A New Frontier

Graham, Frederick

doi:10.1097/nna.0000000000000268

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…Examples of good practice were clearly reported along with, seemingly, inadequate practices. Some of this variation may have reflected pockets of excellence that had resulted from extensive work previously undertaken across the hospital to improve quality of nursing care for cognitively impaired patients ( Graham, 2015 ;Travers et al, 2018 ). In particular, AINs described excellent assistance and handovers on wards that had previously participated in research investigating the use of cognition champions to develop action plans around improving handovers in specialling.…”

Section: Discussionmentioning

confidence: 99%

“…The research site was a major tertiary metropolitan hospital on record for attempting hospital-wide improvements around quality of care for cognitively impaired patients including the introduction of specialised education programmes, specific assessment tools for pain and behaviour in cognitive impairment, recreational resources, clinical champions, employment of a Clinical Nurse Consultant in dementia, and implementation of a shared-care unit for cognitive impairment ( Graham, 2015 ). Like many hospitals, AIN roles in this hospital were employed to undertake specialling as one of their required duties.…”

Section: Research Context and Problemmentioning

confidence: 99%

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“Specialling” and “Sitters”: What does communication between registered nurses and unregulated workers reveal about care?

et al. 2021

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Background: Specialling involves unregulated care workers who, while supervised by registered nurses (RNs), constantly sit with patients at risk of harm.Aim: To describe information exchanges between nurses who "special" people with cognitive impairment experiencing behavioural and psychological symptoms and whether psychosocial strategies are explicitly communicated.Methods: Sequential mixed methods study using online survey (quantitative and qualitative) followed by a group discussion. All Assistants in Nursing (AINs) who worked as "specials' in a large Australian metropolitan hospital were approached to undertake an online survey about specialling that included multichoice questions and free-text responses. Analysis involved univariate statistics and content analysis. Subsequent discussion with a convenience sample of AINs explored content revealed in survey responses.Findings: Of 186 possible AINs, 139 (74.7%) undertook the survey and 14(7.5%) participated in the group discussion. Only 27% reported receiving start-of-shift handovers from an RN, and just 9.4% gave an endof-shift handover to their RN. Some AINs reported receiving hourly over-the-shift communication with their RNs while others reported receiving none. Mostly, AINs received information about physical tasks, not psychosocial care.Discussion: Psychosocial information about patients was communicated considerably less than physical care, suggesting planned non-pharmacological strategies for behavioural and psychological symptoms were either absent or deprioritised. Although exemplary work interactions existed, there were also inadequate interactions regarding care provision highlighting a lack of RN oversight for those nominally under their supervision.Conclusions: This examination of AINs' self-reports, suggests that important psychosocial information is not communicated in specialling, possibly preventing resolution of patient symptoms and perpetuating risks.

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Section: Discussionmentioning

confidence: 99%

Section: Research Context and Problemmentioning

confidence: 99%

“Specialling” and “Sitters”: What does communication between registered nurses and unregulated workers reveal about care?

et al. 2021

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Understanding Frontotemporal Disease Progression and Management Strategies

Mulkey

2019

Nursing Clinics of North America

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One to one specialling and sitters in acute care hospitals: A scoping review

Wood

Vindrola‐Padros

Swart

et al. 2018

International Journal of Nursing Studies

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There is wide variation in what specialling and one to one care entails, which can in turn lead to the provision of poor quality care. A reduction in this variation and improved quality care might be achieved through the development of guidelines, training and standardized decision-making tools. Further research on the impact of one to one specialling on patient outcomes and cost would be beneficial, as well as robust evaluations of the alternatives to specialling.

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A New Frontier

Abstract: Frederick Graham, a clinical nurse consultant from Princess Alexandra Hospital in Brisbane, Australia, presents this month's column focused on improving nursing care for people with dementia and delirium in hospitals.

Cited by 5 publications

References 15 publications

“Specialling” and “Sitters”: What does communication between registered nurses and unregulated workers reveal about care?

“Specialling” and “Sitters”: What does communication between registered nurses and unregulated workers reveal about care?

Understanding Frontotemporal Disease Progression and Management Strategies

One to one specialling and sitters in acute care hospitals: A scoping review

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