Communication between nurses and nurse managers: a case study from an NHS Trust

The role of effective communication in promoting organizational efficiency and effectiveness is being increasingly recognized. This paper proposes a communication audit methodology as a useful means of examining the quality of communication between nurses and their managers. Utilizing a case study methodology, results from an exploratory study are presented and discussed. These data suggest that significant problems in this field currently exist. The general applicability of the findings throughout the NHS are considered, and proposals on how relationships and communication could be improved are examined.     

Barts and The London NHS Trust. Creating a capital service for patients

Nurses at Barts and The London NHS Trust play a key part in initiatives such as a Patient at Risk team, shared governance, Smarten Up and a host of other initiatives to improve the patient experience and working life for staff.     

The length-of-stay pattern of nursing home admissions

The length of stay (LOS) pattern of nursing home admissions has not been directly measured because the long duration of stay of some patients (e.g., 25% of persons admitted reside in homes for longer than 1 year) makes it impractical to follow specific admission cohorts until the members have been discharged. By applying life-table methods to data on current and discharged residents from the 1977 National Nursing Home Survey, the authors were able to generate estimates of this distribution. They estimated that the typical nursing home admission initially has an expected LOS of 456 days, but, more interesting, the remaining LOS is expected to increase, in the intermediate term, with the amount of time spent in the facility. They also examined LOS distributions of subsets of the national nursing home population, and illustrated potential applications for this new information for policy formulation.     

From 19th century nursing reforms to current practice: a selective overview with special reference to The Royal London Homoeopathic Hospital (The Royal London Homoeopathic Hospital NHS Trust from 1993)

Early nursing reforms in the 19th century are usually associated with Nightingale, although later emphasis has been placed on similar movements in the Poor Law sector. Extension of nursing influence over decision-making in terms of nursing practice and education is charted, using examples from 19th century Minutes of hospital committees and more recent experience based mainly on the observations made by one of the writers, who had substantial input into steering the hospital through the stages prior to achieving National Health Service (NHS) Trust status. The significance of nurse executive power following the 1990s NHS reforms is highlighted and means of extending the use of this authority are explored.     

The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust

Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy.     

A study of incidents of violence towards staff by patients in an NHS Trust hospital

The aim of the study was to survey the degree and the extent of violence towards nursing staff by patients within a hospital environment. The information gathered will form a basis for future reference once the care packages are developed in the community. The study investigated the number of recorded incidents of aggression towards nursing staff by patients ( n = 164) in an NHS Trust hospital for one year (October 1993–September 1994). The degree of recorded incidents of aggression was analysed using the Overt Aggression Scale. The results showed that the degree of aggression was mostly moderate to mild and occurred mostly in the Learning Disability Unit. Male staff were more involved in actual recorded incidents than expected in the given population. Health care assistants were more likely to be involved in aggressive incidents than any other grade of staff. There were significant findings in the time and location of the recorded aggressive incidents.
The study, therefore, highlights the need to report and record incidents, the need for ongoing training, skilful management of resources and the recognition of environmental factors that can lead to patients' violence and aggression towards nursing staff.     

Systematic review of trends in emergency department attendances: an Australian perspective

Emergency departments (EDs) in many developed countries are experiencing increasing pressure due to rising numbers of patient presentations and emergency admissions. Reported increases range up to 7% annually. Together with limited inpatient bed capacity, this contributes to prolonged lengths of stay in the ED; disrupting timely access to urgent care, posing a threat to patient safety. The aim of this review is to summarise the findings of studies that have investigated the extent of and the reasons for increasing emergency presentations. To do this, a systematic review and synthesis of published and unpublished reports describing trends and underlying drivers associated with the increase in ED presentations in developed countries was conducted. Most published studies provided evidence of increasing ED attendances within developed countries. A series of inter-related factors have been proposed to explain the increase in emergency demand. These include changes in demography and in the organisation and delivery of healthcare services, as well as improved health awareness and community expectations arising from health promotion campaigns. The factors associated with increasing ED presentations are complex and inter-related and include rising community expectations regarding access to emergency care in acute hospitals. A systematic investigation of the demographic, socioeconomic and health-related factors highlighted by this review is recommended. This would facilitate untangling the dynamics of the increase in emergency demand.     

An evaluation of the critical care assistant role within an acute NHS Trust Critical Care Unit

This study provides an evaluation of a training programme designed for developing six critical care assistants to work alongside registered nurses to care for patients within the critical care environment. The programme was run as a pilot funded from the Department of Health's 'critical care bid'. At 18 months long, the programme incorporated a foundation programme, and National Vocational Qualification (NVQ) level 3 in care and adapted Operating Department Practitioner (ODP) NVQ units. Six critical care assistants successfully completed the programme; however, they all then left the unit to undertake further study for pre-registration nursing qualifications. Upon evaluation, a number of key issues were identified. Clear definition of the critical care assistants's role is essential as are dedicated practice development staff, who focus purely on developing the critical care assistant role. More importantly, however, with such key changes in the staffing structure within critical care units, appropriate change management techniques should be employed, ensuring that all staff contributing to the training and development are fully involved from the start.     

The role of drug-induced illness in admissions to an intensive care unit

All patients admitted during a 33-month period to a multidisciplinary intensive care unit were prospectively studied in order to determine the incidence and severity of drug-induced illness leading to the admission. The role of underlying diseases was assessed and the avoidability of drug-induced illness considered. Out of 1651 patients, 97 (5.88%) were admitted because of drug-induced illness; 74 of these had serious underlying diseases. 13 (13.4%) of the 97 patients died, but underlying diseases accounted for 4 of the 13 fatalities. In nearly half of the cases, the drug-induced illness appeared potentially avoidable.     

Analysis of trends in emergency department attendances, hospital admissions and medical staffing in a Hong Kong university hospital: 5-year study

Background

The workload of emergency departments (ED) continually changes in response to presentations, overcrowding and availability of expertise and investigations.

Aims

To investigate changes in ED presentations and care processes, and the relationship of patient demand and ED staff resources to waiting times and processing times.

Methods

Retrospective analysis of prospectively collected administrative data from January 1999 to April 2005 in an emergency department in a university teaching hospital in Hong Kong. All patients attending the emergency department during the study period were included. Monthly attendance data were retrieved and analysed to determine both qualitative and quantitative changes in the patterns of presentation to the ED using prospectively gathered data.

Results

Total ED attendances decreased by 25% during the study with little seasonal variation. The admission rate and the use of ambulances increased steadily and significantly. Medical patients are increasing proportionately, but trauma patients are decreased in number.

Conclusion

There have been major changes in the patterns of ED attendances and ED waiting times over the study period in this teaching hospital ED. Decreasing overall ED numbers are offset by an increasingly elderly population and a more complex case mix. Reducing clinical staff numbers appears to reduce the ED’s capacity to provide timely assessments and care and to function as hospital gatekeepers. Restoring staff numbers to previous levels may improve the quality and timeliness of ED services. It is necessary to refine measures of ED complexity and workload to determine appropriate staffing levels in the future.     

The clinical content of NHS trust board meetings: an initial exploration

Objectives To differentiate between English NHS trust board meetings according to the percentage of clinical content and to explore which characteristics of board meetings might explain this. Methods Definition of scoring system for clinical content. Scoring of minutes for a random sample of 60 trusts. Qualitative analysis of a sub‐sample, generated hypotheses about factors leading to higher percentage of clinical items was undertaken; testing of hypotheses in a longitudinal sample of minutes from 24 trusts over 1 year. Results Clinical content varied from 2% to 30%. Boards with a more clinical focus tended to link other issues including finance to clinical issues; have non‐executive directors able to question board executives openly; make less use of acronyms in minutes; had more liaison with social services; and accepted questions from the public. Conclusions Counting items in board minutes has prima facie validity as a means of defining how clinically focussed board meetings are, although more research is required to refine the method. The present method of analysing board minutes may provide one way of assessing board culture. Implications for nursing management Directors of nursing can help focus trust board meetings on clinical matters. Further research is required to determine whether greater clinical content in trust board meetings has impacts on clinical practice or organizational performance.