The family planning service in the trust is provided at 9 clinics perweek across five locations and staffed by 4 part time doctors,2 contracted nurses part time clerical staff and bank nursing staff. This leads to a fragmented service sometimes resulting in inappropriately booked appointments.Current waitng times for 1st appointment are up to 18 weeks. The appointment system is kept manually by different clerical officers and family planning clerical officer has only access to diary for clinic she is working at reslting in delays in arranging further appointments.The service has evolved in a piece meal and ad hoc manner and little consideration has been given to its organisational effectiveness.

Hand hygiene is notoriously poorly adhered to by Health Care Workers (HCWs).This has been the finding in numerous studies world wide.The Infection Control Team in Altnagelvin Trust decided to assess our baseline practice in order to plan educational strategies.

Improving the nutritional status of older patients in hospitals remains a challenge for all health care professionals. In our own Elderly Care Unit we introduced a nutritional screening tool but found that this made little difference to how patients were cared for on the wards and to nursing practice. Nurses were keen to change how care was delivered but were unsure how to make this happen.

This project entails the development of a palliative care practice development programme to be piloted within the Trust area, to promote person-centred practice in the delivery of palliative care. In the Down Lisburn Trust area there are approximately 980 nursing home places, the majority of which are used by older people, most of whom will end their lives there, many requiring palliative care and symptom management. Training needs analyses show that in the private sector, fewer than 17% of nurses have received additional training in palliative care, and that as few as 5% of care assistants in the Eastern Board area have NVQ training. Research has shown the importance of creating an environment supportive to change, and the need to adopt a practice development approach in the provision of training.

The aim of the project is to introduce a period of preceptorship for all newly qualified nurses coming to work in Causeway Hospital. It is essential to the enhancement of practice through reducing role transition problems and provision of support and guidance.

Aim of the study was to ascertain if current nurse education provision equips nurses for the purpose and practice of independent and supplementary nurse prescribing and to identify how they are applying their acquired knowledge and skills to their practice

Within each of the Northern Ireland regional maternity services there is an identified midwife responsible for quality issues. Each of these midwives was working independently from the others. In 2000 as a practice development midwife at the Ulster Hospital I contacted all other maternity units in the region and asked if they would be interested in working together collaboratively. Aim: to try to benchmark our own services and help each other progress women centred care issues. Every unit allocated at least one and in many cases two midwives to meet and share work. We have progressed 6 benchmarks to date and are discussing incorporating guidelines into our remit

While our health generally is improving, there are increasing demands made on the NHS due to population changes, lifestyle choices and a widening gap across socio-economic groups. Government policy aims to not only reduce inequalities but to actively promote health. This project is about integrating a public health approach into nursing practice – public health should be a starting point for all nurses. All nurses have a part to play regardless of whether they work in the acute, community or private sectors. Community nurses are active in Health promotion, nurses working in the acute sector also have a critical role in improving health. The project aim is to test out the proposal to mainstream public health activity across all programmes of care, settings and disciplines in nursing in keeping with the DHSSPS nursing strategy by :  Creating an awareness of the public health agenda  Developing capacity across programmes of care  Ensuring capability in public health activity

The assessment of carers’ need has become central to the Government policy on informal carers. Despite the importance placed upon ‘carers’ needs assessment’, a well-defined framework for assessment does not exist and ‘unmet carer need’ is not routinely reported in practice. This suggests that community health care professionals are not working within a recognised framework for assessment. The aim of this study is to evaluate the community health care professionals’ perspective on the assessment of carers’ needs.

CHSST was invited by the DHSSPSNI in conjunction with NIPEC to take part in the regional Essence of Care Project. As a reault the Trust undertook a six month internal project looking exclusively at the Essence of Care toolkit. The project was supported by a Senior Nurse Management Steering Group and a Project Facilitator to co-ordinate the project within the Trust. Three benchmarks were chosen, Privacy & Dignity, Food and Nutrition and the Safety of Clients with Mental Health Needs. For ease of implementation four teams were established and team leaders appointed who could report back to the Project Facilitator on a monthly basis regarding the benchmarking progress. All teams working on the benchmarks were multi-disciplinary and included service users.

Identified need for group to support parents,carers of twins and triplets.

The project is to find out about the information needs of suicidal individuals and their significant others. We feel that people could have easier access to pertinent information and that this could have a positive impact on the experience of managing suicidal ideas or a suicidal significant other.

Within the specialist Continence Team an area of unmet need was identified. This area centred upon the early identification of stress urinary incontinence (SUI) in postnatal mothers (12 weeks or greater post delivery). This was a 2 tiered primary prevention and health promotin project relating to stress urinary incontinence in post natal mothers. Tier 1. A pelvic floor clinic was commenced for post natal mothers which was to run for 12 sessions. Each pelvic floor session would: -Cater for a maximum of 12 clients -Offer health education on pelvic floor exercises -Facilitate individual pelvic floor assessment -Devise and support individulised treatment programmes using verbal/written/information or biofeedback if appropriate -Offer modified pilates as a technique for increasing awareness of the pelvic floor -Act as a support mechanism for these mothers -Offer health promotion advice for mothers and babies by inviting speakers on alternate sessions to talk about family planning,healthy food/baby food made easy.relaxation techniques etc. Tier 2 -Education sessions will be provided to all The Community Midwives and Health Visitors to intrroduce a risk assessment tool for post natal mothers in relation to stress urinary incontinence and increase the knowledge and skills to support mothers in undertaking effective pelvic floor programmes which will reduce thw risk of the development of strss urinary incontinence in later life.

This pilot is one of eight commissioned throughout Northern Ireland (for one year) by the D.H.S.S.P.S. to test out the thinking as discussed in Community Nursing: Current Practice and Possible Futures. (Q.U.B. and U.U. 2003). “To develop innovative models of service delivery for community health nursing that are consistent with public health principles.” The ‘Colin’ area of Twinbrook, Lagmore and Poleglass is recognised as an area where many families have high levels of health need and it has been recognised by nurses working in the area that this pilot creates the opportunity to work “family centred” offering a flexible service in a variety of settings challenging the traditional boundaries that exist within various community nurse specialisms. The vision “… to build services around families and not families around services.”

Wraparound is a project about partnership. The vision of Wraparound is to make a difference to the lives of disabled children (aged 0-18 years) and their families and develop new ways of multidisciplinary/interagency working across the Southern Health and Social Services Board (SHSSB), Northern Ireland. The culture of Wraparound acknowledges parents’ own expertise about their child and family, seeks to empower parents and young people and partnership is the preferred approach to assessing and meeting the needs of the child and family.

Food is one of the basic needs of each individual, yet it has continued to be a low priority in many areas within the health service. Nutrition in the Health Service continues to be highlighted as an area of concern. the Nation Health Plan (2000)reinforced the importance of ‘getting the basics right’ and of improving the patient’s experience in relation to food. In a study carried out by Picker Institute Europe as part of the National Health Service Inpatient Survey programme, 45% of patient questioned about hospital food rated the food they received in hospitals as either fair or poor. This would indicate that all hospitals, which are involved in the delivery of patients’ meals, should review their practices in order to achieve the best possible quality service for the patients, taking into consideration their needs. As the hospital is situated in North Belfast, an area associated with high deprivation and poor dietary intakes, it is important for the hospital to offer a highly nutritious and well balanced diet to the community, which we serve. With this in mind a multi-disciplinary quality circle group was set up within the Mater Hospital in June 2002, to review our existing food service, and work toward improving the quality of our service.

A project commissioned by the DHSSPS & NIPEC in May 2004 was launched across the Province to test the Essence of Care benchmarks within a Northern Ireland context. Staff working within dementia services in Homefirst Community Trust attended and decided to benchmark Privacy & Dignity, Communication and Food & Nutrition within the two assessment wards and the high dependency ward. A steering group led by a senior nurse was establishment and the project was facilitated by the Practice Development Facilitator. Three comparison groups were established and included members from the multi disciplinary team, hotel support services, a carer, the user initiative and the Alzheimer’s Society.

The National Association of Theatre Nurses(2003)issued recommendations to assist perioperative practitioners performing swab,instrument and needle counts. The principle being that all swabs,instruments and sharps are accounted for at all times during a surgical procedure, to prevent the retention of a foreign body or injury to the patient. The count must be carried out by two members of staff,one of whom must be qualified.

The initiative to develop the first nurse-led community based Benign Prostatic Hyperplasia (BPH) clinic in Northern Ireland was launched as a project on 1 January 2003. During the development of Foyle Continence Advisory Service, the Continence Manager became increasingly aware that, within the Primary Care setting, the needs of men with bladder problems were not being addressed to the same extent as those of women. The traditional pathway for men presenting with symptoms of BPH in the Western Health Board area was through GP referral to the Consultant Urologist. However, waiting times for prostate assessment and general urology consultation were becoming increasingly lengthy. Greater emphasis on Primary Care and shared care strategies also provided the context in which the need for a Community based BPH clinic arose. The project was designed to help GPs manage patients with suspected benign prostatic disease more efficiently in the community.

Recent results of many outcome studies support combined psychosocial and pharmacological strategies in improving function of those suffering a disabling severe mental illness (SMI) including schizophrenia (Wykes et al, l998; Goodwin, l998). Non-compliance of medication is one of the major preventable causes of relapse and morbidity (Kemp et al, l998) and rates of poor compliance from l0% to 80% have been cited in various reviews of patients with psychotic disorders (Kemp et al, 1996, 1998; Eckman et al, 1992). Repeated studies implicate poor compliance as a crucial factor associated with relapse and rehospitalisation, length of readmissions and eventual outcome (Kemp et al, l998). Hence the need for effective Medication Management (MM) strategies.

This project is part of a two year Practice Development Programme run by the Royal College of Nursing, Belfast and University of Ulster, Jordanstown to improve existing practices in both hospital and community services. Reasons for chosing the project were as follows: - There is a lack of information available about the wards and community services; - There is a lack of data available on the illness itself, hence relatives lacking understanding about dementia; - There are no Integrated Care Pathways set up yet in dementia services.

Previously in the hospital there was EQUATE and individual departmental audits i.e. Standards of Care. In 2003 as part of the hospital's forward planning and development, it was agreed that a new audit tool would be created using information from the original tools and some new material. This was then incorporated to form the new audit tool - Evaluating Quality Care (EQC). It sets out targets to achieve best patient care and facilitates individualised audits for all services, provided to patients with a learning disability.

To develop a clinical care pathway for patients with CHD and to ensure a joined up service between hospital and community

This project was carried out following an audit of pressure ulcer management within the Newry and Mourne H&SS Trust community setting. The audit took place in September 2004 and the findings highlighted that 75% of pressure ulceration occurred in patients while in the care of the Community Nursing Service. It also highlighted areas of inconsistency in practice within the basic concepts of assessment and management of pressure ulceration, including documentation and the appropriate use of risk assessment tools.

Prior to January 2004 all patients requiring haemodialysis within the Southern Health& Social Services Board area were referred by the Consultants to Belfast City Hospital Education Unit for education to enable patients’ make an informed choice regarding the choices for their treatment. There was, however, a poor uptake of this service which meant that patients may not have chosen the home peritoneal dialysis, and underwent haemodialysis within the Renal Unit in Daisy Hill Hospital three times per week. If patients did opt for the home service of peritoneal dialysis they had to travel to BCH Renal Unit daily for approximately 1-2 weeks for peritoneal dialysis training. Following this, these patients had to travel to BCH for insertion of their peritoneal dialysis catheters and the subsequent management of any complications. The Renal Service Review (DHSSPS 2002) recommended that all Sub-regional Renal Units develop a peritoneal dialysis service locally. To date, Daisy Hill Hospital, Newry, is the only hospital to complete this recommendation successfully. Due to the successful development of this service, and networking opportunities, other units are putting proposals to their Health and Social Services Boards for funding for a peritoneal dialysis nurse. Rationale The impetus for the initiation of the home haemodialysis service was the failure of growth in the Southern Board peritoneal dialysis population. This has put an obvious constraint on the haemodialysis capacity. The experience in England and Scotland indicated that home based training programmes with a locally based peritoneal dialysis service, would enable growth. With this in mind Newry and Mourne Trust decided to devolve the peritoneal dialysis programme and set up a home peritoneal dialysis program, lead by a dedicated peritoneal dialysis nurse.

Increasing health care costs have raised the demands for improved efficiency and cost effectiveness in hospital bed use and occupancy. Coupled with this, the best available evidence on breast cancer services, (NICE Guidelines 2004) advocates the need to improve information and services available. The literature also supports the view that earlier discharge is facilitated through the provision of appropriate information and education to patients (Leadbeater, 2001; Lauri and Sainio 1998). Dietrick-Gallagher & Hyzinski (1989) found that teaching patients to care for their drains not only resulted in decreased length of stay and potential cost savings, but also allows patients to recuperate at home with their families. Early discharge was not associated with any specific complications and proved popular with patients (Boman et al (1993; Holcombe et al, 1995). Earlier discharge for patients undergoing mastectomy has been accepted normal practice in America. Average hospital stay can be shortened by 5 days per patient if patients were discharged with drains, and a service developed to deal with seroma complications following discharge for patients who require treatment. With this in mind, a nurse led service was developed in the Female Surgical/Gynaecological Ward of Daisy Hill Hospital Newry, to support earlier discharge of mastectomy patients with a drain insitu. This project has ‘broke new ground’ in that it has allowed the first nurses within Northern Ireland to be trained to undertake seroma drainage. Prior to this project, the length of stay for patients who had breast surgery was approximately 7-10 days. In the event of post-operative complications, such as seroma formation (a collection of fluid), patients’ would have to contact their GP or district nurse, who would refer them either to the Outpatient clinic or to Accident and Emergency Department to have the seroma drained by a doctor, often encountering a long wait to be seen. The project has thus reduced the average length of stay for patients following mastectomy, reduced anxiety levels and time delays for patients who develop complications, and promotes continuity of care.

In 2000-2001 an Outreach Worker, employed by the Southern Education and Library Board (SELB), was delivering programmes to the youth in four housing estates in the Newry area. The material covered a range of issues including drug and alcohol abuse, crime and risk taking behaviour, which included sexual health. An excellent working relationship was developed with community volunteers and the young people in the estates. The young people expressed concerns to the Outreach Worker and the Community Workers that, within the area of sexual health, there was inadequate provision of information and advice to meet their needs. In autumn of 2001, in direct response to the needs identified, a partnership was formed between the Southern Area Health Promotion Department (SAHPD) and SELB in conjunction with the Magnet Young Adult Centre, Newry and Mourne Health and Social Services Trust and local Community Groups. The main aim of this partnership was to develop a project, which could explore approaches to tackling these issues and take appropriate and relevant action.

The haemodialysis unit had grown from a 6 to a 24 station unit. With this expansion communication difficulties had arisen and practice was not standardised. It was difficult to implement change in practice within the Unit, to evaluate and audit adherence to protocols and to ensure that staff were being trained in a consistent way.

Overall aim: The aim of this study was to ascertain if the raised awareness of the potential for parastomal hernia development, the introduction and teaching of abdominal exercises and the use of support belts from 3 months until 1 year post surgery minimised the development of a parastomal hernia. Parastomal hernia is a common and distressing problem for approximately 10-50% of patients with stomas. Little research into its prevention has been undertaken. Clinician observation and reflective practice of two Stoma Care Nurses in two centres in Northern Ireland revealed an observed finding that those patients with stomas who regularly exercised and possessed strong abdominal muscles were less likely to develop a parastomal hernia. Armed with this knowledge it was decided to investigate the incidence before and after a programme emphasising and teaching the importance of strong abdominal muscles.

A small research study was conducted as part of a Quality and Research Initative within Specialist Practice in conjunction with a role development programme associated with the Macmillan National Institute of Education at Glasgow University. The rationale behind initiating this project was to identify what the learning needs of palliative care nurses were within a Trust area and how their effectiveness impacted upon service delivery. (It is worth noting that although a palliative link nurse system had already been established six months prior to the study no evidence-based research had been conducted into these learning needs and there was no systematic approach to this style of learning.)

Little research is available in relation to stoma care to support practice that is evidence based. Concerns from nurse specialists within the Northern Ireland Stoma Care Forum led to a collaborative approach to the development of protocols. The aim was to address complex nursing issues and provide guidance for nurses in managing clinical problems relating to stoma care.

This project came about as result of clients needs. Mr Alan George spoke to a number of service users and health care professionals. After a lot of research the evidence available examining the social/psychological needs of clients was paramount. When asked clients felt they would like to have a meeting place where they could go to talk with other people suffering like them and get support.

Approximately 20 – 25% of patients who undergo treatment for breast cancer will develop lymphoedema at some stage following treatment. This is a chronic incurable condition, characterised by protein rich swelling within the tissues. Tissue infections requiring hospitalisation are not uncommon. In rare occasions a lymphaemgioscarcoma can develop. The condition can be debilitating and lead to social withdrawal, financial hardship if employment is affected, body image issues. Although the condition may occur there are some measures which may reduce the likelihood of it developing. Patients are advised prior to axillary surgery of the possibility of the condition occurring, preventative measures and what to do should they notice any swelling.

Ladies who attended Breast Clinic often went back to GP for results of findings at clinic but GP had not received communication yet. Very often they had a diagnosis of malignancy – GP not aware, it was difficult to support ladies. Opinion was sought from Macmillan GP Facilitator and members of Breast Team and idea of compiling a letter was put forward and agreed.

Ladies who were returning for results of investigations were being seen in the middle of a very busy Assessment Clinic. Neither group was being given due care and attention. Time spent was rushed and quality care was compromised. Discussion took place with patients, staff and Finance and the subject of a separate clinic was discussed at length. The facility was not difficult because accommodation was available at Breast Clinic.

The Integrated Care Pathway was first established in Liverpool by the Marie Curie Centre and the Royal Liverpool and Broadgreen University Hospitals in the early 1990's. The aim of this Integrated Care Pathway is to provide an evidence-based framework across the organisation for the care of the dying patient and their families. The documentation is multidisciplinary and can be used in all care settings. It provides a method of co-ordinating and standardising care for all patients in the dying phase of their illness. It can be used for patients with advanced malignant and non-malignant conditions.

The aim of the programme is to help patients recover from their cardiac condition by assisting in the maintenance of physical and psychosocial health; as well as by encouraging behaviour and lifestyle changes. Cardiac Rehabilitation has been shown to improve prognosis and function in patients with Coronary Heart Disease. Prior to the project, the cardiac rehabilitation programme was limited to one session per week based in the hospital. By extending the sessions into the local leisure centres it was hoped that access to the programme would be improved and the aim of encouraging lifestyle changes would be better realised.

This project emerged from an Essence of Care Project where it was recognised that the patient gowns were inappropriate. This was also recognised from results of questionnaires that were issued at Breast Clinic. Anecdotal evidence from use of gowns on regular basis demonstrated this fact further. The Breast Clinic is an anxious time for those attending and to have to experience embarrassment compounds this. It can also be very intimate and sometimes an invasion of privacy.

During the last 15-20 years there has been a plethora of reports, studies and evidence identifying very clearly that people with a learning disability have poorer physical and mental health than the rest of the population, and also access mainstream primary care services (GP) less than the general population. With all of the evidence having been around for a number of years now, the starting point, and initial question asked by the Project Team was, ”Why is it that very little has changed or improved?” An audit of Learning Disability in Northern Ireland (McConkey et al 2004) suggests that a limitation of some of the health screening research in Northern Ireland is that although it reports on the number of unmet needs identified, and referrals made to other services, there is no clear indication of the action that these other services subsequently take, and the outcomes achieved for the person with a disability. Therefore, this project centred around “Actioning Health” rather than simply screening, and it was decided to develop and test out the concepts of Health Facilitation and Health Action Planning as endorsed by Valuing People (DoH 2001) within one of the Trust’s statutory residential units for adults with a learning disability.

Nursing staff within the learning disability hospital voiced their dissatisfaction with the care given to patients while they were receiving treatment in the acute hospital. In late 2003, an audit was carried out by the Northern health and SS Board as part of a monitoring programme, to look at the care given to people with a learning disability and people with mental health problems while they were in the acute hospital. It was felt that a joint working party, involving staff from both the acute sector and Muckamore, would be a useful mechanism to address issues of communication and care and drive any changes required.

Foyle Health and Social Services Trust provide a Social Work service in Altnagelvin Health and Social Services Trust. Social Work staff in the hospital regularly receive requests for information, advice and assistance in relation to a plethora of increasingly complex social security benefits. Social work staff have responded to emerging need with a number of initiatives. Links were established over a number of years since 1995 with two community based Welfare Rights groups, Hillcrest House and Galliagh Integrated Advice Service. The development of a specialist welfare rights hospital based service has resulted in significant outcomes in terms of social security benefits and grants obtained at a micro level (patient) in the context of poverty and social exclusion at a macro (institution) level. Literature suggests that appropriate benefit levels assist with safe and effective discharge from hospital and may assist in unnecessary readmission to hospital. The Noble Report (2001), Measures of Deprivation in Northern Ireland, www.nisra.gov.uk/whatsnew/dep/index.html has addressed domains of deprivation which are unique within the Foyle Health and Social Services Trust catchment area. The correlation between poverty and ill health is well established. Hillyard et al (2003) published the results of a large scale study of poverty and social exclusion: Bare Necessities – Poverty and Social Exclusion in Northern Ireland. It is estimated that 156,000 children and 350,000 adults are living in poverty in Northern Ireland. The physical manifestation of an illness and its psychological impact may inevitably lead to a reduction in quality of life for individual patients and contribute to social exclusion. The rationale for the development of the service was therefore primarily to meet emerging need from a variety of patients through a service that is responsive, creative and which promotes patient involvement in reducing inequalities. In the context of human rights and equality legislation, patients and carers ought to have access to appropriately trained welfare rights staff in order to claim relevant social security benefits.

The Erne Hospital Mobile Coronary Care Unit is a 24/7 service serving a population of 58,000 people across counties Fermanagh and South Tyrone, and has been in operation since 1983. The introduction of the EWTD for Junior Doctors' Hours, threatened to deprive the local population of this pre-hospital service from 5.00pm weekdays, all weekends and public holidays. The implications of this meant that the local population could be denied essential thrombolyis therapy in the event of a myocardial infarction, within the timescale recommended in the National Service Framework guidelines. The cardiac unit team agreed to maintain the current level of service by developing a nurse-led mobile coronary care service. The nurse-led service would be desiged to cover the following times; - 5.00pm - 9.00am Monday- Friday - 24 hours all weekends and public holidays

To highlight awareness of the specific problem areas that the older person encounters upon a diagnosis of Established Renal Failure. This educational need arose from students who were completing a short course in renal nursing and who recognised the dramatic increase of elderly patients within this specialised arena. This reflects the current demographic trend within renal nursing throughout the United Kingdom.

“Breathlessness” is a problem commonly encountered in the palliative care of many people with advanced cancer as well as other non-malignant conditions such as Heart Failure and Chronic Obstructive Pulmonary Disease. There was concern that some of our patients especially in the acute sector continue to die with distressing breathlessness. Because of this, a decision was taken to audit current practice, implement process of change so that patients will receive appropriate and effective care across primary and secondary care interface.

Government legislation and professional guidelines containing directives to modernise and improve services to reduce waiting lists. Numerous cited benefits of nurse led care. Extensive knowledge and skills among dermatology nurses.

To explore district nurses' experience of providing palliative care for patients with cancer & their families. There is an increasing demand for palliative care in the community, as many patients wish to die at home. District nurses are central to providing palliative care in the community, but there is a dearth of literature on district nurses' experience in palliative care.

It is estimated that one in six people In Northern Ireland suffer from a diagnosed condition such as depression at any point in time. Primary care settings are considered to be the best location for the delivery of care, mainly because they are less stigmatising than specialist mental health services and more accessible to patients. However, depressive symptoms are undetected in about 50% of patients attending general practice. Mental health nurses can provide the dedicated time to assess, follow up and support patients with depression and have been described as the ‘linch- pin’ for managing depression at practice level. However there are a dearth of benchmarks available to guide, support and develop their practice.

This study was carried out because although loneliness is often discussed by people facing end-of-life situations, there is very little research on the topic.

Challenging behaviour in dementia impacts negatively on the quality of life of the person. It often precipitates a move into hospital or to another care facility and may result in the person being labelled ‘difficult’ (Innes, 1998). A move is disruptive to the individual and also shifts the ‘problem’ without addressing the reasons for its occurrence. This means care home staff have missed a valuable opportunity to learn about why the behaviours were happening. The quality of care provided for people with dementia in nursing homes is the subject of serious concern (DoH, 1999; Ballard et al, 2001). In surveying 17 homes in the north of England, all were rated as ‘requiring major improvement’ or requiring radical improvement.

The Developing Practice Network (DPN) formed in 2002 is a national network for healthcare practitioners, that exists to promote, support and enable the development of practice in health care settings. It provides formal and informal opportunities for practitioners to share knowledge and learning about a wide range of practice development and change activities. This project was an innovative and practical response to a number of members from England, Wales and Northern Ireland questioning the possibility of accessing clinical supervision through the DPN. Clinical supervision might be described as a formal method of supporting practitioners and enhancing clinical practice through a process of action orientated reflection on practice whether as a group, or individually, but more often than not as a ‘face to face’ activity. The latter did not appear feasible due to the geographical distance and it was therefore agreed to explore an alternative method for group clinical supervision.

Challenging behaviour in dementia impacts negatively on the quality of life of the person. It often precipitates a move into hospital or to another care facility and may result in the person being labelled ‘difficult’ (Innes, 1998). A move is disruptive to the individual and also shifts the ‘problem’ without addressing the reasons for its occurrence. This means care home staff have missed a valuable opportunity to learn about why the behaviours were happening. The quality of care provided for people with dementia in nursing homes is the subject of serious concern (DoH, 1999; Ballard et al, 2001). In surveying 17 homes in the north of England, all were rated as requiring major improvement’ or ‘requiring radical improvement.

We embarked on the poject because people who were diagnosed with Alzheimer’s disease and commenced on treatment, then referred to the Specialist Dementia team, were placed on awaiting list for a keyworker. In April 2005, the maximum waiting time for allocation of a keyworker was nine months. Generally those people who were receiving anti-Alzheimer’s drugs waited the longest, as patient’s with more urgent social needs were often prioritised. Currently patient’s who are prescribed anti-Alzheimer’s medication are reviewed by the Consultant. At these appointments monitoring and titration of drug therapy is undertaken. Generally Consultant appointments are short, and it can be difficult for both patients and carers to take in the information given, therefore opportunities for the Specialist Dementia Team to provide timely and appropriate information to this group of patient’s and carers was being lost. The team recognised the significance of this given the identified need by patients and carers for information, at the time of diagnosis. The premises used for Dementia Services, was unsuitable, for people with memory difficulties and their carers. There were not sufficient consulting rooms, meaning a carer could not speak to the Consultant privately without worrying about their relative. Access was difficult, there was insufficient parking close to the premises, and on-site facilities do not lend themselves to patient comfort. In addition the team were aware that research in America, evaluating nurse prescribing showed that, o Quality of care and patient satisfaction can increase when nurses prescribe o The nature of the therapeutic alliance between nurse and service user can improve adherence with medication plans o The quality of user education can be better when nurses prescribe. The team has a qualified Independent and Supplementary Prescriber (ISP), whose skills were not being used. With these in mind the team embarked on a Service Improvement Project, Keep In Mind (K.I.M), to establish a nurse-led review clinic for people prescribed anti-Alzheimer’s treatment.

To explore the research culture among nurses in Foyle H& SS Trust To determine the capacity for research among nursing staff To identify the training needs of nursing staff in the Trust

A review of a critical incident showed that we as Trust needed to review the way that we gave nursing handovers. I was asked to chair this group.

During the last decade there has been an increasing awareness of the prevalence and serious impact of domestic violence on adult victims and their children. Recent research has dispelled the myth that domestic violence was less likely to occur during pregnancy and has in fact highlighted that pregnancy can itself be a high risk factor for domestic violence. A survey of 127 women living in refuges in N.Ireland found that 60% of them had reported violence during pregnancy (Casey 1989). Studies in the U.S.A. have shown that 37% of obstetric patients were at risk of abuse and 48% of abused women were assaulted during pregnancy. Two Confidential Enquiry into Maternal Deaths reports, “Why Mothers Die 1994-1996 and 1997-1999” also endorse this ethos. These reports made key recommendations for professionals providing services to pregnant women. Following the 1994 -1996 Enquiry report Newry & Mourne Trust developed inter-agency guidelines for the identification of vulnerable women who are pregnant and the provision of support for them and their families. These guidelines relate to the identification of women during the antenatal stages of pregnancy and therefore encompass the care of the pregnant woman, the unborn child and any other children within the family. This audit was conducted to assess practice against the above interagency guidelines using funding provided by the Regional Multiprofessional Audit Group (RMAG).

The objectives of the Best Practice Initiative were to improve overall compliance with clinical practice standards, promote best practice and facilitate change implementation within the Emergency Department.

Although the evidence reflects that pain assessment and management are judged to be a priority, little research has examined the care older people (65 years or over) receive in the acute surgical setting. With the number of older patients requiring surgery increasing, it is important to address pain management issues that are particular to this group of individuals. However, it is evident, from both practice and research, that the creation and dissemination of guidelines, along with extensive education programmes has not resulted in healthcare professionals integrating evidence into daily practice. Thus we must address the wider complex of influences on pain and pain assessment in terms of culture and context if we are to improve pain management practices.

To facilitate earlier hospital discharge and enable older people to make informed long term care decisions in community settings. The project also offers older people the opportunity to maximise their independence through individual rehabilitation programmes.

Delivering the Future 1999 recommended obstetric drills were undertaken in every maternity setting. Black and Brocklehurst (2003) noted that research to assess effectiveness was required; confidential enquiries noted problems with teamwork. This formed the background for my PhD studies.

Despite over 10 years of work in this area, and a wide range of publications, there is evidence to suggest that clinical supervision systems are often ineffective, undervalued and may make little difference in terms of developing the quality and safety of care. Given recent public inquiries that have recognised poor supervision systems as a possible contributing factor, the DHSSPS asked NIPEC to review clinical supervision across the HPSS in Northern Ireland.

Prostate cancer is currently the most commonly diagnosed male cancer in the UK with 31,923 men diagnosed each year. A worrying aspect of this disease is that the incidence is showing a clear upward trend. Despite this fact, prostate cancer services have been given a low priority in health care. In 2006, the Governement were urged to improve prostate cancer services across the NHS. This project aimed to address two major issues in relation to prostate cancer. Firstly, PSA is a blood test that may be used in the diagnosis of prostate cancer. However, screening for prostate cancer using the PSA test is not national policy. An informed choice programme is advocated by NHS Cancer Screening Programmes. Despite this, it was felt that many men had PSA test conducted in practice, without making an informed choice. This project aimed to address this deficit in care and influence relevant health care professionals knowledge, attitudes and practice regarding this. Secondly, it is well-documented that patients diagnosed with cancer require adequate information regarding their disease and treatment to help them cope in a more positive manner. This is of particular significance in relation to prostate cancer, as there is often little consensus of the best treatment option for patients. Patients are often presented with various options and they must make an informed choice rgarding their treatment. Therefore, they need adequate information so they can participate in shared decision making and make such a choice. This project aimed to develop a Prostate cancer Information and Counselling Centre, that could be attended by men or significant others at any point on their prostate cancer journey so that they could receive individualised inforamtion regarding their care

The Development Framework project, was established in 2003, with an aim to lead, in partnership with relevant stakeholders, the design of a Framework within which registrants in Northern Ireland could best develop in ways that are safe for the public, responsive to need, ethically sound and professionally stimulating. It sought to support and build on the requirements set out in the NMC Code of Professional Conduct Standards for Conduct, Performance and Ethics (2004), and a set of five guiding principles underpinned its design - Accountability, Person-Centeredness, Continuous Learning, Leadership and Integrity.

Within health visiting practice parents were increasingly seeking help and support in managing their childrens' behaviour. Smacking is not an acceptable means of discipline and parents were searching for ideas for alternative strategies to discipline their children. We believe that the rising need may be associated with societal changes also with increasing isolation from extended family, rising divorce and separation and exposure of domestic violence. In addition affluence contributes to behaviour problems as parents want to give their children material goods that they couldn't have in their youth. Only recently Mr Cameron asked that parents "have the courage to say 'no' to their children".- A telling statement that would certainly have seemed alien 40 years ago. Frequently our work with families involves offering parents strategies to take back that control. When children know their boundaries they are more secure and content. This need was coupled with growing waiting lists at the local Child and Family Clinic. There was special interest in this area among a number of health visitors who sought additional training to enhance their work in behaviour therapy and family therapy. This interest was matched by that of the child psychiatrist,Dr Noel Mc Cune, and clinical nurse specialist in the child and adolescent team, Moira Davren, and with their support a number of health visitors set up a behaviour support service in the form of local clinics within the Trust from 1995.

Intravenous (IV) therapy is a common and essential invasive procedure (Kiernan, 2003). Such breaches in skin can act as a portal for micro-organisms resulting in infection (Gould, 2004). At least 90% of all hospitalised patients require some IV therapy (Hanchett, 2004) and in recent years there has been an increasing nursing contribution to IV therapy and care. Cannulation, venepuncture and IV administration are now seen as subsumed into the core skills of registered nurses (Masterson and Humphries, 2000) and the Nursing and Midwifery Council Code of Professional Conduct (2004) identifies that nurses have a responsibility to deliver evidence based care. Therefore through this initiative safe and appropriate IV therapy could be addressed.

The 2004 Value for Money Audit for Distric Nursing within Newry & Mourne highlighted that 61% of District Nursing caseloads was continence related. There have been no prevalence studies in Northern Ireland of people with continence problems, however studies in the UK would suggest 40 adults per 1000 are regularly incontinent. Good Practice in Continence Services (DOH, 2002) reported that the review of continence services recognised geographical variations in the range and quantities of treatment provided and the time spent waiting. This geographical variation was also noted in the numbers of staff trained and the quality of the education and training given. The aim therefore was to review the services within Newry & Mourne Trust in order to provide a high quality continence service for people with bladder and bowel problems.

The Essence of Care document was used to guide the process for the Safety of patients and clients in the mental health setting benchmark. The comparison group held their first meeting on 5th November 2004. The group was multi-professional from the beginning including clerical staff, domestic services, medical, nursing, occupational therapy, psychology and also included a former patient. Each department and each discipline within the Directorate were invited to send a respresentative to the first meeting. The invitation emphasized the importance and necessity of Essence of Care. The first meeting was well attended with everyone represented except for medical staff however they were represented at subsquent meetings. Having identified areas of practice that could be improved and possible barrriers to improving care, our challenge was to devise an action plan that would put into effect the improvements identified as needed. It was then that our commitment to achieving best practice would be tested. We were under no illusion that change within such a large and complex organisation would create many difficulties. However, all the ingredients for successful change were present within the group including a shared understanding of what needed to be done, commitment to the project and to providing the best possible care to our users.

Project Aim - To ascertain best practice in relation to the assessment, service delivery and evaluation of the health needs of looked after children. Terms of reference To visit sites within the UK where there are established models for the provision of health care to looked after children. To ascertain the roles and responsibilities of the designated Doctor and designated Nurse for looked after children. To ascertain the multidisciplinary co-ordination of the health care needs process. To ascertain the involvement/empowerment of the looked after children, their family and carers in the process. To explore how health care plans are incorporated in the overall Social Services care plan and education plan. To review documentation used in the health care plan. To review how the health care plan is communicated and contributed to by other agencies. To ascertain the audit process in relation to the effectiveness of the health care plan. To understand the relevant legislative and procedural guidance in relation to looked after children. To ascertain the future objectives and plans for the multidisciplinary team with responsibility for the health needs of the looked after children. Many children and young people, for numerous and varied reasons, are unable to remain in the care of their families. These children are known as "Looked After Children" (LAC) and either voluntarily, or as a result of a legal order are in the care of local Health and Social Service authorities. The Department of Health (2002) states that these children are amongst the most socially excluded groups in society. They have profoundly increased health needs, which often remain unmet resulting in poor health, educational and social outcomes. Across the UK specific health services for this vulnerable group are funded and delivered in a variety of diverse ways. A successful application to the Florence Nightingale Foundation Travel Scholarship provided the opportunity to visit sites within Scotland, England and Wales to gain direct experience and knowledge of innovations in multidisciplinary practice with a strong nurse-led component. Rich, copious information was gained and recommendations for local implementation were suggested.

The Fermanagh Active Living Project (FALP) is a secondary prevention programme funded by the Big Lottery aimed at preventing Coronary Heart Disease through physical activity in medically vulnerable clients. There are multiple risk factors for Coronary Heart Disease development both medical & lifestyle . Medical risk factors include diabetes, hypertension and obesity. The second major risk factor for Coronary Heart Disease is Physical Inactivity, which also impacts on at least 3 out of the other 4 main factors. By working in partnership the FALP aims to reduce the risk of heart disease by referring medically 'at risk' clients from their GP to a individually tailored, supervised Physical Activity programme in their local Leisure Centre. The clients initially received 6 month free activity & 6 months ½ price activity in order to maintain behavioural change. Uptake, Compliance, medical data , fitness data and individual diaries are collated throughout. The Project has rolled out shorter versions of the project in other District Council areas & where short listed for the last 2 year for the Northern Ireland Health Care Awards.

In 2005 the recorded infection rates of MRSA had risen within our ward to an unacceptable level. It was clear that in order to reduce infection, a collaborative approach would need to be used to first study the possible causes of infection and then improve practice to prevent infection.

The project began in January 2006 to implement standards for practice following the DHSSPSNI launch of the document 'Tackling Violence at Home' in October 2005. The project was led by a child protection nurse specialist and invloved nurse managers, health visitors, midwives and colleagues from the Women's Aid Federation and refuge staff. A policy for domestic violence was developed with 7 accompanying standards for routine enquiry. A best practice guide and flow chart were also developed to assist midwifery and health visiting staff in their practice when asking women about domestic abuse. A subgroup of the steering group then developed a training programme and timetable for implementation into practice by June 2006. A total of 75 midwifery and 48 health visiting staff plus two physiotherapy colleagues who work with women after child birth, were trained in the policy and process of routine enquiry . The training sessions were co facilitated with Woman's Aid refuge staff and also there was input from PSNI domestic violence officer and social services. These training sessions prepared professions to undertake a risk assessment of domestic violence and develop skills to manage a client's disclosure of domestic abuse. Down and Lisburn HSST began to consider routine enquiry of pregnant women to promote disclosure of incidences of domestic violence following the publication and launch of the DHSSPSNI paper 'Tackling Violence at Home' in October 2005. It was decided that the disciplines of midwifery and health visiting would be involved initially as these two nursing professional groups come in contact with women during pregnancy and in the post natal period. Involving both disciplines also ensured that all service sites in both urban and rural areas of the Trust would be covered by the policy. Support and services were also sought from Women's Aid during the planning, introduction and training stages demonstrating a commitment to interagency collaboration in both policy development and service provision.

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It was recognised that there were no policies or guidelines regarding children visiting our intensive care unit (ICU) and staff were unsure how to deal with a request for children visiting. A focus group was formed comprised of a ward manager, staff nurses and an auxiliary nurse. A questionnaire was devised and given to all staff (nurses, auxiliaries, doctors) regarding this issue and the results analysed. 77% of staff felt children SHOULD be allowed to visit in ICU but it should be facilitated, children should be well prepared beforehand. The focus group set about the task of how best to approach this. In the first instance it was decided a policy would be too rigid and difficult to define however guidelines for staff and relatives were certainly needed and this was the way forward.

The aim of the initiative was to set up a process for developing and implementing Trust wide nurse led discharge (NDL) for patients with simple non-complex discharge requirements. Simple discharges are reported to be 80% of overall discharges (DoH,2004). The objectives of the study were to ensure that patients and their carers were involved in their discharge; to ensure that where possible patients were discharged earlier in the day; to promote seven day a week discharge; to ensure that all band 5( with 18 months experience) and above staff nurses were competent in nurse led discharge and to ensure a standardised approach and documentation was used across the Trust.The Department of Health and Social Services (DHSSPS) has identified timely discharge as a key priority for improvement for all Northern Ireland Hospitals. An analysis of admission / discharge trends by days of the week and times of day revealed variation in discharges by day of the week, few week end discharges and late in the day discharges. Some patients were discharged into the evening. This pattern of activity impacted on patient waiting time in the Accident and Emergency Department (A&E). The backlog of patients waiting in A&E was most evident on Monday mornings and from 4pm onwards each day. On occasions A & E reported diminished floor space for treating patients. Direction was taken from recent government report “Achieving Simple Timely Discharge from Hospital “(DoH,2004) and DHSSPS compulsory actions on discharge that include discharging patients by 2pm, setting an expected date of discharge (EDD) for all patients and putting in place facilities for seven day a week discharge. Nurse led discharge has been acknowledged as an evidenced based method of enabling the achievement of these targets.

The idea began when working on renewing the careplans within the Renal Unit. On discussion it was felt that especially within chronic illness goals are only achieved if working in parnership with patients. In order to see life more from a patient centred approach we needed them to tell us about life from their perspective. We also wanted them to become an active participant in establishing care which met their needs. Assessment schedules are normally filled in by the nurse, to answer the questions the nurse requires. To challenge this, the assessment took the form of a circle in the middle of the page, with the patients name in it. (Patient Centred!!). From this circle came four guiding spokes (of the wheel). Guidance notes on the top of the page were used to prompt the individual to answer 4 questions. They were advised that they could add extra spokes if necessary and even get family members to contribute if they wanted. The 4 guiding questions were: What is important to you? What do you value in life? What areas do you need our help or assistance with? What concerns do you have regarding kidney failure and the treatment?

In the years 2004 to 2006 a research group consisting of nurses from the Nursing Midwifery Planning and Development Unit (HSE Midlands) and researchers from the University of Ulster (Professor Brendan Mc Cormack and Jan Dewing) carried out a collaborative practice development project exploring the processes involved in establishing person-centred care, outcome measurement and evaluation processes in care of the older person. The project was based in two older person settings in the Republic of Ireland ( Birr, County Offaly and Mullingar, County Westmeath). Findings from this work were positive and recommendations informed the research design of this national Practice Development Programme.

This bereavement support midwife post is the first of its kind in Northern Ireland, established in December 2003. The post provides support and counselling to parents who have lost a child through miscarraige, stillbirth, neonatal death or the death of an older child.

Telehealth is a home monitoring system used to record clinical observations and carry out question and answer sessions. Telehealth medicine may offer an alternative strategy to management of patients with COPD over the traditional hospital based model of health care delivery. Telehealth medicine is currently high on the health agenda and has been allocated substantial funds to promote its use.

Response to child protection case management review that recommended improvements are made in relation to the assessment of attachment between children and their primary carers - particularly where neglect is an issue. A number of health visitors had expressed the view that their role within families, including those where there are child protection concerns needed to maintain a preventative focus. To promote infant mental health through development of strong attachment to primary care giver and to secure the long term individual, family and community benefits of this. This is in keeping with Bamford Review recommendations.

Work began on the Respiratory Health and Wellbeing Service Framework (RHWSF) in the spring of 2007. During this time it became clear that the emerging standards would impact the practice and roles of the nursing and midwifery workforce involved with caring for patients and clients with respiratory health and care needs. Assessing nurses’ current skills and competencies against those required to deliver the standards would facilitate appropriate learning and development plans. In June 2007, the Chair of the Northern Ireland Regional Respiratory Forum (NIRRF) asked the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) to facilitate a regional project to produce a learning and development strategy for respiratory care (nursing) to support the implementation of the RHWSF standards.