One of the great things about being involved with CLAHRC Wessex has been the opportunity to engage with other research teams around the country doing similar work. A group of us have been part of a network of people across England, Scotland and Wales who are interested in acute kidney injury (AKI). A challenge with AKI research is that it can be misleading if you don’t use the same methods and definitions to define the condition.
Dr Melinda Taylor, Senior Research Fellow in Organisational Behaviour, NIHR CLAHRC Wessex Data Science Hub
The first blog in this series described how health professionals in our study found it difficult to define ‘frailty’ but agreed that it was an extremely broad concept with no defined boundaries. This has an impact on training in frailty care. This second blog outlines our participants’ views on frailty care training.
Our study evaluated particular aspects of four initiatives intended to enhance the care provided to people regarded as frail. The diverse nature of the initiatives further demonstrates the complex nature of frailty.
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.
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.
To mark International Nurses Day we asked the many researchers who are qualified nurses to answer these three questions:
- What nursing means to you? And is there a different view of it if you’re originally from another country?
- How you would encourage other nurses to progress and conduct research?
- What are the challenges facing the future of nursing that you can see?
Here’s what they said.
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.
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.
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.
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).
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.
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.
In September, Dr Helen Brooks and I popped over to London for the 2017 Mental Wealth Festival, we were talking about the work we had done looking at how pets can help people manage their long-term mental health problems.
It’s common for academics to be found popping up at conferences and even music festivals these days, telling people what they have been finding out in an effort to spread the word and get the message heard. This was just the activity we were engaged in and one of the benefits for us as academics is that we also get to hear about others work and this gives us ideas.
Perhaps you are wondering what the Mental Wealth Festival (MWF) is all about?
The MWF takes place over 3 days in London . The first day takes place in the Houses of Parliament where Baroness Hollins hosts panel discussions on aspects of mental well-being and the next two days take place predominantly in City Lit, a further education college that serves London. Throughout these two days there is a plethora of wonderful sessions that can be accessed, free of charge, by those registered for the event. Attendees include those with lived experience of mental distress, both themselves and as carers; interested members of the public; policy makers; commissioners and professionals from every group with a role in helping those in mental distress.
It really is the most eclectic, informative and creative space to find yourself in. A place where many, sometimes opposing, worlds collide.
Our talk was full, so we had a great audience of interested people who asked questions all the way along and shared their own experiences of being pet owners. What stood out particularly, and resonated with the findings from our study, was the way in which pets give unconditional love which is consistently there regardless of how we are feeling.
Pets are trusted more than people many said and seem to have an intuitive understanding of their owners, knowing just when to demand to go out or to curl up for a cuddle.
For me most important was the knowledge, which we gained from the study, that for our cohort none of the participants had their pets considered as important network members as part of their care and yet all that had pets stated that they were essential.
The room completely agreed with this and the professionals in the room were clear that pets will be considered more seriously in future, in fact two of the attendees stated that they were relieved to have some research evidence to back up something they had wanted to attend to for a while but had felt reluctant to do so in case they were laughed at.
Let me tell you a secret… I am proud of being a nurse but when I was 18 I wasn´t that sure. Finally, advised by friends and family I ended up starting the nursing degree at an excellent and powerful University in Spain… so that was a fair trade for me… Ok… I will do nursing!
Like many other nurse students, at that time I faced several fundamental crises and I even thought of quitting nursing because I had never thought of myself as a nurse and sometimes others’ pain and disgrace gave me the chills.