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Two thirds of nurses struggle to provide good end of life care due to staffing shortages

There are approximately 40,000 nursing and 110,000 social care vaccines in England alone.

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Staffing shortages also mean many are being denied the chance to debrief or reflect.

A survey, carried out by the Nursing Standard and the charity Marie Curie, reveals the devastating impact staffing shortages are having on end of life care across the UK.

There are approximately 40,000 nursing and 110,000 social care vacancies in England alone.

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Almost two-thirds of nurses said staffing shortages are the main barrier to providing good care to dying patients.

Despite so many staff saying their roles involve caring for people in the final months, weeks or days of life, more than half said they found accessing support systems difficult.

‘A lack of time and short staffing’.

Nurses reported they often felt the need for extra support, but a lack of time and short staffing made even the chance to debrief or reflect with colleagues difficult.

One respondent said: “When I was in the ward if the patient had passed away we wouldn’t stop because we have other patients to look after. It’s never easy for nurses.”

Many respondents reported that they drew support from colleagues and expressed the value of a strong team. Although one commented that senior staff seemed to have little idea of the impact caring for patients at end of life could have: “[I] had 10 patients die within six weeks, five aged 45 to 55. [I] spoke to manager about lack of support to staff [and] was told if I needed management support perhaps I was in the wrong job.”

‘Staff are doing their best’.

Julie Pearce, Marie Curie Executive Director of Nursing, Allied Health Professionals and Quality says: “The results show that in the NHS and the caring sector, staff are doing their best to do the right thing for patients, but are feeling hard pressed.

“There seems to be more fragmentation in services, which affects the vital continuity of care for patients and their families during a very significant part of their journey through life and death. There is only one opportunity to get end of life care right for people and when it doesn’t go well it can affect a family for many years.”

She adds that the lack of support for staff is very worrying and would further impact patients and their families: “The emotional burden of care should not be under-estimated and requires active support by employers in supporting the health and wellbeing of its staff.

“To enable staff to care for patients and their families in a compassionate way, organisations really need to invest in the health and wellbeing of staff and the type of support they offer. This is a key area for us as at Marie Curie.”

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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