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BACKGROUND: Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes. OBJECTIVES: To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis. DESIGN: A case study using retrospective hospital data, at ward level. SETTING: A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals. PARTICIPANTS: All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months. METHODS: Data were extracted from corporate hospital systems. The clinical areas were categorised as lower dependency, i.e. wards, or critical care which included ICU and high dependency units. The relationship between nurse staffing characteristics and patient outcomes was assessed using either a Poisson or negative binomial regression model as appropriate. We sought to establish whether the outcomes were affected by the nurse hours per patient day, the permanent nurse hours worked as a percentage of the total hours, and the permanent nurse hours worked as a percentage of the permanent and bank hours combined. RESULTS: In the lower dependency category wards there was only a weak association demonstrated between nurse staffing and the majority of the outcomes. The results from the high dependency critical care areas showed few significant results with only the rate of sepsis being significantly reduced as the ratio of permanent staff hours increased. CONCLUSIONS: The study demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes, however the associations found were weak and did not replicate reliably the findings from previous work. [ABSTRACT FROM AUTHOR]

BACKGROUND: A nurse-led support and education programme for patients waiting for coronary artery bypass surgery was evaluated in a randomised controlled trial of 188 patients at a tertiary centre in the UK. AIM: To add a qualitative perspective to the evaluation by exploring patients' experience while taking part in the trial and staff views of the patients' experience and the intervention. METHODS: A purposive sample of 19 patients was interviewed and the transcriptions read to staff during focus groups. They discussed what they learned from the stories and their own experience of the programme. RESULTS: The patients appreciated support from the nurses but felt communication and physical assessment could be improved. The patients varied in their understanding of the programme and their degree of motivation to improve their health. The staff varied in their approach to preparing patients for surgery. External factors influencing the intervention's impact were length of time on the waiting list and the increasing contribution of local rehabilitation services. CONCLUSION: Staff need to improve communication both between themselves and with the patients. Patients appreciate physical and psychological preparation for surgery, but the waiting period is not the optimal time to address their risk factors for coronary disease. [ABSTRACT FROM AUTHOR]

Aim To explore patient centred leadership at every level in an organisation and provide practical examples of how this was demonstrated in an acute tertiary NHS Trust. Background There is a direct relationship between leadership and quality of care. With increasing expansion of their role nurses are in a key position to influence and lead colleagues to improve patient care. Evaluation The Leadership Qualities Framework (NHS Institute of Innovation and Improvement 2006) is used to illustrate the various qualities used by clinical leaders in examples of leadership in practice. Key issue Leadership development with the emphasis on the patient drives improvements in service delivery and patient safety. Conclusion Patient centred leadership is demonstrated when there is support at the top of the organisation. Politically aware nurses make effective patient centred leaders. Leadership development programmes provide staff with opportunities to acquire essential skills and qualities in order to contribute to the vision of the organisation. Implications for nursing management Managers should support staff and take risks in order to empower nurses to implement initiatives which improve patient care. A process of communication using a variety of tools can have a impact on a range of staff. Patient centred leaders are role models for tomorrow's leaders, their impact has lasting effect and wider implications within an organisation and beyond. [ABSTRACT FROM AUTHOR]

BACKGROUND: The 'Fit For Surgery' programme was based on previous studies suggesting improvement in risk factors contributing to coronary disease while patients wait for cardiac surgery. AIM: To evaluate our nurse-led programme in a randomised controlled trial with 188 patients. METHODS: Patients listed for coronary artery bypass surgery with at least one poorly controlled risk factor were randomised to standard care or the intervention which provided lifestyle counselling and preparation for surgery at monthly intervals. Primary outcome measurements were anxiety, blood pressure, cholesterol, length of stay and body mass index. Costs of the intervention were also collected. RESULTS: For both groups blood pressure and total cholesterol improved (Blood pressure mm Hg (Control -9.11 (CI -4.89, -13.33); Intervention -13.02 (CI -8.76, -U17.29) both p<0.01); total cholesterol (Control -0.20 (CI -0.03, -0.37) p=0.02, Intervention -0.18 (CI -0.02, -0.34) p=0.03). However there were no significant differences between the groups. Cost minimization analysis showed that the total costs were less in the intervention group due to fewer admissions (total costs pound10,754 (3746) v pound13,047 (5835), CI -3743, -843; p=0.002). CONCLUSIONS: The nurse-led programme did not appear to reduce risk factors prior to coronary artery bypass surgery. However, the intervention appears to reduce overall healthcare utilization. [ABSTRACT FROM AUTHOR]

The systematic review is an important research method that allows for the critical analysis of the results from a range of existing studies to answer research questions. The findings can be used to inform clinical decisions, as well as the development of protocols and guidelines. The aim of this paper is to explore the steps involved in undertaking a Cochrane systematic review and to encourage more nurses to participate in this world wide collaboration to answer questions that are relevant to nursing practice. The first stage of a review involves initiating a focussed clinical question in which the patient group or problem is identified as are the intervention, comparison and outcome, which will become the focus of study. Each review is guided by a protocol that is subject to peer review and followed by a structured search of the worldwide literature on the subject. Quality assessment and data extraction are done systematically and subject to cross-checking. The results are analysed using statistical methods, including meta-analysis. Publication is electronic in the Cochrane Library and many will also be published in other journals. As with all research, findings should be presented in a way that enables the reader to assess whether the review can be applied to their patient. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in the United Kingdom. Background. The European Heart Failure Self-care Behaviour Scale quantifies the measures patients take to manage their heart failure. Produced in the Netherlands and Sweden, it has been translated into English. Methods. A convenience sample of 183 patients (response rate 85%) with heart failure (New York Heart Association, Class I-IV) was recruited from an outpatient clinic between July 2004 and July 2005. Mainly men (n = 143), they had a mean age of 65.6 years (SD = 12.3). They completed the Minnesota Living with Heart Failure Questionnaire, the Self-Care of Heart Failure Index, and the European Heart Failure Self-care Behaviour Scale during their clinic visit. The latter questionnaire was repeated at home within 2 weeks. Results. The scale was reliable but internal consistency was only moderate (Cronbach's alpha = 0.69) and lower than in other European populations. It appears to be repeatable in the short-term. Comparison with the Self-Care of Heart Failure Index raised questions about whether the two questionnaires measured the same concept. Variance in self-care was not explained by gender, age or severity of heart failure. Conclusion. As self-care is an important component in the life of patients with heart failure, further exploration of the methods for measuring patients' self-care behaviours is warranted to enable healthcare staff to assess patients effectively. This would also help in understanding the applicability of tools in a range of patients, cultures and settings. [ABSTRACT FROM AUTHOR]

Cardiac nursing takes place within various spheres of health care, reaching into primary, secondary and tertiary care within theses, cardiac expertise falls within four domains: health promotion, cardiac prevention and rehabilitation, acute, chronic and episodic care and palliative care. This paper sets out the possibility for a staged development of the cardiac nurse, which could promote homogeneity in role, skill and practice. A framework ('Expert Cardiac Nurse Pathway') for the United Kingdom, is proposed here, and views on its usefulness throughout Europe are sought. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiac rehabilitation programmes are widely accepted as being of benefit to patients with cardiac disease. The time spent waiting for cardiac surgery can be extremely stressful but can be used to address risk factors and provide information to reduce anxiety and prepare the patient for surgery. AIMS: To pilot the usefulness of a manual for pre-operative cardiac surgical patients, and assess the feasibility and usefulness to both nurses and patients of a monthly education and support programme for patients waiting for cardiac surgery. METHODS: A pilot study of 42 patients followed up for 3 months. Research tools included patient questionnaires and telephone interviews, risk factor measurements and nurse focus groups. RESULTS: Nurses and patients evaluated the manual and overall programme favourably, although the nurses found it was very labour intensive. Changes to risk factors made during the study were small but patients valued the opportunity to raise questions which fell into the categories of medical concerns, hospital procedure and risk factors. CONCLUSION: The manual is a useful tool for patients waiting for cardiac surgery. The programme is useful and feasible but could be targeted more specifically to patients with raised risk factors. [ABSTRACT FROM AUTHOR]

This study was undertaken with the intention of improving the effectiveness of small group tutorials in a diploma in nursing course. There was concern to avoid some of the less valuable aspects of tutorials highlighted in the literature. An investigation was conducted to elicit students' perceptions of the benefits of group tutorials at a comparatively early stage in their 2-year course, at the end of the second term. A qualitative approach was taken to explore the views of four students through individual semi-structured interviews. Additional data were gathered through personal field notes to add the tutor's perspective of the group process. Data were analysed inductively using a phenomenological approach in an attempt to elucidate the essence of each participant's experience of the tutorials. While the findings suggested that students valued their involvement in small group tutorials, some questions were raised which point to the need for further investigation. Themes were revealed which drew attention to the value students place on the experience of small group tutorials, thus endorsing the strategies employed. Benefits to students include the opportunity to get to know a small group of people when part of a larger learning group, support when coping with the pressures of course work and being able to share ideas about issues relevant to nursing. The report concludes that there is scope for further investigation and reflection in order to develop educational practice. [ABSTRACT FROM AUTHOR]

Director of nursing and quality Caroline Shuldham offers an overview of the role of nurse managers in promoting research. [ABSTRACT FROM AUTHOR]

The author shares her experience seeing a child being wheeled into surgery. She states that the incident highlighted to her the fortitude shown by people who are afflicted with disease, or are about to undergo a dangerous operation. She cites that the encounter happened during bad weather, which meant that the staff who went to work underwent risk, showing great commitment on their part. She believes that patients' trust should never be misplaced.

Caroline Shuldham explains how the NHS gateway has had little effect on the burden of paperwork. [ABSTRACT FROM AUTHOR]

Rationale and Key Points: Root cause analysis is a tool that can be used when determining how and why a patient safety incident has occurred. Incidents that usually require a root cause analysis include the unexpected death of a patient, serious pressure ulcers, falls that result in injury, and some infections and medication errors. This article outlines the stages of the investigation process for undertaking a root cause analysis. REFLECTIVE ACTIVITY: 'How to' articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of., Competing Interests: None declared, (©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

It's a heart-sinking feeling when you realise an error has been made, either by yourself or a colleague.

I was a nurse director for more than 20 years, initially at Royal Brompton Hospital, then at Royal Brompton and Harefield NHS Foundation Trust. It was a complex role and an overwhelmingly positive experience. Over the years, however, much has changed, and today the average tenure is about three years.

We have to admire the responses of individuals and organisations to the Grenfell Tower fire and the recent terrorist attacks, where major incident plans were activated. Our colleagues, nurses and the wider healthcare teams showed heroism, expertise, compassion and commitment.

Objectives: Evidence for the efficacy of Cognitive Behavioural Therapy (CBT) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group. This study aimed to assess the feasibility and acceptability of Group-CBT in severe asthma., Method: This was a two-centre, randomised controlled parallel group feasibility study. Eligible participants (patients with severe asthma and a clinically significant diagnosis of anxiety and/or depression - Hospital Anxiety and Depression Scale (HAD) score greater than 8 for the anxiety or depression sub-scale) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only. Follow-up was for 16 weeks and end points were: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire, HAD, Dyspnoea-12, EuroQual-5D and EuroQuol-VAS., Results: 51 patients were randomised: 36% (51 out of 140) consent rate and attrition at week 16 was 12. Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly demands of the programme. Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health. Participants who contributed to focus group discussions reported that Group-CBT contributed to a better understanding of their illness and related approaches to anxiety management and acceptance of their asthma condition. Although weekly face-to-face sessions were challenging, this was the preferred method of delivery for these participants., Conclusions: This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma. It has been possible but not easy to recruit and retain the sample. Options for a less demanding intervention schedule, such as less frequent face-to-face visits and the use of web-based interventions, require careful consideration.

Nurses in all sectors are under pressure as they respond to the rising number of patients, often with multiple problems, and the complexities of care. It is therefore important to look after yourself, both in and outside of work.

Health care is expensive, and nurses, like everyone else, must use resources responsibly. At the start of a new financial year there is usually a focus on budgets: how much was spent last year, what is available for next year and how savings will be made.

If nurses are to recognise good practice, identify problems and make improvements, they have to be sensitive to patients' views. That said, how can any of us truly understand a situation from another person's perspective, and see things as others do?

We all have a choice about how to handle change. Whether to welcome it or resist it, whether to lead or follow, or take a negative attitude and disrupt the changes others wish to make.

A phenomena increasingly recognised is that the experiences of healthcare staff influence the patient experience.

I recently read an advertisement with the headline 'Goodbye job, hello career'. Although it was for an accountancy course, the same message could easily apply to nursing.

Objectives: Schwartz Center Rounds ('Rounds') are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so., Setting: Public healthcare organisations in England., Participants: Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations., Results: The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors-a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being-initially led to Rounds being seen as 'an idea whose time had come'. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of 'mimetic pressure'., Conclusions: The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Measuring aspects of care and patient outcomes can help nurses who want to improve services.