Nursing needs its leaders to respond to FrancisPutting it into practice
Does intentional rounding improve patient outcomes?
Braide M (2013) The effect of intentional rounding on essential care. Nursing Times; 109: 20, 16-18
Snelling P (2013) Intentional rounding: a critique of the evidence. Nursing Times; 109: 20, 19-21
‘Intentional rounding’, the practice of performing regular, set checks on patients regardless of clinical need, has been heavily promoted by David Cameron and NHS leaders and has been introduced in many hospitals.This week we’ve published articles arguing both for and against intentional rounding.
Braide M: “Intentional rounding is a structured approach to the delivery of fundamental care. It is widely recognised to benefit patients and endorsed by prime minister David Cameron as giving nurses “time to care”. Increased scrutiny of NHS care as a result of the Francis report, and the financial pressures caused by the requirement for the NHS to save £20bn by 2015 mean the need to evaluate how we coordinate and improve care has never been greater.”
Snelling P: “Intentional rounding has been heavily promoted by the prime minister David Cameron and others and is being widely implemented in UK hospitals. It is claimed that the practice has a number of benefits, including reduction in call bell use, falls and pressure ulcers and increased satisfaction. In this article, I will submit these claims to close scrutiny and argue that the evidence base is too flimsy to support the claims.
“Individual nurses and nurse managers should look more to evidence than to political expedience when implementing nursing policies.”
What do you think?
- Does intentional rounding improve patient outcomes?
- Is the evidence-base sound enough to support wide-spread use of intentional rounding?
- Does this policy hinder nurses’ ability to make judgements of appropriate levels of observations?
- What has been your experience of intentional rounding?
What lessons can be learnt from witness accounts in the Francis report?
Gallagher A (2013) Learning from family and nurse narratives. Nursing Times; 109: 19, 18-19, 22.
“Now the initial flurry of media attention relating to this year’s Francis report has subsided, it is a good time to take stock and ask what implications the 2010 and 2013 reports and their recommendations will have on nurses and nursing. Two areas have significant potential to contribute to sustainable caring practices: leadership in practice and education; and organisational culture informed by research and scholarship.”
Let’s discuss…
- Is Mid-Staffordshire a “unique case”?
- Should all health workers be “willing and able to challenge others”?
- How can an ethical climate be established and maintained?
- What qualities must leaders have?
Is enough done to reduce hospital-acquired infections?
Spencer F (2013) The infection prevention nurse as change agent. Nursing Times; 109: Online issue.
“This article describes my role as an infection prevention and control nurse in helping staff to change practice and increase compliance with a local protocol to reduce the risk of bloodstream infection with meticillin-sensitive Staphylococcus aureus bacteraemias associated with Hickman-line insertion. It highlights the importance of using a change-management tool to implement and sustain change.”
What do you think?
- Are infection prevention nurses in a position to influence change?
- How do wards and units react to further infection control measures being introduced?
- Is enough done to reduce and prevent hospital-acquired infections?
How can patients be better involved in their care?
Jones H (2013) Any qualified provider: facilitating patient choice. Nursing Times; 109: 17/18, 22-23.
“When patients are referred to specialist services, it is important they have the opportunity to choose a service that best suits their needs. To make this a reality, the government has introduced Any Qualified Provider (AQP) - referrers can show their patient a list of appropriate services that meet standard requirements. This article explains how an AQP pack was developed for continence services.”
Let’s discuss…
- Why is patient choice important?
- What are the drawbacks of using the Any Qualified Provider approach?
- In what other situations can nurses facilitate patient choice?
- What challenges does patient choice present?
How well do universities and placements communicate?
Robinson S (2013) Sustaining mentorship for student nurses. Nursing Times; 109: 16, 24-25
“Much research has focused on relationships between mentors and students, and on mentors’ responsibilities for facilitating students’ learning and assessing their competence. However, the extent to which higher-education institutions and service providers have sufficient capacity to jointly sustain the “hinterland” to mentorship has received much less attention.”
Let’s discuss…
- Is there a ‘hinterland’ to mentorship?
- How well do universities and placements work together?
- How can this relationship be improved?
- Does what students learn in university reflect their practical experience on placement?
- As a mentor, are you kept aware of what the university wants your student to learn from the placement?
How can we prevent patients with borderline personality disorder being seen as “just difficult”?
Pack S et al (2013) Management of borderline personality disorder. Nursing Times; 109: 15, 21-23.
“A person with BPD may experience intense bouts of anger, euphoria, depression and anxiety within a very short period (Zanarini et al, 1997). These feelings may lead to impulsive behaviour and confusion, and result in changes to long-term goals, career plans, friendships, gender identity and values. People with BPD may feel unfairly treated or misunderstood, bored or empty, and have little idea of who they are. Symptoms are often most acute when current events trigger memories of feelings from past traumatic and unresolved events.”
Let’s discuss…
- How can we prevent patients with borderline personality disorder being seen as “just difficult”?
- Have you witnessed patients with BPD being unfairly treated?
- What problems might you experience in nursing someone with borderline personality disorder?
- As a nurse, how can you best help someone with this diagnosis?
Is workplace culture an excuse for poor care?
Mee S (2013) Is workplace culture an excuse for poor care? Nursing Times; 109; 13, 14-16.
“Negative behaviour can be explained by external factors, such as culture and the influence of others, or by internal ones, including a person’s own moral compass. Within the context of the Francis report, this article raises questions about how we can ensure that nurses adhere to their code of conduct.”
Let’s discuss…
- How does workplace culture affect how we practise?
- Why do some nurses perform well in a particular environment while others do not?
- Can external factors be given as a reason for lower standards of care?
- How can we follow our own moral compass in all circumstances?
- What does the NMC code of conduct say about personal responsibility?
Enhanced recovery – How much can patients be involved in their care?
Cottle S, Lewis W (2013) Patient involvement in enhanced recovery. Nursing Times; 109: 13, 24-25.
“There are proven benefits of encouraging patients to play a more active role and take responsibility for their recuperation after all surgical procedures. This article explores the concept of enhanced recovery and the development of tools to support patients and health professionals in using an enhanced recovery pathway.”
Let’s discuss…
- According to the article, patients are often unaware of how they can be involved in their recovery. How can you encourage your patients to play an active role?
- What benefits have you found in involving patients in their care?
- How can you motivate a patient to participate?
- Is it always appropriate for patients to be actively involved in their care and recovery?
What role should nurses play in ward rounds?
Lees L (2013) The nurse’s role in hospital ward rounds. Nursing Times; 109: 12, 12-14
The Francis report has highlighted that nurses have a vital role to play in ward rounds and it is critical that they attend.
- What role should nurses play in ward rounds?
- How can patients benefit from increased nursing involvement?
- How could you encourage colleagues to prioritise ward rounds?
- The author acknowledges that often the wider multidisciplinary team does not prioritise nurse involvement. How can this be changed?
How do you think mobile technology can improve efficiency?
Drayton K (2013) How mobile technology can improve healthcare. Nursing Times; 109: 11, 16-18.
The National Mobile Health Worker Project (MHWP) set out to understand the requirements of mobile working for health professionals and to identify whether it could result in increased productivity and efficiency.
5 Key Points
- The National Mobile Health Worker Project explored the benefits of mobile working for health professionals
- Clinicians could view and share data between the clinical services involved in patient care and avoiding duplication.
- Time spent with patients increased at one site by 104%.
- Data duplication decreased at one site by 92%
- There was a reduction “no access visits” of up to 50%.
Let’s discuss
- How do you think mobile technology can improve efficiency?
- What benefits do clinicians report when using mobile technology?
- How can this technology improve patient care?
- The author identifies challenges in implementing mobile technology. How would you address these in your organisation?
- How would you explain the benefits of mobile technology to a member of staff who is reluctant to use it?
