The ESSENCE Programme: amalgamating marginal gains in ESSEntial Nursing CarE

Nursing care matters a great deal to patients and the public. Distress, unhappiness, and even injury or death can be a result of poor nursing care. The ESSENCE Programme will develop and test  a new system to improve the quality of care for patients in hospitals.

We will develop and test nursing methods that focus on the ‘essentials of nursing care’. We will concentrate on:
• helping patients with
• eating and drinking;
• going to the toilet;
• moving around;
• being clean and comfortable
• communicating with patients

In ESSENCE, nurses will deliver care using a process called the ‘amalgamation of marginal gains’ (AMG). This has been used very successfully in sport and following surgery, but not so far in nursing. The AMG system is designed to help nurses achieve small improvements in many different areas. Combining these (‘amalgamating’) may lead to better results. For example, nurses must pay attention to how people communicate their care needs, what they drink, how they move around and when they go to the toilet. Making small improvements in all of these areas may improve patient experience and reduce the chance of adverse events such as dehydration or incontinence.

Design and Methods
We will use our Programme Development and Programme Grants to develop our amalgamated essential nursing care intervention, test its feasibility and acceptability to patients and nurses, and then evaluate the intervention in a large, multi-site randomised controlled trial.

Stage 1: the Programme Development work (February 2016-) will:
1. interview elite sports teams and healthcare innovators to analyse and understand their methods of operationalising the identification, targeting and amalgamation of marginal gains
2. synthesise evidence for the feasibility, acceptability, and effectiveness of candidate intervention components for a nursing intervention addressing essential communication, nutrition/hydration, elimination, mobility and hygiene needs
3. strengthen our team and stakeholder consultation mechanisms

Stage 2: the Programme Grant (2018-) will consist of four workstreams:
Workstream 1: we will develop a prototype intervention via consultation with hospital patients and nurses.
Workstream 2: we will determine the feasibility and acceptability of the intervention and proposed trial design in a pilot randomised trial.
Workstream 3: we will undertake a definitive randomised controlled trial evaluating the intervention’s effectiveness including process and economic evaluations.
Workstream 4: we will investigate the feasibility of transferring the ESSENCE intervention to nursing/care homes, to assess the work to be undertaken in order to adapt and implement it in these environments.

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