BACCN position statement: Resourcing of intensive care services

BACCN position statement: Resourcing of intensive care services

Research and practice development Joining BACCN If you are not already a BACCN member and would like to be (or know someone who would) please contact...

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Research and practice development

Joining BACCN If you are not already a BACCN member and would like to be (or know someone who would) please contact Merlyn Shenavar, BACCN National Secretary, c/o ICU/CCU North Devon District

Hospital,Barnstaple,Devon EX31 4JB, UK.

The main aim of the critical care nurse is to improve the health and well-being of critically ill patients and their families. This is achieved through collaboration with the multidisciplinary team. The challenge faced by critical care nursing is the ability to articulate the nature and value of the contribution that nursing makes to the health and well-being of patients and their families. Research is a powerful means of achieving this objective. The King's Fund Panel Report on Intensive Care in the U K (1989) highlighted the general lack of evidence on the effectiveness, costs and criteria for the use of intensive care facilities and the level of provision needed. Since a large proportion of the costs and benefits of critical care result from nursing, nurses have a responsibility and indeed a vested interest in multidisciplinary collaboration towards providing answers to questions raised within the report. W e would be naive not to do so. This leads us to ask: h o w much do we know about the effectiveness of the nursing care we give and how can we demonstrate effectiveness and its contribution to patient outcome? This is the challenge faced by leaders within critical care nursing. Enthusiasm for nursing can be greatly enhanced by enthusiasm for research. Research awareness stimulates critical analysis, fosters a willingness to think, to ask, to reason and widens the professional vision leading to creativity and innovation in practice. The professional code (UKCC 1992) demands that practitioners develop awareness of the principles of responsibility and accountability in action. That is, the ability to explain actions and evaluate current knowledge so that the relative benefits of alternative action can be assessed. Practitioners have a duty to be aware of current research and to demonstrate that they are actively seeking to utilise research based knowledge in clinical practice. This is the challenge faced by all nurses working in critical care. The manager is the key person in making research an integral part of nursing practice. This is no easy task within the environment of contracting, demonstrating quality and value from resources within affordable manpower limits. Research and the development of practice are activities which require time and commitment from the nursing team. The creation of an environment or culture that values research and fosters its use both as the basis for practice and to improve the quality of care is the challenge faced by all nurse managers within critical care. The nurse educator has the responsibility of teaching the fundamental processes of reading and utitisation of research along with the generation of positive attitudes towards research and the fostering of the vision that research is not an end in itself, but a means to a stronger more competent nursing team with a commitment to advancing patient centred practice. Nurse education is currently experiencing the transition of nurse education into university education which is a highly political, competitive

Intensive and Critical Care Nursing (1995) l l , l16-119

© 1995 Pearson Professional Ltd

research environment. The challenge for education is to listen to service needs and to provide the education which will support the research and development activity of the service. Nurse theorists and researchers are committed to the testing of current nursing theory. Knowledge is extended and expanded through processes of systematic scientific enquiry. This enables the profession to describe, explain, predict and evaluate nursing practice. The challenge is to enhance the practitioners access to research by encouraging involvement and active participation in the research process, the publication of research reports within journals accessible to practitioners and the presentation of research papers at conferences. A growing n u m b e r o f documents, papers and strategies have been developed and published over the last few years. These set out to reappraise the purpose and organisation of health research (Research for Health 1991/1993); prioritise research and development initiatives (Health of the Nation 1992); and to develop strategic aims for Nursing, Midwifery and Health Visiting in order to identify their contribution to the current N H 8 agenda (Vision for the Future 1993). These documents contain m u c h that is of interest and relevance for critical care nurses. W e are not isolated from the changing agenda of health care and must participate in all ways that we can. W e live in exciting and challenging times and if we are to be successful in achieving our aims to improve the health and well-being of critically ill patients and their families, then research and practice development must be on our own agendas. W h e t h e r we are practitioners, managers, educators, theorists or researchers, we must learn to listen to each other, collaborate with each other and to value the different contributions we all make to patient care.

.Julie Pearce, National Secretary~Chairperson Research and Nursing Practice Development Forum. References Code of Professional Conduct for the Nurse, Midwife and Health Visitor 1992 UKCC 3rd Edn, London The Health of the Nation: A Strategy for Health in England 1989, 1992 HMSO London Kings Fund Panel Report 1989 Intensive Care in the UK Kings Fund, London Research for Health 1993 Department of Health London Research and Development Division Room 449 Richmond House 79 Whitehall London SWIA 2NS Vision for the Future 1993 NHS Executive Health Publications Unit, Heywood

B A C C N position statement: resourcing of intensive care services The British Association of Critical Care Nurses believes that all patients have a right to be treated on the basis of clinical need and their ability to benefit from specific treatment. The National Health Service has a duty to provide appropriate high dependency and intensive care facilities for those people who will benefit from the service.

BACCN News

B A C C N is concerned by evidence which has accumulated over the last 12 months which indicates that intensive care services are underfunded and unable to fully respond to the demands. This evidence is embodied within the Department of Health study and results of a recent survey carried out by St George's Hospital and B A C C N ' s own survey, which is due to be published later this year. B A C C N acknowledges that the situation is complex and includes issues of funding, staffing levels, skill mix, recruitment and access to and funding of nurse education. The key issues are: • the lack of a sophisticated and agreed costing model for intensive care as a service • the difficulty in identifying patients who may not benefit from intensive care services due to the severity of their illness • the inappropriate use of intensive care when high dependency facilities are not provided by a hospital. The collection of nationally agreed clinical information and outcome data will enable the service to articulate appropriate admission criteria and will support the effective use of resources. In the short term, purchasers and providers must review their acute services and contracting arrangements to ensure that current resources are utilised effectively. Members of the public and potential consumers of the service must be assured that the NHS will respond to current difficulties and that intensive care beds will be available to those in need.

Date: February 1995. The above statement was written by the National Executive in a speedy response to the study of the provision of intensive care in England 1993. Members will probably be very aware of the media interest generated in this report and other newspaper articles and reports describing the difficulties in finding intensive care beds when they are urgently required by critically ill people. One of the issues raised by the study was the need for c o m m o n criteria to inform admission to intensive care beds. Responding to this, the Department of Health are initiating an expert working group to look at the importance of establishing c o m m o n admission and discharge criteria. B A C C N has been approached and we are nominating Lynne Harrison, an executive committee member. Lynne currently works at the Charles Frears College of Nursing in Leicester as the Intensive Care Course Tutor and is a very active B A C C N member at regional and national level. Once the working group is established Lynne will provide feedback in the journal and interested members will be able to contact her regarding common admission and discharge criteria. I have been invited to a meeting with Virginia Bottomley, The Secretary of State for Health (representing B A C C N as President), along with other relevant medical and nursing associations to discuss the question of intensive care beds and the availability and use of high dependency beds, staffing mechanisms and mechanisms currently used to coordinate the use of intensive care facilities where a bed may not be immediately available.

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Watch this space for further feedback and discussion! I would welcome members thoughts and comments on these issues, either through Intensive and Critical Care Nursing (address at end of B A C C N News) or directly by phone or letter. Contact: Helen Ellis, Operational Manager, Lancashire College of Nursing and Health Studies, Preston (Tel: 01772 711542/711123).

Helen Ellis, President

Reference Metcalfe A, McPherson K A 1993 A Study of the Provision of Intensive Care in England. Revised Report for the Department of Health January 1994. Health Promotion Sciences Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London

Changing status Although we reported on our change in status in the last B A C C N News (Vol. II: 1, February 1995) this has been deferred for a year to allow the Executive Committee time to put required administrative structures in place. W e continue to hold charitable status and remain governed by our current constitution. Each regional committee has information on this proposed change, so please contact them if you have any queries regarding this issue. The changes will also be discussed at our A G M in April and discussion on this point will be disseminated around the regions and reported in the next issue's (June) B A C C N News.

Netta Lloyd-_jones, Vice President

National A G M Our national annual general meeting was held at the N S P C C National Training Centre at Leicester on 21 April. W e are not able to report on our A G M for this April issue as all contributions have to be in for editing and typesetting by mid February at the latest to appear in the April edition of Intensive and Critical Care Nursing. A report will be in B A C C N News in June. In the meantime information will be circulated around the regional committees and you are welcome to approach any regional committee member or national committee member for information.

Helen Ellis, President

1995 National Conference Our National Conference will be held from 18-21 September at Strathclyde University in Glasgow. Conference posters and booking forms will be out soon, so make a diary date or ring Sue Clark on 01724 845000 to request information and booking forms. W e are organising a 3-day conference to offer a varied programme. As the conference theme is a celebration of critical care nursing we have invited other Associations to support the conference. The Association of British Cardiac Nurses and the Tissue Viability Society, to name but two, will provide a programme supporting their particular interests and their members will be offered the same conference

I 18 Intensiveand Critical Care Nursing rates as B A C C N members. Our programme this year will have sessions supporting the practice o f surgical and medical nurses w h o care for acutely ill people in the ward setting. As the c o n t i n u u m of 'hi-tech' care develops, critically ill people will require intensive care a n d / o r high dependency care to support their progress to health and well being. B A C C N has a c o m m i t m e n t to support all nurses caring for acutely and critically ill people in the hospital and community setting. This commitment is increasingly recognised in our national conferences, so let your colleagues k n o w about this and encourage their attendance at our 10th B A C C N Conference.

Sue Clark, ConferenceDelegate Co-ordinator

Win a prize for a Poster Presentation! Presenting a poster at the national conference provides an excellent opportunity for you to share ideas, innovations and research with other critical care nurses. As 1995 is our 10th National Conference we are planning a large and varied programme that we anticipate will attract nurses from a variety of clinical backgrounds. To maximise opportunities for interaction and networking between delegates we would like to increase the n u m b e r o f poster presentations. Therefore we actively encourage anyone involved or with an interest, in critical care nursing practice, management or education to submit a proposal. R e m e m b e r you do not have to work in an intensive care unit to attend or benefit from a B A C C N conference. As an incentive we hope to be able to offer a prize of £ 2 0 0 for the best poster presentation. Juding will take place during the conference and the winner(s) will be announced in Intensive and Critical Care Nursing and at the Conference Dinner. The theme of this year's conference is ' A Celebration o f Critical Care Nursing'; reflecting our achievements and looking forward to the future. Posters should try and promote these ideas. The first step is to decide what sort of information you want to present (for example a research study, a new technique or evidence of good practice) and if the presentation will be a group effort or confined to one or two people. Secondly, you should obtain an application form from Lynne Harrison orJulie Pearce (see Call for Posters and Papers). Once your poster application has been received you will be sent details of the location of the poster presentations and the size of the space that is available to you. This information will allow you to begin the preparation of the poster. For a poster to be successful it needs to be well-prepared and have a clearly laid-out design. You should sketch the layout of your poster on a large (A3) sheet of paper. Break the poster down into separate sections such as the introduction, main points, methods, findings, conclusions and recommendations. This enables you to judge the impact of the poster and to make adjustments before the real design work begins. There are many variations in terms of poster design and we do not wish to stifle your creativity. However, the following points may help you with your planning:

• Identify a clear title for the presentation and the names of those contributing to its production. • Do not overwhelm the audience with excessive amounts o f text. Choose your words carefully and be ruthless with your editing. • There is always a temptation to present too much information. Posters should ideally contain only one or two 'take home' messages. • Be creative-use coloured string, tape or pins to link sections of the poster together. • Remember, if you use photographs of patients, relatives or colleagues you need to obtain their permission. • Use colour wherever possible but beware of losing the focus or key issues in the midst of a myriad ofcolour. • Think about h o w you can attach the poster to the board, for example Velcro pads, double-sided sticky tape or drawing pins. • It may not be possible for you to speak to all of those delegates viewing your poster; it is useful to have either a note pad for them to leave you messages or alternatively to supply slips of paper with your contact address on. • The poster has to travel to Glasgow therefore the use of laminate or clear pastic sleeves may add to its resilience. Good Luck!

Lynne Harrison, Marketing and Publicity

National Conference 1995: Call for Posters and Papers Fliers are out calling for poster and papers. Julie Pearce Secretary B A C C N will direct any poster enquiries through to Lynne Harrison, whilst she herself coordinates the free papers. Julie can be contacted via the Intensive Care Unit, Southampton General Hospital, Tremona Road, Southampton SO9 4XY on 01703 796368. Those of you wishing to present posters can contact Lynne direct via 14 Thorns Villa Gardens, Worsley, Manchester M28 1UT from April 1995 or on 01169 721298.

The Research and Nursing Practice Development Forum This forum was launched at the 1994 National Conference. The purpose of the forum is to promote research based practice, improve access to research findings, encourage the dissemination of research findings and to provide a means of networking for the sharing of ideas and mutual support. One of the key aims along with the promotion of research is to support and encourage practice innovations within critical care nursing. Members of the National Committee organise the forum activity with Julie Pearce (National Secretary), myself (National representative for Wales) and Tracey Capuano (National representative for the North West) acting as Chair, Secretary and Treasurer respectively. The group's broad objectives, apart from developing a philosophy and disseminating information about the Forum, include the following:

BACCN News • promoting clinical research and practice developments through the organisation of study events • setting up a national database with information regarding nursing research and clinical innovations. • identifying people involved in research and/or engaged in clinical developments within critical care • the promotion of nurse led initiatives within multiprofessional collaborative projects. • securing funding and grants to support the forum and for initiating research. The Forum clearly exists to promote research based nursing care as well as encourage innovative and creative solutions in the progression of critical care nursing practice. W e hope to encourage individual nurses and units to present their work and share their projects with other nurses in the form of free papers, publications and/or poster exhibits. In this way, the forum also seeks to provide a vehicle for celebrating the diversity and creativity of critical care nurses in developing the quality of patient care. Whether this has been achieved through a work project or through field research it must be recognised as valuable and worth discussing with professional colleagues. W e are planning to provide two national events which will combine lectures and workshops on a variety of research themes in order that we can meet the needs of all levels of expertise in this area. The B A C C N Forum meeting on 21 April in Leicester is dealing with practice orientated solutions to the development of clinical practice through action research, the establishment of research interest groups in the clinical setting and the development of clinical protocols. At regional level the research programmes are already available but it is hoped that this will continue to expand. The Research and Nursing Practice Development Forum has not been set up to meet the needs of any particular group of nurses, but as means of enhancing communication about practice and research projects and as a means of demonstrating the commitment of critical care nurses in raising the quality of patient care. Participation in and awareness of nursing research is acknowledged as professionally desirable and has become part of government strategy (Doll, 1993a, 1993b). This however will take sometime to achieve and the BACCN's endeavours will hopefully contribute to this end.

John Albarran, National Committee (Wales)Research and Nursing PracticeDevelopment Forum

References Department of Health 1993a Report of the Taskforce on the Strategy for Research in Nursing, Midwifery and Health Visiting. HMSO, London

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Department of Health 1993b A Vision for the Future. HMSO, London

Focus on the Nothern Region B A C C N Northern was established 13 years ago, being one of the founding regions of B A C C N . O f the founding regional committee members J o h n Short is still present as our Chairman. As many of you probably know, J o h n was also the National treasurer for B A C C N for 11 years, only retiring from this position this year. The region covers a wide area, from the Scottish border in the north to Teesside on the South, and from Whitehaven on the West cost to Newcastle-upon-Tyne on the east coast. W e have a healthy membership of around 200 members and are always encouraging new members to join as well as existing members to rejoin! Our regional committee has 12 members, all critical care nurses, who meet regularly throughout the year to arrange future study events. W e have recently changed our format for study events from study days to study evenings as these attract a higher attendance. W e do, however, plan to keep one study day per year which will include our regional AGM. The following events are taking place within our region: • 28th April 1995 Cardiac Care Study Day and AGM, South Cleveland Hospital, Teesside. • July 1995 Renal Replacement Therapy in ITU, Freeman Hospital, Newcastle- upon-Tyne. • October 1995 Advanced Life Support, Q u e e n Elizabeth Hospital, Gateshead. For details of these events please contact Sally Hodgkiss-Lagan, Tel: 01325 380100, Ext. 3388. W e are always trying to vary the location of our study events, as well as encouraging new speakers to share their experience and expertise. As regional committee member and national representative for the Northern Region I would welcome any enquires. For further details of Study Days throughout the UK, please see Notices, p120.

Annette Richardson, Senior Sister, General Intensive Care, Freeman Hospital, Newcastle- Upon-Tyne.

Writing to BACCN We would like to hear from any of our members, or nonmembers come to that! You may like to write an open letter concerning BACCN or Intensive and Critical Care Nursing; publish your comments about any relevant topic or make a general enquiry to all critical care nurses. Please send your contributions to the BACCN Representative, Intensive and Critical Care Nursing, Churchill Livingstone Journals, Robert Stevenson House, 1-3 Baxters Place Leith Walk, Edinburgh EH1 3AF UK.