An evaluation of an educational intervention (physical assessment module), for the non medical work force to provide unscheduled services across the primary and secondary sector in one SHA

The purpose of this research was to establish how an educational intervention (the physical assessment module) enabled practitioners, drawn from the non medical workforce, to meet the modernising agenda of new ways of working, notably, to provide unscheduled care and to contribute to the transformation of chronic care provision in the acute care sector and Community.To gauge the impact of the physical assessment module on the evolution of competencies to fulfil the demands of new roles in practice a responsive evaluation model was used. Data were gathered from face to face interviews, analysis of relevant documents, and direct observation of working practises. Importantly the approach sought to report findings back into the communities from which these data have arisen to verify the findings but also to enrich and update issues in a rapidly changing context. Therefore, feedback via stakeholder conferences was a critical element in the process.Data were analysed using the constant comparative method. Data analysis ran concurrently with data collection and as emergent issues arose they were abstracted and the topics explored in subsequent interviews.Key findings are presented in three tiers: from theory to practice (learning physical assessment skills and techniques and applying these in practice; from policy to practice (tracking the way in which policy was transmitted from the central government through to organisations and how this impacted on the context in which the practitioners were required to use their skills; and finally from policy to users of the service (examining the evaluation of patients and their relatives about the services provided by nurses undertaking advanced physical assessment skills

An evaluation of an educational intervention (physical assessment module), for the non medical workforce to provide unscheduled services across the primary and secondary sector in one SHA. Final report submitted to Skills for Health and Surrey and Sussex Strategic Health Authority (now NHS South East Coast).

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Factors that influence nurses' assessment of patient acuity and response to acute deterioration.

BACKGROUND: nurses play a crucial role in the early recognition and management of the deteriorating patient. They are responsible for the care they provide to their patients, part of which is the monitoring of vital signs (blood pressure, pulse, respiratory rate and temperature), which are fundamental in the surveillance of deterioration. The aim of this study was to discover what factors influence how nurses assess patient acuity and their response to acute deterioration. METHODS: a generic qualitative approach was used. Some 10 nurses working in an acute NHS trust were interviewed using a semi- structured approach, with equal representation from medical and surgical inpatient wards. RESULTS: the main themes identified were collegial relationships, intuition, and interpretation of the MEWS system (Modified Early Warning Score). Collegial relationships with the medical staff had some influence on the nurses' assessment, as they tended to accept the medical peers' assessment as absolute, rather than their own assessment. It was also highlighted that nurses relied on the numerical escalation of the MEWS system to identify the deteriorating patient, instead of their own clinical judgement of the situation. Interestingly, the nurses found no difficulty in escalating the patient's care to medical staff when the patient presented with a high MEWS score. The difficulty arose when the MEWS score was low-the participants found it challenging to authenticate their findings. CONCLUSION: this study has identified several confounding factors that influence the ways in which nurses assess patient acuity and their response to acute deterioration. The information provides a crucial step forward in identifying strategies to develop further training

Recent development of respiratory rate measurement technologies

Respiratory rate (RR) is an important physiological parameter whose abnormity has been regarded as an important indicator of serious illness. In order to make RR monitoring simple to do, reliable and accurate, many different methods have been proposed for such automatic monitoring. According to the theory of respiratory rate extraction, methods are categorized into three modalities: extracting RR from other physiological signals, RR measurement based on respiratory movements, and RR measurement based on airflow. The merits and limitations of each method are highlighted and discussed. In addition, current works are summarized to suggest key directions for the development of future RR monitoring methodologies