University of Gibraltar and GHA Nursing Conference

The nursing triage team have a set inclusion and exclusion criteria for the MIU. The MIU is located within the Emergency Department footprint but benefits from its own clinical area.

Since its introduction, the number of patients seen in the MIU has increased, reaching the current level of around 800 patients per month. The percentage of patients assessed by MIU clinicians represent the 30% off all Emergency Department attendances.

Average waiting time from triage to seen by a MIU clinician is around 20 minutes. The MIU has completed the evaluation phase of its project which has demonstrated a significant improvement in the overall emergency department waiting time for patients across presentations – both minor and majors – while also improving the working environment for the emergency nursing and medical team.

Before 2025, patients in Gibraltar requiring coronary angiography or percutaneous coronary intervention (PCI) were transferred to external centres, causing delays, fragmented care, and increased costs. To address this, the Gibraltar Health Authority established a local Cardiac Catheterisation laboratory (Cath Lab), with nursing leadership central to service design, workforce development, and the creation of evidence-based pathways.

Aim

To evaluate the impact of introducing a local Cath Lab service on access to care, clinical performance, and system efficiency.

Methods

A prospective service evaluation followed the phased implementation of a nurse-led, multidisciplinary Cath Lab. The service progressed from elective angiography to PCI and primary PCI (PPCI) for ST-elevation myocardial infarction (STEMI). Key development components included structured nursing education, standardised protocols aligned with international guidelines, robust governance and audit processes, and integration with emergency and critical care pathways. Data was collected on procedural activity, case mix, and performance indicators such as door to balloon times.

Results

From December 2024 to early 2026, 340 procedures were completed: 61% diagnostic angiography, 33% PCI, and 61 emergency PPCI cases. The local PPCI service provided timely STEMI reperfusion, with 87% achieving door to balloon times under 90 minutes. The service eliminated routine cross border transfers, improved continuity of care, enhanced patient experience, and reduced healthcare costs.

Discussion and Conclusion

A local Cath Lab within a small health system is feasible and effective. A nurse led model delivered high quality, guideline driven interventional cardiology care comparable to larger centres. Key success factors included strong nursing leadership and multidisciplinary collaboration. Future plans include TAVI and pacing services.

This presentation explores the contribution of primary care nurses to the management of patients living with established long-term conditions within a PCC setting. Through their involvement in hypertension management clinics, the care of patients with chronic wound conditions such as venous leg ulceration, and their role in responding to and treating patients presenting through urgent care pathways, registered nurses provide continuity of care that supports disease control, promotes treatment adherence, and contributes to the prevention of complications associated with chronic illness.

Routine clinical interactions within PCC services require the application of ongoing clinical judgement, risk assessment, and patient education, often in the context of multimorbidity. In this way, clinic-based nursing practice represents a consistent point of engagement for patients requiring both planned and unplanned care within primary care settings.

This presentation will examine how primary care nurses support the ongoing management of long-term conditions through their delivery of both routine and urgent care, highlighting their role in maintaining continuity of care and supporting safe, timely intervention within the PCC setting.

This session will give an overview of what makes Gibraltar unique from a health protection perspective, including cross-border considerations, port health risks and the realities of managing outbreaks in a close-knit community where news travels quickly and resources are limited.

Using highlights from last year’s annual report, I’ll walk through some of the outbreaks and incidents we managed, trends in notifiable diseases, emergency planning work and how we’ve strengthened surveillance and response systems. The focus will be on what this means for nursing practice – collaboration, communication, early identification and coordinated response.

The aim is to give colleagues insight into the work happening behind the scenes in public health, show how it links directly to frontline care, and how we continue building resilience in our small but complex healthcare setting.

Simulation-based education and structured clinical skills training provide high-impact modalities to address these needs. Scenario-based simulation enables nurses, healthcare assistants, allied health professionals, and primary care partners to rehearse the recognition and management of common and high-risk clinical events, including deterioration, sepsis, falls, choking, and end-of-life care. Embedding human factors principles, structured communication tools, and escalation pathways within simulated environments strengthens situational awareness, role clarity, and team-based decision-making.

Targeted clinical skills training, focusing on baseline observations, NEWS2 utilisation, medication administration, moving and handling, and Basic Life Support, supports standardisation of practice, strengthens regulatory compliance, and reduces unwarranted variation in care delivery. When embedded within an interprofessional CPD, these initiatives contribute to measurable improvements in staff confidence, early deterioration recognition, and reductions in avoidable hospital admissions.

Strategically designed, simulation-enabled CPD is therefore, not supplementary, but central to workforce capability, governance assurance, and sustained quality improvement within ERS.

They are a crucial, frontline, universal service for the safeguarding of children from 0-17 years in their public health role as Community Public Health Nurses (CPHN). This role entails preventative public health with early identification of risk both in a physical and psychological sense.

As specialist nurses they build trusted relationships, enabling them to spot signs of abuse, assess family needs, and coordinate multi- agency support to protect vulnerable children.

Safeguarding and Child Protection are core activities of health visiting in Gibraltar. Health Visitors are well placed to undertake this role as:

1. Health visitors provide universal, proactive support to families to prevent harm before it occurs, focussing on health needs and parenting skills. GHA Health Visitors see every child born in Gibraltar and also those who move here who are entitled to use GHA services. This is in contrast to all other agencies and professions who see those referred to them.
2. Professional and clinical skills are used during home and regular clinic visits to detect signs which may indicate neglect, harm or coercive control, therefore not only involving ‘obvious’ signs of physical injuries.
3. Health visitors conduct comprehensive assessments of a family’s functioning and if appropriate respond and report any concerns.
4. They report to the statutory body, i.e. in Gibraltar, the Care Agency and RGP. This requires collaboration and multidisciplinary working with social workers, police, healthcare and education professionals.

Working in Gibraltar means we function within a close multidisciplinary team, but with significant professional responsibility. Due to the size and structure of the service, Breast Care Nurses are not limited to a narrow task-focused role. Instead, we assess, triage, coordinate care, provide results, support treatment decisions, manage benign breast conditions, monitor patients during treatment, and lead follow-up and post treatment care. This level of autonomy is built on advanced clinical knowledge, advanced communication models, and experience, allowing us to practise safely and independently within agreed governance frameworks.

In a smaller healthcare system, continuity is essential. We often follow patients throughout their entire journey, which strengthens therapeutic relationships and ensures seamless communication between specialties. Our ability to manage a substantial proportion of the caseload particularly benign presentations, routine reviews, treatment toxicity monitoring, and supportive care creates a more efficient and responsive service. Patients benefit from quicker access to expert assessment and consistent points of contact, while consultants are able to focus on complex surgical and oncological management.

This model demonstrates how advanced nursing practice in Gibraltar is not only autonomous but integral to service sustainability, quality improvement, and patient-centred care, aligning closely with the conference theme of academic excellence in service provision.

The first point of discussion is the introduction of an enhanced reporting system in late 2023 which saw an increase in reporting by up to 68% to date (depicted in graphs on the poster). This concentrated on introducing the electronic datix system, creating a renewed culture of learning and guiding staff on how to provide structured falls incident reports that tell us what we need to know (to improve practice and prevent future occurrences). Although the project is ongoing and we cannot at present, show a statistically significant reduction in falls, our falls data and our falls auditing process has highlighted opportunities for further quality improvement initiatives such as the introduction of the ERS Post fall Algorithm and the ERS Head Injury Algorithm and the more recent ERS Multifactorial Risk Assessment Tool which we wish to introduce this coming month. Alongside our poster and copies of the above-mentioned tools we would like to showcase some equipment which we have introduced to lift a fallen person in tight spaces and provide interactive demos with simulation props.

These questions are being debated now in the RCN Ophthalmic Nursing forum. The answers are relevant beyond ophthalmology and might shed light on the role of nurses in other specialist disciplines.

The Hospital @ Night (H@N) programme outlines the framework for delivering safe, effective, and coordinated multidisciplinary care during out‑of‑hours periods across the Gibraltar Health Authority. The policy aims to maintain optimal patient safety, ensure timely escalation of deteriorating patients identified through the NEWS system, and support efficient patient flow and bed management. It establishes the structure and responsibilities of the H@N team—including Night Sisters/Charge Nurses, Medical and Surgical NCHDs, CCU registrars, and the Clinical Nurse Manager (Nights)—and emphasises collaborative working, clear communication pathways, and structured handover processes.

Key components include detailed duties for nursing and medical staff, escalation protocols, intra‑hospital transfer procedures, and criteria for patient admission from the Emergency Department. Providing comprehensive guidance on transferring acutely ill adults, paediatric patients, and obstetric cases to tertiary centres, including escort requirements, monitoring standards, and documentation expectations. It also incorporates mental health pathways aligned with the Gibraltar Mental Health Act, training requirements for H@N personnel, and essential contact information.

Overall, this design ensures that out‑of‑hours care is delivered through a coordinated, competency‑based team model designed to enhance patient outcomes, streamline operations, and maintain continuity of care throughout the organisation.

A cross-sectional survey was distributed to 209  RNs, yielding 107 valid responses (51.2% response rate). The questionnaire combined items from the Perceived Stress Scale and the Ways of Coping Questionnaire, adapted for local relevance. Descriptive statistics captured workforce demographics, stressors, symptoms, and coping strategies. One-way ANOVA with post-hoc testing and effect sizes assessed generational differences.

GY formed the largest cohort (56.1%), followed by GX (26.2%), GZ (13.1%), and BB(6.5%). Stress was widespread: 51.4% of RNs reported frequent stress. Key stressors included staffing shortages (94.4%) and resource constraints (89.7%). Common symptoms were fear of errors (82.2%), emotional exhaustion (63.6%), and sleep difficulties (57.9%). Coping strategies were primarily adaptive, with humour (82.2%), peer support (80.4%), and time management (74.8%) most widely reported. However, 24.3% acknowledged maladaptive coping such as smoking or alcohol use.

ANOVA results indicated that most stressors and coping strategies were experienced at similar levels across generations, with effect sizes consistently small. One significant difference emerged: GZ RNs reported higher pre-shift anxiety than GY, GX or BB. Three additional stressors (worry about health, sleep difficulties, and feeling unsupported) and two coping strategies (humour and peer support) reached omnibus significance but were not confirmed post-hoc.

The study concludes that occupational stress is a shared experience across all age groups, shaped more by systemic pressures than by generational identity. Interventions should prioritise systemic solutions in safe staffing, supportive leadership, workplace culture reform, and access to confidential support, while recognising limited generational nuances. Although exploratory, this research provides the first comparative insight into coping across four generations of RNs in Gibraltar and highlights urgent priorities for workforce wellbeing and sustainability.

A qualitative descriptive phenomenological approach, informed by Husserlian principles, was used to explore the lived experiences of five A&E nurses. Semi-structured interviews were conducted and analysed using Colaizzi’s seven-step method. The Biopsychosocial Model guided the organisation of themes, allowing burnout to be examined across biological, psychological and social dimensions.

Findings revealed that burnout was experienced as a complex and layered phenomenon. Physically, nurses described chronic fatigue, disrupted sleep and persistent exhaustion linked to shift work and workload demands. Psychologically, participants spoke about emotional overload, anxiety, reduced confidence and difficulty separating work from personal life. Social factors such as staffing shortages, limited managerial support, workplace cliques and feelings of exclusion also contributed to their experiences. Despite these challenges, nurses described developing personal coping strategies including exercise, journaling, creative hobbies, peer support and setting boundaries between work and home. However, these approaches were largely self-initiated rather than organisationally supported.

The study highlights the need for structured and proactive institutional support within Gibraltar’s healthcare system to protect nurse wellbeing and sustain safe patient care.

Methods and Innovations: Transitioning to 100% post-dilution online HDF for eligible patients improved solute clearance, particularly of middle molecules, and enhanced treatment efficiency. Advanced dialysis platforms enabled high convective volumes, while real-time blood recirculation monitoring facilitated early detection of vascular access dysfunction, reducing long-term fistula complications. The use of high-performance dialyzers and biofeedback systems further optimized treatment precision and safety. Routine incorporation of the Body Composition Monitor (BCM) supported individualized dry weight prescriptions and personalized fluid management.

Quality Improvement: Structured protocols for vascular access surveillance, fluid management, and dialysis adequacy monitoring were implemented. Continuous auditing of clinical indicators—including treatment tolerance, vascular access function, and hospitalization trends—supported data-driven decision-making and sustained quality of care.

Results: Practice-based evaluations demonstrated measurable improvements in intradialytic hemodynamic stability, reduced hypotensive episodes, optimized convective volumes, and better management of fluid overload. Importantly, patient life expectancy increased, a benefit attributed in part to the superior efficacy of post-dilution HDF. Nursing-led clinical leadership and multidisciplinary collaboration were key drivers of these outcomes.

Conclusion: Over two decades, sustained innovation, structured quality improvement, and evidence-based practice have significantly enhanced safety, stability, and survival in dialysis patients. This experience underscores the critical role of nursing leadership in advancing contemporary renal replacement therapy and shaping the future of dialysis care.

Rather than relying solely on constant supervision, PBS has focused on understanding the meaning behind behaviours, identifying triggers and adapting the environment to reduce distress. This has promoted dignity, autonomy and emotional wellbeing.

For our elderly patients and those living with dementia, behaviours that challenge, such as agitation, wandering or resistance to care are often expressions of unmet needs. PBS uses structured risk assessment to proactively identify patterns and prevent escalation. By analysing environmental, physical and emotional factors, we can implement tailored strategies that reduce anxiety and enhance comfort.

The integration of assistive technology has further strengthened this approach. Tools such as bed and chair sensors, cameras and infra- red monitors have allowed us to provide greater independence. Instead of restricting movement, discreet technology has enabled freedom within safe boundaries, reducing falls, nighttime confusion and overall significantly enhanced the quality of life for our elderly patients and those living with dementia.

Shifting from 1:1 nursing to risk-based support has also fostered skill development among staff. Teams become more confident in de-escalation techniques, communication strategies and therapeutic engagement, rather than relying on observation alone. This leads to more meaningful interactions and improved quality of life.

Importantly, this model supports dignity and less restrictive practice. Individuals maintain control over daily routines, social engagement and mobility. Families gain reassurance that care is proactive, evidence-based and centred on their loved one’s wellbeing.

Overall, combining Positive Behavioural Support, thorough falls risk assessment and assistive technology has enhanced safety, promoted independence, reduced restrictive practices and delivered compassionate, sustainable elderly and dementia care.

Specialist palliative care improves patient outcomes and end-of-life care quality. In Gibraltar, public and local data demonstrates a strong preference for home-based care. The Gibraltar Government funded a Community Hospice Outreach Service (HOS) in 2019, delivered by Cancer Relief. While HOS serves most local palliative cancer patients, there is a need for robust outcome data demonstrating the necessity and cost-effectiveness of the service, to shape the future development of community palliative care provisions.

Aim

To pilot a quality improvement study assessing end-of-life care delivered to Cancer Relief clients using bereaved carer feedback, establishing a baseline and assessing feasibility for broader adoption.

Methods

The study draws on NACEL methodology and the International Collaborative for the Best Care of the Dying, which advances care standards through research. Bereaved carers will complete a structured questionnaire (CODE) selected with SMART criteria. A three-month Plan–Do–Study–Act (PDSA) cycle, led by a trained bereavement worker, will guide implementation. Findings will refine the tool for wider rollout.

Outcome-Measures

Domains assessed align with the 10/40 Model of Care, including communication, recognition of dying, symptom control, dignity, emotional and spiritual support, coordination, decision-making, and preferred place of care. Quantitative and qualitative data will provide a comprehensive evaluation of care quality from carers’ perspectives.

Significance

This study offers the first structured evaluation of end-of-life care in Gibraltar and may inform future system-wide audits, service development, and policy decisions, supporting patient- and family-centered care across both charitable and statutory services.

Dementia represents a growing general and public health concern in Gibraltar, a small community with finite resources. An ageing population and increasing life expectancy means prevalence is expected to rise. The high number of comorbidities among older adults results in dementia impacting across acute, community, and long-term care settings, making it relevant to most areas of nursing practice. Within Gibraltar’s strong family-centred culture, stigma and misconceptions surrounding cognitive decline may delay recognition and help-seeking. Baseline community engagement identified gaps in awareness and understanding of dementia, limited knowledge of modifiable risk factors, uncertainty regarding available support services, and reluctance to openly discuss a diagnosis.

Aim:

To enhance community awareness and understanding of dementia and strengthen local support pathways through coordinated, targeted initiatives.

Methods:

Baseline survey findings and stakeholder consultation informed the development of initiatives, including local data collection, Dementia Awareness Month events, family support sessions, education and training programmes, and collaborative working across health, voluntary, and community sectors.

Results:

Early qualitative feedback from relatives and participants suggests increased awareness and understanding, greater openness in discussing dementia, improved confidence in accessing support, and strengthened connections between families and services. Ongoing evaluation will assess sustained impact on awareness and engagement.

Conclusion:

Culturally responsive, locally tailored community initiatives will contribute to reducing stigma, promoting earlier engagement, and strengthening dementia support within small health and social care systems.

Time management emerged as the dominant theme across the narratives of all five candidates. The findings underscore that a student’s ability to manage their time effectively was heavily influenced by personal factors such as prior educational experience, caregiving responsibilities and support systems. The findings of this study appear to align with current relevant literature that associates the presence of time management with a reduction of stress and increased clinical competence.

A further identified theme was that of mentor support, it appeared to act as a key mitigating factor in managing academic demands during placements. Participants expressed that when their mentors were flexible and empathetic towards their needs, they reported feeling more supported and better able to navigate completing pressures. Interestingly, even mentors who prioritised practical tasks over academic flexibility were perceived as having a positive impact especially if their overall relational support was effective. Consequently, this highlights the importance of mentors being attuned to a student’s wellbeing and current demands they are facing at a certain point in time.

The final theme of academic preparedness and transition to higher education exposed variation with respect to how students adapted to the academic demands of a nursing programme. Students with a background of higher education reported smoother transitions, whereas those returning after a long hiatus expressed feelings of overwhelm and uncertainty. These findings reinforce the concept of ‘transition shock’ and point to the need for structured and tiered academic support.

Limitation for this study include the fact the sample lacked any male participants, serving to limit its generalisability. However, the study does offer meaningful contributions to practice, including the advocation for enhanced academic scaffolding and personalised time management training.

Recommendations for future research include the need for longitudinal studies, inclusion of more diverse demographics and evaluation of specific