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Cancer nurse advises BBC on Holby City

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A consultant cancer nurse from Cumbria has said she is delighted to be advising the BBC about a storyline in a medical drama.

Helen Roe works at the Cumberland Infirmary in Carlisle and West Cumberland Hospital in Whitehaven. She is helping writers and research staff on the programme Holby City with a story that covers the way nursing roles are evolving.

She is using her professional knowledge to tell the team if their story suggestions are realistic and explaining how things might play out in a real NHS hospital.

Ms Roe was one of the first consultant cancer nurses appointed in Britain and has been given a number of accolades, including being named one of the UK’s top five cancer nurse leaders.

She said: “Although I have had many other opportunities and recognition in my nursing career, this really is up there with the best - to be involved in the production of a storyline for a programme I watch. I am really grateful to my colleagues who recommended me for the role, and very much looking forward to seeing the storyline develop on TV later this year.”

Ms Roe said her time working with the BBC is revealing a lot about what goes into making a TV show.

“I must admit I was very surprised at the degree of work which takes place behind the scenes to ensure the storylines are as near to real life as possible, along with how much work goes into producing just one on-screen conversation,” she said.

Discuss this further on our forum! “Should nurses more routinely advise on medical TV programmes?”

  • 20 Comments

Readers' comments (20)

  • michael stone

    I have noticed, that both Holby and Casualty, seem to have someone who understands medical ethics, advising them !

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  • Maybe she can make the portrayal of Staff Nurses in these programmes a little more realistic while she is at it? Perhaps then the general public will see us as highly educated, skilled and qualified professionals rather than servile background furniture, only good for following Doctors orders? Just a thought!

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  • michael stone

    I am straying from the topic, here, but I have noticed that 'mike' pops up all over the place.

    Assuming that mike is a highly educated professional, I would be interested in his answer to a question:

    What is the difference between a death with a DNACPR decision in place, and an 'expected' death ?

    I can't get nurses, to give me their answers re CPR and VoD - do yuo want to give me yours, Mike ?

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  • I think TV series such as Holby needs to show the diversity of nursing roles from CSW right through to Nurse consultant. And when was the last time you saw a student nurse on the ward...?

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  • I find it hard to beleive this programme has any medical advisors at all. And why doesnt this fantasy hospital have any nursing managers? I am sick of the myth that they portray of Doctors being Nurses line managers. They constantly have scenes where Doctors are telling nurses off???!!! Where I work Doctors who tried that would get very short shrift! In fact the way they portray all the staff behaving would have you believe that all NHS staff hate each other. They need to be told most of us actually get along.

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  • Michael, so what if I do? What is your point exactly?

    As for your question, I also assume you know exactly what a DNR is, so I won't give you the definitions. The difference is that with a DNR, which can still be an expected death, the patient, or the patients family if the patient lacks capacity, has made an explicit wish alongside the MDT team, not to be resuscitated if the worst happens. A death where there is no DNR, even if that death is 'expected' to an extent, we are still expected to attempt resuscitation. This is a very basic outline, as there are many issues around this, consent, dignity, law, etc that can be discussed ad nauseum. Now, back to my question, what is your point exactly?

    Sarah, I agree with you absolutely. The realism in these programmes is non existent in terms of how hospitals, and our professions actually work. The problem is, this DOES have a real impact on how our profession is perceived by the general public.

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  • michael stone

    My point, mike, is this.

    The law for CPR decision-making, is essentially the MCA, which in turn is an obvious attempt to allow a patient to exercise his right to refuse an offered treatment, at a time when he is incapable of refusing it directly. Which is true, for patients who are in CPA.

    In theory, someone such a tetraplegic patient who is deeply unhappy with 'his non-life', or someone who is say 80, fairly healthy, but wishes to not wake up in hospital after a severe stroke, should be able to refuse CPR by means of an Advance Decision.

    But, currently he cannot ! Firstly, nobody is willing to put in the guidance for ADRTs, a specified wording which ALL clinicians will accept means 'I am refusing future CPR irrespective of the cause of any CPA - if I am in CPA, I prefer death to resuscitation'. That does not stop CPR from being prevented, if 'I know something he didn't know, when he wrote his ADRT, and which if he had been aware of it, would have meant he would not have refused CPR' (section 25 4 (c) of the MCA).

    Secondly, lots of nurses appear to believe, that DNACPR decisions have a direct connection to the clinical cause of a CPA - this is sheer rubbish, because you consider th eoutcomes of attempted CPR, when you decide if you wish for CPR to be attempted !

    Dorset, in its 2008 CPR policy, included this section (and similar stuff, appears elsewhere):

    Resuscitation should not be commenced if a formal DNR order is in place. This can either be communicated verbally by a Doctor or Senior Nurse (provided that it is also documented on the patient record) or in writing (usually a letter or specific form), signed by a doctor. The decision to resuscitate should relate to the condition for which the DNR order is in force; resuscitation should not be withheld for coincidental conditions.


    What the hell, is 'a coincidental condition' ?

    If the treatment being considered is CPR, the condition is logically CPA - whoever wrote that, beleives that th ecause of the CPA is relevant. Sheer nonsense (unless, for reasons very hard to fathom, the cause of the cause of the CPA has been inserted on an ADRT as a 'qualifying condition').

    The Joint CPR Guidance is currently undergoing revision, and I want it to be correct, and to get the theory right this time. The theory, is simple:

    You do not attempt CPR if:

    1) It definitely would not work for a known clinical reason, or

    2) It is known beyond reasonable doubt, that the patient would have refused CPR, if he could somehow express his refusal whil he is in CPA.

    As far as I can work out, many nurses are confusing VoD with CPR, and do not understand that for the purposes of VoD an expected death 'is a death a GP has effectively promised to certify, in advance of the death'. So, when nurses are verifying deaths at home, all they are supposed to be doing, is checking for a natural death - nurses are NOT supposed to be linking the cause of the death, to the known illness (that, is what the GP would do, if deciding whether to certify the death - nurses cannot certify deaths, and all the are really doing, is confirming death).

    This - as I can testify, from personal experience - affects the way DNs and 999 staff behave when patients arrest or have died (and, not in a good way !).

    I am still arguing about this with all and sundry, but clinical guidelines and protocols are simply wrong for patients who wish to die at home, and I simply do not believe that nurses properly understand the law or ethics/morality !

    Basically, you can ask this question:

    How is a patient saying to his GP 'If I arrest from now on, I don't want you to attempt CPR' any different from the patient saying to a relative 'If you think I've stopped breathing, let me die in peace and don't call anyone until I'm dead' ?

    The answer to that, which you get from 'human beings' or consultant doctors, is 'there isn't any fundamental difference' - but one nurse (an EoLC facilitator, with lots of training and experience) answered 'unless it has been witnessed by a professional, the relative must call someone'.

    I am not happy with this - it annoys me, that training in this area seems to be over-complicated, unclear and not in line with either the law or morality ! It also ignores the fundamental logical point, that if a patient is at home with his relatives, the relatives will often 'know something new first' simply because they are present with the patient.

    The existing guidance is wrong, full stop. It needs to be re-written, with an 'inclusive of family carers and relatives' approach, a 'assume honesty as the default position' stance, and an acceptance that everyone - including amateurs - can only act on what they themselves know when they are faced with a decision to make: currently, it inappropriately emphaises the distinctions between clinicians and non-clinicians, when it should emphaises the distinction between 'people who know enough, and people who are 'external''.

    Sorry about the rant - I get very worked up, by this subject !




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  • michael stone

    Sorry about the typos in that posting - I never can see them, despite looking, until too late !

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  • michael stone

    I have just gone to my e-mail, and cut part of somethign I have just sent to the RCN, in response to a 'non-answer' from them - this bit more-or-less makes sense as a 'stand alone' piece:

    Basically, I just find it incredibly offensive that anyone could doubt that morally (ignoring issues of composure), if your dying or suffering relative explains to you ‘if I’ve stopped breathing, let me die in peace rather than calling someone’, that someone who cares for that person {and cares for the person, more than they care about some ideological principle}, wouldn’t feel obliged to follow that instruction (although I’m not so sure people would be able to be sufficiently composed – but, most people would know they should let their relative die in peace).

    And, if I were the one who was dying, or experiencing the suffering, I would find it incredibly offensive if anyone dared to suggest, that refusing future CPR wasn’t my decision (not something for me to negotiate about !).

    And, it is plainly stupid, to ask a relative, who has seen his loved one stop breathing, ‘Why did he die ?’ – that is definitely, a question for a clinician to answer !

    When you add in the difference between ‘how likely to die’ a patient is, and ‘how much suffering a patient is feeling’ (one a clinical judgement, the other something only the patient can judge) then there is so much separation between clinical and non-clinical factors, that the distinctions your protocols currently make between clinicians and relatives are largely inappropriate and arbitrary. There are necessary distinctions between who can reasonably do what – but anyone should be capable of listening !

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  • Okay, not that I disagree with what you are saying (I don't) I don't understand what relevance your point has to this debate?

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