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Nursing innovators in the West Midlands

In the last of Nursing Standard's series showcasing the best of modern nursing in the UK, three nurses in the West Midlands explain how they are keeping children with complex conditions out of hospital, improving the care of patients with chronic lung disease and reducing avoidable infections in care homes. 
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In the last of Nursing Standard's series showcasing the best of modern nursing in the UK, three nurses in the West Midlands explain how they are keeping children with complex conditions out of hospital, improving the care of patients with chronic lung disease and reducing avoidable infections in care homes.

'I'm always inspired when I see or hear about great nursing,' says RCN West Midlands regional director Paul Vaughan. 'Nurses and healthcare assistants in this region are doing brilliant work with skill, compassion and passion at a time when they are under unprecedented pressure.'

Rachel Shanahan (pictured) is sister for children with medical complexities at Birmingham Children's Hospital. Along with her team, she coordinates care with the aim of reducing lengthy hospitalisation and frequent readmission.

Rachel

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In the last of Nursing Standard's series showcasing the best of modern nursing in the UK, three nurses in the West Midlands explain how they are keeping children with complex conditions out of hospital, improving the care of patients with chronic lung disease and reducing avoidable infections in care homes. 

'I'm always inspired when I see or hear about great nursing,' says RCN West Midlands regional director Paul Vaughan. 'Nurses and healthcare assistants in this region are doing brilliant work with skill, compassion and passion at a time when they are under unprecedented pressure.' 


Despite unprecedented pressures, nurses in the West Midlands are developing more personalised care. Picture: Getty 


Rachel Shanahan (pictured) is sister for children with medical complexities at Birmingham Children's Hospital. Along with her team, she coordinates care with the aim of reducing lengthy hospitalisation and frequent readmission.


Rachel Shanahan

'My role is highly unusual and possibly unique. It is part of the Well Child Nurses' Programme, set up to improve the care and support for children with serious, long-term or complex conditions.  
 
'Due to advances in medical care, many children who would previously have had to stay in hospital can now be cared for at home.

'The vast majority have multiple complex needs, including eating or breathing difficulties, learning disabilities or seizures. They may have tracheostomies or require ventilator support.
 
'A few years ago, when our hospital recognised that early forward planning for the discharge of these children could be improved, it was decided that a dedicated key worker could support families in accessing services that could enhance their quality of life.
 
'There are multiple teams involved in their care and I support experts in every specialty throughout the trust. The team comprises specialist doctors, an expert nurse discharge coordinator, an administrator and a family support worker. I bring them all together with the child at the centre.

'I support experts throughout the trust, bringing them all together with the child at the centre,'

– Rachel Shanahan

'Personalised, family-centred care is important to children with complex needs. When they leave hospital, they need health and social care, but there are no bespoke services for them. Caring for a very sick child with complex conditions has a huge impact on a family. I work alongside community teams who offer extended services that specifically meet their needs. 

'Some children may have been in a road traffic accident and have serious mobility problems, they may even be classed as homeless due to their particular housing needs. We identified the need for an expert to work alongside the team and we now have an in-house shelter adviser to try to solve family housing problems. 
 
'All these people play a crucial role in enabling the children to live at home, and in relieving some of the anxiety for their families.
 
'As well as improving discharge planning, we have reduced long-term hospitalisation and frequent readmissions, which are upsetting and disruptive to family life. 
 
'This is a challenging role but I am fortunate to work with people who feel as passionate as I do about trying to find a positive way forward for these children. I believe I have found my dream job and I love it.'


Diane Griffiths (pictured) is lead respiratory research nurse at University Hospitals Birmingham NHS Foundation Trust. She has received international acclaim for her research into chronic lung disease.


Diane Griffiths

'My main interest for some time now has been in chronic lung disease, an area where there is so much to do.  We have inhalers and other devices for symptom control, but there are no disease-modifying treatments for these patients, so we need to focus on what is going on underneath. 

'I have been helping to deliver respiratory clinical trials since 2001, and my first research post was with the ADAPT programme. Birmingham hosts ADAPT, which is the largest cohort of patients in the world with Alpha 1 antitrypsin deficiency (AATD), a genetic condition that shares many features with chronic obstructive pulmonary disease (COPD). 

'We built up a huge database, and patients came from all over the UK for a comprehensive review every year. 

'You gain personal and professional satisfaction by carrying out research, and make a huge difference to patient care,'

– Diane Griffiths 

'When we looked at the data over a five-year period, we found that even though their lung function was getting worse, their health-related quality of life was getting better. This is possibly because they saw someone who took a real interest in them and empowered them about their condition. We were not making them better, but we were making them feel better, which is a huge thing. 

'I became interested in research suggesting that patients with COPD may be more likely to die of a heart attack than of their lung disease.

'I wanted to see if patients with AATD had a higher risk of having a heart attack than healthy people without this genetic condition. My research found a link between lung disease and heart disease, even accounting for age and smoking habits.

'My hope is that we can find treatments that mean people don’t have to suffer shortness of breath and hospitalisation. We currently see people who are symptomatic, and at that stage all we can do is support them. We need to be able to identify patients who are much younger so that we can prevent them from developing COPD. 

'As a mother of three, carrying out research and working full time while doing a master's degree was daunting, but I had fantastic support and wonderful supervision. 

'To nurses who may be interested in doing their own research, I would say "have a go". Not only will you gain personal and professional satisfaction, you will be making a huge difference to patient care.'


Jacqueline Derby (pictured) is head of infection prevention and control at Stafford and Surrounds Clinical Commissioning Group. The training programme developed by her infection prevention and control team (IPCT) is helping to reduce avoidable infections in care homes.


Jacqueline Derby

‘I have responsibility for quality improvement and assurance in relation to infection prevention and control (IPC) across six clinical commissioning groups (CCGs) in Staffordshire and Stoke-on-Trent. 

'When I came here, rates of avoidable healthcare-associated infection were significantly high, meaning we needed to reduce these across the health economy.   

'In my first year in post, we found that indwelling urethral catheters were a common source of infection among care home residents. More infections mean more pain, use of expensive catheter products and antibiotics, which can lead to Clostridium difficile infection and a greater risk of antibiotic resistance. 

'We understand the difficulties care homes can have accessing high quality IPC training, so decided to work collaboratively with the Midlands and Lancashire Commissioning Support Unit lead continence nurse specialist Sue Eley. 

'The training we deliver addresses the gaps we found when we investigated infections related to catheter care. 

'Knowing that fewer patients are contracting healthcare-associated infections makes my job immensely satisfying,'

– Jacqueline Derby

'This has been relatively simple to do and required no additional funding, but has significantly reduced rates of avoidable MRSA bloodstream infection. 

'In addition, the IPCT at Staffordshire and Stoke-on-Trent Partnership Trust developed a competency-based IPC education programme for care home staff. This can be completed at their own pace, accessed online or printed and used as a workbook. It then acts as a passport that they can take with them if they move to another home in Staffordshire. 

'I believe that key to our success is relationship management. When we go into homes, we aim to be supportive rather than punitive, but if we see poor practice we manage it robustly. It's about finding the right balance.  

'Before we began this work, we had up to four avoidable MRSA infections a year relating to care homes in one CCG. Since April 2015, there have been none, so we intend to embed the competency framework into the contract that care homes hold with CCGs.  

'This could result in significant improvement in hundreds of care homes throughout the region. Knowing that fewer patients are contracting healthcare associated infections makes my job immensely satisfying.'


Alison Whyte is a health journalist 

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