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Nurses to hold UK Governments to account over homelessness

Everybody had a right to “have a roof over their head”.

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NursingNotes

Homelessness can leave people with respiratory problems, mental health issues or worse.

Royal College of Nursing members have voted to “hold the Government to account for their inaction over the health crisis of homelessness.”

Nurses voice their concerns today at the unions’ annual congress that homelessness is costing the health service billions by leaving people with respiratory problems, mental health issues or worse.

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The Matter for Discussion, initially proposed by the RCN’s North Yorkshire Branch, changed to an emergency resolution amid fears that any delay in action would only lead to further harm.

Speakers said they felt the situation was continuing to worsen due to the Governments austerity measures and called for urgent action to be taken.

Maria Trewern, the former RCN Council Chair, proclaimed that everybody had a right to “have a roof over their head”.

We don’t always see the homeless.

Helen Donovan, the RCN’s Professional Lead for Public Health, said: “The public often think of homelessness as the problem of seeing people sleeping rough in the streets but we must be wary that we often can’t see most of the people who don’t have a proper home.

“People who are facing eviction, living in temporary accommodation or squatting have great difficulty accessing the healthcare they need for long term conditions or illnesses that onset quickly.

“I think one of the aspects that really frustrates nurses is the feeling that they’re discharging people back into the environment that’s caused their ill health and the feeling of powerlessness that comes with that. Nurses are often the first among frontline healthcare professionals to see the opportunity to break the cycle of admissions.

“They must be supported to pilot schemes that can make a meaningful difference to the health of homeless people or those at risk of homelessness.”

“We must look at a wholescale change to how we approach this emerging public health crisis by examining how we commission services to prevent homeless people becoming iller and iller.”

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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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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