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Over half a million children in the UK are not vaccinated against Measles

Fear and scepticism about vaccines are thought to be contributing factors.

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Vaccine
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The number of deaths caused by measles has increased by nearly 300%.

Over half a million children in the UK missed out on the first dose of the measles, mumps and rubella (MMR) vaccine between 2010 and 2017, a report from UNICEF has warned.

An increase in the number of unvaccinated children is said to be the cause of measles outbreaks hitting several countries around the world

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In the first three months of 2019, more than 110,000 measles cases were reported worldwide – up by nearly 300% from the same period last year. An estimated 110,000 people worldwide, most of them children, died from measles in 2017.

The fear or scepticism about vaccines is thought to be a key contributing factor to the decrease in uptake in high-income counties.

Earlier this month, the head of Public Health England called on nurses to continue to “speak confidently” about the importance of vaccinations as they remain one of the most trusted sources of vaccine information.

‘A growing public health time bomb’.

“The ground for the global measles outbreaks we are witnessing today was laid years ago,” said Henrietta Fore, UNICEF Executive Director. “The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike.”

Simon Stevens, Chief Executive of NHS England’, has urged parents to get themselves and their children vaccinated with the MMR vaccine, which protects against measles, mumps and rubella.

“Getting yourself and your children vaccinated against killer diseases is essential to staying healthy, and vaccine rejection is a serious and growing public health time bomb,” he said. 

“With measles cases almost quadrupling in England in just one year, it is grossly irresponsible for anybody to spread scare stories about vaccines, and social media firms should have a zero-tolerance approach towards this dangerous content.”

The MMR vaccination is provided for free to all children on the NHS as part of the routine immunisation programme.

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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