Alison Moore reports from a recent nursing conference held by the Adelaide Hospital Society

The nursing profession is faced with the challenge of managing patient care and the need to be at the bedside, with increasing demands in terms of managerial,audit and clinical duties, and all this under the ever-increasing burden of stretched staff resources. This was the backdrop to the Adelaide Hospital Society’s recent conference – Careful Nursing- Sensitive, Competent, Professional Nursing,held at TCD’s School of Nursing and Midwifery last month.

The conference was addressed by leading health service policy-makers,nurses working in a variety of settings and clinicians. The speakers addressed the development of the profession and how best to manage patient care within an increasingly demanding environment.

Dr Siobhan O’Halloran, Chief Nursing Officer at the Department of Health, told delegates that her very appointment –the first at assistant secretary level – was recognition by the government of the importance of nursing and midwifery in the health service.

“Nurses are central to our programme of reform. By virtue alone of their numbers,their adaptive capacity and their close proximity to patients, the nursing and midwifery professions have the potential to effect wide-ranging changes in the healthcare system. We need to look at the role of nursing in driving forward reform and in developing our health services in order to address increased demand for high-quality, safe and effective healthcare services.

At the Careful Nursing conference organised by the Adelaide Hospital Society were (l-r): Dr Therese Meehan, lecturer in nursing at UCD and adjunct professor at the Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, New Zealand; Dr Ambrose McLoughlin, secretary general, Department of Health; Dr Siobhan O’Halloran, chief nursing officer, Department of Health; and Yvonne Seville, retired director of nursing, Adelaide Hospital

“It is the case that we have to deliver and drive these changes while managing major cost reductions but, in so doing, patient safety must be at the core of everything that we do. We also need to continue to build in rewards and leadership opportunities for nurses so that we retain them in the profession and that their work continues to be intellectually challenging and emotionally satisfying,”she said.

Dr O’Halloran said that nurses must lead and as a profession must “cultivate new human capital through inspiration” and that it must be recognised that nurses are knowledge workers in an information age who will not respond to autocracy.

She emphasised that values and not self-interest must drive decision making and that nurses should “think critically, care critically and act critically” at all times.

She said she remained confident that the future of nursing in the Irish health service was safe as long as nurses continued to be “passionate and to care”.

Prof Agnes Higgins, Professor of Mental Health and Head of the School of Nursing and Midwifery at TCD said that nurses were coming under increasing scrutiny for failure to escalate or to lead in situations such as those at the Mid Staffordshire Trust in the UK and more recently in Portlaoise.

She stressed that she did not believe that the current generation of nurses was less compassionate than those before them but rather that the way in which nursing is delivered had changed and she felt this wider context must be acknowledged.

She said that careful nursing involved being attentive, conscientious, methodical, alert, tuned in, protective, sensitive, gentle, thoughtful, and seeing the whole patient and not just the illness.

“Careful nursing is very much about an embodied practice; combining health,heart and hand. Meeting another human and recognising their heads and hearts. We need to use our entire selves as a nurse to treat our patients.

“We must recognise that the way we give care matters,” she added.

Dr Therese Meehan, lecturer in nursing at UCD, said that while the environment for nurses has changed over the past 200 years in terms of education and technologies, the basic underlying principles of nursing – compassion, kindness, calmness, tenderness and respect for human dignity– have remained the same. She said the ‘careful nursing’ model is about combining this sense of humanity and the clinical skills to keep patients safe.

Pictured (l-r) at the careful nursing conference were: Sarah McMickan, director of nursing, Tallaght Hospital; Yvonne Seville, former director of nursing at Tallaght Hospital; and Hilary Daly, deputy director of nursing, Tallaght Hospital

Dr Meehan outlined the background to the careful nursing concept and discussed how it was first implemented in the US and in New Zealand, where pilot studies yielded consistently positive results.

Dr Meehan discussed a careful nursing pilot study in a ward at St Vincent’s Hospital,Dublin, which found it had a beneficial impact on delivery of care. Funding is now being made available to introduce the approach across the wider hospital.

“In the current environment with its focus on cost containment and perhaps an over-emphasis on procedures and processes rather than on patients, we need to remember that nurses are particularly well placed to be the eyes and ears of our health services in best managing patient care. It’s important that we don’t forget that, and that the nursing profession continues to be at the left, right and centre of everything that we do,” she said.

Yvonne Seville, the first Deputy Director of Nursing at Tallaght Hospital, now retired, spoke about how much the profession of nursing had changed from the time it first became a regulated profession in Ireland in 1921.

She recalled the words of the first matron she trained under who informed the new entrants that “a nurse walks smartly and never runs, unless in the case of fire and haemorrhage!”

She recalled being given detailed instructions on dusting, the iron rule of the hospital sisters and the fact that first names were never used, either for the nurse or the patient. This was something she said that should still be borne in mind when addressing a patient as not everyone likes to be addressed casually.

Also pictured were (l-r) : Prof Agnes Higgins, professor of mental health and head of the School of Nursing and Midwifery, TCD; and Dr Catherine Darker, Adelaide assistant professor in health services research, TCD Centre for Health Scienc

When she commenced her training, Ms Seville said that the hierarchy of nurses, from trainee to staff nurse to ward sister to matron was easy for a patient and their family to understand. Now there area host of new grades under new names which might not be grasped by those outside the system.

Ultimately, however, despite the evolution of the nurse’s role into greater autonomy and a wider scope of clinical practice, she said that the relationship of trust between patients and their nurses remained and was a fundamental part of the nursing profession.

Also speaking at the conference, Dr Catherine Darker, Adelaide Assistant Professor in Health Services Research at the TCD Centre for Health Sciences, said that the concept of the caring nurse has to beat the core of the 21st century professional nurse’s toolkit.

“At a time of significant pressures within the health service, and high burnout and low morale for some within the profession,we need to make sure that we are not storing up nursing care problems that will come home to roost,” she said.

She added there is a concern that in a situation with decreasing staff numbers and with additional responsibilities being placed on nurses, that the time spent caring for patients would be diminished,with the potential for patient care to be neglected and warning signs go unseen.

It was for this reason she explained,that the Adelaide Hospital Society chose to host this conference, with a wish to”ensure that patient care continues to be our primary focus. For over 150 years, the Adelaide has been training nurses and we have seen huge changes within the profession during that time. But one thing has remained constant when it comes to best outcomes for patients – what we call the ‘careful nurse’ approach, where nurses have meticulous attention to detail in all aspects, from elementary personal care through to the most complex clinical procedures. We need to ensure that nothing happens with the ongoing development of our health service that would change this in any way. Our patients and their families deserve no less,” she concluded.

INMO president Claire Mahon was in attendance at the conference and reports on it on page 51.

Conference report - Careful nursing:Principle of care in a changing environment