Nursing & Midwifery Newsletter Dublin Mid-Leinster · Kathleen Griffin, Practice Development...

Message from Area Director INSIDE THIS ISSUE:

Practice Development Releasing Time to Care ™ Midlands Regional Hospital Page2 National Audit of Public Health Nursing (PHN) Documentation. Page3 Corporate & Clinical Governance

An Integrated Public Health Nursing Team Page 4 International Nurses’ Day & Who Global Hand Hygiene Day in 2013 Page 5 Midlands Regional Dementia Education Project Page 6 HSE and Voluntary Intellectual Disability service providers Dublin Mid Leinster pre HIQA Planning Group Update Page 7 Ensuring patient safety in relation to food in Cherry Orchard Hospital Page 7

Leadership & Innovation

Change our World Self Advocacy Group Page 8 Weaning as a Primary Care Initiative Page 9 Celebration of World Breastfeeding Week Launch of Booklet for Mothers Page10 Chronic Obstructive Pulmonary Disease (COPD) Outreach – Tallaght Hospital Page11 Provision of Safe Quality Care

Lifestyle Intervention and the Role of the Staff Midwife and Advanced Midwife Practitioner (Diabetes) in the Management of Gestational Diabetes (GDM) Page12

Continuing Professional Development & Research

Caring for the child with a Life-Limiting Condition Education Programmes Page13

Patient Satisfaction analysis of the Nurse-led Chest Pain Clinic Page14 Continuous Professional Development in Education A New Initiative Page14 Reaching out to people in Community at risk of Cardiovascular Disease Page15 NMPDU Update Page16 Upcoming Events Page19

VOLUME 1 ISSUE 3 August 2013

Nursing & Midwifery Newsletter Dublin Mid-Leinster

Dear Colleagues Welcome to the summer edition of the Dublin Mid-Leinster - Nursing and Midwifery Newsletter and thanks to all staff who have taken the time to make submissions for inclusion. This edition again contains articles of interest from a variety of services across DML all of which are about improving care for the patients who access our services; e.g. initiatives for women who access maternity or community services, management of chronic disease, staff who provide outreach services to patients and staff development opportunities. In this time of significant change and financial constraint, we are all required to examine our practice and ways of working to ensure that in addition to it being evidence based – it is also cost effective. We have some excellent examples of this work in this newsletter from Virginia Pye and her team in relation to the establishment of an integrated Public Health Nursing team in one of her areas and from Alice Cockram, Barry Pidgeon and Denise Doolan describing the additional care time they have achieved for nursing staff by introducing some of the Productive Ward – Releasing Time to Care™ modules in their area. Since the enactment of legislation and regulations giving medicinal prescriptive authority to nurses and midwives in Ireland 175 have become registered prescribers in Dublin Mid-Leinster. Further information on medicinal prescribing will be included in the next newsletter. The lead person to support services in DML is Ms Ina Crowley. Tel: 061 464007; Mobile: 086 3851729 E-mail: [email protected] I would like to take this opportunity to congratulate Maria Curley and Denise Doolan from Tullamore hospital who will be presenting a paper at the upcoming all Ireland conference on the Productive Ward – Releasing time to Care™ initiative “Realising and Sustaining Frontline Potential” on October 15th . Their presentation will be entitled “Sharing the Patient’s Story by Utilising Effective Communication Processes for Handover”. A number of posters have also been accepted for presentation from other sites in Dublin Mid Leinster including St Vincent’s University Hospital, the National Rehabilitation Hospital, Dunlaoghaire and the Midland Regional Hospital Portlaoise. Well done to all sites for their progression of this initiative which is yielding very positive results for patients and staff. Please contact the named project lead for further information on any of the initiatives. 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 1st November 2013 In the meantime, I hope you enjoy reading this issue.

Liz Roche Interim Area Director – DML [email protected]

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

mailto:[email protected]



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P AGE 2 PRACTICE DEVE LOP MENT & DELIVERY OF SAFER QUALITY CARE DML NEWSLETTER

Releasing Time to Care Midlands Regional Hospital, Tullamore Introduction As part of the Releasing Time to Care ™ project, the MRHT project team have implemented the Well Organised Ward (WOW) module on Medical 2. WOW encourages ward staff to look at the way the ward is organized and the order in which or where equipment etc is stored — is every thing in the right place at the right time and ready for use? WOW aims to reduce the time spent searching, finding or fetching and thus increase direct patient care time. Methodology Carrying out a ward waste walk, the module team noted a large bathroom was being used for furniture storage rather than its intended purpose while stores supplies were held in a number of locations on the ward. On discussion, it was identified that there was no requirement for this large bathroom thus, in collaboration with our maintenance department, it was redesigned into a new stores room where the kanban system was used to create one central location for all stores supplies. Achievements While a once-off stock saving was not achieved as the kanban system has been in place since the relocation of our services to the new hospital campus in 2008, the module team were able to identify savings in the value of stores supplies held and received. By reducing the amount of supplies held, €3,500 was saved over a six month period since the redesign. Given that stores supplies related to specific interventions are now located centrally, this has also impacted on the amount of direct patient care time available for our patients. During a recent activity follow, it was identified that less time is now wasted in searching for equipment thus the time to carry out nursing procedures e.g. a dressing and urinary catheterisation has been reduced by approximately two minutes for both procedures. Conclusion & Moving Forward Through the implementation of WOW, an increase in our direct patient care time and financial savings through stock reduction has been achieved. Moving forward, the emphasis is on maintaining every thing in the right place at the right time and ready for use while identifying other areas for improvements. For further information contact: [email protected] Barry [email protected] [email protected] 0579358133/0579321501 Bleep 408 / 087 9267530

it was identified that less time is now wasted in searching for equipment thus the time to carry out nursing procedures e.g. a dressing

and urinary catheterisation has been reduced by approximately two minutes for

both procedures.

Before WOW

After WOW




NMPDU DML NEWSLETTER P AGE 3 PRACTICE DEVE LOP MENT & DELIVERY OF SAFER QUALITY CARE DML NEWSLETTER

National Audit of Public Health Nursing (PHN) Documentation. Introduction In 2012/2013 The Institute of Community Public Health Nursing (ICHN) supported a project to review the range of existing nursing documentation in use in the PHN service nationally. A sub group was set up and terms of reference agreed. The sub group included representation from the PHN service, ICHN, third level colleges ONMSD and practice development. Method and Sample Samples of all nursing documentation was collected. An audit tool, examining the components of documentation was devised and sent to all 32 PHN service areas nationally. Each PHN service was asked to submit record samples. The return of the audit tool and associated records was 81%. (26 out of 32 areas returned the audit) Outcome Overall there was strong compliance with the audit and service areas took time and consideration gathering and submitting the records. The findings of the audit and the actual records were presented at a workshop on the 18th of Jan 2013 held in the ICHN premises in Dublin. The workshop was well attended by PHN services and there was an opportunity to share records and collect record samples. There were presentations on the day by:

Liz Roche, Interim Area Director Nursing and Midwifery Planning and Development - DML Kathleen Walsh, Professional Officer, Standards of Practice & Guidance, NMBI Anne Mc Donald, Digiphit Project Officer & Pamela Hussey, DCU

Presentations from Practice Child & Family Needs Assessment – Virginia Pye, DPHN, Longford Westmeath Adult records-Annette Irving, ADPHN, Mayo Carer’s Needs assessment – Kathleen Griffin, Practice Development Co-ordinator, Midlands

Next Steps The Sub group plan to consult with the Forum of National Directors of Public Health Nursing to agree a strategy for nursing documentation development in the PHN service. Report Prepared by Virginia Pye DPHN Chair of Sub group For further information contact: Virginia Pye 044 9395078 [email protected]

Kathleen Walsh, Professional Officer, Standards of Practice & Guidance, Nursing & Midwifery Board of Ireland Kathleen Griffin, Practice Development Coordinator, Midlands Liz Roche, Interim Area Director, Nursing & Midwifery Planning & Development – DML Virginia Pye, DPHN, Longford, Westmeath Anne Mc Donald, Digiphit, Project Officer Dr Pamela Hussey, Lecturer DCU Annette Irving, ADPHN, Mayo


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Frontline and management PHN staff in Longford/Westmeath sought to change the existing model of working to address ongoing staffing and caseload management

pressures.

P AGE 3 PRACT ICE DEVE LOPMENT & DELIVERY OF SAFER QUALITY CARE DML NEWSLETTER PAGE 5 CORPORATE & CLINICAL GOVERNANCE DML NEWSLETTER P AGE 4 CORPORATE & CLINICAL GOVERNANCE DML NEWSLETTER

An Integrated Public Health Nursing Team was introduced into Mullingar Town early in 2012 The team incorporates the principles of corporate working which means team management of a client population where a collective caseload emerges from the pooling of a number of individual caseloads. Nursing staff within this team share clinical responsibility while maintaining professional accountability. Why we made the change? Traditionally public health nurses work in small geographical areas individually managing caseloads of approximately 2,500 people. The current recruitment moratorium has put significant pressure on this model of working. Frontline and management PHN staff in Longford/Westmeath sought a change to this existing model of working to address ongoing staffing and caseload management pressures. The move to integrated team working using a corporate caseload approach was seen as a possible solution to these problems The incorporation of skill mix into nursing teams is considered a key reform issue within the reconfiguration of the health services. This team is dedicated to clinical care, managing an active clinical nursing caseload, accepting referrals for nursing assessment and interventions. This team comprises of 5.4 WTE PHNs/RGNs. What the change looks like? Currently the integrated team has a caseload of approximately 500 patients across all care groups (excluding children and families). There are an average of 25 admissions and 500 to 600 patient contacts per month. Nursing services offered by the team range from wound assessment, continence assessment, phlebotomy, male and female catheterisation and holistic assessment for support services. The work of the team is supported by written guidelines.

Feedback on change Preliminary qualitative feedback from staff outside the team (allied health professionals/liaison nurses/support staff) was extremely positive. These staff reported that the integrated team model provided one point of contact, reduced duplication, speeded up response to requests and improved team working. Staff within the integrated team reported reduced stress, more equitable caseloads and much improved support for complex cases and clinical decision making. Patient feedback was positive once patients understood the changes and gained confidence in the service and the continuity of care. Conclusion The integrated model is particularly suitable for urban settings with a critical mass of staff and population. However, continuing staff pressures may require that a similar model is adapted to rural areas. This change management initiative will require ongoing appraisal and merits a more robust evaluation of service and patient outcomes. Finally the success of this project is attributable to the commitment, dedication and hard work of all the team members involved in this change initiative. For further information contact: Virginia Pye 044 9395078 [email protected]


NMPDU DML NEWSLETTER

The Hand Hygiene awareness element of this event facilitated the opportunity for staff to take part in various important hand hygiene awareness raising activities, advocating the on-going need to

improve and sustain hand hygiene practices

International Nurses’ Day & WHO Global Hand Hygiene Day in 2013 – Our Lady’s Hospice & Care Services

Following the successful inaugural celebration of International Nurses’ Day & WHO Global Hand Hygiene Day in 2012, Our Lady’s Hospice & Care Services (OLHCS) enthusiastically celebrated both global events together for the second year running on May 13th. The 2013 International Nurses’ Day honoured the dedication, commitment and quality of nursing care that is continually provided in OLHCS using the theme ‘CLOSING THE GAP: MILLENNIUM DEVELOPMENT GOALS. 8, 7, 6, 5, 4, 3, 2, 1’.

The Hand Hygiene awareness element of this event facilitated the opportunity for staff to take part in various important hand hygiene awareness raising activities, advocating the on-going need to improve and sustain hand hygiene practices to help reduce the spread of healthcare associated infections. The morning was filled with lots of activities which included our famous ‘Bed Making’ competition, the popular Health Check stand which offered staff the opportunity to receive various health checks and a Hand Hygiene Stand which included ‘Pin the Germs on the Hands’ competition. Mass was celebrated in the main chapel with special prayers offered for all staff throughout OLHCS. On behalf of the Department of Nursing we would like to extend a big thank you to all who participated in and supported this fun filled event.

For further information please contact: Penny Long (01) 4068793 Bleep 824 [email protected]

PAGE 5 CORPORATE & CLINICAL GOVERNANCE D ML NEWSLETTER

Enjoying ‘Pin the Germs on the Hands’ Pictured from L to R: Libby McGrane (Infection Prevention & Control Nurse) Arnel Kidpalos (Nurse Tutor Gerontology)


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PAGE 6 CORPORATE & CLINICAL GOVERNANCE D ML NEWSLETTER

Midlands Regional Dementia Education Project. The Midlands Region, established a regional dementia strategy steering group in January 2013. The group chaired by Local Area Manager, Mr. Joseph Ruane has representation from a diverse group of people, including family care givers, the local Alzheimers Society, members from Psychiatry of Later Life Multidisciplinary Teams (MDT); Older Person Services,Senior Managers from the services and the Nursing and Midwifery Planning and Development Unit. The steering group has agreed several objectives, one of which is the provision of dementia education across all the care settings in the region. A sub-education group was set up to develop a MDT approach to the delivery of education. There was general consensus amongst the group to deliver the establised National Dementia Generic Dementia Education and Awareness Programme; Enhancing and Enabling Well-Being for the Person with Dementia (HSE ONMSD programme). The programme structure and delivery format was reconfigured to maximise participant attendance and meet requirements of all members of the multidisciplinary team accross the midlands region. The content of the programme remains unchanged. There are 11 modules which facilitators will deliver on-site, including to the three acute midland regional hospitals. The modules may be delivered in 5 sessions or alternatively over 2 full days. On completion participants will recieve a certificate of attendance. Timetables for the delivery of training have been finalised with the programme due to commence in September 2013. The group have identified key personel within psychiatry of later life teams and older person services, to facilitate the delivery of the programme, thus utilising available expertise within the region. The modules will be delivered over an agreed period of time with local managers. While the overall governance for the management and evaluation of the national programme remains with the Office of Nursing and Midwifery Services Directorate, a regional governance framework has been agreed amongst the team. The responsibility for the delivery and co-ordination at local level is with the psychiatry of later life teams and identified staff from care of the older person units. The sub-education group in the Midlands Region believe that education in dementia will significantly enhance the lived experience for the person with dementia and their carers. For further information contact: Rosalia Kavanagh [email protected] Gerardine Kelly [email protected] Louise Buckley, St Brigids Hospital 057 8646717

‘A Multidisciplinary Team Approach to Improving and Enhancing Dementia Education Knowledge across Care Services’




PAGE 7 CORPORATE & CLIN ICAL GOVERNANCE D ML NEWSLETTER

HSE and Voluntary Intellectual Disability service providers Dublin Mid Leinster pre HIQA Planning Group Update: Following the work previously described in the spring edition of this newsletter, services linked with another area and conducted audits based on three of the standards. Reports on the audit findings were correlated and shared with the individual services who are currently working on the findings of these audits. It is intended to repeat this process for the remaining standards. During the group meetings documents that support preparation for the HIQA inspection process are identified and shared within the group. Presentations have been facilitated from Older Persons services on key areas such as the ‘Statement of Purpose and Function’ by Elaine Keane,Director of Nursing Peamount Healthcare. The ‘Evidence room’ from Maria Daly,Assistant Director of Nursing, Cherry Orchard and Medication Management from Dr.Helen Flint ONMSD. Two working sub groups have emerged from the group. One group are currently working on the development of a Capacity Assessment tool (NMPD Dublin North East are also involved),whilst a second group are working on End of Life Planning. Plans are underway on the development of a preparation package for the staff engaged in the inspection process. This group has facilitated collaborative work between services on their preparation for the HIQA inspection process and had resulted in invaluable ongoing information sharing. For further information contact: Judy Ryan [email protected] 086 8599234

Ensuring patient safety in relation to Food in Cherry Orchard Hospital Familiar home made foods may be of benefit for nursing home resident’s spirits but they can also be a risk. They may have an impact on the health of the resident if their physical condition changed since living at home e.g. the development of swallowing difficulties, or a condition whereby the resident requires a specific diet. Furthermore, families are not expected to have the same standards for food preparation as those established for health care organisations by the Food Safety Authority of Ireland and regulation by European and Irish law, among which are: Regulation on Hygiene of Food Stuffs, EU regulations 852/2004 and all amendments and Traceability of Foodstuffs: EU regulation 178/2002 and all amendments. In addition to the good communication established between nurses and families in relation to all aspects of residents care; a multidisciplinary group in Cherry Orchard Hospital, in partnership with resident advocates developed guidelines in relation to bringing in food and drink to the hospital for residents. For further information please contact [email protected]



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P AGE 7 LEADE RSHIP AND INNOVATION DML NEWSLE TTER

P AGE 8 LEADERSHIP AND INNOVATION DML NEWSLETTER

P AGE 8 LEAD ERSHIP AND INNOV ATION DML NEWSLETTER Change Our World Self Advocacy Group People with an intellectual disability must be consulted on issues that affect their lives (HIQA 2013). In March 2012 people with an intellectual disability in the Westmeath area who access HSE day or residential services were invited to join a self advocacy group. This group, facilitated by Donna Rolfe Speech and Language therapist, Kathy Duff, Programme Facilitator and Judy Ryan,Nurse Practice Development Officer, was initiated to assist individuals with an intellectual disability develop the advocacy skills required to address issues that affect their lives. A group of 20 individuals now meet on a monthly basis in Mullingar and to date have engaged in a number of initiatives; The Group:

chose to name themselves ‘Change our World’ self advocacy group and identified a logo that appears on all of the literature developed by the group

elected a Secretary for their group and learned about the structure of meetings. As a result they are represented on a regional group to progress the (New Directions 2012 Day Service Report Recommendations)

met with an independent advocacy officer for the region and have developed an information poster and leaflet on self advocacy that has been distributed to the services

have represented the group at a national meeting with Minister Kathleen Lynch and attended Inclusion Ireland Conference 2013

have facilitated a presentation on advocacy and the work of the group to post graduate student nurses in Athlone Institute of Technology (Department of Nursing) and presented at a Speech and Language Therapist Conference, Portlaoise.

facilitated an information stand at a disability exhibition in the Mullingar Park Hotel. As a result, have developed links with a Rural Transport scheme, which subsequently provided once- off funding for those needing support to attend the group

share information about what is on in their local area and have co-ordinated a fundraising coffee morning to raise funds for transport costs

have developed information in an accessible format on “Making a Complaint” and are currently working on information on “Managing your Money”. All of this information is distributed to the services and supports the preparation for the HIQA process.

For further information contact: Judy Ryan [email protected] 086 8599234

Change our World Self Advocacy Group



Weaning Session outline What is weaning? Finger foods & snack ideas

Why wait till 6 months? Foods to be avoided

Why not to delay beyond 6 months? Practicalities / equipment required

Signs an infant is ready Food safety preparation and storage

Stages of weaning & skill learned Vitamin D, Iron & Gluten Introduction

Suitable drinks Recipes


Weaning as a Primary Care Initiative Primary care provides an ideal an opportunity to provide families with information on the importance of good nutrition. An Infant’s nutrition will determine their health, physical development, cognitive abilities and well being for the rest of their life. Good nutrition should ideally start with exclusive breast feeding for the first 6 months and appropriate weaning practices during the first year of life. This time provides a unique opportunity to shape an infants future health and help reduce the risk of certain diseases. Public Health Nurses (PHNs) are key professionals in supporting parents on infant nutrition. Routine developmental checks carried out by PHNs in health centres provide opportunities to discuss issues related to weaning and feeding. Difficulties identified at these clinics include issues with breast and formula feeding, starting solids, texture progression, food quantities and fussy eating. Arising from this identified need we established a community based infant weaning programme to support parents living in Shankill, Co.Dublin. This programme is delivered jointly by a PHN and Dietitian. Participants are recruited via the 3 month PHN developmental clinics, and 2 month General Practitioner immunisations. It is also widely advertised in local parent support groups, pharmacies, supermarkets and community centres. The once off, hour and a half long session includes delivery of information on nutrition in the first year of life. To date 22 programmes have been delivered to 159 participants. Infants attending had an average age of 21 weeks, 58% of whom had not yet been weaned. The session highlights the current WHO guidelines on the timing and introduction of solid foods at 6 months of age.

Difficulties identified at these clinics include

issues with breast and formula feeding, starting solids, texture progression, food

quantities and fussy eating.

Parents are encouraged to bring their babies to the session. A relaxed atmosphere provides an ideal opportunity for plenty of discussion and questions. Parents leave the session feeling confident and empowered to make the right choices for their baby. A support booklet containing all the information delivered has now been completed and is provided to participants. Working together as a team of professionals has allowed us the opportunity to provide accurate and appropriate information on best weaning practices which provide the essential building blocks for optimum health. For further information contact: Patricia Whyte, Sonja Lynch – 01 2820344 [email protected]


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Celebration of World Breastfeeding Week- Launch of Booklet for Mothers. Mothers, babies and staff were all on board for the launch in August of a revised booklet on breastfeeding practices for mothers, as part of the National Maternity hospital’s celebration of World Breastfeeding Week 2013. The aims of the booklet are to give women general information on breastfeeding early in their pregnancy, to give them a better understanding of how they can increase their knowledge and skills. This will help them later on to learn together with their babies, how to get breastfeeding effectively established in the early days. The Booklet will be available for all women in the booking pregnancy pack, so that mothers will be able to read during pregnancy. Currently mothers are going home earlier from maternity units after birth and any extra assistance and support is to be welcomed. This handbag sized, evidenced based booklet has been a collaborative service development, from various departments within the hospital- The Breastfeeding support team, Neonatal services, Dietetic services, Community Midwifery services, Hospital Midwives, representatives from Voluntary Groups including; Cuidiu and La Leche League and colleagues in administration, who supported the project in the publishing of the document. For further information, please contact: Nicola Clarke , Assistant Director of Midwifery, 6373100, [email protected]

Participants and staff at the launch of The booklet: Front Row: Thank you to the mothers and babies Back Row: Nicola Clarke, ADOMN Denise McGuinness, CMS Mary Brosnan ( Director of Midwifery) .Catherine McCann CMS, Michelle Walsh,(Admin) Lorraine O’Hagan CMS.


NMPDU DML NEWSLETTER P AGE 11 LEADERSHIP AND INNOVATION DML NEWSLETTER

Chronic Obstructive Pulmonary Disease (COPD) Outreach - Tallaght Hospital In continuing the process of delivering a quality and efficient service to Tallaght Hospital patients, the COPD Outreach service was commenced in Tallaght Hospital in August 2012. What is COPD Outreach? The COPD Outreach service provides a ‘Hospital at Home’ service for patients who present with an acute exacerbation of COPD. The service offers patients who meet certain criteria, a safe planned early discharge option which focuses on management during their acute exacerbation period in the patients’ home. Having been selected onto the outreach programme, patients receive education and interventions which help them to monitor & manage their condition in order to prevent further exacerbations and optimise patients’ ability to live well with COPD. The programme consists of an initial 14-day ‘Hospital at Home’ service and care is extended to include further education, medication management and pulmonary rehabilitation during a 6-week period. The Objectives of the COPD Outreach Service are to:

o Reduce the number of Emergency Departments (ED)presentations and hospital lengths of stay

o Facilitate a safe, planned early/ assisted discharge

o Provide education on the disease process, exacerbation signs and symptoms

o Educate patients and their care givers on medication management

o Facilitate smoking cessation

o Encourage independent functioning, improving quality of life

o Liaise effectively with primary care teams and support services

o Teach appropriate airway clearance techniques

o Encourage early activity and exercise within the patient’s own limitations

o Ensure patients are appropriately referred for follow up services

o Provide objective measurement of the service using clinical audit and outcome measures

The COPD Outreach Team The service has been set up under the National COPD Quality in Clinical Care Programmes (NCQCCP). The outreach team works as part of a multi-disciplinary team and is comprised of; a Lead Consultant Respiratory Physician, Clinical Nurse Manager, Senior Physiotherapist, and the Respiratory Team. To date, over 135 patients have met the inclusion criteria for the COPD Outreach programme. These numbers have been largely due to support provided by clinical areas within Tallaght Hospital, in particular the ED, Acute Medical Assessment Unit (AMAU) & Acute Medical Unit (AMU) The service has been further supported by the Dublin South Community Intervention Team, Smoking Cessation Services and Primary Care services within the locality. For further information contact: Louise Cullen [email protected] Clare Baily [email protected]

‘Hospital at Home’ for patients with Chronic Obstructive Pulmonary Disease.



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P AGE 13 PROVISION OF SAFETY QUALITY CARE DML NEWSLETTER Lifestyle Intervention and the Role of the Staff Midwife and Advanced Midwife Practitioner (Diabetes) in the Management of Gestational Diabetes Mellitus (GDM).

Introduction Data from Western countries suggest that the prevalence of gestational diabetes mellitus is increasing. This has led to >35% attendance increase at the diabetes clinic in the National Maternity Hospital since 2011. Poorly controlled Gestational diabetes has serious implications for the health of mothers and infants. Facilitated group education has been designed and provided by staff midwives and an Advanced Midwife Practitioner (Diabetes) for this high risk group. Aims/ objectives 1. To empower women with a diagnosis of gestational diabetes to make the lifestyle changes required to achieve normoglycaemia. 2. To inform women of their risk of developing Type 2 diabetes in the future. 3. To provide health promotion linking a healthy lifestyle with diabetes prevention in their children. Method Lifestyle Education class: The class employs a facilitated learning style, aimed at promoting self-care and active participation. A. Using a Flip chart, key questions are posed and feedback encouraged. B. A validated knowledge questionnaire is administered to evaluate the session content. C. A booklet - gestational diabetes - is discussed in detail. D. A glucometer is given to self-assess lifestyle changes. E. Nutritional education is provided by the senior dietician. Outcomes Over 350 women have benefited from the enhanced service with very positive feedback. The format of the class is well received. Participants can phone the midwives for advice if they identify glucose levels above the target range. The focus on exercise and healthy eating has impacted on maintaining normal glycaemia. This initiative had contributed to the sustained reduction in insulin initiation rates over two years. Conclusion The introduction of the intervention appears to have improved the experience of women who develop GDM. Participants have adopted an active role in their diabetes management. It has expanded the role of midwives in health promotion and diabetes prevention. There has been a reduced requirement for insulin therapy Plans for the future In collaboration with the dietician and physiotherapist, an advice sheet has been designed for use at first antenatal visit. It allows women to identify individual risk factor for developing gestational diabetes and gives advice to help reduce that risk. Contact details:Authors: 1. Mary Coffey Advanced Midwife Practitioner in diabetes email [email protected] 2. Usha Daniel Staff Midwife in diabetes email [email protected] For further information contact: 0867740742 or 016378278 – Diabetes Clinic

P AGE 12 PROVISION OF SAFETY QUALITY CARE DML NEWSLETTER




THEGE 1 2 P ROVISION OF SAFE QU ALITY CARE DML NEWSLETTER P AGE 13 P ROVISION OF SAFE QUALITY CARE DML NEWSLETTER P AGE 14 CPD AND RESEARCH DML NEWSLETTER P AGE 13 CPD AND RESEARCH DML NEWSLETTER

Caring for the Child with a Life-Limiting Condition Education Programmes The Centre of Children’s Nurse Education (CCNE) is pleased to announce that the Level A and B programmes in the Continuing Education Series - “Caring for the Child with a Life-Limiting Condition” have recommenced. The one day Level A programme aims to raise awareness among registered nurses, midwives and other health and social care professionals who are occasionally required to provide care for children with life-limiting conditions and their families. A total of 75 participants attended the first programme in Tallaght Hospital on the 14th June. The programme included sessions on Pain and Symptom Management, Supporting the Child and Family and Ethical Perspectives of caring for a child with a life-limiting condition. Further programmes are planned for 2013:

26th September, CNME, St Mary’s Campus, Castlebar 7th November, CNME, Mid Western Regional Hospital 5th December, RCNME, Waterford Regional Hospital

The seven day Level B programme aims to provide registered nurses and midwives opportunities to acquire additional knowledge to provide supportive and palliative care for children with life-limiting conditions and for their families. A total of 20 registered nurses and midwives attended the first Level B programme of 2013. There was Representation from the Community, Public Health Nursing, Specialist Palliative Care, Children’s and Intellectual Disability services represented. A second Level B programme is scheduled for October with future dates planned for 2014 and 2015. For further information contact: Email:[email protected] Phone: 01 4096605

Some of the members of the first Level B programme in 2013

Front row L-R Hazel Bayley, Liane Murphy, Hilary Noonan, Myrene Panopio, Aoife McCartin, Elizabeth O'Loughlin Maria Breathnach, Fiona Woods (Programme Co-ordinator)

Back row L-R Anne Lyndon, Muireann Aherne, Maureen Brennan, Eleanor Moran, Theresa O'Kelly, Kate Cullen, Josepha Quinlan, Sinead Griffin/Gillick, Colm Keeley

The programme aims to raise awareness among registered nurses, midwives and other health and social care professionals who are occasionally required to provide care for children with life-limiting conditions and their families.

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PAGE 14 CPD AND RESEARCH DML NEWSLETTER

Continuous Professional Development in Education, a New Initiative In 2012 St. Vincent’s University Hospital (SVUH) and University College Dublin (UCD) School of Nursing & Midwifery developed a new exciting initiative to provide accreditation from UCD for all SVUH Continuous Professional Development Programmes (CPD). These CPD programmes in Intensive Care, Hepatobiliary, Emergency and Orthopaedic Nursing were devised in collaboration with the Registered Nurse Tutors in the Nurse Education Centre, Clinical Facilitators, Clinical Nurse Managers and Assistant Directors of Nursing from Intensive Care, Hepatobiliary, Orthopaedic and Emergency departments in SVUH. The aim of each programme is to advance each student’s body of knowledge, skills and attitudes in order to enable them to adopt a therapeutic and holistic response to the care of each patient. A primary focus of the courses is the development of clinical nursing skills. The Programmes are offered as a specialist stand alone module at level 8. The theoretical component is delivered in the Nurse Education Centre, St. Vincent’s University Hospital. The duration of each course is six months. On successful completion of the academic and clinical assessments the student will be awarded a Level 8 Certificate, accredited by UCD. For further information contact: Orpha Walsh 01 2094548 [email protected]

Patient Satisfaction analysis of the Nurse led Chest Pain Clinic. Introduction The development of Cardiology Nurse Specialist and Nurse Practitioner posts is aimed at improving the process of care experienced by patients who present to Tallaght Hospital with chest pain. Benefits to patients include; consistent rapid access to specialist expertise and skills; a consistent model of care and increased patient satisfaction, in line with standard 4.1 of National Standards for Safer Better Healthcare Method A two page postal questionnaire was distributed to 109 patients who attended the Chest Pain clinic during September and October 2012. The questionnaire comprised of twelve questions. SPSS version 18 was used to analyse the data. Outcome 39% of patients returned completed patient satisfaction surveys. Six surveys were only partially completed which resulted in missing data for those questions. All patients who responded to the question, were satisfied with their consultation and assessment with the nurse specialist: 76% (n=32) were very satisfied and 17% (n=7) were satisfied. When asked which practitioner the patient would prefer to have their consultation with (Nurse specialist v Doctor), of those who responded to the question, 54% (n=20) would prefer the nurse specialist. The reasons given by patients for choosing the nurse specialist included, that the nurse had more time for them, the nurse took more time to explain and make sure they understood the information given and the nurse was more down to earth and approachable. Twelve patients however (32%) would have preferred a doctor, patients indicated they would feel safer, have more confidence and be at ease with the doctor. Patients also felt a doctor would be better qualified to carry out the consultation and assessment. Four patients (11%) indicated that they would be happy with either the doctor or nurse provided they were helpful. Conclusion Advanced nursing roles are being developed in Tallaght Hospital, however it appears that whilst patients are happy with the nurse led service there remains more to do to assure patients about the competence and expertise of the care delivered by the CNS/ANP. The Nurse managed service is a new concept amongst the Irish patient. Nurses who are expanding their scope of practice are providing safe, timely, evidence based nurse-led care to patients at an advanced nursing level. For further information contact: Shirley Ingram 01 4142749 [email protected]




PAGE 15 CPD AND RESEARCH DML NEWSLETTER

Reaching out to People in Community at Risk of Cardiovascular Disease Introduction Cardiovascular Disease (CVD) remains the leading cause of mortality in this country. The Cardiac Rehabilitation (CR) department at Tallaght Hospital is consistently involved in promoting improvements in cardiovascular (CV) health. Aims and Methodology A health promotion education initiative was introduced in an effort to improve local mortality rates. The nurses in the cardiac rehabilitation department reviewed the coronary angiography reports at Tallaght Hospital. Patients with a reported plaque build up within the coronary arteries in the region of 50% or less, and for whom the consultant had recommended aggressive risk factor control, were invited to attend an educational session on identification and management of cardiovascular risk factors, delivered by a cardiac nurse. Of the forty two patients invited, fifteen attended the session: twelve men and three women from within the local Dublin catchment area (Clondalkin, Templeogue, Lucan and Saggart). Prior to delivery of the education session, participants completed a short quiz to assess their level of knowledge about cardiovascular risk factors. A presentation followed on non-modifiable and modifiable risk factors for Cardiovascular Disease, with interaction between the speaker and the patients. Information leaflets on blood pressure, obesity and cholesterol from the Irish Heart Foundation were distributed and all queries were answered. Outcome A brief satisfaction survey was undertaken. Twelve patients stated that they found this education of benefit and they now had a better understanding of the risk factors. Eleven rated the information as very good and one person rated the information as good. Two people did not complete the survey. Conclusion There is potential to improve individuals’ risk factor profiles through health promotion and thus prevent cardiovascular events occurring. It is hoped that this health promoting initiative may have an impact at local level and positively influence patient outcomes. This is an ongoing project within Cardiac rehabilitation as we continue to develop outreach services and links with the local community. For further information please contact: Noeleen Fallon 01 4143097/4142990 [email protected]

There is potential to improve individuals’ risk factor profiles through health promotion and thus

prevent cardiovascular events occurring


EMPLOYEE NEWSLETTER

P AGE 16 NMPDU DML NEWSLETTER

DML Newsletter Summer 2013 NMPDU DML Update

ONMSD National Productive Ward/Releasing Time to Care™ Project This project is being led out from the ONMSD with identified key personnel from the NMPD in each region supporting the implementation of the project. The six DML organisations involved in Phase one which began in 2011 with selected site training, have realized significant increases in direct patient care time. One site reported an increase of 11% in direct care time. All have incurred significant financial savings and there is evidence of sustained culture change in phase one sites where there is visible senior management involvement, enabling front line staff to affect the sometimes small, but significant process changes, which free up time to care for patients. Phase 2 site selection began in the Winter of 2012, and 2 more sites in DML started the project. So far both are well on the way in their implementation, staff enthusiasm is high, and both sites have introduced improvements which have given front line staff more time to spend with patients. A national conference is planned for the 15th October at Farmleigh House in Dublin and will be a showcase for organisations to share their stories and improvements to date. Regional Coordinators are; Raphael Mc Mullin Palmerstown NMPD [email protected] Mary Manning Tullamore NMPD [email protected]

Advanced Nurse/Midwifery Practitioners (AN/MP) The NMPDUs continue to support services in the preparation and development of AN/MP posts in response to service need and service plans. There are currently 20 ANP and one AMP posts in development in the region. Of these, 8 ANP and one AMP posts are expected to be presented to the Nursing and Midwifery Board of Ireland’s (NMBI) registration committee, (previously the committee of advanced practice), by December 2013. Dates for the two next meetings of the registration committee are planned for the 23rd September and the 11th November. Please contact your local NMPDU if you need to discuss any aspect of AN/MP development. THE NMPD (Tullamore) organised for Maria Neary from NMBI to facilitate a workshop on June 26th in Tullamore for those interested in developing ANP/AMP posts in their areas. There was a very good attendance from the DML area. The evaluation was very positive; those who attended commented that it was a very informative practical workshop well worth attending. If areas would like further workshops organised in the DML area, the NMPD would be happy to facilitate. Post Approvals Following Successful Submission Of Documents And Site Visits. Congratulations to the teams at Tallaght hospital who have achieved post approval for an ANP in Cardiology and at St James’ Hospital for their ANP post approval in Breast Care. Registrations as Advanced Nurse Practitioner Congratulations to Caroline Anne O’Neill and Eimear Lavelle in Naas General Hospital who were registered with the NMBI in July as ANPs. We wish them well in their future careers as ANPs in Emergency Care.

Clinical Nurse/Midwife Specialist applications The ONMSD has been directed by the Department of Health to develop an interim process for CN/MS applications. The interim process, based on that devised by National Council for the Professional Development of Nursing and Midwifery, has been drafted and is awaiting legal advice. Services will be notified as soon as this interim process is in place.




P AGE 17 NMPDU NEWS DML NEWSLETTER

Wound management training programme, incorporating leg ulcer management for Public Health Nurses and Community RGNs in Dublin South, Kildare and Wicklow (Update) Following completion of part one of the education programme on wound management which began in 2012, the second and third phases of the project (Leg Ulcer management and Doppler assessment) are now almost completed.

A series of study days on leg ulcer management commenced in September 2012 and were completed in March 2013. Doppler assessment training started in November 2012 and was completed in February 2013. Practical and theoretical assessment for both compression bandaging and Doppler assessment will be completed by November 2013 and results so far are very promising.

A total of 322 staff have undertaken training/updates in compression bandaging and 30 staff the Doppler assessment techniques. Formal (academic and practical) assessment days were held for both skills in a variety of sites. Candidates presented for assessment on completion of a workbook and having deemed that they were competent under the Scope of Nursing Practice framework.

All courses have been developed in collaboration with the RCSI and clinical experts and have NMBI approval and varying CPD credits. A certificate of attendance is issued to all candidates on successful completion of academic and practical assessment. Both of the study days described above will be evaluated using a pre-test, post test approach.

For further information, please contact Raphael Mc Mullin at [email protected]

Child and family health needs assessment In October 2012 A Report on the Child and Family Health Needs Assessment (CFHNA) Framework Project described the development of tools by PHN services in Laois/Offaly and Longford/Westmeath to support Child and Family Health needs assessment in the community. This framework has been endorsed by the ONMSD. The introduction of the CFHNA provides PHN’s with a 2nd level framework for assessing children and families at risk. This framework is based on best practice from the UK and is contextualised within Irish child care policy and strategy. The CFHNAF consists of an assessment framework, assessment record, care plan, resource manual and practice guideline. To support the rollout of this framework in Dublin South, Kildare & Wicklow, a phased approach is being adopted. Dublin South East and Wicklow teams are currently undertaking training with the support of the NMPDU which will facilitate successful introduction of the framework. A 2-day programme of education, designed by the initiating group in Laois/Offaly and Longford/Westmeath is being delivered to public health nursing staff in both areas The remaining 5 sites in the region will introduce the framework in 2014. For further information, please contact: Susanna Byrne Interim Director Nursing & Midwifery Planning & Development Email: [email protected] Kathleen Griffin Nursing Practice Development Co-Ordinator DML Email: [email protected]

Post Natal Depression (PND) Screening Training A series of two-day post natal depression screening education programme for registered PHNs and midwives working in public health nursing services is currently being provided by the CNME Tullamore to staff within the 7 PHN teams in Dublin South, Kildare and Wicklow. The aim of the programme is to facilitate PHNs to develop their knowledge of, and skills in postnatal depression screening. In order to support PHN screening, all areas in Dublin South, Kildare and Wicklow with the support of the CNME Tullamore and NMPDU Palmerstown, have adapted a policy developed in the Midlands, to suit their local referral pathways. Training is NMBI approved and accrues 13 CEUs. For further information, please contact: [email protected]





EMPLOYEE NEWSLETTER

P AGE 18 NMPDU NEWS DML NEWSLETTER

Care planning for older person’s services (Day Care setting) Update The Dublin Mid Leinster Integrated Minimum Dataset (September 2010) has been successfully implemented in many residential services in DML. However this robust tool was deemed inappropriate to meet the documentation requirements for day care services. As a result the Directors of Nursing in Older Persons Services in Dublin South, Kildare and Wicklow identified a requirement for specific documentation to support care planning within day care services for older persons. Subsequently, with the support of the NMPDU and regional Quality, Standards and Governance officer for Older Persons Linda McDermott Scales, models were explored and a draft toolkit was developed (including policy document, care planning tool, audit tool and record keeping guidelines). The toolkit was tested for a three month period in two sites. Audit findings were very positive, a number of interventions, prompted by comprehensive client assessment, averted potentially serious complications for the clients. Staff reported that the new documentation enhanced communication and continuity of care. An amended version of the documentation has been agreed based on findings form phase 1 pilot. The revised document will now be implemented in two additional sites prior to full roll-out. For further information, please contact Raphael Mc Mullin at [email protected]

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or development that has benefited patient/service

user, staff or service?

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Submissions for future issues of DML newsletter are

welcome and should be sent to [email protected]

Staff Changes Margaret Moran, Director of the Centre for Nurse Education in St Vincent’s University Hospital retired in July. The NMPDU would like to formally thank Margaret and acknowledge all the work and commitment she has given to continuing nurse education over the years and wish her the very best on her retirement. Anne Lynott Acting Director of Public Health Nursing in Dublin West has now taken up a Director of Public Health Nursing position in HSE South. We wish her the very best in her future career. Frances McHugh has commenced in the acting Director of Nursing position. Elspeth Finlay has commenced in an acting Director position in the Royal Victoria Eye and Ear Hospital whilst Director of Nursing Marie Tighe will be working on the National Diabetes programme for 6 months. The addiction services for former East Coast Area and former South West Area Health board have now merged and Noreen Geoghegan now has senior nursing management responsibility for all addiction services for Dublin South, Kildare & Wicklow. Angela Tierney has taken up a new position as rehabilitation manager. We wish her the very best in her new position.




P AGE 19 U PCOMING EVENTS DML NEWSLETTER

Dates for your diary

Seminar on Radiation Oncology Nursing St Luke’s Radiation Oncology Centre are hosting a seminar entitled “Advances in Radiation Oncology Nursing” on Saturday, October 5th 2013 from 9.30am – 3.30pm. The seminar will have a variety of nursing speakers from all radiation oncology centres in the HSE presenting on aspects of their work. Additional topics covered will include the vision for radiation oncology nursing in Ireland, Nursing KPI’s, quality assurance, updates in technology, and the establishment of nurse led clinics. To book your place please e-mail [email protected]

NMBI Annual Conference Dublin 9th October 2013

Productive Ward” Releasing time to care”™ Conference: Dublin 15th October 2013

National Mental Health Nursing Conference: Dublin Castle, 5th November 2013

National Home Birth Symposium 25th November 2013 – 9am – 4pm “Home Birth- Back to the Future” Gibson Hotel, The Point Village Dublin National Maternity Hospital Holles Street Dublin Keynote Speaker Jennifer Hollowell PhD, Epidemiologist For further information: Contact Teresa Mc Creery, Community Midwifery Manager, National Maternity Hospital, Holles Street, Dublin 2. [email protected] or 01 6373177

Mental Health Nurse Managers Ireland 14th Annual Conference

Waterford/Wexford Mental Health Services

Mental Health and the Media – Friend or Foe ?

19th September 2013, Ferrycarrig Hotel, Wexford 8.30am – 4.30pm

Conference only - €40.00 Conference & Evening Meal - €70.00

Speakers Mary McEvoy, Harry Kennedy, Paul Connors, John Lonergan, Aonghus McNally, Carl

O’Brien & Guest Chairperson – Anton Savage Pre Conference Evening 18th September

Master Laughs with Comedian John Moynes For booking form please contact [email protected] or 087 7675058

ALL DELEGATES MUST BE REGISTERED AND HAVE PAID RELEVANT FEE PRIOR TO

ATTENDING CONFERENCE

You can advertise your Spring local event here

The next edition of the DML Newsletter &

Midwifery Newsletter will be published at the end of December 2013.

If you would like to advertise your local service led event




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