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Putting it into practice

All posts from: November 2011

Does a mixture of nursing skill-levels affect quality of care?

29 November, 2011 Posted by: -

  • Article: Robb E et al (2011) How skill mix affects quality of care. Nursing Times; 107: 47, 12-13.
  • Author: Elizabeth Robb is chief executive, the Florence Nightingale Foundation; Elaine Maxwell is visiting fellow, London South Bank University; Karen S Elcock is head of programmes - pre-registration nursing, Kingston University and St George’s, University of London.

Although the media have reported failings in patient care as failures in nursing, they have not distinguished between care delivered by registered nurses and that delivered by unregistered healthcare assistants and other support staff.

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Key points

  1. Healthcare assistants increasingly provide fundamental care
  2. The nurses/ HCA boundary is blurring
  3. The media has reported care failures as failures in nursing
  4. There is a correlation between low nurse-to-patient ratios and high rates of mortality, morbidity and adverse events, but increasing ratios alone would not solve the problems
  5. Hospitals with the right culture, workforce, and leadership improve patient satisfaction and save money by reducing adverse events

Let’s discuss

  • Do we need an entirely registered nursing workforce?
  • Do you agree tasks delegated from managers, doctors and others have an unintended consequence of reducing the perceived value of fundamental nursing care?
  • What is the role of the clinical leadership in providing individualised care?
  • How would you define safe, minimum staffing levels?


Comments (3)

How can person-centred care in dementia be improved?

21 November, 2011 Posted by: -

  • Article: Armstrong D, Byrne G (2011) Improving person-centred care in dementia. Nursing Times; 107: 46, 12-14.
  • Author: Dorothy Armstrong is clinical adviser, Scottish Public Services Ombudsman, and programme director, NHS Education for Scotland; Grainne Byrne is communications officer, Scottish Public Services Ombudsman.

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Key points

  1. The number of people with dementia is expected to double in the next 25 years
  2. UK ombudsman reports show shortcomings in dementia care
  3. People with dementia should have their specific needs and preferences recognised
  4. Nurses should identify and record causes and triggers that may result in distressed behaviours
  5. Delirium can occur in up to half of all those aged 65 years or over who are admitted to hospital

Let’s discuss

  • Why do people with dementia frequently become distressed when they are admitted to hospital?
  • What strategies can you use to reduce this distress?
  • Describe the difference between delirium and dementia?
  • How would you explain these differences to a relative or carer?

Does mental health nursing have a place in primary care?

14 November, 2011 Posted by: -

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Key points

  1. The remit of Improving Access to Psychological Therapies (IAPT) is to provide timely and time-limited therapy
  2. New roles in the IAPT framework mean nurses can access new training
  3. Becoming part of the IAPT structure could give mental health nurses the opportunity to have their skills formally recognised
  4. It is up to individual mental health nurses to decide whether they can work within an IAPT model
  5. Nursing must fight to survive and establish its place within a changing healthcare environment

Let’s discuss

Improving Access to Psychological Therapies (IAPT) aims to reduce the state’s welfare bill by increasing the number of people returning to work after suffering common mental health problems such as depression and anxiety. The initiative has raised some fundamental questions for mental health nurses:

  • With 10,000 new paraprofessionals working their way through waiting lists, is there still room for mental health nurses in primary care, or have they been sidelined?
  • Is mental health nursing still a separate profession, with specialist skills and knowledge but with few clearly defined nursing roles left?
  • Should mental health nurses develop into “psychological wellbeing practitioners”, “gateway workers” or “high-intensity therapists”?


Comments (4)

Is communication at night between medical staff and ward staff effective in your hospital?

8 November, 2011 Posted by: -

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Key points

  1. Hospital at night (HaN) services provide cover for roughly 75% of a hospital’s working year and must adhere to the same clinical governance standards as core-time services
  2. HaN practices using bleeps sap staff morale and put patients at risk
  3. Hospitals can function safely out of hours with a small clinical team, but only with the aid of technology to support team processes
  4. Appropriately introduced IT can increase safety and reduce costs
  5. HaN coordinator roles can support ward staff and act as a hands-on nurse with supporting technology

Let’s discuss

The coordination of medical cover in hospitals at night presents a number of challenges.

  • Is communication at night between medical staff and ward staff effective in your hospital?
  • If there are problems how does this affect patient care and staff morale?
  • How can these problems be addressed?
  • What role can technology play in improving communication between wards and medical staff at night?

Comments (2)


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