Category Archives: NIHR

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.

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

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

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

Letting the cat out of the bag at the Mental Wealth Festival – Dr Sandy Walker

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.

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Dr Sandy Walker (L) and Dr Helen Brooks (R)

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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.

Contact Dr Sandy Walker

The importance of the academic citizen in Health Services Research – Dr Gemma McKenna

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It was palpable with research geekery excitement while travelling to Nottingham for the 2017 Health Services Research UK Conference. I needed this, I thought, an opportunity for positivity, to talk enthusiastically about how we as researchers can help sustain the future of the NHS and wider health services. The conference didn’t disappoint.

We are all too aware of the popular rhetoric that consumes newsfeeds and social media channels, with headlines like ‘The NHS is in Crisis’ and ‘too many people are pitching up to A&E’. All doom and gloom. The conference was a perfect antidote to this. While there are no panaceas to these ongoing issues, my fellow health services researchers offered positivity and direction against the troubling backdrop of public service austerity and Brexit uncertainty.

Continue reading The importance of the academic citizen in Health Services Research – Dr Gemma McKenna

Should Wessex implement ReSPECT process? – The NIHR CLAHRC Wessex hosted event May 11, 2017

The event in Southampton attracted organisations* from across the Wessex region and beyond and a wide range of people including the public, paramedics, nursing staff, clinicians, managers and researchers.

Many stakeholders were represented bringing together 44 delegates, all there to examine and reflect on whether the ReSPECT approach to decision making for emergency care should be adopted.

Continue reading Should Wessex implement ReSPECT process? – The NIHR CLAHRC Wessex hosted event May 11, 2017

Making the patient central: Mark Stafford-Watson Public Contributor and PPI Champion

Article by Martin Simpson-Scott, PPI Coordinator NIHR CLAHRC Wessex
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Mark Stafford-Watson

Mark Stafford-Watson is one of our NIHR CLAHRC Wessex public contributors. He’s also ‘PPI Champion’ for our Theme 1 research team (Integrated Respiratory Care) – of particular personal relevance to Mark, as he has a long-term respiratory condition.

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