VOICES
Reflections
Recipe for change Wendy-Ling Relph on a new report that sets out
Nursing workforce needs to what nurses can do to improve patients’ nutrition have more BME managers, says Yvonne Coghill BAPEN and PINNT were keen to Last month, an important report The latest report on the number of black and minority ethnic (BME) staff in senior positions in the NHS, published this month by Middlesex University research fellow Roger Kline, is a must-read for all NHS managers and professionals. The report reveals some shocking facts. Almost a fifth of the nursing workforce come from BME backgrounds, yet only 3 per cent of nursing directors in England do – the same level as ten years ago. The number of BME nurse managers has actually fallen from 8.2 per cent in 2003 to 7.8 per cent in 2012. The research also found that BME staff in London were three times less likely to be promoted to senior management roles than their white counterparts, and that 17 of the 40 London trusts had no BME board members, despite 41 per cent of the workforce being from BME backgrounds. Not only has BME representation at the most senior levels of the NHS not improved over the last ten years, it has gone backwards. And yet we now have strong evidence to show that an engaged, motivated and inclusive workforce delivers higher quality care for patients. In his paper NHS Staff Management and Health Service Quality, Lancaster University professor Michael West says: ‘The experience of BME staff is a very good barometer of the climate of respect and care for all within NHS trusts.’ If the NHS wants a workforce that is willing to continue delivering high quality patient care while coping with reduced resources and rising demands, trusts need to address this issue as a matter of urgency. Yvonne Coghill is senior programme lead for equality and inclusion at the NHS Leadership Academy
on nutrition standards was jointly published by the British Association of Parenteral and Enteral Nutrition (BAPEN) and Patients on Intravenous and Nasogastric Nutrition Therapy (PINNT). The main finding of Nutritional Care and the Patient Voice: Are We Being Listened To? was that more needs to be done to improve the management of nutrition and hydration problems. If its messages are heeded, many aspects of care could be improved. Both the Francis and Berwick reports – and Nursing Standard’s CARE campaign – raised specific, important concerns about nutrition and hydration care in hospitals. They all highlighted the need for a culture change based on leadership, training and information to improve patient experience and safety, underpinned by patient dignity and involvement.
Sole searching Don’t look down on feet, says Jane Bates A notice about a multidisciplinary foot clinic meeting was recently brought to our attention. Sounds like a barrel of laughs, we thought. Feet are not the most charismatic parts of our anatomy. But, on second thoughts, I just had to stand up for them. Feet are pretty crucial in the great scheme of things, and we owe them our support, considering the way they have so unfailingly supported us over the years. Their deterioration is a sad thing to see. All too soon those adorable babies’
know whether patients’ wishes and experiences are central to decisions when nutrition services are developed. They collaborated with nine patient organisations and two NHS trusts to compile their report, which addressed three key issues: whether adequate priority has been given to nutrition and hydration services, and if this has improved in recent years; whether the patient experience associated with nutritional support has improved; and whether inequities in nutritional care have been addressed. The report said many patient groups are uncertain how much progress has been made on nutritional care. Indeed, many of the reports and proposals on patient involvement have not made nutrition a central theme at all. It seems little if any attention has been paid to the methodology for evaluating complex nutritional problems, such as feet, with their chubby little dimpled toes, become gnarled, sweaty and verruca-ridden. Poor things, it all looked so promising. I once worked with a doctor who had a thing about feet. Not in a fetish kind of way, but an I-cannot-stand-them kind of way. He found feet utterly repellent. No wonder he specialised in ear, nose and throat – he got as far away from people’s feet as possible. If a patient tried to show him their corns (people do not always respect the disciplinary boundaries), he would visibly blanch. Never underestimate how difficult foot care becomes as we age. To the young, feet are viewed in a perfunctory way as we cram them into high heels and pound hard pavements without a
26 april 23 :: volfrom 28 no 34 :: 2014 STANDARD Downloaded RCNi.com by ${individualUser.displayName} on Nov 14, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
SCIENCE PHOTO LIBRARY
We want to hear your comments, views and experiences. Please send ideas for your articles to [email protected]
The BAPEN and PINNT report highlighted communication as one of the issues that needs addressing
those experienced by patients receiving home enteral or parenteral nutrition. The report highlighted yet again that service provision and the experience of patients and their families are variable across the NHS. Not surprisingly, the most vulnerable patients are often experiencing the greatest inequalities. The report sets out these findings: Being proactive, not reactive, is key when addressing nutrition and hydration issues. Individuality is key for care given. thought. Then, as middle-age spread takes hold, we lose sight of them, so they tend to get neglected. When older, they cannot be reached, even if they are in view. So there they are, out on a limb, so to speak. Without one’s feet it is hard to stay healthy. Exercise when they are not fully functioning or pain-free is not easy, and without the freedom to walk around, one’s social interactions can become curtailed, leading to isolation and loneliness. So, if someone wants to talk about these overlooked, underappreciated appendages, it is more than okay by me. Jane Bates works in outpatients in Hampshire
Monitoring and following up of patients is vital when they are screened for malnutrition, not just initial treatment. Check advice and never assume that a patient is comfortable with information provided. Patients and their carers must be able to play a proactive role. Transition periods between care settings must be planned. Out-of-hours service provision must not be a ‘tick box’ exercise. Patient training is crucial for those on complex therapies. Patients, families, carers and patient organisations represented in the report stand ready to be involved directly in improving care; they can contribute if they are involved in a meaningful way. Nurses need to be aware of this report and find ways to work with their colleagues and patients to ensure patients are genuinely involved in their care and the development of services. Communication is key, and nurses need time to exchange information and effectively communicate with patients and carers. Wendy-Ling Relph is matron for nutrition and quality improvement at East Kent Hospitals University NHS Foundation Trust and BAPEN communications officer
Quiet please David Newnham would rather not hear some things I am never quite sure why there is so much anxiety about sharing medical records. If the government made it a criminal offence for private companies to profit from our data, I suspect that our fears would evaporate overnight. After all, most people will share the most intimate medical details with strangers at the drop of a hat. The size of your gallstones? Tell me about it, mate. Or try stopping you, more like. And when they are done giving us the low-down on their own dodgy tickers and dicky bladders, they will happily spill the beans about their nearest and dearest. How else would I know so much about Fiachra’s father’s abscess? But the abscess is only half the story. Fiachra’s dad can hardly get a wink of sleep in his hospital bed, what with the lights and the beeps, the to-ing and fro-ing, and the general racket. And that is affecting his health. ‘He is 87. He’s been in there six weeks, and I doubt he’s had more than a couple of hours sleep in all that time,’ says Fiachra. ‘So guess what? When he does get out of bed, he falls over and does himself an injury. Surprise, surprise.’ I know exactly what Fiachra means. I think we all do. What struck me during my own recent stay in hospital was the lack of darkness at night, and the fact that conversations seemed to be going on at normal volume in the very room where SOME OF US WERE TRYING GET SOME SLEEP! A professor was recently sounding off in the media about how the blue light from our electronic devices is interfering with our sleep rhythms and cycles. Failure to get at least seven hours of sleep each night, he said, could result in weight gain, heart disease, diabetes and cancer. It is no secret that patients find it hard to sleep in hospital. I have no idea how you fix this, but perhaps we ought to talk about it. David Newnham is a freelance journalist
NURSING :: vol uses 28 no 34 :: permission. 2014 27 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 14, 2015. For personal use april only. 23 No other without Copyright © 2015 RCNi Ltd. All rights reserved.
Reflections
Recipe for change Wendy-Ling Relph on a new report that sets out
Nursing workforce needs to what nurses can do to improve patients’ nutrition have more BME managers, says Yvonne Coghill BAPEN and PINNT were keen to Last month, an important report The latest report on the number of black and minority ethnic (BME) staff in senior positions in the NHS, published this month by Middlesex University research fellow Roger Kline, is a must-read for all NHS managers and professionals. The report reveals some shocking facts. Almost a fifth of the nursing workforce come from BME backgrounds, yet only 3 per cent of nursing directors in England do – the same level as ten years ago. The number of BME nurse managers has actually fallen from 8.2 per cent in 2003 to 7.8 per cent in 2012. The research also found that BME staff in London were three times less likely to be promoted to senior management roles than their white counterparts, and that 17 of the 40 London trusts had no BME board members, despite 41 per cent of the workforce being from BME backgrounds. Not only has BME representation at the most senior levels of the NHS not improved over the last ten years, it has gone backwards. And yet we now have strong evidence to show that an engaged, motivated and inclusive workforce delivers higher quality care for patients. In his paper NHS Staff Management and Health Service Quality, Lancaster University professor Michael West says: ‘The experience of BME staff is a very good barometer of the climate of respect and care for all within NHS trusts.’ If the NHS wants a workforce that is willing to continue delivering high quality patient care while coping with reduced resources and rising demands, trusts need to address this issue as a matter of urgency. Yvonne Coghill is senior programme lead for equality and inclusion at the NHS Leadership Academy
on nutrition standards was jointly published by the British Association of Parenteral and Enteral Nutrition (BAPEN) and Patients on Intravenous and Nasogastric Nutrition Therapy (PINNT). The main finding of Nutritional Care and the Patient Voice: Are We Being Listened To? was that more needs to be done to improve the management of nutrition and hydration problems. If its messages are heeded, many aspects of care could be improved. Both the Francis and Berwick reports – and Nursing Standard’s CARE campaign – raised specific, important concerns about nutrition and hydration care in hospitals. They all highlighted the need for a culture change based on leadership, training and information to improve patient experience and safety, underpinned by patient dignity and involvement.
Sole searching Don’t look down on feet, says Jane Bates A notice about a multidisciplinary foot clinic meeting was recently brought to our attention. Sounds like a barrel of laughs, we thought. Feet are not the most charismatic parts of our anatomy. But, on second thoughts, I just had to stand up for them. Feet are pretty crucial in the great scheme of things, and we owe them our support, considering the way they have so unfailingly supported us over the years. Their deterioration is a sad thing to see. All too soon those adorable babies’
know whether patients’ wishes and experiences are central to decisions when nutrition services are developed. They collaborated with nine patient organisations and two NHS trusts to compile their report, which addressed three key issues: whether adequate priority has been given to nutrition and hydration services, and if this has improved in recent years; whether the patient experience associated with nutritional support has improved; and whether inequities in nutritional care have been addressed. The report said many patient groups are uncertain how much progress has been made on nutritional care. Indeed, many of the reports and proposals on patient involvement have not made nutrition a central theme at all. It seems little if any attention has been paid to the methodology for evaluating complex nutritional problems, such as feet, with their chubby little dimpled toes, become gnarled, sweaty and verruca-ridden. Poor things, it all looked so promising. I once worked with a doctor who had a thing about feet. Not in a fetish kind of way, but an I-cannot-stand-them kind of way. He found feet utterly repellent. No wonder he specialised in ear, nose and throat – he got as far away from people’s feet as possible. If a patient tried to show him their corns (people do not always respect the disciplinary boundaries), he would visibly blanch. Never underestimate how difficult foot care becomes as we age. To the young, feet are viewed in a perfunctory way as we cram them into high heels and pound hard pavements without a
26 april 23 :: volfrom 28 no 34 :: 2014 STANDARD Downloaded RCNi.com by ${individualUser.displayName} on Nov 14, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
SCIENCE PHOTO LIBRARY
We want to hear your comments, views and experiences. Please send ideas for your articles to [email protected]
The BAPEN and PINNT report highlighted communication as one of the issues that needs addressing
those experienced by patients receiving home enteral or parenteral nutrition. The report highlighted yet again that service provision and the experience of patients and their families are variable across the NHS. Not surprisingly, the most vulnerable patients are often experiencing the greatest inequalities. The report sets out these findings: Being proactive, not reactive, is key when addressing nutrition and hydration issues. Individuality is key for care given. thought. Then, as middle-age spread takes hold, we lose sight of them, so they tend to get neglected. When older, they cannot be reached, even if they are in view. So there they are, out on a limb, so to speak. Without one’s feet it is hard to stay healthy. Exercise when they are not fully functioning or pain-free is not easy, and without the freedom to walk around, one’s social interactions can become curtailed, leading to isolation and loneliness. So, if someone wants to talk about these overlooked, underappreciated appendages, it is more than okay by me. Jane Bates works in outpatients in Hampshire
Monitoring and following up of patients is vital when they are screened for malnutrition, not just initial treatment. Check advice and never assume that a patient is comfortable with information provided. Patients and their carers must be able to play a proactive role. Transition periods between care settings must be planned. Out-of-hours service provision must not be a ‘tick box’ exercise. Patient training is crucial for those on complex therapies. Patients, families, carers and patient organisations represented in the report stand ready to be involved directly in improving care; they can contribute if they are involved in a meaningful way. Nurses need to be aware of this report and find ways to work with their colleagues and patients to ensure patients are genuinely involved in their care and the development of services. Communication is key, and nurses need time to exchange information and effectively communicate with patients and carers. Wendy-Ling Relph is matron for nutrition and quality improvement at East Kent Hospitals University NHS Foundation Trust and BAPEN communications officer
Quiet please David Newnham would rather not hear some things I am never quite sure why there is so much anxiety about sharing medical records. If the government made it a criminal offence for private companies to profit from our data, I suspect that our fears would evaporate overnight. After all, most people will share the most intimate medical details with strangers at the drop of a hat. The size of your gallstones? Tell me about it, mate. Or try stopping you, more like. And when they are done giving us the low-down on their own dodgy tickers and dicky bladders, they will happily spill the beans about their nearest and dearest. How else would I know so much about Fiachra’s father’s abscess? But the abscess is only half the story. Fiachra’s dad can hardly get a wink of sleep in his hospital bed, what with the lights and the beeps, the to-ing and fro-ing, and the general racket. And that is affecting his health. ‘He is 87. He’s been in there six weeks, and I doubt he’s had more than a couple of hours sleep in all that time,’ says Fiachra. ‘So guess what? When he does get out of bed, he falls over and does himself an injury. Surprise, surprise.’ I know exactly what Fiachra means. I think we all do. What struck me during my own recent stay in hospital was the lack of darkness at night, and the fact that conversations seemed to be going on at normal volume in the very room where SOME OF US WERE TRYING GET SOME SLEEP! A professor was recently sounding off in the media about how the blue light from our electronic devices is interfering with our sleep rhythms and cycles. Failure to get at least seven hours of sleep each night, he said, could result in weight gain, heart disease, diabetes and cancer. It is no secret that patients find it hard to sleep in hospital. I have no idea how you fix this, but perhaps we ought to talk about it. David Newnham is a freelance journalist
NURSING :: vol uses 28 no 34 :: permission. 2014 27 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 14, 2015. For personal use april only. 23 No other without Copyright © 2015 RCNi Ltd. All rights reserved.
