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Blog: A different sort of firing line

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'It’s another glaring case of ivory tower research that cannot see the wood for the trees'

These days, when I talk about nursing in the firing line, I don’t mean the kind of firing line that greeted Florence Nightingale and Mary Seacole at the time of the Crimean War in the mid-1850s. I mean the kind of firing line they’re more likely to face in Britain of 2008.

Two reports out in the past month illustrate how difficult it can often be for nurses to please those who presume to sit in judgement on them, even if the judges have never had to change a catheter, bed-bath a patient or sensitively deal with someone in the advanced stages of dementia who cannot remember the people around them or where they are.

First, nurses came in for a bit of a battering from the prestigious Joseph Rowntree Foundation. Based on what purported to be research into night-time care undertaken in three Scottish care homes, the report chastised nurses for undertaking too many allegedly ‘disruptive checks’ on their patients during the wee small hours.

But haven’t some nurses in care homes previously been castigated for supposedly not keeping a close enough eye on their patients? If they find someone who has fallen out of bed in the middle of the night, isn’t it a good idea to come to that person’s assistance? If they find a patient drenched in urine, isn’t it a good idea to change the bedclothes, wash the patient and provide a fresh continence pad? Sadly, it’s another glaring case of ivory tower research that cannot see the wood for the trees.

To cap it all, while the JSF report doesn’t want nurses to intrude on patients at night, it’s perfectly happy for outside inspectors to wander round checking up on the nurses. Bureaucrats with clipboards couldn’t possibly be a nuisance to anyone at two o’clock in the morning, it seems.

The second example of nurses under fire came recently in the form of a report by the All Party Parliamentary Group on Dementia, which is questioning what it sees as the excessive use of neuroleptic (antipsychotic) drugs to control aggressive behaviour in patients afflicted with this progressively degenerative condition.

This is the umpteenth report on the subject in recent years. And whether their accusations are spelt out in plain language or not, all these reports imply that nurses are somehow locked in a conspiracy to subject their patients to what campaigning tabloids like to call a ‘chemical cosh’.

It’s very disheartening to the thousands of nurses who, day in day out, give their all to care for those whom society often marginalises. The vast majority of nurses looking after patients with dementia are doing an excellent job in what are often very difficult circumstances.

They would all agree that every patient needs to be treated as an individual and that whether or not they require medication depends on their individual needs and their responses to treatment and care. Undoubtedly, non-pharmacological approaches are usually to be preferred. Best practice guidelines issued by NICE reinforce this point.

Nevertheless, the innuendo that seeks insidiously to undermine the professional standing of nurses is ever-present in the minds of those who presume to lecture others and those who seek to peddle newsprint. There are times when the Russian guns at Balaclava must seem preferable to the preaching of today’s self-righteous custodians of the public good.

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