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'Nurses need to know their patients and make informed decisions'

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Over the summer I watched the BBC TV drama Trust Me, which depicted a whistleblowing nurse adopting the false identity of a doctor and taking a middle-grade medical job in the emergency department. 

The writer – who is a doctor – noted that many experienced nurses often know more about their specialty than any newly qualified doctor, and many doctors rely on nurses for support in the early days of a new job. However, knowing what should be done and actually doing it are two different things.

During the first episode the fake doctor panics when she is required to put a chest drain in, and I found myself shouting “Go for the fifth intercostal space”. I do know a bit about chest drains but that does not mean I could actually insert one into a critically ill patient.

There is, and has always been, an overlap and sharing of knowledge at the boundaries between medicine and nursing – and these boundaries are changing constantly. As nurses take on new roles involving diagnostic decisions and treatments – such as prescribing and interpretation of X-rays and blood results – the knowledge base for pre-registration students has to change to reflect these new responsibilities.

Nurses need to understand the implications of common blood results and in this archive issue I have selected an article that provides useful revision on urea and electrolytes. This blood test provides essential information on renal function, principally in terms of excretion and homoeostasis; the article is one in a series of articles on routine blood investigations. You may also find it useful to read our recent article on homoeostasis, which includes a self-assessment test so you can assess your knowledge.

Near-patient testing plays an important role in ensuring rapid diagnosis and treatment. Developments in portable bladder ultrasound technology means that suitably trained nurses can now diagnose problems with urinary retention and avoid invasive catheterisation. The second article in this issue looks at the advantages of ultrasound scanning over catheterisation, and gives an overview of the indications and contraindications of the procedure.

Our third article looks at fluid balance and why accurate measurement is essential. This is a core nursing skill but it is generally acknowledged that recording of fluid balance is frequently poor. Recent research published in Nursing Times questioned nurses’ ability to accurately estimate fluid volumes – something you do every day when patients drink from a glass or cup.

These three articles inform each other. For example, a patient with dehydration may have abnormal urea and electrolyte results but these abnormalities may also be present in a patient with chronic retention of urine.

The skill of nurses is knowing their patients and being able to make decisions that are informed by an holistic assessment and a firm grasp of underpinning theory and knowledge.


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