All posts by nihr clahrc wessex

This site promotes independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Funding Scheme. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health

Overloaded A&Es – Have we got this all wrong? Dr Brad Keogh

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Dr Brad Keogh

Accident and Emergency wait times seem to be constantly in the news. Less commonly but equally importantly are headlines that waiting lists for elective operations and procedures are on the rise. Although these topics hit our headlines regularly there is actually very little evidence and understanding behind the reasons for these changes in NHS services, and how the NHS can take positive action to cope with these issues.

From what we understand a lot of the currently held beliefs around the causes for pressure on NHS services come from very basic, non peer-reviewed, and potentially flawed analyses. It does not need too much explaining that making decisions based on these might be a bad idea.

Continue reading Overloaded A&Es – Have we got this all wrong? Dr Brad Keogh

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Let’s learn about Frailty: a blog series on training for healthcare staff in this complex field. By Alex Recio-Saucedo and Melinda Taylor

This is the first of a series of blogs drawing on a study of training for those working in frailty care, with additional reflections from other work.

What is frailty?

Before looking at training in frailty care, it would be helpful to understand something about what frailty is. Descriptions of frailty will almost always refer to the complexity of the condition. But what makes frailty different to other conditions that could be described as complex? We might think perhaps of multiple sclerosis, in which the patient may experience a range of clinical conditions and in which physical, psychological and social factors need to be taken into account. The same can be said for patients diagnosed as frail. Well, in a recent study, our participants considered that the complexity of frailty; how two patients could have such a wide disparity of signs, symptoms and needs; its evolving nature; its acute susceptibility to interventions or to the lack of them, and the high number of professions, sectors and organisations necessary to carrying out effective frailty care, were sufficient reasons for it to stand apart.

This series of blogs draws largely upon an evaluation of the training elements of four very different initiatives to develop frailty care pathways. Two significant themes stood out in this study. Firstly, the high level of staff commitment to looking for ways of enhancing the care provided to patients diagnosed as frail. Secondly, their agreement on the extremely broad and nebulous nature of the concept of frailty. While the various tools and checklists available were helpful in identifying frail patients, all agreed that it was difficult to find a comprehensive definition of frailty that conveyed its real meaning; one patient diagnosed as frail could present quite differently to another. The term could concern age, a single clinical condition or comorbidities, and a range of individual circumstances. As one of the study participants commented:

Not everybody who is elderly is diagnosed with frailty and not everybody who is living with frailty is elderly. The problem is that frailty is not a fixed population and it’s not synonymous with age, so it’s a very variable thing, so people can move from one (level of) frailty to another.’

Others noted the wide range of clinical conditions that could be encountered under the umbrella of frailty, with one sometimes feeling ‘overwhelmed’ with all that was to be learned and taken into account when caring for these patients.

In a further discussion, participants commented that the level of complexity was only revealed when actually working with frail patients; regardless of any formal training or self-directed study carried out beforehand, appreciating the complexities could only be appreciated by active involvement in providing care:‘…you’ve got to live it a little bit to understand it.’ The health care professionals felt that they each interpreted frailty in their own individual ways and that it was necessary to understand how others viewed it and the skills and services each profession contributed in order to develop a more meaningful understanding and to enhance the care they provided.

To add to the complexity, there is the issue of the stigma associated with the term frailty. Health care professionals, of course, need a name, a diagnosis, to know what is being dealt with and to develop a care plan. But patients and others, including healthcare professionals themselves, can associate ‘frailty’ with age, infirmity and loss of mental acuity, and patients can find it difficult to come to terms with being classified as such.

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One patient fought hard against being labelled ‘disabled’, even though he was wheelchair dependent, used a Disability Parking Permit and needed assistance with all personal care and daily living. He preferred to be referred to by his name or as a person with Parkinson’s disease. When later hearing himself referred to as frail, he immediately retorted ‘I’m not frail I’m disabled.’

These are just a handful of the frailty issues that participants discussed and it is interesting to note that they rarely mentioned any particular clinical conditions involved in frailty or offered a definition. Their concerns were focused on addressing complexity rather than specific clinical conditions. Yes, the clinical conditions were important, but they were clearly being viewed within the bigger picture of a system or process of frailty, rather than a discrete event in a patient’s clinical life.

Looking back to our initial question, ‘What is frailty?’, these blogs do not aim to provide the answer but present some of the components of frailty, its complexity and multi-faceted nature, defying comprehensive definition, that were important to those taking part in our study. These elements had a significant impact on how they perceived the training they received for their roles within the new initiatives and their future training requirements.

This was the central focus of our evaluation and, having set the scene for the context of the study, our next blog will provide a brief overview of the initiatives and reflect upon our findings relating to the various approaches to training, preferred methods and why they were thought to be appropriate for training within the speciality of frailty.

Respiratory Nurse team awarded for work on COPD

The respiratory nursing team in Southampton came away with two awards from the Association of Respiratory Nurse Specialists (ARNS) conference in May.

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Emma Ray won best Poster Spoken Session. She said:

I was very pleased to have the opportunity to share the findings of our world COPD day event addressing smoking prevention in school children in Southampton at the ARNS conference.  It was the brilliant idea of our PPI champion Mark Stafford-Watson who sadly passed away last year and is truly missed by our team.

Mark emailed me after that school event to say:

“You don’t know how proud I am of the team who turned up yesterday and made the session so good, you very kindly said that it was my idea, but an idea is not much use unless someone does something with it, and I recognise the amount of effort you put in to make that idea worthwhile, thank-you so much”

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Mark made a true impact to the direction and value of all our respiratory projects and worked hard to be a brilliant advocate for patients.  The world COPD day event was a true reflection of his desire to improve the lives of people in Southampton and he was passionate to address preventing smoking uptake in children, which should be a key priority in the prevention of COPD and the impact it has on other lung conditions.

As our event last year was very positively received by the students and school staff alike, we are hoping to take this work forward and hold future events with secondary school students aimed at raising awareness of COPD and smoking prevention.

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Helen Kruk, Kate Gillett, and Emma Ray

Kate Lippiet, won best poster for her work too. She was delighted.

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Kate Lippiet with her poster

My PhD seeks to understand what people living with COPD and lung cancer find difficult about their treatment and what they find helps them with carrying out their treatment. I hope that my research will identify areas which healthcare professionals and managers can target to improve the experience of treatment for people living with COPD and lung cancer. I was pleased to present my PhD as a poster at the recent Association of Respiratory Nurses Specialist conference and to discover that my research findings resonated with the practical experience of clinicians who work with people living with respiratory disease. Winning best poster was a lovely bonus.

I would like to take this opportunity, like Emma, to emphasise the contribution of Mark Stafford Watson to my research. Mark practically helped the development of my research by reading and commenting on my study protocol and patient information literature. More importantly, he truly believed in the relevance of the research I am undertaking to the lives of people living with respiratory disease. I found his energy and enthusiasm of great help personally. He is much missed.

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Mark worked tirelessly to support respiratory research – seen here in 2016 testing new equipment

What does it mean to be a nurse? International Nurses Day

To mark International Nurses Day we asked the many researchers who are qualified nurses to answer these three questions:

  1. What nursing means to you? And is there a different view of it if you’re originally from another country?
  2. How you would encourage other nurses to progress and conduct research?
  3. What are the challenges facing the future of nursing that you can see?

Here’s what they said.

Professor Peter Griffiths
Professor of Health Services Research and the lead for CLAHRC research into Fundamental Care in Hospital

Professor Peter Griffiths

I remember being asked in my interview for nursing why I wasn’t applying to be a doctor. There’s no simple answer to ‘what nursing is’ or ‘what it means to me’ but the answer I gave then is probably as close as I’ll ever get.

I’m not that interested in disease but I am interested in people. Nursing is about supporting and helping people, often through their most difficult times. While it’s hard to distinguish this from many other caring professions the key (to me) is that the focus is on the person comes first and the rest follows.

Continue reading What does it mean to be a nurse? International Nurses Day

Why might nurses miss people’s ‘danger signs’ at night? – Dr Jo Hope

We know that nurses miss or delay taking patients’ vital signs (such as pulse, temperature and blood pressure) at night. Until now, no one knew why.

The NHS expects hospitals to use ‘Early Warning Scores’ to measure how ill someone is. These are based on the observation of ‘vital signs’ – measurements of things like pulse, temperature, blood pressure and breathing speed. The higher the score, the more often someone’s vital signs should be checked. This is so staff can spot the early danger signs of someone becoming very unwell, in time to help them.

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Your local hospital will probably have an ‘early warning protocol’ that says how often people should be checked according to their early warning score. At higher levels observations will need to be done in the middle of the night. Despite this, we know that nurses are much less likely to do the observations that are expected to be done at night.

Continue reading Why might nurses miss people’s ‘danger signs’ at night? – Dr Jo Hope

(A) Pope in Washington – news from the Deputy Director’s visit to DC – Professor Catherine Pope

My recent study visit to the USA was an opportunity to forge some new connections and to continue conversations begun with colleagues at international meetings and conferences in previous years.

It was a fascinating time to be in the United States Capital city, or ‘the District’ as the locals sometimes call it, not least because my stay coincided with the temporary shutdown of the federal government.

This stormy time precipitated lots of conversation about ‘Politics with a capital P’ as well as American policy and health care research – the subjects I was there to learn more about.

Continue reading (A) Pope in Washington – news from the Deputy Director’s visit to DC – Professor Catherine Pope

What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.

National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1).  It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).

Continue reading What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

CLAHRC dementia care doctoral student event – report from Emily Walters, Dementia Care Doctoral Fellow

We were privileged to be able to attend a 2-day event in London for Dementia Care Doctoral Fellows from Wessex, East of England, Greater Manchester and the Peninsula CLAHRCs. This is the third such event and as before was packed with opportunities for learning, sharing and networking. It truly reflected the essence of CLAHRC – challenging practice, transforming healthcare, improving quality and involving patients and their carers.

Continue reading CLAHRC dementia care doctoral student event – report from Emily Walters, Dementia Care Doctoral Fellow

The movement behind saving our antibiotics

This week has been World Antibiotic Awareness Week to be followed tomorrow (Friday 18 November) by European Antibiotic Awareness Day. So what all the urgent action?

Well it’s well documented that resistance by bacteria to the existing supply of antibiotics is growing. The World Health Organisation has estimated that by 2050 deaths caused by antibiotic resistant bacteria could number 10 million people a year.

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This week NIHR CLAHRC Wessex hosted the Southampton Premiere of the award winning short film Catch, which tells the story of a family broken apart and facing difficult choices in a post antibiotic world.

Continue reading The movement behind saving our antibiotics

How do we support each other with our mental health? Professor Anne Rogers

When people talk about managing mental health the most frequent thing to do is to recourse to self help or looking to services to help.  There is less recognition of the power of social networks for help and support based on connections and reciprocity around us.

Separating out the individual from their need for other people and ability to mobilise resources in order to manage effectively, has meant that the notion of a personal community of support (the array of personal ties with which people are located and embedded) has not tended to be included in understanding or responding to mental health need.

Now there’s a nascent social movement about networks.

Continue reading How do we support each other with our mental health? Professor Anne Rogers