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New ways of nursing at Canberra Hospital to improve patient experience

By Canfan - 21 November 2014 8

The Chief Minister and Minister for Health Katy Gallagher today announced a suite of initiatives to further improve patient experience at Canberra Hospital and make it easier for nurses to continue to offer excellent care.

The new measures include: introducing ‘team nursing’, where nurses share care across a team rather than individual nurses concentrating on a set number of allocated patients; recruiting Assistants in Nursing to free up nurses’ time to use their specialist skills for patient care; changing visiting hours to increase the amount of family support available to patients and bringing in new ways to collect patient feedback.

“We know the overwhelming majority of patients report high satisfaction levels with the care they receive, but it is important that we keep evolving to improve care, make patients’ stays more comfortable and ensure our highly-trained nurses use their skills where they are most valuable,” the Chief Minister said.

“The government has been working since early 2014 on a range of strategies to better support nurses with ways to ensure top quality care in a busy and complex environment can be provided.”

Some of the changes underway or already implemented include:

  • Team nursing which involves nurses working as a team to provide care for all patients on the ward,
    which replaces the model where individual nurses are allocated a set group of patients to care for.
  • Assistants in Nursing added to the teams to supplement delivery of patient care.
  • Visiting hours changes – Shortly, where it is deemed clinically appropriate revised visiting hours of 0600
    to 2100 will be rolled out to align with the opening hours of the hospital. This aims to establish consistent visiting hours across general inpatient wards of the hospital as family and visitors can be an important component of the healing experience for patients whilst at the same time reduce the anxiety and social isolation associated with illness.
  • Implementation of Patient Trackers to enable patients to record and ‘score’ their experience at the actual point of care.
  • The introduction of a tissue viability team, which assesses patients’ skin to identify those at risk of pressure injuries and design plans to minimise the risk of uncomfortable sores or other pressure injuries (there has been an 80% reduction in hospital acquired pressure injuries since 2010).
  • Better/easier to access food packaging.
  • More beds across the Territory.
  • Changes to bed configuration at Canberra Hospital to better match bed numbers with demand.
  • Ongoing development of online consumer portal.

“Assistants in Nursing will help reduce some of the load on nurses by carrying out some basic tasks that don’t require the same high level of training that nurses have. The number of registered and enrolled nurses will remain unchanged, but nurses will have more time for patients to benefit from their professional skills.

“Similarly, team nursing means moving away from the current model where individual nurses care for allocated patients and instead a team of nurses will share care for patients. This means patients won’t have to wait for their dedicated nurse to be available to look after them.”

There has been a continued focus on improving basic care requirement for patients while in hospital. In February 2014, ACT Health conducted an audit of basic care requirements across the hospital which showed that whilst on the whole the care was good, there was potential for improvements. The audits were repeated in September 2014 which indicated care was improving in nearly all areas.

“We also know that sometimes, patients who are feeling particularly troubled or vulnerable often exhibit challenging behaviour. Part of the work that has been underway is to work closely with these patients to further involve families in patient care, where appropriate. We have seen that for some of our more challenging patients, they are more comfortable with their family members assisting them than our staff,” the Chief Minister said.

“This work is work that has been underway for some time and will be ongoing. This is about further improving the patient experience in the hospital. Our feedback figures show that the overwhelming majority of our feedback is positive and complimentary and it is clear that feedback to government is increasingly positive.”

(Katy Gallagher Media Release)

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8 Responses to
New ways of nursing at Canberra Hospital to improve patient experience
Sandman 10:43 pm 24 Nov 14

housebound said :

I’m in two minds about expanding visiting hours. The current hours are impossible for many, and a couple of extra hours in the mornings would be good. But open slather all day would be hard for everyone. They’re not in hospital to party.

There needs to be some restrictions on extended visiting hours. I recently spent 4 days in there after a splenectomy and one of the guys in the ward seemed to have a constant stream of visitors. There was anywhere up to 8 people there for for him at one time. Every time we had to hear him repeat all the same stuff about his motorcycle accident and what the doctors had said etc etc. The poor old 84 year old lady in the next bed who spent a good portion of the night throwing up can’t have gotten a lot of rest during the day when she needed it. His 3 year old son came at least once a day for a good 2 hours at full volume.

I was pretty annoyed when I figured out 3 days in that there was a lounge not 10 metres away from our ward. Not like he wasn’t mobile. The nurse had to call his mobile one night at 1am to find out where he was. He’d gone 8 floors down to a mates ward to watch the footy at about 6:30 and then stayed to watch the following movie as well.

housebound 2:33 pm 24 Nov 14

sepi said :

It actually makes sense to me to have a more menial level of nurse assistants. it seemed crazy to me that in a nursing shortage in hospital we expect nurses to do cleaning and make beds etc. It seems a strange job – one minute resuscitating your baby, next minute making your bed.

On the other hand increasing visitor hours so family can assist with the healing process sounds like a third world system where your family has to look after you in hospital. And also means no peace, as you have to put up with everyone else’s family hanging around all day long.

I’m in two minds about expanding visiting hours. The current hours are impossible for many, and a couple of extra hours in the mornings would be good. But open slather all day would be hard for everyone. They’re not in hospital to party.

switch 8:26 am 24 Nov 14

Nursey said :

We all know what this will mean. More managers, less workers, more stress on nurses, less efficiency.

You’re probably right, unfortunately. But the numbers will be beautiful!

Nursey 7:10 am 24 Nov 14

We all know what this will mean. More managers, less workers, more stress on nurses, less efficiency.

miz 6:56 am 24 Nov 14

Sepi, there is no ‘shortage’, only an unwillingness to pay for registered nurses.

sepi 2:34 pm 23 Nov 14

It actually makes sense to me to have a more menial level of nurse assistants. it seemed crazy to me that in a nursing shortage in hospital we expect nurses to do cleaning and make beds etc. It seems a strange job – one minute resuscitating your baby, next minute making your bed.

On the other hand increasing visitor hours so family can assist with the healing process sounds like a third world system where your family has to look after you in hospital. And also means no peace, as you have to put up with everyone else’s family hanging around all day long.

rommeldog56 2:06 pm 23 Nov 14

Superficially, some of the initiatives outlines by the Chief Minister/Minister for Health superficially seem like action in the right direction. But how many extra beds precisely ? Surely “Team Nursing” will mean less patient/nurse contact time ? Will there be additional funding provided for initiatives such as the “tissue viability team” for example.

Whilst any action that improves what appears to be the terrible current state of public hospitals in the ACT, the actions outlined in the Press Release are already underway or already implemented (ie not “new”). It seems to me to be a political reaction/statement to the current outpouring of complaints.

In the meantime, the b$1 Light Rail progresses to meet the “demands” of our growing population. But it seems, the public hospital system does not !

miz 12:30 pm 23 Nov 14

I am really worried about the proposed ‘solution’ to add another hierarchical level, namely ‘assistants in nursing’. How will this solve the actual (chronic understaffing and under-skilling) problem?

Historically, the tasks that are now supposedly going to be covered by the assistants in nursing used to be part of the registered nurse’s role; more recently those tasks became the responsibility of the enrolled nurses. This has not worked, as can be seen by the situation we are now in. Adding another level is simply ridiculous – it’s throwing good money after bad. I know ‘teams’ are trendy, but unless someone is actually in charge of a patient, the result will inevitably be mediocre with no one taking responsibility for the outcome. Remember uni group assignments, anyone?

IMHO, it is not unreasonable for people admitted to hospital to expect treatment from properly qualified nursing staff, not someone who doesn’t seem to know what they are doing, keeps having to say ‘hold on I’ll get the registered nurse to look at that,’ or ignores or cannot understand what you say. A lot is learned about a patient’s health and wellbeing simply by showering or toileting them. Sure, those tasks are more menial, but they are actually an essential part of the holistic caring process (and all jobs have menial aspects as well as the interesting bits). Registered nurses understand this, but have no time to do their job properly because of chronic understaffing (and they also seem to be the ones who are overwhelmed with administration instead of actually using their specialised skills). While enrolled nurses are cheaper to employ, they have only done a brief TAFE course. The appalling state of care in TCH demonstrates the adage ‘you get what you pay for.’ I know which I would prefer if I was in hospital. I am more than willing to pay twice as much Medicare levy if it resulted in going back to proper hospital care provided by registered nurses.

See below for some examples of where massive improvement is required, based on the horrible experiences of two people close to me who had the misfortune to be in Canberra Hospital recently:

* allocated nursing staff (irrespective of what they are called) need to be specifically taught/instructed on how to have more patient care. That is, not to neglect the small things that a regularly are overlooked through ‘carelessness’. For example, when covers are taken off a patient’s arm so observations can be taken, or the mobile table is moved, put them back where they were so the patient does not get cold and can access their belongings (such as reading glasses, hearing aids, mobile phone, glass of water). Sounds obvious, and such things would never have occurred under previous nursing models – yet it happened time and time again.

* While it is not PC to say so, ongoing language and communication difficulties with overseas staff caused a lot of extra difficulties. People in hospital are sick, in pain and drugged up. If they are older, they may also have hearing aids, walking sticks and chronic medical issues that need managing in addition to the reason for admission. However, even my teenage daughter had difficulty with this issue during her stay.

* Both stays involved a series of unfortunate events which should never have happened, complicating their care and requiring medical rectification. This was not only poor health-wise, but if you extrapolate that this happens to a certain proportion of patients then that has significant cost implications.

* It took days to get a crucial scan, resulting in a significantly longer than necessary stay and more drugs having to be administered to manage things in the meantime.

*A pre-existing health problem flared up during the hospital stay because a doctor had removed a vital medical aid ‘to see what happens.’ This problem was ignored for weeks, causing significant patient suffering, and was not dealt with except by covering the problem with blankets. To add salt, staff continued to wrongly advise that there was no specialist in that field attached to TCH. The patient subsequently required weeks of painful treatment after discharge. The relevant specialist was furious when he was finally informed of what had happened and had to pick up the pieces.

* Nurses often took several minutes to respond when patients pressed nurse attendance bells. Staff were so busy and understaffed that they tended to assume it was simply that a drip had run out. However, when a patient in the same ward stopped breathing, other patients had to loudly call out to get the urgent attention of staff as the bell was ignored.

* Patients without a support person e.g. to advocate on their behalf, notify staff when they were in pain or something had happened, check medications / prevent errors with dosages, timings etc (this happened more than once), and a myriad of other issues, clearly received a far poorer level of care.

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