References • Chenoweth et al. (2014) Attracting and retaining qualified nurses in aged and dementia care: outcomes from an Australian study. Journal of Nursing Management 22:234 – 247. • Cummings et al. (2010) Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International Journal of Nursing Studies 47(3):363-385. • HEE (Health Education England) 2014 Growing Nursing Numbers. Literature Review on nurses leaving the NHS. Available at: https://www.hee.nhs.uk/sites/default/files/documents/Growing%20nursing%20numbers%20%E2%80%93%20Litera ture%20Review.pdf • Heinen et al. (2013) Study to determine factors associated with nurse retention in a cross sectional observational study in 10 Euro countries. International Journal of Nursing Studies • Lake, E (2002) Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing and health 25 (3):176-188 • Maslach, C. and Jackson, S (1981) MBI Human Services Survey Available at: http://www.mindgarden.com/117- maslach-burnout-inventory • NMC (2018) The NMC Register. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/other- publications/the-nmc-register-2018.pdf • RN4CAST. Nurse Survey in England 2012. National Nursing Research Unithttp://www.kcl.ac.uk/nursing/research/nnru/publications/reports/rn4cast-nurse-survey-report-27-6-12-final.pdf • UCAS (2017) 2017 End of Cycle Report. Available at: https://www.ucas.com/corporate/data-and-analysis/ucas- undergraduate-releases/ucas-undergraduate-analysis-reports/2017-end-cycle-report 42 www.bournemouth.ac.uk
Coffee Break
Presentations from nurses in Dorset Introduced by Pam O’Shea Deputy Director of Nursing and Quality, NHS Dorset CCG
The development of an Advanced Nurse Practioner led service Clare Byrne Advanced Nurse Practioner Royal Manor Health Centre and Lecturer Practitioner, Bournemouth University
Autonomous practice What is an Value based Critical care Advanced Thinker ? Nurse Practioner? Management/ Innovative practice leadership Advanced decision making and problem solving
Department of Health Health Education England Position Statement Framework November 2010 November 2017
Reshaping the workforce to deliver Advanced practice roles offer opportunities to fill in gaps in the medical workforce; improve clinical continuity; provide mentoring and training for less experienced staff as well as offering a rewarding clinically facing career option for experienced staff” ‘ Reshaping the NHS Workforce’ 2016
Royal Manor Health Care Approx 13, 000 patient population 4 GPs 6 ANPs 5 Practice Nurses 2 HCAs
What were the drivers for change? • for change? • Patient access to timely Discussions with GP partners, Practice manager & ANP team healthcare • Team approach through meetings with • Supporting GP clinicians and reception/admin staff workload • CCG support with Patient engagement • Developing services for meetings Portland • Publicised with support of local media • ANP development services Patient and Staff feedback
The new plan GP refers to GP will external services reviews ANP books future appointment or via ANP arranges for ANP books future reception immediate GP appointment with GP due to input by duty GP complexity Appointment with ANP ANP refers to external Patient treated & Or services no further follow Seen by ANP in ‘Walk In’ up is needed appointment PATIENT ACCESS TO APPOINTMENTS
• Review • ANP caseload • Multi-professional ACPs • Community services under one roof • Nurse Partner • Employ GPs
An integrated approach to e-health, data collection and patient-reported outcomes in outpatient care Pearl Avery IBD Specialist Dorset County Hospital
For more information Contact Clare at cbyrne@Bournemouth.ac.uk or clare.byrne@dorsetgp.nhs.uk
The benefits of eHealth for our IBD patients
What is eHealth or Digital Health? The RCN defines this as Concerned with promoting, empowering and facilitating health and wellbeing with individuals, families and communities, and the enhancement of professional practice through the use of information management and information and communication technology (ICT).
Importantly, they go on to say… There is more to eHealth than just technology. It is about finding, using, recording, managing, and transmitting information to support health care, in particular to make decisions about patient care. Computers (and other ICT devices) are merely the technology that enables this to happen.
eHealth covers: • Electronic patient records • Electronic communication with patients and professionals • Telehealth/telecare • Information management • Information governance • Personal health records
eHealth in IBD Dorset County - background • Participating in IBD Registry since 2015 • Using the IBD Registry InfoFlex patient management system (PMS)- • Electronic patient reported outcome measures (PROMs)
Benefits to patients - efficiencies • Deal with queries efficiently • MDTs - Improved decision making at point of care • Increased efficiency even as patient population has grown • Supports remote monitoring, reducing hospital visits • System generates GP and patient letters • Better continuity of care
Case Study Patient A 32 year old man Called the Advice line on no medication UC and Auto Immune Hepatitis intolerant of Azathioprine weaned from Tacrolimus 12 months before. Information was available on the clinical management system 2 mins to find this out Patient signed up to the IBDoc Calporotectin test using APP and web portal. Treatment decision next day to escalate to biologics.
Case Study Patient B • CD age 24 female with perianal disease seton in situ and on adalimumab • Patent Reported Outcome Measure (PROM) completed by patient before appointment scored 2 with a general well being score of 50 out of 100 • Patient attended clinic asked how she was and she said FINE • Clinician able to help patient agenda set with PROM information and unpick the FINE into the reality of concerns; over output from fistulae; Fatigue and ongoing treatment options.
Case Study • Advice line contact • UC Flare patient unsure of medication dose and what to do symptoms are distal despite having Total colitis. • Clinical Management system record shows on Mesalazine 1.6g a day. Has never tried rectal treatments. • Clinician able to help patient to optimise treatment on the first contact.
Benefits to clinical team • Helps us streamline our processes and focus on delivering patient-driven care • Easier auditing • Virtual MDT meetings • Better view of IBD population • Tracking all helpline calls allows us to show value of nurse specialists
Downsides • Only as good as the data you put in • Entering data takes time and planning • Need to consider patient • Move the furniture!
Development and setting up of a Telehealth Servcie for palliative care patients Emma Randall, Community Nurse, Weldmar Hospice, Dorchester
Why pilot this at Weldmar? • Rurality – clinician travel. • More patients needing specialist palliative care • Clinicians access to patient data
My post • Telehealth pilot lead - funded by Macmillan. • Working closely with Weldmar Community Nurse (WCN) team
Telehealth PODS • 15 PODS • Patients use daily and feedback • Questions - IPOS scoring system and Barthel Index • PODS - skype call
Results from PODS • Results stored on PODS • Home and remote access to results
Telehealth Pilot • 47 patients aged 34 – 93 • Questionnaire sent to 32 patients, 84.4% response rate
Patient Feedback •“ Saves time by not having to wait in for a nurse” • “Daily record for me as to how I have felt” “ • “It is great fun, I have had a very good experience of pilot and it has put my mind at rest.“
Mr B “I am very happy to complete the questions daily and my mind has been put at rest by being part of this pilot. My Weldmar nurses are great and there is always someone at the end of the phone. Taking part in the Telehealth pilot has been great fun”
Carer Feedback “ My wife thinks it is useful to have a log of symptoms and to know they are being reviewed” “They think it’s a good idea especially given our rural location.” “Great to have the history tab as family who live away can look at history of symptoms when they visit”
Skype Consultations – Clinician Feedback •Observe a patient’s body language •Visually assess a patient’s condition • Keep in touch with patients
Staff Feedback • Easy access to results •“ Prompted me to call a patient when they had scored highly on a symptom that had previously been well managed, or was a new symptom.”
Telehealth – the benefits • Patients - control and self-management • Symptoms monitoring
Thank you Emma.Randall@weld-hospice.org.uk
Pre-hospital critical care nursing Stuart Cox, Trainee Specialist Practitioner Critical Care Owen Hammett, Specialist Practitioner Critical Care Dorset and Somerset Air Ambulance
Pre-hospital Nursing Stuart Cox Owen Hammett
Content ● Nursing within SWASfT ● What is PHEM/Critical Care ● Dorset and Somerset Air Ambulance ● Our experience ● Global picture of evidence ● Nursing role ● The future ● Discussion
Nursing roles within the SWASfT Clinical Supervisors ● Ambulance Nurse (trial starting July 2019) ● Mental Health ● Education ● Governance and Quality ● Research ● Specialist Practitioner - Emergency and Urgent Care ● Specialist Practitioner - Critical Care ●
Specialist practitioner - Critical Care/PHEM Critical Care Team ● Patient groups ● 19 hours a day, 365 days a year ● AW169 ● Enhanced Care Car ● Anywhere in two counties in ● less than 20 minutes SWASfT Governance ● Charity funded ●
What is PHEM and Critical Care? ‘Pre - hospital’ refers to all environments outside an ED or a place specifically ● designed for resuscitation and/or critical care PHEM encompasses the knowledge, technical skills and non-technical skills ● required to provide safe pre-hospital critical care and safe transfer The PHEM practitioner role is uniquely challenging, requiring the application ● of significant knowledge and skills to a high level
Our background to Critical Care/PHEM Owen Stuart Community first responder Critical Care Nurse ● ● Emergency Nurse Military secondment ● ● Critical Care Technologist Fixed wing air ambulance ● ● RCN forum Emergency RCN forum Critical Care ● ● Nursing Nursing Dip IMC Critical Care ACCP ● ● MSc (pending) MSc (pending) ● ● Full time Part time ● ●
Nursing in pre-hospital care internationally is seen as the normal ● 2002 American study ● Trauma patients ● A total of 1193 patients met the inclusion criteria and had the crew ● configuration No significant difference existed in patient outcomes ●
Study assessed the attitudes of each ● others' professional roles Both groups of professionals ● In order to increase the competence in the ambulance ● acknowledge the advantage of having service in 2000 every ambulance should be manned complementing skills, to improve service by at least one RN There is rivalry between nurses and ● Data collection was carried out by a focus group ● paramedics interview Nurses in pre-hospital care is ● The findings indicated an increasing independence in ● contributing to the quality of service by decision-making after RNs become a part of the raising the competence level of the team ambulance service
Nursing role in PHEM/Critical Care Clinical Non-Clinical Training ● Aviation ● Pre-hospital Anaesthesia ● Response driving ● Advanced analgesia ● Charity engagement ● Resuscitative surgical skills ● Research and audit ● Blood product resuscitation ● Service development ● Ultrasound ● Education ● Vascular access ● Primary prevention ●
Benefits Patient care ● Inter-professional working ● Clinical development ● Diverse workforce ● Job planning ●
The future SWASfT Nursing Strategy 2019 ● Advanced Practice Framework ● Job planning / flexibility ● Ambulance nurse trial - Gloucester ● Faculty of Pre-hospital Care Examinations ●
Summary Nursing in pre-hospital care is in its infancy ● Nursing in pre-hospital care is evidenced based ● Strengthens patient care through interprofessional working ● Opportunities for workforce diversity ● Development of Advanced Practice career pathways ●
The Ward Leader Leading change and adding value Jody Bryant Matron for General Medicine, Poole Hospital
Personal reflection • Standards in ward maintenance • Standards of care The ward leader’s role is pivotal in managing clinical services, improving patient outcomes and effective team working.
Key components of the role • Centre of patient care. • Budget management • 24 hour responsibility for • Audit • Policy, procedure and guidance their ward • Lead the delivery of high development • Expert practitioner quality care • Provision of effective workforce • Complaints manager • Role model • Business Manager • Teacher
Qualities • Innate desire to do the • Always fair and consistent • Valuing staff right thing • Guardian of the 6 C’s • No blame culture • Approachable • Ability to prevent issues escalating • Flexible, able to continuously • Desire to make a difference adapt to change
Creating the right culture • Being a role model As a ward leader you are • Being present and visible in an influential role. • Supporting all professionals • Setting high standards You can make a real • Not being afraid to challenge difference • Nurses revalidation
You must become the change you want to see in your team or organisation
Peers and Nurses working in partnership from a lived experience perspective Jane Carey Kerry Matcham Dorset Mental Health Forum
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