Practice team blog
All posts from: March 2012
When I was a student there were very few options for dressing a wound; eusol and paraffin, paraffin gauze, hydrogen peroxide or a dry dressing.
And guess what? Wounds rarely healed. The field of tissue viability has developed significantly over the last 20 years and now wound management requires considerable skills including detailed assessment and product selection.
This growth in nursing knowledge is not confined to tissue viability and the challenge is to squeeze more and more into the nurse curriculum so that newly registered staff will be able to hit the ground running.
Happy Newly Qualified Nurses’ Week!
You can read our FREE content on how to manage the transition from student to qualified nurse here
I remember being petrified on my first day as a staff nurse; a different uniform brings an expectation that you know what you are doing, have all the answers and are able to make decisions. You have passed your exams so you must be a competent practitioner.
But registration is just the beginning of the journey to becoming a nurse.
New staff nurses must be nurtured so they not only consolidate their practical skills but are able to live up to the guiding principles and ideals that brought them into the profession in the first place. Failure to give this support leads to frustration, disillusionment and ultimately loss of good nurses from the profession.
Perhaps nurse training just isn’t long enough. Extending it to four years to include a 12-month postgraduate preregistration experience would enable nurses to consolidate their theoretical and practical skills and begin the transition from novice to expert in a protected environment.
This would follow the pattern set by other professional groups. Pharmacy is now a five-year course with a one-year postgrad prereg course where pharmacy graduates gain essential practical experience.
Why can’t nursing replicate this model?
The subject of assisted suicide, it seems, just won’t go away.
Legal cases come up with increasing frequency, in which individuals wanting the right to die at a time of their choosing challenge one aspect or another. In the meantime healthcare professionals appear to be polarised, making it impossible for the associations representing them to develop policies that gain support from a majority of their members.
The latest case to come to prominence is that of Tony Nicklinson, who earlier this month won the right to ask the courts to declare that a doctor can end the “indignity and misery” of his life.
Mr Nicklinson has had locked-in syndrome since, at the age of only 51, a stroke in 2005 left him paralysed and only able to communicate through an Eye Blink Computer. While his body may be helpless, Mr Nicklinson’s mind was undamaged. He now says he is Anyone wanting to gain some understanding of what this means for his quality of life should read the Patient Voice article Mr Nicklinson wrote for Nursing Times in 2011. After seven years Mr Nicklinson wants the right to ask a doctor to end his life without fear of legal redress.
Unless he wins his case and succeeds where others have failed, the law on assisted suicide will almost certainly continue to be challenged by other individuals who are unable to end their own lives but either already find them intolerable or know that a time will come when they do. At present their only option is to refuse food and die a lingering death of starvation.
Of course, if the law were to change, the onus would then move onto the people asked to facilitate assisted suicide. Many health professionals, even if they support the principle of assisted suicide, would not wish to actually administer the drugs that would end these intolerable lives.
I suspect that sooner or later those who argue for assisted suicide will prevail, simply because there will always be another determined individual ready to fight all the way to the highest court. Each time the subject hits the headlines in a way that demonstrates just what such people endure every day, public opinion is likely to shift in their favour.
If and when the law does change, there must, of course, be rigorous safeguards to ensure no one is pressurised to request assisted suicide. However, there must also be support and training for any health professionals willing to accede to such requests – and no professionals must be pressurised to do so.
I was up in Glasgow for the Diabetes UK annual conference last week.
Diabetes is an important topic for nurses - and for us at Nursing Times, one which we marked with our diabetes special that included a range of useful practice articles - after all, there is not many days go by when you don’t meet a patient who has diabetes.
Some shocking statistics about lower limb amputations were revealed. Shocking in numbers and shocking because, for the most part, this is a preventable complication of diabetes. 80% of people who have a lower limb amputation die within five years.
Proper foot care is at the heart of prevention which is why another statistic, that 2% of foot ulcers occur while patients with diabetes are under care in hospital, is important. If foot ulcers can develop under the noses of health professionals then something is wrong.
Diabetes UK launched their Putting Feet First campaign in Glasgow to try to get the message out about the need for better foot care. Nurse education is crucial and our free-to-access online learning unit produced with NICE is part of the solution. If you have not yet done it and want to be part of a better statistic (the number of nurses who are up-to-date on diabetic foot care) then get to it.
As a student nurse I was taught to address patients formally - Mr, Mrs, Miss, Ms - unless they requested otherwise. It was drummed into us that patients must never be labelled as bed numbers or by their diagnosis - “the stroke in bed 4” was deemed unacceptable as were terms of endearment such as “sweetheart”.
I found these rules relatively easy to follow. I had been brought up to address adults formally and it still makes me laugh that my mother never granted permission to use her first name, not even to her children’s partners.
But such rigid social conventions are no longer the norm and walking the line between formality and informality is a difficult one. So, a cautionary tale…
I once nursed a lady, let’s call her Mrs Devlin. Her first name was Elizabeth. She lived alone and had no family in England. She had long-term mental health problems and was very suspicious of nursing staff. Every time I looked after her I addressed her as Mrs Devlin and we got on brilliantly, but some nurses found her uncooperative and difficult.
No one noticed a connection between her name and how she related to staff until her sister visited from Ireland. She noticed that some of the staff referred to Mrs Devlin as Elizabeth. Apparently, from childhood, Mrs Devlin hated her first name and had always refused to answer to it, preferring to call herself Lily. No one asked Mrs Devlin if they could call her Elizabeth and she responded by withdrawing from them. Clearly, an attempt to break down barriers through informality had only created yet a bigger one.
Many nurses ask their patients whether they would prefer to be addressed by their first name or as Mr, Mrs, Miss or Ms. This is a loaded question which perhaps implies that nurses want to be on first names terms, and I am sure many patients feel pressurised to comply with this expectation.
We can never make assumptions about patients and basic social conventions are vital in establishing relationships, particularly when patients feel vulnerable, dependent and emotionally fragile. Patients must retain the right to decide how they are referred to by health professionals and to assume otherwise is disrespectful.