Newsletter - Autumn 2003 edition

Letter from the Chair - Susan Kennedy

Perhaps for the first time I can confidently say that the role of the nurse in detecting and managing hypertension is being recognised. The Nurses Hypertension Association must not miss the opportunity of being able to offer advice and support to other nurses who are developing their expertise in this area. For those of you who were able to share in the glorious sun filled days at St John's College in Cambridge this September at the Annual Scientific Meeting I hope you too felt this shift. There was a real sense of urgency in developing what we began last year in nurse prescribing in hypertension and producing guidelines to support nurses.

Since my last letter to the NHA membership there have been some exciting developments. In particular a few of the committee met with Charles Phillips and Charlotte Scrutton of Pfizer. This meeting was co-ordinated with the help of the BHS, in particular Neil Poulter. As a result our crisis on how to fund the last Scientific Meeting was resolved and it is hoped that we will continue to work with Pfizer on a number of exciting projects. These projects coincide with the aims and objectives of the committee, that is, to promote our organisation by producing NHA sponsored support materials and to develop an accredited course on hypertension for nurses. Hopefully after the new committee meet there will be more to report on these in the next newsletter.

It is always a worry when organising a meeting that at least most people will not only enjoy the event, but also leave more enthusiastic about developing the role of nurses in hypertension. If you have any suggestions for improving the format of the meeting please email Alison Cox, the NHA secretary. I had hoped to speak to more members this year but was amazed to discover sitting behind me at the very last session an ex committee member from Wales (Hi Sian!) who I had not seen let alone spoken to throughout the whole meeting! Hopefully next year we can introduce some kind of social event where NHA members can meet informally before the supper and the debate if they wish. This year's venue was excellent except we had not bargained for the heat or the exploding light! Hopefully the nurses who were sitting beneath the light have recovered from the fright. The food in particular was delicious. Therefore you will be glad to know that we are to return there next year.

Thanks are due to all the speakers, and to Sally Brett who organised the programme. There was diversity amongst our invited speakers. The first was an update on stroke management from Professor Gordon McInnes whose wit and insight certainly caught our attention. Paula Delaney, from another nurse specialism, diabetes, gave a very useful overview of the imminent changes in nurse grading and pay structure. Our last speakers, Professor Andy Shennan and Annette Briley, described a fascinating study into pre-eclampsia. It was also excellent to have them in the audience where we discussed BP monitoring as their perspective on automated devices was very useful to our debate. As a new venture this year we introduced two Open Forums. One was on nurse prescribing where there was a consensus that supplementary prescribing was the most likely way forward. It was agreed to introduce a small working group of nurses under the leadership of Alison Cox to develop a patient care pathway in hypertension prescribing suitable for nurses and their medical teams. The second forum was on BP measurement at which many of the old problems as regards automated devices, availability of cuff sizes etc were aired. As a result of this forum Michele Beevers has been asked to join a national group considering BP Measurement within the NHS.

Finally I would like to thank all the nurses who took part in presenting their own research, ongoing or complete. Without you we would not have a meeting. The topics were relevant to us as nurses and hopefully stimulated others to realise that there are research questions out there that need addressed. Copies of the abstracts are available for any NHA members who were unable to attend from Sally Brett.

I look forward to my second year as Chair mainly because I know that I am supported with an excellent committee plus two new nurses, Susan Corbett and Josephine Studham. Sally Brett has handed over the role of Scientific Secretary to Ursula Kirwan, and Clare Addison has become the Treasurer. Next year there will be a lot of change so be ready to send in your proposals for new committee members!

Although the newsletters are less frequent please remember to check the website occasionally for any news.

Susan Kennedy

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British Hypertension Society Updated Guidelines

The new British Hypertension Society hypertension management guidelines will be published in the March 2004 issue of the Journal of Human Hypertension. You can access a copy in March by downloading them from our website www.bhsoc.org, or you can request a copy by contacting the British Hypertension Society Information Service (contact details below).

British Hypertension Society Information Service

Who are we?

The British Hypertension Society Information Service is based at St George's Hospital. The Information Service is structured as part of the British Hypertension Society Guidelines and Information Working Party - the Chair of which is Professor Bryan Williams (based at the Leicester Royal Infirmary). The person you should contact in the first instance is Dr Emma Fluck, the Development Officer, at the address below.

What do we do?

Our key activity is to provide an information service and to give advice on hypertension management guidelines to healthcare professionals. We give advice and provide guidance about all aspects of hypertension management such as validated blood pressure monitors, blood pressure monitoring, lifestyle measures, blood pressure treatment thresholds, blood pressure treatment targets, cardiovascular risk assessment, antihypertensive drug treatments (including recommendations for combining antihypertensive drug treatments), and special patient groups (the elderly, in the prevention of and its recurrence of stroke, individuals with diabetes, renal disease, women's health, ethnic minorities and pregnancy).

You can telephone for advice and information about hypertension from Monday-Friday 9.00-5.30pm. We can also be contacted by fax, email or post at the details listed below.

Information available

• Hypertension management Guidelines
• Poster on the British Hypertension Society recommendations for the treatment algorithm on combining antihypertensive drugs
• Guidance for measuring blood pressure
  • Posters on guidance for measuring blood pressure using digital devices or by manual methods
  • Blood pressure measurement tutorial available to download from our website (taken from the CD ROM 'Blood pressure measurement')
• British Hypertension Society guidelines on the validation on and use of blood pressure monitors
• British Hypertension Society live clinical trials feedback via webcasts
• Hypertension referral centres database

Future information

• Updated guidelines (March 2004 - see above announcement)
• Specific written advice on special patient groups
• Educational slide resource on the Guidelines
• Slides on the results from important clinical trials
• Blood pressure measurement CD ROM available to purchase

Our contact details

Dr Emma Fluck
Development Officer
Blood Pressure Unit
St George's Hospital Medical School
Cranmer Terrace
London
SW17 0RE

Tel: 020 8725 3412
Fax: 020 8725 2959
Email: bhsis@sghms.ac.uk
Website: www.bhsoc.org

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Profile of a ’Modern Matron’

Josephine Studham
St John Michael Centre, Hammersmith Hospital

My background in nursing is that I was a clinical research nurse working in the Department of Clinical Pharmacology firstly in the Royal Postgraduate Medical School (RPMS) at the Hammersmith and then Imperial College (IC) when the RPMS merged with IC in 1997.

In 2000 the Hammersmith Hospitals NHS Trust and Imperial College launched a joint venture to develop a Clinical Investigation and Research Centre on the Hammersmith site. There is a long history of clinical research involving both patient and healthy volunteers on the Hammersmith site and there was a real need to provide a focus for this research as a lot of it was performed in less than ideal settings. In order to justify the ring fencing of space for this purpose the Trust and IC opted to combine space usage with ring-fenced space for planned elective admissions for patients requiring clinical investigation and treatment. This ensures that the space is always in use. But responsive to clinical research need. All patients and volunteers admitted to the Centre have planned admission and discharge dates, their beds are blocked and can only be released if the patient cancels their admission, does not attend or the team have to cancel the admission for some reason. The Centre does not take acute admissions. I was appointed as the Manager of the Centre when it was still at the refurbishment stage and spent the first three months of my post wearing a hard hat!

Early on in the development of the Centre the Government re-introduced the role of Matron. This role was added into my job description because at the time the Centre was placed outside of the other Clinical Directorates in the Trust, so none of the other 'Modern Matron' roles would cover the Centre. Currently there are 32 Modern Matrons or Head Nurses as they are called in the Hammersmith Hospital NHS Trust. The role is supported by a Forum which meets every other month and a Working Group which meets in the intervening months to establish what areas we feel need direct and group action in order to effect positive and enduring change for patients.

Using the ten key roles I would like to review what being a 'Modern Matron' has meant to me and the Centre.

Be Innovative

The most important impact of having a Head Nurse for Centre has been to enable it to continue to function as an independent Centre supporting a variety of therapeutic areas, rather than just one clinical directorate. The concept of the Centre is one of innovation in that it has ring-fenced beds that are equally available to clinical patients and research volunteers. I have to use my role on a regular basis to impress upon users the need to work co-operatively to ensure that the best use of the space is made.

Improved outcomes for patients

The Head Nurse role has supported the intention of the Centre to improve outcomes for patients attending the Trust for elective procedures in the following ways. Encouraging the clinical teams to plan the whole of an elective admission rather than just the admission date and leaving the rest to chance. The teams have to demonstrate a clear plan of action for patients during their admission and it falls to the Head Nurse to offer both assistance and advice to those teams who are new to this concept.

Lead by example

All staff in the Centre are encouraged to look at the whole patient admission and to seek help and support in ensuring the patient is cared for in an exemplary fashion. They are encouraged to think of their role as a part of a multidisciplinary approach rather than something that runs in parallel to the multidisciplinary team.

Make sure patients get quality care

I feel that even without the Head Nurse role quality care would not be an issue. All staff in the Centre provide a high standard of care. Where there are issues about the standard of care, support through mentorship and objective setting has been offered.

Make sure wards are clean

The use of environmental standards forms has helped to identify what the specific problems with cleanliness actually are. It is clear that standards fluctuate between good and bad, though it is possible to effect a change more rapidly because one is able to identify areas requiring attention more quickly. In addition as a Head Nurse there is a means to impact directly on the company responsible for cleaning and catering by advising the Trust Board of their failure to meet prescribed standards. This is certainly an avenue that the Head Nurse Forum at the Trust have had to use.

Ensure patients’ nutritional needs are met

Nutritional assessment has been added to routine admission of patients and it has been part of the Head Nurse role to gain acceptance by nursing staff of the assessment as a part of the in-patient admission procedure. I think there has been an improved awareness to nutritional needs.

The quality of meals has improved and patients do actually comment positively on their 'likes and dislikes sheets' (given to them on admission) about the food.

Prevent hospital-acquired infection

As a Head Nurse I have to ensure that all nursing staff in the Centre are in the process of, or have attended the infection control updates. In addition they have indirectly received extra training on infection control issues as a result of the initiation of Gene therapy work in the Centre since March 2002. As Head Nurse of the Centre I have been involved in the development of a Gene Therapy Code of Practice for the Trust and sit on the Trust Genetic Modification and Gene Therapy Safety Committee.

Improve the ward for patients

In order to make the most of the Ward Environment fund that we are given each year, I have developed a 'likes and dislikes form' for patients to complete on a voluntary basis. They are given the form at admission and invited to complete it and return it on their discharge. I have also used the experiences of other Head Nurses in the Trust to look at innovative ways of improving the patient's stay.

Empower nurses

Since opening the Centre all nursing staff are actively encouraged to do the in-house cannulation training. They have been encouraged to view their role in patient care as an interactive one and to this end use the multidisciplinary patient records.

All staff in the Centre are encouraged to use the weekly ward meetings to discuss how to improve and develop the service we provide. The ward computer shared account has been expanded to included notes from Ward meetings and each staff member has the opportunity to request items to be discussed at the weekly ward meetings using the shared drive to accommodate an agenda for the ward meeting that is readily accessible.

On an individual level each member of staff in the Centre has a mentor and Individual appraisal sessions with their mentor 4 times a year. As of November 2003 we have started to ask staff to develop a Personal Development Plan.

The Centre has also become the focus of the Clinical research Nurse Group, which meets every other month. This has been of value to both Trust and IC employed nurses who work in a largely autonomous setting. The group meetings offer a mixture of planned talks and social meetings. In the coming year it is intended to create a series of teaching sessions covering all areas of clinical research that have till now been learnt largely 'on the job'.

Make sure patients are treated with respect

All members of the Centre's staff demonstrate a great deal of respect for patients attending the Centre. I have not felt that this has been a problem in the Centre at any time.

Resolve problems for patients and their relatives

We have been very fortunate in that in the last year as previously we have received an overwhelming amount of unsolicited compliments about the care received by patients and their relatives. We have always sought to act quickly when a patient expresses either concern or dissatisfaction about their care. As Head Nurse I try to visit all the in-patients on a regular basis and this has proved very informative. I have a much better understanding of the patients and relatives perception of the service that we offer and how we might continue to improve it.

Ensure staffing is appropriate to patient need

I continue to encourage all nursing staff to undertake the cannulation training, as this is pivotal to the work they are expected to do in the Centre.

In addition to developing the nursing role in the Centre the A&C staff have been given the opportunity to develop their role to facilitate the timely and efficient admission and discharge process.

It is important to recognise that although the intention was to create a highly visible role of 'Modern Matron', that role is only of value if it is integrated into the nursing population. Unless 'Modern Matrons' work in partnership with all levels of nursing and the multi-disciplinary team they will not achieve any of their ten key roles. I have found the transition from working autonomously as a clinical research nurse to being a 'Modern Matron' challenging, vexatious and yet very rewarding. I am very fortunate in that I work within a very good team of nurses and clerical support that make my job mostly pleasurable.

Josephine Studham

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Blood Pressure Association - an update

BPA National Blood Pressure Testing Week

The Association's third national blood pressure testing week took place across the UK in September with the support of thousands of volunteers - 2029 Pressure Stations ran and an estimated 180-200,000 people were tested throughout the week. A specially branded BPA bus drove through London on the first day of the testing week, offering testing - Public Health Minister, Melanie Johnston supported the event by having her blood pressure measured onboard. The bus was also used as the setting for an interview with GMTV.

Sir David Attenborough, Sir Trevor McDonald, Stephen Fry and Ian Wright MBE all supported the event and press coverage included 10 articles in national newspapers, hundreds of articles in local and regional press, 50 radio stations and 6 television appearances.

This year the BPA's priority groups (South Asian, African Caribbean, Over 55s) were targeted by encouraging Pressure Stations in appropriate areas. This includes Pressure Stations in mosques, temples, churches with largely black congregations and working with the Women's Institute, Age Concerns and community groups.

Many thanks to all from the NHA who took part and helped to make the event a big success.

New email service

The Blood Pressure Association web site now has an email information service for members of the public to ask questions about high blood pressure and for health professional to order information. The service has so far proved to be very popular and there are many plans to develop the web site further over the coming months - see www.bpassoc.org.uk for more information.

Regional network

In response to requests from people with high blood pressure the Association is starting a regional network, with local groups whose aim is to help people with the condition inform and support one another, with lifestyle changes and home monitoring. The first three groups should begin at the end of 2003, with more coming on board in 2004. If you are interested in helping your patients to set up a group, or would like more information, please contact Gemma Heiser on 020 8772 4989 or at g.heiser@sghms.ac.uk

Sarah Ransome
Information and Support Manager

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Diary Dates 2004

NHA - Annual Autumn Scientific Meeting

13th - 15th September 2004
St. Johns College
University of Cambridge
Cambridge
CB2 1TP    View Map to St Johns College

Website: www.joh.cam.ac.uk

Notification will be sent out to all NHA members in due course by Hampton Medical Conferences Ltd.

Time to start thinking about abstracts!!!!

St Georges Hospital Medical School - Meetings for Nurses 2004

March 16th 2004 - Prevention of Stroke and Heart Attacks
October 5th 2004 - Hypertension for Nurses

For further information contact:

Nirmala Markandu
Hon Senior Lecturer/Clinical Manager
Blood Pressure Unit
St Georges Hospital Medical School
London
SW17 0RE    View Map to St Georges Hospital

Tel: 020 8725 2849
Fax: 020 8725 2959

London Hypertension Society - Evening Meetings 2004

February 3rd 2004, April 6th 2004, June 22nd 2004 - all 6pm start.

Medical Society of London
11 Chandos Street (off Cavendish Square)
London
W1M 0EB    View Map to Chandos Street

London Hypertension Society - Annual Symposium

May 25th 2004

Royal College of Surgeons of England
35-43 Lincoln's Inn Fields
London
WC2A 3PE    View Map to Royal College of Surgeons

For further information on all LHS meetings contact Lindsay Queen, LHS Secretary.

Tel: 020 7848 6208
Email: lindsay.queen@kcl.ac.uk

Diabetes UK - Annual Professional Conference

March 17th - 19th 2004

International Convention Centre
Birmingham

For further information go to www.diabetes.org.uk

European Society of Hypertension - 14th European Meeting on Hypertension

June 13th - 17th 2004

Palais des Congres
Paris, France

Abstract submission deadline 8th Jan 2004
Early registration deadline 31st Mar 2004
Pre registration deadline 30th May 2004

Refer to www.eshonline.org for detailed information (including housing) and dates.

European Society of Hypertension Newsletter

The ESH publish a newsletter on their website: www.eshonline.org

This newsletter is in journal form and is full of original articles and relevant information.

For Reference:

The Nurse's Role and Skills in Hypertension Care: A Review

Bengtson, A. Drevenhorn, E.
Clin Nurse Spec, Voluume 17(5). September 2003. 260-268.

A review aimed at examining studies on nursing in hypertension care to find out about the nurse's role and skills.

Download the review here.

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Job Opportunity: Trials Centre, St Mary's Hospital

Trials Centre (ASCOT House & Peart-Rose Clinic)
Research Nurse - Clinical Trials
(Grade E - G + £3,333 LA)

The department of Clinical Pharmacology, together with the Diabetes Unit based at St Mary's is conducting international multi-centre clinical trials (ASCOT & ADVANCE) comparing different therapeutic strategies for the prevention of coronary heart disease and stroke in high risk patients with hypertension and diabetes. We are managing large cohorts of patients for these trials and the clinical team needs a research nurse to carry out recruitment and organisation of these and subsidiary studies. You will be responsible for data collection, treatment and follow-up, study documentation and administration, and may also become involved in other projects within the Peart-Rose Cardiovascular Disease Prevention Clinic.

You should be organised, meticulous and able to work well in a team. Experience in the care of patients with hypertension and diabetes is desirable but not essential.

The post offers an exciting opportunity to work with a committed research team and to consolidate your own skills. Starting salary dependent on experience. Enquiries from applicants wishing to work part time will be welcome.

Informal enquiries to Dr Simon Thom on 020 7886 1172. Applications in the form of a full CV with names and addresses of 2 referees should be sent to:

Dr Simon Thom
Clinical Pharmacology
Imperial College School of Medicine
Norfolk Place
London
W2 1PG

Closing date: imminent

Salary scales:
E grade: 21,699 - 25,511
F grade: £23,701 - 28,766
G grade: £27,367 - 31,523