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With the increased focus on meeting health care needs, the first healthsurveillance nurse in post assisted in setting up clinical services atWaddiloves Resource Centre, initially dental and podiatry services.

There are now three health surveillance nurses in post, work completed bythese individuals includes:

Assisting in further development of services at Waddiloves including cytology, audiology, visual assessment and biomechanics.

Developing a "well persons clinic" specific to people with learning disabilities.

Supporting clients in accessing health services, and offering support to clinicians delivering health care.

Leading on the development of clinic protocols

Delivery of joint training with the Oral Health Promotion Unit

Input into Trust and Local Authority day services, including planning for health promotion, advising on available services, and health surveillance advice.

A number of initiatives have been developed across the community hospitals toinvolve the public in service development, these include:

• Patient/user group evaluation of services

• Carer/user satisfaction survey

• Local children's contribution to religious collaborations involving community hospital units through schools, Brownies, youth clubs etc.

 

Introducing pro-active health promotion/health information for elderly peoplein the community hospitals via a health promotion project.

The design, introduction, evaluation and publication of aproject introducing Multidisciplinary notes in a community hospital setting.

Evaluation and publication of a project to manage patientswith DVT in their own homes and workplaces instead of in an acute hospitalsetting.

Health Visitors work as Primary Mental Health Workers in a GPsurgery. All children with emotional or behavioural problems are referred tothis clinic by GPs. Supervision is provided within the Child and AdolescentMental Health Services to whom patients are referred onto if necessary. This hasproved popular with GPs and reduced unnecessary referrals to the Child andAdolescent Mental Health Services.

Set up by Bradford's first schools with school nurseinvolvement. Enables a proactive approach to be taken in dealing with thebehavioural and emotional problems of school age children.

To provide a patient administered well evaluation home basedcardiac rehabilitation programme, one community nurse from each PCG is trainingto use the "heart manual" with all post MI discharges.

Being set up as a pilot in North Bradford to implement theleg ulcer guidelines. Intention to then roll this model of service out acrossthe city.

A health visitor and family worker working as part of aprimary health care team. They have taken a community development approach totheir work and set up a number of community groups to address identified healthneed. For example, a young person's drop in - highest rate of teenagepregnancies in the District are in this area and the drop in address issues ofsexual health and family planning. Also they deliver a well-evaluated parentingprogramme.

The provision of Dermatology services are based around therequirements of our client group.

The aim of the unit is to provide an easily accessibleservice. Flexibility is, therefore, essential and nursing staff work "outof hours" to ensure that clients can visit after work, school, or otherdomestic routines so ensuring minimal disruption to their daily lives. Toachieve this the clinics are nurse led, nurses supplying and administeringtreatments via agreed protocols.

The goal is to give optimal nursing care when required andthrough education and support, aid clients to secure the knowledge required togain some control over their condition.

Practice is evidence based and innovative.

Research is undertaken regularly and nurses are as muchinvolved in this as medical staff.

Audit has indicated high levels of satisfaction amongst theclient group.

The unit is recognised Nationally as many of our research projects have beenpublished in professional journals and the Unit recently became second in theDoctor/Team of the year award.

CITY HOSPITALS SUNDERLAND NHS TRUST

Nursing Practice Centre (NPRC)

The Nursing Practice Centre (NPRC) was established inDecember 1998, creating a unique partnership between City Hospitals Sunderland(CHS) and two local universities to support nursing research and development.The Centre has an academic steer from a chair from the University of Northumbriaand a senior lecturer from the University of Sunderland. The Centre also has twoseconded lecturer practitioners.

The purpose of the Centre is to provide an infrastructure forsupporting nurses and midwives to engage in research and evidence in theireveryday practice.

The development of the NPRC has three distinct phases:

 

• Analysis of the current R&D capability in CHS

 

• To develop a number of strategies and approaches to increase R&D capacity and culture in the Trust

 

• Practice Development Initiatives throughout the Trust.

 

 

 

Harrogate Health Care Trust, in recognition of the need forstudents on clinical placement to bridge the theory practice gap, made asuccessful bid against Consortia monies to develop a project to work withstudents to enhance their learning experience and promote evidence basedpractice within clinical areas. The bid, amounting to E87,000, has enabled theTrust to introduce 8 Practice Development Nurse posts working 2 days a week overa period of 18 months in all clinical areas, ie Surgery, Medicine, Care of theElderly, Learning Disabilities, Community, Midwifery, Pediatrics and MentalHealth. The Practice Development Nurses, who are principally existingexperienced F grade nurses, will develop strong links with the University whilstcontinuing to work in the clinical setting to ensure practice is evidence basedand patient focused. The posts will enable the Trust to provide high qualityplacements which will develop students' practice skills, reduce the theorypractice gap and improve retention rates and fitness for purpose onqualification, thereby enhancing patient care. The posts will be monitored,reviewed and evaluated in terms of the expected outcomes by a Project ManagementTeam with regular reports to the Education Consortium.

An annualized hours programme is well established in thisward area, this incorporates a self-rostering system to undertaking ward staffsof duty. This is in conjunction with the implementation of flexible Fostering inaccordance with family friendly working policies.

Research has been undertaken by Sr Angela Neal looking intotemperature taking in the paediatric setting. This research is available from SrNeal.

Kirsty Gardner, the nursery nurse in this area has recentlycompleted the Hospital Play Specialist course and is building her newlydeveloped skills into the ward area.

Staff Nurse Liz Bishop has developed an aromatherapy massageservice to assist staff, in dealing with stress; this service has been widelytaken up by staff. Liz is currently looking at developing a clinic for referralsfrom the paediatric medical/nursing staff for children who would benefit fromthis service.

The acute paediatric wards are at the present timeundertaking a survey of parents who have used the acute services to determinehow to develop the service in line with what service users want.

Apollo ward is involved in the parent satisfaction survey asdescribed above. The ward has also developed an Adolescent steering group thatis looking at all aspects of Adolescent care. This includes:

• Comment slips

• Service user consultation using a questionnaire on aregular basis

• Integrated care pathways for a variety of issuesincluding self-harm.

The group has also develop a support group for staff thatWorks in Partnership with the Child And Family Service. This group helps staffto work through any difficult issues with regards to Adolescent care.

The ward is looking at developing shared care with tertiarycentres, at present we have links with Paediatric Intensive Care and Oncologyand are developing this service in conjunction with Leeds hospitals.

This unit has developed a very successful baby massage service for all babies in Huddersfield. This service helps with a variety of issues from bonding to colic and is in great demand. The colic service is run on a demand basis.

The unit runs a Breast milk bank early feeding of pre term infants.

A midwifery led drop in service is also available for breastfeeding problems.

The unit runs support groups for families.

Bereavement support groups are run with a multi disciplinary team this group runs a professional led support group and facilitates a parent led support group.

A nurse led asthma clinic has been running from this area.The lead nurse Sr Dawne Halstead is currently auditing this service. Sr Halsteadleads a multi disciplinary respiratory group that is developing respiratoryservices across boundaries.

A nurse led allergy service is being developed at the presenttime, including anaphylaxis education and training, dietetic advice, skin pricktesting and allergy avoidance. The service incorporates nurse, dieticians, and aConsultant Paediatrician.

Paediatric Phlebotomy is usually undertaken in thedepartment.

An epilepsy service is being developed with Dr Short, aSapphire epilepsy nurse, Chrissy Thompson, and a link nurse from the paediatricclinic.

The department has just completed a year long project withthe IYCE initiative this was the first consultation with service usersundertaken within children's services. The projects main aim was to developservice user involvement in decision making. To ensure this work continues weare developing a children's and young peoples consultative group that will giveit's advice and opinions and will problem solve any issues and concerns of youngpeople.

This tem are developing a pro-active service that works inpartnership across many boundaries the group have led the way in shared careinitiative. This team is involved in training carers in conjunction with socialservices. This is a joint funding initiative.

The teams are setting up a database to measure theeffectiveness of the service that they provide. This database will move awayfrom monitoring the by admissions and re admissions but will look at health careoutcomes. This database will also be able to provide financial informationaround packages of care.

The teams are working with clinic to develop the anaphylaxistraining and education.

A nurse led minor injuries unit based in a health centre -possibly the first in this country. Minimal Medical Cover - Nurses working to,and filfther developing protocols and the introduction of care pathways.

Tissue Viability refers to the preservation of healthy tissueand more broadly, to the prevention and management of tissue damage.

Hull and Holdemess Community Health NHS Trust are developinga leading edge approach to tissue viability, including leg ulcers, woundmanagement and associated pain management. However tissue viability is oftenperceived as the 'Cinderella' service in the general field of medicineconsequently the workload and responsibility, in wound management is delegatedfrom General Practitioner (GP) to the nurse.

The concept of a centre, dedicated for the management andcare of wounds is developing in Hull, as the first Tissue Viability Centre. Itwill provide a focus for training, education, information, research and a bridgebetween health technology, health care and patient's through evidence, practiceand clinical specialty.

To facilitate this 'Excellence in Care' Hull and Holdemesshave established Partnership with Adam Spencer Ltd (local independentpharmacist), the Centre for Community Nursing, the Centre for Primary HealthCare Education, Research and Development, other researchers in the Faculty ofHealth, the University of Hull based within the Trust and private companiesincluding Smith and Nephew Healthcare Ltd, and Nutricia Clinical Care (TowbridgeUK).

The centre will incorporate a flexible approach to itsservice with colleagues within the acute and private sector, whilst providing aunique opportunity to develop the service provision. It will be a key player inimplementing changes at a practical level as it is felt that a hands on approachappears to be the best way to achieve the most efficient and cost effectivesystem.

Anxiety management groups - for people with LearningDisabilities without verbal communication. This group has been set up withCommunity Nurses working in "collaboration" with Speech and LanguageTherapy using pictures, symbols and signing. The group follows on fromsuccessful groups for people with Learning Disabilities to enable people toself-manage the anxieties.

Health promotion groups for people with Learning Disabilities- a workshop run with nurses in partnership with a number of differentagencies, including Social Services, Youth Services and PAMS. The workshop hasdeveloped to include the health of carers working with District Nurses andHealth Visitors.

Health screening sessions - for people with LearningDisabilities run in partnership with GPs, Practice Nurses etc.

Offender’s forums - development of a regular forumwhich meets to address the complex needs of people with Learning disabilitieswho attend. This has seen GP, Solicitors, RNMHs working together at a levelwhich addresses and informs different agencies/organisations on approaches toworking with offenders.

Development of an Epilepsy nursing assessment.

Working with colleagues within Social Services, GeneralPractice, and acute services to ensure people with Learning Disabilities aregiven the opportunity to give informed consent where possible. This has involvedworking in partnership with Speech and Language Therapy in the development ofspecific communication packages to inform clients of the procedure involved,including the risks and being offered the choice to say Yes or No.

The Health garage is a concept thought up by community nursesin the North Locality and includes Health Visitors, School Nurses, DistrictNurses, Learning Disability Nurses and an exercise instructor from the Healthpromotion Department.

This is an open access afternoon for anyone of any age fromthe local community. Participants are offered basic health checks, if they wish,to include pulse, blood pressure, urine testing peak flow, weight etc. Therefollows 2 half hour sessions of exercise to music with a break in between forrefreshments and specialist topics eg stress control, relaxation techniques,massage healthy eating, aromatherapy, smoking cessation etc.

At the end of the session participants are shown how toassess their recovery pulse rate and a client-held record card is kept is assesstheir own progress.

The School Nurses and Community Learning Disability Nursesalso adapted the above to appeal for 12 - 13 year olds, offering 'street dancingtuition instead of exercise to music in after-school sessions. Two younglearning disabled teenagers were integrated into the sessions successfully.

The project was a combined effort between the healthPromotion Department at the East Yorkshire Community Trust at the Westwood andstaff from specific wards at Castle Hill and the OPD at CHH and the Westwood, inresponse to the Governments target within our Healthier Nation. Wards 21, 22 and7, the OPD at CHH and Occupational Health are piloting the project, whichcommenced in September. A total of 50 patients and 5 members of staff will jointhe programme, which includes support from smoking cessation advisors along withnicotine replacement therapy.

The patients and staff members will be followed and recordsmade as they progress through their twelve-week programme. The patients attendthe OPD on a number of occasions and have their nicotine levels recorded at eachvisit, as well as receiving help and advice. As the pilot has only justcommenced we are experiencing some minor teething problems, but this wasexpected. A report of the success or otherwise of the pilot will be provided atthe end of the programme (which owing to only being able to recruit a maximum ofseven patients weekly to avoid having too many patients attending in the OPDtogether) will not be ready until February/March 2000.

The overall aim of the project is to establish whether NRTand counselling is more effective for patients than just NRT alone.

Funds were made available from the Charitable Funds for theproject with East Riding Health helping with some of the NRT patches.

We were going to develop this programme as a full researchstudy, but owing to time constraints of some of the group it was decided toleave that part of the programme to the proposed smoking cessation advisorappointee, who I think will work for East Riding Health.

The East Yorkshire NHS Hospital Trust has a small MaternityUnit, situated at Castle Hill Hospital in Cottingham, near Hull. The Departmentof Women's Health has approximately 2.5 thousand deliveries per year.

In 1994, partly due to the constraints of the 'Calman' reportand the 'New Deal' and also the fact that there were no on-site consultantpaediatricians; the hospital lost itsabilitytofunctionasatraininghospitalforjuniorpaediatricmedicalstaff. In order tomaintain a functioning paediatric service and therefore a maternity service, theTrust decided to implement the first totally autonomous Advanced Neonatal NursePractitioners (ANNPS) in the UK.

Collage: this innovative work involves use of collage as amedium for working with people with cognitive impairment. Awarded Queen'sNursing Award for Innovative October 1999.

1. Community Development with Health Visiting:

A full time Health Visitor was taken out of caseload work and given the briefof-

a) Identifying wider health needs of the inner city, multi-cultural area of Leeds I 1.

b) Establishing links with the voluntary and statutory sectors locally.

c) Drawing up an action plan to address problems identified.

A report is available outlining the work done and what has been achieved so far:

The South Area Rehabilitation Team

The aims of the team are to:

Facilitate early discharge from hospital.

Assist in the transitional period between hospital and home.

Avoid hospital admission where possible.

d) Work with other care providers in an integrated way.

The team is expanding in size and is very flexible, eg able to pick up the extra work from the 'Winter Pressures' initiatives.

 

The Intensive Home Treatment (IHTT) has similar aims to the Rehabilitation Team, but works with people experiencing mental health problems. They offer an on-call system 'out of hours' and work very closely with other care providers. There is felt to be a need to extend this team's remit.

 

3. Learning Disability Service

 

Nurses working in in-patient Nursing Set-vices haveimplemented innovative ways of communicating understandable information forclients.

Eg Nursing Philosophies User Carer Information Complaint procedures

This has enhanced the value and respect we have for clients with learning disabilities and has enabled the client group to have a say in their care and whether or not that care is to their satisfaction.

Karp, T (1994) Neonatal Intensive Care Excellence in Nursing Practice ora

Dead-End Profession. Neonatal Nurses' Year Book; CNLA Medical Data Ltd.340-352.

Woodal, T (I 998) Reflective Supervision Model. Unpublished.

THE NEWCASTLE UPON TYNE HOSPITALS NHS TRUST

Dermatology

In September 1996 the maximum waiting time for new outpatientdermatology appointments at the Royal Victoria Infirmary in Newcastle was 57weeks. Dermatology was firmly on the local purchasers 'black list' of 'problem'specialties. By June 1998, the maximum waiting time had reduced to 13 weeks andthe specialty was awarded national Beacon status in 1999 for its achievements.The reduction in waiting times had resulted from a wide variety of changes tooperational and administrative processes, nursing and models of servicedelivery.

The Organization and skill-mix of the nursing was reviewed and changes implemented to improve efficiency and flexibility. For example the nursing structure was changed from two separate hierarchies into one unified staff group, and the role of the support worker was extended to include duties such as venepuncture.

Nursing protocols for discharging patients from courses of sunlight and PUVA treatment were implemented, so that outpatient appointments with medical staff were no longer needed for patients to be discharged from treatment.

A weekly nurse-led minor surgery session for benign lesions was introduced. This freed up a medical session to increase the outpatient service capacity.

 

Nurse-led clinics for review patients with eczema, leg ulcers and psoriasis were implemented. This enabled appointment slots in medical staff clinics to be freed up for more new outpatients.

 

A nurse-led GP direct access clinic (for new patients already diagnosed by their GP as having eczema, leg ulcers or psoriasis needing information or advice) was implemented. This service includes direct access to nurse-led day case surgery for patients with diagnosed benign lesions who require them removing. These clinics have freed up medical staff appointments for more new outpatients to be seen.

 

 

 

Nurses manage groups of patients through the disease process- they take over patient screening etc and manage the whole process.

Doctors are available if a patient's condition deteriorates

To develop effective, socially and culturally relevantsupport for parents to help children who are perceived to have disruptivebehaviour problems.

The prevalence of child and adolescent mental health problemsis estimated at 20%. 50% of all clinical problems seen within child andadolescent mental health services are associated with disruptive behaviourproblems which without intervention can prevail into adult life leading toincreased probability of subsequent development of mental health problems andcriminality. Children who are perceived to have disruptive behaviour problemshave low self esteem, poor social skills and poor peer relations which can leadto increased isolation and vulnerability and an inability to achieve academicand personal goals. Parents of children who are perceived to have disruptivebehaviour problems have been found to have low self-esteem and higher rates ofsocial isolation and depression. Around 80% of those children most in need donot currently receive extra support.

To establish which current interventions are most useful toparents in supporting their everyday lives and experiences. To develop morerelevant support systems arising from parents' experiences and knowledge. Todevise a model of parenting which facilitates parents to become collaborativepartners in the generation of research and practice knowledge.

Child and Adolescent Mental Health

Fleming Nuffield Unit Annex, 1 Tankerville Terrace

Jesmond, Newcastle upon Tyne, NE2 3AH

Tel: 0191 219 6470

Fax: 0191 219 6483

Professor of Nursing Development c/o Primary Care DevelopmentCentre Newcastle General Hospital Westgate Road, Newcastle upon Tyne, NE4 6BE.

Tel: c/o 0191 256 3004

Fax: c/o 0191 273 2340

Development and application of the "Tidal Model"approach of psychiatric and mental health nursing practice

To define a structure for the provision of nursing input tocare in a way that is complementary to the work of the rest of themulti-disciplinary team and which acknowledges nurses' two discreterole-relationships: the therapeutic relationship with the person (and theirfamily) and the professional relationship with the rest of the team.

First commissioned by Newcastle City Health NHS Trust theTidal Model is presently the subject of extensive international evaluation. Themodel emphasizes the importance of collaborating with the individual (and familywhere appropriate) to plan and deliver care, empowering the person by puttingthe experience of illness and health at the heart of the care plan, integratingnursing with the services provided by the rest of the multi-disciplinary team,resolving problems and promoting mental health by providing arrange ofinterventions eg individual and groupwork. Using the water to emphasise thefluid nature of human experiences (crisis = "drowning", discharge ="return to sea" etc) the Tidal Model goes on identifying threedistinct, but related dimensions of care each relevant under each differentcircumstances; world dimension - the need to be understood, the self dimension -the needs for security, others dimension - support required from outside.

This model is now in the process of being applied to each ofthe Trust's seven acute adult mental health wards and associated clinical teams.Practical experience has shown that this has been a difficult but rewardingexperience. In implementing this model it has been recognised that this haschallenged traditional ways in which nurses have been trained and have worked.Ongoing support for staff in implementing this model will be required in orderfor the model to be as effective as it can be.

Mental Health Programme Management Offices

St Nicholas' Hospital, Jubilee Road

Gosforth, Newcastle upon Tyne, NE3 3XT

Tel: 0191 219 2835

Fax: 0191 223 2211

Bewick Ward, Hadrian Clinic

Newcastle General Hospital

West gate Road, Newcastle upon Tyne NE4 6BE

Tel: 0191 273 6666 ext 23071

Fax: 0191 256 3088

Department of Psychiatry

Leazes Wing, Royal Victoria Infirmary Newcastle upon Tyne,NEI 4LP

Tel: 0191 227 5073

Fax: 0191 227 5108

To raise awareness that an individual's sexuality during therehabilitation process is part of holistic care within the multi-disciplinaryteam.

Sexuality is a huge topic and one which many individuals havedifficulty in addressing within their own lives. Within a health care settingsexuality becomes a subject which is often overlooked, ignored or activelydiscouraged from being discussed where health care workers hide behind theirtaboos, prejudices and embarrassment.

Evidence within neuro-rehabilitation services based withinNewcastle City Health NHS Trust supports the above strong statement. TheRegional Rehabilitation Centre works with a client group 16 - 65 years old,across various minority groups with or without partners. Referrals includeclients who have sustained brain injury leaving them with severe physicalemotional and psychological problems. Staff have developed a workshop to raiseawareness amongst the multi-disciplinary team of the importance of addressingthis area as part of a package of holistic care for clients.

Social Therapy and Recreational Rehabilitation (STARR) TeamLeader

Hunters Moor Hospital, Hunters Moor Road, Newcastle upon Tyne

Tel: 0191 219 5672

Fax: 0191 219 5665

Hunters Moor Hospital Hunter Moor Road,

Newcastle upon Tyne

Tel: 0191 219 5676

Fax: 0191 219 5665

The Tissue Viability Centre (TVC) is run by the communityNursing Service with North Tyneside and operates from North Tyneside GeneralHospital. The Centre provides specialist assessment and treatment services forpatients with chronic wounds, leg ulcers and pressures sores. A range ofspecialist treatments are offered including Low-Level LASER therapy, Larvaetherapy using sterile maggots, compression therapy and skin grafting usingartificial skin.

In addition to the clinical services provided the centre runsENB N49 and ENB N18 courses in association with the University of Northumbria, aDistance Learning short course with Robert Gordon University, Aberdeen. Thecentre also hosts and annual National Wound Care Conference which attractsdelegates from around the UK. The Centre have also established an interactiveweb site (Tissue Viability Interactive) for which they were awarded a Queen’sNursing Institute Innovations Award.

An attempt to encourage joint working in the Ashington areawas not working when directed from above. However, once all the interestedprofessionals (health, social services, education, voluntary sector) gottogether to look at the services provided, and the gaps that these left, thework – and communication increased by leaps and bounds. One of the biggestgaps was with Education and activities are now in place to overcome this. Otherinitiatives, supported by the local community paediatician are better supportfor breast feeding mothers and a higher bid for children failing to thrive.

Berwick Family Centre is an independent self financingproject which has been set up to address the needs, health of, and other issuesaffecting children and their families living in the Borough of Berwick UponTweed.

In 1993 a Health Needs assessment by Health Visitorshighlighted levels of poverty and deprivation in 5 of the 16 wards. Managementsupported a health visitor to investigate further.

The Family centre developed as the result of partnershipbetween health, statutory and voluntary organisations has raised £300,000 inthe last five years. For three years Health Visitors held the position ofsecretary and treasurer.

The multi-disciplinary management committee supports 5 fulltime staff, 4-6 sessional workers and a pool of 12-14 volunteers.

Premises are in a former shop gifted by Berwick Boroughcouncil.

It provides a range of services including parents and toddlergroups, after school homework groups, holiday play schemes, women’s healthgroups, cookery groups, women’s training courses, positive parenting,counselling and advice services and support in rural areas.

It uses a community development approach in all it’s workand continues to work in partnership with statutory and voluntary organizationsand individuals.

Future plans include the development of the Rural DevelopmentPlan, development of services for 12-15 age group and application for HealthLiving status.

The idea of a local health column written by localprofessionals started when Health Visitors and Midwives in Berwick were tryingto find an effective way of promoting a pre-conceptual care campaign.Professionals had found one off campaigns to be of limited value and had beenlooking for a method of giving ongoing information on health matters.

With the support of the Editor of the local paper covering apopulation of 27,000 the monthly column "Health Matters" started inFebruary 1996. The local paper is well read and is a good vehicle forinformation on health issues.

The column was co-ordinated by a Health Visitor and theprogramme discussed feedback disseminated at Health Visitor team meetings andprimary health care team meetings.

To make health promotion more local and personalised

To reach a wider audience

To give regular and ongoing information to local people bylocal professionals

To give information that is easy to read, informative andfun, on a wide range of issues

To reach local community and put health as a talking point onthe first Thursday of every month.

To include Health of the Nation key areas

 

Contributors included the staff of two primary health careteams and other community health professionals.

A wide range of topics were covered with one main theme eachmonth. These dovetailed with national campaigns but were firmly rooted in locallife, reflecting issues of local concern. Ensuring that only local well-knownprofessionals wrote the articles it was felt that this would have more impact.

Each month 155 patients (Out, In, Day, Maternity and Private)are invited to complete anonymously and return in a pre-paid envelope, aSatisfaction Survey. We average a 50% response. From the results a quarterlypublication of all the written comments "What Our Patients Think…. OfUs" is produced and circulated to all wards and departments and members ofthe Trust Board. Staff are encouraged to take action where appropriate, on theconstructive comments.

Twice each month a pressure sore prevalence is undertaken onall patients. The prevalence demonstrates the incidence of acquired sores, sorespresent on admission, the grading and sites of sores. Results are publishedquarterly and circulated to wards. The Trust Board received monthly the averagepercentage figure of sores acquired. This information is also displayed on thePatient’s Charter Information Board in the main entrance to the FriarageHospital.

Pre-assessment has been extended to include patientsrequiring minor as well as major surgery. This is demonstrating efficiency inthe optimum use of nursing resources and theatre time.

Representatives of Catering, Nursing and Dietetics meetquarterly to discuss issues surrounding Patient Nutrition. A copy of the minutesof each meeting is circulated to all wards and departments in the Trust. Aseminar ‘Eating Matters’ was attended by 50 staff. Professor Senga Bondaddressed the seminar.

A booklet ‘Catering Services’ has been produced, and setsout to identify and explain the Trust’s Patient Services Policy and lists theservice and standards patients can expect. A copy of the booklet is available inall patient lockers.

3-year project commences on 1^st April 1998 inconjunction with the University of York. Research Assistant working in the Trustrunning multi-disciplinary workshops. Medline/Cochrane accessible via PCs on thewards. Research Assistant just returned from lecturing in USA on this project.RCN filmed health visiting and district nurses using evidence base in practice.

Raises awareness of public health issues

Gives the public information

Publicises current thinking

Discusses current issues

Responds to national health campaigns, crises, (egmeningitis)

Felt more confident in dealing with issues relating to CAMH

Felt more skilled at offering intervention

Felt they had a better idea of when referral to specialistservices was appropriate

Enjoyed better communication with colleagues in CAMH

 

Work in the forthcoming year aims to focus on developinggroupwork skills to work with children and your people, (eg in relation toself-esteem, assertiveness) and with parents.

‘Winner of Patient Partnership Practice Management Award1999’

Listed are some contact names and telephone numbers:

Contact: Helen Boon Practice, Development Nurse (Viability)

Telephone: 0191 220 5916 Wallsend Health Centre

Website: www.northumbriacommunity.org/tvi

Contact: Janet Leigh, Health Visitor

Telephone: 01670 813167

 

Berwick Family Centre

Contact: Jane Steven, Health Visitor/PCG Executive Nurse

Telephone 01289 308822

Fax: 01289 308843

E-Mail: berfamc@AOL.COM

 

Newspaper Column

Contact: Jane Steven, Health Visitor/PCG Executive Nurse

Telephone: 01289 356960, Tweedmouth Clinic

 

 

NORTH DURHAM HEALTH CARE NHS TRUST

 

Breast Feeding

 

Over the last nine months Midwives in North Durham HealthCare NHS Trust have been involved in Breast Feeding Workshops.

Following attendance at training sessions, Midwives beganrunning Workshops which women can attend in the Antenatal period and cancontinue to attend in the Postnatal period.

These Workshops not only provide instruction and advice forbreast feeding women but are also a source of peer support and encouragement tothose attending.

The Midwives also run Workshops for Health Professionals.These have been attended by Midwives, Health Visitors and Team Assistants, theiraim is to increase knowledge about breast feeding techniques and provide somestandardisation of advice given by Health Professionals to breast feeding women.

The Workshops have evaluated very well by both the women andthe Health Professionals who assess them.

A nurse led Acute Respiratory Assessment Service (ARAS) wasintroduced in Dryburn Hospital from January to May 1998 for patients with acuteexacerbation of Chronic Obstructive Pulmonary Disease.

Patients are assessed by the Respiratory Nurse using:

A standard history

Vital signs

Pulse oximetry

Oxygen saturation

Capillary blood gas

Chest x-ray

 

This is a very successful scheme which:

Reduces hospital admissions

Facilitates early discharge (saving 3.7 beds per day)

Delivers high quality care with patient satisfaction

 

ARAS has aroused considerable interest from hospitals in theUnited Kingdom who are contemplating setting up similar services. Our findingshave been the subject of abstracts and presentations given at regional andnational meetings.

Courses run by Health Visitors and School Nurses –evaluation positive

Achieved Level 1 status as PDU currently towards Level 2

A project with Midwives/Health Visitors/GPs awarded firstlevel UNICEF Breast Feeding award June 1999.

Arthroplasty Unit developed Pathways and changed practice

All procedures follow pathways

Patients held records developed

Northallerton Health Services NHS Trust

Friarage Hospital

Northerallerton

North Yorkshire

DL6 1JG

Direct Number: 01609 762508

Fax: 01609 7779911

Nursing staff working with Northgate and Prudhoe NHS TrustMulti-disciplinary Palliative Care Team have led the development of a tooldesigned to assess pain in non-communicative patients.

The tool takes the form of a checklist, which assess bodyposture, habits and mannerisms, vocal sounds and body observations to identifychanges, which may indicate pain and distress.

Designed to be used by carers, it aims to improvecommunication with the individual as well as assessment of pain. Following aninitial pilot study, the team have modified the tool and are currentlyundertaking a further pilot, prior to widespread application.

Following the identification of weakness in the evaluation ofnursing practice within established models of care, a team of nursing staffworking in the Kenneth Day Unit, a medium secure facility based at Northgate andPrudhoe NHS Trust, have developed their integrated care and treatment plans inorder to deliver a more holistic approach to care within a secure setting.

The tool is based on monitoring nursing interventions byestablishing priorities and incorporating reflection on how the individualbehaves.

Bereavement Support Group established within the IntensiveCare Unit. Initiated and led by nurses, the process involves the nurse makingherself known to the bereaved and following up contact by sending a condolencecare by telephone contacts. Further information from Tony Douglas, NurseManager, and Trauma Services.

 

Nurse led cataract follow up and discharge clinic. Followingsurgery patients are seen by the Nurse Practitioner rather than a Doctor. Usingprotocols the nurse will discharge the patients and either put them down on thelist for surgery on the opposing eye, if necessary, or arrange further follow-upappointments.

 

Opthalmic Unit are piloting ‘one stop clinic’. Patientsare referred by GP, are seen by the Consultant, and then if surgery isindicated, the pre-assessment nursing team undertake any necessaryinvestigations/measurements at the same time.

 

Theatre team developing STEPS, (Systematic Training forEducation and Practice) a competency based development programme.

 

Nurses within the day surgery unit have built upon anddeveloped their existing

pre-operative assessment clinics. Protocols based theseclinics now see over 90% of patients.

 

Renal Assistants training programme. A nurse led development,which provides staff able to provide nursing and technical assistance topatients undergoing dialysis, within defined parameters specified by the nurse.

 

Nurse led Cardiac Rehabilitation Manual Programme

 

Development of cardiac nurse practitioner role

 

Nurse led unrodynamics clinic - joint initiative across twoTrusts

 

Nurse led continence clinics - include pelvic floorassessments and providing biofeedback to patients.

 

Nurse led, protocol based telephone follow up for patientshaving undergone TURP

 

Nurse led ‘drop in’ stoma clinic for patients withutrostomies

 

 

SOUTH TEES ACUTE HOSPITALS NHS TRUST

New Deal Modern Apprenticeship Scheme

In order to meet the shortfall of theatre nurses in Durhamand Teesside and to create work/training opportunities for unemployed youradults (18-26 years) we have developed a

2 year training programme for Operating DepartmentPractictioners (NVQ III).

The qualification is also accepted by the University ofTeesside as an access qualification into nurse training.

The scheme will be funded by local TECs and the Education andTraining Consortia and will be training 12-15 students per year.

The above service will provide an early supported dischargefor patients with COPD for a twelve-month pilot period, funded by the Divisionof Medicine. The purpose of the service is to facilitate a safe, planned earlydischarge for this group of patients. Similar pilot projects have concluded thatthis type of service reduced the length of hospital stay, reduced re-admissionrates and improved patient/carer satisfaction.

A Respiratory Nurse Specialist, two COPD Outreach Nurses anda Physiotherapist will provide the service. The patient will be assessed forsuitability as soon as possible after admission with an exacerbation of COPD. Ifsuitable the patient is discharged under the care of the COPD team. They willreceive a tailored treatment package and daily visits from the COPDNurse/Physiotherapist, as required, until they are recovered sufficiently to bedischarged back to the care of their GP.

Development of a Trust wide link nurse network for Tissue Viability

 

Development of equipment library which has a decontamination facility – initially just for support mattresses.

 

Commencing leg ulcer service – training key nurses throughout the trust so that when patients are admitted with existing leg ulcers community nursing protocols can be adhered to.

 

Nurse led initiative to re-design general and ophthalmic dressing packs. Design is evidence based and cost effective.

 

Development of nurse led ‘drop in’ centre for patients with cancer

 

 

One example of a nurse initiative relates to the work beingdone between Denis Bostock and Jill Loggan (two nurses) to promote skills inmanaging mental health problems in primary care. The project is still beingdeveloped, but they are using the pace, (promoting action in clinicaleffectiveness) approach and focusing on depressions. They are going to run aseries of education sessions in GP practices on managing depression and thenintroduce a pathway to promote the management of low risk depression in primarycare. The outcome should be a reduction in appropriate referrals to MentalHealth Team and Consultants, better risk management of depression and generallya more evidence based framework for managing depression. Given that GPs see atleast one depress patient every surgery, this initiative will support theforthcoming NSF for Mental Health.

Currently there seems to have been little or no work donenationally on improving the management of depression in primary care.

Another possibility might be the developing role of aspecialist nurse, working from one of the personal medical service pilots, insupporting local nursing homes by:

Acting as first point of contact when the homes request a consultation or advice regarding the medical condition of one of their residents.

Undertake initial clinical assessments of patients in nursing homes

Advise on the nursing management of those patients.

 

The important point of this initiative is that, althoughthere will inevitably by some Physician substitution activity, the focus is toremain on attempting to ensure the highest quality nursing management of thisclient group. The hope is that this input will mean that the likely developmentof conditions which require medical type intervention, or even admission tohospital, are minimised.

The efforts of midwifery staff to attain a certificate ofcommitment for the Baby Friendly Initiative has shown considerable team work andthe willingness to change practice. Not only is the department one of the few inthe country to attain the certificate, they are working towards full complianceof all standards and there is a visit arranged at the end of the year. In a areaof significant deprivation and unemployment this is a great step forward,linking midwifery practice with health education, involving families and theprofession, showing that professional education and training money, when linkedto commitment, can not only achieve individual attainment but move theprofession and improve the health of the population significantly over a periodof years.

We also have a professional development practice runningwhich has been accepted as an exact for the forthcoming National ClinicalGovernance Conference in London. Three of the four projects, which have beenrunning for eighteen months now, have been accepted for National publication.This is an example of the commitment of individuals and teams of staff workingtogether with Education Providers. The projects are:

Accident and Emergency staff proactively working with the local community and schools, in particular in increasing awareness of the need for cycle helmets, following on from the high incidence of head injuries in children and adolescents. The staff have visited a significant number of schools, sought and gained sponsorship from local industry, organised competitions with prizes of cycle helmets and has recently been published in the Accident and Emergency Professional Journal.

 

Unified patient record organized through the Younger Disabled Unit, to bring together all patients documentation into the useable form which the patients themselves can take with them and use across primary and secondary care. This has been an extremely useful intensive piece of work, involving patients, families, professionals across the organisation and it has now been written up and published in the Nursing Times.

 

Project to improve liaison between paediatric ward staff and Health Visitors, bringing together the two teams to work much more closely and proactively together, improving the links between primary and secondary care and therefore the care of children. This has also been accepted for national publication and has recently been awarded a top prize in the Health Visitor’s Association Quality Awards and the staff have been awarded jointly £1,000 which they plan to use to run a paediatric conference across Cumbria later on in the year.

 

 

Student nurses undertaking a Project 2000 programme spend 50%of their three years in clinical placements. It is there that they learn thepractical skills of nursing under the tutorage of qualified nurses with patientcare responsibilities who mentor them and assess their competence. Although theprinciples of skill development are taught by teachers in the classroom, masteryof skills can only ever be learned in the real world situation of a patient caresetting.

The introduction of Project 2000 coincided with theimplementation of the NHS and Community Care act. The introduction of theinternal market led to reductions in the provision of hospital beds, skill mixreviews and to a significant increase in the Ward Managers began to limitseverely the number of students they accepted on placement in an attempt toreduce the demands of teaching and assessing. At the time the reduction in theavailability of acute placements was mercifully masked by a concomitantreduction in the number of students, and it was only in 1996 that the NHS beganto recognise the possible effects of years of

under-commissioning. This culminated in the report producedby the Institute for Employment Studies, (Seccombe and Smith 1996) whichindicated that one quarter of all trained nurses would be eligible forretirement by the millennium. The University of York responded to consortiumdemand by broadening its base of placements.

However, recent research carried out by the University hasdemonstrated that despite assiduous efforts to maintain and enhance skilldevelopment, there was a perception amongst Ward Managers that at the point ofregistration, some nurses were insufficiently skilled in skills commonly neededin acute medical and surgical areas. The University followed up this work byundertaking an analysis of student in acute medical and surgical nursing areas.The University’s creativity in the development of alternative placements hadoccurred at the expense of exposure to the areas where key skills could bedeveloped.

In January 1999, the Director of Nursing in York agreed anumber of measures with the University of York to maximise the capacity ofskills development. Fundamental to this was the need to change the culture sothat student nurses were once again welcomed onto wards as key contributors tothe care process, (Lankshear, 1998). This is entirely consistent with theprinciples of the introduction of Project 2000 which acknowledged that studentnurses made a de facto contribution to patient care. A pilot project wasintroduced with the aim of engendering a "win-win" scenario in whichWard Managers came to believe that students were valuable additions to the wardteam and worthy of the necessary investment in teaching and assessing.

In June/July 1999 a pilot project was conducted in York Trustdesigned to increase substantially the number and quality of placements. Thishas just been evaluated and has been highly successful both from the point ofview of students, and most critically, from what that of Ward Managers. Theproposed project will allow for the extension of this project to cover all areasof York Trust.

The project will ensure:

Maximisation of clinical placements with six students allocated to designated acute wards at any one time. This will represent a 30% increase in acute placements at York.

 

Time-tabling students to attend placements for blocks of four to twelve weeks instead of two – three days per week. The removal of college days during placement periods will give freedom to ward staff to allocate students across twenty one shifts per week inclusive of night duty.

 

York Health Services NHS Trust, with the support of the University of York hereby bids for one F grade nurse in support of the project. This individual, fully supported by the University of York will:

 

Ascertain the problems envisaged by Ward Managers and qualified staff in managing six students and responding to them and their needs.

Liaise with link teachers

Advise clinical assessors on efficiencies in completion of assessment documentation.

Clarify the rights of clinical staff in the management of their allocated students

Offer support to the pilot wards in the management of students

Offer clinical support to students

Act as trouble shooter

 

As the aim of the project is to effect a change in therelationship between the Trust and it’s students it is expected, and the basisof the success of the pilot project, confidently predicted, that at the end ofthe year the project co-ordinator can be withdrawn with no adverse effects.

Nurses working in in-patient Nursing Services haveimplemented innovative ways of communicating understandable information forclients.

Eg: Nursing Philosophies

User Carer Information

Complaint Procedures

This has enhanced the value and respect we have for clientswith learning difficulties and has enabled the client group to have a say intheir care and whether or not that care is to their satisfaction.

Three nurses are working and based full time with a number ofGPs, creating an extension to the normal primary care team.

The roles including screening, assessment, intervention,education, counselling and case management.

A one year evaluation of the service demonstrates clinicaleffectiveness on a case by case basis.

The approach fills a gap between GP care and secondary mentalhealth care provided by Community Mental Health Teams.

 

Intensive Home Treatment – Mental Health Services

 

An extensive home treatment team has been established, towork alongside four community Mental Health Teams as part of a servicedevelopment that has resulted in the use of a reduced bed base from 47 to 30beds for a population of 150,000.

Its key objectives are:

 

Increased proportion of mental health care to be provided in peoples homes

 

Facilitation of earlier hospital discharge

 

Alternative to hospital admission

 

Increased access 24 hours a day, 7 days a week

 

Community Group Treatment for People with Severe and Enduring Mental Illness

 

This initiative provides weekly two hour community groups forclients with severe and enduring interpersonal problems.

It particularly focuses upon clients with a history ofemotional and behavioural problems, which may include self harm behaviour

Associated problems of alcohol and drug misuse, eatingdisorders and mood disorders are regularly seen.

The group takes place at Tuke House in Leeds, a communitybased service specialising in providing a rolling programme of brief dayattendance group psychotherapy.