Practice team blog
All posts from: August 2011
Having a clear out at home a few weeks ago I came across an old jewellery box, a Christmas present from my parents some 35 years ago.
The ballet dancer no longer goes round as the key to turn it was lost years ago. Inside was a load of rubbish; earrings without a matching pair, a couple of old bangles, some fake pearls… but at the bottom was my hospital badge.
Finding it brought back fantastic, happy, memories of learning to be a nurse. I trained at Charing Cross Hospital in Hammersmith in the 1980s, and the hospital badge complete with military style ribbon was one of the most distinctive in London. I am happy to argue this point!
I was so proud as a newly qualified staff nurse to get my medal, bringing with it a sense of belonging, achievement and also history.
And the story behind the hospital badge tradition is fascinating – each is unique and personally special to the nurses who wore it.
I recently came across a wonderful article by Sue Sullivan, who explains the history of the Charing Cross medal. She says, “It is rumoured that the bronze metal was from a cannon captured in the Crimean war. The ribbon attached is supposedly from the Colonel in Chief of the Household Brigade, who was thrown from his horse and taken to the hospital. In order to show his gratitude for his nursing treatment, he asked Queen Victoria for the right of nurses at the hospital to wear the ribbon of the regiment.”
Good story, but do badges have any relevance to nurses today?
If I am honest I’m not sure.
I stopped wearing mine in practice as it used to hit patients, often in the face. Some trusts now advise staff not to wear badges for a variety of infection prevention and health and safety reasons. Perhaps moving nurse training away from hospitals to academic institutions, with their own system of honours and awards has made them obsolete. Are they are just part of a bygone age, in which hats, cuffs and aprons kept us in our place? Should they be consigned to the history book as an interesting novelty? Perhaps it doesn’t matter.
Mine is back in the box with fond memories. Secretly I am very proud to own it.
Should you wake patients at 2am to measure vital signs? We posed this question last week in Behind the Rituals and the debate is still going on in Twitterland.
Why did we ask? A few of you thought this was a stupid question. @firstilast gave me the biggest laugh of the week “No, let’s not carry out clinically indicated observations. That way patients get to sleep… for a very long time”.
Good point, but for others the issue is less clear cut.
If a decision has been made to carry out 4-hourly obs then surely nurses are obliged to do them?
As a student nurse I remember making a list of patients who should have their obs done in the middle of the night. Clinical judgement was used and usually involved patients who had just had surgery or were critically ill. Everyone else was left to sleep – which begs the question why 4-hourly obs were needed in the first place.
@AshDuffyHayes suggested the positives of waking patients outweigh the negatives, but others voiced concerns about loss of sleep. @JuliePacker highlighted the effect of disturbed sleep in ITU and this was reinforced by @AgencyNurse who said “it’s all about clinical judgement and should be individual to the patient. Routine obs [can] wait until the pt wakes”.
Many nurses commented on the expertise of the nurse making the decision, using terms such as instinct, clinical judgement, intuition and knowing your patient. Perhaps this is where the answer to the question lies.
Rigorous adherence to 4-hourly observations is probably a good idea for the novice nurse who is still learning and developing skills. In the hands of the expert nurse informed decisions can be taken to prioritise sleep over recording observations. As David Jones noted in his expert comment, nurses should be able to carry out an “end-of-bed” observation without waking a sleeping patient… but they should also trust their instinct and if they feel the patient is deteriorating the question they should ask themselves should be whether four-hourly observation is enough”.
Nurses have to balance competing priorities when caring for patients and the patient’s best interest has to be at the heart of this process. As @ShannonsideTrng says “It depends on the competence of the nurse to judge, therein lies the art and science of nursing!”
One of the reasons I love my job is that it feels worthwhile. I and the rest of the practice team may not be actually delivering patient care, but we are helping you to do so. We do this by publishing double-blind peer reviewed articles, written in plain English by experts in their fields and focusing on the implications for nursing practice.
We often come up against a barrier when inviting these people to write for us - their universities insist that they only write for journals with an impact factor
While many of our authors are nurses working in clinical practice, a substantial proportion work in higher education. However, we often come up against a barrier when inviting these people to write for us - their universities insist that they only write for journals with an impact factor. This is a method of assessing the value of research through the number of times articles are cited by other authors.
The IF has a huge influence on universities’ ability to attract funding for future research, so I can entirely understand their wish to focus on journals with an impact factor. However, nursing journals with a high impact factor tend to be the highly academic or specialist titles. These have small circulations, and few of their readers are likely to be providing hands-on patient care. So a lot of excellent research, with real implications for nursing care and patient outcomes is barely seen by the nurses who could really use it. And the people undertaking the research are frustrated that their valuable work is not being circulated widely.
The method of evaluating the quality of universities’ research is due to change in 2013. From then, universities will have to demonstrate that it has an impact outside academic circles. Quite how has yet to be finally determined, but they are likely to be required to provide case studies. This will involve huge amounts of work on the part of universities, to set up relationships with clinicians who can put their research into practice or track down instances of it being used, then additional form-filling.
It seems to me that a useful addition to the new evaluation structure would be to encourage universities to ensure their research is disseminated to a wider range of publications. Of course I’m biased, I think nurse researchers should be required to submit all research that adds to the nursing evidence base straight to us at Nursing Times. However, I’d settle for them being encouraged to ensure their research is published somewhere that gives it a good chance of being seen by the people who can use it to make a difference.
A large proportion of universities’ research is publicly funded. That means you and I pay for it.
Doesn’t that mean we should benefit from its findings when they could improve the healthcare we receive?
Nurses are not always good at being patients.
I realised that I need to practise being a better patient after a recent visit to the doctor with a foot problem.
I had done my usual thing when I have an ailment that needs medical attention. First, I gather together information, some of it up to date and some not, and then supplement it with background info from the internet.
Using that combination, I will then decide whether it is worth going to the doctor and, a significant percentage of the time, will decide nothing can be done and so will stay at home. If I do decide that a visit to the surgery is worthwhile, I will go with a preconceived idea of what action will be taken.
I discovered last week that my approach is not doing me any favours.
Having had my sore foot for some time, deciding that it would be a waste of time to go as the evidence base was not in favour of steroid injections, etc, I did finally go to see the doctor. And he came up with a solution, and a good one, that I had not anticipated. A simple soft heel pad that could be bought from the chemist and time will do the rest.
Thank you for asking – yes it is gradually getting better.
I am not really sure why I have decided that my ‘knowledge’ will be better than that of the expert who is paid to keep up to date with treatments for common problems in primary care.
So that’s it, I am letting go.
I am going to pretend I’m going to the hairdresser, not the doctor. Instead of triaging myself I am just going to look in the mirror and think – someone needs to do something about that - just show up and let the expert do the rest.