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Nurse pioneers transforming care

Nursing Standard is marking the RCN’s centenary year with a monthly series celebrating modern nursing across the UK. Here, Alison Whyte highlights the innovative work of nurses in the eastern region   
Pioneering nurses in the Eastern region are transforming care. Picture: Getty

Nursing Standard is marking the RCNs centenary year with a monthly series celebrating modern nursing across the UK. Here, Alison Whyte highlights the innovative work of nurses in the eastern region

The three nurses featured here work in very different settings but have in common their inspirational approach, according to RCN Eastern region director Karen Webb. These nurses, who work in the vital areas of child mental health, emergency care and patient records, demonstrate how by taking an inspirational approach - nurses are improving patient experience.

Across the Eastern region there are many more nurses leading innovations that will leave a legacy of better care and excellent service.

Carol Evans, community psychiatric nurse, Cambridgeshire and Peterborough Foundation Trust

In September 2015, with two other mental health nurses, Carol Evans set up the pioneering Project for Schools.

Carol Evans ...

Nursing Standard is marking the RCN’s centenary year with a monthly series celebrating modern nursing across the UK. Here, Alison Whyte highlights the innovative work of nurses in the eastern region

The three nurses featured here work in very different settings but have in common their ‘inspirational approach’, according to RCN Eastern region director Karen Webb. ‘These nurses, who work in the vital areas of child mental health, emergency care and patient records, demonstrate how – by taking an inspirational approach - nurses are improving patient experience.

‘Across the Eastern region there are many more nurses leading innovations that will leave a legacy of better care and excellent service.’


Carol Evans, community psychiatric nurse, Cambridgeshire and Peterborough Foundation Trust

In September 2015, with two other mental health nurses, Carol Evans set up the pioneering Project for Schools.

Carol
Evans

‘I have been a mental health nurse for 30 years and have a lot of experience of working with children. When we launched the project there were long waiting lists for CAMHs (child and adolescent mental health services) and many families needing Early Help.

‘Child mental health services have decreased in recent years and schools are desperately trying to manage. Higher thresholds for assessment means that many children referred don’t meet the criteria.

‘Teachers are expected to do a multitude of things – as well as teach - with little training or expertise. At first it was difficult to explain that we didn’t have a magic wand to change children’s behaviour overnight.

‘We launched a daily advice line for teachers to discuss their concerns about a child, or to ask us to observe a child and provide advice. Most schools are really pleased to have someone to talk to.

‘We made Information packs to help school staff support children who are struggling with mental or emotional problems before they become pathological or entrenched. We also created a training package to raise mental health awareness, with information on attachment, autism, ADHD, anxiety and trauma.

‘We work with around half of the 70 primary schools in our area. In September, we plan to target the other primary schools and the project may be extended to secondary schools. Sadly, because of the demand, the children who are quiet and withdrawn don’t come to our attention unless there is a very insightful teacher.

‘We work closely with the local Primary Behaviour Panel, which is part of the Early Help service, so we have access to information about families. We know, for example, if the family has been involved with social care or if there is domestic abuse so we are able to think about whether the child has a behavioural problem or a mental health condition.

‘It’s satisfying to know that we’re helping children to get recognition for the difficulties they face, and that our support to the teachers is being used and valued.’


Matthew Osborne, emergency department charge nurse, in Southend University Hospital’s lecturer in adult care, University of Essex

Matthew helped create over a dozen new care pathways. He is also an RCN steward.

Matthew Osborne
Matthew
Osborne

‘Southend emergency department (ED) has frequently been high-performing in reaching the four-hour target. However, like all EDs, due to pressure on local services we’re seeing a rising number and acuity of patients presenting on a daily basis.

‘Following a series of clinical audits, we decided that we could improve and streamline the service to help us treat more people, more effectively and in less time.

‘With input from colleagues, I began to design new, integrated pathways that would enable us to collect accurate clinical information from patients and prompt speedy decisions about their care.

‘The first two pathways were for non-invasive ventilation for CPAP (continuous positive airway pressure) and Bi-PAP (bilevel positive airway pressure). Both interventions were usually carried out by the medical team to ensure follow through to the respiratory ward, but this meant care in the ED was delayed until the medical team had reviewed the patients – only by a few minutes, but an unnecessary delay.

‘We then embarked on developing a sepsis tool. Sepsis cases have been inadequately recorded by hospitals, there is insufficient knowledge of early treatment and its definition has been recently updated. We thought that a simple assessment tool and treatment plan for all ED staff would be a vital contribution to resolving this situation. To begin with we used it alongside our usual care.

91%

The proportion of sepsis patients treated within first hour at A&E

‘We now identify and treat more than 91% of sepsis patients within their first hour of arrival in the ED. The tool has been so successful it has been adopted and rolled out across the trust.

‘In the last seven months, I have designed and launched 12 new pathways for serious and life-threatening conditions and several others are in the pipeline.

‘Throughout my career, I have been a passionate educator to colleagues and mentor to nursing students. I’m currently studying to become an advanced nurse practitioner in emergency care.

‘I get satisfaction from a job well done, and I take pride in knowing that I am helping my colleagues to make a difference to the care of potentially hundreds of people every week.’


Sarah Seeley is transformation nurse lead, Ipswich Hospital NHS Trust

Sarah has introduced electronic observation charts and is pioneering new electronic developments to improve patient care.

Sarah
Seeley

‘The electronic era presents us with exciting opportunities to improve the patient’s journey and outcomes. My role is to advise, support and develop what works in clinical practice trust-wide.

‘Paper charts pose risks – they can be misplaced, partially completed or duplicated, and are only viewable at the bedside. Observations can be delayed, there is poor MEWS (Modified Early Warning Score) compliance and escalation relies on action by an individual.

‘In early 2015, under the Safer Hospital, Safer Wards scheme, the trust gained funding to implement electronic observations to improve deteriorating patients, reduce cardiac arrests and improve patient outcomes.

‘This led to the introduction of the Nervecentre system, which works on all computers and any mobile device. We chose Apple IPods for ease of use, size and security. Most staff members have their own IPod for recording patient’s vital signs electronically.

‘The system is configured to calculate the MEWS from the vital signs policy with the hospital’s escalation process automated. It enables the user to alert the nurse in charge, on call doctor and critical care outreach team when a patient scores high on the MEWS. The system also takes account of special circumstances for different patient groups, such as end of life or chronic respiratory disease.

‘The electronic era presents us with exciting opportunities to improve the patient’s journey and outcomes’

Sarah Seeley

‘All medical and surgical wards went live by October 2015.

‘Resistance to change was a barrier initially, but my senior nurse experience gave me clinical credibility and I worked closely with all the clinicians to demonstrate the benefits of viewing the patients’ observations electronically and remotely.

‘Escalation to senior colleagues electronically means ward staff can manage the sick patient earlier, doctors can be more proactive in monitoring patients’ observations as they can view them wherever they are and support can be sent to the wards as needed.

‘We have seen a month-on-month reduction in cardiac arrests and an increase in medical emergencies, which arises from earlier detection of the deteriorating patient.

‘I have always had a passion for innovation within nursing. I have seen many developments throughout my 27-year career, but implementing the electronic recording of patients’ vital signs and knowing that we’re developing systems that work clinically to improve care has been the most rewarding.'


Alison Whyte is a freelance journalist

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