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ISSN 1361 -4177
Vol. 10 - Issue 8
SCOTTISH
NURSE
Infection Control
part 1
Care Planning
in long-stay care
ECG Rhythms
part 3
Drugs Feature
part1 Anticoagulants
Nutrition & Obesity
‘Fat Happens’
Trauma Management
part 1
Libya Sentence Doctor & 5 Nurses to Death Pages 6&7
Recruitment section
General
& Overseas
www.scottishirishhealthcare.com
1
Contents
4
News
International and local news
14
What’s On
Find out what’s on in and around your area
18
Infection Control part1
Routes of transmission
22
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Part 3 in this series of ECG rhythm recognition.
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Managing Director: Jim Brown
Distribution Manager: Jim Brown
News Editor & Design: Hamish Bell
Clinical Editor: Charlie Bloe
Assistant Clinical Editor: Scott Kane
Admin Manager: Heather Robertson
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Wound Care & treatment
Minimising the risk of further skin damage
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SCOTTISH
NURSE
Published by:
Strathayr Publishing Ltd
Gibbs Yard
Auchincruive Estate
Ayr
Ayrshire
Scotland
KA6 5HN
ECG Rhythms ...Without the Blues!
Care Planning
Long stay care of the older person
30
Mental Health
A brief overview of BPD
32
Drugs Feature
Anticoagulants
33
Nutrition & Obesity
‘Fat Happens’ by Anne Diamond
34
Trauma Management part1
Disturbing & traumatic events commonly dealt with by nurses
36
Sexual Health
Clamydia is at a party near you
41
Product Focus
41
Recruitment
General & Overseas
46
Education & Training
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articles to appear in our publication. Please send your editorial, news articles, event details,
press releases etc., to the Editor at the address opposite.
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3
Better prevention, more local care and improved support to help
aid recovery are to be the focus of mental health services in the
future, according to a delivery plan Delivering for Mental Health
published today.
There are also to be a new set of high-level targets to provide
better care in the community by cutting back on the increase
of anti-depressant prescribing by supporting people in different
ways, and reducing the number of people with mental ill-health
who need to be re-admitted to hospital.
Deputy Health Minister Lewis Macdonald said:
“Improving mental health services in Scotland remains a top
priority for the Executive. We have made significant progress in
improving services and reducing stigma around mental ill-health
but we now want to take this further.
“Our new wide-ranging plan will change the way mental health
services are delivered in the future so there is a focus on better prevention, more local care and improved support to help aid
recovery.
“It is vital that services are sensitive to people’s individual needs
and focus on social inclusion so people feel able to seek help
earlier. Improvements to access and quality of services will meet
the needs of everyone, from the quarter of the population who will
experience mild to moderate mental ill-health in their lifetime to
the two per cent of people who will experience severe and enduring mental illness.
“Children and young people’s mental health needs are a priority
too and we have set out a commitment for everyone working with
or caring for children to have basic mental health training by 2008.
We are also committed to halving the number of admissions of
children and young people to adult beds by 2009.
“We have also set ambitious new targets of reducing anti-depressant prescribing and repeat hospital admissions for mental illness
by 2009. NHS Boards working with their partners have several
years to make the necessary service changes to help them meet
these targets, such as developing more talking and psychological
therapies.
“We will invest £2.5 million of new money to help implement the
Plan and we are working with NHS Education for Scotland to
enable mental health staff to gain the skills required to offer more
talking and psychological therapies.”
Dr Tom Brown, Chair of The Royal College of Psychiatrists in
Scotland, said:
“The plan, as well as the new targets, underline the Executive’s
increased emphasis on the importance of the promotion of good
mental health and the care and treatment of the mentally ill. We
wish to collaborate with the Scottish Executive to take this plan
forward.”
The mental health delivery plan seeks to integrate mental health
services into the core work of the NHS. There are two new targets
which are:
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• To reduce the yearly increase in the prescribing of
anti-depressants to zero by 2010
• To reduce the number of hospital re-admissions by
10% for people who have already had hospital
admission of over seven days (within one year) by
the end of December 2009
There is also one existing target (of reducing suicide rates by
20percent by 2013) and collectively these targets are designed to
introduce service change and benefit patients. There are also 14
commitments that cover areas such as increasing assessments
of patients’ mental and physical health needs, more mental health
and suicide prevention and awareness training for key staff and
more community care.
NURSES CALL FOR NEXT GOVERNMENT
TO MAKE CHILD HEALTH PRIORITY
RCN Scotland has called on Scotland’s next government to
make child health a national health priority. Speaking today
(Wednesday) at a briefing to MSPs following the launch of their
Manifesto for Nursing and Health, Scotland’s largest nursing
union challenged politicians to tackle the health challenges facing
the nation’s children and young people.
The call comes as Scottish Executive statistics show that 1 in 5
Scottish children are overweight, 1 in 10 has a mental health
issue and over half of the children who have had a drink in the
past week have also used drugs.
RCN Scotland Board Chair, Jane McCready said: ‘The health of
Scotland’s children and young people is clearly of central importance to the future health of the nation. The Scottish Executive
and Scottish Parliament have given children’s health a great deal
of attention since 1999 and a number of policy initiatives have
been introduced. However, there is much still to do.
‘Children growing up in our most deprived neighbourhoods are
particularly at threat from a life of ill-health. In order to give
Scotland’s next generation the best possible start, Scotland’s
next government must make child health a national health priority.
Giving it such status will ensure that current policy initiatives are
translated into co-ordinated national policy and investment as well
as local action and change.’
‘To help support this priority and ensure it has a positive impact
on the wellbeing of children and young people, RCN Scotland
is also calling for a review of children’s nursing. The continuing
contribution of nurses to the welfare of school-aged children must
also be recognised and grown.’
Paula Evans Parliamentary Officer at Children in Scotland added:
‘Children in Scotland welcomes RCN Scotland’s call for child
health to be a national priority. Our own manifesto published in
August, also calls for this change. We believe that improving child
health through joined up and well resourced policies should be
the priority for the next Scottish Parliament and Executive. It will
improve the health of children now as well as in the future.
News
Kidney Units Turning Away
Patients Despite Concerns
Supplied by Richard Hoey Clinical News Editor of Pulse
Hospital kidney units are so overwhelmed with work they are
being forced to send patients back to their GP despite concerns
over whether they will be properly treated, a Pulse investigation
reveals.
Pulse found new incentives for GPs to pick up and treat chronic
kidney disease had swamped hospitals with a huge increase in
referrals – up by an average of 2.5-fold since April. But 71 per
cent of renal units say they are not sufficiently
resourced to cope with the increase. Almost all are refusing to
see many patients GPs refer to them – with some renal units
sending back as many as 70 per cent of cases.
Some 29 per cent of the 24 renal units surveyed say they are
forced to send back patients even though they have concerns
over whether GPs have sufficient specialist knowledge to manage
the cases.
Renal specialists described the rise in referrals – by up to five-fold
in some cases – as ‘phenomenal’.
Dr Izhar Khan, consultant nephrologist at Aberdeen Royal
Infirmary, told Pulse: ‘There has certainly been an increase in
referral rates. We are not adequately resourced to meet the
increased burden. A lot of patients with normal excretory function
will be wrongly medicalised.’
Jo Haynes, editor of Pulse, said: ‘This is a mess entirely of the
Government’s own making. GPs are now expected to detect and
treat huge numbers of patients with early signs of kidney illness
– but with very little idea about how to look after them.
HSE Launches 2006/2007 National
Flu Vaccination Campaign
The Health Service Executive has launched the 2006 National
Influenza Vaccination Campaign and is urging people to get
vaccinated against flu without delay. The vaccine is provided free
of charge for the key risk groups:
• Everyone aged 65 and over
• People with a chronic illness
• Health Care workers and carers who have
direct patient contact.
A National public awareness campaign including advertising
and information leaflets goes live today and there is also a
specific campaign for health care workers.
Further information is available on www.immunisation.ie or
from your local health office.
Flu is highly infectious, and many people do not realise that the flu
virus changes every year - so new vaccines have to be developed
each year to protect against each new emerging strain.
All those at risk should get the flu vaccine this year to ensure
that they are protected, said Dr Pat Doorley, National Director of
Population Health, HSE.
Additional supplies of flu vaccine have been secured for this
years�TMs campaign. The vaccine is free to all persons over 65
and for people with long term illnesses, like heart, lung or kidney
disease, diabetes, or people with a suppressed immune system.
In addition the vaccine is recommended for health care staff and
carers who have direct patient contact.
‘As a result the number of referrals has shot through the roof, but
with no new money to deal with the extra workload, renal units
are creaking under the strain. There’s a real prospect that some
patients who do need specialist treatment will miss out.’
She added: ‘The Government should have phased in the new
management of kidney disease much more gradually, trained up
GPs properly in advance and ensured renal units were properly
resourced.’
Prime minister Tony Blair has defended his government’s
controversial NHS reforms, saying that service is improving.
Addressing the NHS Confederation, Mr Blair said that if healthcare workers stayed “steadfast” to the changes then the service
as a whole and patient care would improve.
He also compared the service to that of a decade ago and said
that there had been real improvements.
Mr Blair said: “We are in the decisive phase of reform. This is the
watershed moment, when we pass from one type of system to
another.”
“At times the way capacity is provided may be changed. I don’t
minimise the importance of that. But we do need to make the case
for these changes.”
Hospitals are closing due to an effort to put services in the local
communities, not because of the NHS’ financial troubles, added
Mr Blair.
Much of the government reform of the service has taken the form
of taking more services out of hospitals and localising them within
communities.
www.scottishirishhealthcare.com
5
News
In a joint statement about today’s decision
by the Libyan court, the International
Council of Nurses and the World
Medical Association said:
that these children were infected well
before the medical workers arrived at
the hospital.
‘How many children will go on dying
in Libyan hospitals while the
government ignores the root of the
problem ?’ ‘If there is any hope of
justice for these nurses and this doctor,
we appeal to the Supreme Court to
again quash these death sentences.’
‘We are appalled by the decision of
the Libyan court to sentence the five
Bulgarian nurses and the Palestinian
doctor to death. Today’s decision
turns a blind eye to the science and
evidence that points clearly to the fact
The Doctor and 5 Nurses have been in detention
since 1999, during which time 52 of the 426 infected
children have died of Aids.
Medical experts including the French co-discoverer of
the HIV virus had testified on behalf of the medics.
And the World Medical Association and the
International Council of Nurses said Tuesday’s
verdict ignored scientific evidence.
The nurses and doctor were sentenced to death
in 2004, but the Supreme Court quashed the
ruling after protests over the fairness of the trial.
The defendants say they are being made scapegoats for
unhygienic hospitals.
Defence lawyers said the medics would appeal against the
new verdict, expected to be the final appeal allowed under
Libyan law.
The defence team told the court that the HIV virus
was present in the hospital, in the town of Benghazi, before the nurses began working there in 1998.
Western nations had
calling for their release.
backed
the
medics’
case,
Bulgarian officials quickly condemned the verdicts. Foreign
Minister Ivailo Kalfin described the ruling as
“deeply disappointing”.
EU Justice Commissioner Franco Frattini expressed his
shock at the verdict and urged the Libyan authorities to
review the decision.
Oxford University in the UK said the verdict ran
counter
to
findings
by
scientists
from
its
Zoology Department.
A research team had concluded that “the subtype of HIV
involved began infecting patients long before March
1998, the date the prosecution claims the crime began”,
a statement from the university said.
Libya has asked for 10m euros (£6.7m) compensation to
be paid to each of the families of victims, suggesting the
medics’ death sentences could be commuted in return.
But Bulgaria has rejected the proposal, saying any payment
would be seen as an admission of guilt.
Concluding a retrial regarded by the outside world as a
test of justice in Libya, the court will make a decision that,
either way, is likely to have repercussions on the north
African country’s gradual rapprochement with the West.
were
The six are accused of intentionally infecting 426 Libyan
children with HIV at a hospital in Benghazi in the late
1990s. The prosecution has demanded the death penalty.
Some cried out in court as the verdicts were delivered,
while others were gathered outside carrying banners.
“We are fully confident that the accused group is criminal and will be convicted,” Ramadan Faitori, a spokesman for the HIV-infected children’s families, told Reuters.
Tsvetanka Siropoula, the sister-in-law of one of the
convicted nurses, told the Reuters news agency
that the sentence of death was to be expected.
Defence lawyer Othman Bizanti told Reuters: “No one can
predict the verdict.A just verdict would represent the real and
legal truth, which we presented to the court in our pleading.”
“I am sure they will be released, but it will take time. It is
so sad that so many years have passed and they are
still in jail.”
Rights groups the world over have rallied to the medics’
defence to stop what they say may be a miscarriage
of justice.
Contested Evidence
The medics protested their innocence throughout the
case, retracting confessions that they said were obtained
under torture.
But in Benghazi, where more than 50 of the infected children have died, there is profound public anger
against the nurses and international efforts to free them.
Parents of the infected
happy with the verdicts.
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children
said
they
News
The Bulgarian nurses and the Palestinian Doctor wait for the verdict
State-controlled media want a guilty verdict for the six,
who have been in detention since 1999.
“We say to everyone: Our children’s blood is precious,”
Aljamahirya newspaper wrote.
A group of Libyans demonstrate their approval of the verdict in the case
The case has hampered Tripoli’s process of rapprochement
with the West, which moved up a gear when it abandoned its
pursuit of nuclear, chemical and biological weapons in 2003.
Al-Shams newspaper wrote: “It’s very difficult to understand
the stance of those in solidarity with the accused.”
But analysts say freeing the defendants would put the
focus on alleged negligence and poor hygiene in Libyan
hospitals, which western scientists say are the real
culprits in the case.
“Who deserves greater reason for solidarity -- The children
who are dying without having committed any offence,
or those in white coats who distributed death and
wiped the smile from the lips of hundreds of families?”
Bizanti has said that in 1997 -- a year before the nurses came
to Libya -- about 207 cases of HIV infection had been found
in Benghazi that had not resulted in any legal proceedings. He
has questioned why the authorities have not followed them up.
U.S. Assistant Secretary of State David Welch, who helped
negotiate a full resumption of diplomatic relations between
the United States and Libya, arrived in Tripoli on Friday and
discussed “issues which hinder improvements in relations”
with Libyan officials, the Libyan news agency Jana reported.
In June 2005 a Libyan court acquitted nine Libyan
policemen and a doctor of torturing the medics.
It gave no details. Welch has previously said a way
should be found for the nurses to return home.
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Washington backs Bulgaria and the European Union in
saying the medics are innocent. Libya has proposed
compensation which it says would open a
way for a pardon and the medics’ release.
Sofia and its allies reject that proposal.
Scottish Nurse Magazine has set up a financial fund to help towards the costs of the defence
and appeal of both the nurses and doctor in what we consider to be a gross miscarriage
of justice.
These Nurses and Doctor are being used as pawns in a game of political chess.
We are calling on all members of the healthcare profession to send us a contribution no matter
how small to help towards the legal costs and the immediate families of the nurses and doctor involved.
Send messages of support to:
www.mfa.government.bg
(please, note there is a link to
the English version of the website).
Scottish Nurse Magazine is donating
50% of all our January & February Advertising Revenue
from advertisers who wish to support our campaign
All cheques should be made payable to;
Global Media & Exhibitions (Bulgarian Nurses)
Gibbs Yard
Auchincruive Est.
Ayr
KA 65HN
Scotland
www.scottishirishhealthcare.com
7
News
National Occupational
Therapy week
As part of National Occupational Therapy Week, NHS Ayrshire &
Arran visited local colleges to raise the profile of, and to promote
occupational therapy as a career.
Local occupational therapists visited Ayr College, Kilmarnock
College and James Watt College in Kilwinning and met with
students interested in the profession. Similar events are
happening all over the UK as part of the annual event run by
the College of Occupational Therapists.
Occupational therapists help people who are unable to do the
things that are important to them – such as preparing a meal,
working, or undertaking a favourite hobby due to illness, disability
or the effects of ageing. There are over 26,000 qualified
occupational therapists in the UK.
Morven Gemmill, Head of Service for Occupational therapy
commented: “Being an occupational therapist is a fantastic
profession, helping people to lead more independent and
rewarding lives. There are great job opportunities for
occupational therapists working in hospitals, social care,
schools and charities. We hope that by providing information
more people will consider occupational therapy as a career.”
Further details can be found on the College of Occupational
Therapy’s website: www.cot.org.uk
Scottish Arthritis Patients
Get the Upper Hand
Britain due to this disease, the equivalent of £833 million in lost
production.
“Up to 30% of patients do not respond to, or cannot tolerate
anti-TNF therapies, which are drugs currently used in treatment
of severe active RA. MabThera provides these patients with an
alternative treatment option. This is a very effective treatment for
people with severe forms of RA so it is great news that patients
in Scotland will now have full access to the drug.” said Dr David
Marshall, Consultant Rheumatologist at Inverclyde Royal Hospital.
Although MabThera was licensed for use across the whole of the
UK in July 2006, it is only now being reviewed by the National
Institute for Health and Clinical Excellence (NICE) with a decision
expected some time next year, which means that for the time being, many doctors may be unable to prescribe it. SMC consistently
publishes decisions on new medicine close to the start of their
license, whereas NICE often takes a year or more.
A group of brave nurses from the Psychiatric Intensive Care
Unit at Ailsa Hospital are planning to pedal the 23 miles across
the Irish Sea to Northern Ireland. What started off as a joke has
turned into the ultimate challenge as the team will attempt to
pedal from Portpatrick in Dumfries and Galloway to Bangor in
County Down.
Through a number of fundraising events the group is aiming to
raise at least £10,000 for the charities CLIC Sargent and the
Cardiomyopathy Association.
Stewart Main, Nursing Assistant and Project Manager explains:
“We have been very fortunate so far as we have obtained
sponsorship from various companies and attracted attention
from all over world.”
The intrepid crew spotted a boat for sale on the internet. When
the owner heard of their worthy cause he kindly donated the boat
to the team and even transported it half way to Scotland from
Birkenhead. The boat is currently in Fairlie Quay Marina, where it
is being converted to pedal power. The team are also in training
for the challenge, which will hopefully take place in May 2007,
weather permitting.
SMC beats NICE to a decision on another potentially
life changing treatment
Today’s decision by the Scottish Medical Consortium (SMC) to
approve the use of MabThera®(rituximab), for the treatment of
adults with severe active rheumatoid arthritis (RA), marks yet
another decision which has provided Scottish patients with access
to treatments currently denied to patients in some areas across
the border.
There are an estimated 35,000 people in Scotland living with RA.
The disease can cause severe pain, extreme fatigue, disability
and has a significant impact on peoples’ social and working lives.
Between 1999-2000, 9.4 million working days were lost in Great
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Derek Cobb, Stewart Main, Ronnie Holmes of Fairlie Quay Marina, and Alan Ramsay
Dr Allan Gunning, Chief Operating Executive comments: “We are
happy to support the team in this very unique challenge and wish
them all the best with their fundraising events.”
More information on the challenge and details on how to make
a donation can be found on their website www.pedalochallenge.
co.uk or by contacting their Project Manager Stewart Main on
[email protected].
News
NHS Ayrshire & Arran is asking for help from patients and visitors
in keeping hospital entrances smoke-free.
Members of our Fresh Air-shire team have been on stand-by
at Crosshouse Hospital all week to answer questions and offer
advice and support on stopping smoking to staff, patients and
visitors.
Under the Smoking Health and Social Care (Scotland) Act 2005,
smoking is banned in enclosed public places such as hospitals,
workplaces, pubs and restaurants.
Under the Act, patients, visitors, staff or contractors who smoke
in no-smoking premises are liable to a fixed penalty fine of £50.
Refusal to pay or failure to pay may result in prosecution and a
fine of up to £2,500. In addition, NHS Ayrshire & Arran can also
be fined £200 every time a smoker breaks the law.
Dr Carol Davidson, Director of Public Health – NHS Ayrshire &
Arran, commented: “Coming to hospital, either as a visitor or
patient, can be a very stressful time. This can make it even more
difficult for smokers to think about kicking the habit. However, we
can offer a range of support and treatment if they do want to stop
smoking.
at the Get Your Life Back tour
JOIN ANNE DIAMOND
and Bariatric surgeon
Mr. Shaw Somers as
they discuss weight
loss surgery and her
inspirational story.
BIRMINGHAM
Copthorne Hotel
Tues 23rd January 2007
MANCHESTER Town Hall
“We would also ask smokers to spare a thought for non-smokers, and to use the smoking shelters at Ayr, Crosshouse, Ailsa
and Biggart Hospitals rather than stand at the entrances to the
hospitals.”
Wed 24th January 2007
From Monday 4 December a Smoking Awareness Officer will
be on duty in the main foyer at Ayr and Crosshouse Hospitals
between 2pm and 8pm to highlight the law.
Thur 25th January 2007
For more information and advice on the type of support on offer
to people who want to stop smoking, call our Fresh Air-shire team
free on 0800 783 9132 or visit our website, www.nhsayrshireandarran.com.
LEEDS Weetwood Hall
For details visit www.tfa-group.com
www.scottishirishhealthcare.com
9
News
East Ayrshire’s Community Health Partnership launched its
innovative pharmacy project on 6 November 2006 to improve the oral
health of local children up to 12 years old. The Community Pharmacy
Oral Health Project aims to encourage parents and
carers in Kilmarnock to ‘Choose a smile for your child’.
The pilot project, which will run for 12 months, aims to work with the
community to improve the health of local children and to involve
parents and carers in decisions that affect their child’s oral health.
Parents and carers are encouraged to visit their local community
pharmacy1 for help and advice on sugar-free medicines, baby drinks,
local dental services and tips on how to look after you and your
children’s teeth. Your child can also get a free toothbrush and toothpaste, or you can take part in a baby bottle swap, and collect a free
baby-feeding cup.
Joyce Mitchell, Community Pharmacy Advisor - East Ayrshire
Community Health Partnership (CHP), said: “Over the next few
months, oral health support workers will distribute vouchers to families
throughout North West Kilmarnock. However the service is available
to all children under 12 years old, within the Kilmarnock area.
“You can take the vouchers to the participating pharmacies1 and
exchange them for toothbrushes, toothpaste and feeder cups. We
want to let parents know that your local pharmacy is here to help
and can be a great source of free advice.
“On behalf of East Ayrshire CHP, I would like to thank the staff from
the eight participating pharmacies. By working with parents and
carers, we hope to improve the oral health of kids from Kilmarnock.”
NHS Ayrshire & Arran is delighted to congratulate the newly
qualified nurses who have successfully completed the
Professional Development Programme.
The programme offers a six-month period of support to recognise
the difficulties student nurses can experience making the
transition to staff nurses.
Mrs Fiona McQueen, Executive Nurse Director – NHS Ayrshire
& Arran, also presented the programme tutors with certificates,
acknowledging their vital role in supporting the new staff nurses in
their clinical practice.
The recently qualified enrolled nurse conversion students pictured with
their mentors.
We would also like to congratulate the seven first-level nurses
who successfully completed the conversion programme at the
University of Paisley. The open learning programme is designed
to allow experienced enrolled nurses to achieve first-level
registration. They were presented with the Paisley badge in
recognition of their completed studies.
Representatives from NHS Ayrshire & Arran and the University
of Paisley took part in the presentations, which took place on 6
November 2006 in Ayr Hospital.
For further information on the Community Pharmacy Oral Health
Action Project, contact Joyce Mitchell, Community Pharmacy Advisor
on 01563 537243, or Karen Parker, Oral Health Project Co-ordinator
on 01563 544741.
Mrs McQueen commented: “We would like to wish all the newly
qualified nurses every success in their careers and extend our
gratitude to the teachers and mentors who supported the nurses
through their studies.”
A new report has highlighted the prevalence of MRSA in
European hospitals.
The recently qualified enrolled nurse conversion students pictured
with their mentors.
MRSA ‘rife’ in European hospitals
The European Antimicrobial Resistance Surveillance System
(EARSS) 2005 Annual Report, has said that the presence of MRSA in
European hospitals continues to rise, with the UK being the fifth-worst
affected country after Malta, Cyprus, Romania and Portugal.
However, Slovenia and France have managed to cut rates of MRSA
through implementing long-term prevention efforts.
Mark Wilcox, clinical director of microbiology and infection control
at Leeds Teaching Hospital, explained: “The findings of the EARSS
report are worrying and clearly illustrate that antibiotic resistance is
continuing to increase markedly.
“If this trend continues and is not tackled effectively, it is likely that
more patients will die because of infections caused by multi-drug
resistant bacteria.”
Longer hospital stays and increased levels of treatment for the disease will financially impact European health care systems, Mr Wilcox
added.
MRSA is a strain of the staphylococcus aureus bacterium that has
formed antibiotic resistance to all penicillins.
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www.scottishirishhealthcare.com
We would also like to congratulate the seven first-level nurses
who successfully completed the conversion programme at the
University of Paisley. The open learning programme is designed
to allow experienced enrolled nurses to achieve first-level
registration. They were presented with the Paisley badge in
recognition of their completed studies.
Representatives from NHS Ayrshire & Arran and the University
of Paisley took part in the presentations, which took place on 6
November 2006 in Ayr Hospital.
Mrs McQueen commented: “We would like to wish all the newly
qualified nurses every success in their careers and extend our
gratitude to the teachers and mentors who supported the nurses
through their studies.”
The recently qualified enrolled nurse conversion students pictured
with their mentors.
News
An overarching strategy ‘Delivering Care, Enabling Health’ will
give nurses, midwives and allied health professionals (NMAHPs)
a far bigger role in the delivery of care, while ensuring that caring
for, and empowering, patients remains at the heart of modern
health services.
The proposals in the ‘Review of Nursing in the Community,’
also published today, provide a blueprint for the future of nursing
designed to fit in with the changing face of health care in
Scotland.
The television, radio, press, pharmacy bag and poster campaign
runs from November 27 to February 4 2007.
With an increasing emphasis on anticipatory and community
based care, this new approach will provide an opportunity to test
and develop a new Community Health Nurse role.
“Every year, NHS Scotland actively plans for the increased
pressures on services the winter months can bring, and thorough
preparations have been made to meet these challenges. NHS
Boards and NHS24 have worked together to increase their
capacity to deal with out-of-hours and public holiday calls.
Mr Kerr said:
“In the future I want to see a health service which is aimed at
making sure fewer people get ill in the first place and when they
do, that they are treated as locally as possible. That will mean an
increasingly important role for nurses, midwives and allied health
professionals, and that’s why we must update the way the
profession works in Scotland.
“In particular, testing and developing the new role of Community
Health Nurse will aim to establish a single point of contact for
people receiving care in their own homes. This is about building
on experience - particularly in relation to delivering public health
services. A recent World Health Organisation report has
highlighted the success of this approach.
“Finally, I’m particularly pleased the new strategy seeks to
enhance nursing’s reputation as the caring profession.
The comfort, reassurance, and encouragement to get well that
nurses, midwives and AHPs can provide should never be lost.”
The Minister was joined at today’s launch by Olivia Giles, the
Broadcaster and Meningitis campaigner who wrote a foreword
to ‘Delivering Care, Enabling Health’. Olivia received extensive
nursing care at St John’s Hospital in Livingston in 2002 after
contracting septicaemia. She said:
“Good health care is about caring for people - with the emphasis
on ‘people’ - to enable them as much as possible.
I am heartened to see that this principle is the linchpin of
Delivering Care, Enabling Health’.
Both ‘Delivering Care, Enabling Health’ and the ‘Review of
Nursing in the Community’ have been drawn up in partnership
with staff representatives including the Royal College of Nursing,
Amicus, UNISON, Queen’s Nursing Institute - Scotland, the Royal
College of General Practitioners, NHS Education Scotland and
academic heads.
A spokesperson from the RCN said;
“RCN Scotland fully supports the overall theme and direction of
Delivering Care, Enabling Health and the Review of Nursing in
the Community. Critical to the success of the Review will be the
development sites that are now starting to take shape. RCN
Scotland looks forward to engaging fully in these and ensuring
nurses play a lead role in addressing the health inequalities in
Scotland.”
Scotland’s Chief Nursing Officer Paul Martin added;
“Today’s announcement is about taking traditional values forward
and applying them in a modern context. That’s why it was vital
that we didn’t lose sight of the reason NMAHPs are here - to care
for, enable, support and comfort the people who use our services.
I have no doubt those values will be upheld.”
The new Community Nurse Pilot role will be tested and developed
in four areas across Scotland. Discussions are taking place with
local Boards to choose the locations.
NHS Scotland already employs a limited number of Family Health
Nurses whose role is comparable to that of a Community Health
Nurse. The Family Health Nurse position was commended in the
recent ‘WHO Europe Family Health Nursing Pilot in Scotland,
Final Report’ which can be accessed at,
http://www.scotland.gov.uk/Publications/2006/10/31141146/0
NHS Scotland Chief Executive Kevin Woods said:
“The public can, and do, play an important part in helping the NHS
to ensure that these pressures do not cause significant disruption.
The advertising campaign focuses on what the public can do to
help particularly before the extended public holiday periods over
Christmas and New Year - helping the NHS get help to those who
need it most this winter.”
Professor Peter Donnelly, Deputy Chief Medical Officer, said:
“At Christmas and New Year many GP practices will be closed
over the two four-day periods. This campaign asks individuals to
do a few simple and sensible things to ease the pressure on
out-of-hours services.
“Making sure that you have a prescription for any repeat
medication you may need over weekends and public holidays,
and only using the out-of-hours services if you can’t wait until your
GP practice re-opens are the two main things that the public can
do to help.
“As well as gearing up the NHS and encouraging the public to
play their part, we also need to look at what individuals can do
to help themselves and others. People can access the opening
times and locations of their local pharmacies along with other
winter health related information through NHS24’s website at
www.nhs24.com. The website also has a self-help guide and
health encyclopaedia.”
Practical steps people can take are:
• If you take repeat medication, make sure that your
doctor gives you a prescription to cover the holiday period
(December 23 to 26 and December 30 to January 2)
• Where possible, use your GP Practice for health care advice
by making a routine appointment; use out of hours services
only when you think it can’t wait until your GP Practice re-opens
• Ask your pharmacist for advice on treatments for common minor
illnesses
Gambro Hospal Ltd, a whollyowned subsidiary of Gambro AB,
has introduced the new Gambro
Inventory
(GMI)
Managed
programme, which provides cost
efficient, reliable
deliveries,
coupled with lower stock levels
to allow carers more time with
patients in the renal unit.
Gambro Managed Inventory
(GMI) is a customised and
convenient logistical service
based on over 40 years of
focusing on renal unit and
patient needs. As a result, it
reduces clinic overheads and
secures a stock of disposables
tailor-made to individual user
requirements. Stock is managed
and orders placed using an
online web tool from Gambro.
Time
consuming inventory
administration
is
radically
reduced.
GMI is easy to use and
guarantees the maintenance of
an optimum level of stock.
An initial meeting establishes product range to be stocked,
required levels and stock-take frequency. Deliveries are
arranged for a set day at convenient intervals to suit each renal
unit.
All customers need is a browser and internet connection to get
started. Gambro provide a password and backup training.
For further details
of GMI, please
telephone
Gambro on
01480 444000.
Gambro Hospal:
A better way to
better care.
A monthly follow up routine ensures that the GMI tool is
continuously updated, and stock levels adjusted to allow for
fluctuating consumer demands.
GMI is the result of a Gambro initiative to combine world-class
expertise with quality inventory and logistical services. The
result is a simple outcome, to make patient care more
rewarding and administration more manageable.
www.scottishirishhealthcare.com
11
News
There is to be an annual public review of the
state of Scotland’s health.
First Minister Jack McConnell made the announcement today
as the first annual Health Improvement Report was published by
Health Minister Andy Kerr.
The report was commissioned by last year and was approved by
Scotland’s Cabinet last month for publication at the World Health
Organisation (WHO) conference taking place in Edinburgh this
week. It will be the first of a new form of annual reports to the First
Minister covering all actions on health improvement.
At the WHO conference, the First Minister explained that the
report will now form part of a new systematic annual process to
examine Scotland’s health needs and to identify priorities for the
year ahead.
in GP practices
A campaign aimed at tackling violence and aggression towards
staff in GP practices has been launched today.
The poster and leaflet campaign pack is being sent to over 1,000
GP practices across Scotland as they gear up for the busy winter
period - usually one of the worst times for incidents of physical
and verbal abuse in surgeries.
Practices will also be able to access a simpler reporting system to
record instances of unacceptable behaviour.
At a Health and Violence Seminar in Edinburgh organised by the
Violence Reduction Unit, Mr Kerr said:
“The consequences of violence are visible on a daily basis in our
hospitals, clinics and GP surgeries.
The new approach is aimed at enabling better co-ordination
and prioritisation of initiatives already taking place to improve
Scotland’s health record.
“Physical and verbal abuse inflicts injuries and illness on our NHS
staff, and is a drain on vital healthcare resources. It’s a major public health challenge and one we are determined to address.
Mr McConnell pointed to the impact poor health has on people’s
quality of life, economic growth and the cost to the NHS as
‘reasons why improving our health matters and it matters to all of
us, not just those in the NHS’.
“GP receptionists rank high on the list of those somehow seen
as acceptable targets. These new ‘crime scene’ materials bring
home the seriousness of the crimes and their punishments, and
urge staff to report all incidents. We hope to extend this campaign
to dental practices, pharmacies and hospitals over the course of
the next year.
The FM made it clear that, for this reason, the new public review
will engage expertise from outside the health service and harness
a more rounded approach to addressing health needs.
The report also measures progress being made across
government to improve Scotland’s health with the aim of bringing
it up to a par with the best in Europe.
It highlights initiatives such as the ban on smoking in public
places, improved school meals and the alcohol test purchasing
pilot as examples of how all parts of government are working
together, in addition to stressing the role of the NHS in more
preventative and proactive care.
The FM said:
“My vision for a healthier, happier more productive Scotland is
one shared by the vast majority of Scots.
“For that reason I feel confident that we can open up our work on
health improvement to a wide range of partnership organisations,
experts and influential stakeholders.
“The annual health report we have published today will be sent
for comment and engagement to the widest range of stakeholders
- here in Scotland and beyond - to encourage them to play a
full part in a healthier Scotland. Their input will be even more
important in future years.
“And to monitor progress and create a shared national agenda,
there will be an Annual Public Review based on the report and
what needs to be done.
“Our message is clear and simple - abuse is a criminal offence.”
Michael Fuller, Amicus Scottish Health Sector Secretary, said:
“It is quite appalling that staff who are seeking to care for others
on a daily basis should be subject to threats, abuse and even
assaults. Decency demands that such staff should be allowed to
practise their precious skills free from fear.
“The prerequisite for quality health care is an environment where
the safety of all staff, as they carry out these responsibilities, is
paramount. This campaign brings that message home to all.”
Dr Dean Marshall, Chairman of the BMA’s Scottish General Practitioners Committee, said:
“More than one third of doctors report they have experienced
some form of violence in the workplace in the last year. This is
completely unacceptable. No one should have to deal with violent
or threatening behaviour as part of their job.
“It is important that patients and their relatives are aware that
their actions are punishable by law. We therefore welcome this
campaign to protect doctors and their staff working in GP surgeries across Scotland.”
The Emergency Workers (Scotland) Act now provides greater protection in law for all emergency workers. Penalties are available of
up to nine months imprisonment and a fine of £5,000 for anyone
assaulting or hindering healthcare workers in a hospital setting or
those doing emergency work in the community.
“This new, very public, annual check up will be a way to rigorously
examine what has been done, so that our health improves and
our economy grows.
“Our poor health impacts not just on individual lives but on the
NHS, our economic growth and our international reputation.
These are just a few of the reasons why improving our health
matters and it matters to all of us, not just those in the NHS.
“But to turn around the reality and the perception of the personal
health of Scots, we need to step up our efforts, create a shared
national purpose and check against progress each year.
“While we recognise that Government cannot force people into
lifestyle choices, we do believe that there is enormous scope for
individuals in Scotland to make more of their lives.”
12
www.scottishirishhealthcare.com
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WILL BE A ‘NO HOLDS BARRED’
PAGE OF LETTERS FROM NURSES AND
OTHER PROFESSIONALS WORKING IN
HEALTHCARE WHO HAVE A POINT TO
MAKE OR AN ISSUE TO RAISE.
SEND YOUR SUBMISSIONS TO:
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STRATHAYR PUBLISHING LTD
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THERE
OR E-MAIL:
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ARE STARTING A LETTERS PAGE IN
ALL FUTURE EDITIONS OF SCOTTISH
NURSE & IRISH NURSE MAGAZINES.
IS NO LIMIT TO THE SCOPE OF
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COULD BE WORK-RELATED, POLITICAL
OR EVEN PERSONAL - IT’S UP TO YOU!
SO
IF YOU HAVE A STORY TO TELL JUST
LET US KNOW WHATS ON YOUR MIND
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News
NHS Ayrshire & Arran is urging people to add some important basic
medicines to their Christmas shopping list.
The John Lynch Renal Unit at Crosshouse Hospital
recently received a generous donation from the
Ballochmyle Inn, Mauchline.
We are advising people to keep medicines at home that treat commonly
occurring minor ailments for unforeseen circumstances. For example,
paracetamol or ibuprofen to deal with pain such as toothache, sprains or
headache. They can also treat high temperatures associated with coughs,
colds and sore throats. Community pharmacists will be able to advise on
what medicines are best to keep. It is also worth keeping a supply of
plasters, bandages and dressings for minor injuries.
Every year thousands of people attend their local Accident & Emergency
(A&E) department with relatively minor ailments, this is probably because
they are unaware of the alternatives available. Approximately 60 per cent of
A&E attendances can be treated in the community, which results in quicker
and easier access to healthcare for the public.
Mrs Michele Caldwell, Director of Pharmacy – NHS Ayrshire & Arran,
commented: “Your local community pharmacist can give you advice about
minor ailments. If you need treatment, your pharmacist can recommend the
most appropriate medication to buy.”
Libby and Tracey Lyle from the Ballochmyle Inn are pictured handing over their cheque for £300 to
Staff Nurse Amanda Blair and Auxiliary Nurse Lynne Collins
When they heard one of their locals was receiving treatment in the unit,
kind-hearted new owners Libby and Steven Lyle took the opportunity
to raise money. They raised the grand total of £300 at a fancy dress
party at Halloween, which included ‘dooking’ for apples, a disco and
other fun party games. The bar staff also donated all their tips for the
night to the donation.
Staff Nurse Amanda Reid commented: “We would like to thank all the
staff of the Ballochmyle Inn, and of course the party-goers for their
generous donation to the renal unit. This will be put to good use and
will benefit all the patients in the unit.”
People who are exempt from prescription charges can register for the new
Minor Ailment Service in community pharmacies. People can consult their
community pharmacist about minor ailments and, where appropriate, the
pharmacist can prescribe a medication to treat the condition free of charge.
For more information on how to sign up for this service contact your local
community pharmacy.
Minor illnesses that community pharmacists may treat:
•Cold sores •Cough •Diarrhoea •Sore throat •Head lice •Athlete’s foot
If your community pharmacist has concerns he/she may also refer you to
your GP or directly to NHS 24.
Mrs Caldwell continues: “People with common winter illnesses should
follow these simple steps, where possible. This will make sure that NHS 24
and NHS Ayrshire Doctors on Call (ADOC) get help to those who need it
more urgently.”
A leaflet on “How to keep well over winter” will be available from GP
surgeries and community pharmacies over the coming weeks.
The children’s ward at Crosshouse Hospital received an
early Christmas present when a local business donated 40
toys for the children in hospital over the Christmas period.
The newly opened Trading Post cash and carry at Meadowhead Industrial Estate, Irvine, asked staff to pick 40 toys of any size and price to be
donated to the ward to keep the youngsters entertained this Christmas.
Details of all pharmacies open over the Christmas and New Year period will
be advertised in the local press, on our website, www.nhsayrshireandarran.
com and on the NHS 24 website, www.nhs24.com.
If you need urgent medical attention when your GP practice is closed, call
NHS 24 on 08454 24 24 24. In the event of an emergency you should dial
999.
CareMax International Ltd Announce UK Launch
CareMax International Ltd, providers of Integrated Managed Healthcare
services has today formerly launched the company in the UK, after two
years of painstaking research and development. It aims to become a
European leader and a major source of influence within health and social
care initiatives by adapting a cross section of North American managed
healthcare best practices into UK health and social care provision and
patient care management.
CareMax is the only UK based provider of diverse
and comprehensive evidence-based Integrated
Managed Healthcare services to the public and
private health and social care sectors: working with
patients and health and social care professionals to
improve the health and well being outcomes of
patients, particularly those with long term
conditions, disabilities or at high risk.
Tom Storrie and Tom Donaldson from Trading Post cash and carry, present their donation of 40 toys
to Michelle Frew (playleader), Senior Staff Nurse Lorraine McRae and Sister Fiona Scott.
Sister Fiona Scott commented: “We are very grateful to Tom Storrie and
all the staff at the Trading Post cash and carry for their generous donation. The toys will certainly be well used to make the youngsters’ stay in
hospital over Christmas that bit more enjoyable.”
We can even
show you
where she is
Now, Sarah is
more than just
a number
Aid Call’s unique new Radio
Nurse Call system can display
more information than any
other system on the market.
•
•
•
Quick and easy to install
Call logger to record all calls
Displays names, locations and
times with optional map
For details on our full range or free demonstration, call freephone
0800 052 3616
www.aidcall.co.uk
CareMax International Ltd has developed its services
and technology system to deliver this integrated
collaborative approach. Unlike other organisations
which focus mainly on elderly care, CareMax aims to
support a wider patient population, whose need for
coordinated health resources are independent of age and circumstances.
Elizabeth Crocker,
R.N., MSc(Hons)
Chief Executive Officer
and Founder CareMax
International Ltd.
The CareMax e-health system will create electronic patient records to
capture and share information from all health and social care providers and
professionals for the patient’s illness or injury. CareMax case managers will
employ evidence based care pathways and case management guidelines
to collaborate and coordinate timely and appropriate patient care services,
monitor progress and measure health and well-being outcomes.
Care Max services include:
• Consultancy and Integrated Health Services Design
• Education and Training
• Integrated Care Management and Disability Incapacity Management
• Life Care Planning
www.scottishirishhealthcare.com
• Resource Utilisation and Outcomes Measurement
13
S
N
Healthcare Events
.........
in and around your area
SCOTTISH
NURSE
23rd January 2007
NHS-ConNeCT, Breastfeeding: Exploring
Peer Support
Tullie House Museum and Art Gallery,
Carlisle. £78.00.
Various Dates 2007
An Audience with Anne Diamond
at the Get Your Life Back tour
JOIN ANNE DIAMOND and Bariatric surgeon
Mr. Shaw Somers as they discuss weight loss surgery and
her inspirational story.
BIRMINGHAM
Copthorne Hotel
Tues 23rd January 2007
MANCHESTER Town Hall
Wed 24th January 2007
LEEDS Weetwood Hall
Thur 25th January 2007
20th December 2006
9am to 4pm
Mind your health
Working together to develop our services
Information/bookings tel. 020 8993 3441
or e-mail:[email protected]
24th January 2007
Network Event for all District Nurses in Scotland
Tullie House Museum and Art Gallery,
Carlisle. £78.00.
An Opportunity for RCN Scotland to consult and
hear their views of district nurses
RCN Scotland, 42 South Oswald Road, Edinburgh
As part of the RCN District Nursing Forum, a
network event will be held for all district nurses in
Scotland to be conculted and express their views.
Venue: RCN Scotland, 42 South Oswald Road,
Edinburgh
Venue: University Campus, Craigie, Ayr
Contact:
Rona Agnew, Primary Care Advisor
RCN Scotland, 42 South Oswald Road Edinburgh
EH9 2HH
Tel: 0131 662 6171
Fax: 0131 662 1032
E-mail: [email protected]
15th January 2007
How Does Nurse Prescribing Impact on
Patient Care?
6th February 2007
SIGN Heart Disease Guidelines
Launch event
Following Ayrshire & Arran NHS Board’s decision1
to carry out a strategic review of mental health
services, the Mind Your Health Project will be
launched at a large stakeholder event .
RCN Quality Improvement Network
Come along to this event from 11am to 3.30pm
and explore recent developments in nurse prescibing and the way in which this impacts on patients
and on the profession.
Venue: Easterhouse Health Care Glasgow
Discussion will be led by Dr Linda Pollock and
Jame Camp. A light lunch will be provided. Contact Ann Marie Hawthorne for more inforamtion.
Contact:
Ann Marie Hawthorne, Education and Clinical
Effectiveness Adviser, RCN Scotland, 42 South
Oswald Road, Edinburgh, EH9 2HH
Tel: 0131 662 6154
E-mail: [email protected]
14
www.scottishirishhealthcare.com
The Scottish Intercollegiate Guidelines Network
(SIGN) is publishing five new Heart Disease
guidelines which will be launched at this meeting.
The launch will be an opportunity to discuss national and local implementation strategies, to look
at what patients can expect from the guidelines
and to consider the potential resource impact of
implementing the guidelines.
Venue: SECC, Glasgow.
Registration fee £30 (£60 for industry). A limited
number of free places for patients and carers only
are available.
For more information and to register for the launch
please contact Lesley Forsyth, Events Coordinator,
SIGN
If you have any forthcoming events you
would like to highlight please contact:
Hamish Bell (News Editor)
Tel: 01292 525970 or e-mail:
[email protected]
Contact:
Lesley Forsyth, Events Coordinator, SIGN
28 Thistle Street, Edinburgh EH2 1EN
Tel: 0131 718 5109 / 5090
Fax: 0131 718 5114
E-mail: [email protected]
8th February 2007
NHS-ConNeCT, Teaching Stress Management
In The Antenatal Period
Dalgety Bay, Fife. £78.00.
Information/bookings tel. 020 8993 3441
or e-mail:[email protected]
23rd February 2007
Therapeutics 2007: Improving Clinical
Effectiveness and Patient Safety
Royal College of Physicians of Edinburgh In
Association with the Royal Pharmaceutical
Society of Great Britain In Scotland
In the modern NHS key objectives for clinicians
are to maximise clinical benefit and effectiveness,
particularly of new drugs. At the same time patient
safety needs to be considered, particularly by
addressing and implementing techniques to
reduce the risks of drug use.
Contact:
Christine Berwick, Education Department, Royal
College of Physicians of Edinburgh
9 Queen Street, Edinburgh EH2 1JQ
Tel: 0131 247 3634
Fax: 0131 220 4393
E-mail: [email protected]
6th March 2007
Fourth annual nurse practice event
Free conference and exhibition for primary care
nurses.
Designed specifically to meet the educational
needs of practice nurses and other primary care
specialists, the programme for this event will
feature an impressive collection of speakers
delivering highly topical and relevant
presentations, for example, diabetes,
cardiovascular diease, mental health, obesity,
sexual health, asthma, and more.
The event is endorsed by the RCGP and is divided
into two sections which run concurrently:
an educational conference, which is accredited
by the RCN, working towards the nurses’ CPD,
and also a large exhibition.
Healthcare Events
.........
Contact:
Campden Publishing,
Tel: 020 7214 0500
E-mail: [email protected]
13th March 2007
2007 RCN Scotland Member Conference
‘Right for Nurses, Right for Patients’ How you can
make a difference!
This annual conference is your opportunity to help
us get it right for the future of nursing of Scotland,
in particular the conference will have a
political focus coinciding in the run up to the
Scottish Parliament elections. In line with RCN
Scotland’s diversity beacon status, the conference
will also have an international flavour, in line with
the overall campaign.
Contact:
Tracey McRae, Communications Assistant
RCN Scotland, 42 South Oswald Road,
Edinburgh EH9 2HH
Tel: 0131 662 6135
Fax: 0131 662 1032
E-mail: [email protected]
14 - 16th March 2007
Diabetes UK
Annual ProfessionalConference
It is our pleasure to invite you to the 2007 Diabetes
UK Annual Professional Conference in Glasgow.
With our largest exhibition area to date and an outstanding programme with something for everyone,
we hope that you’ll mark your calendars now.
Venue: SECC Glasgow
Book online now at www.diabetes.org.uk/apc
or telephone Virlina Choquette on 020 7424 1156
DIARY DATE
19-25 MARCH 2007 - DO IT FOR THE BOY’S TOO.
Prostate cancer is now the most common cancer diagnosed in
men in the UK -every hour at least one man dies from this disease.
It is a cause that has suffered from years of neglect, so plan
NOW for next year’s Prostate Cancer Awareness Week,
19-25 March 2007 - it’s your chance to make a difference.
During the week, thousands of individuals and groups across the
UK will join forces to help raise awareness of prostate cancer and
raise vital funds to improve research, information and support
services for men and their families who are affected by this disease.
For further information contact: Kate Stewart, Josie Gray or
Nikki Nagler on 020 8222 7653/7648/7670.
Out of hours contact: 0798 432 5001.
[email protected] [email protected] or [email protected]
www.scottishirishhealthcare.com
15
fit and well
But what if something
goes wrong
We are presently helping a
number of Nurses both
young and elderly. If you
know someone who you
think needs our help
contact:
Margaret Sturgeon
15 Camp Road
Motherwell ML1 2RQ
Telephone: 01698 252034
Donations required
to continue the
work of the Fund
Visit our website for more details
www.bfns.org.uk
16
www.scottishirishhealthcare.com
Registered charity no. SC006384
Charles Bloe BSc RN NDN ITU cert
Clinical Editor
CEO Charles Bloe Training Ltd.
Charlie graduated with a BSc in Social Sciences
and Nursing Studies from the University of
Edinburgh in 1984 and spent much of his
clinical career as a senior nurse in Cardiac Care
and Medical High Dependency. He is now CEO
of Charles Bloe Training Ltd. who deliver onsite
and online clinical updates to healthcare staff
across the UK and beyond.
Editorial Board
Michael Canavan Dip N RN ALS
Lead Resuscitation Training Officer,
Ayrshire & Arran NHS Trust
Greig Ferguson BSc RN DSc
MD ATLS ALS EPLS
Registered Nurse Accident & Emergency
Scott Kane RMN MSc
Assistant Clinical Editor
Clinical Nurse Specialist in Liaison
Psychiatry, Tayside Health Board
Scott undertook his RMN training in Dundee,
qualifying in 1991. Since that time has worked
in acute, long-term, rehab and supported
accommodation. He was appointed Clinical
Nurse Specialist in Liaison Psychiatry in 1996.
Scott has also completed an MSc in cognitive
and behavioural psychotherapy
Kirsten Ramsay RN DipN ALS
Hospital at Night Practitioner,
Fife Acute Hospitals NHS Trust
After a period of 7 years as
senior Staff Nurse in Coronary
Care Michael was appointed
Resuscitation Training Officer
in Forth Valley Acute Hospitals
NHS Trust. He has since moved
to Ayrshire where he is lead
Resuscitation Training
Officer at Ayrshire & Arran NHS Trust. Michael is a
Resuscitation Council (UK) approved Advanced Life
Support Instructor and ALS course Director. He is also
the lead Resuscitation Advisor and Lecturer to Charles
Bloe Training Ltd delivering updates across he UK.
Greig initially trained as a Royal
Kirsten spent much of her early
clinical career as Staff Nurse
Marines Commando,
undertaking the military
in Coronary Care and Medical
Paramedic course in 1992.
High Dependency. She was
On attachment he attended
among the first Nurses in the
Chicago Medical School 1993
UK to undertake the role of
at the Rosalind Franklin
nurse initiated coronary
University of Medicine and
thrombolysis. Kirsten now
Science. Completed initial internship at the
works as a Hospital at Night Practitioner at Fife Acute
Department of Emergency Medicine. Greig is
Hospitals NHS Trust.
currently employed as a Registered Nurse in A&E,
Trauma Orthopaedics, and Critical Care.
Sheenagh Orchard RN RNT Cert Ed
(FE) DN (Lond)
Moving & Handling Consultant
Maureen Benbow MSc BA
RN HERC
Senior Lecturer,
University of Chester
Sheenagh qualified in 1975
and is currently a Moving &
Handling of People Specialist
undertaking assessment,
training and a number of
speaking appointments at
National Conferences.
She is one of the co-authors
of ‘The Guide to the handling of People’ 5th edition.
Sheenagh is an active member of the National Back
Exchange and was vice chair of the National Executive
1998 – 2001.
Maureen worked as a Tissue
Jamie has spent his career
Viability Nurse at Mid Cheshire
working in the Accident &
Hospital Trust, Crewe for 14
Emergency environment. He
years and in 2004 transferred
has held Staff Nurse, Deputy
to the University of Chester.
Charge Nurse and Charge
Her clinical background is in
Nurse Positions before moving
orthopaedics and accident
onto his current position as an
and emergency. Maureen’s
Emergency Nurse Practitioner.
on-going interest is in tissue viability and in particular
He has specific interests in resuscitation, minor injuries
pressure ulcer prevention
and development of emergency care systems.
and wound management, and research.
Deborah Ward MA, BSc (Hons), RN
Infection Control Nurse Specialist.
Deborah has worked as an
infection control nurse since
1998, working both inside
and outside the NHS in both
acute and non-acute settings.
She now works outside the
NHS for a national
organisation across England,
Scotland and Wales.
Jamie Jones RN (Adult) BSc DipHE PGDip
ALS(I) APLS(I)
Emergency Nurse Practitioner,
Pontypridd & Rhondda NHS Trust.
Steven Morrison Dip N Bachelor Nursing
RN ALS
Senior Clinical Nurse & Thrombolysis
Practitioner,
Forth Valley Acute Hospitals NHS Trust.
Steven has spent much of his
clinical career in Coronary
Care and has been particularly
proactive in the development
& implementation of Acute
Coronary Syndrome
management programmes.
He has also spent some time
working in Medical HDU, as a Resuscitation Training
Officer and is an ALS Instructor
Heather Liddell BSc RN ALS SPQ
Cardiology Chest Pain Assessment Nurse,
Forth Valley Acute Hospitals NHS Trust
Heather has spent much of her
senior clinical career working
in Cardiac Care and Medical
High Dependency.
She is currently a chest pain
assessment practitioner at
Stirling Royal Infirmary.
Clinical Articles Wanted
At Scottish & Irish Nurse we are always interested in good quality clinical editorial. We’d love to hear from you regardless of whether you’ve had work published before.
Your submission needn’t be a very detailed clinical paper.
For example you can forward:
• A review of a local initiative that has delivered best practice leading to an improvement in patient care.
• Results of an audit or survey that has led to an improved service to patients and their relatives
• An article relating to an area of particular interest to you or involving your specialist area. We are
particularly keen to receive articles related to Cardiology, Respiratory, Diabetes, Nutrition, Midwifery,
Mental Health, Intensive Care and Dementia
• A service redesign initiative that has achieved demonstrable results
• Or just anything that’s going on locally or that you and your team has achieved that you’d like to share
with over 20,000 Nurses fortnightly.
Our articles are typically 1500 words, although there is a fair degree of flexibility, and fully referenced
where appropriate. Don’t worry about pictures and graphics as we can insert these for you.
For authoring guidelines or to submit editorial e-mail:
[email protected]
Postal address:
Charles Bloe Training Ltd, Editorial Dept, 15 Highland Dykes Drive, Bonnybridge. FK4 1PE.
Or if you have any queries give me a call on 01324 ~ 814946.
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17
Infection Control
“Trusts must do better” says Minister.
“I am disappointed that, despite many Trusts making
significant reductions in infection, the overall figures
do not reflect these improvements”
Jane Kennedy, Health Minister
Few things undermine patient confidence in the healthcare system
more than Healthcare Associated Infection (HCAI) In this edition we
are launching the first of a 10 part series in Infection Control that will
equip healthcare workers with much of the knowledge required
to improve patient care and reduce HCAI.
Viruses:
Viruses are identified by their shape, whether they are enveloped or nonenveloped and whether they possess RNA or DNA. Viruses need living
cells in order to multiply and affect cells by either causing:
•
The death of the cell e.g. respiratory syncytial virus
•
The cell to change to a malignant form such as to become
cancerous e.g. hepatitis B causing liver cancer
•
A latent infection whereby it may become an active infection
later and which is still a potential source of infection to others
e.g.Varicella-Zoster virus
At the end of each article we will provide you with a number of work Examples of virus infections include Influenza, Lassa fever, Glandular fever,
based activities that will help you implement your knowledge in your own Chickenpox, Hepatitis A & B and Norwalk virus.
Viruses can be destroyed outside the body by heat, UV radiation and
clinical setting.
some chemicals.
Infection Control Part 1
Fungi:
Classification of Micro-organisms and Routes of Transmission
Fungal infections such as Ringworm & Aspergillosis, can be either
superficial or deep. They are divided into 3 main types:
Author:
•
Yeast / yeast like e.g. Candida albicans
Deborah Ward MA, BSc (Hons), RN
•
Filamentous e.g. ring worm
Infection Control Specialist Nurse.
•
Dimorphic e.g. blastomyces
Deborah has worked as an infection control nurse since 1998, working
both inside and outside the NHS in both acute and non-acute settings.
She now works outside the NHS for a national organisation across Parasites:
Parasitic infections such as Malaria, Head Lice,Tape worms,Threadworms
England, Scotland and Wales
and Scabies, include those caused by:
•
Protozoa
Specific learning objectives for this section:
•
Helminths
•
Ectoparasites
By the end of this section you should be able to:
Prions
•
Describe the main micro-organisms that may cause infection
These are infectious agents composed of protein alone. Human forms
include CJD, FFI (Fatal Familial Insomnia) and Kuru. Much research is
•
Describe chain of events leading to the transmission
ongoing with regards to prion diseases as prions cannot be destroyed by
of infection.
our usual methods of decontamination.
•
Describe the routes of transmission for infections
The Chain of Infection
Micro-organisms that can cause infection are divided into four main The chain of infection is a representation of the chain of events leading to
the transmission of infection. Removal of one link in the chain means that
categories:
infection will not be transmitted. Knowledge of this chain is therefore
important in the prevention and control of infection.
•
Bacteria
•
Viruses
The six links in the chain are:
•
Fungi
•
Parasites
1. A causative micro-organism (bacteria, viruses, parasites, fungi)
2. A reservoir in which the organism can live (people, animals,
Bacteria: These are identified by their shape, whether they require
food, water, dust etc)
oxygen or not and Gram staining.
3. A portal of exit i.e. a way for the organism to get out of the
reservoir (excretions and secretions, shedding skin etc)
a) Shape – bacteria are either spherical (cocci), straight rods
4. A mode of spread or route of transmission
(bacilli), curved/spiral rods (vibrios and spirochaetes)
5. A portal of entry into the body in order to cause an infection
b) Oxygen requirement – some bacteria require oxygen to
(e.g. via broken skin, the respiratory tract etc)
multiply, others need to be without oxygen and some can
6. A susceptible host i.e. a person at risk of acquiring the
multiply either with or without oxygen – the terms ‘aerobic’ or
infection
‘anaerobic’ are used
c) Gram staining – this is a laboratory process and bacteria are
SUSCEPTIBLE HOST
either Gram positive or Gram negative, depending on whether
they take up the stain or not
Therefore, a bacterium which is referred to as a Gram positive anaerobic
bacillus takes up the Gram stain in the laboratory, can survive in an
environment without oxygen and is a straight rod in shape.
Bacteria such as MRSA, campylobacter, salmonella and myobacterium
which cause infections in humans are more likely to survive and multiply
at body temperature.
Bacteria also need water and other nutrients in order to multiply and
grow. However, bacteria can be killed quite readily outside the body.
PORTAL OF
ENTRY
CAUSATIVE
MICRO-ORGANISM
MODE OF
TRANSMISSION
RESERVOIR
PORTAL OF EXIT
If we consider Meticillin resistant Staphylococcus aureus, the chain of
The following methods can be used to destroy bacteria outside the body: infection could consist of the following:
heat, drying, antiseptics, disinfectants, radiation
1. MRSA
2. Reservoirs include skin, wounds, urine
3. Portal of exit will depend on reservoir but could include shed
Spores:
skin, pus, wound exudates, urine, sputum etc
Some bacteria can produce spores which can survive for long periods
4. Means of transmission would generally be contact but could be
of time and can cause infection at a later date when suitable conditions
airborne if the reservoir is sputum
arise. Examples of spore forming bacteria include the bacillus which
5. Entry could be via exposed wounds, invasive devices, surgical
causes anthrax; and Clostridium difficile. Spores cannot be destroyed by
incisions etc
disinfection.
6. A person at risk would be any exposed person, particularly
those with portals of entry
18
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Infection Control
When we consider where infection comes from, we first need to look at
human normal flora.
People are colonised with micro-organisms at different sites of the body.
At these sites this flora can help to prevent colonisation by other microorganisms. Under normal circumstances, this normal flora does not cause
us any problems but can become pathogenic under certain conditions.
Examples of normal flora on the body include Staphylococcus epidermidis
on the skin, lactobacilli in the female genital tract and Enterococcus faecalis
in the upper gut. Normal flora can, however, vary from one person to
another depending on factors such as their general health and age.
However, what also needs to be considered here is the fact that some
people in the population carry organisms which others do not and may
do so without demonstrating any symptoms i.e. they are colonised with
these micro-organisms. While these are not causing any problem to the
carrier, they may cause infection or even death in others and also in
themselves if these micro-organisms are transferred from one area of the
body to another.
Because people colonised with such micro-organisms are not symptomatic,
we are unable to identify who carries which micro-organism by looking
at individuals. We therefore have no idea what we ourselves may carry
and need to remember that we should not only be concerned with what
a patient may transmit to us but also with what we may transmit to the
patient, both from ourselves as well as from others.
Transient micro-organisms are those which we can pick up from others
or the environment or move around our own bodies which can be easily
transmitted to others or to sites on our own bodies where they may
cause infection. These are one of the main concerns in HCAI.
Sources of infection can be:
•
•
•
Endogenous
Exogenous
Environmental
Endogenous infections are self infections i.e. infections caused by
ones own micro-organisms or transmitted to oneself by organisms that
have been picked up, such as from the environment. An example of an
endogenous infection might be if someone carried group A streptococcus
in their throat and then put a cut finger in their mouth, they might
transmit the micro-organism from their mouth to their finger and cause
an infection in that finger. This infection would therefore not be caught
from anyone else but would be endogenous.
Exogenous infections are those which are caught from an external
source such as other people or animals. In many infections, it is not
possible to determine whether the source of infection is endogenous or
exogenous as many infections can be aquired from either source.
Environmental sources are also exogenous and are under-estimated
as a significant source of infection but are becoming more focused upon
with hospital cleanliness becoming a political issue. As some microorganisms can live in the environment in dust and skin scales as a reservoir
and some bacterial spores can survive for several years on inanimate
objects, environmental sources should be considered to be important
with regards to the transmission of infection.
4.
The blood and body fluid route – this
can be horizontal transmission via
inoculation with the micro-organism
(such as a bite, injection, blood transfusion)
or through unprotected sexual intercourse;
or vertical i.e. from mother to baby e.g.
Malaria, Hepatitis C, Dengue fever, HIV
Infection Risks
One of the links in the chain of infection is the susceptible host. While
we do not always know what makes a particular person susceptible to
infection by a particular agent at a certain point in time, there are several
factors which can increase a person’s risk of acquiring or developing an
infection.
Some of these factors are personal and specific to the patient themselves
while others are related to the environment in which they are being
cared for.
Personal factors include things such as age, where the very young and
elderly are at increased risk of developing infections.
Other personal factors which may increase a person’s risk of infection
include: nutritional status, immunity (either due to condition, treatment
or immunisation status), chronic conditions such as diabetes, medication
such as steroids, other treatments such as chemotherapy, physical wellbeing, hygiene standards, psychological well being, job, presence of invasive
devices or wounds, medical intervention, obesity and splenectomy
Environmental factors may be related to different care environments
such as hospitals, nursing homes, clinics, hospices, mental health facilities,
schools and the patient’s own home. These include factors such as:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Some of the factors above can be addressed but others cannot. We
therefore need to accept that this may be a link in the chain that we
cannot always remove. Much of the time we can minimise the risk of
infection but we cannot completely remove it.
Work based activities
•
Identify the common types of infections in your
department and consider whether they are bacterial,
viral, parasitic or fungal in nature
•
Identify a patient who has been admitted to
your department and attempt to identify any
potential routes of infection transmission and steps
that you may take to minimise the risk
•
Ask a senior member of staff to demonstrate how a
patient is screened for infection e.g. blood tests undertaken,
vital signs recorded, procedure for obtaining swabs
Routes of Transmission
Where infections are not endogenous, there are four main routes of
transmission or modes of spread:
1.
The airborne route – this involves
transmission via aerosols and droplets in
the air – these could be via coughing or
sneezing or via aerosols in vomit e.g.
Influenza, Norwalk virus, Legionnaires
disease, Pulmonary TB
Shared facilities
Facilities available for care
Number of contacts
Patient and carer knowledge
Workload
Staffing levels
Mass catering
Cleanliness
Caring for infected patients
Invasive devices
Communication
Policies and procedures
Staff education
Chronic wound management
References / further reading
Shanson DC (1999) Microbiology in Clinical Practice 3rd ed.
Butterworth-Heinemann, Oxford
Stucke VA (1993) Microbiology for Nurses 7th ed.
Bailliere Tindall, London
2006/2007 OXOID INFECTION CONTROL TEAM OF THE YEAR AWARDS
NOW OPEN FOR ENTRY
2.
3.
The faecal-oral route – this is the hand
to mouth route and is a cause for concern
in transmission of food poisoning e.g.
Norwalk virus, Hepatitis A, Campylobacter
The contact route – this can be direct
contact from person to person or
indirect via food or the environment e.g.
MRSA, Ringworm, Scabies,
The 2006/2007 Oxoid Infection Control Team of the Year Awards with 1st prize: £5,000, 2nd prize: £1,000, 3rd prize: £500, are
now open for entry. Oxoid Ltd is pleased to announce that the 2006/2007 Oxoid Infection Control Team of the Year Awards
are open for entry. The winning team will receive a cheque for £5,000 in recognition of the improvements that they have
made to infection control within their hospital, and 2nd and 3rd prize winners will receive £1,000 and £500 respectively.
To enter, summarise (in 2000 words or less) the infection control challenges faced in your hospital, the communication
methods you have used to respond to these challenges, the work undertaken, outcomes and improvements made, and
finally say why you think your team should win this prestigious award.
Fiona Macrae, Clinical Applications Manager at Oxoid and Chairman of the Judges gave some clue as to what the judges are
looking for. “Amongst other things, the judges are looking for evidence of the impact of outcomes and improvements made.
Where possible, facts and figures are the best way to do this. For example, saying that
the impact of a certain intervention was ”significant”, “enormous” or “excellent” does
not tell them nearly as much as, „the rates of infection fell from 260 in Q1 to 122 in Q3”.
Facts and figures allow the judges to gauge the level of improvement made and, of
course, a graph or table is an easy way to present such information.
Entries for this international Awards scheme are welcome from infection control teams
(including microbiologists, laboratory professionals, infection control doctors and
nurses) in all countries around the world.
The Awards closing date is 31 January 2007.
Oxoid Awards Setting Standards Update newsletter, giving details of last year‚s winners
and full details of how to enter, can be found on www.oxoid.com. Alternatively, please
ask your local Oxoid representative to obtain a copy, or contact Val Kane, Oxoid Ltd,
tel: +44 (0) 1256 841144, fax: +44 (0) 329728, Email: [email protected]
The 2006/2007 Oxoid Infection Control
Team of the Year Awards are now open
for entry. Representatives of the
2005/2006 winning teams are pictured.
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19
Working together in Scotlandʼs Health Service
problems at work . . .
tackling bullying and stress . . .
improve health and safety at work . . .
for information on your workplace rights . . .
join GMB Scotland
Call Alex McLuckie
GMB Scotland Organiser
in the Health Service
Tel: 0141 352 8130
email: [email protected]
GMB Scotland
Regional Secretary: Harry Donaldson
Regional President: Brian Johnstone
WWW.GMB.ORG.UK
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21
ECG Rythms
“ECG Rhythms ………..
Without the Blues!”
(Part 3)
Author: Charles Bloe BSc RGN NDN ITU cert
Lead Lecturer and CEO - Charles Bloe Training
Welcome back! So far in this series we’ve looked at normal ECG rhythms and ectopics.
In this issue we are going to look at two very common and potentially dangerous ECG rhythms
called atrial fibrillation and atrial flutter
ATRIAL FIBRILLATION
What to look for on the ECG:
Atrial Fibrillation (AF) is one of the most common
arrhythmias that we see in clinical practice. It is
particularly prevalent in the elderly population.
Atrial Fibrillation has the following ECG characteristics.
AF has been referred to as a ‘sheep in wolves clothing’
due to the potential complications associated with it.
AF can cause or worsen heart failure and there is an
increased risk of embolic complications such as stroke.
Atrial fibrillation can be chronic i.e. a permanent
feature or it can also be paroxysmal where it occurs
for short episodes (typically a few minutes) and ends
spontaneously
In AF there is a lack of organized atrial activity as the
atria typically discharge 400 - 600 random impulses
every minute. This chaotic activity results in loss of atrial
contraction causing the atria quiver of fibrillate.
•
•
•
•
•
•
•
The rhythm is irregularly irregular
The heart rate can be variable and depends on
how many atrial impulses are transmitted from
the atria to the ventricles
There are no P waves
P waves are replaced by fibrillatory waves ~ f
waves (look like squiggly lines!)
There are QRS complexes and T waves
P:QRS ratio is not applicable as we have no P
waves
P-R interval is not applicable
See if you can spot these appearances on the following
example of atrial fibrillation:
Fig 1: Atrial Fibrillation
The AV node is bombarded by this barrage of impulses
and cannot conduct all of them to the ventricles thankfully! Conduction to the ventricles is variable and
can range from bradycardia to tachycardia.
When more than 100 atrial impulses are conducted to the
ventricles this results in a ventricular rate of more than
100 beats per minute. We call this fast or uncontrolled
atrial fibrillation. A ventricular rate of less than 100 is
generally referred to as controlled atrial fibrillation.
Atrial Fibrillation may be seen in the following
circumstances:
•
•
•
•
•
•
•
•
•
22
Advanced age
Atrial enlargement
Drug effect e.g. Digoxin
Alcohol
Myocardial Infarction
Heart Failure
Pulmonary embolism
Pericarditis
Idiopathic
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Useful tip!
When you see an irregularly irregular rhythm without
obvious P waves then there is a good chance you are
looking at atrial fibrillation
Treatment options for AF may include:
•
•
•
Anticoagulation due to the risk of emboli
Drug therapy e.g. Digoxin to control the rate
Electrical cardioversion
ATRIAL FLUTTER
Atrial Flutter occurs when the atria discharge between 200
- 400 regular impulses every minute. This atrial activity
results in P waves with a saw-tooth appearance. This is
the most distinctive feature on the ECG. There are no
isoelectric segments between the waves just a succession
of flutter waves blending into one another
ECG Rythms
The ventricular response is normally slower and can
occur regularly or irregularly. It is not uncommon for the
ventricles to respond to every second atrial impulse. For
example if the atrial rate were 300 then we would have a
ventricular rate of 150. This is referred to as atrial flutter
with 2:1 block
See if you can spot these appearances on the following
example of atrial flutter:
Fig. 2. Atrial Flutter
Atrial Flutter may be seen in the following circumstances:
•
•
•
•
•
Useful tip!
Atrial enlargement
Drug effect e.g. Digoxin
Myocardial Infarction
Pulmonary embolism
Pericarditis
The most common atrial rate in atrial flutter is 300 beats
per minute and one of the most common conduction ratios
to the ventricles is 2:1. This would result in a ventricular
rate of 150 beats per minute.
Atrial Flutter has the following characteristics.
•
•
•
•
•
•
•
Whenever you see a ventricular rate of exactly 150 beats
per minute think atrial flutter!
The rhythm is usually regular but can be irregular
The heart rate can be variable and depends on
how many atrial impulses are transmitted from
the atria to the ventricles
There are no P waves
P waves are replaced by saw tooth flutter waves
waves ~ F waves
There are QRS complexes and T waves
P:QRS ratio is not applicable as we have no P
waves (but there may be a set ratio of flutter
waves to QRS complexes e.g. 2:1)
P-R interval is not applicable
Join us again in the next issue when we will examine
the most serious ECG rhythms – those that can result
in Cardiac Arrest
In the meantime if you want to enhance your ECG skills
then why not sign up for our new online ECG programme.
Available for only £25! For further details see the advert in
this issue or visit our web site at www.cb-training.com.
Charlie Bloe BSc RGN NDN ITU cert
For more information on ECG Training visit : www.cb-training.com
CalMed is one of Europe’s foremost
manufacturers of Custom Procedure
Trays (CPTs), and a leading distributor
of other top quality medical devices
including Heart valves, Cannulae and
Off – Pump retractors, recently adding
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The facility is situated within the Medipark at Strathclyde Business Park to
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We operate our own delivery service in
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Combining manufacturing and
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Sourcing superior quality disposable
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staff a CPT that contains the full range
of disposable product needed during
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CalMed introduce New Product Range
CalMed have introduced the specialised
Eurosets range of medical devices into
the UK. These products include
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sequential tube clamp plate and automatic negative pressure valve, for use in
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autotransfusion system. Having a sterilising membrane both entry of non sterile
air in the recovery circuit and contamination of the non disposable components
are prevented which allows for direct
reinfusion of the recovered blood by
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Other products will be added to this
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For more information or to discuss you
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Stuart Hawker Sales & Marketing
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24
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Wound Care & Treatment
Authors:
Mr. D.O McConville M.Chs, Podiatrist
Mr. R. Hannon, FRCS,Vascular Surgeon
Belfast City Hospital
Referral
This case describes the development of a large heel blister in an
in-patient following arterial bypass.The patient had been referred
by the vascular nursing team for advice regarding the management
of a large heel blister that was continuing to increase in size.
Medical history
The patient’s risk factor profile for peripheral vascular disease
was that she was not diabetic, had normal lipid profile, wasn’t
hypertensive or in renal failure. She had no symptomatic ischaemic
heart disease but was a smoker of between 10-15 cigarettes per
day. On admission to hospital the patient described how the left
foot suddenly went white and cold and became extremely painful.
Prior to this the lady had described intermittent claudication at a
distance of about 100 metres for approximately six months.
level of anti- septic protection after drainage. The Aquacel® was
used to absorb and retain exudates, which in this type of wound
can be significant. The Allevyn® heel pad was used to achieve
further absorbency. If maceration of the surrounding skin were
to occur, secondary infection would become more likely. This
dressing regime was changed daily for six days and then changed
to dressings of Inadine and plain gauze daily until the level of
exudate had reduced. Wounds of this nature may resolve quickly
when tissues adapt to the reperfusion.
Clinical examination
The patient was in sinus rhythm. Both femoral pulses were
palpable, both foot pulses on the right side were bounding and
foot pulses on the left were impalpable.
Atrophic skin changes were evident.
• The veins on the dorsa of both feet were prominent.
• The right foot was swollen.
• The right foot was warm and the left foot was cool, with a
temperature gradient from proximal to distal.
Investigations
Ankle-Brachial index on admission was 1.02 and the left 0.46.
Surgical treatment
Following arteriogram an occlusion of the left superficial femoral
and popliteal arteries was shown. A left femoro - anterior tibial
bypass was performed.
Wound presentation
Six days after the bypass was performed, it was noted that a large
blister had developed on the heel.
Wound Progress
This was not incised but was drained with a needle puncture to
minimise overlying tissue trauma, reduce loss of epidermal tissue
and reduce the likelihood of infection.
Following drainage the heel blister site was dressed with Inadine®,
Aquacel® and an allevyn heel dressing. The rationale of this
regime was based on the reasoning that the Inadine® afforded a
Case learning
Combining dressing types may be good practice when a number
of different objectives are to be achieved. If the blister had
ruptured a larger area of skin may have been damaged and a
much larger wound would have been generated. Wound healing
requires a moist environment(1) Drainage of blisters may be
achieved successfully by aspiration. Management of maceration
may protect the surrounding skin from damaging effects of wound
exudates(2,3). The risk of secondary infection is increased when a
larger area of dermis is exposed. There is evidence to suggest
wound healing is improved under occlusion(4) and that wounds
heal better in a moist environment(5). These considerations
must be balanced against the risk of damage to the skin by
the presence of excessive moisture and the increased risk of
secondary infection in macerated skin.Water activity may enhance
enzymatic activity of bacteria(6). Dressing such a wound with an
antiseptic film may reduce the likelihood of infection developing.
A foot wound complicated by the presence of infection, is an
important consideration when vascular intervention has been
carried out. It has been reported that wound fluid from pressure
ulcers contains elevated levels of proteases compared to acute
wounds, these can be damaging to the surrounding skin(7). The
dressings employed were chosen to minimize the likelihood of
damage to the skin by exudate. Relief of pressure on the heel is
an important dimension for healing. If a patient is unable to sit,
it is important to remove the weight of the leg acting through
the back of the heel. This can be achieved by positioning a pillow
beneath the posterior aspect of the leg and so increasing the
surface are through which weight is borne
References
(1) Winter GD
The formation of the scab and rate of epithelialisation of superficial wounds in the skin of the young domestic pig Nature 1 93: 293-294
1962
(2) Bowser PA White RJ Isolation, barrier properties and lipid analysis of the stratum corneum British Journal of Dermatology 112-114
1985
(3) Cutting KF Avoidance and management of peri-wound maceration of the skin Professional Nurse 18 (I):33-36 2002
(4) Pirone L, Monte K, Shannon R et al (1990) Wound healing under occlusion and non occlusion in partial thickness and full thickness
wounds in swine.Wounds 2:74-81
(5) Vogt PM,Andree C, Breuing K et al (1995) Dry, moist and wet skin wound repair. Annals of plastic Surgery 34:493-500.
(6) Troller JA,Stinson JV(1978) The influence of water activity on the production of extracellular
enzymes by Staphylococcus aureus. Applied and Environmental Microbiology 35(3): 521-26
(7) Yager DR, Chen SM,Ward SI et al (1996) Wound fluid from human pressure ulcers contain elevated matrix metalloproteinases levels and
activity compared to surgical wound fluids. J Invest Dermatol; 107:743-748.
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25
Care Planning
This paper aims to reassure staff of the benefits of care planning.
Author:
Claire Lisa Welford RGN, Dip N.S., BNS–Hons., MSC.
Nursing, PGC (TLHE) Clinical Link Facilitator & Lecturer –
Gerontology. NMPDU & NUIG.
Introduction
Every time that the author walks into a different long-stay care of the
older person unit it is found that the staff are struggling with care
plan introduction. Healthcare professionals are constantly looking for
clarification on the subject. So what is it that frightens many healthcare
professionals about care plans? And why are there problems surrounding
their implementation? How can we educate student nurses on the
importance of care planning if we fail to provide accurate and consistent
documentation practices across our sites?
Care planning has its roots in the nursing process which dates back to
the 1970’s. It involves assessment, planning, implementation, evaluation
and documentation. The irony is that all
healthcare professionals automatically carry
out this process in their everyday work and
yet when asked to document this in a care plan
it immediately becomes a monster! So what
is a care plan? “It is a written, structured, plan
of action for patient care based on holistic
assessment of patient need, identification of
specific patient problems and the development
of a plan of action for their resolution”
(Mason, 1999: 380).
The professionalisation of nursing demands
systematic approaches to healthcare. The
care given is reflected in the care plan thus
demonstrating this level of professionalism as
it clearly shows how care is approached in a
rational, evidence based and holistic manner.
The written plan is thus goal-orientated,
efficient, effective & individualised. However
healthcare professionals have difficulty writing
these plans of care (Chavasse, 1981, Norton,
1981 & Roberts, 1982).
Barriers
Lack of relevant education may be viewed
as a barrier to care plan introduction. The
healthcare professional needs to possess
requisite skills, knowledge and experience.
Very often care plan introduction is expected
by management and professional bodies but
the educational resources and facilitative
support may not be provided for same thus staff struggle in the swampy
lowlands as they blindly attempt care plan introduction. Skill mix and
re-organisation of the work schedule to enable time for documentation
are also barriers to successful care plan introduction. One of the biggest
offenders that the author has observed is when staff are not involved
in the care plan design. Very often care plans which are working well in
other sites are introduced without evaluation of their appropriateness
and thus inevitably they sink like the titanic. Staff can’t understand how
if the care plan works well somewhere else why it will not work in their
area. The answer is simple: it is unsuitable to their care environment,
patient profile and services available. If care plans are to be successful
a bottom-up approach is called for whereby all staff are involved in
designing, piloting and evaluating the documentation. This approach will
lead to a user-friendly document which staff will embrace with pride.
This user-friendliness will enable the care plan to be kept active and not
just left in a folder on a shelf gathering dust. Keeping care plans active
will enable healthcare professionals to see their benefits rather than
viewing them as another piece of documentation that just needs filling
out. Mason (1999) supports this by offering that two important factors
are involved in successful care plan introduction: being clinically driven
and local ownership. O’Connell et al (2000) argues that few care plans
have been able to reveal the current context of care being provided to
a patient, were not informative, not specific, out-of-date and not easy to
read or understand. Qamar (1990) supports this by reporting that preprinted care plans are taken off the shelf, the patients name is applied,
the nurse’s signature is applied and the document is then ignored. Mason
(1999) found that these pre-printed care plans with tick boxes hinder
individualized care by discouraging freedom for each nurse to approach
26
www.scottishirishhealthcare.com
assessment in their own unique way.
The UKCC (1993) outlined the need to reduce documentation to a
minimum, avoiding duplication and collation of unnecessary information.
This duplication can be eroded if care plans are kept active and not
left sitting in the patients file. If the care plan and the daily notes are
kept together one will complement the other. They should be used
simultaneously thus reducing the need to repeat information. All care
should be visible at a glance and one should not have to sift through
repetitious pages detailing the same information.The author has observed
in many sites that assessment tools are completed on admission and then
all of the same information is replicated within the care plan.Thus it is no
wonder that healthcare professionals rebel against the extra paperwork
that care plans sometimes entail. Surely the assessment tools are already
part of the care plan and repetition is not necessary. The Waterlow scale,
FRASE scale, mini-nutritional assessment chart
etc are thoroughly devised and accredited,
so why do we feel the need to repeat the
information contained within them? Siegal
& Fischer (1981) described the care plans
which they reviewed as being unsystematic,
fragmented, often illegible, not valid and with
poor readability.
The Future
The population is ageing and recent media
attention has directed healthcare professionals
to focus on the standard and quality of care
provided in long-stay care of the older person
units.As current healthcare practices evolve and
as the focus of health care shifts to recognising
the importance of person-centred care then a
re-invention of the care-plan for older peoples
services is required. Mason (1999) offers that
this move should not be confined to being
based on a nursing model. Mason (1999) also
argues that new and imaginative designs should
be encouraged which are developed at ward
level, tailored to meet the needs of the client
and should involve minimum documentation.
Healthcare professionals often write care plans
which relate to their needs as practitioners
rather than focusing on the patients needs
(McMahon, 1988). Several authors have written
about the need to shift current healthcare
practices from routinised and ritualistic care
to person-centred and relationship centred
care. It is argued that if a care plan is to be realistic then the healthcare
professional needs to establish a relationship with the resident in order
to fully understand their needs.
McCormack (2001) aimed to develop this theory and offered from his
work that there are four concepts underpinning person-centred nursing.
These are: being in relation, being in a social world, being in place and
being with self. The explanation of these terms includes; the relationship
between the nurse and the patient, knowing the person’s social world
and devising life-plans for them, the working environment and its systems
which may promote or hinder person-centred practice and finally
knowing the patient and their values. This reflects Curtin & Flaherty’s
(1982) belief that the foundation of the nurse-patient relationship is
based on a mutual humanity of the participants with its nature rooted in
the determination of the patients human needs & the nurses response
to them. The “senses framework” was introduced by Nolan et al (2001)
and believes that experiencing a “sense” of security, belonging, continuity,
purpose, achievement and significance are key in creating a caring
environment.
McCormack (2001) supports this by saying that the expert gerontological
nurse tries to give the patient as many opportunities as possible to
exercise freedom of choice, to express opinions, to make decisions, to talk
while the nurse really listens and to have the opportunity to express their
authentic self in a negotiated partnership with the nurse. However, many
healthcare professionals fear sharing care and control with the patient
believing that they may have neither the desire or the knowledge to
fully orchestrate their own health care. Sharing information with patients
empowers them to make rational decisions about their own health.
Care Planning
Patients can become active participants rather than passive recipients
of healthcare. Evidence suggests that patients who actively participate
in their own care have more favourable clinical outcomes (Kaplan et al,
1989 & Greenfield et al, 1985).
In the past healthcare for older people has focused on meeting the
residents physical needs such
as washing, dressing, eating,
toileting etc. but the future
of older person care directs
healthcare professionals to
focus on these needs combined
with the residents social needs.
Community nursing units by their
very name imply that they exist
as part of a community but the
reality is that they often operate
in isolation with little outside
involvement. Ruddle et al (1997)
quoted one of the residents as
saying “losing contact with one’s
friends and neighbourhood is a
big problem” and it was further
found that an important concern
was the standard of care that
they could expect to receive and the level of independence they could
maintain in the unit. When older people realise that they are no longer
part of their human world, they experience despair (RCN, 1993).
Thus the future of care planning for older people demands a need to
move from the medical model of care to the social model of care. The
author has developed a care plan in collaboration with two long-stay
care of the older person units in the West of Ireland. It focuses on both
McCormack’s (2001) and Nolan’s et al (2001) work and is based on
New Zealand’s domains of assessment for older people. These domains
are identified as the issues of most importance to older people and
are: personal care, safety, food, social participation, daily life and acute
episodes.
The success of this care plan reflects the earlier recommendations:
•
•
•
•
•
•
•
•
•
A bottom-up approach
Collaboration and inclusion of all team members
Education
Piloting on a small number of residents
initially and celebrating small wins
User friendly
No repetition
No jargon – easy to read and understand
Freedom of the healthcare professional enabled
through limited use of a tick boxes
Inclusion of the resident in the care plan essential
due to its design
Thus the author concludes with the positive motivational fact that
successful care planning is possible.
References
Assessment processes for older people (2003) New Zealand Guidelines Group (NZGG).Wellington: New
Zealand.
Chavasse, J. (1981) From task assignment to patient allocation: a change evaluation. Journal of Advanced
Nursing. 6: 137-145.
Curtin, L. & Flaherty, M.J. (1982) Nursing Ethics:Theories and Pragmatics. Englewood Cliffs: Prentice-Hall
International Editions.
Greenfield, S., Kaplan, S. & Ware, J.E. (1985) expanding patient involvement in care: effects on patient
outcomes. Ann Intern Med. 102: 520-528.
Kaplan, S.H., Greenfield, S. & Ware, J.E. (1989) Assessing the effects of physician-patient interactions on the
outcomes of chronic disease. Med.Care:110-127.
Mason, C. (1999) Guide to practice or “load of rubbish”? The influence of care plans on nursing practice in
five clinical areas in Northern Ireland. Journal of Advanced Nursing. 29(2): 380-390.
McCormack, B. (2001) Negotiating Partnerships with Older People: A Person-Centred Approach. UK:
Ashgate.
McMahon, R. (1988) Who’s afraid of nursing care plans? Nursing Times. 84: 39-41.
Nolan, M.R., Davies, S. & Grant, G. (2001) Working With Older People and Their Families: Key Issues in
Policy and Practice. Buckingham: Open University Press.
Norton, D. (1981) The quiet revolution: an introduction of the nursing process in a region. Nursing Times. 77:
1067-1069.
O’Connell, B., Myers, H.,Twigg, D. & Entriken, F. (1998) The clinical application of the nursing process in
selected acute care settings: A professional mirage. Australian Journal of Advanced Nursing. 15: 22-32.
Qamar, S.L. (1990) An integrated nursing care plan. Nursing Management. 21: 96-97.
Roberts, C.S. (1982) Identifying the real patient problems. Nursing Clinics of North America. 17: 481-489.
Royal College of Nursing (1993) Older People and Continuing Care- The skill and Value of the Nurse.
London: RCN.
Ruddle, H., Donoghue, F. & Mulvihill, R. (1997) The Years Ahead Report: A Review of the Implementation of
its Recommendations. Dublin: National Council on Ageing and Older People. Report No. 48.
Siegal, C. & Fisher, S.K. (1981) Psychiatric Records in Mental Health Care. New York: Brunner-Mazel.
United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1993) Standards for Records
and Record Keeping. UKCC: London.
www.scottishirishhealthcare.com
27
Care Planning

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


The England Ladies Flyfishing Association and the
Countryside Alliance have joined forces to launch
Casting for Recovery (UK & Ireland), a unique
outdoor-based programme specifically designed
for women who have or have had breast cancer.
Casting For Recovery will provide fly-fishing programmes at
idyllic retreats around the UK and Ireland. Any woman who has
experienced breast cancer is eligible to apply to attend a retreat
(with medical clearance from their doctor).






Weekend retreats are provided at no cost to the participants
including accommodation, meals, counselling, and professional
instruction. Trained medical staff and fly-fishing instructors will
be on hand at all times.

Manual Handling Solutions
58, Paige Close, The Meadows, Watlington
King's Lynn Norfolk PE33 0TQ
Tel 01553 811977 Fax 01553 811004





Researchers have discovered two biomarkers which could
potentially predict the spread of breast cancer.
Taken from primary tumour biopsies, researchers have found
two proteins which are highly linked to the spread of breast
cancer to lymph nodes nearby.
In a group of 65 patients, the under-expression of one protein
and the over-expression of another is 88 per cent accurate in
identifying breast cancer which has spread.
The results of the study were published in the December 15th
issue of Cancer Research.
Lead author of the study, Dr Dave SB Hoon, said: “We want to
be able to predict, at the earliest stages, if a tumour has spread
and how dangerous it will be.
“These two proteins may allow us to target aggressive tumors
with more extensive therapy management to some women,
while sparing others from needless treatment.”
Hunting for lymph nodes during surgery only tells one whether
the nodes are positive or negative, added Dr Hoon.
Breast cancer is the most common form of cancer in females
worldwide.
28
www.scottishirishhealthcare.com
Fly-fishing offers proven benefits for recovering breast cancer
patients. The casting action provides the gentle exercise
recommended by physiotherapists for joint and soft tissue
mobility. Fly-fishing also offers participants a chance to reflect
and escape in tranquil surroundings. Casting for Recovery was
founded in the United States in 1996 and has since helped more
than 2,000 breast cancer survivors. The first course in the UK
will take place at Duncton Mill, West Sussex between 17-19
September 2007. World-famous fly-fishing retailer Orvis has
generously supplied the equipment and clothing needed to run
the event.
The UK Planning Co-ordinator is Sue Hunter, who recovered
from breast cancer to become an international gold medallist
and captain of Team England 2007. Sue said: “My aim is for
Casting for Recovery to be as successful in the UK and Ireland
as it has been in the US and Canada and for us to reach as many
women as possible who might benefit from the experience.”
Wendy Miller, Chair of the England Ladies Flyfishing Association commented: “The Association is extremely proud to launch
Casting for Recovery here in the UK and Ireland. We look
forward to working with the Countryside Alliance, who will plan
with us the initial retreats and beyond. Also, it’s wonderful to
have the support of Orvis UK, who have graciously extended
the sponsorship they give to Casting for Recovery in the US. I
am personally thrilled to see the project move forward, and
would like to thank everyone involved. Breast cancer is an issue
that I feel very passionate about, there are few families who have
not been touched by it, mine being no exception.”
For further information, contact:
• Sue Hunter, UK Planning Co-ordinator: 07931 448090
• Robert Gray, Countryside Alliance: 07917 476318
• Countryside Alliance press office: 0207 840 9220
www.scottishirishhealthcare.com
29
Mental Health
A Brief Overview
of Borderline
Personality Disorder
By Philip James, Clinical Nurse Specialist,
Young Persons’ Substance Abuse Programme.
Introduction
The purpose of this article is to provide nurses
with an update on Borderline Personality
Disorder (BPD). This article aims to provide a
succinct overview of the recent research and
literature in order to make it accessible to all
nurses, thereby promoting evidenced based
practice. Areas covered include a definition,
the prevalence as well as causal factors and
treatment of the disorder. The author will also
recommend some suitable articles and books
for those who wish to read further into the
topic.
A point of interest is that the Mental Health
Act (2001) clearly states that Personality
and Substance Abuse Disorders are not
included in its definition of mental illness,
(Government of Ireland, 2001). However, the
more recently published Report of the Expert
Group on Mental Health Policy (hereafter
referred to as Expert Group) states that
the care of those with a diagnosis of BPD
is clearly within the remit of the psychiatric
services. This document makes the topic
of BPD relevant to all psychiatric nurses in
Ireland, as they can therefore expect to see
more energy and resources being directed
towards this client group. Furthermore, as
many acute psychiatric units are based in
general hospitals, Accident and Emergency
Departments have now become the first port
off call for those seeking psychiatric services
out of hours. Coupled with the tendency of
clients with BPD to self-harm, be impulsive
and to abuse drugs and alcohol, it is hard to
imagine any nurses who will not have some
contact with this client group.
Definition of BPD
Personality
disorders
are
psychiatric
diagnoses which are clearly defined in both
the DSM-IV (APA, 2000) and the ICD-10,
(World Health Organisation, 1989). Everyone
has their own distinct personality traits which
influence how they think, feel and behave in
their lives. These personality traits tend to
become evident in an individual by adolescence
or early adulthood and remain relatively stable
over time. However, sometimes these traits
can become particularly maladaptive and
result in significant distress and impairment to
social functioning for an individual. The DSMIV criteria for diagnosing BPD are presented
in Box A, however a little time will be spent
explaining how these symptoms might present
in practice. Hurt et al’s. (1992) division of the
DSM criteria into three areas (identity, affect
and impulsivity) makes them more accessible
and so will be used here.
Identity symptoms include intense fears of
abandonment by others, feeling empty and
without purpose, fluctuating self image and
lacking a sense of self. In practice these
symptoms often present as the client being
very anxious in relationships and frequently
seeking reassurances from significant others,
including staff. Clients with BPD can also
appear to have little direction in their lives and
often speak about not knowing what to do
with life. Affective or mood symptoms are a
major part of the borderline presentation.
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In particular, feelings of anger and hurt can
present as very intense and often appear
to the onlooker as inappropriate or as an
over reaction. Due to the client’s fear of
abandonment or mistreatment by others
their anger is often directed at people who
they perceive have betrayed their trust in
some way. These feelings often result in
relationships which appear very unstable with
the client moving from hating someone to
loving them (and often back again) in a very
short space of time. As well as the feelings of
anger, depressive feelings are very common
among clients with BPD along with a poor
self-concept. Finally, impulsive symptoms
are most commonly associated with selfharm and suicidal behaviours but many other
behaviours can also be extremely impulsive.
For example, clients with BPD often engage
in a variety of risky and impulsive behaviours,
such as substance abuse, unprotected sex
or drink driving. Impulsivity may also explain
how the client approaches many important
decisions in their lives such as ending or
starting relationships, quitting a job or moving
house.
Incidence
International research estimates that about
2% of the general population meet the
diagnostic criteria for BPD. According to
Irish statistics the admissions and treatments
of clients with any personality disorder is
relatively uncommon. For example, clients
with a diagnosis of Personality Disorder
account for about 4% of the admissions
to psychiatric units and amount to 3% of
inpatient days, (Daly and Walsh 2003a &
2003b). On the other hand, the American
Psychiatric Association (2000) estimate that
approximately 20% of all inpatients and 10%
of all outpatients meet the diagnostic criteria
for BPD. These figures suggest that many
clients with BPD may be going undiagnosed
in Irish services.
Females account for about 70% of those
diagnosed with BPD, (Krawitz and Watson
2003) but things may not be this simple.
Becker and Lamb (1994) asked professionals
to assign a likely diagnosis to a client based
on a written case history where the sex of the
client (and no other details) was randomly
changed. They found that professionals
were more likely to attribute a diagnosis
of BPD to women than men which the
authors suggest questions the validity of the
diagnosis. Simmons (1992) echoes this idea
claiming that angry and promiscuous women
are likely to be diagnosed with BPD while
males exhibiting the same characteristics are
more likely to draw a diagnosis of antisocial
personality disorder. Becker (2000) has
further argued that the current trend to see
BPD as a “consequence of character” has led
many professionals, concerned about blaming
clients, to embrace diagnoses that are seen
as a result of fate, such as post-traumatic
stress disorder, instead. These studies may
help to explain why the diagnosis of BPD is so
rarely used in Ireland when compared to the
international research on the incidence within
psychiatric clients.
Causal factors
Like the majority of psychiatric disorders BPD
has no single identified cause and is probably
best viewed as the result of interplay between
various factors. It is impossible to present
a complete review of the literature on the
aetiology of BPD in this article therefore those
interested should consult the further reading
section at the end of this article.
Traditionally, many professionals have viewed
personality disorders as simply a personality
quirk but recent research is starting to
suggest that some biological factors may also
play a role. We will therefore view BPD from
a biopsychosocial perspective in this section
starting with biological factors.
While the research is sparse to date, some
research has suggested that genetics may
play a role in the development of the disorder.
Torgerson et al. (2000) report that twin
studies demonstrate that in identical twins
the concordance rate is 35% while in nonidentical twins the rate is only 7%. Krawitz
and Watson (2003) cite numerous studies
which point to a reduction in serotonin activity
in clients with BPD and such reductions have
been linked with increased anger, impulsivity,
suicidal ideation and irritability as well as a
lowering of mood.
From a social perspective clients with a
diagnosis of BPD are predominantly female
and “adverse events” in childhood are evident
in about 40% to 71% of cases depending on
which studies are examined, (Lieb et al. 2004).
The difficulties in childhood most frequently
reported by client’s ranges from neglect to
emotional, physical and sexual abuse. The
literature has paid particular attention to
the high levels of sexual abuse, including
rape, reported by those with BPD with some
studies suggesting up to 70% of clients have
experienced some form of sexual abuse,
(Krawitz & Watson 2003). However, Krawitz
and Watson caution against the simplistic
view that BPD is the result of sexual abuse as
most clients who suffer sexual abuse do not
develop the disorder and about 30% of those
with the disorder were never abused.
While most schools of psychotherapy have
a theory as to the cause and development
of BPD, the cognitive behavioural therapies,
particularly Dialectical Behaviour Therapy
(DBT), have developed the most evidence
for there effectiveness and therefore only
this theory will be presented here. DBT views
those with BPD as having a fundamental
difficulty or lack skills in tolerating frustration
and unpleasant experiences or emotions.
This inability to deal with frustration leads
those with the disorder to go to great lengths,
such as self-harm, to distract themselves
from the unpleasant experience. DBT also
postulates that clients often have a deficit in
life skills and that these need to be taught to
the client if they are to be able to deal with
strenuous life events.
In order to make therapy work, in the
face of frequent crisis and high levels of
suicidality being experienced by the client,
it is recommended that the therapist have
a hierarchy of goals when working with the
client, (Lenihan 1993). Typically, suicidal
and self-harming behaviours are targeted at
the beginning and once some reduction and
control has been found in this area other
behaviours which interfere with therapy are
targeted. For example, a client with BPD
may find it difficult to trust a therapist due to
a fear of abandonment and as a result they
may not attend for many appointments. The
therapist may therefore help the client to
control these fears and behaviours so that
they do not interfere with the therapy. Finally,
once, suicidal, and self-harm behaviours and
other behaviours which interfere with therapy
are causing fewer problems for the client,
the therapy can focus on the clients other
difficulties such as self-concept and anger.
Mental Health
Treatments
It is important to note that the main form of
treatment for BPD needs to be psychotherapy
(American Psychiatric Association, 2000) and
any attempts to treat them without the use of
psychotherapy are likely to be inadequate.
The Expert Group (2006) states that the
treatment of BPD needs to be addressed
and recommend the development of
therapeutic teams to address their need and
suggest that a DBT team is likely to be an
effective means of providing this care. DBT
is a form of cognitive behavioural therapy
(CBT) specifically designed to treat BPD
and was outlined in the previous section on
causal factors. DBT differs from traditional
psychotherapy in that that DBT is delivered
by a team of therapists. Typically the client
attends weekly “skills training” groups with
other clients to learn new ways of coping with
difficult situations and emotions. They also
have an individual therapy session, usually on
a weekly basis. Other therapies, particularly
CBTs, have been found to be helpful and
there are various articles and books available
which outline their use in both individual and
inpatient settings. Typically effective therapies
help the client to examine their dysfunctional
relationship patterns while teaching problem
solving skills and providing acceptance and
validation, (Expert Group 2006).
Medications may be of some help to clients
but the benefits are likely to be modest which
should be made clear to the client and their
family, (Fagin 2004). Fagin (2004) provides
a good overview of the use of medications
with clients with BPD and his points will be
summarised here.
Mood problems, such as low mood, anger
and hypersensitivity, are common in those
with BPD and antidepressants may be of
use. High doses of fluoxetine (60mg) should
be the first line treatment but venlafaxine and
MAOI’s could also be considered if there is
no response from the fluoxetine. In order to
target impulsive behaviour numerous drugs
may also be used such as mood stabilisers,
antipsychotics and SSRI’s. Many clients
with BPD experience psychotic symptoms
resulting
in
antipsychotics,
including
clozapine being used. Benzodiazepines can
be used to treat anxiety but caution is needed
due to the tendency of such medications to
create dependency which only complicates
matters further. Fagin (2004) specifically
mentions clonazepam as being useful and
recommends against alprazolam which he
states can provoke aggressiveness. With all
medications the potential gains will need to
be carefully weighed against the risks on a
client to client basis. For example, placing a
client on an MAOI may seem appropriate if
they are depressed but the client will need to
comply with a strict diet due to the “cheese
effect” and MAOIs may be fatal in overdose,
(Healy, 2005). If the client is impulsive or
actively suicidal MAOIs may therefore need
to be withheld or closely supervised.
Some nurses believe that patients with BPD
should not be admitted to inpatient units as
this is counterproductive (James, 2005).
Research indicates that this is not the case
and those with BPD can do well in longterm residential care where psychotherapy
is provided, (Gabbard et al., 2000) or in
therapeutic communities, (Kelly, et al. 2004).
Given that most units in Ireland will not be
providing psychotherapy it would seem likely
that long term admissions for clients with BPD
are unlikely to be helpful. Maltsberger (1994)
points out that chronically suicidal patients
frequently evoke a strong counter-suicide
response from staff, leading to prolonged
admissions.
Short admissions, (a few hours to a few days)
can be helpful in providing an opportunity for
assessment, respite and crisis intervention if
the risk of suicide or self-harm is particularly
high, (Krawitz & Watson 2003, Fagin 2004).
Nehls (1994a & 1994b) describes the use of
brief hospital admissions for this client group
where the client initiates admission for an
agreed length of time (usually a few days) and
this approach was positively viewed by staff
and led to a decrease in time in hospital for
clients. Working with clients with BPD can be
challenging and staff need to be consistent in
their approach as the client is often chaotic and
chaotic staff will only aggravate this further.
Box B contains some general principles for
providing care to clients with BPD which are
particularly important in inpatient settings.
Summary
As this article has shown, BPD is a common
disorder that can be very debilitating for those
affected. Recent Irish Government policy
has firmly laid the responsibility for caring for
these clients with the psychiatric services. The
result of this is that knowledge of BPD and its
treatment is likely to become more relevant
to psychiatric nurses in Ireland. International
research has indicated numerous approaches
to working with these clients which can be
helpful including medication, psychotherapy
and the use of short term crisis admissions.
As working with these clients can sometimes
be challenging it is also worth bearing in
mind that the disorder has a better prognosis
than other mental illnesses such as Bipolar
Affective Disorder, (Lieb 2004). In fact
numerous studies have shown that at 6 year
follow-up of previously hospitalised clients
with BPD, over 75% of clients no longer met
the criteria for BPD, (Lieb, 2004).
Further reading
Some of the references used in writing
this article may be of interest to various
professionals working with clients with
BPD. For an overall view of BPD I highly
recommend the book by Krawitz and Watson
(2003) which is very easy to read. It would
be a good investment for any team or unit
which works with these clients as it covers
practically every area including the history
of the disorder, treatments as well as legal
issues. The article by Lieb et al. (2004)
attempts to present a summary of all areas in
a more condensed version so is well worth a
look. For nurses working on inpatient units the
article by Fagin (2004) provides some useful
and practical advice. I would recommend
that all staff familiarise themselves with the
contents of the Expert Group’s Report (2006)
as this will have a huge influence on the
development of the mental health services
and not just in relation to BPD. For those
interested in learning more about the use of
Brief Hospital Treatment Plans the articles
by Nehls (1994a & 1994b) are reccomended.
Finally, the anxiety and turmoil created by
caring for clients who are chronically suicidal
and self-harming is likely to be something all
mental health staff are familiar with and the
article by Maltsberger (1994) provides a very
useful discussion on this topic.
Diagnostic Criteria for Borderline
Personality Disorder
‘A pervasive pattern of interpersonal relationships, selfimage, and affects, and marked impulsivity beginning in
early childhood and present in a variety of contexts as
indicated by five of the following:
1. Frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behaviour
covered in Criteria 5.
2. A pattern of unstable and intense interpersonal
relationships characterised by alternating between extremes
of idealisation and devaluation.
3. Identity disturbance: markedly and persistently
unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially selfdamaging (e.g. spending, sex, substance abuse, reckless
driving, binge eating). Note: Do not include suicidal or selfmutilating behaviour covered in Criteria 5.
5. Recurrent suicidal behaviour, gestures or threats, or
self-mutilating behaviour.
6. Affective instability due to a marked reactivity of mood
(e.g. intense episodic dysphoria, irritability, or anxiety
usually lasting a few hours and only rarely more than a few
days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling
anger (e.g. frequent displays of temper, constant anger,
recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe
dissociation symptoms.’
Box A
Principles for providing care to clients with BPD
(adapted from Fagin 2004)
• Necessary limits should be clearly set and explained to the
clients. Avoid power struggles and be willing to be flexible
when possible.
• Be prepared to tolerate intense feelings from the client
such as anger and hate.
• Encourage the client to reflect on their emotions, thoughts
and actions and the relationships between these.
• Invest time in developing a strong therapeutic alliance.
When possible allow the client choice and input on
decisions.
• Avoid team inconsistencies and be careful not to reinforce
the client’s view of good and bad staff, i.e. splitting. Care
planning decisions should ideally be agreed as a team and
then discussed with the client.
• Be conscious of the stress and strong emotions frequently
provoked by these clients. Supervision and team support
are vitally important.
Box B
References
American Psychiatric Association (2000) Diagnostic and Statistical
Manual of Mental Disorders (4th Edition – Text Revision). American
Psychiatric Association. Washington D.C.
Becker, D., Lamb, S. (1994) Sex bias in the diagnosis of borderline
personality disorder and posttraumatic stress disorder. Professional
Psychology: Research & Practice.55(1) pp. 55-61.
Becker, D. (2000) When she was bad: borderline personality disorder
in a posttraumatic age. American Journal of Orthopsychiatry,70(4) pp.
422-432.
Daly, A., Walsh, D. (2003a) Activities of Irish Psychiatric Services 2001.
Health Research Board, Dublin.
Daly, A., Walsh, D. (2003b) Activities of Irish Psychiatric Services 2002.
Health Research Board, Dublin.
Expert Group on Mental Health Policy (2006) A vision for change:
report of the Expert Group on Mental Health Policy.Dublin, The
Stationary Office.
Fagin, L. (2004) Management of Personality Disorders in acute inpatient settings. Part 1: Borderline Personality Disorder. Archives of
Psychiatric Treatment. 10, pp. 93-99.
Gabbard, G.O., Coyne, L., Allen, J.G., Spohn, H., Colson, D.B., Vary, M.
(2000) Evaluation of intensive inpatient treatment of patients with severe
personality disorder. Psychiatric Services.51(7) pp. 893-898.
Government of Ireland (2001) Mental Health Act. The Stationary Office,
Dublin.
Healy, D. (2005) Psychiatric Drugs Explained (4th Edition). Elsevier
Churchill Livingstone, Edinburgh.
Hurt, S.W. et al. (1992) Borderline behavioural clusters and different
treatment approaches. Chapter in Clarkin et al. (editors) Borderline
personality disorders: clinical and empirical perspectives. New York,
Guildford Press. Cited in Krawitz, R. & Watson, C. (2003) Borderline
Personality Disorder: a practical guide to treatment. New York, Oxford
University Press.
James, P. (2005) A survey of the Knowledge, Experience and Attitudes
of Irish Psychiatric Nurses regarding clients diagnosed with Borderline
Personality Disorder. Unpublished MSc. Thesis, Faculty of Nursing and
Midwifery, Royal College of Surgeons in Ireland.
Kelly, S., Hill, J., Boardman, H., Overton, I. (2004) Therapeutic
communities. In Camping, P., Davies, S., Farquharson, G. (Eds) From
toxic institutions to therapeutic environments: Residential settings in
mental health services. Gaskell, London, pp. 254-266.
Krawitz, R., Watson, C. (2003) Borderline Personality
Disorder: a practical guide to treatment. Oxford University
Press, Oxford.
Lenihan, M.M. (1993) Cognitive-behavioural treatment of Borderline
Personality Disorder.New York, Guilford.
Lieb, K., Zanarini, M.C., Schmahl, C., Lenihan, M.M., Bohus, M. (2004)
Borderline Personality Disorder. The Lancet. 364 pp. 453-461.
Maltsberger, J.T. (1994) Calculated Risks in the Treatment of Intractably
Suicidal Patients. Psychiatry, 57 pp. 199-212.
Nehls, N. (1994a) Brief hospital treatment plans for persons with
Borderline Personality Disorder: Perspectives of Inpatient Nurses and
Community Mental Health Centre Clinicians. Archives of Psychiatric
Nursing.8(5) pp. 303-311.
Nehls, N. (1994b) Brief hospital treatment plans: innovations in practice
and research. Issues in Mental Health Nursing.15 pp. 1-11.
Simmons, D. (1992) Gender issues and borderline personality disorder:
Why do females dominate the diagnosis? Archives of Psychiatric
Nursing.6(4) pp. 219-223.
Torgersen S, Lygren S, Per A, et al. (2001) A twin study of personality
disorders. Comprehensive Psychiatry. 41(6) pp.416–25.
World Health Organisation (1989) International Classification of
Diseases (10th Edition).World Health Organisation, Geneva.
www.scottishirishhealthcare.com
31
Drugs Feature
This edition of Scottish Irish Healthcare sees the launch of the first
in this new series on drugs commonly used in clinical practice.
This ongoing series will build up into an invaluable resource for you
to refer to in the workplace.
This edition features antiplatelet drugs, Aspirin and Clopidogrel, and
in coming week we will cover anticoagulants and thrombolytic drugs.
If there is a particular drug or group of drugs that you would like us
to feature in forthcoming editions then please drop me an e-mail to
[email protected]
Charlie (Clinical Editor)
Anticoagulant Therapy
Anticoagulation therapy refers to a group
of drugs that are given to prevent clot
formation (thrombosis) within the heart
and blood vessels. These drugs may be
administered orally, by subcutaneous
injection or by intravenous infusion.
The most common form of anticoagulation
therapy is Warfarin. Almost 1 million
people in the UK are taking warfarin.
Due to a number of factors such as an
ageing population, increased clinical
use and National Service Framework
recommendations it is possible that this
may increase by a factor of five over the
next 10 years. (Coronary Heart Disease
National Service Framework. www.doh.
gov.uk/nsf/coronary.htm) The other major
drugs used for anticoagulation therapy are
Aspirin, Clopidiogrel and Heparin.
It is important to stress that anticoagulants
do not dissolve existing thrombus
but prevent new clot formation and
propagation of existing clot while the
body’s natural fibrinolysis mechanisms
do this. There are fibrinolytic drugs such
as Tissue Plasminogen Activator (TPA)
that may be used when clot dissolution is
considered necessary e.g. after an Acute
Myocardial Infarction
Over the coming weeks we will examine
each of these drugs.
Aspirin (Acetylesalicyclic acid or ASA)
Aspirin belongs to the family of salicylates
Indications:
While it is used primarily as an analgesic
and antipyretic agent it is also the most
common anticoagulation therapy
medication used.
Its effects were first recognised in the 5th
Century when Hippocrates wrote about
an extract from willow tree bark that could
ease aches and reduce fever.
Uses
• Analgesic for aches and pains e.g.
headache, joint pain, Flu aches
• Antipyretic in fever
• Anticoagulation in Coronary Heart
Disease, Cerebrovascular disease
• Rheumatic Fever
• Pericarditis
Mode of Action:
Low dose Aspirin irreversibly blocks the
formation of thromboxane A2 in platelets
by inhibiting the production of
cyclo-oxygenase and therefore reduces
platelet aggregation. Higher doses of
Aspirin also inhibit the synthesis of
prothrombin and so produce a second
different anticoagulant effect.
32
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Preparation:
A number of oral preparations are
available. Enteric coated Aspirin and
suppositories are also available. The
most common preparations are:
• 75mg ‘Junior’ Aspirin
• 325mg tablets
• Prevention of vascular ischaemic events
in patients with symptomatic atheroscle
rotic disease e.g. recent stroke
• Acute Coronary Syndrome: Co-therapy
with Aspirin in Acute Coronary
Syndrome. (ACS) The Clopidogrel in
Unstable Angina to Prevent Recurrent
Events (CURE) study demonstrated that
the combination of Aspirin and
Clopidogrel in patients with Unstable
Angina / Non ST segment elevation
Acute Coronary Syndrome resulted
in fewer cardiovascular problems than
those on Aspirin alone. In ST elevation
ACS clopidogrel has also been shown to
decrease adverse outcomes.
• Co-therapy with Aspirin to prevent
thromboembolism following
intracoronary stenting
• Antiplatelet therapy when Aspirin is
contraindicated
Drug Action:
Clopidogrel is a potent oral antiplatelet
drug. It exerts it action by blocking the
ADP receptor on platelet membranes.
This inhibits platelet aggregation by
blocking the glycoprotein IIb IIIa pathway.
Platelets exposed to the effects of
clopidogrel are affected for the remainder
of their individual lifespan.
Dose:
• 300 - 1000mgs up to 4 times daily
(maximum dose of 8000mgs per day)
• Low dose 75mgs daily (or up to
325mgs) in coronary heart disease and
stroke to prevent recurrent Myocardial
Infarction or Stroke
• Taken with or after food to reduce
gastric irritation
Side effects and cautions
• Avoid if known allergy to Aspirin
• Gastrointestinal such as upset stomach,
dyspepsia, nausea and vomiting
• Gastrointestinal bleeding and ulceration
(risk increased if taken with alcohol)
• Tinnitus and vertigo
• Derangement of liver enzymes and
liver damage (rare)
• Chronic nephritis
• Angioedema
• Haemophilia
• Caution in Asthma as may cause
bronchospasm
Signs of overdose:
The toxic dose of Aspirin is approx.
150mgs per KG of body weight.
Severe toxicity and fatal doses are
generally above 300mg per KG.
Signs of toxicity are:
• Nausea and vomiting
• Abdominal pain
• Tinnitus and vertigo
• Hyperthermia in severe cases
• Confusion
• Seizures
• Pulmonary oedema
Preparation:
Pink tablets containing 97.875 mg of
clopidogrel bisulfate which is the
molecular equivalent of 75mgs
clopidogrel base
Dose:
75mgs taken once daily with or without
food
Half Life:
7 – 8 hours
Metabolism and Excretion:
Clopidogrel is metabolised in the liver and
is excreted mainly renal and biliary.
Side effects:
• Abdominal pain, diarrhoea
• Bruising
• Severe neutropenia
(incidence 5 in 10,000)
• Gastrointestinal bleeding
( 2% incidence)
• Cerebral haemorrhage
(incidence 0.1 – 0.4%)
• Thrombotic Thrombocytopenic Purpura
or TTP (rare)
• Use with caution in patients with severe
hepatic disease or renal impairment.
Further reading:
There is no antidote and so adsorption of
the drug within the gastrointestinal system
is important.
Hillman RJ, Prescott LF (1995) Treatment of salicylate poisoning with repeated oral charcoal. British Med Journal 291 (6507)
1472
McQuaid KR, Laine L (2006) Systematic Review and meta
analysis of adverse effects of low dose Aspirin and Clopidogrel
in randomised control trials. American Journal Med 119 (8):
624-38
The Clopidogrel in Unstable Angina to prevent Recurrent
Events Trial Investigators. Effects of Clopidogrel in addition to
Aspirin in patients with acute coronary syndromes without ST
elevation. New England Journal Medicine 2001; 345; 494 - 502
Observation of vital signs, serum
electrolyte levels and fluid status
are important in the management
of poisoning with Aspirin.
(Heart at Risk Testing)
Initial management of overdose involves
the administration of activated charcoal.
Clopidogrel
Clopidogrel is marketed by
Bristol Myers Squibb and
Sanofi Aventis under the
trade name Plavix.
Indications:
Clopidogrel is given to reduce
thrombotic events as follows:
Scottish H.A.R.T.
Researching Cardiomyopathy and other heart disorders
Advocating screening for all young sportsmen and women
and saving lives through Public Access Defibrillation
Donations Welcome - In Scotland, for Scotland
P.O. Box. 1403, Selkirk, TD7 4YA
www.scottishhart.com [email protected]
Tel. 01750 721297
Nutrition & Obesity
BY ANNE DIAMOND
I don’t care what anyone says. I looked in the mirror
one morning and there it was – a load of fat. How
it got there, I don’t know. But suddenly, and most
unfairly, I was the new owner of a double chin, a spare
tyre and flabby bingo wings, as well as tree trunk legs
and a puckered bum. Not a pretty sight.
How I hate those skinny so-called experts who pout:
“It cannot just have happened.You must have realised
you were putting on weight! It doesn’t just appear
overnight!”
A fat lot they know. They’ve never had an ounce of
it on their tiny carcasses. Fat can just appear – or at
least, that’s how it seems. Because half the reason you
put on weight, I reckon, is because you take your eye
off the ball. You know what I mean? You’re so darn
busy, so stressed out with trying to earn a living and
keep your kids off the street, that you take yourself
right off the priority list.You don’t look in the mirror
that often – and when you do, it’s just to try on the
latest range of elasticated waistlines and stretch
fabric jeans. Looking after your body, your self and
your self esteem is the last thing on your mind.
Until that one morning, when you have got five minutes to spare
between bed and bath. Or until crisis hits because you’ve got to go to
a wedding/funeral/christening and the only thing that fits is your hat.
That’s when you realise fat has happened to you. And it’s devastating.
It happened to me the week I agreed to be on Celebrity Big Brother.
I had that moment where you sit on the edge of the bed, with your
entire wardrobe of clothes cascading onto the floor, and you’re crying
because you look like a bag of lentils in all of them.
so much ignorance surrounding the subject. I
made mistakes, too (like going for a cut price job
in Belgium, that didn’t work!) so there’s lots to say.
(details of the tour on www.FatHappens.com or
www.TheHospitalGroup.com )
But the media sneers in a fit of fat fascism. You
didn’t do it the right way, they snigger. The truth
is that, in this toxic environment where it’s made
easy for you to make unhealthy choices, and it’s
hard to shop, cook, eat and exercise the healthy
way, you have to find your own path.
Not for one minute am I suggesting that we accept
obesity – it is unhealthy and, in some cases, life
threatening. At 15st 10lbs, I felt aches and pains in
my joints, I had crippling backache some mornings,
I had swollen ankles at night and huffed and puffed
after climbing stairs. I was possibly on the brink
of diabetes, and I know I had an increased risk of
heart disease, stroke and even cancer. I already had
high blood pressure.
I knew the statistics – that two thirds of us in the
UK have a major weight problem, and could die ten years before their
time. Yet still I couldn’t lose the damn weight without surgery! That’s
not a sign of my personal weakness – it’s a mark of just how difficult the
problem is. It is hard enough to try and slim without society throwing
brickbats at you. To lose weight, you need love and support, tons of
encouragement, and constructive advice.
I rang a friend.
In the USA, the famous TV therapist, Dr Phil McGraw, won’t even try
to help you lose weight unless you have support at home. He says it’s
impossible without the hands-on caring help of another person, because
our environment is so hostile to us would be slimmers. We’re poked
fun at, called names, bullied in the workplace, and the schizophrenic
media berates us whilst selling us junk food and glorifying chocolate.
“Do you think the press will be really horrible to me because I’ve put
on weight?” I moaned. We talked long and hard – and both came to
the conclusion that they might have a little carp, but wouldn’t get too
cruel, since so many of their own readers suffered from obesity. No
newspaper would want to insult its precious readers, now, would it?
We don’t all have a support system in place. Many women I know have
husbands who moan if there’s a diet product in the fridge, and refuse to
change their habits or lifestyles. Other families have mums who think
stuffing hubby and kids with crisps and puddings is a way of showing
love.
How wrong we were. My later experience on Celebrity Fit Club was
even worse. It’s a sin to be fat, in the eyes of our media. But it’s an even
bigger sin to try and do something about it, and fail.
That’s why I strongly believe we have to change society’s attitudes, and
de-stigmatise obesity. I have even heard, from health professionals, that
some doctors, nurses and researchers are patronised because they deal
with obesity. Certainly one recent study showed that society not only
shuns fat people – but also their friends. It’s as though obesity might
be contagious! It’s just got to stop. You wouldn’t be allowed to ridicule
drug addicts who are trying to reform, alcoholics who’re drying out, or
smokers who want to give up. So it must be with obesity. We should
applaud, help and praise people who want to fight their flab. And when
they falter and fail, and they will because they’re human, we should pick
them up and bolster their self esteem so they can start again.
Fat prejudice is all around us – it’s not only allowed in our society,
but encouraged. Fat people are automatically assumed to be ugly, lazy,
stupid and worthless. TV shows ridicule them, radio phone-in shows
ask for our views on whether or not fat people should be forced
to pay for two airline seats, fat women denied IVF or refused NHS
treatment because obesity is a self inflicted condition.
We live in a blame culture, and I think I got the flak from editors and
lady columnists who are all a bit worried about what’s happening to
their bulging waistlines. They certainly live in an environment where
they eat, drink, smoke and take drugs too much – and they know
one day they will pay the price. But right now, it’s easier to hit out at
someone else – and that someone was me.
And you wouldn’t believe the amount of patronising, ignorant and illinformed comments I get about the gastric band, which has helped me
lose four stones, and put my life back on track. After a decade of failed
dieting, and yet more criticism, I decided to take charge. Yes, it was
extreme (as is, I suppose, all elective surgery) and no, I would definitely
not suggest it is a first measure, but it was decisive and effective. In the
New Year, I am embarking on my “Get Your Life Back” tour, to spread
the word and raise awareness of weight loss surgery – because there’s
That’s why I set up www.FatHappens.com. It’s a free, non profit-making
support website which works on a buddying system, where you can find
support and encouragement from new, like-minded friends. Central,
too, is the belief that there is no single way to lose weight – you have to
find something that works for you. Of course, we all know that the key
is healthy eating and more exercise – but there’s so much more. If only
the GPs knew that! So many website members complain that their GPs
give them a diet sheet and tell them to exercise – and that’s it! So many
members are, as it happens, nurses! It’s about self-esteem, stress relief,
trying to change your lifestyle, learning to prioritise yourself without
jeopardizing your values.
If you find yourself having one of those edge-of-the-bed, mirror
moments – it’s no longer a personal matter and you shouldn’t feel
alone.You’re part of a social problem, and society should help you.
www.scottishirishhealthcare.com
33
TRAUMA
MANAGEMENT
PART 1
Dr Greig Ferguson, DSc BN(Hons) ALSBATLS/BARTS, Tutor, CB Nursing Updates Ltd
A casualty with multiple traumatic injuries needs to be rapidly and methodically
assessed to preserve life and to reduce any longterm disability. Road traffic
incidents, assaults, gunshot wounds, stabbings, and burns are disturbing but
common traumatic events that many nurses deal with the world over. Although the
media might portray these injuries as glamorous, reality is different and often distressing
Within the hospital environment it is essential to have sound
preparation and planning for dealing with trauma victims. The best
way to achieve this is to have a sound relationship with the local
ambulance service that will provide the trauma team with precise
(or as near as) details of the incident. Preparation within the
department is also essential in order to allow the management of the
patient to run smoothly. This involves the following;
Prepare :
Triage :
Safety :
Space – clear the non-essential cases
where possible.
Staff – alert them to the possibility of
sensitive situations.
Supplies & equipment – you don’t want
to run out of essentials.
“possible” or “impossible” – heads up
on extent of injuries & other disciplines
required.
Staff : environment /universal
precautions – especially when
dangerous or hazardous materials
involved.
A complete trauma team usually consists of four doctors, five nurses,
and a radiographer. In many parts of the world (including parts of the
United Kingdom) however, this is not possible, and the trauma team
consists of two or three doctors and a similar number of nurses. A team
leader should be chosen, preferably ATLS© trained (Eaton 1999) before
the patient arrives and a role assigned to each individual. Some degree
of overlap is inevitable and flexibility is essential. In order to avoid chaos
and disorganisation, no more than four people should be touching the
patient at any given time.
In difficult circumstances such as trauma resuscitation, you may only
have your five senses, plus common sense, as diagnostic aids to assess
casualties and the situation. Use all six!
• talk to the casualty - listen to the response
• listen for abnormal airway noises
• feel for air movement & smell his breath
• look at his colour, respiratory effort & for obvious
injuries & bleeding
• the smell of fear - reassure!
• is the situation dangerous (i.e. petrol soaked clothes
from RTI)? Use common sense and know-how..... all
of this takes a few seconds
Primary survey and resuscitation
The primary survey is a structured assessment that aims to identify and
treat immediate and life threatening problems. Each patient is assessed
in the same way and the routine should be familiar to everyone who
works in a clinical setting (Gwinnutt and Driscoll 2003). It is essential
that within the hospital environment the team leader re-evaluates his
or her findings on a continuous basis, as patients may deteriorate
rapidly. In fact, impaired consciousness is the most commonly missed
diagnosis in trauma patients (Skinner et al1996).
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The most effective
way of dealing with trauma patients is by following the ABCDE
principles (ATLS©1976):
A
Assessment of the patient whilst approaching
A
Airway (with cervical spine control)
B
Breathing
C
Circulation (with control of external bleeding)
D
Disability of the nervous system
E
Exposure of the patient with environmental
control
Assessment
In the pre-hospital environment things are slightly less controlled and
dangerous, therefore before diving head first into a road traffic incident
(RTI) at the scene, STOP and THINK. Do not rush in yourself or let
other group members become another casualty (Eaton 1999). Look at
the accident setting and assess any particular hazards such as running
water, smoke, traffic, falling rocks. Remember that some hazards are
invisible, for example the risk of fire or explosion. Assess the number
and severity of all casualties if more than one person is injured.
If absolutely necessary carefully remove the casualty to a place of safety
(“scoop and run”). If possible find out what has happened and how and
why it happened. This also may be helpful in the search for injuries.
Within the controlled environment of the resus room the same
principles should initially be applied (Gwinnutt and Driscoll 2003).
STOP and THINK. Listen to the team leader or most senior member of
staff. Observe and apply universal precautions including the correct use
of protective gloves and other barriers to protect yourself from bloodborne diseases such as Hepatitis B and HIV. The procedure for assessing
trauma patients should be followed along the lines of this following lists
based upon an ATLS© (1976) model.
Airway
Assess without moving the neck if possible. Get someone else to hold
the head still, if help is available. You should assume a neck injury is
present if there is any significant injury above the collarbones (Gwinnutt
and Driscoll 2003). Apply a rigid neck collar if available, or stabilise the
neck in other ways.
Look for, and remove, any obvious obstruction but do not poke fingers
blindly into the mouth (there is a risk of inducing vomiting or being
bitten). Open the airway using chin lift or jaw thrust. Portable suction, if
available, may be used to remove vomit and secretions. Consider simple
airway devices such as:
Guedel airway
Naso-pharyngeal airway (it is unlikely that intubation equipment will be
available on an expedition, however some people may consider a
laryngeal mask airway - LMA)
Look at the neck for injuries which may compromise the
airway/breathing:
• Swelling, deformity, neck wounds
• Deviation of the trachea to one side.
Breathing
Once the airway has been checked (and opened if necessary), assess
breathing. Look, listen and feel for breathing (10 seconds). If respiration
is absent start artificial respirations. Give oxygen – preferably at
15L/min via non-rebreather mask with oxygen reservoir, but any
supplementary oxygen is better than none. Check the breathing rate; if
greater than 25/minute or there are signs of respiratory distress,
examine the chest – look for symmetrical chest movements, open
chest wounds, a flail segment, listen to the breath sounds:
• Penetrating objects should be left in position
• A flail segment should be stabilised.
• A tension pneumothorax (signs of shock and severe
respiratory distress, trachea deviated away from
collapsed lung, ‘barrelling’ of the chest and absent
breath sounds).
Circulation care with haemorrhage control
Look for any major external bleeding. If present, control with direct
pressure and elevation.
Check for signs of shock – cold, pale, clammy skin.
Measure the pulse rate and assess pulse character
(thready/bounding). If the pulse is absent start CPR.
Assess the blood pressure:
• Carotid pulse (neck) - Systolic blood pressure at least
60 mmHg
• Femoral pulse (groin) - Systolic blood pressure at least
70 mmHg
• Radial pulse (wrist) - Systolic blood pressure at least
80 mmHg
Capillary refill should be less than 2 seconds in a warm casualty.
Treat shock:
• Keep the patient flat
• Raise the legs (unless leg, pelvic or spinal injuries are
suspected)
• Keep warm and reassure
• If indicated and once prescribed, commence an
intravenous infusion and remember to replace lost
blood according to local protocols (Gwinnutt and
Driscoll 2003).
• Monitor pulse and blood pressure.
Disability
Briefly assess the patient’s neurological status using the AVPU scale
(Gwinnutt and Driscoll 2003)
• A Alert
• V Responds to verbal command
• P Responds to pain
• U Unresponsive
Assess the size of pupils and reaction to light. Ask the patient if they
can feel you squeezing their fingers and toes. Ask the patient to squeeze
your hand and wriggle their toes. Exposure and environmental control
Where possible, examine the casualty in a warm, light environment. Be
GENTLE, unnecessary roughness may aggravate the problem. Be aware
of hypothermia which can compound shock associated with trauma
resuscitation.
Secondary survey
The aim of primary survey is to simultaneously identify and treat lifethreatening problems. Secondary survey is a methodical head-to-toe
search for all injuries that may be present. It may be possible to conduct
a full secondary survey where the patient is found, but in a wilderness
setting it is likely that the patient will need to be protected from the
environment using a group shelter or tent. If the patient must be moved
remember the possibility of spinal injury and try to conduct a limited
secondary survey first.
Medical history
In injury cases take a brief history using the AMPLE formula:
• A Allergies
• M Medicines
• P Past medical history
• L Last meal
• E Events leading to the injury.
Examination
The casualty should be undressed to enable a complete
head-to-toe examination. Examine the whole body in
the following order:
• Head
• Neck
• Chest
• Abdomen
• Pelvis
• Legs
• Arms
• Spine and back
Examination of the Head
Scalp
bleeding, swelling, deformity
Conscious level
measure using the Glasgow Coma Scale
Eyes
pupil size and reaction to light, if
conscious assess vision
Nose
look for discharge (cerebrospinal fluid
(CSF) leak), bleeding
Ears
discharge (CSF leak), bleeding,
haemotympanum
Face
feel the face on both sides, looking for
deformities and tenderness
Mouth
abnormal smell (e.g. alcohol)? any broken
teeth or broken jaw?
Examination of the neck
The patient may complain of limited or painful neck movements or limb
tingling/weakness. Look and feel down the neck for any tenderness,
abnormal ‘step’ or swelling. If there is any possibility of a neck injury the
casualty’s neck and back must be kept ‘in-line’ during evacuation.
Examination of the chest
Look for tracheal deviation, asymmetrical chest movements (flail chest),
open wounds, bruising - and is there tenderness on rib springing?
Listen for reduced air entry on one side of the chest.
Examination of the abdomen and pelvis
Look for bruising, open wounds.
Feel in all four abdominal quadrants for localised tenderness, particularly
rebound tenderness.
Listen for bowel sounds.
Gently spring the pelvis to elicit pain/movement.
Examination of the limbs
Look for bruising, swelling, deformity, wounds, shortening.
If injuries are found check movement, circulation and sensation
(M, C + S).
Apply splints to immobilise fractures.
Examination of the spine
If a spinal injury is suspected do not move the patient unnecessarily.
Log-roll and use neck immobilisation.
Look for loss of movement or sensation .
Feel for swelling, tenderness.
In males an involuntary erection of the penis (priapism) indicates a
spinal injury.
Monitoring and Reassessment
Continuously monitor and record the vital signs during treatment:
• Airway
• Breathing - rate
• Circulation - pulse and blood pressure
• Disability - Glasgow Coma Scale
• Drug and fluid administration
Conclusion
This article has looked at the need for the trauma patient to be rapidly
and methodically assessed in order to preserve life and to reduce any
long-term disability.
Part 2 next month will look at the mechanisms of injury
involved with specific types of trauma, which shall
underpin the most appropriate treatment.
Part 3 will go on to examine the various treatments
appropriate to specific situations.
References
ATLS (1976) American College of Surgeons Committee on Trauma Report. Chicago.
Eaton JC (1999). Essentials of Immediate Medical Care. (2nd Ed), London: Churchill Livingstone.
Gwinnutt C, Driscoll P (2003). Trauma Resuscitation – The Team Approach. (2nd edn), Oxford: BIOS
Scientific Publishing.
Skinner D, Driscoll P, Earlam R. (1996). ABC of Major Trauma. (2nd edn), London: BMJ Books.
www.scottishirishhealthcare.com
35
Sexual Health
Article supplied by The Scottish Executive
The findings of an annual report on the progress made by NHS
Boards to implement the Executive’s national sexual
health strategy were published.
Health Minister Andy Kerr said substantial improvements have
been made to sexual health services across the country but
further action is needed to help improve Scotland’s sexual health.
The Minister also launched an educational DVD created by young
parents in West Dunbartonshire which gives an insight
into the challenges of young parenting and aims to
help reduce unintended pregnancies.
The DVD will be distributed around secondary schools in West
Dunbartonshire to generate discussions on young parenting.
Mr Kerr said:
“Sexual health in Scotland is historically poor, but we are
committed to changing this through better education and
improved access to services.
“Today’s annual report clearly illustrates substantial progress
has been made since the Strategy was launched 18 months
ago but we cannot be complacent.
“We know sexually transmitted infections (STIs) have
increased and while this can partly be down to more
awareness and more testing, it shows we all need to take
more responsibility for our own sexual health. Syphilis has
re-emerged in Scotland in recent years and gonnorrhea,
Chlamydia and HIV rates are now at record levels - this must
be tackled.
“We’re delivering quicker waiting times, improved communications
with patients and better advice and support. Educational projects
in settings such the community, schools, prisons, youth groups
are aiming to change attitudes to sexual health in the long-term.
“However, when it comes to reducing STIs, unintended
teenage pregnancies and abortion, education can only ever
be part of the answer. We will continue to improve access to
support and advice to help people make informed choices.
But there also needs to be individual responsibility. Parents also have a role to play in encouraging their children to
discuss relationships and sex openly with them.”
Mr Kerr today met Sammy Bentley, one of the young parents
who created the ‘9 Months After’ DVD. She said:
“I was gutted when I found out I was pregnant, it meant that I
couldn’t go to college. But I’m trying to make the best of it.
When we were at school we didn’t learn anything about
the reality of having a baby and I wanted to let other
young people know what its like to be a young parent.
“Its been good going into the schools and showing the DVD,
because you can see the young people are learning something and
that they didn’t realise what its really like to be a mum or a dad.
“You have to make the best of it and I’m still young. I want to
do my teacher training, definitely. Sometimes I just want a bit
of peace from Grant (her son) but I do love him.”
The Executive has provided an additional £15 million over
three years to support the delivery of the sexual health strategy
and action plan which was published in January 2005.
Each NHS Board has appointed an Executive Director
and Lead Clinician for sexual health and every local authority
has a Strategic Lead in sexual health.
36
www.scottishirishhealthcare.com
Free for your patients
WellBeing of Women’s
Gynaecological Cancer Awareness Campaign
The Low Down on Down There
WellBeing of Women (WoW), the only UK charity dedicated
to solving the health problems that solely affect women, is
offering a free information booklet on gynaecological cancers as
part of their ‘Low Down on Down There’ gynaecological cancer
awareness campaign. The drive is to encourage women to be aware
of the signs and symptoms of the most common gynaecological
cancers. Written by a leading consultant in gynaecological
oncology, the booklet covers ovarian, cervical, endometrial
and vulval cancer. The aim of the Low Down on Down There
campaign, which launches on 30th January, is to raise awareness
and funds for research into these types of cancer.
Each year nearly 17,000 women are diagnosed with a
gynaecological cancer. Much attention is given to breast cancer
awareness and as a result most women know to check their
breasts monthly and are aware of the early signs of the disease.
WellBeing of Women believes that gynaecological cancer
should have the same level of awareness and are encouraging
women to be familiar with the symptoms of the four main
gynaecological cancers, to attend regular screening, to be
self-aware and to notice changes in their body.
The key messages of the campaign are:
• Know your norm - be aware of any changes in your
body, i.e. bleeding between periods, bloating and
abnormal discharge
• Regularly attend routine screening
• Be aware of the symptoms of gynaecological cancers
• Seek medical attention as soon as possible –
if unsatisfied with diagnosis, do not be afraid to ask
for a second opinion
• There’s no need to be afraid – the earlier a cancer is
found, the easier it is to treat
From the beginning of February 2007 you will be able to request
copies of the booklet, by calling the Supporter Services Team on
020 7772 6400 or emailing [email protected].
The Scottish Haematology Society
Fri September 28th- Sat Sept 29th 2007
2007 will see the inclusion of a Nurses Group as part
of the Scottish Haematology Society’s Annual Meeting.
In order to have full participation in the Annual
Meeting, it is envisaged that the Nurses Group would meet for
1 hour immediately prior to and after the main programme,
It is hoped that this will become an annual event and will
allow Nurses in Scotland to meet and engage in education and
discussion on issues relating to care of Haematology patients.
With this in mind, I would like to hear from any Haematology
nurses from around Scotland concerning:
Would you be interested in attending the Nurses Group meetings?
Is there any specific topic that you would like to discuss?
Is there any topics/presentations you would wish to present?
Would you be interested in playing an active role in
planning future annual meetings?
Please contact Ann Graham on 01382 660111 ext. 36608 or at
[email protected]
or Gillian Wilson at [email protected]
Sexual Health
NHS Ayrshire & Arran wants you to have a healthy Christmas and New Year.
But apart from winter ailments and the effects of over-indulging, there is
another risk for those in the party spirit.
Sexually transmitted infections (STIs), such as
chlamydia, HIV, gonorrhoea and syphilis are on
the increase. The most common STIs include:
• Chlamydia – symptoms may include
unusual discharge and discomfort but
most people have no symptoms.
Antibiotics are effective but if untreated
can lead to pelvic infection and infertility
in both men and women.
• Genital warts – small growths around
the genitals that can be treated but
may recur.
• Genital herpes – passed on by sexual
intercourse and oral sex. Symptoms can
include genital blisters that can be treated
but may recur.
• Trichomoniasis – women may
experience unusual discharge while men
rarely have any symptoms. It can be
treated with antibiotics.
• HIV – if infected your body loses the
ability to fight disease, allowing infections
to attack your body. HIV can develop
into AIDS. Globally, sexual intercourse
accounts for about three-quarters of all
new HIV infections.
• Gonorrhoea – affects the urethra,
throat, rectum or cervix. Symptoms
include abdominal pain, sore throats and
mouth sores. Can be treated by
antibiotics but can lead to infertility if
untreated.
• Syphilis – early symptoms include
painless sores followed by a skin rash.
Can be treated with antibiotics but can
cause heart problems if left untreated.
Syphilis infection rates are on the
increase.
Tina McMichael, Sexual Health Promotion Officer
comments:
“At this time of year, after having a few drinks you may
do things that are out of character. You may feel that a
Christmas fling is all part of the festive fun.
“You can’t always tell if someone has a STI, and
infections such as chlamydia are passed easily whether you are gay or straight, through unprotected sex,
including oral sex. The best way to keep safe is to have
a long term relationship with one partner.But if that is not
possible, be safe and be sure and always use a condom.”
Condoms provide a barrier between you and your
partner, helping to prevent the spread of STIs, and also
reduce the risk of unwanted pregnancy. All condoms
should be branded with a British Standard kite mark or
European CE mark. This means their quality is strictly
assured. Remember to check the expiry date of your
condoms, and don’t use any that have passed their
expiry date.
If you notice any unusual rash, discharge or soreness,
you should avoid having sex, and see your doctor or
local Genital Urinary Medicine (GUM) clinic nurse immediately.
Tina McMichael adds: “While you may have noticeable
symptoms, some STIs, such as chlamydia have no symptoms. So, if you have had unsafe sex, it is best to get
yourself checked out.”
For information about GUM clinics in Ayrshire and Arran, and where to obtain free condoms, contact the
Sexual Health Department on 01294 323226, or visit
our website, www.shayr.com.
www.scottishirishhealthcare.com
37
STAY SAFE ON THE ROAD
Main findings are:
Road casualties
• 286 deaths on Scotland’s roads in 2005 - 7 per cent
fewer than in 2004, and the lowest figure for more than
50 years
• between 1995 and 2005, the number of road deaths fell
by 30 per cent, from 409 to 286
• 2,652 people reported as seriously injured in 2005 4 per cent fewer than in 2004, and the lowest number
since the current series began in 1950
• between 1995 and 2005, killed and seriously injured
casualties (combined) fell by 45 per cent, from 5,339
to 2,938
• a total of 17,821 reported casualties (including deaths
and “slight” injuries) in 2005 - 3 per cent fewer than in
2004 and the lowest figure since 1952
• between 1995 and 2005, the total number of reported
casualties fell by 20 per cent, from 22,194 to 17,821
Child casualties
• 368 children killed or seriously injured in 2005, of whom
11 died (1 fewer than in 2004)
• 2,166 child casualties, 10 per cent fewer than in 2004
• between 1995 and 2005, child casualties fell by 45 per
cent, from 3,935 to 2,166
Types of transport used
• 10,955 car user casualties in 2005, 5 per cent fewer than
in 2004 and 16 per cent below the 1995 level
• 3,033 pedestrian casualties in 2005, 1 per cent fewer than
in 2004 but 35 per cent below the 1995 level
• 1,082 motorcyclist casualties in 2005, 10 per cent more
than in 2004 and 11 per cent more than the 1995 level
• 780 pedal cyclist casualties in 2005, 1 per cent more than
in 2004 but 41 per cent below the 1995 level
• young male drivers are the most likely to be involved in
road accidents - in 2005, the number of car drivers involved in accidents represented 4.0 per thousand of the
population aged 17 and over, but 9.4 per thousand of the
total population for men aged 17-22
38
www.scottishirishhealthcare.com
Types of road
• 72 per cent of all road deaths (207 out of 286) in 2005
occurred on “non-built up” roads (“non built-up” roads
are those which have a speed limit of more than 40 mph)
• 53% of people who were killed or seriously injured
(1,545 out of 2,938) were involved in accidents on non
built-up roads
• relative to the total volume of traffic, Motorways have
the lowest accident rates. Fatal accident rates tend to be
highest for non built-up A and B roads, but overall accident
rates (including “slight injury” accidents) tend to be highest
for built-up B, C and unclassified roads
Progress towards the road casualty reduction
targets for 2010
Compared with the “baseline” averages for 1994-98,
in 2005:
• 39 per cent fewer people were reported as killed or
seriously injured - so, on the basis of these figures, the
target of a fall of 40 per cent by 2010 has almost been
achieved
• 56 per cent fewer children were reported as killed
or seriously injured - so the target of a 50 per cent
reduction by 2010 has been achieved
• the slight casualty rate (per 100 million vehicle
kilometres) was 25 per cent lower, so the target of
a 10 per cent reduction has been achieved
Drink-driving
• about 1,060 casualties in drink-drive accidents in 2004
(the latest year for which an estimate is available), 9 per
cent fewer than in 1994, around 40 of whom died
• in 2005, 3.7 per cent of drivers involved in injury
accidents who were asked for a breath test registered
a positive reading or refused to take the test
Comparison with England and Wales
• in 2005, Scotland’s casualty rates were 3 per cent
higher (killed), 5 per cent higher (killed and serious)
and 26 per cent lower (all severities)
• in all three cases, this represented an improvement
in Scotland’s relative position compared with the
1994-98 averages
THIS FESTIVE SEASON
Comparison with countries in Western Europe
and elsewhere
Using figures for 2004 (the latest year for which they are
available):
• Scotland’s overall road death rate of 60 per million population was the fifth lowest of the 31 countries for which
figures are available
• Scotland’s pedestrian fatality rate of 15 per million population was the eighteenth lowest (of 31 countries)
• Scotland’s child fatality rate of 13 per million population
was the sixth lowest (of 28 countries for which figures are
available)
• Scotland’s fatality rate for people aged 65+ was 83 per
million population, the fifth lowest (of 28 countries)
Comparison with countries in Western Europe
and elsewhere
Using figures for 2004 (the latest year for which they are
available):
• Scotland’s overall road death rate of 60 per million population was the fifth lowest of the 31 countries for which
figures are available
• Scotland’s pedestrian fatality rate of 15 per million population was the eighteenth lowest (of 31 countries)
• Scotland’s child fatality rate of 13 per million population
was the sixth lowest (of 28 countries for which figures are
available)
• Scotland’s fatality rate for people aged 65+ was 83 per
million population, the fifth lowest (of 28 countries)
Contributory Factors
driver/rider failed to look properly - 21 per cent of all
accidents for which Contributory Factors were recorded
loss of control - 16 per cent
driver/rider failed to judge other person’s path/speed 15 per cent
slippery road (due to weather) - 12 per cent
driver/rider careless / reckless / in a hurry - 12 per cent
pedestrian failed to look properly - per cent
travelling too fast for the conditions - 10 per cent
Contributory Factors most often reported for
fatal accidents were:
• loss of control - 36 per cent of all fatal accidents for
which Contributory Factors were recorded
• driver/rider careless / reckless / in a hurry - 20 per cent
• driver/rider failed to look properly - 19 per cent
• travelling too fast for the conditions - 17 per cent
• exceeding speed limit - 10 per cent
• pedestrian failed to look properly - 10 per cent
Vehicles, road traffic and accidents
• between 1995 and 2005, vehicle numbers increased by
almost a third from 1.91 million to 2.53 million
• the total volume of traffic on all roads increased by 16
per cent from 36.7 billion vehicle kilometres in 1995 to
42.7 billion in 2005
• 13,397 reported injury accidents in 2005 - 4 per cent
fewer than in 2004 and the lowest number since recording
of the
numbers of injury accidents began in 1966
• 264 fatal accidents - 6 per cent fewer than in 2004 (more
than one person may die as the result of one fatal accident
- e.g. if the drivers of both cars involved in an accident die,
that is one fatal accident and two deaths).
The Ayrshire and Arran Alcohol and Drug Action Team’s
(ADAT) Christmas campaign promoting sensible drinking
is well underway.
Over the Christmas and New Year period people will be
going on more nights out than usual, and the campaign
gives information on how to drink sensibly as well as
how to look after yourself.
The campaign information is contained in credit card-sized
pink compacts for females and brown wallets for males, and
targets young adults aged 18-30. The credit cards will be
distributed throughout Ayrshire in various colleges, pubs
and clubs. The message is about looking good and staying
healthy, with lots of good advice on how to have a fantastic
night out that you will be able to remember. You will also
find useful contact numbers for taxi firms and local
hospitals included.
The recommended safe level of alcohol per week is 14
units for women and 21 units for men. Remember that
even the day after a night out, you are at risk of losing
your driving licence if you are caught driving with alcohol
still in your body. It takes approximately one hour for your
body to break down one unit of alcohol.
Dr Maggie Watts, ADAT Chairperson, commented: “We
want everyone to enjoy the festive season, to drink sensibly
and to know their limits. Everyone enjoys a good night
out, but sometimes what can start out as fun can lead to a
nightmare.”
Posters and leaflets with the message “Alcohol know your
limits, don’t push it!” will be displayed at various venues
including Rugby Park, Kilmarnock, Ayr Racecourse and
on Stagecoach Buses highlighting useful information on
the dangers of binge drinking and how to calculate units
of alcohol. It is also important to remember it is illegal for
anyone to buy alcohol on behalf of a person under 18, and
this could lead to a
fine of up to £2,500.
The leaflets and posters can also be found at participating supermarkets during December with a competition to
win a £25 food voucher. Leaflets will also be handed out at
Rugby Park with a special competition prize kindly donated
by Kilmarnock Football Club.
www.scottishirishhealthcare.com
39
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1504MY Bardex I.C. Ad for Scotti1 1
15/12/06 13:47:34
The survey was sponsored by sanofi-aventis
New survey data released today shows that the average Scottish
Santa has a waist circumference of 47 inches, which probably makes
him too big to fit down most chimneys! Santas in Edinburgh were
the most rotund having an average waist circumference of 51 inches
with those in Aberdeen being the most svelte at 43 inches.
The findings among Scottish Santas is not surprising given that
recent research reveals that men in Scotland are
significantly more likely to be abdominally obese,
compared to men in England and Wales.
According to leading guidelines, having a waist
circumference of more than 40 inches for
men or 35 inches for women is a key indicator of
abdominal obesity and is associated with a greater
risk of developing heart disease or type 2 diabetes.2
Abdominal obesity suggests the presence of excess
visceral fat, an active type of fat that is wrapped
around the abdominal organs. Visceral fat
secretes hormones that can have a negative
impact on diabetes control (HbA1C), ‘good’
cholesterol
(high-density
lipoprotein
(HDL)
cholesterol) and ‘bad’ blood fats (triglycerides).3,4,5
Santa,
the
jolly
image
associated
with
Christmas,
actually carries a serious health message. Data have shown that, in
middle aged men, waist circumference is a better indicator of risk of
developing heart disease and diabetes than body mass index (BMI).6
“There is no doubt that carrying excess weight around the waist
increases the risk of type 2 diabetes, says Natasha Marsland, Care
Advisor Manager at Diabetes UK. “Taking a simple waist measurement is an easy way to tell if you’re at risk. Women with waists of over
31 and a half inches and men with waists over 37 inches or 35 inches
for South Asians are at increased risk of developing type 2 diabetes.
City
Number of santas measured
Aberdeen
Dundee
Edinburgh
Glasgow
40 www.scottishirishhealthcare.com
11
7
12
10
“On average people have the condition for up to twelve years before
being diagnosed by which time serious complications are already
developing, including heart disease, strokes, kidney and nerve damage.”
The annual cost to the NHS in Scotland of obesity and obesity–related
illness, including heart disease and diabetes, has been estimated
at £171 million.7 Throughout Scotland there is a trend towards increased
prevalence of obesity with increasing deprivation.8
“Scotland is facing an obesity time bomb and we
really cannot sit back and watch this happen.
Obesity and obesity-related illness are placing
a huge burden on the Scottish health service and we
need to take action and treat now.” Dr Miles Fisher,
Consultant Physician, Glasgow Royal Infirmary, Scotland.
Obesity must be recognised as a chronic condition
requiring long-term therapy. Like any chronic condition,
such as diabetes or hypertension, people may
regain the weight that they have lost, when their
weight medications are withdrawn. If it is not treated
for the duration of the patient’s life, obesity
re-emerges as a potent comorbid risk factor
for disability or premature death.9
The new Joint British Societies’ guidelines on prevention
of heart disease in clinical practice recommends that all adults who are
40 years or over should have risk assessment, even if they have no history
of heart disease or diabetes. This assessment should include
waist circumference, weight, non-fasting lipids (total and HDL
cholesterol), non-fasting blood sugar and blood pressure.10
About the survey
The survey undertaken by the Consumer Analysis Group measured the waist
circumference of Santa in Aberdeen, Dundee, Edinburgh and Glasgow. The field
team measured 40 santas in shopping centres, stores and on the streets of
Scotland during the last week of November and the first week of December.
Average waist circumference
43 inches
48 inches
51 inches
44 inches
Average height
5’ 9”
5’ 10”
6’ 0”
5’ 9”
Product Focus
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1
contact: Jim Brown - Director
e-mail: [email protected]
Tel: 01292 525970
Fax: 01292 525979
General Recruitment
S
N
SCOTTISH
NURSE
Scottish Nurse Magazine has set up a financial fund to help towards the costs of the defence
and appeal of both the nurses and doctor in what we consider to be a gross miscarriage
of justice.
These Nurses and Doctor are being used as pawns in a game of political chess.
We are calling on all members of the healthcare profession to send us a contribution no matter
how small to help towards the legal costs and the immediate families of the nurses and doctor involved.
Please see the article about this
atrocity on21/12/06
pages 6 &11:44
7.
BBTSN271206
Page 1
Moving your career to Australia is easy
…Deciding what to do on your days off is the hard part
BBT Global Resourcing is working in partnership with RSL Care in Australia to
recruit Registered Nurses for their Aged Care Facilities located throughout
Queensland and New South Wales.
All locations offer the chance to enjoy Australia’s renowned and diverse
lifestyle. Candidates seeking professional development combined with
adventure and a travel experience of a lifetime are encouraged to apply!
RSL Care are offering an unbeatable benefits package:
•
•
•
•
AU$50,000+ shift allowances + 9% retirement fund
5 weeks annual leave • Structured clinical transition support programme
Accommodation support available • Opportunity for permanent residency
Flights paid for over 2 year sponsorship • Airport meet and greet
If you are interested in working for a progressive industry leader and winner
of several national awards for excellence, innovation and people development,
please contact Gladness Ngweya.
tel: 0 11 245 9500 email: [email protected]
www.bbtglobal.com
www.scottishirishhealthcare.com
41
General Recruitment
Careers in
Healthcare
DAUGHTERS OF CHARITY SERVICE
For Persons with Intellectual Disability
The Daughters of Charity Service is one of the largest service providers
within the Intellectual Disability sector in Ireland. We are constantly
growing and developing an extensive range of services across the
age continuum to meet future challenges and circumstance.
Community Residential Services, Dublin 15
Residential Services, Navan Road, Dublin 7
Staff Nurses (Day & Night Duty)
Ref: SNCRS907
Are you looking for a change or a challenge? Would you like to join a new team
in opening a Community House in the Dublin 7 area for Service users with
varied needs, or work within our Residential Service in Navan Road.
As a Staff Nurse you will work under the direction of the senior nursing
personnel/administrator and within the agreed house guidelines.
You will support senior personnel and management in the implementation
of person centered care and safety of the clients.
Applicants should:
• Be registered with An Bord Altranais, preferable with RNID qualification,
other nursing disciplines with relevant experience will be considered
• Have Experience of working with people with intellectual disabilities
• Be flexible, enthusiastic, dynamic and have good coping skills
• Adapt to ongoing changes within the Health Service
Experience in Challenging Behaviour is desirable.
NURSING
Registered Psychiatric Nurse
Acute and Community Psychiatry, initial assignment
Lakeview Unit, Naas General Hospital, Ireland
Ref: SN/NSS/248/06
For further information and job descriptions or to apply online:
Freephone 0800 056 9710
www.careersinhealthcare.ie
We are an equal opportunities employer. Shortlisting may apply and
panels may be formed from which future vacancies may be filled.
Full driving licence desirable.
Informal enquiries to:
Nurse On Call
Agency & Recruitment,
Dublin 6.
Ms. Mary Lucey-Pender, Administrator, Community Residential Services. Tel. (01) 822380;
Sr. Marian Harte, Administrator/Director of Nursing, Navan Road Tel. (01) 824 5303
To obtain an application form for the above position please either e-mail
[email protected],
or telephone (003531) 8245431 quoting the position and reference number.
Completed application forms should be received in the
HR Department, Central Management
no later than 3.00 p.m. on Thursday 21st December.
Tel: 00 353 1 4965199
Fax: 00 353 1 4965690
Please note:
No applications will be accepted after the closing date/time
No CVs will be accepted unless accompanied by a completed Application Form
Interviews will take place in our offices in Dublin in January 2007.
The Daughters of Charity Service for Persons with
Intellectual Disability is an equal opportunities employer.
E-mail: [email protected]
Website: www.nurseoncall.ie
Exciting opportunities exist for motivated
and enthusiastic individuals to work as
part of our multi-disciplinary team.
A number of vacancies exist within Mental
Health Services at Knockbracken Healthcare
Park within South & East Belfast Trust in
the following grade and areas:
S
N
SCOTTISH
NURSE
NURSE (MENTAL HEALTH) BAND 5
Acute Psychiatric Intensive Care, Elderly, Frail Elderly, Rehabilitation,
Brain Injury, Adolescent Psychiatry
Hours: Full-time & part-time posts available. 37.5 hours per week for full-time.
Shift system, on a rota to include weekends and internal rotation, if appropriate
Salary: Band 5: £18,039 - £24,803 pa (pro rata for part-time)
Student Nurses expecting to complete the Mental Health Nursing Diploma or Degree during
2006/2007 are welcome to apply. Students will be paid on the Band 3 payscale £16,799 pa
pro rata pending confirmation of registration.
Benefits: Superannuation Scheme, Family Friendly Policies, Salary Sacrifice Child Care Scheme,
Opportunities for personal and professional development, Relocation Packages available
Name...................................................................................................
For further information and an application form, please visit www.sebt.n-i.nhs.uk and apply
on-line or contact Miss E Donnan or Miss MT Conlon, by telephoning 028 9056 5613/5616.
If you are thinking of returning home or relocating to Belfast, please visit the following
website for useful links and information: www.gotobelfast.com
Please note that this is an open ended advertisement with no closing date.
Address to send magazine..............................................................
SOUTH & EAST BELFAST HEALTH AND SOCIAL SERVICES TRUST
We are an equal opportunities employer. All staff must comply with the Trust's No Smoking Policy.
42
You can now have your own personal copy mailed to
your homeeach month. For a full years subscription,
please complete thecoupon and send to our address
below along with a cheque for £25.
www.scottishirishhealthcare.com
...............................................................................................................
............................................................Postcode..................................
Job Title................................................................................................
Please post to:
Please make cheques made payable to Strathayr Publishing Ltd
Strathayr Publishing Ltd, Scottish Nurse Magazine,
Gibbs Yard, Auchincruive Estate, Ayr, UK KA6 5HN
www.scottishirishhealthcare.com
43
Overseas Recruitment
44
www.scottishirishhealthcare.com
Put yourself
in this picture
Make your next career move to the
Royal Children’s Hospital
in sunny Brisbane, Australia.
Positions are now available for experienced paediatric
nurses in Perioperative, Intensive Care, Neurosurgery,
Oncology, Orthopaedic, Medical, Emergency,
Community Child and Youth Mental Health. Health
visitors may apply.
to stimulating continuing education, career development
and active nursing research mentorship programs.
Up to $5,000 (AU) relocation and accommodation
assistance is available on successful appointment
(conditions apply). Sponsorship to Australia is also
available. The Royal Children’s Hospital Brisbane offers
the opportunity to work across acute and community
settings in supportive team environments, with access
This is destination nursing at its best. It’s one hour to
the world renowned beaches of the Gold and Sunshine
Coasts and only ten minutes to the city centre. A green
sub-tropical environment and active cafe society makes
this one of the most liveable cities in the world where
sunny winter days average 11-21° C.
In five years, following a major redevelopment, the
hospital will merge with other facilities, expanding
to a 400-bed world class paediatric hospital.
The time is right to make your career move to
the Royal Children’s Hospital, Brisbane, Australia.
Photos courtesy
of Tourism Queensland
Enquiries and applications to:
[email protected]
or visit our website www.health.qld.gov.au/rch
health • care • people
www.scottishirishhealthcare.com
45
BC000 Health 267x190 Edit&Press
Education & Training
15/12/06
10:55 am
Page 1
A HEALTHY CHOICE FOR
STUDY OR A CAREER!
Bell College has unveiled an exciting range of health-related courses
suitable for people working in health, social care and related
professions. Bell’s School of Health Studies has a well earned and
highly- respected reputation among health professionals across
Scotland and produces highly-qualified students ready to work in this
most exciting and rewarding of areas.
The College is always keen to develop courses which suit the needs
of individuals working in these fields. It is widely accepted that
health care and allied professions are an ever-changing environment
where new skills constantly need to be learned to enhance
professional capabilities.
Among the courses being offered are:
A Masters qualification (MSc) in Health Studies - ideally suited for
nurses, midwives and related health professionals plus an MSc in
Nursing Studies and a MSc Specialist Nursing Practice/ Specialist
Practitioner Qualification for qualified nurses with an existing degree
in the areas of adult nursing, older adult and mental health nursing.
The School of Health also offers a Bachelor of Science degree (BSc) in
‘Interprofessional Practice’ (Health and Allied Professions) suitable for
those with a background in health and social care, plus a wide range
of individual courses and study days.
Of particular note is a Diploma in Higher Education in Complementary
Therapies which reflects the increasing popularity of other methods of
health provision which are now widely accepted as beneficial.
This particular course examines such things as aromatherapy, and
reflexology. Again, it is suitable for health professionals who may have
an interest in learning within this area.
Meanwhile, the first students who have attained their Masters
qualifications in Advanced Health Studies graduated from Bell College
in November.
Course Leader Pat Watson said: ’We are particularly pleased that our
first-ever Masters students have graduated from the College
reflecting the strong commitment of Bell to advanced learning for
people working in a variety of health-related careers.’
DID YOU
KNOW...
HEALTH MATTERS AT BELL COLLEGE?
PART-TIME PROFESSIONAL
DEVELOPMENT COURSES
FOR HEALTH, SOCIAL CARE
& ALLIED PROFESSIONALS
For more information or
an application pack
call 01698 894412 or
email [email protected].
/ MSc HEALTH STUDIES
/ MSc NURSING STUDIES
(ADULT, MENTAL HEALTH, OLDER ADULT)
/ MSc SPECIALIST NURSING PRACTICE/
SPECIALIST PRACTITIONER QUALIFICATION
(PG Cert/PG Dip ALSO AVAILABLE FOR
THE ABOVE PROGRAMMES)
/ BSc INTERPROFESSIONAL PRACTICE
(HEALTH AND ALLIED PROFESSIONALS)
/ DipHE COMPLEMENTARY THERAPIES
/ WIDE RANGE OF STAND ALONE MODULES
AND STUDY DAYS AVAILABLE
School of Health Studies, Bell College, Caird Building, Caird Park, Hamilton, ML3 0QA.
46
www.scottishirishhealthcare.com
Programmes are offered at both
Hamilton & Dumfries Campuses.
All part-time programmes
commence January 2007 and are
aimed at those in Health, Social
Care and other Allied Professions
who wish to develop their
understanding or gain a
recognised qualification.
Many modules can be taken on an
individual basis for professional
development purposes.
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www.scottishirishhealthcare.com
47
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48
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www.scottishirishhealthcare.com