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Face masks rarely deliver 100% oxygen
I would like to make some observations following the article on conventional non-rebreather masks (NT Clinical, 7 August 2007, p26).
While a tight-fitting mask with no side ports should be able to deliver 100% oxygen, commonly quoted values acknowledge that some dilution does occur, although this is rarely quantified and is assumed to be minimal.
However, in the US it is not uncommon to see an anti-suffocation port with a valve removed for patient safety, creating a substantial source of room air dilution that cannot easily be countered with increased oxygen flows.
Many healthcare providers are taught that conventional ‘100% NRMs’ can deliver close to maximum oxygen levels but there is little independent evidence to support manufacturers’ claims – in fact studies suggest significant dilution often occurs.
Inadequate oxygen therapy can increase shortness of breath, which exacerbates room air entrainment. The effect of room air dilution through NRMs is significant, especially when a patient is short of breath.
While these masks perform suitably in many cases, patients who continue to deteriorate may benefit from more advanced oxygen delivery systems.
Ted Reesor
Respiratory therapist

Care roles are blurring but are still different
RGNs do more than hand out pills and write things down (NT Opinion, 18 December, p13).
I work as a staff nurse on a colorectal surgical ward. A senior HCA and myself share responsibility for recording care and communicating that care to the oncoming shift. However, I have overall responsibility so I have to be well-informed about all the patients.
While I am giving medication or attending to medical issues, the HCA is busy giving fundamental nursing care.
Very often, when I do attempt to wash and mobilise patients, constant interruptions mean I become frustrated and they get cold. It seems that the cost of employing more RGNs so they could become more hands-on would be too great.
It concerns me that HCAs are not involved with medication as much can be learnt about conditions and nursing needs from this. However, were HCAs to administer medication, the line between HCA and nurse would be even more blurred.
David Salvage

Get the facts rights on missed appointments
I wonder if Rob Harteveldt has looked into why his patients miss appointments (NT Opinion, 18 December 2007, p10).
Did the patients actually receive appointment letters or did letters arrive after the consultation date? This is not as unusual as you might think – I have experienced both. From letters in the local paper and talking to people, I believe problems with administration are common.
So, before labelling patients as ‘did not attend’, check they received their letters. Missed appointments might be a matter of life or death for a patient.
Sally Kendall
Retired nurse teacher

Profession is promoted by Queen’s Nurse title
Drew Payne questions the need for the Queen’s Nurse title (NT Opinion, 11 December, p12).
To become a Queen’s Nurse, I had to submit a comprehensive package demonstrating how I had influenced and changed practice in primary care.
Yes, I got myself noticed and gained recognition of my clinical expertise. I see my role as a leader influencing nursing and care in all settings.
I am proud to be a Queen’s Nurse as it provides me with opportunities to develop nursing. I will continue to push for recognition as dermatology needs all the attention it can get. I make no apology for being who and where I am.
Sandra Lawton
Nurse consultant dermatology,
Queen’s Medical Centre, Nottingham University Hospitals NHS Trust

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