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Hospital introduces ‘comfort trolleys’ for the families of palliative care patients

The trolleys include; light snacks, tea, coffee and toiletry items for relatives to freshen up.

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comfort trolleys' for the family of dying patients
Southern Health and Social Care Trust

The trolley gives families a little bit of comfort during a very difficult time.

A hospital has introduced ‘comfort trolleys’ for relatives sitting with patients who are nearing the end of life.

Staff on Ward 2 at the Lurgan Hospital in Northern Ireland launched the initiative after they noticed that many visitors were often reluctant to leave the side of dying relatives or ask ‘busy staff’ for help.

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The trolleys, which is left in the rooms of patients nearing the end of their lives, includes; light snacks, tea, coffee and toiletry items for relatives to freshen up.

A senior nurse for the trust praised the team saying the initiative has given families “a little bit of comfort during a very difficult time”.

They are now available on all wards in Lurgan and Loane House, South Tyrone Hospital having won a ‘Dragon’s Den’ style competition for funding at the Trust’s Quality Improvement Event last year.

Showing great compassion.

Pat Nugent, Head of Service for the Southern Trust’s Non-Acute Hospitals explains: “As a Non Acute Hospital, our team at Lurgan specialise in offering high-quality rehabilitation services.”

“In some cases, patients are sadly unable to rehabilitate and can deteriorate to the stage of requiring end of life care, known as Palliative Care. As a very emotional time for the whole family, this involves looking after the patient as well as their loved ones, with great compassion.

“Understandably, families want to spend as much time as possible with their loved one at the end of life and we do everything we can to allow this, supporting them with their emotional as well as physical needs.

“Often families don’t want to leave their relative to go for refreshments during their last hours or don’t want to ask staff, who they feel are already very busy looking after patients.

“The Trolley which is left in the patient’s room for families to help themselves is a very simple and inexpensive solution.

“I sincerely thank those staff members who came up with this concept which will go a long way in offering a little bit of comfort during a very difficult time.”

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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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Nurse with patient in bed

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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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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