Message from Area Director

Nursing

Nursing & Midwifery Newsletter Dublin Mid-Leinster

Summer 2014 Volume 2 Issue 2

Feedback, comments & submissions for future issues are welcome and should be sent to: [email protected]

Message from Area Director

INSIDE THIS ISSUE: Practice Development “Caring for a child with a Life Limiting Condition” Page2 Launch of Foundation Toolkit for Family Centred Developmental Care Page2 HSE Dublin Mid Leinster Longford Westmeath Mental Health Services Page3 Corporate & Clinical Governance Increasing the provision of Adaptation and Assessment programmes to support the employment of RN in private nursing homes and ensure timely discharge from hospital Page4

Leadership & Innovation Nurse Prescribing in Public Health Page5 Launch of Welcome Pack in Our Lady’s’ Hospice & Care Services Page5 Promoting World Asthma Day in the Paediatric Respiratory Department Tallaght Hospital Page6 A pedometer challenge for 2014 – National Maternity Hospital Page7 Leadership Development workshop for Nurse & Midwifery Managers in the midlands Page7

Provision of Safe Quality Care Supporting Volunteers at Our Lady’s’ Hospice & Care Services to assist with feeding residents incorporating experiential learning Page8

Continuing Professional Development & Research Centre for Midwifery Education (CME) Foundation Modules in Neonatal Nursing Page9 New Registered Advanced Nurse Practitioners in Tallaght Hospital Page9 Hypnobirthing Page10 Patient/Parent Experiences of Registered Nurse Prescribers in Tallaght Hospital Page11 The Benefits of a Nurse Led Secondary Prevention Clinic in a Stroke Service Page12 NMPDU NEWS Masterclass: Dealing with Difficult Employees Page13 Nursing and Midwifery Quality Care-Metrics Project UpdateDublin South, Kildare & Wicklow Page13 New Metrics Project Officer DML Mid Region Page13 Website for NMPDU Dublin South, Kildare & Wicklow Page14 Advanced Nurse Pactitioner Page14 Registration as Advanced Nurse Practitioners Page14

Upcoming Events Nursing and Midwifery Innovation & Information event November 11th 2014 Page15 Clinical Nurse/Midwife Manager event day Winter 2014 Page15 Other Events of interest Page15

Dear Colleagues Welcome to the summer 2014 edition of the Dublin Mid-Leinster - Nursing and Midwifery Newsletter and many thanks to all staff who have made a submission. This edition contains articles from all nursing and midwifery disciplines across Dublin-Mid-Leinster and highlight innovations that are taking place in all clinical services. The innovations outlined benefit patient care, staff health and/or their professional development. Advanced nursing/midwifery practice applies highly developed clinical nursing or midwifery knowledge and critical thinking skills to independently assess, diagnose, treat and discharge patients from a full episode of care. It is provided by autonomous, experienced nurses and midwives who are competent, accountable and responsible for their own practice. The core concepts of advanced practice include autonomy in clinical practice, expert practice, professional and clinical leadership and research. The SCAPE study (2010) highlighted strong evidence of the positive impact of advanced nurse/midwife practitioner roles on patient care, professional leadership and service improvement. The Nursing and Midwifery Board of Ireland, under Statutory Instrument No 3, Health Order 2010 (An Bord Altranais additional functions) have responsibility for the registration of individual advanced practice nurses and midwives in the appropriate Divisions of the Register. At present they also assess the suitability of the clinical site for the development of advanced practice posts. Many congratulations to our new Registered Advanced Nurse Practitioners in Tallaght and St James’ Hospitals: Adrienne Brennan, Ann Connolly, Shirley Ingram, Barry Mc Brien, Anthony Kearney and Yvonne Hanhauser. The development of these posts is a tribute to the vision of these individual nurses, other professionals with whom they work, and senior nurses in these organisations who have recognised the benefit of advanced practice for patient care and experience and have supported their development. I would also like to welcome Mary Nolan to the team in the Nursing and Midwifery Planning and Development Unit in Tullamore. Mary will be leading the nursing and midwifery metrics project in this area. I hope you enjoy reading this edition of the newsletter and if you require further information on any of the initiatives please contact the named project lead. Sharing good practice is very beneficial for all of us and once again thank you to those who have submitted articles. A call for items for the next newsletter will be made on the 3rd November 2014.

Liz Roche Interim Area Director – DML [email protected]

mailto:[email protected]


Launch of Foundation Toolkit for Family Centred Developmental Care The Coombe Women & Infants’ University Hospital in collaboration with Cork University Maternity Hospital launched the first Irish Foundation Toolkit for Family Centred Developmental Care in Dublin in July 2014 at a very successful meeting which was attended by 45 delegates from Ireland & the UK

The Toolkit provides an overview of the scope of family centred developmental care and the evidence supporting it, along with practical guidance. It is the first step in an early-intermediate level pathway for developmental care education called the “Family and Infant Neuro-developmental Education” (FINE). All levels of FINE are based on a conceptual framework derived from, and compatible with, the advanced level NIDCAP (Newborn Individualised Developmental Care and Assessment Programme). The education/NIDCAP programme workshop leaders must be either NIDCAP trained or have worked closely with NIDCAP trained professionals to ensure consistency and quality.

The aim of this programme is to provide a comprehensive, evidence based introduction to family centred developmental care that will help the health care professional to evaluate and identify goals for the baby’s continuing development.

Why is family centred developmental care important?

Premature birth places the baby’s brain at risk for adverse outcomes. The intensive care technology and treatments necessary to save these infants’ lives can disrupt the infant brain’s development. The dual stress of being isolated from the mother and experiencing daily pain and discomfort can result in neurotoxic brain-altering events, (Anand & Scalzo, 2000).

The NIDCAP approach focuses on a detailed reading of each infant’s behavioural cues in order to reduce / minimise disruption and help support normal neurodevelopment in the baby. The environment and care are adapted to enhance each infant’s strengths and self-regulation collaboratively with the infant and parents, who play the primary role in providing daily nurturance. Individualised developmental care in the neonatal intensive care unit (NICU), originated in the early 1980s by Heidelise Als. NIDCAP is based on Als’ synactive theory (1982) and supported by scientific evidence.

The challenge for neonatal intensive care staff therefore, is not only to ensure survival, but also to optimise developmental outcome. NIDCAP’s goal is to prevent unexpected sensory overload and pain and to enhance strengths and competence. It adapts intensive medical care and environments to the neurodevelopmental individuality of each infant and fundamentally changes traditional care from being task-orientated to care that is timed and adjusted to the sensitivity of each infant. Its ethos is based on family-centred care.

We would like to acknowledge the financial support received from NMPD DML in respect of NIDCAP training.

For further information contact: Telephone 01 4085200 [email protected]

PRACTICE DEVELOPMENT & DELIVERY OF SAFER QUALITY CARE DML NEWSLETTER

“Caring for a child with a Life Limiting Condition” Level A and Level B programmes in the Centre for Children’s Nurse Education, Our Lady’s Children’s Hospital, Crumlin. In June 2014 Cecilia Mc Garry was appointed the new co-ordinator of the “Caring for a Child with a Life Limiting condition”(CLLC) Level A and B programmes. Prior to this Cecilia worked as Clinical Nurse Facilitator/ Course Facilitator in The Emergency Department of Our Lady’s Children’s Hospital, Crumlin. The one day CLLC Level A programme aims to raise awareness among nurses and allied healthcare professionals who care for children with life limiting conditions. This programme includes topics such as pain assessment, pain and symptom management, ethical issues and supportive care of the child and family. Level A programmes for 2014 are planned for; 30th September Galway University Hospital

5th November Regional Education Centre, St Brigid’s Complex, Ardee Co Louth. Plans are currently underway to revise and deliver six level A programmes nationally in 2015. The revised Level A Programmes will be themed and reflect different aspects of caring for a child with life limiting conditions.

The seven day CLLC Level B programme aims to provide additional and more in depth specific information to registered nurses and midwives caring for children with life limiting conditions. This programme takes place in the Centre for Children’s Nurse Education in Our Lady’s Children’s Hospital, Crumlin three times a year. The programme is run two days a week over three weeks. The next date for this programme is October 2014. Both Level A and B programmes, as well as enhancing knowledge and skills of participants, also provide a great means of networking for staff working with children with life limiting conditions. For bookings or further information please contact: Cecilia McGarry, Programme Co-ordinator Email: [email protected] Ph: 01 4096605



PRACTICE DEVELOPMENT & DELIVERY OF SAFER QUALITY CARE DML NEWSLETTER

HSE Dublin Mid Leinster Longford Westmeath Mental Health Services Ashbrook day centre, Mullingar recently won the National Service User Executive (NSUE) award for best mental health day centre in Ireland as voted from a national user satisfaction survey . The day centre has capacity for 40 daily places and supports individuals experiencing severe and enduring mental health difficulties. The ethos of Ashbrook is to promote mental health recovery, working in partnership with local and national support agencies, charities and Non Government Organisations. The basis for its award was on the merits of providing high quality care to clients in a homely, friendly, inclusive and supportive environment. The day centre provides a variety of activities, programmes and interventions as follows:

Social inclusion and community involvement such as bowling, day trips and boating trips .

VEC supported programmes such as literacy, arts, crafts, photography, IT, cookery, bakery.

Cognitive stimulation activities such as table quizzes, pool, crossword, chess, cards, bingo and music sessions.

Good physical health is a challenge for people with mental health difficulties and the centre

works with a VEC tutor in providing tailored armchair exercise, Tai Chi and a walking group. Innovative classes included: 12 week photography course that produced beautiful photographs and a short animation film. A Mental Health Association (MHA) funded project of an individualised autobiography called “This is Me” which means each client received their own bound book of their unique story of one’s self.

Ashbrook Centre Philosophy includes: People attending the centre always come first. Staff have a positive and hopeful approach and the focus is on what a person can do. The relationship between staff and Service Users is of upmost importance and based on mutual respect, trust and honesty. Centre programmes and activities are chosen by staff and service users together. The award demonstrates that the philosophy is experienced by the people who attend and enjoy coming to the centre. For further information contact:0449342363 [email protected]

Staff and Service Users from Ashbrook Day Centre pictured with NSUE award.


CORPORATE & CLINICAL GOVERNANCE DML NEWSLETTER

Increasing the provision of Adaptation and Assessment programmes to support the employment of registered nurses in private nursing homes and ensure timely discharge from hospitals Introduction: The provision of Adaptation and Assessment programmes requires significant co-ordination to ensure that all candidates meet the requirements and standards necessary to register as a nurse/midwife on the Nursing and Midwifery Board of Ireland (NMBI) register. This includes recruitment on to the programme ensuring that participants meet all the requirements from a visa perspective, from an occupational health perspective, ensuring they have the pre-requisite training before commencing clinical placement, co-ordination and delivery of the educational component and ensuring governance of their documentation in relation to their registration with the NMBI. It is also critical that appropriate numbers of suitably prepared staff are available in the required service areas (medical and surgical wards) to clinically supervise and assess candidate nurses whilst on placements. Increasing capacity A project, supported by the ONMSD and national HR in the HSE to provide adaptation and assessment programmes using a hub and spoke model has commenced with the national centre (St Michael’s Hospital, Dun Laoghaire) coordinating all aspects of the programme and the clinical placements will be provided across a number of hospital sites nationally. Specific clinical placement and assessment sites in DML are/will be St Michael’s Hospital, Naas Hospital, and Tallaght Hospital, a sincere appreciation is extended to these hospitals for supporting this initative. A national co-ordinator – Mr Adrian Connor, supported by the ONMSD and kindly facilitated by St Michael’s Hospital commenced this one year project in June. The first two nationally coordinated programmes with 56 candidates commenced in July and August in St. Michael’s Hospital where they received one week’s orientation/theoretical instruction followed by at least 6 weeks clinical placement and assessment in various acute hospital sites throughout the country. Two additional programmes with an increased number of participants are scheduled to start on 13th October and 1st December 2014. The number of programmes to be delivered in 2015 will be published as soon as possible. Programme entry criteria and advice for employers booking prospective candidates for clinical adaptation is available through the St. Michaels Hospital website: http://www.stmichaels.ie/wp-content/uploads/2014/02/Employer-Information.pdf Changes to work permits Recent legislative changes to work permits will come into effect from September 2014. From then, candidates who are applying to register as a nurse/midwife with the NMBI and require a period of adaptation and assessment, will need to apply to the Department of Justice and Equality (Irish Naturalisation and Immigration Service) under the “Atypical Working Scheme” for permission to enter the state to undertake the adaptation and assessment programme. This scheme provides them with a single 6 month period to successfully complete the programme, apply and receive registration with the NMBI. Further information is available on http://www.inis.gov.ie/en/INIS/Pages/Atypical%20Working%20Scheme%20Guidelines After successful completion of the programme and registration with the NMBI the nurse/midwife can apply to the Department of Jobs, Enterprise and Innovation for a work permit which will be called a “Critical Skills Employment Permit”. This will also have to be completed within the single 6 month period. http://www.djei.ie/labour/workpermits/nursesupdate.htm For further information on the adaptation and assessment programme contact Adrian Connor at [email protected] or Liz Roche at [email protected]

http://www.stmichaels.ie/wp-

http://www.inis.gov.ie/en/INIS/Pages/Atypical%20Working%20Scheme%20Guidelines

http://www.djei.ie/labour/workpermits/nursesupdate.htm



LEADERSHIP & INNOVATION DML NEWSLETTER

Nurse Medicinal Prescribing in Public Health

Both national and international evidence supports the role of the registered nurse/midwife prescriber identifying that nurses and midwives are safe medicinal prescribers and that patients view the nurse/midwife prescriber role favourably due to their ability to communicate clearly and empathise with the patient. The requirement for development of the nurse prescriber role in tissue viability n the community was identified following a needs analysis. A nurse commenced the theoretical and clinical education programme, required by the Nursing and Midwifery board of Ireland (NMBI), and the development of collaborative practice agreements with the general practitioners (GPs) with the aim of becoming a registered nurse prescriber.

The overall aim was to develop the role of the nurse in the Nurse-led leg ulcer clinic to increase the efficiency of care and to provide right care to the right patient in the right setting in line with recommendations from the Department of Health. This involved extensive communication and collaboration with all GP’s in the two counties (Laois/Offaly) to inform them of the role of the nurse prescriber; discuss the Collaborative Practice Agreement (CPA) and gain their consent to prescribe for their caseload of patients. This process took almost 9 months to complete and resulted in improved lines of understanding and communication between General Practice and the Public Health Nursing Service. The final CPA was reviewed and agreed by the Drugs and Therapeutic Committee. and the nurse registered as a Registered Nurse Prescriber with the Nursing & Midwifery Board of Ireland (NMBI).

Patients have commented on the positive impacts this service has made on their care, stating; “that the service is convenient, easily accessed and that they have a greater understanding of the reasons why a drug or preparation is prescribed.” They also find it easier to communicate with the Registered Nurse Prescriber. It is hoped that these positive impacts will lead to improved client concordance with treatment and a more effective service.

For further information contact: 086 3837170 [email protected]

Launch of Welcome Pack in Our Lady’s’ Hospice & Care Services Introduction Our Lady’s’ Hospice & Care Services (OLHCS) celebrates its 2nd successful year of the Patient Priority Pledge (PPP) with the launch of our new Welcome Pack. Step Into My World is a core activity of the PPP, the aim of which is to develop staff’s awareness and understanding of the experience of the patients’/residents’ journey in OLHCS. The Welcome Pack was developed to support the patient/resident and their families in “settling in” to OLHCS. Methodology The concept of the welcome pack was proposed to our Quality and Practice Group (QPG) and received with enthusiasm and a shared commitment to establishing it within OLHCS. Sample packs were created with leaflets such as; what the patient/resident can expect from all OLHCS staff in respect of confidentiality, the importance of hand hygiene, why our nurses wear red aprons and more. We also included a questionnaire asking patients/residents five key questions focusing on improving their experience. A complimentary tea/coffee and scone voucher is also included in the pack to encourage the patient/ resident and their families to visit our coffee shop. Following feedback from QPG, staff and patients/residents some more changes were made to the content of the sample welcome pack such as using bigger font sizes and inclusion of other information leaflets. An information session was held to inform staff about the Welcome Pack and its purpose for patients/residents and families. The packs were distributed to all wards in June and staff were advised to offer a Welcome Pack to all new patients/residents and their families admitted to OLHCS. Outcome We plan to evaluate the efficacy of the Welcome Pack by including it in our Nursing Metrics and issuing quarterly reports based on the results of the patient experience questionnaires. These results will be available to all staff, patients/residents and their families. For further information contact: [email protected] 01 4068793




Promoting World Asthma Day in the Paediatric Respiratory Department Tallaght Hospital The Paediatric Respiratory Department in Tallaght Hospital held an event to promote World Asthma Day (WAD) on Tuesday May 6th 2014. The goal of WAD is to raise awareness of the condition (Asthma) amongst patients and the public. This year the Asthma Society of Ireland’s theme for WAD focused on the needs of children with asthma and their parents. To highlight the focus on children a special event was organised by the Respiratory Nurses with the hospital Art Department. A unique afternoon of children’s activities focusing on asthma and the lungs was held in the Children’s OPD. The department was decorated with asthma themed posters designed by children, a specially designed poster advertising the event and balloons from the Asthma Society. The activities organised to raise asthma awareness in children included face-painting and craft making to help children understand the function of the lung. The children made windmills on a stick and practised blowing them. With the help of the very enthusiastic art volunteers the children coloured and did drawings of pictures of lungs and asthma triggers. An information stand was set up providing asthma information booklets and inhaler leaflets for parents. Throughout the afternoon an inhaler demonstration DVD was shown and the respiratory CNSp was available for questions. An information stand was also set up in the main hospital atrium to raise public awareness. A photo shoot of the event was taken by the photography department. Feedback on the event from children, parents and staff was very positive and indicated that this event enabled learning about asthma and the lungs in an interactive and fun way. It is hoped following this feedback that similar events will be organised in the future. For further information contact: Phone:01 4142000 bleep 2945/7302

[email protected] [email protected]; [email protected]

Pictured from left to right Mary Devitt, Paediatric Respiratory CNS Mary Mc Donald, Paediatric Respiratory ANP Candidate





A pedometer challenge for 2014 – National Maternity Hospital The Department of Health has recently published a framework document – Healthy Ireland (HI), a Government plan for improving Health and Wellbeing. In response to this a Multidisciplinary team in the National Maternity Hospital have introduced many initiatives to enhance the health of patients and staff. One element was to focus on daily activity undertaken by staff using a pedometer to measure the number of steps taken in a day Pedometers were made available to staff for purchase or loan and a challenge was posted in our quarterly magazine.:

How many steps do you need to take daily to

keep fit?

How many Kilometres do you walk at work each day?

Which department is the most active in the hospital?

To date 117 people have taken up the challenge to get more active by using a pedometer to count the number of steps taken each day. Staff have been observed comparing the number of steps they have taken as they pass on the corridors encouraging healthy rivalry. It is known that an increase in daily activity enhances overall wellbeing and may help reduce the risk of developing Type 2 diabetes. The initiative has also generated lots of discussion and interest among friends and families. Some comments from staff included:

‘Met a friend in the supermarket – she had done 6000 steps. I said I am getting one because I must do 12,000 if she does that much!’

‘Didn’t do enough steps – made me go for a

walk’

‘Think it’s great, my husband wants one’

‘It’s great fun!’

‘Really love it- it keeps me in check’

‘It made me walk up the stairs instead of using the lift’

The feedback has encouraged an increase in activity by staff – especially using the stairs! We hope to take part in a Smarter Travel Workplaces national pedometer challenge in the autumn. For further information contact: Mary Coffey 086 7740742 (ANP Diabetes) [email protected]

Leadership Development Workshop for Nurse & Midwifery Managers in the Midlands In March this year a series of nursing leadership workshops were held across the acute hospitals in the Midlands Professor Patrick Geoghegan OBE and Peter Wadum-Buhl MBA, facilitated the workshops Patrick and Peter have over 60 years experience, between them, in the areas of nursing, clinical & organisational governance, health service leadership, training & organisational development, regulation and ‘turn around’ of failing healthcare organisations. The workshops were designed in collaboration with the NMPD to ensure the content was aligned to the needs of the staff. There was a series of three one-day workshops for frontline Clinical Nursing & Midwifery Managers followed by a session with the Senior Nursing & Midwifery Managers from all three hospitals. The aims of the workshops were for participants to:

consider the learning from Mid Staffordshire and other

failings in the quality of clinical care;

explore the areas of under performance and the potential for future failings in their areas of responsibility;

develop leadership strategies and a range of interventions using a variety of approaches/tools.”

In addition to the above, the final workshop for the senior leadership included a session to consider how best to support staff with challenges they had identified in the first three days. The workshops were delivered using a combination of didactic teaching, group work, video and scenario based learning methodologies. The materials used were developed and selected to encourage open disclosure of the challenges that nursing and midwifery leaders were facing whilst developing practical and pragmatic solutions that could be taken back to the workplace. All participants were asked to plan and pledge action that they would take when returning to their workplace. The evaluations from the 3 day workshops was excellent and staff said they felt both invigorated and supported throughout the days For Further information contact: [email protected] 086 806 9861



PROVISION OF SAFE QUALITY CARE DML NEWSLETTER

Supporting Volunteers at Our Lady’s’ Hospice & Care Services to assist residents at mealtimes incorporating experiential learning Introduction Alongside our staff, volunteers assist the residents at mealtimes in Our Lady’s’ Hospice & Care Services. In order to support the introduction of this practice, volunteers received theoretical training. In collaboration with the Quality & Practice Development Team, experimental learning was incorporated into the training in order to develop the volunteer’s awareness and understanding of the experience of the patients’/residents’ mealtimes. Aims/Objectives The aim of the learning was twofold.

1. For volunteers to learn how to assist a resident to eat and drink in a safe and competent manner while maintaining their dignity.

2. To develop the volunteer’s awareness of what it feels like to require assistance eating and drinking and understand their valuable role in making it a pleasurable experience for the patient/ resident.

Methodology Eighteen volunteers attended the workshop. The theoretical element was presented and written instructions provided for volunteers to refer back to at any point. Each volunteer was then invited to pair up to practice the technique using yoghurt and a spoon. Following the workshop, volunteers’ feedback included

he experiential piece and included, ‘the person can be quite close to your face; invading

your space’, ‘longer spoons are needed’, ‘you should be prepared and have everything to hand’ ‘you should communicate with the resident to gain their trust’. ‘we should try with our eyes closed” - by doing this, the volunteer has to describe the

food (name the food, texture, consistency, colour, etc). Outcome The results were positive with all participants finding both workshop and training methods beneficial to their role. It was agreed that long handled teaspoons would be sourced. The Volunteer Co-ordinators will incorporate the experiential aspect of training into their workshops in future. For further information contact: [email protected] 01 4068793


CPD & RESEARCH DML NEWSLETTER

Centre for Midwifery Education (CME) Foundation Modules in Neonatal Nursing

Principles of High Dependency and Special care nursing Principles of Neonatal Intensive Care nursing

Neonatal care is a constantly evolving field, presenting neonatal nurses with many challenges. Practitioners are expected to acquire the requisite knowledge and skills in order to provide competent nursing care for this population of preterm and sick infants. The Centre for Midwifery Education (CME) has therefore developed two Foundation Modules in neonatal care nursing. The first module, focusing on the Principles of High Dependency and Special Care Neonatal Nursing was the result of a collaborative process between the Centre for Midwifery Education (CME) and the three Dublin maternity hospitals. To date, two programmes focusing on both theoretical knowledge and clinical practice development have been held in the CME with very positive feedback from all staff in attendance and their clinical managers.

In response to the report by Murphy, Nicholson and Turner (2012; 2013), a second module was developed on the Principles of Neonatal Intensive Care Nursing, and was held in February - March 2014. The cohort in attendance, numbering fifteen, was representative of five hospitals. Focusing on the integration of theory to practice, the objective of this module is to develop learner competence, enabling the delivery of individualised quality care to the stable neonate in the Intensive Care Unit.

Those attending either module are encouraged to seek out appropriate learning opportunities which will enhance their clinical development. The learners, acquiring their clinical experience external to the three maternity hospitals affiliated to the CME, must satisfy in relation to the following:

Access to Clinical Placements Suitability of the Clinical Environment(s) Support of Nursing Management Access to an Assessor/Supervisor

At present, both modules are delivered over a six-week time frame, comprising theoretical presentations, supervised facilitation in clinical practice and independent self-learning. It is anticipated that some presentations will be made available via Blended Learning. Both programmes are accredited by the NMBI with 35 and 28 continuing educational units (CEUs) respectively. For further information please contact: 01 4085200 [email protected] / [email protected]

New Registered Advanced Nurse Practitioners in Tallaght Hospital “Advanced Nursing and Midwifery practice is carried out by autonomous, experienced practitioners who are competent accountable and responsible for their own practice (National Council 2004).” Since the Commission on Nursing (1998) advanced practice has developed significantly nationally. A part time Project Officer was appointed in Tallaght Hospital in January 2014 to work with Candidate Advanced Nurse Practitioners (cANP) and the interdisciplinary working groups to complete the extensive site preparation and portfolio development each candidate requires prior to registering with the Nursing & Midwifery Board of Ireland (NMBI). This post has been funded for one year by a Nursing and Midwifery Innovation Grant from the NMPDU Dublin South, Kildare & Wicklow (Palmerstown). There are currently eight Registered Advanced Nurse Practitioners (RANP’s) in post across the Adult and Children’s Services in Tallaght. The specialities where RANP’s currently work include; Emergency Departments (Adult & Children), Occupational Health, Women’s Health, Cardiology, Epilepsy (Children) and Diabetes Mellitus (Children). Congratulations to the most recent registrants;

RANP Diabetes Mellitus (Children)- Adrienne Brennan

RANP Epilepsy (Children) -Ann Connolly

RANP Cardiology- Shirley Ingram

Three further Candidates hope to be registered in the coming weeks. The development of these senior clinical nursing roles are in areas identified as key to service delivery in line with Hospital Strategy, and supports, the implementation of the Health Service Reform. The Scape study (NCNM 2010) has shown that ANPs, in collaboration with their multidisciplinary team colleagues and within agreed scope of practice guidelines, provide more timely care, promote self-management and adherence to treatment, decrease re-admission rates, leading to improved patient satisfaction and contributing to reduced healthcare costs (National Council for the Professional Development of Nursing & Midwifery 2010). For further information contact: 01 4142000 [email protected]




Hypnobirthing Women in Ireland are expressing an increased interest in alternative means for coping with labour and birth, in particular hypnobirthing. Hypnobirthing is a method of birthing calmly, gently and with confidence, with a focus on natural birth. It uses the power of positive language to combine easy to learn methods of deep relaxation, breathing techniques, visualisation and affirmative positive thinking to reduce anxiety, stress, fatigue and fear, and, as a result, also reduce pain. It has been shown to reduce length of labour and the need for pharmacological analgesia with less intervention resulting in a higher rate of normal births. In May of this year, nineteen midwives from the National Maternity, the Rotunda and the Coombe Women & Infants University Hospitals attended a four day Hypnobirthing Practitioner Training Programme. The training was coordinated by the Centre for Midwifery Education (CME) and was facilitated by Judith Flood, a registered midwife and founder member of the Association of Hypnobirthing Midwives in the UK. Whilst focusing on the techniques and exercises used in hypnobirthing, the training encouraged reflection on normal birth processes and rebuilt confidence in normal physiological birth amongst those present. Since completing the training, midwives involved in Antenatal Parent Education are incorporating aspects of the training programme into their classes and there are plans to review the possibility of commencing Hynobirthing classes for pregnant women at local level. Others reported feeling confident to support women and their partners who choose to use hypnobirthing in labour and commented on how the knowledge and techniques learned are useful for their own calmness both personally and professionally. Going forward, the CME will schedule hypnobirthing information sessions for healthcare professionals, facilitated by the newly trained Hypnobirthing Practitioners. Training was supported by the NMPD Palmerstown under the Nursing and Midwifery Innovation Funding Grants 2014. For further information contact: 01 4085200 [email protected]

Midwives from the National Maternity, Rotunda and Coombe Women & Infant University Hospital who attended Hypnobirthing Practitioner Training, pictured with the facilitator Judith Flood.



Patient/Parent Experiences of Registered Nurse Prescribers in Tallaght Hospital Background to the study In December 2008 the first prescription by a Registered Nurse Prescriber (RNP) was written at Tallaght Hospital. Since then 8,893 prescriptions have been written by RNPs across the adult and children’s services. To date, auditing has demonstrated a high level of compliance with national standards. However, the patient/parent experience of nurse prescribing has not been examined since the National Independent Evaluation of the Nurse and Midwife Prescribing Initiative (Drennan, et al., 2009). This study aimed to identify perceived levels of satisfaction amongst patients/parents with nurse prescribing in Tallaght Hospital. A pilot study was carried out using the patient satisfaction component of the national evaluation study questionnaire (Drennan, et al., 2009). The pilot phase is now complete, the findings of which are presented here. Findings of Pilot study In total 70 questionnaires were circulated, of which 23 were returned completed, representing a response rate of 33%. Overall the findings are reflective of the national evaluation (Drennan et al., 2009). It is clear that most respondents (96%, n=21) were supportive of nurse prescribing, with only one individual disagreeing with the statement that “Nurses should be able to prescribe medications for patients”. Importantly 21 respondents (96%) indicated they were ‘Very likely’ to comply with the treatment prescribed by the RNP. Over 95% of respondents (n=21) agreed that this service had reduced their waiting times – a key target for all health service providers. A minority of respondents (n=2) indicated they would have liked more time with the RNP, while only one individual indicated not being completely satisfied with the RNP consultation. A little under one fifth of respondents (19%, n=4) agreed they would have preferred a doctor to prescribe their medication compared with 6% who reported the same in the national study (Dennan et al., 2009). Interestingly, most of these respondents (3/4) were parents/guardians of patients attending children’s services. Given the small pilot sample size in the pilot phase of this study it is difficult to draw conclusions at this stage. Nevertheless, an important consideration for the research team will be to explore further whether parent/guardian respondents of children are more likely than adult patients to indicate a preference for a doctor prescriber, a question not considered in the national study. Next steps The next stage of this study will commence in October 2014 with a completion date set for mid-2015. The aim of this report will be to identify areas of good practice as well as areas for improvement that can be actioned as required. The report will be shared all with relevant stakeholders.

For further information contact: 01 4142000 [email protected]





THE BENEFITS OF A NURSE LED SECONDARY PREVENTION CLINIC IN A STROKE SERVICE Background The World Health Organization (WHO) highlighted the importance of lifestyle modification interventions other than the use of affordable, accessible and effective pharmacological treatments in the prevention of TIA/Stroke. Risk factors which contribute towards 90% of all strokes are hypertension, unhealthy diet, physical inactivity, excessive alcohol intake, psychosocial stress, atrial fibrillation, smoking, high cholesterol and diabetes. Thus, appropriate secondary stroke prevention is required in modifying these risk factors via educational intervention. While stroke education is required during hospitalisation its value to retention of important information remains poorly understood (Handler and Alexandrov, 2014). Stroke patients and caregivers may be best supported by provision of information following discharge with more advanced teaching. With this in mind a need was identified for a Nurse led Secondary Prevention Clinic in Tallaght Hospital to reinforce education given to patients during their inpatient stay. The clinic was established and outcomes audited to evaluate:

Patients understanding of stroke and stroke risk factors following attendance at the clinic That any questions/concerns that they had were addressed during consultation Whether any positive lifestyle modification had been made as a direct result of attending the clinic.

Overview All patients who are admitted under the care of the Stroke Service in Tallaght Hospital are screened by the Stroke CNSp. All patients who meet set criteria receive an outpatient appointment to attend the nurse led secondary prevention clinic within 4-6 weeks post discharge. In order to assess risk factors and to allow individualised patient assessment two documents were developed, ‘Stroke Secondary Prevention Clinic: Patient Assessment’ and the ‘Modified Distress Management System Assessment’. These documents aim to

Provide ongoing assessment and care post discharge Assess and track outcomes beyond discharge Assess post discharge progress and management of post stroke life Reduce risk of recurrent stroke in our local population Screen for psychological distress and facilitate onward appropriate referrals Determine compliance with medication Assess ongoing personal risk factors for stroke occurrence Provide education reinforcement and support of secondary stroke prevention strategies Facilitate onward referral to stroke MDT where necessary

Methodology An audit was conducted over a three month period, of patients who attended the clinic, n= (61), and who required onward referrals to the Stroke MDT. A service user questionnaire was also completed to determine the benefits of the Nurse Led Secondary Prevention Clinic. Results 77% n= (43) patients required onward referral (16% of which required referral to 2 or more services)

Ambulatory Blood Pressure Monitor application: 15% Referred for further investigations e.g. CT Brain, Holter Monitor, Blood Testing: 25% Medical Team Review: 20% Clinical Nutrition: 30% Occupational/Physiotherapy/Medical Social Worker: 5% Clinical Psychology: 5%

42 service user surveys were distributed, of which there was a 69% n=(29) response rate. 79% of respondents reported an improved understanding of stroke and stroke risk factors following attendance at the clinic. 86% felt that any questions/concerns that they had were addressed during consultation and 55% reported making a

positive lifestyle modification as a direct result of attending the clinic.

Conclusion As results demonstrate, through attendance and individualised assessment at this clinic, the need for patients to have further treatment and onward referral is identified promptly post discharge, decreasing the risk of potential post stroke complications. Patients are educated to make positive lifestyle modifications thus reducing their risk factors for stroke. For further information contact: 01 [email protected]/ [email protected]




NMPDU NEWS DML NEWSLETTER

Masterclass: Dealing with Difficult Employees A Masterclass was held on Wednesday 6th August 2014 in HSE Palmerstown for Directors and Assistant Directors of Nursing/ Midwifery in the DML region entitled ‘Dealing with Difficult Employees’. The Masterclass was facilitated by Mr Gearoid Hardy who is a management specialist and has demonstrated expertise in developing individual talent and business potential. The event was a resounding success as revealed in the evaluations of the event by the 77 attendees. Participants said that the event helped them to discover practical and feasible solutions to real work challenges. Many also felt that realising that many other organisations had similar challenges in the workplace was in itself a positive outcome of the morning as services got an opportunity to share experiences, network and agree common solutions with the guidance of the expert facilitator Gearoid.

Nursing and Midwifery Quality Care-Metrics Project Update Dublin South, Kildare & Wicklow Nursing and Midwifery quality care-metrics are supported nationally by Dr. Michael Shannon, Office of Nursing and Midwifery Services Director (ONMSD), to assist services to provide assurance of the quality and standards of nursing and midwifery care they provide. Nursing and Midwifery Metrics present ways of measuring the quality of fundamental nursing and midwifery care that utilise process performance quality indicators which provide a framework for how fundamental nursing care can be measured (Foulkes 2011).Work on the Nursing & Midwifery Quality Care-Metrics Project has been progressing steadily over the summer within Dublin South, Kildare & Wicklow. To date, 21 sites within the region have expressed an interest in being involved in the project in order to assist them measure and report on the quality of their nursing and midwifery care processes. Of these, 4 sites have completed a readiness and capacity check for the project and have been established on the ‘Test Your Care’ software system which is a web-based licensed package that facilitates data collection at ward level. The ‘Test Your Care’ system was originally developed by the Heart of England Foundation Trust and delivers seamless data analysis and reports on Metrics. The same core metrics are recorded by all hospitals and services that use the ‘Test your Care’ package. Ownership and accountability of the results lies with the Director or Nursing/Midwifery of the relevant service. Training on the system and support in the implementation of the project can be provided by your local NMPDU metrics project officer.

If you are interested in implementing Metrics in your organisation, information on the project along with a template that you can use to evaluate your readiness to engage in the project is available at: www.hse.ie/eng/about/Who/ONMSD/NMPDU/NMPDUDSkilwicklow/Nursing_and_Midwifery_Quality_Care_Metrics.html Alternatively you can contact: Ciara White, Metrics Project Officer, NMPDU Dublin South, Kildare, Wicklow, [email protected], 087-6458059

New Metrics Project Officer DML Midland Region As part of the National Nursing and Midwifery Metrics Project, Mary Nolan has joined the Midlands NMPD team as metrics project officer for Longford/Westmeath and Laois/Offaly areas. Nursing and Midwifery Quality Care Metrics provide up to the minute information on the quality of our nursing process and help capture the unique contribution of nurses and midwives to care. Metrics (measurements) provide a clear, user friendly facility to measure care and assists with the drive towards safe, effective, person-centred care for patients/service users. Mary will be representing the DML midland area and will join 7 other regional project officers on the national metrics program. An invitation to join the metrics project will be issued to all services in the midland region over the coming weeks. In the interim, Mary is available to anyone who would like further information on the metrics initiative as follows. For further information contact: [email protected] tel. 057 9357865

http://www.hse.ie/eng/about/Who/ONMSD/



NMPDU NEWS DML NEWSLETTER

Website for NMPD Dublin South, Kildare & Wicklow The NMPDU have a section on the ONMSD website where relevant information can be accessed by all nurses and midwives including

o The 2013 NMPD Annual report o DML Newsletters o Application forms and funding Guidelines o Updates information in relation to regional projects e.g. Quality-Care metrics o Presentations from events held

We promote the use of the website for accessing these resources and information as it is more efficient and convenient for all concerned. The Website can be accessed here: http://www.hse.ie/eng/about/Who/ONMSD/NMPDU/NMPDUDSkilwicklow/

Advanced Nurse Practitioner Update The development of Advanced Nurse Practitioner roles continues throughout the region and is testament to the commitment and vision of the Directors of Nursing and the nursing and multidisciplinary teams involved in site preparation. Since our last edition, NMBI site accreditation was achieved in diabetes (children), and for 3 posts in the emergency department at Tallaght. oooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo Registration as Advanced Nurse Practitioners Congratulations to Barry Mc Brien and Anthony Kearney who were registered as Advanced Nurse Practitioners Emergency in July at Tallaght Hospital and to Yvonne Hanhauser at St James’ Hospital, who was registered as an Advanced Nurse Practitioner in Breast Care. For further information about the development of ANP posts, please refer to the NMBI website WWW.nmbi.ie For further information contact: Raphael [email protected] for services in Dublin South Kildare & Wicklow [email protected] for those in the Midlands Region of DML


You can advertise your Winter local event here

The next edition of the DML

Newsletter & Midwifery Newsletter will be published at the end of

December 2014 If you would like to advertise your

local service led event

http://www.hse.ie/eng/about/Who/ONMSD/NMPDU/NMPDUDSkilwicklow/

http://WWW.nmbi.ie/




UPCOMING EVENTS DML NEWSLETTER

Date for the Diary: Nursing and Midwifery Innovation & Information event November 11th 2014 All nurses and midwives in the Dublin South, Kildare & Wicklow region are invited to and innovation and information event on 11th November 2014 which will be hosted by NMPDU Palmerstown. The event will provide an opportunity to share and celebrate nursing and midwifery innovations that have been supported by the NMPDU over the last two years. The event will also provide an opportunity to provide relevant information updates to nursing and midwifery staff (as a follow on from the first information event on March 3rd 2014). There is no fee for attendance but registration is required. Further details and agenda for the day will be circulated via Directors of Nursing/Midwifery in due course. Upcoming event: Clinical Nurse/Midwife Manager event day; 12th December 2014 A recent meeting between took place in NMPDU Palmerstown with Directors of Nursing and Midwifery or their representatives from the Dublin South Kildare and Wicklow region to discuss CN/MM development requirements. One of the agreed actions of the meeting was to convene a day specifically for CNMs where attendees would have an opportunity to be updated on relevant developments within the health service, have an opportunity to articulate challenges and seeking solutions, sharing experiences and networking with colleagues. Further details and agenda for the day will be circulated via Directors of Nursing/Midwifery in due course.

Other Events of Interest

The ninth annual Nursing conference will be held at Tallaght hospital on the 30th September. Closing date for bookings, which are essential, is the 19th September 2014. Enquiries to [email protected]

The NMBI national conference will be held on the 9th October 2014 at Chartered Accountants House Pearse

St. D.2. The theme for this year’s conference is “Professionalism in Nursing-how the code can work for you”. Poster presentations will also be on display. See the NMBI website for more details on how to submit a poster.

The 15th Healthcare Interdisciplinary Research Conference and Student Colloquium will be held at Trinity

College Dublin on the 4th-6th November “Health Wellbeing and Innovation-Recent advances in research practice and education”. For more details contact Jeni Ryan Administrative Officer events-School of Nursing and Midwifery TCD email [email protected] or phone 01 896 3860

The 4th national Patient Safety First conference will be held on the 7th November at Croke Park Conference

Centre. For more details visit www.patientsafetyfirst.ie

Celebrating Nursing Practice in the Midlands: October 21st, 22nd & 23rd Our three day conference provides a platform for nurses and midwives to showcase their innovations and achievements in demonstrating best practice. It also offers staff an opportunity to listen to keynote speakers and engage in discussion on topics including:

Leadership and Nursing: Dr. Michael Shannon Regulation and the Role of HIQA: Phelim Quinn HIQA Assisted Decision Making ( Capacity) Bill 2013: Patricia Rickard Clarke Clinical Governance and Quality: Maureen Flynn Master Class on Resilience, Self Care & Leadership: Sheila Mulcahy Evidence Based Practice competency and Continuing Professional Development: Dr. Mary Doolan.

Over the 3 days there will be 26 concurrent sessions with presentations from nursing colleagues across the services. There will also be poster presentations on display throughout the event Nursing and midwifery colleagues, across all healthcare sectors are welcome to participate. Venue: NMPD, HSE, Unit 4 Central Business Park Clonminch Tullamore Co. Offaly Contact: Mary Manning; [email protected] phone is 0579357870



http://www.patientsafetyfirst.ie/


Message from Area Director

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Transcript of Message from Area Director