Practice team blog
Some procedures are carried out in hospital wards across the country each and every day with no ill-effect to patients. However this does not mean that because a procedure is common, and generally problem free, that there are no dangers that staff need to watch out for.
One example is the removal of a naso-gastric tube.
Naso-gastric tubes are often used in healthcare and staff are now more familiar with the risks of this method of feeding patients. In the last few years there has been an emphasis on the importance of making sure naso-gastric tubes are correctly placed to avoid serious complications or even death.
Wrongly placed, naso-gastric tubes are a never event for the NHS.
Another potentially harmful issue around the use of naso-gastric tubes is when a tube can become looped or knotted. When removal of the tube is attempted this will cause the patient pain and distress.
As our expert article published this week explains, nurses need to be aware of the possibility of knotting so they know what to do if they experience resistance when removing a tube. As our author makes clear, it is important that a tube is removed in a slow controlled way not whipped out at speed. This will allow any resistance to be responded to and will not result in the knot causing damage. Knotted tubes need to be removed with an endoscopy.
Take a look at our article and have this issue in your and your team’s mind when carrying out this common procedure.
Today, thousands of nurses are expected to take part in industrial action.
Members of Unison, Unite, GMB and the RCM will stage a four-hour stoppage, followed by “four days of action short of strike action”, in which members will stop working during breaks or staying late.
So far, so expected. There’s a lot of anger over the real-term pay decreases nurses have faced over the past few years and the word “strike” has been bandied about for months.
But the fact that really surprises me is that this will be the first time such action over pay has been taken in 32 years.
I’m not surprised that nurses don’t take strike action lightly; you come into this career to do your best for patients and no matter what is put in place to protect them, they will be affected. The characteristics that draw people into nursing are the same personality traits that prevent them from kicking up a fuss.
What does surprise me is the apparent lack of awareness among those making the decisions of just how dire the state of play is for nurses. Nurses are angrier than they’ve been in 32 years.
As Dave Prentis, Unison general secretary, puts it: this government has shown “utter contempt” for NHS workers.
But no matter how bad things get for health professionals, I know from my own experience of working in the health service that it’s often easier to just keep turning up at work, doing your best and going home again. When you’re part of an organisation as huge as the NHS, it’s hard to see that anything you do can make a difference.
Health professionals can often fall into the trap of accepting that pay freezes, short staffing and low morale are just part of the job. Maybe they’ll moan in the staff room but ultimately accept that as one cog in a huge machine, they don’t have the power to influence change.
Is it possible that the government is counting on nurses’ altruistic natures and lack of morale to get away with cutting pay?
If so, then the more they get away with, the worse things will get.
The Nursing Times team will be attending as many hospitals as we can on Monday morning to offer our support and find out first-hand how nurses are feeling. If you’re a member of a union that is striking, please make every effort to be there. You deserve better.
Find out how the profession reached the point of industrial action on our NHS Strike page.
In my job as clinical editor I see the latest trends in quality improvement as hospitals quickly implement the latest policy or idea but I often wonder what happens in the long term when the initial fuss has died down? How often do we see a five or ten year follow-up of a nursing innovation?
Take for example productive ward. Last year the NHS Institute which spearheaded the productive ward initiative closed and many nurses wondered what would happen to the valuable knowledge, experience and support they offered. A few weeks ago I can across an interesting paper which identified an apparent declining interest in the initiative in the UK with fewer evaluations being published.
Does this mean that productive ward has hit the buffers or are trusts continuing to implement the philosophy that underpins this patient-focused innovation but are not publishing the outcomes? I wonder if I walked on a ward today and asked about productive ward would health care professionals describe it as something they did a few years ago when they tidied the cupboards? Would they be able to tell me how it is has continued to develop over time? Or would I just get blank looks?
“The problem is we never really find out what works or why it works”
The same question could be asked about intentional rounding. This initiative was given official backing a few years ago from the prime minister and considerable effort went into its implementation but did it make a difference? Is it still happening?
Considerable investment of time and emotion go into making ideas a reality in busy nursing teams. I am not surprise when nurses become cynical about change when no sooner have they implemented one new idea when policy makers move onto the next thing.
The problem is we never really find out what works or why it works.
What nurses want is change that is going to help them improve care and give them stability. Perhaps it is time to take stock of all the recent quality improvement initiatives in the UK and invest in looking at the long term outcomes because without this information we will continue to go round in circles. If you have been around the health service as long as I have you will know what I mean.
The horrifying ebola epidemic currently running out of control in West Africa seemed a distant problem not too long ago. Voluntary organisations such as MSF and the World Health Organization had been warning for some time that it was rapidly turning from a largely healthcare problem into a social and economic catastrophe, but still it was happening to “other people”.
It was only when western voluntary workers became infected that it began to really penetrate our consciousness. Then a British nurse became infected – and fortunately survived – and the issue really hit home.
This weekend I received a call from a national TV news channel wanting to discuss whether British nurses should be able to travel to West Africa to help deal with the crisis when we have a nursing shortage in the UK. The conversation prompted me to check how UK nurse numbers compare with those of West Africa; I was surprised to find that we’re ranked 47th worldwide, with 54 nurses per 10,000 people – way behind Finland, which tops the table at 222, and runner up Ireland with 185.
But if you really want to talk about nursing shortages, look at the countries affected by ebola: the best resourced appears to be Sierra Leone, with four nurses per 10,000, while Liberia has just one.
The developed world has benefited from centuries of exploiting Africa – it would be nice if this crisis could galvanise us to give something back. That means we should celebrate the fact that over 160 NHS professionals have already volunteered to go out there during the epidemic, but once it’s over we should not simply walk away. The west must help these countries to prevent further outbreaks of ebola and improve general health by helping them to increase the numbers of nurses and educate their populations on how to protect themselves.
After all, it’s not just a moral responsibility – international travel means that if we don’t, ebola could one day be not just a catastrophe for people far away. It could land on our own doorstep.
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: email@example.com
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.