- Email: [email protected]
Cost benefit analysis in intensive care
INTENSIVE AND CRITICAL CARE NURSING
gration
of art, science,
intuition,
personal
knowledge
and the interpretation of perceptual cues. I believe that nursing practice is at this end of the continuum; that it is context dependent and complex. Tools that attempt to measure competency from the more simplistic perspective tend to be reductionist in approach and are almost insulting to the critical care nurse’s knowledge and skill, through their view of what competency is. If nursing practice is a complex phenomena then appropriate processes need to be used to access, understand and improve it. Clinical supervision using Chris John’s model of guided reflection is presented as one such approach to understanding the nature of competency and how to improve it. This approach is used within the context of both group and individual supervision. Through using this model the realities of practice are acknowledged, the factors influencing practice are identified and the frustrations evident to the practitioner dismantled. Such a model recognises all four ways of knowing central to nursing, and empowers nurses to become more effective in their practice.
APL/APELi are we achievingequity? Carol Haigh APL Co-ordinator, Lancashire of Nursing
and Health
Studies,
College
UK
Myth 1: APL is un easy o,btion - it is my contention that APL is not an easy way out of study as examination of an outline portfolio will show. Myth 2: how much credit you get depad.s upon who you talk to- for an APL system to be academically credible as rigorous system must be in place for the assessment of portfolios. Myth 3: ?&singAPL is a ks credible option than completing study-APL can be shown to be as credible (if not more so) than traditional study. Myth 4: credit exemption is something fm nothing - this will concentrate upon the notion of ‘tariffing’ and will examine the processes behind the tariffing of courses. It is hoped that by consideration and discussion of these factors the question of APL and equity will be resolved.
Fw,, College
and the higher
erson Lecturer in Nursing, of Nursing, London, UK
at the
‘bedside’
in order
to promote
and
enhance innovations in care is increasingly being identified and acknowledged (UKCC 1990, ENB 1992). This paper explores the history of and the likely implications fo; critical care nursing practice of the ENB framework and the Higher Award. It will argue that the nursing care of people with life threatening problems and their families is an extremely complex activity, requiring advanced knowledge and expert practice skills, consequently the creation of educational and development opportunities, such as those that framework and Higher Award potentially offer, for high quality patient care.
and that practice the ENB are vital
The paper will open with an exploration of the key concepts and values enshrined in the framework and Higher Award. A brief resum6 of the history of these developments and the rationale for their adoption will follow. Drawing extensively from the recent British, North American and Australian literature, searching questions will be posed regarding the universality of access, academic recognition, other alternatives to meeting the same ends, the implications for managers and marketability of these developments to nurses and others. Finally some attempt will be made to evaluate he ENB framework and the higher Award in the light of empowering critical care nurses and nursing.
References
In order to discuss how well we are achieving equity via APL/APEL processes it is necessary to consider the various myths that have sprung up around the AF’L concept.
Evaluating the ENB framework
remain
305
IANE Royal
Historically, nurses wishing to advance their careers have had to choose between education and management, however, a need for advanced practitioners to
ENB 1992 Framework for continuing professional education. London. ENB
Cost benefit adysis
in intensive care
Mike Proctor Nurse Manager, UK
Intensive
Care, York,
The financial limits imposed on health care have been brought increasingly in to focus during the past few years. Intensive therapy is an expensive resource and it is anticipated that in the future the benefit of this therapy will have to be proved in relation to particular patient groups rather than assumed. This paper describes how an intensive care unit in York has begun to assess the cost/benefit of the service they offer. This will be presented in two sections: 1. Assessing the cost. The elements of the total cost of intensive care will be identified and the move towards using a modified Therapeutic Intervention Scoring System to identify cost per case will be described. 2. Assessing the benefits. The protocol and initial results of an ‘outcome of intensive care’ study will be summarised. The system in operation in York for assessine cost/benefit is in its infancv and is far from perfect, however, it does represent a first step towards an acknowledgement of the reality of health care finances in 1994 and beyond and has
306
INTENSIVE AND CRITICAL CARE NURSING
brought the debate in our own unit about the rationing of the intensive care resource out into the open.
Supportingvictimsof violence: families Anne Viney Assistant Director, Victim Support Victim Support grew out of the concern for members of the public and people working in the criminal justice system that the needs of victims interest were not being considered. Until the middle of the 19th century, victims of crime normally prosecuted their own offenders. This ensured victims had a pivotal place in the criminal justice system. The introduction of police prosecutions changed victims’ rights and responsibilities. They were no linger involved in cases unless they were required as witnesses to give evidence. Over time victims became invisible and powerless. In 1974 a group of professionals working with offenders in Bristol established a pilot project to consider the experiences of victims and to provide them with appropriate support. The project, which became the first Victim Support group, was managed by a committee drawn from a wide range of backgrounds. The police undertook to refer all victims of personal crime in the area to the Victim Support group. These were then contacted and, where possible, visited by trained volunteers. The project found that victims and their families encountered enormous practical and emotional prob lems and needed a great deal of support. The Bristol project encountered people in other areas to set up Victim Support groups. In 1979, 16 schemes joined to set up the National Association of Victims Support Schemes which was registered as a charity. Representatives of the police and probation took up positions on the charity’s national council. The Home Offtce made funding available for a national officer and I then took up this post. A national code of practice was drawn up which Victim Support schemes had to adhere to. This stated that each scheme should have a management committee which would include representatives of the police, a social work agency and a voluntary organisation. Victim Support decided early on that its central aim should be to help crime victims. It took an early decision not to become involved in the campaigns for stiffer
penalties for offenders. The charity’s national council felt that commenting in their area would compromise its work helping victims and would undermine the organisation’s aim to work on behalf of all victims of crime, whatever their views. Over the next few years Victim Support developed rapidly and schemes were set up in England, Wales and Northern Ireland. A survey published in 1982 by the Oxford Centre for Criminological Research confirmed Victim Support’s findings that even so-called ‘lesser crimes’, such as burglary, could produce long-term and often serious effects for many victims and their families. A further report commissioned by the Home Office identified Victim Support as the most appropriate agency to offer help to victims. The Home Offtce study argued that victims of crime needed an outreach service as few would make direct approaches to ask for help. A number of police forces accepted this recommendation and agreed to make automatic referrals to Victim Support of victims who had suffered crimes like burglary and theft, and of victims of serious crime with their consent. By 1987 Victim Support schemes were between them helping over 0.25 million people each year. Many of them were struggling to keep up this number of referrals with so few resources. 90 MPs of all political parties wrote to the Government to put the case for a pro gramme of national funding. That year the Home Office made available &2 million to help pay for staffing and running costs. This figure has continued to rise steadily over the last 7 years, just keeping up with the rapidly increasing referrals of victims of crime. Today, 20 years after Bristol Victim Support was set up, schemes nationwide provide help to nearly 1 million people every year. Victim Support volunteers offer information, advice and emotional support to victims of a wide range of crimes, from burglary and theft to assault, rape or the murder of a relative. Schemes offer trained volunteers for victims to talk to in confidence, information on police and court procedures, practical help, including advice on insurance and crime prevention, advice on compensation for violent crime, as well as volunteers to accompany people to the police station or to court. Schemes use their links with local statutory and voluntary agencies to help victims with other difficulties they face as a result of the crimes they have suffered.
gration
of art, science,
intuition,
personal
knowledge
and the interpretation of perceptual cues. I believe that nursing practice is at this end of the continuum; that it is context dependent and complex. Tools that attempt to measure competency from the more simplistic perspective tend to be reductionist in approach and are almost insulting to the critical care nurse’s knowledge and skill, through their view of what competency is. If nursing practice is a complex phenomena then appropriate processes need to be used to access, understand and improve it. Clinical supervision using Chris John’s model of guided reflection is presented as one such approach to understanding the nature of competency and how to improve it. This approach is used within the context of both group and individual supervision. Through using this model the realities of practice are acknowledged, the factors influencing practice are identified and the frustrations evident to the practitioner dismantled. Such a model recognises all four ways of knowing central to nursing, and empowers nurses to become more effective in their practice.
APL/APELi are we achievingequity? Carol Haigh APL Co-ordinator, Lancashire of Nursing
and Health
Studies,
College
UK
Myth 1: APL is un easy o,btion - it is my contention that APL is not an easy way out of study as examination of an outline portfolio will show. Myth 2: how much credit you get depad.s upon who you talk to- for an APL system to be academically credible as rigorous system must be in place for the assessment of portfolios. Myth 3: ?&singAPL is a ks credible option than completing study-APL can be shown to be as credible (if not more so) than traditional study. Myth 4: credit exemption is something fm nothing - this will concentrate upon the notion of ‘tariffing’ and will examine the processes behind the tariffing of courses. It is hoped that by consideration and discussion of these factors the question of APL and equity will be resolved.
Fw,, College
and the higher
erson Lecturer in Nursing, of Nursing, London, UK
at the
‘bedside’
in order
to promote
and
enhance innovations in care is increasingly being identified and acknowledged (UKCC 1990, ENB 1992). This paper explores the history of and the likely implications fo; critical care nursing practice of the ENB framework and the Higher Award. It will argue that the nursing care of people with life threatening problems and their families is an extremely complex activity, requiring advanced knowledge and expert practice skills, consequently the creation of educational and development opportunities, such as those that framework and Higher Award potentially offer, for high quality patient care.
and that practice the ENB are vital
The paper will open with an exploration of the key concepts and values enshrined in the framework and Higher Award. A brief resum6 of the history of these developments and the rationale for their adoption will follow. Drawing extensively from the recent British, North American and Australian literature, searching questions will be posed regarding the universality of access, academic recognition, other alternatives to meeting the same ends, the implications for managers and marketability of these developments to nurses and others. Finally some attempt will be made to evaluate he ENB framework and the higher Award in the light of empowering critical care nurses and nursing.
References
In order to discuss how well we are achieving equity via APL/APEL processes it is necessary to consider the various myths that have sprung up around the AF’L concept.
Evaluating the ENB framework
remain
305
IANE Royal
Historically, nurses wishing to advance their careers have had to choose between education and management, however, a need for advanced practitioners to
ENB 1992 Framework for continuing professional education. London. ENB
Cost benefit adysis
in intensive care
Mike Proctor Nurse Manager, UK
Intensive
Care, York,
The financial limits imposed on health care have been brought increasingly in to focus during the past few years. Intensive therapy is an expensive resource and it is anticipated that in the future the benefit of this therapy will have to be proved in relation to particular patient groups rather than assumed. This paper describes how an intensive care unit in York has begun to assess the cost/benefit of the service they offer. This will be presented in two sections: 1. Assessing the cost. The elements of the total cost of intensive care will be identified and the move towards using a modified Therapeutic Intervention Scoring System to identify cost per case will be described. 2. Assessing the benefits. The protocol and initial results of an ‘outcome of intensive care’ study will be summarised. The system in operation in York for assessine cost/benefit is in its infancv and is far from perfect, however, it does represent a first step towards an acknowledgement of the reality of health care finances in 1994 and beyond and has
306
INTENSIVE AND CRITICAL CARE NURSING
brought the debate in our own unit about the rationing of the intensive care resource out into the open.
Supportingvictimsof violence: families Anne Viney Assistant Director, Victim Support Victim Support grew out of the concern for members of the public and people working in the criminal justice system that the needs of victims interest were not being considered. Until the middle of the 19th century, victims of crime normally prosecuted their own offenders. This ensured victims had a pivotal place in the criminal justice system. The introduction of police prosecutions changed victims’ rights and responsibilities. They were no linger involved in cases unless they were required as witnesses to give evidence. Over time victims became invisible and powerless. In 1974 a group of professionals working with offenders in Bristol established a pilot project to consider the experiences of victims and to provide them with appropriate support. The project, which became the first Victim Support group, was managed by a committee drawn from a wide range of backgrounds. The police undertook to refer all victims of personal crime in the area to the Victim Support group. These were then contacted and, where possible, visited by trained volunteers. The project found that victims and their families encountered enormous practical and emotional prob lems and needed a great deal of support. The Bristol project encountered people in other areas to set up Victim Support groups. In 1979, 16 schemes joined to set up the National Association of Victims Support Schemes which was registered as a charity. Representatives of the police and probation took up positions on the charity’s national council. The Home Offtce made funding available for a national officer and I then took up this post. A national code of practice was drawn up which Victim Support schemes had to adhere to. This stated that each scheme should have a management committee which would include representatives of the police, a social work agency and a voluntary organisation. Victim Support decided early on that its central aim should be to help crime victims. It took an early decision not to become involved in the campaigns for stiffer
penalties for offenders. The charity’s national council felt that commenting in their area would compromise its work helping victims and would undermine the organisation’s aim to work on behalf of all victims of crime, whatever their views. Over the next few years Victim Support developed rapidly and schemes were set up in England, Wales and Northern Ireland. A survey published in 1982 by the Oxford Centre for Criminological Research confirmed Victim Support’s findings that even so-called ‘lesser crimes’, such as burglary, could produce long-term and often serious effects for many victims and their families. A further report commissioned by the Home Office identified Victim Support as the most appropriate agency to offer help to victims. The Home Offtce study argued that victims of crime needed an outreach service as few would make direct approaches to ask for help. A number of police forces accepted this recommendation and agreed to make automatic referrals to Victim Support of victims who had suffered crimes like burglary and theft, and of victims of serious crime with their consent. By 1987 Victim Support schemes were between them helping over 0.25 million people each year. Many of them were struggling to keep up this number of referrals with so few resources. 90 MPs of all political parties wrote to the Government to put the case for a pro gramme of national funding. That year the Home Office made available &2 million to help pay for staffing and running costs. This figure has continued to rise steadily over the last 7 years, just keeping up with the rapidly increasing referrals of victims of crime. Today, 20 years after Bristol Victim Support was set up, schemes nationwide provide help to nearly 1 million people every year. Victim Support volunteers offer information, advice and emotional support to victims of a wide range of crimes, from burglary and theft to assault, rape or the murder of a relative. Schemes offer trained volunteers for victims to talk to in confidence, information on police and court procedures, practical help, including advice on insurance and crime prevention, advice on compensation for violent crime, as well as volunteers to accompany people to the police station or to court. Schemes use their links with local statutory and voluntary agencies to help victims with other difficulties they face as a result of the crimes they have suffered.