We use RITA across 2 wards and, when we do a group activity, we sometimes mix patients from both wards who vary in their levels of illness and mobility. After each activity we see a marked improvement in mood of the sicker patients.”

Activity Coordinator, Pennylane Ward, Midlothian Community Hospital

Watching ‘It’s a Wonderful Life’ with patients – an observation

Rebecca Caulfield, NHS Lothian Charity

Inspired by a positive pop-up cinema experience provided by NHS Lothian Charity: Tonic Arts, staff at the Pennylane and Roselane wards in Midlothian Community Hospital recreated this experience for patients using RITA, a bluetooth speaker, screen and projector. I was invited along for one of these viewings.

On the day I visited, the Activity Coordinators had gathered eight patients along with two support staff to the cinema room. The staff made the patients comfortable on the sofas and seats, the screen was lowered, the curtains were closed, and they agreed on a film from the catalogue in RITA. They decided on ‘It’s a Wonderful Life’.

I noticed some of the patients seemed slightly agitated and were moving around the room but as soon as the lights went down and the movie started, all the patients settled down into their chairs. I could see the smiles appear on their faces as the movie titles began, the room was silent as they watched.

The atmosphere in the room felt calm and soothing. The Activity Coordinator told me:

Sometimes they even fall asleep when they are in there, which is good for those patients that are unsettled and like to pace the corridors”.

The Activity Coordinators also explained that using RITA can have a big impact for staff on wards, especially when they bring a number of patients into the cinema room:

Taking so many patients off the ward at one time allows the staff time to finish any outstanding work and free up staff who are required to care for someone on a 1:1 basis. You can see the ward staff are less stressed during this time.”

The team intend to apply for funding for an additional RITA as the current one is shared across 2 wards. This will allow the Activity Coordinators to use RITA for more group activities, for individual use and within the new sensory room which is in development on the ward.

NHS Lothian Charity has funded 10 mobile touch screen units for Reminiscence Interactive Therapy Activities (RITA) totalling £49,945.

RITAs have been funded in wards at the following sites;

Belhaven Hospital, East Lothian
East Lothian Community Hospital
Midlothian Community Hospital
St John‘s Hospital, Livingston
Western General Hospital, Edinburgh

You can find out more about RITA here: https://www.myimprovementnetwork.com/my-name-is-rita