Practice team blog
Patients with chronic obstructive pulmonary disease (COPD) must come to terms with having a progressive and incurable disease that will increasingly limit their capacity for physical activity, and is almost certain to cause their death. And the fact that it affects the ability to breathe means they are constantly reminded of this frightening prospect.
But these patients also experience acute exacerbations, in which their condition worsens in a terrifyingly short time – often requiring emergency admission to hospital.
Like many long-term conditions, the progression of COPD can be slowed, and its effect on quality of life can be minimised. This requires patients to have a good understanding of their condition, how to manage it themselves and when to call in specialist help – and for that specialist help to be available when needed.
The fourth national COPD secondary care audit, published last week, reveals that care for this group of patients has improved since the last audit in 2008. Unfortunately, it also reveals that specialist help is not always available.
Patients with COPD need to be cared for by a multidisciplinary respiratory team – particularly in times of crisis. These teams can help to slow disease progression and maintain patients’ quality of life. By teaching patients to manage their own condition and recognise the early signs of deterioration they can also reduce admissions to hospital of patients with COPD exacerbations that could have been averted with early intervention.
The audit reveals a range of aspects of care in which there are variations across the country. It is depressing to see that access to respiratory specialist nurses has declined; only 71% of units audited have access to these nurses for all their patients, compared with 80% in 2008. However, the audit also suggests this is not necessarily due to budget cuts: a total of 551 specialist nursing posts were vacant when the audit was completed.
It would be useful to investigate the reasons for this high level of vacancies – is the shortage due to staff levels lagging behind rising patient numbers, a shortage of funds to train respiratory nurses, or a large proportion having left the specialty in a short time?
Whatever the reason, patients with COPD – and other long-term respiratory conditions – need this gap in services to be filled as quickly as possible.
Last week we reported that staff at Doncaster Royal Infirmary are trialling a traffic light-style hand hygiene reminder tool.
The device is being used in the emergency department and on a ward. The badge-like device is worn on the upper body and detects hand movements and the presence of hand gel. Green means the hands are clean, amber shows they are ready for washing, and when the hands remain unwashed the device turns red and beeps.
Don’t get me wrong, I am all for new technology – and this seems like a clever device. But something about this new invention strikes me as wrong.
I think for me the hand hygiene light should be going on in every nurse’s head, not on a badge. The need to clean your hands between patients should an intuitive and automatic part of nursing practice. And of course every member of the multidisciplinary team has the same responsibility.
As with other pieces of technology, there is a danger that health professionals will start to rely on the device rather than taking responsibility for themselves. That they will start to think that the device means they no longer need to focus on the issue of hand hygiene.
Hand hygiene is essential – and particularly so at this time of year, with the winter pressures looming. However, carrying out effective hand hygiene is well within the scope of nursing staff and I would prefer to see the NHS spending money on new technology that cannot easily be replaced by the actions of staff.
Twitter is full of nurses. But when I told some non-nursing friends this, they didn’t believe me.
Nursing is seen as traditional and professional, whereas Twitter’s reputation is built more on tales of scandal and pictures of cats. It’s associated more with Kim Kardashian than Edith Cavell.
But, as well as being a provider of by-the-minute celebrity gossip, it’s also a valuable tool for sharing best practice and debating Jeremy Hunt and Dan Poulter’s latest scheme.
Almost daily, we receive tweets from nurses and students looking for advice – a quick retweet will result in dozens of answers from nurses and other health professionals eager to offer their support. Nurses who, without Twitter, would never have been able to connect.
This is why we’re launching Nursing Times’ Nurse Tweeter of the Year 2014.
We’re inviting all nurses and student nurses (sorry no organisations, just individuals only) to put themselves, or their colleagues, forward as Nurse Tweeter of the Year. All you need to do is tell us in 140 characters why you, or your nominee, should win – a character limit you should be comfortable with!
As well as the chance to win a luxury hamper from Waitrose, this is your opportunity to boost your following, increase your influence and demonstrate thought leadership. Twitter is being used more and more by nursing leaders and Nursing Times’ Nurse Tweeter of the Year will be someone who shows excellent communication skills and an ability to not only adapt to new ways of working, but to embrace change and make the absolute most of the tools available to you.
Entries close at midnight Saturday 15 November and the Nursing Times team will then shortlist 20 tweeters. But that’s the only input we’ll have – from then on it’s down to you and your followers to choose who deserves the Nurse Tweeter of the Year crown.
After all, it’s your opinion that matters; you decide who is worth following.
Here’s what happens next:
17 - 24 November: FIRST HEAT
10 of the shortlisted tweeters will be randomly chosen for the first heat, which is open to public vote. You will be able to visit this site to vote for who you think should get through to the semi-final, and invite your followers to do the same.
The five with the most votes will go through.
24 November - 1 December: SECOND HEAT
The second team of 10 face the public vote. As in the first heat, only the five with the most votes will go through – regardless of how many votes those in the first heat receive.
1 - 8 December: SEMI-FINAL
The five top-rated tweeters from each heat will again face the public vote – votes from the first round won’t count so you’ll be testing your followers’ dedication by asking them to again help you get through (voting takes just seconds so not a huge ask!)
8 - 15 December: FINAL
The scores are reset and the top 3 highest-rated tweeters battle it out as their followers are asked for the final time to vote for who deserves to be NT’s Nurse Tweeter of the Year.
Monday 15 December: Winner announced
This will be based solely on votes received in the final; the highest number of votes at midnight Sunday 14 December will be Nursing Times’ Nurse Tweeter of the Year 2014.
Good luck to all our entrants!
I was struck last night by a tweet which quoted a CEO of an NHS Trust saying “I’m running the biggest nursing home in Europe. We haven’t done any elective work in years”.
If this is true across the country, it raises some challenges for nurses working on acute wards.
The first is the perception of older people who cannot be discharged from hospital as a burden on services.
The Francis report raised an interesting question about the rights of older people to access services: “Although older people hold the same right of access to NHS services as any younger adults, why are older people accused of ‘blocking’ the beds?”
In my view a patient should never be considered a burden. If they cannot be discharged because they need nursing or social care then they have a right to that care.
“In my view a patient should never be considered a burden”
The next challenge is whether the acute services have sufficient appropriate skilled nurses to care for very dependent older people. This issue was raised by Mr Francis who asked, “When admitted to a general adult ward, where older adults now outnumber younger adults, why is specialist gerontological nursing not widely available to prevent readmission?”
However the suggestion by Mr Francis to develop a specialist role for older peoples’ nurses who could “change the care of older people and create a different value system” was rejected.
While initiatives such as the Health Education England one-year, part-time fellowship for older peoples nursing is developing leaders in the field, there are initially only two cohorts of 12 nurses which is unlikely to meet the growing demand for expertise in the acute sector this winter.
Which leads to the problem of staffing numbers.
“Failings in workforce planning are yet again challenging the standards of care nurses will deliver this winter”
Sadly, Nursing Times has reported this week that the Francis effect seems to have stalled with nursing numbers falling. Yet our ageing frail population who occupy large numbers of our acute beds need experienced motivated nurses to care for them but also pairs of hands so care can be delivered in a dignified and timely manner.
Failings in workforce planning are yet again challenging the standards of care nurses will deliver this winter.
It is nearly two years since the publication of the Francis report which laid down the challenges of providing care to older people in acute hospitals.
While we can discuss and attribute blame about failure to act on these challenges, it is nurses who will have to manage the fallout of poor planning. Poor morale, poor recruitment and retention of staff is the net result.
What will it take for people to realise that making money out of other people's misery is utterly unacceptable?
It’s Hallowe’en again, and as sure as ghouls emerge from graveyards, we have another crop of “hilarious” costumes making a joke out of mental illness.
Asda and Tesco were forced to apologise last year after coming in for a barrage of criticism for selling “mental patient” and “psycho ward” costumes, so you might think companies would have learnt that it’s really not on.
Well think again.
This year the cream of the crop comes from Joker’s Masquerade, which had a whole selection of “lunatic”, “schizo” and “psycho” costumes on sale a couple of weeks ago (it also had a couple of Ebola costumes in case you fancied having a laugh about people dying horrible deaths right now).
After a Twitter storm and stories run by the BBC and various local and national press, the company seems to have removed the bulk of the costumes from sale - although Adult Psycho Ward is still available as I write.
But the company isn’t remotely repentant, as its blog makes clear. Apparently the people who took exception are, among other things “incestuous Tweeters”, attacking an “ethical” company.
I’d love to see its ethical policy.
Many people with mental health problems already feel isolated and vulnerable - seeing themselves treated as figures of fun might just be the last straw for some.
What will it take for people to realise that making money out of other people’s misery is utterly unacceptable?
Some procedures are carried out in hospital wards across the country each and every day with no ill-effect to patients. However this does not mean that because a procedure is common, and generally problem free, that there are no dangers that staff need to watch out for.
One example is the removal of a naso-gastric tube.
Naso-gastric tubes are often used in healthcare and staff are now more familiar with the risks of this method of feeding patients. In the last few years there has been an emphasis on the importance of making sure naso-gastric tubes are correctly placed to avoid serious complications or even death.
Wrongly placed, naso-gastric tubes are a never event for the NHS.
Another potentially harmful issue around the use of naso-gastric tubes is when a tube can become looped or knotted. When removal of the tube is attempted this will cause the patient pain and distress.
As our expert article published this week explains, nurses need to be aware of the possibility of knotting so they know what to do if they experience resistance when removing a tube. As our author makes clear, it is important that a tube is removed in a slow controlled way not whipped out at speed. This will allow any resistance to be responded to and will not result in the knot causing damage. Knotted tubes need to be removed with an endoscopy.
Take a look at our article and have this issue in your and your team’s mind when carrying out this common procedure.
Today, thousands of nurses are expected to take part in industrial action.
Members of Unison, Unite, GMB and the RCM will stage a four-hour stoppage, followed by “four days of action short of strike action”, in which members will stop working during breaks or staying late.
So far, so expected. There’s a lot of anger over the real-term pay decreases nurses have faced over the past few years and the word “strike” has been bandied about for months.
But the fact that really surprises me is that this will be the first time such action over pay has been taken in 32 years.
I’m not surprised that nurses don’t take strike action lightly; you come into this career to do your best for patients and no matter what is put in place to protect them, they will be affected. The characteristics that draw people into nursing are the same personality traits that prevent them from kicking up a fuss.
What does surprise me is the apparent lack of awareness among those making the decisions of just how dire the state of play is for nurses. Nurses are angrier than they’ve been in 32 years.
As Dave Prentis, Unison general secretary, puts it: this government has shown “utter contempt” for NHS workers.
But no matter how bad things get for health professionals, I know from my own experience of working in the health service that it’s often easier to just keep turning up at work, doing your best and going home again. When you’re part of an organisation as huge as the NHS, it’s hard to see that anything you do can make a difference.
Health professionals can often fall into the trap of accepting that pay freezes, short staffing and low morale are just part of the job. Maybe they’ll moan in the staff room but ultimately accept that as one cog in a huge machine, they don’t have the power to influence change.
Is it possible that the government is counting on nurses’ altruistic natures and lack of morale to get away with cutting pay?
If so, then the more they get away with, the worse things will get.
The Nursing Times team will be attending as many hospitals as we can on Monday morning to offer our support and find out first-hand how nurses are feeling. If you’re a member of a union that is striking, please make every effort to be there. You deserve better.
Find out how the profession reached the point of industrial action on our NHS Strike page.
In my job as clinical editor I see the latest trends in quality improvement as hospitals quickly implement the latest policy or idea but I often wonder what happens in the long term when the initial fuss has died down? How often do we see a five or ten year follow-up of a nursing innovation?
Take for example productive ward. Last year the NHS Institute which spearheaded the productive ward initiative closed and many nurses wondered what would happen to the valuable knowledge, experience and support they offered. A few weeks ago I can across an interesting paper which identified an apparent declining interest in the initiative in the UK with fewer evaluations being published.
Does this mean that productive ward has hit the buffers or are trusts continuing to implement the philosophy that underpins this patient-focused innovation but are not publishing the outcomes? I wonder if I walked on a ward today and asked about productive ward would health care professionals describe it as something they did a few years ago when they tidied the cupboards? Would they be able to tell me how it is has continued to develop over time? Or would I just get blank looks?
“The problem is we never really find out what works or why it works”
The same question could be asked about intentional rounding. This initiative was given official backing a few years ago from the prime minister and considerable effort went into its implementation but did it make a difference? Is it still happening?
Considerable investment of time and emotion go into making ideas a reality in busy nursing teams. I am not surprise when nurses become cynical about change when no sooner have they implemented one new idea when policy makers move onto the next thing.
The problem is we never really find out what works or why it works.
What nurses want is change that is going to help them improve care and give them stability. Perhaps it is time to take stock of all the recent quality improvement initiatives in the UK and invest in looking at the long term outcomes because without this information we will continue to go round in circles. If you have been around the health service as long as I have you will know what I mean.
The horrifying ebola epidemic currently running out of control in West Africa seemed a distant problem not too long ago. Voluntary organisations such as MSF and the World Health Organization had been warning for some time that it was rapidly turning from a largely healthcare problem into a social and economic catastrophe, but still it was happening to “other people”.
It was only when western voluntary workers became infected that it began to really penetrate our consciousness. Then a British nurse became infected – and fortunately survived – and the issue really hit home.
This weekend I received a call from a national TV news channel wanting to discuss whether British nurses should be able to travel to West Africa to help deal with the crisis when we have a nursing shortage in the UK. The conversation prompted me to check how UK nurse numbers compare with those of West Africa; I was surprised to find that we’re ranked 47th worldwide, with 54 nurses per 10,000 people – way behind Finland, which tops the table at 222, and runner up Ireland with 185.
But if you really want to talk about nursing shortages, look at the countries affected by ebola: the best resourced appears to be Sierra Leone, with four nurses per 10,000, while Liberia has just one.
The developed world has benefited from centuries of exploiting Africa – it would be nice if this crisis could galvanise us to give something back. That means we should celebrate the fact that over 160 NHS professionals have already volunteered to go out there during the epidemic, but once it’s over we should not simply walk away. The west must help these countries to prevent further outbreaks of ebola and improve general health by helping them to increase the numbers of nurses and educate their populations on how to protect themselves.
After all, it’s not just a moral responsibility – international travel means that if we don’t, ebola could one day be not just a catastrophe for people far away. It could land on our own doorstep.
The increase in liver disease is startling with it now being the fifth biggest killer in England and Wales with around a 25% increase in deaths in the last decade.
The UK’s drinking culture has its part to play with younger people now affected more by liver disease as a result. Rates of hepatitis C are increasing but unfortunately the level of treatment has not kept pace. Last month Nursing Times reported a steep rise in deaths from this virus in the UK with experts saying that the rate of treatment for hepatitis is “unacceptable”.
Nurses can help identify those at risk and boost the numbers treated from this disease. However it is a disease area which nurses sometimes feel they do not know enough about.
The Royal College of Nursing has produced a competence framework for nursing to provide professional quality standards to support nurses, regardless of their own clinical background, to offer appropriate, timely and quality care for people with and at risk of liver disease.
Two of the authors of this framework have worked with Nursing Times to produce a learning unit which is free for all to access. Liver Disease: risk factors and treatment is aimed at nurses working in all healthcare settings; it will enable you to identify patients at risk of liver disease, offer them health education to reduce their risk, and recognise those who require referral to specialist liver services.
And of course it will add to your CPD hours with a certificate that you can print off and keep in your portfolio.