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Gloves are costly, ‘often unnecessary’ and could ‘increase the risk of infection’

The Royal College of Nursing is asking healthcare staff to “think twice” before using gloves.

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Healthcare staff are being asked to “think twice” before using gloves.

The Royal College of Nursing (RCN) is asking all those involved in nursing and healthcare to think twice before using examination gloves when carrying out tasks.

The union states that, despite the NHS spending over £35 million a year on more than 1.5 billion boxes of examination gloves, their use is ‘often unnecessary’ and could instead lead to poor hand hygiene – increasing the risk of infection.

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Additionally, every year around 1,000 health care workers develop work-related contact dermatitis of the hands – a painful, debilitating condition which may require nursing staff to be moved out of clinical areas due to the risk of infection.

‘Gloves on?’

‘Glove Awareness Week’ (29 April – 3 May) will give nurses and healthcare workers the opportunity to think about when the gloves should be on or the gloves should be off and what they can do to reduce the risk of damage to their hands.

According to the campaign, gloves should be worn if there is a ‘high-risk’ of coming into contact with blood/body fluid, non-intact skin, or mucous membranes and when using certain chemicals such as disinfectants, preserving agents or cytotoxic drugs.

Staff should be aware of and ensure they abide by their organisations’ infection prevention and control policy.

To support nurses in becoming more glove aware the RCN has produced a series of resources including posters, leaflets and a selfie-board.

‘Being glove aware’

Rose Gallagher, RCN Professional Lead for Infection Prevention and Control said: “All those who work in healthcare have a responsibility for caring for our patients but we also have a responsibility for looking after ourselves and that can start with being glove aware.

“Ensuring gloves are worn in appropriate circumstances is equally as important as considering when not to wear them.

“Using gloves should not be seen as a replacement for good hand hygiene. With proper washing and moisturising of hands along with appropriate use of gloves we can look after our hands as well as preventing the spread of infections.

“If we don’t’ look after our hands we may not be able to look after our patients and ultimately risk long-term damage to our hands which in some cases can be life-long damage.”

Learning Disabilities

Mental health and learning disability services are deteriorating, says CQC

Growing pressure on services alongside chronic staffing issues risk creating a ‘perfect storm’ for patients.

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Nearly one in ten acute mental health and learning disability services are now rated as ‘inadequate’.

The quality of care provided by mental health and learning disability services has deteriorated in past last year, a report by the Care Quality Commission (CQC) has warned.

In the CQC’s annual assessment of the state of health and social care in England, the regulator warns that growing pressures on services alongside chronic staffing issues risk creating a ‘perfect storm’ for patients using mental health and learning disability services.

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The report reveals that 10% of learning disability inpatient services and 8% of acute mental health units and psychiatric intensive care units are now rated as ‘inadequate’, compared with just 1% and 2% respectively last year.

Fourteen independent mental health hospitals were placed into special measures since last October and three were closed permanently.

The number of child and adolescent mental health inpatient services rated inadequate has also risen to 8%, up on just 3% last year.

‘A perfect storm’.

Ian Trenholm, Chief Executive of the Care Quality Commission (CQC) said: “In this year’s State of Care, we have highlighted mental health and learning disability inpatient services because that’s where we are starting to see an impact on quality – and on people.

“There has been a deterioration in ratings in these services – and our inspection reports highlight staff shortages, or care delivered by staff who aren’t trained or supported to look after people with complex needs, as a reason for this.

“Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all.

‘Immediate and firm action is needed’.

Commenting on the report, Patricia Marquis, Director for RCN England, said:  “With this report, the official inspectors are putting England’s nursing shortage front and centre as a key reason for poor care – no area of care appears safe from the engulfing workforce crisis. Now that their concern is on record, it leaves Ministers with nowhere to turn – they must take immediate and firm action to address the 40,000 unfilled nurse jobs.

“The CQC is painting a picture of too many nurses reaching burnout or breaking point with patients paying the price. In A&E in particular, nursing staff and their colleagues are left trying to treat patients as best they can in a system without enough capacity or boots on the ground.

“The independent inspection body backs calls made by the RCN and others for a coherent workforce plan and also puts on record its view that the removal of the bursary for nursing students led to a decline in people able to train. Now that it has been recognised here, the Government must act to put at least £1 billion extra per year into nursing education if it hopes to recover lost ground and fill these vital jobs.”

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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