Celebrating Nursing Practice: Seven of the best projects

Funding provided by the RCN Foundation will allow nurse innovators to develop and expand their local projects. The charity hopes the programme will have a lasting legacy   

Funding provided by the RCN Foundation will allow nurse innovators to develop and expand their local projects. The charity hopes the programme will have a lasting legacy

Deepa Korea: These are future
leaders. Picture: David Gee

Nursing staff leading seven diverse and innovative projects have been invited to make their case for extra investment under the RCN’s Celebrating Nursing Practice programme. Those selected for further funding will be able to implement their good practice more widely and evaluate its impact.

The RCN Foundation has given £130,000 worth of backing to the programme. The charity wanted the projects to reflect a breadth of topics, nursing specialties, geographical areas and nurses at different stages of their careers – from nursing students to established academics. ‘They demonstrate great work in different ways,’ says head of the foundation Deepa Korea. ‘These are the leaders and innovators of the future and that comes through very strongly.’

Some of the projects that have shone most brightly have focused on making small changes. ‘It’s not necessarily about changing systems, although that may end up being the wider impact,’ says Ms Korea. ‘But the focus is always on changing practice to be beneficial to the care of patients.' 

Among the foundation’s central objectives is to raise the profile of nursing, highlighting the contribution the profession makes to healthcare in the UK. ‘This project sits firmly in the middle of that aim for us and is very important,’ says Ms Korea.

What the RCN Foundation does

The RCN Foundation is an independent charity that supports nursing staff to improve the health of the public and offers financial support and career development opportunities to UK nurses, midwives, healthcare assistants and nursing students.

It funds nursing-led projects and has benevolent funds that provide financial help to past and present members of the nursing community. Bursary schemes support nursing staff in learning, development and research, while project grants are awarded to nurse-led work.

The foundation hopes the programme will have a lasting effect. ‘I would like more people to become aware of nurse innovators and how they add value to the healthcare system,’ says Ms Korea. ‘This is work they are doing every day but is often taken for granted. I’d like that “taken for granted” element to stop and for their contribution to be more widely acknowledged.

‘The projects that will go through for further funding and development have the potential to change the way practice in some settings is delivered. It will be interesting to see how those lessons can be embedded more widely. If that is the legacy, I would be delighted.’

A unified public health team

Angela Ladocha.

Creating a unified public health team, which looks after babies, children and young adults from birth until the age of 19, can help maintain relationships between families and professionals and support continuity of care, says Angela Ladocha, a team leader with Locala Community Partnerships, a social enterprise that provides NHS community services to people in Kirklees, West Yorkshire.  

‘Previously we had a health visiting service for children up to five, and a school nursing service for those up to 16. The two services worked separately and my plan was to integrate them.

‘Many services nationally are changing to this kind of approach and it has a number of benefits. It removes unnecessary barriers or disruption to care and prevents “silo” working, duplication and fragmentation. It also helps maximise the opportunities to support families, making every contact count.

‘Developing a competent workforce has been key to the project’s success, and we have created four comprehensive workbooks that incorporate e-learning resources, further guidance and reading. They include an induction for new staff and skills-sharing workbooks, enabling those who worked with different age ranges or as health visitors or school nurses to develop by learning each other’s skills.

‘To date we have developed 28 competencies, which are being tested. We are capturing stories to illustrate good practice and we also plan to gather feedback through client surveys.’

Visual aid for new mums

Janine McKnight-Cowan.

A simple visual tool designed by health visitor Janine McKnight-Cowan helps healthcare professionals explain to new mothers who have had a caesarean section why it’s important to ‘take things easy’.

‘More than a quarter of all babies born in the UK are delivered by caesarean section, with women who are recovering told “to take things easy” for a few weeks,’ says Ms McKnight-Cowan, who works for Derby Community Health Services.

‘Following my experience as a scrub midwife, I invented the Five Guide Tool. As I knew how many layers of their skin had been cut and sutured, I could encourage women who were recovering to become more in tune with their anatomy and its healing process.

‘The tool helps clinicians explain abdominal healing, using their own hand to create a visual picture. This shows the thumb as layer one and the skin wound, the index finger as the fat layer, the middle finger as the separation of the abdominal muscles, the ring finger as the separation of the peritoneum and the fifth and final finger as the womb.

‘From September to November 2017, 15 health visitors in two teams received training on the initiative, while 14 women who had C-sections provided feedback. Staff found the tool effective, with positive comments including “powerful and easy to remember”, “visual and always at hand” and “each time I now use it, it reminds me every woman needs to hear the same information”. They are now using it each time they care for a woman who has surgically delivered her baby.

‘Eleven of the patients felt it had been the most beneficial information they had received. One woman’s partner said: “Each time she tries to Hoover or clear up, I can remind her she has five layers of skin healing, and not just her skin wound.”

‘We are now looking at producing a workforce training video, with the aim of increasing its scope to a wider audience.’

Practice nurse protocols

Lucy Wood.

General practices have multiple protocols for practice nurses, and these vary hugely between areas. Standardising the protocols brings a range of potential benefits, says Lucy Wood, educational lead at Devon Community Education Provider Network.

‘Many nursing hours are wasted each year with individual practice nurses writing and reviewing protocols. Challenges include enormous variation in content and quality, as they are not regulated or externally checked. Guidance on diagnosis, treatment pathways, evidence and updates can be out of date by a time a protocol is agreed, and they can also be difficult to find and access.

‘My idea to centralise and standardise protocols would lead to clear improvements in quality, including improving experience, care and safety for patients. In addition, it would save clinical time and reduce unwanted variations in care between surgeries.

‘After gaining support from key organisations, including clinical commissioning groups, two pilot protocols have been developed and are being tested. These are in chronic obstructive pulmonary disease and diabetes. A working template for further protocols will follow.

‘Once they have been quality approved, practice nurses throughout Devon will be able to access up-to-date protocols at their desktop, while a central repository means they can be easily updated. This relieves pressure to develop them from individual nurses, giving them more time to focus on patient care.’

Help from a picture book

Can a picture book help reduce obesity and promote physical well-being for people with a learning disability? Practice development facilitator Giselle Cope of the Foundation of Nursing Studies and assistant practitioner Laura Lovejoy-Carter, who works at an inpatient learning disability service in Northampton, are evaluating its impact.

‘The picture book Rose Gets in Shape follows Rose through the struggles and successes of her weight loss journey, the activities she takes up and the friends and support she finds along the way.

'Our project has been co-designed with patients to assess its effectiveness in supporting health outcomes, including reducing obesity and promoting physical well-being. Our intention is to share how patients used the book, written by Roger Banks and Paul Wallang, with illustrations by Mike Nicholson, looking at the benefits of these kinds of specialist publications.

‘After setting up a core project group, we identified two wards to take part, training six nursing staff in visual literacy techniques. In January, we held two focus groups on women’s medium and low secure wards, with ten patients in total. Book clubs were then piloted.

‘As a result of the work so far, we believe the project is an effective model of working with people with a learning disability to achieve health benefits, and it could be used to address a wider range of health issues.

‘Pop-up book clubs can be easily replicated, providing people with learning disabilities the chance to make their own decisions and have meaningful social interaction. They can also help combat loneliness, providing a setting where people can discuss their thoughts, feelings and worries, and support each other.’

Toolkit for complex needs

Picture: Alamy

While patients with complex needs should complete health passports, they are often not detailed enough. Third-year children’s nursing student Ewout van Sabben of the University of West London is proposing a new and comprehensive toolkit to improve communication.

‘There can be a lot of staff anxiety about communicating with patients who have complex needs, especially those with learning disabilities, and this can lead to making the person’s hospital stay a negative experience.

‘A specially created toolkit will help bridge gaps in communication. This will reduce staff anxiety and provide a more positive experience for everyone involved. The aim is to provide tips from specialists, signposts and resources on effective communication that can be easily implemented on a ward setting. 

‘Alongside the toolkit, I also propose having RCN “communication champions”, who would provide regular training sessions for other staff to ensure the toolkit is used properly. They would also be able to share good practice and help evaluate progress.’

More details on Ewout van Sabben’s project

Keeping baby safe

Desiree Deighton with her
Safe Baby picture book.

Desiree Deighton hopes a book that helps nurses communicate with parents who don’t speak English will support the prevention of sudden infant death syndrome (SIDS). Ms Deighton is in her final year of studying children’s nursing at the University of Bradford.

‘Bradford infants are at an increased risk of SIDS as there is a high incidence of poverty, deprivation, prematurity and low birth weight. The city’s safeguarding board found the primary modifiable cause of child death from 2008-16 was co-sleeping and SIDS.

‘Meanwhile the Born in Bradford study has outlined the need for tailored advice about SIDS for the city’s parents as mothers reported it was "irrelevant" to them and so did not follow safe sleeping guidance. A further study showed that South Asian infants were more likely to be placed on sofas, bed-share with parents, have pillows and a duvet, be positioned on their front or side, be swaddled and breastfed in bed. Yet currently there are no leaflets or guidance available that are language-friendly, with clear “how to” images.

‘I created the picture-based Safe Baby book to support nurses in communicating the importance of safe sleeping guidelines to parents who don’t speak English. With help from an illustrator, I designed each page of the booklet according to SIDS prevention guidelines and reflecting specific issues I encountered on my placement. The booklet includes step-by-step health messages and features characters from a wide range of ethnicities.

‘I believe this book could reduce child deaths by making parents more aware of how to prevent SIDS. It would also make discharge easier for nurses, save time on repeated home visits and help to educate parents. Trials could be carried out in other areas that have a similarly vulnerable demographic and eventually I think it could be used throughout the UK. Looking ahead, a series of Safe Baby books could include other topics such as sterilising bottles and breastfeeding.’

Template for leg ulcer care

Leg ulcers can ruin people’s quality of life, yet their impact is not always discussed or addressed. Following her own research, lecturer Julie Green of Keele University created a consultation template, encouraging nurses and patients to talk about these issues and act on them.

‘Research carried out as part of my PhD showed the devastating impact of chronic venous leg ulcers on patients, who talked about their pain, odour and social isolation. But despite these frank revelations, patients would tell their nurses they were comfortable, even though in interviews they said they were in pain and unable to sleep.

‘To help patients and nurses discuss the impact on quality of life, I developed a simple, patient-led consultation template, which enables individuals to direct care to the issues affecting them. A small-scale pilot has indicated improvement in both satisfaction with the consultation and quality of life outcomes.

‘Before I developed this tool, issues with a psychological underpinning were least likely to be raised or explored. Consultations tend to focus on the healing of the wound and although this is often the patient’s focus too, there are many day-to-day effects that could be alleviated if only the clinician were made aware.

‘Since its development in 2014, the template has been adopted by several trusts, but uptake has been slow. Now the aim is to roll it out nationally. In the future, the focus of wound care consultations could be changed to provide our patients with a voice.’

Lynne Pearce is a freelance health journalist 


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