Clinical Updates
Mums to be are to be offered one-to-one support to stop smoking
Partners of pregnant women will also be encouraged to kick the habit to give new mums the best chance of not smoking again.
Mums to be will offered NHS-funded one-to-one support to stop smoking.
Under the NHS Long Term Plan, Mums to be are to be offered NHS-funded one-to-one support to improve their own health and give their newborn babies the healthiest start in life.
The most recent figures show that women in England are amongst the most likely to smoke during pregnancy with 10% still lighting up at the time of their baby’s delivery, which doubles the risk of still birth, substantially increases the likelihood of miscarriage and triples the chances of sudden infant death.
Across the country, there is significant variation in the number of pregnant women who smoke, ranging from 2% in Kensington & Chelsea to over one in five in Blackpool.
Partners of pregnant women will also be encouraged to kick the habit to give new mums the best chance of not smoking again.
Announcing the plans, NHS England chief executive Simon Stevens said; “Alcohol and tobacco addiction remain two of the biggest causes of ill health and early death, and the right support can save lives.
“Every smoker admitted to hospital will be offered NHS support to quit”.
Smoking cessation specialist midwives are needed.
Sean O’ Sullivan, Head of Health and Social Policy at the Royal College of Midwives said; “The RCM welcomes this announcement in particular the focus on tackling smoking rates during pregnancy. The commitment to fund intensive support for women to stop smoking during pregnancy and to encourage their partners who also smoke to quit is particularly welcome.
“What the RCM would like to see is a major investment in smoking cessation specialist midwives if these plans are to become a reality. In a recent survey conducted by the RCM in which heads of midwifery from across the UK responded it was reported that almost 70 percent of them did not have a smoking cessation specialist midwife in their maternity teams.
“Also, midwives need access to appropriate training and need time off to complete training to become a specialist midwife and we know as our members tell us often maternity services are too short staffed that planned training is postponed far too often as midwives are called back to understaffed labour wards to care for women and their babies.
“While the RCM welcomes these plans we are concerned that health budgets to councils have been cut and as a consequence local authorities who provide smoking cessation services are struggling to meet the demand within local communities in England.
“While the RCM supports this part of the NHS long term plan, the implementation of the entire plan just like the recently announced new maternity package cannot be done on a shoestring – successful implementation of any such plans will need real investment in the recruitment and retention of midwives, in the training of more specialist midwives.”
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.
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.
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.”
Clinical Updates
Nurses’ ‘worry’ better than most early warning scores, finds study
Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’.
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.
Nurses were asked to grade each patient between “no concern” and “extreme concern”.
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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