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Over 4,000 additional mental health nurses needed in the next five years

4,230 mental health nurses are needed to ensure the Government can deliver the NHS Long Term Plan. 

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Over 2,000 nurses are required throughout children’s and young people’s mental health services.

A report has revealed that an additional 4,230 mental health nurses are needed to ensure the Government can deliver the NHS Long Term Plan.

Published last week, the new NHS Mental Health Implementation Plan for 2019-20 to 2023-24 sets out how NHS England aims to deliver on the commitments made for mental health services in the NHS Long Term Plan.

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The NHS Long Term Plan promised extensive investment in both acute and community mental health services, with strategies such as liaison support in emergency departments and the introduction of mental nurses in ambulance control rooms.

The report predicts that in five years’ time there should at least an additional; 2,110 nursing staff working in children and young people’s mental health services, 2,010 nursing staff working in acute adult and community care and 110 nursing staff working in perinatal mental health.

With an estimated 40,000 registered nursing vacancies in England and an overall decline in the number of applications to undergraduate nursing courses, experts are concerned about how this target will be met.

The workforce remains a worry.

Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, said: “The ambitious vision of the NHS Long Term Plan provides a further step change for mental health services, with more people able to access treatment and more specialised services.

“The Implementation Plan now gives us a clear route to living that vision. There is much to welcome, not least the roll-out of a Patient and Carer Race Equality Framework and clarity on opportunities for voluntary, community and social enterprises to lead in the delivery and implementation of services.

“However, the timescales are tight for planning in the first year and we must be careful, too, about being too prescriptive. Ultimately, we believe the best approach is to empower local leaders to use their knowledge to drive these improvements and do what works best in their areas.

“Workforce remains a worry – it is good news that local areas will be more involved in developing their workforce but, with mental health services suffering from particularly high vacancy rates, we will need to see support from the centre.

“And we must acknowledge that mental health services cannot succeed in a vacuum. Mental health services must work in partnership with other parts of the system, with mental health being threaded throughout STP and ICS plans.

“Importantly, investment is needed in the wider health and care system – including in social care, capital, public health and supported housing – if the vision of the Long Term Plan is to be achieved.”

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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