An evaluation of a specialist nursing service for adult patients with congenital heart disease.

The purpose of this study was to evaluate grown-up congenital heart (GUCH) patients' experiences and satisfaction with the delivery of a nurse specialist service, including perceived priorities and recommendations for future service delivery. A service evaluation utilizing descriptive, cross-sectional survey principles was conducted over a 2 year period. Postal questionnaires were sent to three patient cohorts (general adult n = 747; pregnancy n = 202; learning disability n = 72). Quantitative data were analysed using descriptive statistics. The majority of respondents were satisfied with the nursing care provided, including information provision, time made available to discuss needs, emotional support, well-being, self-management and symptom distress. Priority areas included timely information and advice; specialist knowledge and expertise; effective care coordination, monitoring and support. Accessibility, contact and responsiveness were dominant. A majority of patients agreed that their first, second and third-rated priorities had been met. Findings identified strong commitment, support and satisfaction with the GUCH nurse specialist service.

Using action research to develop a thoracic support nurse role to enhance quality of care.

AIM: The project aimed to develop a new nurse role to support thoracic patients with complex needs. METHOD: An action research approach enabled frontline staff, called co-researchers, to systematically explore the change and development process of the new role. The 60 participants were the co-researchers, patients, ward nurses, and the multidisciplinary team. RESULTS AND DISCUSSION: Thematic analysis revealed five key themes: it is the need to improve patient care; bringing research to life; a rollercoaster of emotions and experiences; process is as important as outcome; and we did it ourselves and learnt so much. CONCLUSION: Patients and staff recognised howthe new role significantly improved the quality of thoracic nursing care. However, there were many challenges to address, including role conflict and funding.

Redesign of thoracic surgical services within a cancer network-using an oncology focus to inform change.

Thoracic surgical services for one cancer network in London are based at one NHS Trust. Approximately 80% of the surgery performed in the period January-December 2003 was for the diagnosis, palliation or treatment of cancer. The range of different patient groups and needs is very wide, ranging from teenagers undergoing metastatectomy to adults and older adults undergoing resections or palliative surgery. An audit of lung cancer resections performed in 2001 on behalf of the Network lung tumour board indicated that the service was fragmented and there were several bottlenecks in the lung cancer pathway, causing patient delays and a feeling of dissatisfaction amongst referrers and patients. A clinician with oncology experience was appointed in 2002. Immediate action to track patients and ensure referrers knew the outcome of surgery and histology was taken. As part of the NHS Modernisation agenda, the local Cancer Services Collaborative then facilitated mapping the pathway for lung cancer, identifying problems and ways of tackling them. Changes from this, subsequent initiatives and adopting a collaborative approach have also had a positive impact on the lung cancer service. These strategies have been adapted to all thoracic surgery pathways for cancer or suspected cancer. Examples include decreased wait time, sector-wide patient information, multiprofessional working practice and educational initiatives.

A magical factor.

THERE IS a magical factor that improves patient care, promotes team relationships, develops critical thinking and facilitates staff retention.