Empowering nurses to make improvements

Ismalia de Sousa is a clinical nurse specialist in stroke at Charing Cross Hospital. At the beginning of her career she was inspired by a senior nurse to make improvements on her ward. Years later, she’s found a great way to encourage nurses in her team to do the same.

In 2009, I started working at the hyper acute stroke unit at Charing Cross Hospital. I was a newly-qualified nurse and had plenty of questions for Dr Julia Slark, a senior clinical nurse specialist in stroke. Julia was a kind and supportive nurse leader, always patient with my questions and keen for me to improve my nursing practice. She took the time to teach me new skills and encouraged me to explore opportunities beyond the walls of the ward, including attending stroke conferences.

With Julia’s support, I enrolled in a master’s programme, where I wrote a paper on improving foot care for people with diabetes who are recovering from a stroke in hospital. The paper was accepted to the British Journal of Neuroscience Nursing and published in 2013. Back on the stroke ward, the critical analysis of that paper inspired Julia to start training other stroke nurses and healthcare assistants in foot care. I’m proud that the observations in my paper led to real improvements for patients. It empowered me to want to make more changes and encourage those around me to do the same.

My quality improvement journey

Julia Slark, who did so much for me at the start of my career, eventually left the Trust but I’ve always thought about her and how I could replicate the way she mentored and supported me with the nurses on my wards. How could we give busy, clinical staff the space and resources to make those connections that lead to innovations in patient care? The Trust’s quality improvement team, set up in 2015, helped me find the way.

I worked with quality improvement fellow Joanna Fisher to get the ball rolling. She set up a tailored half-day session to introduce the stroke team to the Trust’s quality improvement methodology, which starts with deciding what you want to accomplish and how you’ll know a change is an improvement. From there, Joanna taught us to brainstorm changes that could lead to improvements followed by the ‘plan, do, study, act’ cycle. Plan to make a change, implement it, assess the results and act on them for a further improvement round.

The sessions were really positively received and had great support from the ward managers in the stroke units. Embedding the concept of quality improvement has been a challenging process nonetheless – even the most motivated of nurses can struggle to squeeze more into their already busy days. One group of nurses decided to try to improve our swallow screening in stroke patients. Swallowing difficulties are common after stroke and there is a risk of infection if we don’t identify this early. In the stroke units, it is the responsibility of the nurses to carry out a swallow screening within four hours of hospital admission. The group looked at the way we work now, presented their findings to the rest of the multidisciplinary team and made suggestions on where we could make improvements. For example, it is often the stroke doctors rather than nurses who are the first to meet patients who have had a stroke, so it was suggested that they perform this screening – a recommendation that has now been successfully adopted throughout our stroke service.

Opportunities to improve care on stroke wards

Nurses work face-to-face with our patients, day in and day out. Our patients teach us so much about how it feels to deal with the impact of stroke. This gives us a chance to work with our patients to make positive changes to the way we care for them. The ‘plan, do, study, act’ approach helps us facilitate those changes in the high-pressure environment of a busy ward.

I’ve had so many opportunities to research, develop and implement improvements since I first became a nurse, and I want to make sure other nurses have the chance to do the same. It’s been less than a year since we brought the Trust’s quality improvement approach to the stroke ward, and I’m already very optimistic about its potential. It gives our nurses a way to channel their skills and energy into making real improvements in partnership with our patients. This enables our nurses to drive better care for our patients and develop their careers. Ultimately, I believe this also helps creates the nurse leaders of our future. This outlook can be a really valuable tool in a nurse’s kit, which is why I encourage every nurse to become a quality improvement nurse.

Want to learn more about quality improvement? Email Imperial.hub.quality@nhs.net to find out how you can get involved.

Have questions for Ismalia? Find her on Twitter @Ismalia_S.

Want to hear more from Ismalia's team? Staff nurse Timothy Cormont and senior staff nurse Sarah MacDonald share their experiences on Vimeo.