Practice team blog
The increase in liver disease is startling with it now being the fifth biggest killer in England and Wales with around a 25% increase in deaths in the last decade.
The UK’s drinking culture has its part to play with younger people now affected more by liver disease as a result. Rates of hepatitis C are increasing but unfortunately the level of treatment has not kept pace. Last month Nursing Times reported a steep rise in deaths from this virus in the UK with experts saying that the rate of treatment for hepatitis is “unacceptable”.
Nurses can help identify those at risk and boost the numbers treated from this disease. However it is a disease area which nurses sometimes feel they do not know enough about.
The Royal College of Nursing has produced a competence framework for nursing to provide professional quality standards to support nurses, regardless of their own clinical background, to offer appropriate, timely and quality care for people with and at risk of liver disease.
Two of the authors of this framework have worked with Nursing Times to produce a learning unit which is free for all to access. Liver Disease: risk factors and treatment is aimed at nurses working in all healthcare settings; it will enable you to identify patients at risk of liver disease, offer them health education to reduce their risk, and recognise those who require referral to specialist liver services.
And of course it will add to your CPD hours with a certificate that you can print off and keep in your portfolio.
Most nurses experience it right at the start. It could be on the bus to your first day of placement, when you have the urge to lean over and tell a stranger that you’re a nurse by the way.
Or the butterflies you get when you put on your uniform and realise there’s a real-life nurse staring back at you in the mirror.
Or maybe it’s that first time you answer the ward phone and introduce yourself as “student nurse”, trying not to grin from ear to ear.
For me, it was in the months leading up to starting my nursing degree. I was working as a carer and had gone to the shops to pick something up for a resident wearing my uniform. I was in a rush to get back and frustrated to find a queue trailing right round the shop.
But then a man near the front clocked my uniform and insisted I was served first. No one in the queue complained. In fact they all smiled at me warmly.
What was this power my uniform possessed?
Was this… respect?
Our #proud2nurse campaign developed from discussions in the NT office about whether nursing is losing that respect.
We worry that a little bit more pride is lost from the profession every time a negative headline accuses nurses of lacking compassion or suggests training is not fit for purpose, or a story about one nurse carries the implication that nursing as a whole has “lost its way”.
It frustrates us – and we’re not the ones out there on the frontline experiencing a fourth year of pay freeze or below-inflation pay rises. And you do it while managing growing expectations and seeing much of the blame for the ills in healthcare cast in your direction.
Hearing negativity about the job you’re proud of, the career you joined to make other peoples’ lives better, must be disheartening.
So, we’re fighting back. We’re going to show the world that nurses are proud and why they have every right to be.
Add your voice and share your stories. There’s loads of ways you can get involved - here’s just a few:
- Take a selfie and email it to us at the address below – print off our #proud2nurse sign and add your reason, making sure it can be clearly read in your picture
- Tell your story – email us your short stories of what gives you that buzz of pride (no more than 100 words please!)
- Tweet us – since we started this campaign, there’s already been hundreds of tweets with the #proud2nurse hashtag
- Make a video – we’re not looking for Oscar-winning performances, simply tell your camera phone why you’re #proud2nurse, then email it to us
- Appreciate what you and your colleagues do – it may seem sentimental, but take a moment to appreciate the fact that every day you come to work you make someone’s life better
Send your contributions to our campaign to: firstname.lastname@example.org
Over the past few weeks I have edited a five-part series on blood transfusion, which has reminded me of the multiple points at which things can go seriously wrong, from taking a cross-match blood sample to administration of a blood transfusion.
I was surprised to see how often Serious Hazards of Transfusion (SHOT) receives reports of patients being given the wrong blood. In 2012, 252 incidents were reported and, of these, 151 errors originated in the clinical area.
The consequences of receiving incompatible ABO blood products can be life threatening, and NHS England has labelled these errors never events.
Yet in 2012, 10 incidents occurred and three of these patients went on to experience severe harm as a result of the inadvertent transfusion of ABO-incompatible blood components. In two-thirds of cases transfusion errors were caused by human error, often due to misidentification of the patient.
Interestingly, NHS Blood and Transplant and SHOT are seeking to empower patients with a campaign encouraging them to ask health professionals “Do you know who I am?”. They make it clear that patients should understand what the blood samples are being taken for and give their consent.
It is surprising that despite policies that dictate rigorous checking procedures and careful observation of patients, errors continue to occur. Clearly we can’t rely on patient empowerment to ensure that the right patient gets the right blood, but we have a responsibility to ensure we are up to date with the latest evidence on the management of transfusion.
To support you in this Nursing Times is publishing a five-part series on blood transfusion written by experts from the NHS Blood and Transplant Patient Blood Management Team. It aims to help you provide evidence-based care to your patients and help avoid errors that can lead ultimately to loss of life.
The series covers:
- Consent for transfusion (published 3 September)
- Processing, storage, testing and selection of blood components (10 September);
- Safe administration (17 September);
- Transfusion reactions (24 September);
- Patient Blood Management(1 October)
Public health has long been the poor relation in the healthcare family. While preventing ill health may seem an obvious candidate for generous funding, too many aspects of this important area of healthcare have been largely sidelined for decades.
Unfortunately, most public health interventions can be seen as making long-term investments. It takes years to reverse trends such as rising obesity and type 2 diabetes. In the absence of results to justify funding, public health has tended to lose out to the services dealing with patients who have already developed these conditions.
Now the NHS has a body responsible for public health in each of the four countries in the UK. Hopefully this means ring-fenced funding and dedicated focus will begin to make inroads into the long-term causes of ill-health that will otherwise eat up the lion’s share of NHS budgets.
However, as the chief executive of Public Health England recently acknowledged, most causes of poor health are not related to healthcare, but to economic and social issues such as employment, housing and companionship.
Nurses and other professionals working in public health do great work, but they need more than just serious funding for long-term initiatives.
They need our increasingly unequal society to realise that a long-term investment in reducing poverty may involve some short-term financial pain for the more comfortably off, but that in the long term we will all benefit.
If anyone ever needed irrefutable evidence that depression doesn’t discriminate, the death of Robin Williams is surely it.
When the news broke last week, you couldn’t move on twitter for people offering their condolences and the hashtag #depression littered every other tweet. Depression stopped being a hidden illness to be swept under the carpet and became something peoplecould feel confident talking about.
But this hasn’t always been the case. The word “depression” in itself is not a scary word- how many times have you heard someone, or even said yourself, “Oh I’m so depressed!” when what you really mean is “I’m disappointed that I forgot Tesco closes at 4pm on a Sunday”?
Depression has become an everyday word. Pre-fix it with the word “clinical”, however, or add suicide into the equation and you’ve got a whole different story.
I’m a registered mental health nurse and volunteer on a mental health helpline. At least once a week I ask a stranger “When you say you ‘feel like ending it’, do you mean suicide?” And yet, on a personal level it feels uncouth saying the ‘S’-word out loud.
In fact most people I know would be surprised to hear that my life was changed by suicide when I was 18. Just writing that sentence makes me feel like I’ve over-shared, I’ve been back over it again and again, trying to somehow make it more comfortable to write – and more comfortable for you to read.
Yet, if I told you I’d lost someone from cancer, would that be more palatable?
In our open society, with all the doors social media has opened and every topic under the sun being blogged about on a daily basis, suicide remains one of the last taboos. A subject that feels uncomfortable to bring up.
But open discussion is important. It makes it ok for people to ask for help, to express how they’re feeling and recognise that others feel the same.
By openly talking about his illness, Robin Williams has helped us take a huge step towards changing how society views depression and suicide. Even, perhaps, towards depression being recognised for the debilitating, involuntary, and sometimes terminal, illness that it is.
Whenever NHS services are reorganised to offer specialist services in centres of excellence there tends to be a public outcry about the loss of local services, with accusations that the reorganisation is an attempt to cut spending. Local MPs vociferously defend those on their patch – often when the reorganisation is the result of their own party’s policies.
It’s great, therefore, to see the effect of such a reorganisation on stroke care in London.
According to a study published in BMJ, the creation of specialist stroke units and hyperacute stroke units offering quicker intervention and intensive rehabilitation is saving an average of 100 lives a year in the capital and cutting the average length of admissions.
In Manchester, public opposition led to compromise arrangements whereby no hospitals stopped providing stroke care, and only patients presenting within four hours of the onset of symptoms receive hyperacute stroke care. The study found no reduction in mortality, although length of hospital stay was reduced; the researchers estimate that if Manchester had adopted the same approach as London, around 50 lives a year would have been saved.
What’s more, the reconfiguration in London was undertaken at strategic health authority level and took account of the fact that older people tend to live in the suburbs, so the eight specialist centres were spread widely to ensure they were as close to patients as possible.
Although it is too early to say how it has affected morbidity, the study results suggest the rest of the NHS should move to adopt the London model. Perhaps this example can also be used to illustrate to worried members of the public that sometimes, closing beloved local services is the only way to ensure patients get the specialist care they need.
I can’t imagine what it is like to look after someone with ebola but I got an insight last week when BBC news interviewed a nurse who had just seem a baby die from the virus.
On the point of tears she demonstrated care and compassion for her patients but what really struck me was her immense bravery working with a high risk group of patients.
After watching the clip I was left with so many questions about her motivation to work with people with ebola and why she had put herself in such a high risk situation. I was also left feeling guilty that I have never done something as amazing and self-sacrificing.
We can’t all set off to Sierra Leone or Liberia to look after people with ebola, but that short news report made me reflect on what motivated me and others to become nurses and why the system sometimes knocks it out of us.
In the busy and sometimes chaotic world of clinical nursing it can be easy to lose sight of that original motivation.
Sometimes getting the job done is the only achievable goal but as Florence Nightingale said: “The tasks can all be done but the patients receive no care”.
Yet, despite all of the barriers and obstacles, I meet nurses all the time who are doing amazing things for patients. Such as the nurse who organised a singing group for people with COPD and the nurse who made an activity board for her patients with dementia.
Inspirational nurses whose work is guided by the needs of patients. That is how nurses make a difference every day.
Inevitably nurses in some areas such as cardiac care and casualty are more ready than others. Are you ready for such an event?
Months and even years can go by in some wards and departments without the resus trolley and equipment being used. But it can happen.
Someone can have a cardiac arrest in the street and passersby will do all they can to help. The more widespread availability of portable defibrillators – in major railway stations for example — is helping improve survival rates.
Anyone having a cardiac arrest in a healthcare setting – a hospital, outpatient department or GP surgery stands a far better chance of survival. But that does depend on appropriate response from staff on hand.
Every nurse needs to have a good understanding of what is in the resus trolley and how to use it – wherever they work. This familiarity and skill will help to save lives. Of course some specialty areas see far fewer patients in cardiac arrest each year. But the risk is always there and nurses need to be prepared.
To that end we have just published a two-part series on the cardiac arrest trolley. Part one details at the equipment in the trolley to maintain airway management and breathing while part two focuses on circulation and in particular the drugs used in emergency situations.
Don’t wait until it is too late to make sure you and your resus trolley are up to date.
The second I walked onto the ward I knew something was wrong.
I’d been qualified seven months, one of those incredibly keen, yet still incredibly unsure, nurses.
“Hi Fran,” Rachel smiled at me as I walked into handover, ready for the late shift to start. “So… err… Ann and Michelle are both sick. You’re the only qualified on this afternoon.”
She went from being my best friend, who’d just signed off my preceptorship paperwork, to my worst enemy.
I was 22 years old, how could I run a busy acute mental health ward? I wasn’t old enough to make decisions!
Yet for some reason, the trust was happy to let me take full responsibility of the keys and keep 20 patients alive for the next 7 hours and 23 minutes.
A nurse-to-patient ratio of 1:20 is not unusual in mental health, it should be, but it’s not. I survived the shift, as did all my patients, and I got through it the next time it happened, and the next. But the care that I and the three HCAs working with me gave was not what service users should expect.
No-one could use their escorted section 17 leave as the HCAs were permanently on special obs and I wasn’t able to leave the ward in case there was an emergency. I had to cancel the one-to-one sessions I’d planned with my named patients to prioritise giving everyone their medication and when a doctor arrived on the ward and wanted a chaperone while he saw a patient I had to say no, I needed to discuss prn with a service user who was clearly escalating.
In theory, when NICE’s new safe staffing guidelines come into force, this sort of experience will be a thing of the past. Fewer than two registered nurses on a ward during any shift, day or night, will be deemed a “red-flag”. This will “prompt an immediate escalation response”, such as allocating additional nursing staff to the ward.
Some of you reading this will be asking “but where from?” Nurses don’t grow on trees, if one ward is short-staffed, it’s unlikely that another has an abundance of nurses sat around twiddling their thumbs.
But the guidance makes it clear that it is unacceptable for acute wards to be run with fewer than two registered nurses. That acknowledgment is a huge step towards safer wards and safer patients. The red-flag events will still happen, but maybe if they keep being pointed out, trusts will be forced to do something.
Please report your red-flag events. Let your trust know the guidance isn’t being followed. It’s five minutes that you can’t afford to spend on paperwork but if it puts pressure on your trust to make wards safer then it’s worth it every second.
A few weeks ago nurses at RCN congress hotly debated a controversial resolution to introduce a standard charge for GP appointments. Thankfully it was overwhelmingly rejected.
My concern is charging, while dressed it up as an attempt to discourage non-attenders, is just a strategy to control supply and demand.
What happens when a patient with difficult asthma or COPD puts off seeing their GP, ends up in A&E and is admitted with uncontrolled asthma?
The recent report on asthma deaths provides clear evidence of poor outcomes for patients who fail to access services and we need to be wary of putting barriers in their way. We need primary care to be more open and accessible for these patients to prevent them becoming trapped in the revolving door of readmission with its associated costs.
“We have a problem with funding health care, but charging for GP services is not going to resolve it.”
We already see patients rationing their own health care because of worries about prescription charges. GPs and pharmacists report incidents where patient ask to prioritise the most important drugs and take a chance on not taking the others because of costs.
We all have to resist this steady creep towards rationing state-funded health care services and ensure that the NHS remains true to its founding principles of free at the point of access. We need to think carefully about the effects of charging on our most vulnerable patients and for the public health of the nation and make sure we speak up for the people in our care.
We have a problem with funding health care, but charging for GP services is not going to resolve it.
Surely, this will just put pressure on another part of the system. What we actually need is a grown up conversation about how we pay for healthcare through taxation.
But once charging is introduced the system will no longer be universal and those who can afford will benefit most. Is that right? Is it just?