- Email: [email protected]
Conference report: ‘Research and Innovation 2006’
Accident and Emergency Nursing (2006) 14, 178–181
Accident and Emergency Nursing www.elsevierhealth.com/journals/aaen
Conference report: ‘Research and Innovation 2006’ The Faculty of Emergency Nursing 8th annual conference, March 23rd 2006, held in collaboration with the British Association for Emergency Medicine (BAEM), during the BAEM annual conference 2006 at the Centaur Centre, Cheltenham Racecourse. Alastair Gray, FFEN, Board Lead Research Professional Development and Scholarship, Senior Lecturer (Emergency Practice) Coventry University and Mary Hutchinson, FFEN, Service Manager, Minor Injury Units, Burntwood, Lichfield and Tamworth Primary Care Trust.
For the last 8 years, an annual emergency nursing research conference has taken place during the spring season in Britain. Its genesis, under the leadership of emergency nursing lecturer Ian Wood, was in association with Keele University. After a couple of years a group of Black Country emergency nurses took it on to Wolverhampton where it ran successfully for a further 6 years. During that period a variety of colleagues presented the most varied and relevant subjects, colleagues from all parts of the United Kingdom and beyond. Video conferencing helped to stretch the audience wider to delegates in Scotland. Throughout this period the driving passion was to provide a platform for nurses from the whole family of emergency care to share their insights and seek to influence and shape emergency practice. In the early years the conference committee forged a pivotal relationship with the Faculty of Emergency Nursing, and its Research subgroup. Both groups found common aims in shared commitment to: (1) seeking to improve patient care; (2) facilitating lifelong learning and career progression through education, research and leadership within emergency care; doi:10.1016/j.aaen.2006.05.001
(3) providing transferability of knowledge, skills and practice for emergency care settings; and (4) providing a mechanism for generating new knowledge. As year succeeded year, the shape of each conference has reflected the maturing of confidence of emergency nurses, colleagues with something important to say! More papers have been received for consideration each year and this has ensured the standard of the conference has remained consistently high. For the 2006 conference the intention was to broaden the scope of the conference to explicitly include innovation as well as research. However, this change was complemented by a further one, when BAEM invited FEN to work with it in organising a joint conference between nursing and medicine. This change became reality in our new venue, the Centaur at Cheltenham Racecourse. Indeed, that we were in a different venue was clear from the point of registration. Not only were delegates greeted by the colourful produce of the Cheltenham and District Farmer’s Market on display in the foyer, but these gave way in the main hall to
Conference report: ‘Research and Innovation 2006’
179
an array of up-to-date exhibitions. These were provided by the various commercial sponsors of this joint conference. Accident and Emergency Nursing journal and their parent company Elsevier, announced their formal support of the Faculty of Emergency Nursing and their sponsorship of the nursing conference. It’s kind donation of two book prizes were well received, one each for best plenary session and best poster presentation. Sherri Cheal, Deputy Lead Nurse, Gloucester Royal Hospital, was awarded best plenary presenter, with her presentation entitled ‘Student and staff nurse induction – the Faculty of Emergency Nursing way’. By contrast, Tim Barr, Lecturer, Cardiff University took best poster presenter with his work on the development of care pathways.
lack of standardised training and adequate time to develop competence for nurse practitioners in emergency care was an important issue, as was the need to further evaluate the contribution that allied health professions could make to emergency care. Felicity Johnson reported on her qualitative phenomenological study carried out in 2005 in three Irish emergency departments. Core clinical skills were identified and this knowledge was used to develop a new and a comprehensive set of specific clinical learning outcomes. These incorporated specific clinical evaluation methods, and were formulated into a workbook. This work clearly related to the FEN career and competency framework and is further evidence of its international appeal. Conan Castles, SHO from Antrim Hospital, discussed safely improving the specificity of D-dimer assay as a rule-in test for diagnostic imaging in patients with a diagnosis of pulmonary embolism (PE). Though he did acknowledge the need for further study to replicate the findings of his work, he and his colleagues did discern from their 2 year retrospective study of patients who had attended with potential PE, and who had both D-dimer assay and scan, that a D-dimer value of 0.8 was a valid diagnostic marker and could have saved 27% of scans. This rose to 47% of scans saved when the D-dimer was 1.2. It was very sobering to listen to the findings of Mr. Anathallee from Manchester Royal Infirmary. He and his colleagues had carried out a telephone survey of 261 UK Emergency Departments to assess their level of preparedness for a biological or bioterrorist threat, asking them about facilities, procedures and isolation practices. Though the majority of departments have isolation facilities, they are of inadequate standard to block the spread of contaminants; <10% of departments would adequately isolate their patients. This work highlighted the need to train all healthcare workers about isolation practices and especially triage nurses to have early recognition of symptoms that should give them an increased index of suspicion of biological contamination. Rebecca Hoskins, Consultant Nurse from University of Bristol Hospital Trust and the University of Western England, had researched postgraduate education in emergency care, asking ‘Is there a role for inter-professional education?’ Through email questionnaire to the Department of Health Emergency Care Consultant Nurse Group, she was able to discern their perception of their continuing professional development needs, and the obstacles and advantages that they felt would be encountered
The day’s events Nigel Brayley, Chair of the Clinical HRG Working Group, opened proceedings with a detailed presentation explaining the dynamics underpinning present day political strategies. He also gave the audience more than a hint that to attract adequate funding for future emergency care activities, making transparent firm evidence of the value of investigations and treatments provided for patients is essential. Sir George Alberti, National Director for Emergency Access, followed on with a vision and direction proposed for the delivery of urgent care in the future. This will be patient focused and community centred, with safe and high quality care close to home wherever possible. He acknowledged that at present there are not sufficient numbers of nurse practitioners and emergency care practitioners to provide an equitable mobile urgent care response to patients, but he was optimistic that this would be resolved over the next year or two. Moreover, only those who truly require the expertise or facilities of an acute hospital should be attending the Emergency Department of the future. Breakout sessions provided the delegates with a rich choice of speaker and subject. These were mixed to include both nursing and medical contributions. Observations from a selection of these are presented. These complement the presentation of speaker abstracts presented in the last edition of Accident and Emergency Nursing, April 2006. Captain Jane Currie (QARANC) based at Frimley Park Hospital, Camberley had explored the perceptions of the medical and nursing professions on their current and future roles. Her findings revealed that nurses had greater concern about their role development than their doctor colleagues. The
180 if doctors and nurses truly began to learn from one another. Frequency and pattern of attendance in the Emergency Department is often thought to be a marker for child protection concerns, but Sally Gibbs, Paediatric SpR from Sheffield, did not find this was borne out in practice when she carried out a retrospective analysis of 150 children prior to their identification as being ‘at risk’. While the reported rate of missed Cervical Spinal Injury is reported to be very low, its potentially devastating consequences have traditionally led emergency pre-hospital care staff to respond with triple immobilisation of the cervical spine. The presentation of this paper, led by Bruce Armstrong, Consultant Nurse in Basingstoke, demonstrated the findings of a pilot study to enable EMS technicians and paramedics to clear the cervical spine. Its findings, that clearance of the cervical spine by pre-hospital care personnel can have significant impact, was warmly received by the delegates present. Rob Way, Consultant Nurse in Oxford, provided reflections on what he had learned from carrying out discovery interviews with older people and their carers about their experience of using the emergency care systems. His work will be replicated across England by 100 emergency nurses over the forthcoming months in the hope that, through listening to patient/carer experience, they can discern where small local service improvements could make a positive difference to the future emergency care of the older person. Nursing students and staff nurses who work in the ED of Gloucester Royal Hospital are encouraged to take ownership of their learning and development through meeting the competencies of the Faculty of Emergency Nursing. Sherri Cheal described the work done to adapt and modify the FEN competency framework to meet the needs of the individual member of staff, and to develop a career framework for all staff. One of her ED consultant colleagues made the comment that this method of staff induction had made a palpable positive difference to the quality of emergency nursing in the department, and that it would be replicated for the induction of new SHOs. Nicola Weatherup, SpR from the Royal Hospital for Sick Children in Glasgow, found that she achieved increased analgesia and increased parental happiness when she offered children between the ages of 1 and 13 years intranasal diamorphine instead of oral morphine as pain relief for their acute injuries. Patients presenting with mental health problems in Emergency Departments often receive less
Conference report: ‘Research and Innovation 2006’ than ideal care. This is particularly true during unsocial hours. Tim Barr presented an honest perspective on developing a programme for a group of commited RNs (non-RMN) to be able to assess and manage/refer patients. The principal goal was to risk manage these patients and ensure appropriate conduits of referral were available. The programme has overcome many difficulties, thanks to the commitment of those who see themselves as Mental Health Triage Nurses and the Trust’s recognition of the need to now employ two (instead of one) liaison nurses. No current emergency care conference would be complete without some reference to the 4 h target, and Gerard Cronin did not disappoint with his Trust’s innovation of breach avoidance facilitator (BAF). Reporting an April 2003 performance of 64.83%, a programme of radical change was introduced. The role capitalized on the extensive clinical experience of senior nursing staff, and put them into a supernumerary completely clinically based role allowing them to take pre-emptive managerial action to avoid patients breaching the 4-h target. Challenges were discussed and the vision for this role to evolve to improve the patient experience. Delegates posed a variety of questions that enabled a useful discussion to round off this presentation. The need to develop a procedural sedation registry and encourage clinicians to record the depth or level of sedation achieved and the patient outcome was highlighted by Alistair Dewar, 4th year medical student from the University of Edinburgh. Detailed data collection and analysis of this part of a journey of care could inform optimal sedation techniques of the future.
Posters A wide range of poster presentations made for stimulating viewing during the refreshment breaks, Tim Morse, Senior Lecturer, Coventry University led with his wider professional perspective on paramedics rising to the challenge of higher education; Tim Barr contributed two posters, use of portfolios in summative assessment, and care pathways. The day was drawn to a close with three inspiring speakers: Dr. Sian Koppel, Consultant Forensic Psychiatrist, discussed her work with the perpetrators of violent crime. Professor Jonathan Shepherd from Cardiff described how collaborative work between ED physicians, the police and purveyors of alcohol had actively reduced violence in city centre ‘hotspots’. Dr. Chris Moulton from Bolton challenged
Conference report: ‘Research and Innovation 2006’
181
delegates to choose which acute interventions they would prefer should they succumb to an acute coronary event! The overwhelming evaluation of the day was that it had surpassed the organising team’s expec-
tations. Colleagues had mixed well and the discussions that took place reflected a true collaborative spirit. There was a clear desire to impact practice and much material was provided for delegates to take away and do just that.
Accident and Emergency Nursing www.elsevierhealth.com/journals/aaen
Conference report: ‘Research and Innovation 2006’ The Faculty of Emergency Nursing 8th annual conference, March 23rd 2006, held in collaboration with the British Association for Emergency Medicine (BAEM), during the BAEM annual conference 2006 at the Centaur Centre, Cheltenham Racecourse. Alastair Gray, FFEN, Board Lead Research Professional Development and Scholarship, Senior Lecturer (Emergency Practice) Coventry University and Mary Hutchinson, FFEN, Service Manager, Minor Injury Units, Burntwood, Lichfield and Tamworth Primary Care Trust.
For the last 8 years, an annual emergency nursing research conference has taken place during the spring season in Britain. Its genesis, under the leadership of emergency nursing lecturer Ian Wood, was in association with Keele University. After a couple of years a group of Black Country emergency nurses took it on to Wolverhampton where it ran successfully for a further 6 years. During that period a variety of colleagues presented the most varied and relevant subjects, colleagues from all parts of the United Kingdom and beyond. Video conferencing helped to stretch the audience wider to delegates in Scotland. Throughout this period the driving passion was to provide a platform for nurses from the whole family of emergency care to share their insights and seek to influence and shape emergency practice. In the early years the conference committee forged a pivotal relationship with the Faculty of Emergency Nursing, and its Research subgroup. Both groups found common aims in shared commitment to: (1) seeking to improve patient care; (2) facilitating lifelong learning and career progression through education, research and leadership within emergency care; doi:10.1016/j.aaen.2006.05.001
(3) providing transferability of knowledge, skills and practice for emergency care settings; and (4) providing a mechanism for generating new knowledge. As year succeeded year, the shape of each conference has reflected the maturing of confidence of emergency nurses, colleagues with something important to say! More papers have been received for consideration each year and this has ensured the standard of the conference has remained consistently high. For the 2006 conference the intention was to broaden the scope of the conference to explicitly include innovation as well as research. However, this change was complemented by a further one, when BAEM invited FEN to work with it in organising a joint conference between nursing and medicine. This change became reality in our new venue, the Centaur at Cheltenham Racecourse. Indeed, that we were in a different venue was clear from the point of registration. Not only were delegates greeted by the colourful produce of the Cheltenham and District Farmer’s Market on display in the foyer, but these gave way in the main hall to
Conference report: ‘Research and Innovation 2006’
179
an array of up-to-date exhibitions. These were provided by the various commercial sponsors of this joint conference. Accident and Emergency Nursing journal and their parent company Elsevier, announced their formal support of the Faculty of Emergency Nursing and their sponsorship of the nursing conference. It’s kind donation of two book prizes were well received, one each for best plenary session and best poster presentation. Sherri Cheal, Deputy Lead Nurse, Gloucester Royal Hospital, was awarded best plenary presenter, with her presentation entitled ‘Student and staff nurse induction – the Faculty of Emergency Nursing way’. By contrast, Tim Barr, Lecturer, Cardiff University took best poster presenter with his work on the development of care pathways.
lack of standardised training and adequate time to develop competence for nurse practitioners in emergency care was an important issue, as was the need to further evaluate the contribution that allied health professions could make to emergency care. Felicity Johnson reported on her qualitative phenomenological study carried out in 2005 in three Irish emergency departments. Core clinical skills were identified and this knowledge was used to develop a new and a comprehensive set of specific clinical learning outcomes. These incorporated specific clinical evaluation methods, and were formulated into a workbook. This work clearly related to the FEN career and competency framework and is further evidence of its international appeal. Conan Castles, SHO from Antrim Hospital, discussed safely improving the specificity of D-dimer assay as a rule-in test for diagnostic imaging in patients with a diagnosis of pulmonary embolism (PE). Though he did acknowledge the need for further study to replicate the findings of his work, he and his colleagues did discern from their 2 year retrospective study of patients who had attended with potential PE, and who had both D-dimer assay and scan, that a D-dimer value of 0.8 was a valid diagnostic marker and could have saved 27% of scans. This rose to 47% of scans saved when the D-dimer was 1.2. It was very sobering to listen to the findings of Mr. Anathallee from Manchester Royal Infirmary. He and his colleagues had carried out a telephone survey of 261 UK Emergency Departments to assess their level of preparedness for a biological or bioterrorist threat, asking them about facilities, procedures and isolation practices. Though the majority of departments have isolation facilities, they are of inadequate standard to block the spread of contaminants; <10% of departments would adequately isolate their patients. This work highlighted the need to train all healthcare workers about isolation practices and especially triage nurses to have early recognition of symptoms that should give them an increased index of suspicion of biological contamination. Rebecca Hoskins, Consultant Nurse from University of Bristol Hospital Trust and the University of Western England, had researched postgraduate education in emergency care, asking ‘Is there a role for inter-professional education?’ Through email questionnaire to the Department of Health Emergency Care Consultant Nurse Group, she was able to discern their perception of their continuing professional development needs, and the obstacles and advantages that they felt would be encountered
The day’s events Nigel Brayley, Chair of the Clinical HRG Working Group, opened proceedings with a detailed presentation explaining the dynamics underpinning present day political strategies. He also gave the audience more than a hint that to attract adequate funding for future emergency care activities, making transparent firm evidence of the value of investigations and treatments provided for patients is essential. Sir George Alberti, National Director for Emergency Access, followed on with a vision and direction proposed for the delivery of urgent care in the future. This will be patient focused and community centred, with safe and high quality care close to home wherever possible. He acknowledged that at present there are not sufficient numbers of nurse practitioners and emergency care practitioners to provide an equitable mobile urgent care response to patients, but he was optimistic that this would be resolved over the next year or two. Moreover, only those who truly require the expertise or facilities of an acute hospital should be attending the Emergency Department of the future. Breakout sessions provided the delegates with a rich choice of speaker and subject. These were mixed to include both nursing and medical contributions. Observations from a selection of these are presented. These complement the presentation of speaker abstracts presented in the last edition of Accident and Emergency Nursing, April 2006. Captain Jane Currie (QARANC) based at Frimley Park Hospital, Camberley had explored the perceptions of the medical and nursing professions on their current and future roles. Her findings revealed that nurses had greater concern about their role development than their doctor colleagues. The
180 if doctors and nurses truly began to learn from one another. Frequency and pattern of attendance in the Emergency Department is often thought to be a marker for child protection concerns, but Sally Gibbs, Paediatric SpR from Sheffield, did not find this was borne out in practice when she carried out a retrospective analysis of 150 children prior to their identification as being ‘at risk’. While the reported rate of missed Cervical Spinal Injury is reported to be very low, its potentially devastating consequences have traditionally led emergency pre-hospital care staff to respond with triple immobilisation of the cervical spine. The presentation of this paper, led by Bruce Armstrong, Consultant Nurse in Basingstoke, demonstrated the findings of a pilot study to enable EMS technicians and paramedics to clear the cervical spine. Its findings, that clearance of the cervical spine by pre-hospital care personnel can have significant impact, was warmly received by the delegates present. Rob Way, Consultant Nurse in Oxford, provided reflections on what he had learned from carrying out discovery interviews with older people and their carers about their experience of using the emergency care systems. His work will be replicated across England by 100 emergency nurses over the forthcoming months in the hope that, through listening to patient/carer experience, they can discern where small local service improvements could make a positive difference to the future emergency care of the older person. Nursing students and staff nurses who work in the ED of Gloucester Royal Hospital are encouraged to take ownership of their learning and development through meeting the competencies of the Faculty of Emergency Nursing. Sherri Cheal described the work done to adapt and modify the FEN competency framework to meet the needs of the individual member of staff, and to develop a career framework for all staff. One of her ED consultant colleagues made the comment that this method of staff induction had made a palpable positive difference to the quality of emergency nursing in the department, and that it would be replicated for the induction of new SHOs. Nicola Weatherup, SpR from the Royal Hospital for Sick Children in Glasgow, found that she achieved increased analgesia and increased parental happiness when she offered children between the ages of 1 and 13 years intranasal diamorphine instead of oral morphine as pain relief for their acute injuries. Patients presenting with mental health problems in Emergency Departments often receive less
Conference report: ‘Research and Innovation 2006’ than ideal care. This is particularly true during unsocial hours. Tim Barr presented an honest perspective on developing a programme for a group of commited RNs (non-RMN) to be able to assess and manage/refer patients. The principal goal was to risk manage these patients and ensure appropriate conduits of referral were available. The programme has overcome many difficulties, thanks to the commitment of those who see themselves as Mental Health Triage Nurses and the Trust’s recognition of the need to now employ two (instead of one) liaison nurses. No current emergency care conference would be complete without some reference to the 4 h target, and Gerard Cronin did not disappoint with his Trust’s innovation of breach avoidance facilitator (BAF). Reporting an April 2003 performance of 64.83%, a programme of radical change was introduced. The role capitalized on the extensive clinical experience of senior nursing staff, and put them into a supernumerary completely clinically based role allowing them to take pre-emptive managerial action to avoid patients breaching the 4-h target. Challenges were discussed and the vision for this role to evolve to improve the patient experience. Delegates posed a variety of questions that enabled a useful discussion to round off this presentation. The need to develop a procedural sedation registry and encourage clinicians to record the depth or level of sedation achieved and the patient outcome was highlighted by Alistair Dewar, 4th year medical student from the University of Edinburgh. Detailed data collection and analysis of this part of a journey of care could inform optimal sedation techniques of the future.
Posters A wide range of poster presentations made for stimulating viewing during the refreshment breaks, Tim Morse, Senior Lecturer, Coventry University led with his wider professional perspective on paramedics rising to the challenge of higher education; Tim Barr contributed two posters, use of portfolios in summative assessment, and care pathways. The day was drawn to a close with three inspiring speakers: Dr. Sian Koppel, Consultant Forensic Psychiatrist, discussed her work with the perpetrators of violent crime. Professor Jonathan Shepherd from Cardiff described how collaborative work between ED physicians, the police and purveyors of alcohol had actively reduced violence in city centre ‘hotspots’. Dr. Chris Moulton from Bolton challenged
Conference report: ‘Research and Innovation 2006’
181
delegates to choose which acute interventions they would prefer should they succumb to an acute coronary event! The overwhelming evaluation of the day was that it had surpassed the organising team’s expec-
tations. Colleagues had mixed well and the discussions that took place reflected a true collaborative spirit. There was a clear desire to impact practice and much material was provided for delegates to take away and do just that.