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We need a maximum safe working temperature, says UNISON

Current legislation specifies minimum working temperatures, but not a maximum.

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Measures could include flexible working, extra breaks, access to water, cooling systems and air conditioning.

With temperatures soaring above 40 degrees on some wards, clinics and offices earlier this week, UNISON has welcomed a pledge to legislate for a maximum safe working temperature.

The Labour party revealed plans earlier this week for changes to law requiring employers to ensure effective measures in place if the workplace temperature gets above 30˚ Celsius – or 27˚C for those doing strenuous work.

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Those measures could include flexible working and travel arrangements, extra breaks, access to water, cooling systems and air conditioning, flexible dress codes or the provision of protective clothing.

Current health and safety legislation specifies minimum working temperatures, but not a maximum.

‘Not safe’.

A lack of a maximum working temperature means most workers have no legal safeguards to protect them from working during uncomfortably high temperatures or dangerous extreme heat.

UNISON head of health and safety Robert Baughan points out that both the union and the TUC “have long called for indoor maximum of 30˚C. We would also call on employers to do more to protect those working outdoors in these temperatures.

“The sort of temperatures we are seeing this week may mean it is just not safe to carry on working as normal. A change of duties may need to be considered or stopping work altogether.

“Other measures would include making sure workers are appropriately clothed to protect them from the sun, and making sure they have enough liquid.

“Employers should also consider relaxing dress codes – whether staff are working indoors or outdoors.”

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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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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