Respecting Human Rights During Treatment @MentalWelfare

This week is #MentalHealthAwarenessWeek2020 #mentalhealthawarenessweek and lets remember that it’s OK not to be OK and it is always OK to ask for help.

The theme for this week has been #KindnessMatters but kindness alone is not going to help if you require help from mental health services. What might matter more is having your dignity and human rights protected in your journey through care.

So I welcomed the publication by the Mental Welfare Commission for Scotland’s  Rights in Mind pathway which is designed to help staff in mental health services ensure that patients have their human rights respected at key points in their treatment. Their Rights in Mind booklet features an illustrated pathway of a patient’s journey through inpatient care, and provides a list of human and legal rights at each key stage in their care and treatment.

There is further resources on the site where you can download the booklet which you will find here  and if you work for in Scotland and can access LearnPro, there are courses on Rights In Mind available for staff who have been given access. Worth asking particularly if you are mental health nurse working in Scotland.

Today, May 22nd. 2020 is also the global day of solidarity so I have used their image on my Blog and suggest that you visit their website at https://solidarityinaction.org/or go to #StrongerTogether and show your support for the UN’s Global Goals for Sustainable Development

 

@WHO Good News! #WorldHealth Statistics

On the 13th of May the World Health Organisation(WHO) published its statistics for 2020.  The WHO’s World Health Statistics is an annual check-up on the world’s health. It reports progress against a series of key health and health service indicators, revealing some important lessons in terms of progress made towards the United Nations 17 Sustainable Development Goals and gaps to fill.

What this years statistics are saying is that both life expectancy and healthy life expectancy have increased, but unequally. The biggest gains were reported in low-income countries, which saw life expectancy rise 21% or by 11 years between 2000 and 2016 (compared with an increase of 4% or 3 years in higher income countries).

One driver of progress in lower-income countries has been improved access to services to prevent and treat HIV, malaria and tuberculosis, as well as a number of neglected tropical diseases such as guinea worm. Another was better maternal and child healthcare, which led to a halving of child mortality between 2000 and 2018.

Unfortunately though in a number of areas, progress has been stalling. Immunization coverage has barely increased in recent years, and there are fears that malaria gains may be reversed. Worryingly there is an overall shortage of services within and outside health care systems to prevent and treat noncommunicable diseases (NCDs) such as cancer, diabetes, heart and lung disease, and stroke.

This uneven progress broadly mirrors inequalities in access to quality health services. Only between one third and one half the world’s population were able to obtain essential health services in 2017. Service coverage in low- and middle-income countries remains well below coverage in wealthier ones; as do health workforce densities.

In more than 40% of all countries, there are fewer than 10 medical doctors per 10,000 people. Over 55% of countries have fewer than 40 nursing and midwifery personnel per 10,000 people.

In 2017, more than half (55%) of the global population was estimated to lack access to safely-managed sanitation services, and more than one quarter (29%) lacked safely-managed drinking water. In the same year, two in five households globally (40%) lacked basic handwashing facilities with soap and water in their home.

The overall message from the report is clear. As the world battles the most serious pandemic in 100 years, and we are just a decade away from the Sustainable Development Goal deadlines there is a need for action from High, Mid and Low income countries to work together to strengthen primary health care worldwide and focus our attention on the most vulnerable in order to eliminate the gross health inequalities that still dictate who lives a long, healthy life and who doesn’t.

A fantastic visual summary of the WHO Health Statistics Report 2020 can be seen at: https://www.who.int/data/gho/whs-2020-visual-summary 

For Carers in Scotland During #Lockdown

Yes folks, this is what I look like! With Dr Barbara Sharp a friend and colleague.

Anyone who knows me will be aware that I have great admiration for everyone who is an informal (unpaid) carer, perhaps because I have been one several times myself.  There are almost seven million informal carers in the UK – almost one in ten people. A figure that is rising. It is often forgotten that 42% of carers are men and 58% are women. There value of the contribution made by carers in the UK is £119 billion per year and without them the NHS and social care system would be overwhelmed many times over COVID-19 or no COVID-19.

So at this time it must be particularly difficult. This Blog is a set of resources for them. Recently, Carers Scotland noted that currently reduced or closed care services meant that family members in Scotland were picking up even more care for older, sick or disabled relatives with many of them feeling overwhelmed and at risk of burning out. See their report HERE . So this seems like the least I can do.

Firstly, you can go to the Carers Scotland Website, where you will find a really useful list of Sources of Help and Advice for Carers in Scotland. To find it CLICK HERE.

Secondly, the Scottish Government’s own carers page is HERE 

Thirdly, If you are looking for advice on mental health, adults and the law there is a really useful guide for families and carers on THIS WEBPAGE  from the Mental Welfare Commission. This page also has Frequently Asked Questions guidance for practitioners and formal carers. (Both guides were released last week).

Finally, my own contribution, the video at the top of the page, alongside the contributions of some of the team I work with @AlzScotCPP  All we have done is available on the Alzheimers Scotland COVID HUB.  Where there are some more videos and the accompanying leaflets for my video and the others which we hope will help. They are useful for many carers not just those looking after someone with dementia!

#StayHome #StaySafe

 

State of the World’s Nursing Report-2020

In a week and a day on the 12th of May 2020 it will be the bicentennial of Florence Nightingale’s birth. This year as always the International Council of Nurses (ICN) leads global celebrations on International Nurses Day, the anniversary of the birth of nursings most famous pioneer. This year the celebrations should have been “extra special” because 2020 has been designated the Year of the Nurse and Midwife by WHO but it really is the year of the nurse for much more sombre reasons. In the UK has now become more dangerous than being in the army.  https://www.nursingtimes.net/news/workforce/in-memory-a-list-of-nursing-staff-who-have-sadly-died-from-covid-19-20-04-2020/ 

If you are a nurse though what has probably passed you by completely is a landmark publication by the WHO’s State of the World’s Nursing Report 2020, which should have been one of the highlights of the year. So it has now been published and its interesting although somewhat depressing to look at. This is some of what it says.

  • The global shortage of nurses, which was estimated to be 6.6 million in 2016, had decreased slightly to 5.9 million nurses in 2018. An estimated 5.3 million (89%)
    of that shortage is concentrated in low- and lower middle-income countries, where the growth in the number of nurses is barely keeping pace with population growth, improving only marginally the nurse-to-population density levels.
  • Countries with lower numbers of younger nurses (ie under 35), like the UK and many other westernised economies  will have to increase graduate numbers and strengthen retention packages to maintain current access levels to health services.
  • To address the shortage by 2030 in all countries, the total number of nurse
    graduates would need to increase by 8% per year on average, alongside an improved capacity to employ and retain these graduates.
  • 78 countries reported having advanced practice roles for nurses. There is strong evidence that advanced practice nurses can increase access to primary health care
    in rural communities and address disparities in access to care for vulnerable populations in urban settings.
  • One nurse out of every eight practises in a country other than the one where they were born or trained.
  • Nursing remains a highly gendered profession with associated biases in the workplace. Approximately 90% of the nursing workforce is female, but few leadership positions in health are held by nurses or women. There is some evidence of a gender-based pay gap, as well as other forms of gender-based discrimination in the work environment.

The report suggests 10 key actions to address these international nursing problems.

  1. Increase funding to educate and employ at least 5.9 million additional nurses worldwide
  2. Strengthen capacity for healthcare workforce data collection, analysis and use.
  3. Nurse mobility and migration must be effectively monitored and responsibly
    and ethically managed.
  4. Nurse education and training programmes must produce nurses
    who drive progress in primary health care and universal health coverage.
  5. Nursing leadership and governance is critical to strengthening the workforce.
  6. Planners and regulators should optimize the contributions made by nurses to make use of their full scope of practice.
  7. Countries must provide an enabling environment for nursing
    practice to improve attraction, deployment, retention and motivation of the nursing
    workforce.
  8. Countries should deliberately plan for gender-sensitive nursing workforce
    policies.
  9. Professional nursing regulation must be modernized.
  10. A huge amount of collaboration, more than we have ever witnessed before is required to achieve key actions 1-9.

The report concludes that if the investment in nursing is made then the returns for societies and economies can be measured in terms of improved health outcomes for billions of people, creation of millions of qualified employment opportunities, particularly for women and young people, and enhanced global health security.

The full report can be accessed at: https://www.who.int/publications-detail/nursing-report-2020

A summary in English of the report, which this Blog has been based on is available at: https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf

The case for investing in nursing education, jobs and leadership is very clear when you read this. Relevant Governments, professional organisation and all  stakeholders must commit to taking action.  SOON… the clock is already ticking.

April @BloggersNurse Challenge: the Retention of Healthcare Staff

Last week I said I’d look at the topic of retention and said that would be interesting once this lockdown phase of the COVID-19 story passes. However, before we get to my thoughts on this you need to understand the context.

So rather than give a history lesson this article by Poly Toynbee in the Guardian on the 25th April does a much better job than I would ever do. See https://www.theguardian.com/commentisfree/2020/apr/24/year-nurse-tories-10-years-bad-care-nhs-crisis

As Poly says

…retention isn’t difficult, there is nothing insoluble about it. Pay them decently, give them as clear a career path ahead as doctors enjoy, and see what happens.

So getting beyond the politics of a pay rise, cancelling healthcare workers student debt, improving healthcare workers working conditions and terms of employment and providing a career path that includes recognition of health care workers in the care home and social care sectors… what does the professional literature suggest.

In a systematic literature review published last year Brook et al (2019) looked at the issue of retaining early career nurses. Early career nurses are important because it is in the transition from student to registered nurse that that the losses to the profession are at their highest.

So what did they say about retaining staff in the first year of practice. Firstly, employers have to offer a transition to practice programme. The form that the programme takes, be it preceptorship, mentoring programmes, residency programmes, internships, externships,orientation to practice programmes or clinical ladder programmes is not as important as having one in place. That is because of the message that it sends out; that the organisation by doing this is indicating the importance attached to their newly-qualified staff and this alone is enough to positively influence recruitment
and retention; especially if the organisation is perceived to be investing in the workforce to a greater extent than competitors.

Interventions with the highest benefit appear to be an internship/residency programme
or an orientation/transition to practice programme that incorporates formal teaching, a preceptorship element and possibly the addition of a mentorship element. They suggest that programmes need to last 27–52 weeks in duration. These findings align with
support that is already offered in USA, Canada and Australia. In the UK preceptorship and mentorship are embedded in our culture so we may be starting from a good position.

Unfortunately most of the studies done looking at this topic have been done in high income economies. The quality of their findings have also been affected by inconsistent and incomplete description of the interventions, missing detail of some components of the intervention and variations in methods of evaluation across the studies Brook et al (2019) reviewed indicating that many of the studies on this topic so far were not conducted using rigorous research methods of evaluation. The quality of this review, like many others has been  limited by the quality of the study reports that are available.

What is of interest is not the interventions but a need to refine and review already established transition programmes. If the programmes focussed more on the elements of teaching, preceptorship and mentorship and considered how these added to the new staff nurses experiences then more successful programmes might result. However, variation in the quality of mentors, preceptors and teaching are bound to affect the outcome of support programmes; so Brook et al (2019) suggest reviewing these before you start out.

The full review is available and published as follows

Brook, J., Aitken, L., Webb R., MacLaren, J., Salmon, D. (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review, International Journal of Nursing Studies, Volume 91, Pages 47-59,
ISSN 0020-7489.
https://doi.org/10.1016/j.ijnurstu.2018.11.003

Unfortunately it does not appear to be open access.

So to the UK response to Coronavirus. Effectively all 4 nations in the UK have just sent all their students out into practice prior to completing their education at a time of crisis. It is not likely that the usual transition programmes that most hospitals and employer they are being sent to are running, or will be in place for them, or even considered, until this lockdown ends and something like ‘normal’ service is resumed.

What happens this month and over the next few months may well shape the outcome of hundreds of new students attitudes towards their profession. Are they going to transition well into their new roles with more limited support? Will the NHS and other employers consider offering better support to those who have commenced ‘early’ to help them out in the current situation? Will the Government follow through on the plans it says it has to better support and reward front-line health and social care staff? Will the COVID-19 situation encourage people to join health and social care professions or will it put them off?

I really don’t have the answers to the above questions. We will just have to wait and see… but I am worried already and angry at how depleted the nursing workforce has become and how badly the successive Conservative governments have treated Nursing and  other AHP professionals.

If nothing else, its time to change or my profession will become less attractive and the recruitment and retention problems existing at the moment will only worsen.

(You can follow me on Twitter @uwsraymondduffy)

 

Hidden By The Crowd: Covid Advice for the Learning Disabled and Others

I am writing this really to provide some assistance to some of the groups hidden by the current focus on the health of the population. Clearly the messages for everyone of us at this time#StayHome #StaySafe are really important but there are many people for whom that message is really challenging, for example those with Autism or a Learning Disability. What about those who are vulnerable and isolated or who have a dementia causing illness. So this is for them and those looking after them.

So the resources I want to highlight first are from the Social Care Institute for Excellence.  They ahve produced a set of guides for families and professionals supporting autistic adults and adults with learning disabilities during the coronavirus (COVID-19) crisis. There guides, released on April 17th can be accessed HERE

They have also produced a guide for supporting people who are isolated or vulnerable again release only last week that can be accessed HERE This resource contains a great list of things that you can do during lockdown so what it is suggesting applies much further than the groups it targets. Take a look and you’ll see what I mean.

Regarding people living with dementia and their carers, the Alzheimers Society updated their COVID-19 pages on the 16th of April so you can look at their latest advice by clicking THIS LINK

It is very difficult for society’s marginalised groups at this time. While I can’t cover them all I hope this helps a few people.

As for the @NurseBloggers challenge. It will have to wait until next week. The topic is retention… well that will  interesting when you consider what’s happening just now. Will this encourage people to join health and social care professions or will it put them off… what happens in the next month may well shape the whole sectors future.

Easter Advice on PPE; April 2020

Next week many of the final year undergraduate nursing students at my University go out to join the health and social care workforce. The University, my colleagues at UWS and I are very proud of the 1,200 UWS students joining the frontline fight against COVID-19 next week – a huge thank you to those who have volunteered to join the workforce, to help protect us all 🌟 https://www.uws.ac.uk/…/uws-students-join-nhs-frontline-co…/ #WeAreTogether

However, its far from a bed roses out there, particularly in relation to the Personal Protection Equipment (PPE) that you all require. On Tuesday the BMA published a snapshot survey that 2,000 doctors had responded to. According to their survey, more than half of doctors working in high-risk environments said there were either shortages or no supply at all of adequate face masks, while 65% said they did not have access to eye protection. Alarmingly many felt pressurised to work even in high-risk area despite not having adequate PPE. The shortage appears worse among GP’s with more than half saying they bought their own and only a small number feeling adequately protected. See BMA Survey HERE

So if you are going out to look after our older people and others who may have COVID-19 what do you need to know?

Health Protection Scotland have a page dedicated to COVID-19 that provides an extensive guide to using PPE in the fight against COVID-19  that includes a number of workforce education resources. You can access them at https://www.hps.scot.nhs.uk/web-resources-container/covid-19-guidance-for-infection-prevention-and-control-in-healthcare-settings/

With a weekend to go this would be a good time to sit down and do some reading and learning if you haven’t done this yet. If you do encounter someone with COVID-19 as some inevitably will, then make use of these COVID_19 NICE Guidance and make your clinical colleagues aware of them.

Finally, if you are concerned about your PPE or the supply of PPE, in Scotland there is a helpline which has has been set up for services registered with the Care Inspectorate regarding access to personal protective equipment (PPE).

All services who are registered with the Care Inspectorate and are providing social care support, who have confirmed/suspected cases of COVID-19, and have an urgent need for PPE after having fully explored local supply routes/discussions with NHS Board colleagues, can contact a triage centre that is being run by NHS National Services for Scotland (NHS NSS). This helpline is to be used only in cases where there is an urgent supply shortage after business as usual routes have been exhausted and a suspected or confirmed case of COVID-19 has been identified. The following contact details will direct providers to the NHS NSS triage centre for social care:

Email: support@socialcare-nhs.info

Phone: 0300 303 3020. The helpline will be open (8am – 8pm) 7 days a week.

This helpline is not for NHS staff or for NHS providers who have an NHS BAU supply route.