Innovation in action: transforming patient care in Northern Ireland
The latest in Nursing Standard's series marking the RCNs centenary year by celebrating modern nursing roles focuses on the work of four nurses in Northern Ireland.
These nurses are leading the way in transforming how care is delivered to patients through establishing new and innovative services, says RCN Northern Ireland director Janice Smyth.
With determination and commitment, they have made a huge difference to patients experience and quality of life.
Northern Ireland Hospice (Adults) clinical services manager Hilary Maguire and Northern Ireland Childrens Hospice transition nurse specialist Anne OReilly created a new transition health service for young people with complex needs who previously did not have appropriate care.
Children with life-limiting conditions are a distinct group with specific psychological, cognitive and social needs.
Having had the same...
The latest in Nursing Standard's series marking the RCN’s centenary year by celebrating modern nursing roles focuses on the work of four nurses in Northern Ireland.
‘These nurses are leading the way in transforming how care is delivered to patients through establishing new and innovative services,’ says RCN Northern Ireland director Janice Smyth.
‘With determination and commitment, they have made a huge difference to patients’ experience and quality of life.’
Northern Ireland Hospice (Adults) clinical services manager Hilary Maguire and Northern Ireland Children’s Hospice transition nurse specialist Anne O’Reilly created a new transition health service for young people with complex needs who previously did not have appropriate care.
‘Children with life-limiting conditions are a distinct group with specific psychological, cognitive and social needs.
‘Having had the same paediatrician since birth, at 18 or younger they were suddenly discharged, and the only generalist medics are geriatricians. When they left the children’s hospice they weren’t admitted to adult hospice unless they were actively dying.
‘A growing number of children with life-limiting conditions were falling into “limbo” between paediatric and adult health and social care provision.’
‘We had been lobbying individually for young people’s services and in 2010 began working together.
‘We formed a regional group to look at creating transition services for young people with complex needs, and our workshops laid the foundation for the Health and Social Care Board’s Children and Young People’s Strategic Partnership.
‘Young people and parents highlighted four areas of concern: staff in adult hospitals may not have cared for someone with their condition, the shortage of suitable respite (some had been in nursing homes with adults in their 80s), non-transferrable care packages and lack of transition planning.
‘In 2013, we gained funding for a short pilot to deliver hospice day care to young adults. We involved young people at every stage – they learned interviewing skills and kept a film diary throughout the pilot.
‘The service in the adult hospice was staffed by nurses from adult and children’s Hospice at Home, and the young people called it ‘Beyond Horizon’.
‘The pilot resulted in 2 years’ funding to include developing best practice and e-learning modules. Our work laid the foundation for a Northern Ireland Hospice Corporate Transitions Group that has agreed criteria and a process for transitioning from child to adult hospice services.
‘The first young person was admitted to the adult hospice for symptom management last December, and others are being supported by adult community hospice nurse specialists.
‘Several make a 100-mile round trip to attend the Beyond Horizon day hospice group. They like meeting friends and doing ‘normal’ things in a safe environment with nursing support.
‘When a young person dies it can be difficult for the rest of the group. But we have well-established peer supervision and access to counselling, and encourage them to talk or join a group discussion.’
Northern Health and Social Care Trust Macmillan uro-oncology project nurse Kirsty McKay has developed a nurse-led post-radiotherapy review clinic for men with prostate cancer.
‘I’ve specialised in oncology for almost 18 years. About 2 years ago I saw there were long waiting times in the prostate cancer clinic. Our trust covers a large geographical area, so some older men come from far away to attend a 10-minute appointment.
‘This was frustrating for patients and the oncology team. Older men are often less willing to ask for help: there was no clinical nurse specialist and they were unsure who to go to if they had a problem.
‘I was concerned they would leave the care pathway after treatment, so decided to set up a nurse-led review clinic.
‘We take a holistic approach, looking at their emotional and physical well-being and how they’re managing at home, and we make a care plan available to patients after each review.
‘Since May 2014, the clinic has reviewed more than 330 men. Patients are generally receptive – they appreciate someone taking the time to listen and they know I will call them after their appointment.
‘Older men are often less willing to ask for help. I was concerned they would leave the care pathway after treatment.’
‘They also find it reassuring that they can call me if they have any problems.
‘Initially, it was a bit uncomfortable asking men about their sexual function, but most of them are pleased that help and support is available. They like the continuity, and I can refer them to a counsellor or psychologist or other support services.
‘Through partnership with a number of charities, I secured funding for an 8-week self-management programme for men and their partners. We wanted to include health and well-being, exercise, stress management and coping with sexual dysfunction.
‘The programme was successful and we ran it three times. Patients say they enjoy meeting other men in a similar situation and their partners say they gain a better understanding of the condition.
‘My project has been continued because it works. Current funding lasts until the end of 2017, but the trust is looking at ways to continue it.’
Four Seasons Health Care regional manager Lorraine Kirkpatrick created new mental health units that enable clients who have spent years in psychiatric hospitals to ‘live again’.
‘I always wanted to be a psychiatric nurse, but implementing change in a psychiatric hospital was difficult.
‘At Four Seasons I’ve been able to develop new mental health units with in-patient beds, complex mental health recovery beds and residential rehabilitation services.
‘Belfast Trust informed me they were closing long-stay wards in a psychiatric hospital and I told them we could meet their needs.
‘I created a training programme to build on staff skills and the first 17-bed unit opened in Belfast in 2014. The design of the units was led by patients and supported by staff and trust colleagues.
‘Some of the patients had been hospitalised for 25 years, and suddenly they had a bedroom they could paint and could choose pictures for their walls. They could go golfing or to the weekly market.
‘We’ve seen a 100% positive change in self-care and living skills and have created jobs for nurses.’
‘At the initial assessment we find out where they want to be in a year’s time and start with what’s achievable. Having a doctor working in the units who is skilled in mental health has been helpful.
‘Anti-psychotic injection therapy has been eradicated in the mental health residential unit and there has been a significant decrease in anti-depression medication.
‘Confidence in us as good providers has grown, all of our units are full, and we’re now working in partnership with three trusts. In 2014 we opened a 15-bed unit in the South Eastern Trust, and have since opened a second unit in Belfast and an 8-bed unit in the Northern Trust.
‘The key to our success is positive risk management. We’ve seen a 100% positive change in self-care and living skills, and we’ve created jobs for nurses.’
Alison Whyte is a freelance journalist
More in this series
Nursing Standard is marking the RCN’s centenary year by celebrating the astonishing range of modern nursing roles and the often unheralded great work by nurses across the regions.
- The changing face of modern nursing in the south west
- Great achievements by dedicated nurses in the south east of England
- The inspiring nurses in the north of England who make a difference in their modern roles
- Inspirational, meaningful care: quality nursing across Scotland
- Nurse pioneers transforming care in the eastern region
- Improving patient care and staff satisfaction in north west England
- From nutrition to co-production: celebrating nursing innovation in London
- Celebrating nursing innovation across Yorkshire and the Humber
- Nurse-led initiatives transforming patient care across the East Midlands
- Setting the bar high: nurses in Wales deliver improvements for patients
- A new approach: celebrating nurse innovation in the West Midlands
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