Nursing's Golden Ratio: Safe-Staffing:Law

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - POPULATION

Care Philosophy: Task orientation Vs Person-centred (Reality: Hybrid that assures person-centredness?) Individual Patient's, Friend's and Family impression Individual Patient's, Friend's and Family experience (AND memory) Confidence in Care (Confidence as a Learning Environment)  Individual Nurse's Values Individual Patient Outcomes PURPOSES	Numbers - count "40,000 missing Nursing" [RCN] Ratios: x :: y Staffing Research (Falls, Quality...) Operational Research; Measures Dependency; Chronicity; Nursing hours / day; Skill-mix; Care undone Productive Nursing Care Demographics: Local, National, Int. TIME: tasks, events, priorities, shifts The E's: Efficiency, Effectiveness, Equity, Equality  PROCESS
Qualitative Duty of Care Public awareness / sensibilities History of Research into Staffing (Time and Motion studies) Direct Nursing Care High Quality Nursing Care = The Golden Ratio PRACTICE	Quantitative Recruitment, Retention, Attrition Workforce Planning Professional Accountability Commensurate: Policy - Law NMC Code of Conduct Contract of Employment Employment T&C Emigration Policy, Overseas Workers Professional Bodies inc RCN, Unions ... Nurse Administration Support Information System - Synergy?  POLICY

My prompt with thanks: https://twitter.com/DannGooding/status/1110929934262898689


Additional sources [ c/o @DannGooding ]

A critical moment: NHS staffing trends, retention and attrition
Health Foundation, ISBN: 978-1-911615-25-5

RCN

American Nurses Association, Nurse Staffing Literature Review

Patient Education: Stable - Unstable Plaques c/o twitter ...

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

'The patient' Insight, Awareness, Understanding Attention, Engagement, Recall Health Literacy	Stable-Unstable Plaques Statins Post Myocardial Infarction Evidence-Based Care
Love this unstable plaque explanation - why this man should take a statin post MI @Channel4 #GPsBehindClosedDoors - please namecheck this nurse if you know her @theRCN @RCNconnects @NursingTimes @TheBHF @BritishCardioSo @DrPascalMeier @Heart_BMJ @JACCJournals #medshr pic.twitter.com/r1t0VCL0SL — Dr Asif Qasim (@DrAsifQasim) December 5, 2018	Policy Post MI Intervention or Pre MI? Clinics ('Real time'?) Public Health Funding

PROCESS and tick the boxes DO

For four decades at least and much longer (70 years?) within many health services there has been a preoccupation with process. Patients and carers may then perceive such services and how services are delivered as machine-like. As a whole the experience then constitutes an actual output - an outcome of clinics, appointments, waiting lists, tests and treatments. This is very unfortunate amid ongoing claims for services that are person-centred, individualised, patient oriented and even patient-first.

The patient is left to feel like a diagnosis, or even worse a problem in search of a diagnosis; tossed from one clinical encounter to another. In-between all this activity there are hopefully some compassionate brush strokes that soften the picture and patient experience. If not people notice the impact on values and quality of care ...

One of my pet hates right now is 'process before patients'. It's becoming more prevalent in healthcare and IMO it's wrong.

— Clive Blanchard (@blanchyshed) September 28, 2017

Whenever I see the word 'holistic' I wonder if it really is holistic? Yes, you can be holistic by ticking all the boxes, but nursing involves much more.

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

✓	✓
✓	✓

'Process' has been delivered at the door of nursing by management and the appeal to theory to inform practice. Nursing itself produced the 'nursing process'.

The nursing process through the stages of assess, plan, implement and evaluate prompted the argument that nurses were processing patients. To nurses of a certain age the nursing kardex, the record filled in every shift mirrored the nursing process. In a way recourse to process is not a problem, it is inevitable. It is to be expected. As we deal with space, time, risks and decisions ... we have to make judgements that are invariably process bound.

The four P's can help to 'balance the books' ...

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

PURPOSE	PROCESS
PRACTICE	POLICY

We need to remind ourselves of the four P's as they affect us individually and as organisations and collaborative agencies.

PURPOSE	PROCESS
PRACTICE	PURPOSE PROCESS PRACTICE POLICY

Perhaps, patient engagement can be defined as when the tick-boxing is obvious but it is also taking account of the 4Ps (and in a way beyond tokenism). For example, patients, carers and the public involved in policy review? The patient is then more realistically involved in the activity. Anything else, really is a tick-box exercise.

Progress has been made (at least in the four decades of my purview). Government policy is in continuous development but there remains - as ever - much to do. Especially in spanning the various distances that apply from policy, experience, care to be delivered and how; from the individual to the health services and health system as a whole.

('P'rogress! Mm... Is there another way to measure progress?) ;-) 

A Health Self-Portrait...

individual - self - patient - client - carer - person - resident - guest ...
 (you get the picture...?)

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

How easy is  it to create  a portrait of a  patient's health? How easy is  it for a patient to create a  health self-portrait?	Self-portrait pic.twitter.com/nA5gv1Qk2H — The Human Experience (@thehumanxp) February 2, 2018

Source:
https://twitter.com/thehumanxp/status/959501549901934593
https://twitter.com/thehumanxp/status/959501549901934593

Comment: From universal health coverage to right care for health - The Lancet

"What is right care? In its simplest definition it is care that weighs up benefits and harms, is patient-centred (taking individual circumstances, values, and wishes into account), and is informed by evidence, including cost-effectiveness." p.1.

Kleinert, S. & Horton, R. (2016). From universal health coverage to right care for health. The Lancet. Published Online January 8, 2017 http://dx.doi.org/10.1016/S0140-6736(16)32588-0

How can we reflect upon universal health coverage and 'right care'?

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

harm to the individual wishes values patient (person) centered	information resources harm - benefit ratios unnecessary care over diagnosis
beliefs community leaders harm to the community social benefits human relationships	Universal health coverage cost   finances organisations power policy

My source: Twitter greg fell

"End of Guidelines - a parody of End of the Line"

individual

|

INTERPERSONAL : SCIENCES

humanistic ---------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group

Original source (edited):

James McCormack, BSc(Pharm), Pharm D
Professor
Faculty of Pharmaceutical Sciences
UBC, Vancouver, Canada
Co-host - Best Science (BS) Medicine Podcast

therapeuticseducation.org

http://earthcitizenshealth.blogspot.com/2016/05/end-of-guidelines-parody-of-end-of-line.html

Mohammad Zakaria Pezeshki, M.D.

Associate Professor
Department of Community Medicine,
Tabriz Medical School, Golgasht Avenue, Tabriz, Iran.

The Willis Report on Nursing Education [ ii ]

The Willis Report -

https://www.macmillan.org.uk/documents/newsletter/willis-commission-report-macmail-dec2012.pdf

includes a series of technical papers one of which Pre-registration nurse education: Overview of themes from literature 2010-2012 outlines Skill Sets. I could relate Hodges' model to the identified skill sets in this paper using the 2x2 HTML table, but perhaps there's another way by considering the skills sets:

• ICT skills/health informatics 
• Literacy and numeracy skills
• Life support and airway management 
• Infection prevention 
• Genomics
• Bioscience 
• and Learning disabilities

Using these I can also explain how they both help and hinder the case for Hodges' model and illustrate the complexities of nurse education.

The subjects of genomics and bioscience can be placed quite reliably in the sciences domain. Life support and airway management are pretty explicit in their physicality. In an emergency you need to act. The individual's physiological (mechanics) functioning is compromised. This must be assessed urgently and compensated for. The model was also created with people living with learning disability very much in mind; consider the reference to the individual, the family, the increasing relevance of the POLITICAL domain to this client group and their families? ICT skills are primarily directed at intrapersonal knowledge and skills, physical and virtual spaces, drawing on the sciences. These domains are the preserve of the individual, in terms of learning, experience and sense making.

The biggest challenge for Hodges' model is context. Context is rarely rectilinear, try as we might it springs out of the intended boxes and categories we try to stuff it into. We very quickly have to acknowledge the social and political dimensions of ICT skills and health informatics. For example, the importance of information governance, confidentiality, legislation, policy and training provision. Returning to the learning disabled individual, they must contend (often as a community) with ongoing social stigma and the socio-political matter of having access and opportunity to education, buildings, facilities and technologies. Access then is not just a matter of cognition and physical mobility, movement and proximity.

If Hodges' model encourages us to place concepts in boxes

(the care domains)

 it also forces the realisation of the need 

to think outside the box. 

To relate, to associate with the domains adjacent - 'next door'. Ultimately can we integrate the care concepts providing a conceptual scaffold for person-centred, holistic care? There is in effect a cognitive rule, a heuristic - that is not necessarily very expensive cognitively or temporally, but can (I believe) pay huge dividends in assuring the quality of care. It runs as follows:

For any given care concept in learning

 consider how it applies and relates 

to each of the care domains.

See also:

The Willis Commission on Nursing Education [i]
The Willis Commission on Nursing Education [iii]

The Willis Commission on Nursing Education [ i ]

from the commission website:

The Willis Commission has now published its full report into the future of nursing education.

See the key findings from the report below (with my emphasis)

• Patient centred care should be at the heart of all pre-registration nursing education and continuing professional development.
• There were no shortcomings found in nursing education that could be directly responsible for poor standards of care or a decline in care standards.
• Nurses and their organisations must stand up to be counted on the challenge of poor care and loss of public confidence in order to restore professional pride.
• Nursing education needs to imbed patient safety and dignity as a top priority.
• Better evaluation of and research into nursing education programmes is necessary to ensure a programme that is fit for purpose.
• The future nursing workforce requires nurses to work in a variety of settings.
• Recruitment campaigns need to widen their diversity in order to encourage the widest, best possible range of applicants.
• Health care service providers must fully support nursing education.
• Universities need to recognise nursing as a practice and research discipline.
• Attention needs to be paid to developing a strategic understanding of the nursing workforce as a whole and as a UK-wide resource.

View the full report here (1,105kb)


Previous posts:
The Willis Commission on Nursing Education [ii]
The Willis Commission on Nursing Education [iii]

Big Hero 6 - clip (Healthcare is never 'Frozen')

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

My source:
Educate the Young - Disney and Pixar Understand Patient-Centered Care