Angela Grange

The nature and purpose of acute psychiatric wards : The tompkins acute ward study

Background: Acute inpatient care in the UK is being subjected to increasing critical scrutiny, highlighting concerns about content and quality. There is an absence of clarity and consensus on what acute inpatient care is for, adding to difficulties in developing this service sector. Aim: To define the function of acute psychiatric wards. Methods: Interviews were conducted with multidisciplinary staff (13 Ward Managers, 14 F Grade nurses, 11 Occupational Therapists and 9 Consultant Psychiatrists), on rationales for admission, their care and treatment philosophy, and the roles of different professionals. Results: Patients are admitted because they appear likely to harm themselves or others, and because they are suffering from a severe mental illness, and/or because they or their family/community require respite, and/or because they have insufficient support and supervision available to them in the community. The tasks of acute inpatient care are to keep patients safe, assess their problems, treat their mental illness, meet their basic care needs and provide physical healthcare. These tasks are completed via containment, 24-hour staff presence, treatment provision, and complex organisation and management. Conclusions: Professional education, audit, research and the structuring of services all need to be oriented towards these tasks. Declaration of interest: This study was funded by the Tompkins Foundation and the Department of Health Nursing Quality initiative.

Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare

Problem Chronic kidney disease is increasingly recognised in the UK, leading to a greater demand for specialist services. Traditional means of meeting this demand rely on GP referral of patients to see a nephrologist. Hospital assessment may be inconvenient for patients and inefficient for health services. Setting 17 general practices and a secondary care nephrology service in Bradford, UK. Design A before and after evaluation comparing nephrology referrals from implementation and non-implementation practices following the introduction of electronic consultations (e-consultations) for chronic kidney disease. Key measures for improvement The number, appropriateness and quality of new referrals (paper and electronic) from primary care, the timeliness of responses and the satisfaction of patients and health professionals with the new service. Strategies for change Electronic sharing of primary care electronic health records with the nephrology service was introduced to implementation practices. Participating GPs attended education workshops and received paper and e-guidance about the new service. Effects of change There was a significant reduction in paper referrals from implementation practices. E-consultation provided nephrologists with access to more clinical information. GPs reported that the service was convenient, provided timely and helpful advice, and avoided outpatient referrals. Specialist recommendations were well followed, and GPs felt more confident about managing chronic kidney disease in the community. Lessons learnt E-consultation promotes effective management of patients with mild-to-moderate chronic kidney disease in primary care, allowing specialist resources to be directed towards supporting patients with more complex needs. There is a potential role for e-consultation in other chronic disease specialties.

Stakeholders’ perceptions of a research capacity development project for nurses, midwives and allied health professionals

AIMS To evaluate stakeholders perceptions of the extent to which a research facilitator post was addressing aims of: * providing academic support to enable research involvement of nurses, midwives and allied health professionals; * supporting dissemination of research into practice; * contributing to research strategy development. BACKGROUND Barriers to research capacity development have been recognized for nurses, midwives and allied health professionals. A project established in a London NHS trust aimed to address these. METHODS A mixed methods approach was used. RESULTS Responses were generally very positive. The post effected improvements in the research culture and perceived increase in research-related activities. CONCLUSION The post made substantial progress towards its aims. This approach may be useful in other healthcare locations to build research capacity. IMPLICATIONS FOR NURSING MANAGEMENT Challenged by increasing priority accorded to research capacity and service research implementation yet recognition of barriers to achievement, this study offers insights from one means to address this.

Building research capacity: Angela Grange and colleagues describe a project that has enhanced the research capabilities and career opportunities of nurses, midwives and allied health professionals

ExcEllEncE in pAtiEnt cArE depends on the presence of a knowledgeable healthcare workforce, a sound evidence base to underpin practice and the appropriate integration of this evidence based practice (RCN 2003). Nurses, midwives and allied health professionals (AHPs) represent the largest group of professional staff providing patient care in the NHS, and their potential contribution to the provision of good care is significant (Department of Health 1999, 2000a, 2002). These professionals increasingly seek to use research to improve patient care and service provision, and to influence the research and evidence based practice agendas. However, while there is a tradition and culture of research in medicine, the research profile of nurses, midwives and AHPs needs to be enhanced. This article reviews the literature on capacity building in non-medical professions and outlines some of the challenges facing nursing, midwifery and AHP leaders in promoting research capacity and capability. It also describes a model adopted by Barts and The London NHS Trust that aims to build and support a skilled workforce that can advance research to maintain or improve health.

Burnout mediates the association between depression and patient safety perceptions: a cross‐sectional study in hospital nurses

AIMS The aim of this study was to investigate the relationships between depressive symptoms, burnout and perceptions of patient safety. A mediation model was proposed whereby the association between symptoms of depression and patient safety perceptions was mediated by burnout. BACKGROUND There is growing interest in the relationships between depressive symptoms and burnout in healthcare staff and the safety of patient care. Depressive symptoms are higher in healthcare staff than the general population and overlap conceptually with burnout. However, minimal research has investigated these variables in nurses. Given the conceptual overlap between depressive symptoms and burnout, there is also a need for an explanatory model outlining the relative contributions of these factors to patient safety. DESIGN A cross-sectional questionnaire was distributed at three acute NHS Trusts. METHOD Three-hundred and twenty-three hospital nursing staff completed measures of depressive symptoms, burnout and patient safety perceptions (including measures at the level of the individual and the work area/unit) between December 2015 - February 2016. RESULTS When tested in separate analyses, depressive symptoms and burnout facets were each associated with both patient safety measures. Furthermore, the proposed mediation model was supported, with associations between depressive symptoms and patient safety perceptions fully mediated by burnout. CONCLUSION These results suggest that symptoms of depression and burnout in hospital nurses may have implications for patient safety. However, interventions to improve patient safety may be best targeted at improving burnout in particular, with burnout interventions known to be most effective when focused at both the individual and the organisational level.