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S N 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 S N Part 3 in this series of ECG rhythm recognition. 25 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 Admin: Stephen Hartshorn Sales Representatives: Gordon Smith John McConnachie John Randall Suzelle Murray Anthony Spronger Telephone: +44 (0)1292 525970 Fax: +44 (0)1292 525979 Website: www.scottishirishhealthcare.com Email: [email protected] Copyright Warning: All rights reserved. No part of this publication may be copied or reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopy or otherwise without prior written permission of the publisher. Wound Care & treatment Minimising the risk of further skin damage 26 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 www.scottishirishhealthcare.com As a reader of Scottish Nurse we value your input and are always looking for new articles to appear in our publication. Please send your editorial, news articles, event details, press releases etc., to the Editor at the address opposite. Subscriptions . . . You can have your own personal copy of Scottish Nurse magazine mailed to your home each month. For a full year’s subscription, please send a cheque for £25 along with your name, address and job title to our address opposite. (Please ensure cheques are made payable to Strathayr Publishing). www.scottishirishhealthcare.com 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: 4 www.scottishirishhealthcare.com • 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. 6 www.scottishirishhealthcare.com 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. S N SCOTTISH NURSE 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 8 www.scottishirishhealthcare.com 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. 10 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 THIS 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: HAMISH BELL STRATHAYR PUBLISHING LTD GIBBS YARD AUCHINCRUIVE ESTATE AYR AYRSHIRE KA6 5HN SCOTLAND TEL: 01292 525978 THERE OR E-MAIL: WE ARE STARTING A LETTERS PAGE IN ALL FUTURE EDITIONS OF SCOTTISH NURSE & IRISH NURSE MAGAZINES. IS NO LIMIT TO THE SCOPE OF SUBJECTS WE ARE LOOKING FOR, IT 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 OR CONCERNING YOU OR EVEN SHARE A FUNNY STORY WITH OTHER HEALTHCARE PROFESSIONALS. [email protected] IF YOU HAVE IMAGES TO ACCOMPANY YOUR SUBMISSION PLEASE SEND THEM IN JPEG OR PDF FORMAT. £50 OR €70 WILL BE AWARDED TO THE AUTHOR OF THE ‘LETTER OF THE MONTH’. 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. www.scottishirishhealthcare.com 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 www.scottishirishhealthcare.com 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. www.scottishirishhealthcare.com 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 20 www.scottishirishhealthcare.com www.scottishirishhealthcare.com 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 www.scottishirishhealthcare.com 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 to our portfolio with the Eurosets Drainage and post operative Autotransfusion devices. The facility is situated within the Medipark at Strathclyde Business Park to the East of Glasgow. Our manufacturing area includes two state–of–the-art clean rooms, with sterilising facilities and secure warehousing also provided on-site. We operate our own delivery service in Central Scotland and have a longstanding arrangement with our courier company to ensure that products are delivered to our customers on time. 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Eurodrain : A multi chamber thoracic drainage device, equipped with unique features such as, a sterilising membrane, sequential tube clamp plate and automatic negative pressure valve, for use in cardio-thoracic postoperative care. Ortho PAS : Orthopaedic postoperative 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 means of a closed circuit technique Cardio PAS : Cardiopulmonary postoperative autotransfusion system, a fully disposable system, which combines the characteristics of a “closed circuit autotransfusion system “ with a “multichamber thoracic drainage system” Other products will be added to this portfolio in 2007. For more information or to discuss you specific requirements, please contact Stuart Hawker Sales & Marketing Director on 07883 020466 or e-mail [email protected] www.scottishirishhealthcare.com 23 24 www.scottishirishhealthcare.com 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. www.scottishirishhealthcare.com 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 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. 30 www.scottishirishhealthcare.com 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 www.scottishirishhealthcare.com 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). 34 www.scottishirishhealthcare.com 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 Female Order Codes Size Community Hospital 12Ch D236912S 236912UKS 14Ch D236914S 236914UKS 16Ch D236916S 236916UKS New female length Foley catheter technology in the fight against healthcare acquired infections (HCAIs) Bard Limited, Forest House, Tilgate Forest Business Park, Brighton Road, Crawley, West Sussex, RH11 9BP, UK Tel: +44 (0)1293 527888 Fax: +44 (0)1293 552428 Please consult product label and insert for any indications, contraindications, hazards, warnings, cautions and directions for use. *The Foley catheters included in the BARDEX I.C. System contain Bacti-Guard® silver alloy coating which is licensed from Bactiguard AB. BARD, BARDEX, and the I.C. logo are registered trademarks of C. R. BARD, Inc., or an affiliate. Bacti-Guard is a registered trademark of Bactiguard AB. ©2006 C. R. BARD, Inc. All Rights Reserved. P1206/1504MY 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 ��������������������������������� � ������������������������ � �� ����� ����� ���������� ���������� ��� ��� ���� ������ ��� ������ ������������ ��������� ��� ��������� ������ ���������� ����� �������� ���� ������ ������ ������ ��� ���� ����� �������� ������� ���� ���� ��������������� ��� ���������� ����� ��� ��� ������� ��� �������� ����� ����� ����� ���� ������������ ���������� ����������� �� for all your design & print ��� � � requirements:- �������������������������������������������������� ����������������������������������������������������� �������������������������������� � ������� ���� ����� ������� ��� �������� ����������� ����� �������� ������� ����� ��������� ���� ����������� �������������������������������������������������� ����������� ���������������������������������������������������� ��� ������ ������� ��������� ����� ������� �������� ���� ������� ������������� �������� ��� �������� �������� �������������������������������������������������� � � � ������� � ���� tio Infec magazines, brochures, hcare sh Healt hIriish ScottishIr l ntro 1 n Co part t en gem t 1 na par Ma ma apy ther & 2 ycho parts1 p Ps ou Gr s ythmt 3 G Rh par EC leaflets, fliers, au Tr Infectio n Con trol part 1 Trau ma Man agem ent part 1 g nin e Plan car re tay Ca long-s in letterheads, wallplanners, Group Psych hoth erap parts1 y &2 : ture cas fea cal Verru Clini arts & W ECG ctionre.c eas t se ersthca Ovheal men & irish ralttish cruit ne.sco Re Ge www om 1 diaries, business cards Rhythm s part 3 Care Planning in longstay care Diary 2007 Clinical Warts feature: & Verru cas Recr uitm www.sc ent sect Gene ottishir ral ishhealt ion & Ov hcare.c ersea s om & much more! 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. ����������������������������������������� �������������������������������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ��� ���� ��� ��������� �������������� �������� ������� ��� ��������� ���� ���������� ��������� ��� ����������������� ����������� ������ ��������� �������� ������������ ������������� ������������� ���� ���������� ������������� ���� ������ ����� ������������ ��� ����� ������� ��� ����� ������������� ��� ��� ��������� ����� ������� ��� ���� ���� ��� ��������� ����� ����� ����������� ��������� ��� ���������� ������������� ����� �������� ���������� ��� ������������������ ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ ����������� ���� ������ ���������������� ����������������� ������� ���������������� ���������������� ����������� ���������� ����������������� �������������� ��������� ���� ��������� ���������������� ���� ��������� ���������� ��� ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ������ ������������� ������������������ �������� ������������� ��������������� ������������ ������ ���������������� ������������� ������ ������� ���� ��������� ������������� ���� ���� ������ ����� �������� ������� ���� ���� ������ ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ ������������������������������������������������������������������������������ ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� www.scottishirishhealthcare.com 47 Fling out your expensive wipes! Tuffie - the cost effective hygiene solution! NEW E RIC P R E W O L TO SAVE UP * Tuffie are the SOLE BRAND of Surface Wipes contracted to NHS National Services Scotland! 34% Available direct from Vernacare or your local distributor including aaaaa Wipes per pack Vernacare Code Detergent Wipes 100 901DW100 Detergent Wipes 225 901DW225 Disinfectant Wipes 200 901CR200 Tuffie Product SAVE up to* 22% 34% 16% * New prices available from 1st December. Savings dependent on route of purchase. VERNACARE LTD, FOLDS ROAD, BOLTON, BL1 2TX TELEPHONE 01204 555999 FAX 01204 521862 www.vernacare.com 48 CALL NOW ON 01204 555999 FOR YOUR FREE TUFFIE WIPE SAMPLES www.scottishirishhealthcare.com