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Practice team blog

All posts from: July 2012

'Nothing in nursing is really simple; comprehension of its complexity is vital'

30 July, 2012 Posted by: -

Like many of you who commented on the story on this website, I question whether the staff had grasped the significance of their patient’s diagnosis.

After all, if they did understand the implications of diabetes insipidus they should have been able to give Kane the care he needed. If not, they had a responsibility to get the information they needed to ensure his care was safe and effective.

When a student, I was told never to give a drug unless I knew the indication, contra-indications, side effects and normal dose; the same went for understanding a patient’s diagnosis and treatment. Indeed, if you don’t truly understand what is wrong with your patient - the underlying anatomy, physiology and pathophysiology, then how can you look after them? Without this knowledge, nursing is nothing more than tasks - and tasks without understanding are dangerous things.

Which brings me to skill mix. Recent data from national nursing research unit suggests the average proportion of registered nursing staff - compared to unregistered healthcare assistants - on day shifts is 56%. This places the onus on the registered nurse to ensure that HCAs carrying out day to day care, such as fluid management, understand the significance of patient diagnosis. This is probably easy when staffing is stable and patients are on appropriate wards, but what happens to patients who have multiple and complex conditions?

It is often claimed in the media that anyone can give someone a drink but it’s not “simple” for someone with diabetes insipidus. Anyone can wash someone but it takes a bit more thought if a patient has a fractured neck of femur. Anyone can help someone to eat but not if they have dysphagia. Nothing in nursing is really simple which is why delegation has to be managed carefully and nurses given time to ensure those giving care, who often are not nurses themselves, understand the significance of what they are being asked to do.

Comments (49)

'The time that students offer to patients can be invaluable'

23 July, 2012 Posted by: -

In this time of stretched resources and staff cuts, student nurses can provide an extra element of care for patients.

I was watching a student nurse recently carrying out mouth care and her inexperience and nervousness about this new skill meant that she carried out the task carefully and slowly.

The patient was obviously enjoying the attention and slower pace of the care. The student nurse grew in confidence and had made a good relationship by the end of the procedure.

Student nurses are a valuable resource and often have a little bit more time to offer patients which they will value. And although they move around they become recognised members of the hospital staff.

My mother recently went back into hospital and greeted a student nurse that she had met on another ward a few months earlier like an old friend.

Student nurses are invaluable members of the team who although inexperienced can offer time and a different dimension of care.

We celebrated the importance of student nurses in our first Student Nursing Times Awards – an event that  was so uplifting and reassuring about the future of nursing that we are already planning next year’s event.

'Whistleblowers need a supportive stance to be reflected in UK law'

16 July, 2012 Posted by: -

The recent news that pharmaceutical giant GlaxoSmithKline had received a record-breaking fine for fraud grabbed my attention.

The company admitted to offering doctors regular golf lessons, fishing trips, and basketball tickets while promoting the use of an antidepressant drug for use in children - a use for which it was unapproved. It also and failed to report safety data about a diabetes drug, as well as improperly marketing other drugs. As a result, it was fined an eye-popping $3bn.

As I listened to the story I felt a familiar mix of anger and resignation that wells up when the increasingly frequent examples of corporate misbehaviour hit the headlines. But then the story took another turn, which really piqued my interest.

The illegal activities came to light because an employee blew the whistle. Greg Thorpe raised concerns over the ethics of the company’s business practices with senior managers back in 2001. He was forced out of the company for his pains. So far, so familiar.

But the story didn’t end there - Mr Thorpe took his concerns to US regulators. And far from burying the issue, they spent 10 years getting to the bottom of the story. And here’s where Mr Thorpe’s story differs from those of so many UK whistleblowers. In the US, whistleblowers receive a share of any money recovered by federal government as a result of their disclosures. Yes, you read that correctly - in the US you can actually benefit from bringing to light corporate lawbreaking.

How different from the UK, where whistleblowers are routinely harassed, maligned and disciplined, many having their careers blighted and their mental health destroyed - and often for raising concerns that do not even involve lawbreaking but simply practices that need to improve. If they do receive any money it is in the form of a gagging clause to ensure their information does not reach the public domain.

Yes, Mr Thorpe lost his job, but at least the law in the US takes a more supportive stance towards whistleblowers. Perhaps if we had a similar law here in the UK employers would feel less inclined to protect themselves by destroying the credibility of whistleblowers, and more prepared to learn from the valuable information they disclose.

Comments (38)

'It can be hard for acute units to change their mindset to care for the dying'

9 July, 2012 Posted by: -

A report has found that relatives and carers are less satisfied with the experience of having a loved one be cared for in an acute hospital setting than in a hospice or at home.

The DH commissioned survey found that bereaved family members found that 87% of doctors and 80% of nurses in hospices showed dignity and respect “all the time” but that in hospitals this fell to 57% for doctors and 48% for nurses.

 Marie Curie Cancer Care and National Council for Palliative Care and the Dying Matters Coalition rightly call for better end-of-life care and express disappointment  that increased training has not improved care.

Sadly the reality is that the dying person will be unlikely to  receive the same quality of care in the acute setting as they do in a hospice but there is a reason for that.

Hospices’ work is focused on and dedicated to the physical, emotional, spiritual and social needs of those with a life-limiting or terminal illness. Acute units are dedicated to preserving life and striving to get patients well enough to be discharged.

As a result it can be hard for acute units to change their mindset to care for the dying. Acute units are busy noisy places that are struggling to provide the level of care they aim to with the current level of resources.

It can be hard for staff working in acute care to accept that a patient is not going to survive. Nurses can feel that they have ‘failed’ and so they can be reluctant to redirect the energy of their work away from preserving life to ensuring that a dying person is comfortable.

Surveys like these should not be used to criticise staff for their shortfalls but should be used to enquire why the system is not working. Issues such as these are generally a system failure not that of individual staff.

Hospital nurses need support and resources to be able to offer end-of-life care as it requires significant skills offer to such care within the often frenetic life that is the acute ward.

Comments (11)

'When I first heard about the family and friends test I was sceptical'

3 July, 2012 Posted by: -

Last week my new neighbour asked if I could recommend my GP practice.

Yes I did recommend it but the recommendation came with clarifications about which GP was good with children, which one listened and which was quick if you had something fairly straight forward. Not a simple “yes” or “no” answer.  

Currently the NHS is asking patients whether they would be happy for their friends and family to be treated by their service in a test which will be used to compare trusts’ performance. These so called net promoter scores are used in the independent sector to measure the quality of services in competitive industries.

When I first heard about the family and friends test I was sceptical. Is it possible to measuring satisfaction with healthcare in the same way as buying a tin of baked bean or getting my car serviced?  My scepticism was confirmed last week when research raised doubts about the “friends and family” test as a single indicator of patient experience.

The research published by the Picker Institute Europe and Care Quality Commission found that people didn’t understand what they were supposed to be recommending, and “some interviewees gave high scores despite describing very poor experiences to the interviewer”.

Researchers did find one question which worked well, in which patients were asked to score their overall experience of care from “0 (I had a very poor experience) to 10 (I had a very good experience)”.

It seems to me that NHS is continually searching for new ways of asking people about their experiences of healthcare. But why roll out a scheme like this and then do the research to find out if the right question is being asked?

Front line staff need to know how they are doing and if they are getting it right for the people in their care. Net promoter scores tick the box labeled consumerism but considerable time and effort goes into collecting this information and if we are asking the wrong questions the information is useless both to patients and staff.

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