1. health and fitness

Volume 1—Nursing & Midwifery Practice
Development Dublin Mid-Leinster Newsletter
Dear Colleagues
Welcome to the first edition of the Dublin Mid-Leinster Nursing and Midwifery Newsletter. The main aim of this
newsletter is to disseminate information about initiatives
developed and delivered by nurses and midwives in the
Dublin Mid-Leinster area. We hope to issue it three times per
annum and thank those who shared their developments for
this our first edition. Articles of interest from services including
CNME’s and NMPDs are included.
Information and updates provided are categorised in
accordance with the strategic themes of the HSE Office of the
Nursing and Midwifery Services Director. These include:
• Practice Development
• Continuing Professional Development
• Provision of Safe, Quality Care
• Corporate and Clinical Governance
• Leadership and Innovation
I hope you enjoy reading this issue and that it will provide you
with the opportunity to hear about developments in nursing
and midwifery practice across Dublin Mid-Leinster. Please
contact the named project leads for further information on any
of the initiatives. A call for items for the next newsletter will be
requested before the year end.
Liz Roche
Interim Area Director - DML
Liz Roche—Interim Area Director
Dublin Mid Leinster
Phone: 01620 1732
FAX: 01 620 1625
Email: [email protected]
Mary Manning
Interim Director
NMPD, Block 4
Central Business Park, Clonminch
Tullamore, Co. Offaly
[email protected]
05793 57870
Feedback, comments and submissions can be sent to:
Susanna Byrne at [email protected]
Judy Ryan at [email protected]
Sinead O’Reilly at [email protected]
Helen Bohan at [email protected]
Raphael McMullen at [email protected]
ONMSD Website: www.hse.ie/go/onmsd
Page Content:
Letter of introduction: Ms Liz Roche
Practice Development
Preparation for HIQA ID services
Productive Ward:
•
Releasing Time to Care
•
Patient Status at a Glance
The Creative Well Programme
The Introduction of Doll Therapy
Mental Health Assessment Tools
Early Pregnancy Unit
When the Girl Came to Stay
Specialist Palliative Care Services
Continued Professional Development and Research
Standard Documentation for Public
Health Nursing
Development of Advanced Nurse/
Midwife Practitioner.
Wound Management Training
Growth Charts
Care Planning In Older Person
Services
X-ray Prescribing
Education Centre Tallaght Hospital
Child & Family Health Needs
Assessment Framework
Provision of Safe Quality Care.
Development of Carer Needs
Assessment Tool
Corporate & Clinical Governance
Patient Priority Pledge
Development of a preventative and
Management Strategy for Pressure
Ulcers.
Leadership & Innovation
Launch of Resources & Midwives
Care for People with MS
Development of an End of Life
Suite
Home Birth Information Booklet
Paediatric Documentation
Page 2 Practice Development
NMPDU DML Newsletter
Preparation for HIQA in Intellectual Disability Services in DML
A
group
of
Intellectual
Disability
Service providers in the DML region
(HSE and Voluntary) have commenced
working together to develop an action
plan to prepare to meet the National
Quality Standards: Residential Services
for People with Disabilities that are
expected to be implemented by HIQA
in 2013.
Facilitated by the Nursing and Midwifery
Planning and Development Units (DML)
the group have identified a strategy to
conduct pre HIQA audits via a peer review
process. The strategy will involve Services
allocating staff within their organisation to
be involved in the peer audit process.
Auditors will attend a preparation
training day where they will receive a
presentation from a HIQA inspector. This
will be followed by audit skills training and
overview of the governance structures
that will guide the process presented by
Dr Samantha Hughes Quality and Clinical
Audit Department (HSE). The next phase
of the project will involve each auditor
pairing up with a colleague from Auditors will not be involved in auditing
another service.
their own service. This approach facilitates
cross
service skill and information
sharing. The
audits will address three
standards initially and the service will
receive a written and verbal report on
the findings. The report will belong to the
service and the direction that the
organisation
takes
to
address
the
recommendations will be in the control of
the service. It is envisaged that this
partnership project will also promote
information sharing, support networking
and create sustained
learning
and
awareness for all staff working within
Intellectual Disability Services in DML.
Phase 1 of the project was due to
commence this Autumn 2012 however
due to the HSE additional cost saving
memorandum announced on 29th August
2012 this project has been deferred until
early 2013.
For further information contact Judy Ryan:
[email protected]/ or 086 8599324
Page 3
Practice Development
NMPDU DML
Newsletter
Productive Ward
Productive Ward –“Releasing Time to Care”™
The ‘productive Ward’ is a ward/unit based
improvement methodology programme that
empowers nurses/midwives and multidisciplinary
teams to redesign and streamline the way they
manage and work. This helps achieve significant
and lasting improvements – predominately in the
extra time that they give to patients, as well as
improving the quality and safety of care delivered.
It is currently being introduced nationally across
17 pilot sites. In Dublin Mid Leinster, the pilot
sites include;
•
The Coombe Women’s and Infant’s
University Hospital
•
St Vincent’s University Hospital,
•
Midland Regional Hospital Tullamore
•
Midland Regional Hospital Portlaoise
Show case wards in all four sites are
enthusiastically implementing the programme.
At St Vincent’s University hospital, a second ward
has begun implementing the project . Three foundation modules are well underway and some process
modules have also commenced. All staff are enthusiastic and motivated. The positive interface between
front line staff and senior management has enable
many improvements at ward level. Trend analysis of
monthly metrics have demonstrated the benefits of
the project.
In the Coombe Women’s and Infants University
hospital, through implementation of the ‘Well
Organised Ward and Knowing’ how we are doing
modules, Our Lady’s ward has been transformed.
Many small improvements have been made and staff
enthusiasm has resulted in a cultural shift where a
quality improvement culture has been born!
For further information, please contact Raphael
McMullin at [email protected] or
Mary Manning at [email protected]
Productive Ward Tullamore
Patient status at Glance (PSAG)
One of the modules underway in the
Midland Regional Hospital Tullamore is a
modular programme called ‘Patient Status
at a Glance’ (PSAG). This module involves
re-designing the patient whiteboard, so
that information is easily retrievable by a
member of the Multi Disciplinary Team
(MDT), measurable by the three second
rule. This means
that the required
information should be easy to find in
three seconds. Before starting, the team
undertook an audit
called ‘Activity
Follow’. This involved following a staff
nurse for a 12 hour shift and recording
activity at 1 minute intervals. The results
reveal the amount of time spent on direct
and indirect care. The audit also
recorded the number of
interruptions
experienced by a staff nurse in the same
period in this case a total of 130
interruptions, 51%
of
which related
directly
to
enquiries
around patient
status. A new PSAG board was designed
and developed by staff to reduce these
interruptions, thus allowing more time for
direct patient care. Boards have now been
placed in the ward for a one week
familiarisation period and go live next week.
To date feedback by all members of the MDT is
favourable. An evaluation/ audit will take
place as part of the on going process. An
Operation Procedure has been developed
outlining the procedure to follow when using
the board.
It is planned as part of the next Productive
Ward module that nurse handover will take
place around the boards, thus freeing
up
nurses’ time further.
For further Info contact: Alice Cockram or Regina
Fallon, [email protected]
Left to right:
Denise Clarke
(Discharge
coordinator)
Linda Sinnott (Staff
Nurse)
Maria Curley (CNM 1)
Louise Cooney
( Health Care
Assistant)
Page 4 Practice Development NMPDU DML Newsletter
The Creative Well Programme: a new prescription for Mental Health
The Rehabilitation Team Kildare/West Wicklow Adult Mental Health Services
The Creative Well Programme is an exciting new
integrated arts and health programme which draws
on a number of well established U.K. arts on
prescription and ‘social prescribing’ projects for
inspiration and evidence based practice.
Catherine O Grady Clinical Nurse Specialist with
the Rehabilitation Team Kildare/West Wicklow
Adult Mental Health Services developed this model
of working, in partnership with the arts services, to
meet the needs of many of the service users.
The rationale for developing The Creative Well
Social isolation is experienced by many mental
health service users. Feelings of social isolation,
compounded by low self esteem, prevents people
from joining and engaging in meaningful activities
or relationships within their community. This pilot
programme provides a unique opportunity for
mental health service users to mix with others in
their local community outside of the mental health
system.
The therapeutic effects of the arts have been
recognised for centuries, but only in recent years
has systematic research been carried out to
validate these effects. The arts have been shown
to enable people regain control over their inner
world (Jensen,1997) and to improve their cognitive
and social skills (Snow, 2003).
Aim: The aim of the Creative Well Programme is
to develop a social model for supporting mental
health and wellbeing through the use of the arts
within the context of local communities.
Objectives: To provide a regular programme of
weekly arts workshops in County Kildare,
facilitated by professional and experienced artists,
to support and promote mental health and well
being. This was achieved by using the arts as a
social development tool, to create opportunities for
participants to;
•
•
•
•
build self-esteem and confidence,
enhance personal development,
develop skills,
connect with others and form links in their local
communities and explore creative ways of
overcoming emotional difficulties. Content varied
on the programmes and included visual arts,
drama, dance, creative writing, film and animation,
music and storytelling. On completion of the
programme participants are signposted to other
activities or opportunities in their local community.
What makes the Creative Well Programme
unique?
Participation is open to all in the community, but a
number of places are reserved for mental health
service users. All applicants are interviewed prior to
commencement to allow for the best possible mix of
abilities and outcomes.
Evaluation:
The programme, which was piloted in September
2011, was tested using self evaluation; participants
completed the W arwick-Edinburgh Mental
Well-being Scale (WEMWBS) before and after the
intervention. This provided a pre-validated scale of
their overall positive feeling towards themselves. The
findings conclude that the intervention had a positive
effect on the well being of the participants. Further
programmes are now planned.
Testimonials from participants include:
“I have to say this has been the most wonderful
experience, something very special comes from
classes like this”
“This course has added interest to my life and has
inspired me to be more creative”
“Every week I just lived for the workshop and looked
forward to meeting the other participants”
“We also learned from each other and learned to
appreciate each others abilities”
“I rediscovered a hobby I loved and the happiness it
brings to create something.”
For further information contact: Catherine O’Grady at:
[email protected]
Page 5
Practice Development & the Provision of Safe Quality Care NMPDU DML Newsletter
The Introduction of Doll therapy in the Meath Community Unit
People with dementia often have complex
needs that can be difficult to meet. A person
centred approach focusing on improving the
overall well being of the person is recognised
as being the most successful approach to the
delivery of quality care and meeting the needs
of people with dementia. Unmet needs may
be expressed through behaviours which staff
find challenging.
The introduction of doll therapy provoked
strong reactions from many staff working in
the unit. Some felt that if the residents choose
the doll it was alright, others were very
concerned that it was demeaning and childish.
Despite varying opinion no one could argue
with Ann’s response to the doll and it’s
apparent positive effect on her overall well
being.
Research has shown that the introduction of
doll therapy can improve the well being of
some older people with dementia (Fraser &
James 2008), resulting in a reduction in agitation. The doll may serve as an attachment
object and help alleviate feelings of loss and
abandonment. It may also be useful as a
focus for staff interactions and may enhance
communication and help build relationships.
Doll therapy is a cost effective non
pharmacological intervention which may help
enhance the well being of the person living
with dementia, however, doll therapy is not for
everybody. The importance of education and
awareness for staff and families when
considering doll therapy must not be
overlooked.
Case Study
Ann had lived in our unit for 2 years. On
admission she presented with mild to
moderate cognitive impairment, however, as
her dementia worsened we noted an
increased agitation particularly in the
afternoon and evening. This agitation caused
an increased risk to her safety. During her
daughter’s visits, Ann was noted to be
interacting with her granddaughter who was
playing with her doll. Ann expressed an
interest in the doll but felt that she might look
silly with one.
Ann’s daughter discussed this with ward staff
and it was decided to introduce a doll to the
environment. The doll was left near Ann and
she immediately reacted positively by smiling
and talking to the doll. This progressed to her
holding and cuddling the doll.
Initially Ann seemed to know she was holding
a doll but she began to care for it like a baby
and it became central in her life. Ann’s
ag it at ion
cease d
com plet el y,
her
communication increased and she became
much calmer.
Throughout this process other people had
dolls left close to them and they took no notice
of them, some picked them up and looked at
them but replaced them. People with
dementia may respond negatively if they do
not choose to care for the doll. While it is
apparent
there
have
been
positive
responses from some people with dementia, it
is clear that care must be taken when
introducing dolls to the environment. Further
research will be undertaken in the Meath
Community Unit to provide evidence for
practice.
For further information contact Caroline Doran
at: [email protected]
Page 6
Practice Development NMPDU DML Newsletter
Development of Laois Offaly Longford Westmeath
Mental Health Services Mental Health Assessment Tools
The revised edition of the Portfolio of
Mental Health Assessment Tools brings
significant changes to the first copy which
was published in 2008. Validated
assessment is widely recommended in
leading
health
guidance
and
health strategy documents. This book
provides a user friendly evidence
based compendium of 28 validated
assessments. These are a range of
screening tools/scales, aiming to improve
patient
engagement in their plan of
care, and support measuring patient
outcomes.
The 2012 Book of mental health
assessments aims to:
•
•
•
•
•
•
•
•
•
•
Enable professionals in mental
health practice to have a suite of
tools to deliver comprehensive
h ol is t ic
a sse ssme nt
t ha t
improves care.
Increase use of evidence-based
practice.
Integrate the use of validated
assessment tools by mental health
professionals that strengthen the
care plan.
Assist in developing a standardised
approach to clients’ care ,monitoring
of
interventions, and outcome
measurement.
Increase an outcome focused
approach
to
care,
providing
measurable data that is useful for
identifying key
performance
indicators.
Provide a curriculum course book
for undergraduate nursing students
in validated assessment
Assist in tracking clients’ progress
through their recovery journey.
Provides useful evidence for clinical
decisions,
such
as
in
risk
assessment/management.
Screening for symptoms of mental
illness, mental health difficulties
and positive or negative coping
strategies
Provide a more accurate health/
illness/coping picture.
Brief view of content of the
assessment portfolio:
Each tool/scale in the publication is
accompanied by explanatory information
and all the tools are referenced. The
assessment tools/scales contained in this
portfolio are for use by professional
members of the Multi-Disciplinary Team in
mental health practice who have had
appropriate training on their application.
It is important to acknowledge that this
represents a very broad range of
measuring tools and thus the users will
have to decide which tools are applicable
to various areas of practice and to
different client needs. The Portfolio is
divided into five sections that out-lines the
various components of care. These are:
•
•
•
•
•
Mental Health Screening Tools
Medication Related Screening Tools
Addiction Screening Tools
Living Skills Screening Tools
Making sense of the assessment data
(including a stress vulnerability
framework from a psycho social
model that can assist in guiding users
on how to
incorporate assessment data into
practice, and a nursing supporting
guideline for same)
Availability of Mental Health
Assessment Tools 2012:
The book is available through
the HSE website, through Library services
as in the HSE Lenus website:
http://www.lenus.ie/hse and through
other national mental health website
forums. Limited hard copies are available
on request.
If further information or additional advice
is required please contact the mental
health assessment group via e-mail at:
[email protected] or Margaret
Daly (Chair) at [email protected]
Tel: 057 9357862
Page 7
Practice Development NMPDU DML Newsletter
Midland Regional Hospital Mullingar Early Pregnancy Unit
Reports in June 2010 of cases of misdiagnosis of miscarriage appeared in the Irish news media,
leading to widespread public concern. Following on a review was commissioned and established
by the HSE. The report of the Miscarriage Misdiagnosis Review (April 2011) concluded that the
HSE should implement
national guidelines for the management of early pregnancy complications and put forward a number of
recommendations including the following:
1.
2.
3.
All units that provide emergency gynaecological care should have a dedicated early
pregnancy assessment unit with adequate staffing, equipment, facilities and opening times to
meet local needs
Multidisciplinary education programmes for all staff involved in early pregnancy care to be
implemented by collaboration between the Institute of Obstetrics and Gynaecology and UCD
School of Medicine and Medical Science to provide a national training programme for all
trainees in Obstetrics and Gynaecology including midwives.
Relevant support to be provided to women who have suffered early pregnancy loss in all
units.
Midland Regional Hospital Mullingar have expanded the role of some of their
midwives to undertake Pelvic Ultrasonic Scanning. Midwives will undertake Clinical
and academic training of ultrasound and it’s role in the management of pregnancy.
Each midwife must undertake the UCD Accredited course Graduate Certificate in
Obstetric Ultrasound which is a Multidisciplinary Course.
The midwife will develop competencies in relation to:
•
Performing Pelvic Ultrasound safely and competently
•
Recognising normal and abnormal parameters
•
Report scans findings in Clinical context and knows when to refer patients for
more detailed assessment.
Client benefits include
•
•
•
•
•
Midwives will perform ultrasound scans at booking clinics
Provides continuity of Care
More efficient, cost saving and client friendly service.
Shorter waiting time to be seen
Decreased congestion at clinics etc
Left to Right:
Gemma Gannon (CNM)
Marian Hurley (Staff Midwife)
For further information please
Gemma Gannon at:
[email protected]
contact
Page 8 Practice Development NMPDU DML Newsletter
When the Girls Came to Stay.
Interaction with animals can provide a focus
and interest for older people in Residential
care and can have a positive impact on their
wellbeing. Animal assisted intervention (AAI)
is a broad term encompassing Animal
Assisted Therapy (AAT) where animals are
used as part of a person’s specific treatment
and Animal Assisted Activities (AAA) where
the individual has access to animals in a
general way.
To facilitate Animal Assisted Activities (AAA),
our residential care facility in Peamount
Hospital, with the support of the Residents’
committee, brought 5 hens to live at the
facility. The hens are housed in a purpose
built coop located in a green area near the
unit which is visible from the windows of the
unit. The hens roam freely around the
grounds during the day and are shut in at
night. Staff,
residents and family members
care for the hens and attend to feeding,
cleaning the coop and egg collecting.
Aim: The aim of this study was to establish
what effect, if any, the presence of the hens
had on residents in the care facility.
Method: Informal discussions were recorded
between one staff member and a number of
residents (n=10) and their relatives (n=4) with
specific reference to resident attitudes to the
hens and relatives’ impressions of behaviour
change in relative attributable to the animals.
Opportunistic observations of resident
behaviour in relation to the animals were also
Findings: References to hens (n-52) were
noted and a number of main themes emerged
from discussions and observations which
included:
Initiated Conversations/Socialisation (n-13)
‘We watch them (the hens) together out the
window. Dad can’t get out of bed much now so
it nice to have a distraction and something to
talk about, Patricia - Relative
Ownership/Responsibility (n-7)
‘If they’re not shut in at night, I couldn’t go out
myself but I make sure someone closes the
little gate, wouldn’t want the fox to get them ...’
James – Resident
Reminiscence/Past ownership (n-4)
‘My father always had black hens when we
were children we...., I hadn’t seen a black hen
for years’
Margaret – Resident
Increase in Related /Outdoor Activity (n-26)
‘ I walk over to see them, sometimes twice a
day, they follow me everywhere’...
Christine - Resident
Decrease in loneliness (n-2)
‘ It’s nice to have them out there, when I sit out
there in this (wheelchair) they get all around me
up on the table and all .....It doesn’t seem so
lonely when you see them wandering about’
James - Resident
For further information please contact Mary
Doyle, Peamount Healthcare or
[email protected]
Page 9
Continuing Professional Development & Research
The Introduction of Standard
Documentation for Public Health
Nursing Services in Dublin South,
Kildare & Wicklow
It is essential that nursing care is supported by clear
documentation, reflecting appropriate patient
assessment, engagement, on-going evaluation of the
patient’s condition and care planning. The Directors
of Nursing in Dublin South, Kildare & Wicklow linked
in with the NMPDU to progress some work in this
regard. A project was developed to introduce a
standardised system of nursing documentation in
Dublin South Kildare and Wicklow community care
areas.
A care planning record, which was initially developed
and tested through a previous project between the
NMPDU and Dublin South City Public Health Nursing
team, was determined to be suitable for replication
across all community care area.
A comprehensive education programme in the form
of workshops was delivered to support successful
implementation of this standard documentation and
275 registered nurses attended from across the
region.
Auditing of the documentation system is due to start
this September supported by bespoke guidance
documents and audit tools. The envisaged outcome
is that all staff will have the skills and tools to
accurately document patient care whilst also meeting
with requirement and standards as outlined in An
Bord Altranais, to enhance communication and
promote safe practice. For further information, please
contact Raphael Mc Mullin at:
[email protected]
Development of Advanced
Nurse/Midwife Practitioners
Congratulations to Allen Doyle, St Vincent’s
University hospital who has registered as Advanced
Nurse practitioner Emergency. At present the scope
of the
post includes Rapid Assessment and
Treatment of patients according to the portfolio, and
to the staff at Naas General Hospital who have successfully obtained site preparation for 3 ANP posts (2
in Emergency and one in Cardiology). Several other
sites in Dublin South, Kildare & Wicklow are in the
process of developing site preparation documents.
For further information about developing AN/MP
sites/roles, please contact Raphael Mc Mullin at
[email protected]
NMPDU DML Newsletter
Wound management training
programme, incorporating leg ulcer
management for public health nurses
and community RGN’s
Lower limb ulceration affects up to 2% of the adult
population with venous ulcers accounting for
approximately 70% of all ulcers (O'Brien et al. 2000).
It is essential that individuals presenting with lower
limb ulceration or at risk of ulceration are
appropriately assessed and managed. The Directors
of Nursing in Dublin South, Kildare & Wicklow
identified a need to update nurses working in public
health nursing teams in wound management and
approached the NMPDU to assist them. An
education programme was developed incorporating a
three pronged approach. This programme was
divided into three components, the general principles
of wound management, as a precursor to education
in leg ulcer management, and Doppler assessment,
followed by clinical practice and formal assessment of
technique. Staff nominated for training in Doppler
assessment must have undertaken first 2
components of the programme.
A series of updates on the general principles for
wound care were attended by 384 nursing staff. The
study day was evaluated very positively by the
participants. Further study days on leg ulcer
management for these 384 staff will commence in
September 2012. Four staff per local area have been
nominated for Doppler assessment training, which
will commence in November. All courses have been
developed in collaboration with the RCSI and have
ABA approval with varying CPD credits. Both of the
latter study days will be formally evaluation using a
pre-test, post test approach.
For further information, please contact Raphael
McMullin at: [email protected]
Growth Charts
Growth Charts. Work is ongoing on updating unit 6
(Growth Monitoring) of the Programme of Action for
Children (PAC) training series and the introduction of
the new centile growth charts will commence in
January 2013. Training materials will be placed on
the HSE website for general access and resources
permitting a "train the trainer" event will take place in
the Autumn.
delete
d insert
ed for
ectors
son's
h Kili-
Page 10
Continuing Professional Development & Research section
NMPDU DML Newsletter
Care Planning for Older Person’s Services ( Day Care Setting)
The Dublin Mid Leinster Integrated Minimum Dataset (September 2010) has been successfully implemented
in many residential services in DML. As this tool was designed for residential care, the Directors of Nursing in
Older Persons Services in Dublin South, Kildare and Wicklow identified a requirement for specific
documentation to support care planning within day care services for older persons.
Subsequently, with the support of the NMPDU and regional Quality, Standards and Governance officer for
Older Persons Linda McDermott Scales, models were explored and a draft toolkit was developed (including
policy document, care planning tool, audit tool and record keeping guidelines). The toolkit is being tested for a
three month period in two sites. Audit findings will inform further changes required with a view to finalising the
document for roll out by the end of the year.
For further information, please contact Raphael Mc Mullin at: [email protected]
Midland Regional Hospital Portlaoise: Prescribing of Ionising Radiation
by Registered Nurses
The expansion
of
practice was recently •
extended to Registered nurses working in the
Emergency Department of Midland Regional
Hospital Portlaoise (MRHP) with the introduction
•
of X Ray Prescribing
Benefits
•
Improve the provision of safe, effective
and timely care to patients/service
users in the
Emergency Department (ED).
•
Improve access by patients/service
users to radiological diagnostics
while adhering to the ALARA
principle (as low as reasonably
achievable).
•
Reduce waiting times in the Emergency
Department of the MRHP.
•
Increase convenience for patient/service
users, with enhanced user satisfaction.
•
Ensure effective and efficient
utilisation of nurses’ competencies and skills.
•
Increase awareness of risk
management issues associated with ionising
radiation (X-ray) amongst nurses.
Prescribe for adult only patient/service
user populations within the practice
setting and scope of practice set out
in MRHP Policy.
Work
collaboratively
with
other
members of the healthcare team in
order to enhance therapeutic outcomes
for patients/service us.
Emergency Department - LIG Range of
Approved X-rays
Patients presenting with
trauma:
•
Mid shaft of humerus
Elbow
•
Wrist
•
Forearm
•
Scaphoid
•
Hand
•
Finger /Thumb
•
Mid shaft of femur
•
Knee
•
Ankle
•
Foot
•
Patella
•
Tibia & Fibula
•
Toe
The role of the Registered Nurses with
Authority to Prescribe Ionising Radiation
(X-Ray) is to:
•
Make
an
independent decision to
prescribe ionising radiation (X-Ray).
•
Be responsible for the assessment of For further information please contact Ann Sheerin
the patient/service user, determining Divisional Nurse Manager Portlaoise Hospital
what the problem is and making a E-mail [email protected]
diagnosis that may lead to a clinical
decision to prescribe ionising radiation
(X-Ray).
Page 11
Continuing Professional Development & Research section
NMPDU DML Newsletter
New Programmes being delivered in the
Education Centre Tallaght Hospital
Picture of education centre tallaght to be inserted.
This education programme will be delivered
on a monthly basis in the Education Centre
commencing in August 2012. It comprises of
pre-course work and a 4.5 hour attendance
at the education programme.
Cervical Check update for Health
Professionals
Academic Writing Education
Programme
The Education Centre at Tallaght Hospital
has been extremely busy over the past
few months with the introduction of
many
new
programmes for Tallaght
Hospital Staff and for the Nurses/ Health
Care
Assistants
in
our
surrounding
community. Brief detail of these programme
are outlined here. This summer we have
developed and delivered an Academic
Writing Education Programme’. Academic
writing is an integral part of academic
education therefore the rationale for this
programme was to introduce students to
the skill of academic writing which they will
be expected to use in undertaking further
post graduate studies. It was designed to
be practical, relevant and participative with
an emphasis on improving skills and
knowledge. We hope to deliver
this
programme again during the summer 2013.
A cervical check update for health care
professionals was delivered on the 17th and
18th of July in the Education Centre. This
update was for Health professionals working in
midwifery, gynaecology & Colposcopy. It
provided an update
on the cervical
screening programmes programme policy
and guidelines.
Cancer Education Programme for
General Nurses working in a Hospital
Setting
The Education Centre Tallaght Hospital and
Naas
General
Hospital
are
working
collaboratively on the above programme.
This programme will be a pilot programme for
the National Cancer Control Programme - A
strategy and Educational Framework for
nurses Caring for People with Cancer in
Ireland. This programme is currently in
the developmental stage.
Falls Education Programme
Dementia Education Programme
Commencing again in October 2012 the
Education Centre in Tallaght Hospital will
d e li ve r
this
National
educ ational
programme, the overall aim to provide all
staff working across all disciplines, with
the knowledge skills and attitudes required
to deliver high quality, person-centered care
to the person with dementia and their
family/carers. The programme will be delivered over a 3 day period with a 2 week
interval in between programme days.
COMPASS Education Programme
COMPASS is an interdisciplinary education
programme designed to enhance our health care
professional understanding of patients who are
clinically deteriorating, and the significance of
altered clinical observations. It also seeks to
improve communication between health care
professions, and adopt a
patient-centred,
quality-driven approach, enhancing the timely
management of patients. Within Tallaght
Hospital we have a multidisciplinary cohort of 16
programme.
facilitators of the COMPASS
The ‘Strategy to Prevent Falls and Fractures in
Ireland’s Ageing Population’ published (June
2008) set out to address the serious problem
of fall related injuries in older people and to
improve bone
health
in
the
whole
population. This strategy will ultimately
minimise the health, social and financial
impact of falls related injuries and osteoporosis
in Ireland. It is based on best evidence and
encourages
Multidisciplinary team (MDT)
working collaboratively.
The Falls Education
Programme, therefore, sets out to educate
staff on some key messages from this strategy
involving a range of MDT members, in order
to facilitate best practice and evidence
based care for all patients who might be at
risk from falls. The EducationCentre will
deliver our first ‘Falls Education Programme’
on the 4th of October 2012.
Further information contact: Sandra McCarthy,
Education Co-ordinator
[email protected]. Tel: 01 4142857
Page 12
Continuing Professional Development & Research section
NMPDU DML Newsletter
Child and Family Health Needs Assessment Framework
In February 2010 The Public Health
Nursing Department in HSE Dublin
MidLeinsterinthe Laois/Offaly
and
Longford/ Westmeath area initiated the
development of a child and family
needs assessment framework (CFHNAF).
A multidisciplinary Steering Committee
was established with representation
from:
A 2 day programme of education was
also designed to provide public health
nurses and registered midwives (working
in the Public Health Nursing Services) with
the knowledge and skills necessary to
undertake
the
assessment,
approximately 120 staff have undertaking
the training.
Public health nursing in the Midlands and Dublin area;
NMPDU
Tullamore, Dublin and Cork;
PHN Consultant;
Regional Centre of Nursing and
Midwifery Education;
National
Children
and Families
Education Training Research and
Policy Group
Social Work Department
An evaluation of the implementation
and use of the CFHNAF was completed
and a report is currently being finalised
and will incorporate a number of
recommendations for
implementation.
Use of the record has allowed for the
objective
measure
of
‘at
risk
families’ that public health nurses have
within each caseload. PHN managers now
have a means of determining caseload
acuity and of allocating resources
according to caseload weighting.
•
•
•
•
•
The steering committee was set up to
o ve rse e
th e
d e velopment
and
implementation of the framework. Public
health nurses provide a universal child
health screening service to all children
under the age of 5 years. Standards for
these core visits are evidence based
and derive from the Programme for
Action modules. The introduction of the
CFHNA
provides PHN’s for the first time
with a 2nd level framework for assessing
children and families at risk. This
framework is based on best practice
from the UK and is contextualised
within
Irish child care policy and
strategy.
Prior
to
the
introduction
of this
framework PHN’s had no formal tool for
assessment of ‘at risk’ children and
families or recording of risk and
protective factors. The purpose of the
CFHNAF is to gather and interpret
information on the needs of vulnerable
children and families using the domains
of child’s developmental needs/parenting
capacity/family and
environmental
factors.
The CFHNAF consists of an assessment
framework, assessment record, care
plan resource manual and practice
guideline.
It has also initiated a timely process of
reflection by both front line PHN’s and
PHN management on the crucial role
that the PHN service can offer to
vulnerable ‘at risk’ families.
A governance group is now being set
up in the midlands area to support the
ongoing sustainability of
the CFHNAF
and support any issues that may arise.
Once the report is finalised it will be
circulated to Dr. Michael Shannon,
ONMSD and the Directors of Public Health
Nursing throughout the country.
Further information is available
from:
Ms. Virginia Pye
Director Public Health Nursing Health
Centre, Mullingar, Co. Westmeath
[email protected]
0449395078
Page 13
Continuing Professional Development & Research section
NMPDU DML Newsletter
Mental Health
Connecting Mental Health and Addictions
Services through Innovative
Training Courses on Dual Diagnosis
Dual diagnosis refers to the co-existence of
mental illness and substance use disorder in a
person (MacGabhann et al 2004). A training
course was developed by Hanora Byrne, a
Clinical Nurse Specialist in Addictions and a
Dr.Shobha
Rani,
Clinical
Placement
Co-ordinator within the Irish National Forensic
Mental Health Services in 2008 to address a
void in training/education on dual diagnosis in
Ireland. Service users were also involved in
the delivery of the training course. To date, it
has been delivered to almost 100 people
across a multitude of backgrounds including
mental health, addictions, probation services
and gardai throughout the 26 counties. The
training course has Category 1 approval from
An Bord Altranais.
The training evolved from a needs analysis
conducted with 20 probation officers and 20
psychiatric nurses. The developmental
process of the training course is published as
an article in the International Journal of
Nursing Education. To ascertain the
effectiveness of the training course, a
qualitative descriptive study was carried out
using three different methods: pre and post
evaluation, daily evaluation and a focus group
interview. Findings of this study were recently
published in the Journal of Psychiatric and
Mental Health Nursing. Furthermore, a
qualitative study was undertaken to explore
service users’ experiences of their
involvement in the delivery of the training
course. An article pertaining to this research is
currently awaiting publication in the Journal of
Nursing Education in Practice. In addition, to
pr om ot e
st af f
f acilit at ion
of
the
psycho-educational group programmes for
patients with dual diagnosis a ‘Group facilitation skills training’ course was developed
which has Category 1 approval from An Bord
Altranais. This course was attended by multidisciplinary team members. An audit was undertaken to identify staff knowledge, attitude
and experience regarding patients’ drug and
alcohol use.
Health Promotion Initiative
The Irish National Tobacco Control Framework
(Health Service Executive (HSE), 2010) stated
that all HSE campuses will become tobacco
free by the year 2015. In order to meet this
objective, the CNS in Addictions at the National
Forensic Mental Health Service is delivering a 7
session
weekly
programme
‘Smoking
Cessation’ developed by the HSE. To date, 40
service users have completed the Smoking
Cessation programme. The effectiveness of
these groups were evaluated using a
pre-test-post test design. By the end of year
2013 it is envisaged that every service user in
the central mental hospital will have completed
the programme.
National Forensic Mental Health
Service, Central Mental Hospital
A training programme at the National Forensic
Mental Health Service, Central Mental Hospital,
Dublin-14 is due to commence in February
2013. The programme “Dual Diagnosis: Training in
Psycho education Programmes” (An
Bord Altranais Category 1 Approved). This 35
hours (5-day) training programme, delivered
over three weeks, is aimed at introducing the
concept of dual diagnosis and the psychoeducation group programmes that may be utilise in services while dealing with dual diagnosis
service users.
For further information please contact:
For further information contact:
Hanora Byrne (CNS) or Dr.Shobha Rani, (CPC)
Email: [email protected]
Page 14 Continuing Professional Development & Research section NMPDU DML Newsletter
HSE opens new Residential Unit in Mullingar
Cluain Lir Care Centre is a new purpose built
residential care centre opened by Dr O’Reilly,
Minister for Health in July 2012. It is located on the
grounds of St Mary’s Care Centre on the outskirts
of Mullingar and very close to the Midland Regional
Hospital.
Within the care centre there are two distinct
residential care services. There is a 48 bed
Community Nursing unit for older persons and a
separate 42 bed unit fro Psychiatry of Later Life. A
separate Day Care Centre operates adjacent to the
Community Nursing Unit on a five day weekly
basis.
The new unit replaces St Mary’s Care Centre and
Psychiatry for Late Life services from the St
Loman’s Hospital campus in Mullingar. The transfer
of residents to the Community Nursing Unit took
place on a phased basis over a two week period.
The state of the art building facilitates the provision
of an excellent standard of in care in contrast to
facilities previously provided in the old St Mary’s
building which was built in 1841. All bedrooms have
ensuite facilities and full coverage with ceiling track
hoist system. The units are designed around a
central courtyard garden and are fully contained to
facilitate residents with various stages of Dementia
and dependency.
The ethos of Cluain Lir Community Nursing Unit is
one of person centeredness. All care is planned and
delivered in collaboration with residents and their
families. Residents remain at the centre of everything
that the Community Nursing Unit strives to do. An
environment of open communication through the
facilitation of resident meetings and resident
representation is fostered at all times
The staff of Cluain Lir Community Nursing Unit are
dedicated to delivering high quality standards of care,
both physical and psychological using a person
centred approach. Staff encourage, promote and
develop independence and work in partnership with
both residents and their families. Staff see residents
as complex individuals with a variety of needs and
want them to enjoy life where all aspects of their
existence are meaningful and harmonious within their
environment.
We believe in achieving excellence in outcomes of
care delivered through continuous performance and
quality improvement using evidence-based practice.
Staff at Cluain Lir Community Nursing Unit are
committed to their role as resident advocates and
constantly strive to ensure that each resident receives
optimum quality holistic care. Staff endeavour to
address the physical, emotional social and spiritual
needs of all residents with a holistic approach of
empathy and kindness.
For further information or to arrange a visit to the Centre please contact either Mairéad Campbell,
Director of Nursing or Emer Hyland, Assistant Director of Nursing on 044 9394934.
Page 15 Provision of Safe, Quality Care
NMPDU DML Newsletter
Development of Carer Needs Assessment Tools
The assessment tool can be used in
the following situations:
•
As part of the CSAR documentation;
•
In situations where Elder Abuse is
suspected or reported;
•
To assess the needs of Parents/
Carers of children with life limiting
illnesses.
•
At the discretion or clinical judgement
of community nursing staff.
The term ‘Carer’ can be used to describe
anyone who looks after, or feels
responsible for
someone who cannot
manage at home without some support.
This
may
be
because
of
illness, disability, mental health needs or
intellectual disability. Census figures
indicate
that Carers
account
for
approximately five percent of the general
population of our region.
Section 3 of the Common Summary
Assessment Record (CSAR) was the
stimulus for the development of a Carer
Needs
Assessment Tool which has
recently been
developed and piloted in
the Longford/Westmeath and Laois/Offaly
Community Care areas. The Public Health
Nursing Service is committed to utilising
this evidence based assessment tool
which will assist them to explore carer
needs and identify appropriate supports
that will result in improved outcomes for
both the carer and the care recipient.
Following the implementation of the
CSAR, a working group was formed to
explore and research assessment tools
in use, specifically for carers, or if
necessary to develop an assessment
tool, which would be user friendly,
evidence
based,
effective
and
appropriate within the staffing and
financial constraints which prevail.
The potential benefits of the Carer’s
needs assessment include the
following:
•
It provides an opportunity to identify
the
carer’s needs and to provide
information on available resources.
•
It acknowledges and validates the
carer in their caring role.
•
It
may
assist
the
nursing/
multi-disciplinary team in the clinical
decision making
regarding the
allocation of and resources.
Plans for the future:The new Carer
Needs Assessment Tool is currently at final
draft stage and has been approved by the
Directors of Public Health Nursing. Training
and rollout is currently in progress and
following final approval will be available to
all Community Nursing teams in Longford,
Westmeath, Laois and Offaly.
For further information contact: Cáit
McKeon at: cà[email protected]
Something to think about…..
Page 16 Provision of Safe, Quality Care
NMPDU DML Newsletter
Longford Westmeath Community Specialist Palliative Care Service
The Longford and Westmeath community
specialist palliative care service has been
enhanced by the addition of a Hospice unit
in Athlone (South Westmeath Hospice).
Although the unit is small (consisting of
four beds), it supports the work of the
community specialist service by providing
an inpatient facility. Care is provided by a
team of nursing staff that are committed
to the provision of palliative care.
Input from the specialist community team
supports the education of the staff and the
care provided to ensure that the palliative
needs of the patient and their families are
met. Patients are generally known to the
specialist community team prior to
admission and this facilitates continuity of
care.
The Clinical Nurse Manager 3 in specialist
palliative care is the first point of contact
for a proposed admissions. Palliative care
criteria
are
used
to
gauge
the
appropriateness of
admission and a
discussion within the team follows. The
Hospice unit is built alongside St Vincent’s
hospital and the unit is supported
operationally by the hospital. The success
of the unit relies on good communication
between all. The main reasons for
admission to the unit is support with the
management of difficult symptoms that
require closer monitoring than can be
achieved at home or one to two week
periods of respite to enable the patient
and their carer/carers to continue coping
at home thus preventing unnecessary
hospital admissions. The provision of end
of life care where home is not a feasible
option for the patient.
The aim of the unit is to provide a high
standard of patient centred palliative care.
Palliative care is defined as the active,
holistic care of patients with advanced
progressive disease. Management of pain
and other symptoms and provision of
psychological, social and spiritual support
is paramount. The goal of palliative care
is achievement of the best quality of life
for patients and their families. There are
three levels of palliative care, which refer
to
the
expertise
of
the
health
professionals delivering palliative care.
There are three approaches to palliative
care: Level one - Palliative Care
Approach where all health care
professionals should practice palliative
care principles. The palliative care
approach should be a core skill of every
clinician at hospital and community
level. Many patients with progressive
and advanced disease will have their
care needs met comprehensively and
satisfactorily without referral to specialist
palliative care units or personnel.
Level two - General Palliative Care:At
an intermediate level, a proportion of
patients and families will benefit from
expertise
of
health
care
the
professionals
who,
although
not
engaged full time in palliative care, have
had some additional training and
experience in palliative care, perhaps to
diploma level. Such intermediate level
expertise may be available in hospital
or
community
settings.
Level three - Specialist Palliative Care:
Specialist palliative care services are
those services whose core activity is
limited to the provision of palliative care.
These services are involved in the care
of patients with more complex care
needs, and consequently, require a
greater degree of training, staff and
other resources. It is essential for
specialist palliative care services to
function alongside other secondary
or
tertiary
health
care
services.
South Westmeath Hospice is a level two
hospice. So far this year sixty episodes of
care
have
been
supported.
Feed back from patients and their
families has been extremely positive.
For further information contact:Margaret
Wilkie at: [email protected]
Page 17
Corporate & Clinical Governance
NMPDU DML Newsletter
The Patient Priority Pledge– Your Journey Our Mission
Our Lady’s Hospice & Care Services, Harold’s Cross
Within our Clinical Governance Framework, an
exciting Quality Initiative was launched in June 2012.
It’s aim, to review and improve patients/residents
experiences in Our Lady’s Hospice & Care Services
using methods that have been described in various
hospitals in the NHS-UK. We wanted to ensure
continued focus on our “Quality Accounts”.
Measurement of outcomes and patient’s experience
are ‘hot topics’ in the Health World. We have
combined these topics into our own unique
manifesto to celebrate where we are and where our
patients think we should be.
The initiative is titled “The Patient Priority Pledge –
Your Journey, Our Mission”. This was chosen by
patients/residents from a selection of titles and it
contains the top two preferences. A “pledge” was
developed including a set of shared values and
behavioural standards expected of staff. A poster
has been designed and outlines the five components
of the initiative (see below).
Our pledge was launched by Claire Byrne, our
“National Quality Champion” and was attended by Dr
Michael Shannon, who celebrated along with
patients/residents and staff of all disciplines. We are
now in the third month of the implementation phase
of the Key Performance Indicators, using a traffic
light scoring system and are delighted to report that
all areas are scoring green. Once the pilot phase of
implementation is over we intend to publish results
on all ward notice boards.
Key Performance Indicators/Audit
Eight Performance Indicators are completed by the
Department of Nursing each month (Infection
Control, Privacy and Dignity, Tissue Viability, Falls
assessment, Observations and assessments, Pain
management, Medication Management & Patient
Experience)
Monthly, each ward receives a record of
results and a report is sent to the Quality and
Risk Committee. Further Key Performance
Indicators will be developed incorporating an
interdisciplinary approach.
•
Currently our multi-disciplinary team carry out
audits to ensure optimum care in a safe and
clean environment
•
Results are closely monitored to ensure
continuous improvement.
Step into my world
We use a variety of methods to understand the
experience of patients/residents to ensure that we
•
Examples as follows:
•
Senior staff including management and board
members are invited by the nursing staff to
visit residents/patients periodically to establish
their satisfaction.
•
Staff review care from a patient/resident
perspective and from this information review
practice.
Champions Groups
Champions Groups are made up of members of staff
with expert knowledge in a particular area of need in
the Hospice. This ensures best practice, awareness
and provides a source of expertise for staff on their
wards/departments.
L.E.A.P
Linking
Education
and
Practice is a
multidisciplinary education programme for all staff.
Quality, Performance and Practice Group (QPG)
This encompasses staff from all specialities leading
on Quality, Performance and Practice across the
Organisation. This group act as a consultative group
on the review and development of standards/
guidelines and policies.
For further information contact: [email protected] or
[email protected]
Page 18
Corporate & Clinical Governance
NMPDU DML Newsletter
Development of a Preventative & Management Strategy for Pressure
Ulcers within the Midland Regional Hospitals at Mullingar, Portlaoise &
Tullamore and reduce the incidence of hospital acquired pressure ulcers.
Pressure ulcers are a significant challenge in
healthcare, given their widespread occurrence
and economic consequences. A nursing and
midwifery strategy to address the prevention of
hospital acquired pressure ulcers within
Mullingar, Tullamore and Portlaoise hospital
network group was implemented and highlights
the benefit implementing a Pressure Ulcer
Prevention & Management Strategy.
Pressure ulcers represent a major burden of
sickness and reduced quality of life. They
create significant difficulties for the patient,
their carers’ and their families. Even a grade
one pressure ulcer is very painful. New
pressure ulcers are estimated to occur in
4%-10% of patients admitted to acute hospitals
in the UK, with one study documenting 20%
occurrence (Clark, Bours & Defloor 2004).
Studies in the Irish Acute Hospital services
report prevalence rates of 12% (Moore &
Pitman 2000) 21% (O’Brien 2003) and 18.5%
(Gallagher et al 2008).
The majority of pressure damage starts in
the first few days following admission with
an acute episode of illness or enforced
immobility. Risk factors for pressure ulcer
development are; 70 years and older, current
smoking history, dry skin, low body mass
index,
impaired mobility,
altered mental
status,
urinary and faecal incontinence,
malnutrition, physical restraints, malignancy,
history of pressure ulcers, (Guralnik et
al.1988, Berlowitz 1989, Brandeis et al.1990).
In 2006 Ireland had approximately 462,000
people over the age of 65. This figure is
projected to increase to 1.4 million by 2041
(Central Statistics Office 2011). Within the
three acute hospitals Mullingar, Portlaoise,
Tullamore, the number of patients accessing
our services over the age of 65
is
increasing. The total number of patients
over the age of 65 who received care
both on an in patient and day case basis
in the three hospitals was 124,015 for the
six year period of January 2005December 2010. This group of patients
because of their age and co-existing
morbidities are at increased risk of developing
pressure ulcers.
Within this hospital network a total of fifty
five (55) hospital acquired pressure ulcers
were reported during the six year period from
January 2005 to December 2010. These
figures for incidence of hospital acquired
p r e s s u r e
u l c e r s
a r e
much lower than the average reported
Nationally
and
Internationally
where
prevalence rates of 12%-21% are recorded.
The
pressure
ulcer
prevention
and
management strategy included staff education,
the use of good quality and clinically effective
pressure relieving mattresses, individualised
plan of care , with continuous monitoring, and
evaluation of the patient.
Further information is available from:
Bernadette Kerry
E-mail [email protected]
See additional information overleaf
Page 19
Corporate & Clinical Governance
NMPDU DML Newsletter
Development of a Preventative & Management Strategy for Pressure Ulcers within the
Midland Regional Hospitals at Mullingar, Portlaoise & Tullamore and reduce the
incidence of hospital acquired pressure ulcers.
Table 1. Incidence of Hospital Acquired Pressure Ulcers in the Midland Regional Hospitals at
Mullingar, Portlaoise and Tullamore Period January 2005- December 2011
Hospital
Total Bed
Number of Hospital Ac-
Six year
Yearly
Numbers
quired Pressure Ulcers
Average
Average In-
Mullingar
Portlaoise
202
164
9
15
Incidence
4.45%
9.1%
cidence
0.74%
1.52%
Tullamore
302
31
10.26%
1.71%
Total
668
55
8.2%
1.37%
Table 2 : Midland Regional Hospital Mullingar Patients Admitted Over the Age of 65
Year
2005
2006
2007
2008
2009
2010
Subtotal Total
4,039
4,418
4,450
5,022
5,136
4,977
Total Patients
28,042
No of Hospital Acquired Pressure
Ulcers
0
0
0
2
6
1
9
Table 3 : Midland Regional Hospital Portlaoise Patients Admitted Over the Age of 65 years
Year
2005
2006
2007
2008
2009
2010
Subtotal
3,178
3,188
3,092
3,271
3,188
3,319
Total Patients
19,236
No of Hospital Acquired Pressure
Ulcers
1
1
4
4
0
5
Table 4 Midland Regional Hospital Tullamore Patients Admitted Over the Age Of 65 years
Year
2005
2006
2007
2008
2009
2010
Subtotal
7,149
10,412
11,606
13,388
15,930
18,252
Total Patients
No of Hospital Acquired
Pressure Ulcers
76,737
0
7
3
4
9
8
31
Page 20
Leadership and Innovation
NMPDU DML Newsletter
Launch of Resources to support Nurses and Midwives Care
for People with Multiple Sclerosis (MS)
Resources to support specialist and non specialist
nurses and midwives who care for people with
Multiple sclerosis were launched by Dr Kathleen
MacLellan, Nurse Advisor; Department of Health on
Friday September 7th. These documents were
developed by the Irish Network of Multiple Sclerosis
Nurses in partnership with the HSE National Nursing
and Midwifery office.
Multiple Sclerosis Manual for Specialist Nursing
in Ireland: In 2003 the Irish Network of Multiple
Sclerosis Nurses developed the first edition of the
Irish Multiple Sclerosis Nursing Manual. Adapted
from the Canadian, European and UK documents, it
is an important manual for specialist nurses as it
provides an international perspective on all aspects
of the diagnosis, assessment, treatment and care of
people with MS. This manual has now been
updated with current evidence for nursing care and
treatment of patients with MS.
A handbook for non specialist nurses/midwives:
A handbook for non specialist nurses and midwives
was also developed.
The handbook has a general introduction; it describes
how a diagnosis of MS is made, briefly outlines some
of the main medical treatments used with patients and
the roles of the various Multidisciplinary teams both in
the hospital and in primary care. Importantly it
provides guidance to nurses on the specific issues to
assess in relation to MS in the context of their holistic
care to patients. Both resources have been peer
reviewed by number clinical experts from a variety of
professions.
At the launch Liz Roche noted “The publication and
launch of these documents reflects the importance of
developing an integrated approach to the work of all
stakeholders in the care of people with MS throughout
their journey in life and most importantly to working in
partnership with the person themselves”.
Copies of the manual were given to all MS specialist
nurses nationally and copies of the handbook are
being sent to all services. All resources will be on
http://www.hse.ie/eng/about/Who/
ONMSD website
ONMSD/. For further information please contact: Liz
Roche at: [email protected]
Development of End of Life Suite, Midlands Regional Hospital, Tullamore, Co. Offaly
The Midlands Regional Hospital, Tullamore
has been participating in the Hospice
Friendly Hospitals (HfH) programme since
2010. Through the implementation of the
Quality Standards for End of Life Care in
Hospitals, (HfH,2010) we are striving to
improve the experience of End of
Life
Care
for
patients, families and staff
members. While we are mindful of facilitating
expected deaths at home, this may not
always be possible, depending on individual
situations. Where it is not a possibility, our
primary objective is to ensure a positive
experience for both our patients and their
families. Following the transfer of all
services to our new hospital facility in 2008,
a dedicated area, incorporating a patient
bedroom with a family area was opened
on a Medical Ward (2).While this is area is
actively used, there is greater demand for a
second area of this nature within the
hospital campus. A recent initiative developed by the MRHT End of Life Committee,
based on Standard 1, The Hospital
(HfH, 2010), focuses on developing the hospital environment to meet End of Life Care
needs.
We are currently in the process of
developing an End of Life Suite in Medical 1.
This suite compromises of patient bedroom
with en-suite bathroom facilities, a family
room and access to an enclosed garden area.
The suite will be located on the ground floor of
the hospital in close proximity to our healing
garden. Funding for this project has been
supported by the Friends of the Midlands
Regional Hospital, Tullamore. We are now at
the end stage of planning for this initiative
and construction works are beginning in the
next number of weeks. It is anticipated the
suite will open in early 2013 and will support
the improvement of the physical hospital
environment to ensure our patients die with
dignity.
For further information, please contact Denise
Doolan
at:
[email protected]
or
057 93 8133/58091
or Clare O’Dea at: [email protected] or
057 93 58361/58091
Page 21
Leadership and Innovation
NMPDU DML Newsletter
Homebirth Information Booklet developed by Community
Midwives at the National Maternity Hospital (NMH)
The community midwives from
the
National Maternity Hospital have offered
an outreach homebirth service for the
last 13 years. The Minister for Health,
Dr. James Reilly (Irish
Times, June
2012) endorsed the option of homebirth
f o r wom en in t h e a p p ro p r i a te
circumstances.
Less than 0.5% of all women have
homebirth in Ireland, but this is often
due to the lack of services available
rather than a lack of demand. There is
limited written information available on
homebirth in
Ireland. Women and
their partners in
particular, often ask
the staff for literature on the subject
but little is documented.
their partners can make informed
decisions about selecting location of
birth.
The philosophy of the community
midwives from the National Maternity
Hospital outreach home birth service is
that the birth process is not just a
physical act but profound social and
psychological life event. Our aim is to
facilitate informed choice and to foster a
non-interventionist, non intrusive approach to birth whenever possible
within the realms of safe midwifery
practice. As midwives working at the
NMH we recognise that child-birth is a
life enhancing event.
To bridge the information gap the
midwives have just completed
a
homebirth booklet to give parents
information on homebirth, to facilitate
decisions in relation to choice of birth
place. The aim of this booklet is to
explain
the
service
that
the
community midwives offer.
The Royal College of Midwives (RCM) and
the Royal College of Obstetricians and
(RCOG)
support
Gynaecologists
homebirth
for
women
with
uncomplicated pregnancies. There is
evidence to
show that women
labouring at home increases the likelihood of a birth that is both satisfying
and safe”.
The objective of this booklet is that
women with low risk pregnancies and
For further information contact ???
When you are a mother, you are never
really alone in your thoughts. A mother
always has to think twice, once for
herself and once for her child. Sophia Loren,
Page 22
Leadership and Innovation
NMPDU DML Newsletter
Midland Regional Hospital Portlaoise:
Paediatric Documentation
Information has most value when it is
accurate, up to date and accessible
when it is needed. The quality of records
maintained by nurses and midwives is a
reflection of the quality of the care
provided by them to patients/ clients.
Nurses and midwives are professionally
and legally accountable for the standard
of practice which they deliver and to
which they contribute. Good practice in
record management is an integral part of
quality nursing and midwifery practice.
(ABA 2002).
An Bord Altranais states “individual
nurse/midwife should establish and
maintain accurate, clear and current
client records within a legal, ethical
and professional framework”. Nurses
and Midwives are professionally and
legally accountable for the standard of
practice to which they contribute and
this includes
record
keeping.
Accountability is the cornerstone of
professional nursing and midwifery
practice. In the course of professional
practice, nurses and midwives must be
prepared to make explicit the rationale
for decisions they make and to justify
such decisions in the
context of
legislation, professional standards and
guidelines, evidence based practice and
professional and ethical conduct (Scope
of Nursing and Midwifery Practice
Framework, April 2000). Good record
management
therefore
underpins
professional practice.
Midland Regional Hospital Portlaoise
recently introduced a new paediatric
nursing booklet for all patients.
Previous audits
of
the old
documentation
highli gh ted
s ome
recommended changes in line with
HSE Records Management Policy 2010
and An Bord Altranais Recording Clinical
Practice Guidelines for Nurses & Midwives
2002. Paediatric Nursing staff and
Regional
Pra c ti ce
Development
nursing
Coordinator
examined
documentation utilised in Children’s
Hospitals
both
nationally
and
internationally. The nursing process
for this
provided the framework
initiative.
Benefits: The new documentation is
inclusive of child assessment, problem
identification, goal setting, plan of care
with interventions and subsequent
evaluation of the effectiveness of the
care given. The documentation also
includes discharge planning. A new
addition to the document is the Braden
Q Paediatric Risk Assessment tool for
predicting
Pressure
Ulcers . Staff
education in relation to care planning is
being supported by both
Regional
Nursing
Practice
Development
Co-ordinator and Centre for Nurse
Education. For further information please
contact on: Bernadette Kerry, E-mail
[email protected] or Berna Keating,
E-mail [email protected]
Left to right: Mia Byrne, Berna Keating,
Margaret Brown,
Backrow Left to right: Cathy Fitzpatrick,
Suzanna Pearson, Clodagh Mansfield,
Georgina Doyle