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Clinical Updates

RCN launches member survey on decriminalisation of termination of pregnancy

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The RCN is launching a UK-wide survey of its members on the principle of removing criminal sanctions from termination of pregnancy.

The online survey, which will run from Friday 16 February to Sunday 18 March 2018, will help the RCN to form a position on decriminalisation.

Currently, termination of pregnancy is legal in England, Scotland and Wales, within certain criteria that must be agreed by two doctors. Without this agreement, termination is a criminal offence which could result in a prison sentence. In Northern Ireland, termination of pregnancy is illegal except in very limited cases.

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There is growing debate about removing criminal sanctions from termination of pregnancy. Currently, the RCN does not have a position on decriminalisation. The College is committed to developing a position so that it can contribute to the debate.

The survey will not consult on the wider issues around termination of pregnancy, including the arguments for or against the procedure. The RCN is not calling for any change to gestational limits or changes to the right to conscientious objection by health care professionals.

There are different ways in which termination of pregnancy could be decriminalised but the survey will only focus on the principle of whether or not it should be removed from criminal law.

Commenting on the survey launch, Janet Davies, Chief Executive and General Secretary of the Royal College of Nursing, said:

“Decriminalisation is an important issue for today’s society to consider and one the College is committed to having a position on.

“As the largest nursing organisation in the United Kingdom, we wish to understand the views of our members.

“I encourage all RCN members to complete the survey to help us inform our position.”

You can take part in the survey hereResponses to this survey will not be shared publically and RCN membership numbers will be removed before the results are analysed so that views cannot be attributed to individual members.

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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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