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Putting it into practice

All posts from: October 2011

Is the doctor-nurse game still being played?

31 October, 2011 Posted by: -

  • Article: Holyoake DD (2011) Is the doctor-nurse game still being played? Nursing Times; 107: 43, early online publication.
  • Author: Dean-David Holyoake is a senior lecturer in the School of Health, University of Wolverhampton.

Key points

  1. The doctor-nurse game says that doctors and nurses share a special relationship founded on role expectations based on power, influence and territory. The nursing role showed respect, acted passively and never disagreed with the doctor
  2. In recent years, nursing has aspired to be a profession and take on greater responsibilities
  3. By 1990, the author of the doctor-nurse game said it was no longer being played because nurses were no longer competing
  4. Yet many of those working on the front line believe the doctor-nurse game is still being played
  5. Nursing is more dependent on medicine than ever before and medicine still holds all the cards

Let’s discuss

“Nursing has been so intent and fixated in mirroring medicine that it has turned itself into little more than a clone.”

Do you agree?

To think about:

  • Have doctors tactically delegated tasks to nurses so they can move onto more sophisticated aspects of care?
  • Is it relevant to measure the progress made by nurses in terms of medical functions they undertake?

Follow the debate on Twitter #NTjournalclub

Comments (13)

Why is vocal cord dysfunction frequently misdiagnosed as asthma?

24 October, 2011 Posted by: -

  • Article: Haines J (2011) Diagnosing and treating vocal cord dysfunction. Nursing Times; 107: 42, 18-20.
  • Author: Jemma Haines is principal respiratoryspeech and language therapist, Airways Clinic Services, Lancashire Teaching Hospitals Foundation Trust.

Key points

  • Vocal cord dysfunction (VCD) is the abnormal closure of the vocal cords during breathing, most commonly during inspiration
  • Symptoms are often misdiagnosed as asthma, meaning some patients suffer unnecessary treatment morbidity
  • There is poor awareness and understanding on how to best manage VCD due to a lack of robust prospective research
  • Diagnosis is typically based on case history and laryngoscopy, but pulmonary function tests, such as spirometry, can add further support
  • Patients who have limited, inconsistent or unexpected relief from bronchodilators may have VCD rather than asthma

Let’s discuss

  • Why is vocal cord dysfunction frequently misdiagnosed as asthma?
  • What are the signs and symptoms of vocal cord dysfunction?
  • How would you manage a patient with suspected vocal cord dysfunction?
  • How would you explain vocal cord dysfunction to a patient?

Follow the debate on Twitter #NTjournalclub

Should volunteers feed patients?

18 October, 2011 Posted by: -

Key points

  • Over three million people in the UK are affected by malnutrition and the healthcare costs associated with that exceed £13bn annually
  • In the past 10 years, the proportion of patients being discharged from English hospitals while malnourished has risen by 85%
  • Malnutrition has clinical implications, such as delayed healing, development of pressure ulcers and prolonged hospital lengths of stay
  • Nurse awareness of nutritional screening, as well as using protected mealtimes, can help to maintain the nutritional care of patients
  • Mealtime volunteers can support patients by carrying out simple tasks such as completing menus, opening packaging and encouraging them to eat

Let’s discuss

Using volunteers for feeding

  • Should volunteers feed patients?
  • Are there safety issues and if so, how can these be addressed?
  • What other nursing tasks could volunteers undertake on wards?

Follow the debate on Twitter #NTjournalclub

Comments (6)

What advice would you give a patient who has repeated episodes of hypoglycaemia?

10 October, 2011 Posted by: -

Key points

  • Hypoglycaemia is common and can occur in people with either type 1 or type 2 diabetes who use insulin or oral medications that stimulate insulin production
  • Maintaining well-controlled blood glucose levels can reduce the risk of diabetes complications
  • Hypo-glycaemia is mild if people can treat it themselves, and severe if they require the help of a third party
  • Some patients have “hypoglycaemia unawareness” – they have no symptoms and may lose consciousness without warning
  • Anyone using a treatment that can cause hypoglycaemia should be warned about this risk and when it can occur

 

Let’s discuss

  • How would you treat a patient who you suspect has hypoglycaemia but has lost consciousness?
  • What advice would you give a patient who has repeated episodes for hypoglycaemia?
  • Some patients have “hypoglycaemia unawareness” – they may lose consciousness without warning. How could you support a patient who is told they cannot drive because of this problem?
  • What are the clinical signs of hypoglycaemia?

Follow the debate on Twitter #NTjournalclub

Comments (1)

What advice would you give a patient who has repeated episodes for hypoglycaemia?

10 October, 2011 Posted by:

Key points

  • Hypoglycaemia is common and can occur in people with either type 1 or type 2 diabetes who use insulin or oral medications that stimulate insulin production
  • Maintaining well-controlled blood glucose levels can reduce the risk of diabetes complications
  • Hypo-glycaemia is mild if people can treat it themselves, and severe if they require the help of a third party
  • Some patients have “hypoglycaemia unawareness” – they have no symptoms and may lose consciousness without warning
  • Anyone using a treatment that can cause hypoglycaemia should be warned about this risk and when it can occur

 

Let’s discuss

  • How would you treat a patient who you suspect has hypoglycaemia but has lost consciousness?
  • What advice would you give a patient who has repeated episodes for hypoglycaemia?
  • Some patients have “hypoglycaemia unawareness” – they may lose consciousness without warning. How could you support a patient who is told they cannot drive because of this problem?
  • What are the clinical signs of hypoglycaemia?

Follow the debate on Twitter #NTjournalclub

What do the words “Gypsy” and “Traveller” mean to you?

3 October, 2011 Posted by: -

  • Article: Francis G (2011) Attitudes towards Gypsy Travellers. Nursing Times; 107: 39, early online publication.
  • Author: Gill Francis is health inclusion worker for Travellers and Gypsies at Homerton University Hosptial, NHS Foundation Trust, London.

Key points

  • Gypsy Travellers experience inequalities, and have poorer health than other English-speaking black and minority ethnic groups in the UK
  • Nurses often have a limited understanding of Gypsy Travellers’ culture and issues affecting them; perceptions can be influenced by media stereotypes
  • Bias is a normal survival mechanism; recognising this can make it easier to discuss negative views about a particular group
  • In accordance with the Nursing and Midwifery Council’s code of conduct, nurses must demonstrate a professional and personal commitment to equality and diversity
  • Training can help nurses to challenge negative attitudes, and explore how such views can lead to discriminatory practices

Let’s discuss

  • What do the words “Gypsy” and “Traveller” mean to you?
  • Where do your perceptions come from? For example, are they influenced by your personal experience of travellers or media stereotypes?
  • If a nurse has negative perceptions of a particular group or community do you think this affects the care they give to people from that group?
  • There is often a gap between personally held views and opinions and our public voice and professional practice. Is it possible to compartmentalise personal views from professional practice?

Follow the debate on Twitter #NTjournalclub

Comments (7)

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