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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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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.

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

Healthcare staff have a ‘professional responsibility’ to get the flu vaccine

This seasons flu vaccination target is set “above 90%”.

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Frontline health and social care workers will be offered the seasonal vaccine by their employer.

Healthcare staff have a “very strong professional responsibility” to get the winter flu vaccination, argues England’s Deputy Chief Medical Officer.

Figures show that while the number of healthcare workers getting the vaccine has “improving remarkably”, with around 70% receiving the vaccination last season, there is still work to be done as in some areas uptake rates were “in the 40s or 50s”.

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With this seasons target set at “above 90%”, frontline health and social care workers will be offered the seasonal vaccine free of charge by their employer.

‘Staff can spread flu without realising it.’

Professor Jonathan Van-Tam, Deputy Chief Medical Officer for England, said: “We do know that flu infections, while sometimes severe, can also be asymptomatic, and staff can spread flu without realising it.

“From a patient perspective, you don’t want to be in a situation where you feel that seven out ten of the healthcare professionals you meet will be vaccinated; you’d like to be in a situation where nine or ten out of ten you meet are vaccinated.

“So I think there’s a very, very strong professional responsibility on healthcare workers to be vaccinated.”

‘Staff should be encourage not coerced.’

Commenting on the call from the Deputy Chief Medical Officer for England for healthcare workers to have the flu jab, UNISON head of health Sara Gorton said: “No NHS worker would ever willingly put patients or colleagues at risk.”

Empahsising; “the highest vaccination rates are in trusts that encourage staff to get the jab, not those where employees are coerced.

“Pressuring staff to have the injection, when some may be reluctant for genuine reasons, is counter-productive. The NHS couldn’t get by without the goodwill of its staff and trusts shouldn’t jeopardise that.”

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