Southern Derbyshire Acute Hospitals NHS Trust
Name of Contact: Judith Tanner
Phone: 01332 340131 extension 6725
E-mail: judith.tanner@sdah-tr.trent.nhs.uk
Description of Trust
e.g geography, type of trust, nursing WTE etc
The Southern Derbyshire Acute Hospitals NHS Trust incorporates the Derbyshire Royal Infirmary, Derby City General Hospital, Derbyshire Children's Hospital, Derby Chest Clinic and the Grove Hospital.
We have been rated a three-star Acute Trust by the Department of Health for the past three years and provide a wide range of services including general medical, surgical, maternity, rehabilitation care and accident and emergency services. We have a total of 1,235 beds and serve a population of over half a million people throughout Southern Derbyshire.
The Trust employs over 6,500 staff, from doctors and nurses to housekeepers and porters, with an annual budget of around £200million. This year our Trust will see and treat over 600,000 people as inpatients, outpatients, emergency patients and day cases.
Infrastructure to support R&D
Include here any reference to R&D strategy and HEI links / joint appointments, career pathways, IT access, research support networks, evaluation / outcomes etc
Research posts
The Trust employs a Lead for Nursing Research whose salary is funded by charitable trust funds. (The Trust also employs a Lead for Midwifery Research whose salary is funded by the NHS R&D Levy). The Lead for Nursing Research is managerially responsible to the Research and Development Manager and reports to the Director of Nursing. This post holder also sits on the Nurses and Midwives Advisory Council which is the Trust’s monthly strategic meeting for its most senior nurses. By sitting in both Departments, Nursing Research is firmly embedded in both Nursing and the Research and Development Department. The Research Lead is skilled in undertaking research, supervising research and disseminating research studies.
We are currently negotiating the possibility of implementing nursing researcher/practitioner posts. These posts will allow staff to combine working in clinical practice with undertaking practice-based research and will enable us to develop new researchers and form part of a career pathway for staff. These post holders will be supported to undertake research qualifications.
Research strategy
Nursing research is addressed in two complimentary strategies, the Nurses, Midwives and Therapists Research and Practice Development Strategy and the Trust’s Research and Development Strategy.
Nursing has teamed up with Midwifery, Therapy and Practice Development to present a combined Nurses, Midwives and Therapists Research and Practice Development Strategy. The overall purpose of this strategy is to deliver evidence-based patient-centred care.
While the Trust promotes a multi-professional approach within the Trust’s Research and Development Strategy, nursing research is highlighted as requiring specific attention to promote capacity building activities.
Initiatives to support research within the Trust
We run a number of initiatives within the Trust to support nursing research. These include:
Research and Practice Development Support Scheme. This scheme is designed to help nurses, midwives and therapists undertake a piece of research and implement their findings in practice. Nurses who are undertaking the Scheme are given two hours per week for a year to undertake a research project and also allowed to attend four training workshops. The training workshops focus on practical skills such as ‘gaining ethical approval’ ‘writing for publication’, ‘designing PowerPoint presentations’ and ‘how to get research findings into practice’. All the nurses who are undertaking this scheme have two supervisors: a Research Lead and a Practice Development Nurse. The Practice Development Nurses assist the nurses with implementing their findings into practice. At the end of the scheme the nursespresent their research at the Trust’s annual Research and Practice Development Conference.
Nurses, Midwives and Therapists Research and Practice Development Conference. This conference is held annually and presents around 25 speakers. The speakers are nurses, midwives and therapists who have undertaken some research activities in the past year. In a letter to the Director of Nursing, our Professor of Surgery, congratulated the staff who presented at this conference on their enthusiasm and said that their work was equivalent to many of the projects being carried out by Senior House Officers and Specialist Registrars.
Research Interest Group
This is an electronic newsletter, which is compiled by the Lead for Nursing Research and is distributed every 2 weeks to over 100 research-interested nurses, midwives and therapists throughout the Trust. The newsletter provides research-related information such as funding and training opportunities relevant to Trust staff. The first section in the newsletter is headed ‘Congratulations to ...’ and provides information on nurses who have, for example, had an article published, given a conference paper or received funding. (The RCN Research Round-ups are attached to this electronic newsletter.).
Recognition for research achievements
We endeavor to recognise research achievements such as changes in practice resulting from research studies, publications, conference papers and funding awards. Each nurse who achieves one of these successes receives a letter from the Director of Nursing congratulating them on their achievement. This recognition does not cost much but can have quite an impact on the recipients. Some nurses who have received these letters keep them in their personal portfolios and in one of our paediatric wards they are displayed in the Sisters’ Office.
In addition, nurses who are undertaking some research activity are featured in the hospital magazine and the electronic research newsletter.
Research is one of the headings on the nursing staff appraisal form. This shows that research is valued by the Trust and considered to be part of the nurse’s role
Research outcomes
Changed or informed practice is the most important outcome for a research project. By focusing on changes in practice we emphasize the relationship between research and practice development and stress that research is about improving patient care and not merely an academic exercise. Some examples of our research projects are given in the following section.
We also expect all nurses who are undertaking research to disseminate their findings through publications and conference papers and we provide support to enable them to do so. In the past year (2002-2003) we have had over 30 articles accepted for publication.
Being awarded funding is another indicator of our research activity. In the past year (2002-2003) 4 studies were awarded external funding and 1 study was awarded internal funding.
Links
Internal
To provide a co-ordinated approach to research-based practice we have found it important to closely link research and practice development. We hold joint meetings between research staff and practice development staff to ensure that research feeds into practice development and that practice development feeds into research.
Like many other Trusts, staff find it difficult to differentiate between research, audit and service evaluation. We have found it helpful, therefore, to have close links with the Audit Committee and Service Evaluation to pick up projects which have been submitted to the wrong department. To facilitate this the Lead for Nursing Research also sits on the Audit Committee and the Service Evaluation Panel.
External
We have links with our local universities, Primary Care Trusts and Acute Trusts. For example, representatives of both our local universities attend regular Research and Practice Development Steering Group Meetings. We also have regular formal meetings with representatives from the Primary Care Trusts in Southern Derbyshire and are in contact with the Research Leads at the other Acute Trusts in Nottinghamshire and Derbyshire.
Joint appointments
We are currently discussing the possibility of having joint research appointments with one of our local universities.
Examples of clinically based research and development projects / activity that have made a difference to patients experience / outcomes
Include here for example projects, conferences etc.
Ideally all nursing research projects conducted within the Trust focus on improving patient care and meeting local or national needs. The following 5 studies provide examples of projects that have changed, or will change, our clinical practice.
Temperature measurement in paediatrics
Our paediatric wards used to use both tympanic and underarm thermometers to measure children’s temperature. The selection for either device was based on the availability of thermometers and staff preference. After staff noticed that some children found tympanic thermometers painful, a group of nurses joined together to study which method of temperature measurement children preferred. The nurses were assisted in the design of their study by the Research and Development Department and the Trust’s statistician. Contrary to the nurses’ initial impression, the study found children preferred tympanic measurement. Our paediatric wards now routinely use tympanic thermometers unless there are contraindications for doing so. In addition, the nurses who conducted this study presented their findings at the Trust’s Annual Research Conference and have had two papers based on this study published in Paediatric Nursing.
Pre-operative shaving
Within the Trust we have a total of 25 operating theatres spread across 8 theatre departments. The theatre staff in these departments were using different techniques for removing patients’ hair pre-operatively and there was some debate whether all theatres should use surgical clippers to remove hair instead of razors or depilatory cream. To be able to introduce a Trust-wide policy on pre-operative hair removal two theatre nurses teamed up with the Lead for Nursing Research to review this topic. It was decided that a systematic review would provide the best form of evidence upon which to base a Trust policy. External funding was secured from the Theatre Nurses Trust Fund and the research team are currently conducting a systematic review on pre-operative hair removal under the auspices of the Cochrane Collaboration. When the study is completed the Trust will be able to implement a research-based pre-operative shaving policy and the review will be published in the Cochrane Library. The protocol for this review has already been published in the Cochrane Library.
Bladder spasm in patients undergoing trans-urethral surgery
One of our recovery nurses noticed that a number of patients who wake up in recovery following trans-urethral surgery are in extreme discomfort caused by bladder spasm. A literature review on this subject suggested that bladder spasm is not well recognised and is poorly managed. The nurse decided to identify the incidence of bladder spasm among this group of patients and identify any commonalities among patients who have or do not have bladder spasm. This involved retrospective data collection from 200 sets of patients’ notes. Funding was obtained from the Siobhan Rankin Award. Preliminary statistical analysis suggests that bladder spasm is linked to length of surgery, insertion of a catheter and is most effectively treated by Buscopan. The findings will be used to develop a protocol to manage pain relief for patients undergoing trans-urethral surgery. In addition, as per the terms of the funding body, the researcher will be presenting her findings at the National Association of Theatre Nurses Congress 2003 and will publish an article based on the study in the British Journal of Perioperative Nursing.
Surgical hand scrubs prior to surgery
One of our theatre sisters was challenged by a member of staff regarding scrubbing their hands prior to assisting for a surgical procedure. The theatre sister discovered that we do not have a hand scrubbing policy and the literature on this subject recommended various different practices. She therefore decided to undertake a systematic review of hand scrubbing and use this review to develop a Trust policy. She was awarded funding from the Southern Derbyshire Acute Trust Small Grants Funds to undertake this review. This study is being conducted under the auspices of the Cochrane Collaboration and the protocol has already been published in the Cochrane Library.
Patients, visitors and staff preferences for hospital visiting times
In an attempt to make visiting easier for patients and visitors, the Trust has an open visiting policy which means that visitors may visit patients at any time. Informal feedback suggested that some nursing staff and patients would prefer a visiting policy which was more restricted. The Director of Nursing commissioned a study to determine which visiting policy our patients, visitors and nursing staff would prefer. Nine hundred completed questionnaires were received from patients, visitors and nursing staff on our 35 in-patient adult wards. The main finding showed that that neither patients, visitors or nursing staff considered open visiting to be their first preference for a visiting policy. In addition the patients and visitors often held opposing views from nursing staff, for example, both patients and visitors preferred to have a rest period during the day and staff preferred set visiting hours. The Trust is currently deciding how we can reconcile the preferences for each group and implement a visiting policy which best meet the needs of our patients, visitors and staff.
Any internet links
Is your strategy for example available for others to access online?
The nursing research strategy is not currently available online but the lead for Nursing Research will be pleased to discuss any aspect of nursing research at Southern Derbyshire Acute Hospitals NHS Trust.