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‘Significant staffing gaps’ will make the crucial expansion of mental health services difficult

“Making mental health nursing an attractive career and retaining experienced mental health staff must become a priority to ensure no one with a mental health problem is left behind.”

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Significant staffing gaps will make the announced expansion to mental health services difficult.

Philip Hammond has announced a 15 percent real-terms spending rise on NHS mental health services in England.

Hammond revealed: “The NHS 10 Year Plan will include a new mental health crisis service with comprehensive mental health support available in every major A&E children and young peoples’ crisis teams in every part of the country.

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“More mental health ambulances more ‘safe havens’ in the community and a 24-hour mental health crisis hotline.”

He adds: “These new services will ensure that people suffering from a crisis, young or old, can get the help they need, ending the stigma that has forced too many to suffer in silence and the tragedy of too many lives lost to suicide

“We are proud to have made this extraordinary commitment to funding our NHS.”

Retaining mental health staff must be a priority.

However, the Royal College of Nursing says increasing mental health services will be difficult without equivalent increases in mental health staffing.

Dame Donna Kinnair, RCN Acting Chief Executive and General Secretary, said: “Ensuring a bigger proportion of the money promised by the Chancellor to the NHS is spent on mental health is a crucial first step to correcting the historical underfunding of services for people with mental health problems. This will go some way towards putting physical and mental health services on an equal footing – as long as the extra money is ringfenced to prevent it being diverted to ease crises at NHS Trusts as another tough winter approaches.

“While it makes sense to set up closer links between schools, social services and the NHS, around 5,000 mental health nurses have left the health service since 2010, so it’s difficult to see how this vision will be realised without a sufficient, well-trained nursing workforce.  A&E departments already have significant staffing gaps.

“Making mental health nursing an attractive career and retaining experienced mental health staff must become a priority to ensure no one with a mental health problem is left behind.”

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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