11-17 JANUARY 2011 “Start with the patient PLUS NURSINGTIMES.NET NURSES REJECT £1.80 Vol 107 No 1 and then work outwards” JOB SECURITY Viv Bennett p8 FOR PAY RISES

Does discharge planning actually work? p24

When to use nasal cannulas p16 Jungle fever: how to be a nurse on expedition p28 Frontline trauma: the experts What you can learn from military casualty care p17

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>> Book before the 17th December to benefit from our early bird rate at www.healthcareinnovationexpo.com Contents Editor's view The Nursing Week “Top honours prove 2 Nurses reject the o er of a freeze on pay increments in return for no redundancies nurses drive change” 4 RCN is being investigated over claims that a council member was unfairly removed 6 New Year Honours recognise nurses appy New Year. I feel slightly anxious about uttering 7 Living healthily doesn’t just mean going to those words when 2011 is set to usher in such a mas- the gym, says John Bromley sive raft of changes in the NHS. But I’m still confi - 8 We speak exclusively to deputy chief dent about your ability as a profession to navigate nursing o­ cer Viv Bennett H your way through this new NHS roadmap. 11 Mark Radcli e says it's neither cheesy nor Nursing is often portrayed in the media as a downtrodden crackers to celebrate public services profession – rarely do we see nurses taking the initiative, making changes that will affect patients and other health professionals. In real life, though, nurses do exactly that, and have been well acknowledged in the New Year Honours list for driving Nursing Practice change and leading it. 13 Comment: Maggie Ioannou on why a Rosalynde Lowe, chair of the Queen’s Nursing Institute, commissioning role would release nurses' was made Commander of the Order of the British Empire (CBE). creativity Other nurses who were among those honoured were: Julia Styles, 16 Practice questions: when should a nasal former head of nursing at the Blaenau Gwent Local Health Board; cannula be used to deliver oxygen? Margaret Berry, director of quality and executive nurse at NHS Luton; and Bruce Armstrong, consultant nurse and emergency 17 Innovation: caring for critically injured planning offi cer at Basingstoke and North Hampshire Founda- soldiers presents specifi c challenges tion Trust, who is also a major in the Territorial Army and who 21 Practice review: dealing with phantom played a signifi cant role in setting up the emergency depart- limb pain after amputation ment at Camp Bastion in Afghanistan. These nurses received an 24 Evidence based practice: a Cochrane Offi cer of the Order of the British Empire. Well done to all of review looks at whether discharge them. See our story on the New Year Honours list on page 6. planning improves care and cuts costs The new year also heralds a new look for Nursing Times. 25 Research: what prevents one to one care Over the past few months, we’ve been talking to nurses and in mental health acute hospitals? fi nding out what you want from this magazine. The answers came back loud and clear – you asked for prac- tical advice, quick tips on how to improve your practice and your leadership skills, inspiring stories from nurses, and career Nursing Life sections. You also asked for humour, so we’ve added that in too. 28 60 seconds with We hope you enjoy it, but do take the time to let me know Mandie Sunderland your thoughts. It’s your magazine, and we want you to fi nd it Role model: we meet a useful, interesting and inspiring. nurse who swapped the ward for the jungle Jenni Middleton, editor [email protected]

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www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 1 “To see these women change and develop as they became more confi dent was The astonishing” Nursing Rosalynde Lowe CBE p6 Week But an online poll of more are likely to centre on the fact than 1,500 Nursing Times that the guarantee on readers found 84% wanted compulsory redundancies their local union does not apply to bands 7-9. representative to reject the Royal College of Nursing offer. head of employment relations Nearly 70% of nurses said Josie Irwin said this was the proposed agreement was a “sticking in the craw of a lot “disgrace”, while 21% said it of members”. was “unfair”. The survey results suggest Two thirds said they would there was disagreement seek a job at a neighbouring among nurses on that issue. trust if their organisation Although only 17% of all went ahead with it. respondents said they agreed One respondent said: “I do that those on bands 7 and not believe this will secure above should be excluded jobs, nor will it improve from the job guarantee part of services. Instead, it will the proposal, that increased to damage morale and 28% among band 5 demotivate a hard working respondents, with a further Telling it straight: nurses say trading pay for jobs is a “disgrace” workforce.” 20% saying they did not know. The result was little Ninety-one per cent of affected by respondents’ area respondents on band 7 of work or AfC pay band. disagreed. Fury over Despite their hostility to Perhaps refl ecting the the proposal, 42% of different make-up of the respondents thought it was unions, 14% of Unison quite likely or very likely that members said representatives their union representatives should accept the deal, jobs o er would accept it. compared with 10% of RCN Unison senior national members and 11% of non- offi cer Mike Jackson said it union members. was too early to reject the However, Ms Irwin said proposal outright: “People are nurses were concerned that very worried about job trusts would not honour the Steve Ford and that up to 60,000 jobs could security. It’s a very big “no compulsory redundancy” Charlotte Santry be at risk if the deal – hoped decision.” side of any bargain. to save £1.9bn a year – is not However, it looks That was backed up by the The overwhelming majority of accepted. increasingly unlikely that the survey. More than 80% said nurses wants unions to reject Under the proposal by NHS deal will be accepted without they had little confi dence that a freeze on pay increments in Employers, increments for all further negotiations. Mr their employer would honour return for a guarantee of no NHS staff would be frozen for Jackson added: “It would be the pledge. compulsory redundancies, a two years from April and very unusual for unions to One respondent said: “The Nursing Times survey has those in Agenda for Change accept a fi rst offer.” premise that fewer NHS staff found. bands 1–6 would receive a “no Unions will deliver their will lose their jobs because of This is despite Department compulsory redundancy” verdict to NHS Employers on pay freezes is unfounded. It is of Health calculations sent to guarantee over the same 20 January, after consulting inevitable that more cuts will unions last week, warning period. with members. Discussions be made.”

2 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net The Nursing Week News

Students face stiff competition Vaccine uptake Stats “disappointing” among staff Charlotte Santry 84% There are likely to be at least Nursing Times Jaimie Kaffash 27% more applications to readers who university nursing courses would reject a A “disappointingly low” than places this year, figures pay increment percentage of frontline staff obtained by Nursing Times Applications for university freeze in return had flu vaccinations this suggest. places are up on last year for job security winter, the NHS chief By the end of December, executive has said. the Universities and Colleges Hamilton said: “It’s a concern Sir David Nicholson said Admissions Service had that more potential applicants 584 that only one in five frontline received 29,285 applications to won’t get a place.” UK women using staff (20%) had been nursing courses – 11% more He attributed the rise to Implanon who vaccinated against seasonal than in the same period last the move to make nursing a became pregnant flu this year. year. graduate profession. He said: in 10 years Although he described that If the number of university “People have realised that as a “disappointingly low places does not rise above last nursing is a complex figure”, it represented a slight year’s 23,000, more than 6,000 profession with a number of improvement on last year's candidates look set to be skills required – people skills, £1bn figure of 18.3%. rejected. academic skills.” Amount wasted a Sir David’s comments However, places are widely Swansea University year by the NHS came as figures suggested expected to be cut because of nursing department head paying different there had been an increase in government spending limits. David Barton said competition prices for the NHS staff sickness absences Council of Deans of Health for places would be “a lot same equipment over December. director of policy Matthew tougher” this year. Data on absences at 22 NHS trusts was extrapolated 69 by FirstCare, a company that Follow-up fear toddler phase of the Healthcare staff helps organisations reduce programme. This runs from 12 in the New Year's sickness absence. in family pilot to 24 months, when the Honours list This suggested that 366,180 mother is expected to staff days were lost to flu-like “graduate”. illness in December 2010. That Nurses working on the Family However, some nurses compares with 243,593 lost Nurse Partnership pilots continued to visit young 50 days in December 2009 – an UK flu deaths so continued to visit parents mothers because of “concerns increase of 50%. far this winter after the programme had about the level of support that There were 55,600 absences formally ended because they would be available from other between 4 and 6 January – up were concerned about a lack services such as health 6,000 on the same period in of good follow-up services visiting and Sure Start”. 2009. Flu-like illness such as health visiting. Unite professional officer accounted for 17% of absences A study for the Dave Munday said nurses and in December and January Department of Health by families faced a “cliff edge” at compared with 11% in the Birkbeck College looked at the the end of the two years. same period last year. However, nurse managers told Nursing Times their units Theatres against cuts had not suffered from high absences and Sir David said Around 150 theatre nurses and the NHS was “coping well”. other staff at St George’s Meanwhile, the Royal Hospital in London began 2011 College of Physicians reported with a lunchtime protest this week that back-to-work against public sector cuts. plans are produced in 97% of The staff are also concerned cases of long term absences in about proposals for theatre the NHS. However, it added reorganisation. The trust is that, in 30% of cases, staff had planning to change working been off sick for at least 12 patterns to “achieve cost weeks before assessment by

savings of £190,000”. occupational health services. Report digital

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 3 The Nursing Week News

In brief RCN in hearing over members being ousted without warning WaterXxxxxxx was xxxxcut off from several Northern Ireland hospitals over the Christmas period due to the crisis that Charlotte Santry “hundreds of errors in the left 40,000 people without database system, hundreds of water. The fire and rescue The Royal College of Nursing error logs… and… poor service provided water to is being investigated by the strategic awareness of the South Tyrone Hospital, trade unions’ watchdog over system problems in the RCN Dungannon, and patients claims that a council member at a senior level.” were given bottled water. was unfairly removed due to The RCN refused to release Lagan Valley Hospital in “widespread” problems with the audit and other internal Lisburne and Longstone its membership database. findings as they were seen as and St Luke's hospitals in A Certification Office confidential, according to the Armagh were also affected. hearing on Tuesday will statement. consider claims by former Claims have been made that the Former council vice-chair A former nurse who RCN council member David RCN unfairly removed a member Gerry Bolger stood down last became a brothel madam Dawes that he was ousted and summer in protest at the claimed she did so because unfairly barred from standing comment on that, or on the decision to remove Mr Dawes. NHS wages were too low. as deputy president, after his case, until after the hearing. He told Nursing Times: “I Marcia Howard, 68, gave up membership was found to Mr Dawes has submitted a had a duty as council member nursing in the 1990s to have lapsed. witness statement to the to support corporate deci- become a joint owner of Mr Dawes claimed his Certification Office. This sions; however… I really didn’t two massage parlours, membership was cancelled names nine college members support how this had been Manchester Crown Court automatically with no he personally knows to have handled by the organisation heard. She also admitted warning, due to a technical been affected, including two as a whole or by the council. money laundering, and was fault with the RCN database. regional board members, a “The organisation will need jailed for 10 months. He said the problems were lead steward and a former to tighten up [its systems] and leading to many nurses being national committee member. understand why it’s losing the Hospitals in the north west stripped of their membership The statement reads: number of members it is.” are under emergency by mistake. “There is a widespread Around 1,800 names are "command and control" As RCN membership also problem within the RCN of deleted from the RCN register measures as flu cases includes indemnity cover for members having their each month, although it is surged this week. All non practising professionals, such membership automatically not known how many of these life saving surgery has been a database error could alarm terminated without receiving are due to technical errors. cancelled or postponed, some members. However, the warning letter that is If the Certification Officer and the SHA has taken over a spokesman for the stipulated in the union rules.” rules in Mr Dawes’ favour, the managing admissions. college said it would be It says an external audit of RCN may have to re-run the “inappropriate” for it to the system had revealed deputy presidential election.

the primary care trusts that I have had related to the Training blamed for were in debt used it to shore insertion technique.” that up. That may mean less The Royal College of access by women to the full Nursing’s adviser for mid- Implanon failure range of contraception wifery and women’s health provided by appropriately Jane Denton said: “One of the Ben Clover hit the headlines last week trained staff.” concerns we have seen after patients sued for Around 4 million people a reported [in the media] is a Inadequate training could compensation. year use contraceptive services. failure of this technique. If have caused contraceptive The FSRH told Nursing Roughly three-quarters access nurses are carrying out this devices to be fitted incorrectly Times the money earmarked them through a GP and the procedure, they should have in women who later became for contraception training in a rest through a specialist clinic. the appropriate training, for pregnant, the Faculty of three-year programme Partner at Anthony Gold which guidance is set.” Sexual and Reproductive beginning in 2006 had not all Solicitors Stephanie Prior, The Medicines and Healthcare has said. been used for that purpose. who is representing some of Healthcare products Regula- The Implanon device, Vice-president Alyson the claimants, told Nursing tory Agency said that, which is inserted in the arm Elliman said: “The funding Times: “Training is one of the correctly fitted, Implanon was by a nurse or other clinician, wasn’t ringfenced. Some of issues here. A lot of the cases “safe, effective and reliable”.

4 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net “I dressed a few blisters Blogs and spent the rest of the time with a fi lm crew” James Moore p28

I went to the o ce last week to fi nd the deputy matron sitting behind her desk alone. "No meeting Journal club today," she said. "There aren’t enough sta nurses to meet" Becky Cridford, nursingtimes.net Visit nursingtimes.net to fi nd out how to get involved in our online Journal Club, where you can discuss nursing Mr Door has been back research and articles in all specialisms with your nursing colleagues to the doctors today Complementary therapy advocacy, according to nurse carers using the 10-item Clinical because his hands are still can be lethal in children researchers from London and Epidemiological Scale Depres- numb, his balance is o and www.adc.bmj.com Reading. They interviewed 14 sion Scale and found 38 per his vision is funny, and various Complementary medicines can patients with long term cent had scores of four or other stu is happening. be dangerous for children and conditions on their experiences above – predictive for a Slightly worryingly, the can even prove fatal if substi- of their community matrons. diagnosis of depression – on doctor has referred him to a tuted for conventional treat- Patients said the matrons the patient's admission. The neurologist under the two ment, according to an Austral- helped them understand jargon authors said: “The results week wait rule; apparently ian study. Parents often and supported them at hospital support screening of caregivers her “best guess” is that he’s misguidedly think such appointments, providing a link for depression symptoms.” had a mini stroke treatments are better for to secondary care. The authors Not a Nursing Student Blog, children, warned the authors said: “The impact of this role on Echinacea does little to notanotherstudent.blogspot. online in the Archives of the patient experience needs to alleviate common colds com Disease in Childhood. They be taken into account… as Annals of Internal Medicine audited adverse events data for benefi ts may not be captured (2010) 153: 769-777 Andrew Wakefi eld, the three years, identifying 39 by relying solely on quantitative The herb echinacea has little paediatrician who cases associated with comple- evaluations of hospital benefi t in treating the common sparked o the MMR mentary treatment, including readmission rates.” cold, according to US research- autism scare, has been four deaths. Events ranged ers. They studied 719 patients accused of fraud by the from constipation, bleeding, Advance warning test on with cold symptoms who were BMJ. Hysterical shrieking by mouth ulcers and pain to pre-eclampsia outcomes randomised to receive no pills, the anti-vaccine brigade to allergic reactions, seizures, www.thelancet.com a placebo, or echinacea. commence in 10…9…8… vomiting, infections and death. International researchers have Echinacea patients received Mental Nurse, mentalnurse.org developed a model that 10.2g of the herb during the Doctor calls for local midwives could use to predict fi rst 24 hours and 5.1g for the anaesthetic in IUD fi tting the likelihood of a poor next four days. The researchers http://tinyurl.com/iud-anaes outcome for pregnant women found no signifi cant diŽ erence Tweets Less than 5 per cent of women with pre-eclampsia. They in illness duration or severity fi tted with intrauterine devices studied 2,023 women with with echinacea compared with receive eŽ ective pain relief, pre-eclampsia and assessed the placebo or no pills. However, even though over half experi- relevance of 34 variables in they added: “The trends were in “Keep calm and get ence pain when a coil is predicting the risk of life-threat- the direction of benefi t, vaccinated [against inserted, a doctor has said in ening complications. They com- amounting to an average the Journal of Family Planning bined the seven most signifi - half-day reduction in the fl u]. Listening to and Reproductive Healthcare. cant – gestational age, chest duration of a week-long cold.” the UK media, Dr Sam Hutt of London’s pain, shortness of breath, liver there is clearly the Margaret Pyke Centre said enzymes, platelet counts, Sickness absence project ritualistic panic sexism, misguided professional kidney function and blood ine ective in long term pride and a lack of knowledge oxygen levels – in one model, Occupational Medicine (2011) and hysteria” about safe and eŽ ective pain which they said identifi ed 61: 57-61 @gerrybolger relief were to blame. He says an adverse outcomes up to seven A programme to reduce twitter.com/#!/gerrybolger injectable local anaesthetic days before they would appear. sickness absence among could prevent “unnecessary student nurses by helping them “NHS sta face and avoidable” pain. Hospice admission may stay active and manage stress pay freezes while lead to carer depression did not have a sustained long Patients approve of Journal of Hospice & Palliative term eŽ ect, a study has found. banks dish out community matron role Nursing (2010) 12: 345-357 Danish researchers oŽ ered a bonuses, fair? I Journal of Advanced Nursing Nearly four out of 10 people programme of physical training, think not” (2011) 67: 86-93 caring for patients with cancer patient transfer techniques and @S_Para_Sashs Community matrons improve may develop depression if the stress management to 568 twitter.com/S_Para_Sasha patient perceptions of care, patient is admitted to a students. It reduced sickness psychosocial support, hospice, US researchers have levels after 14 months but this and access to services and warned. They assessed 578 was not sustained at 36 months.

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 5 The Nursing Week News

Nurses earn New Year Honours Movers keep NHS Sarah Calkin pensions Seven nurses and a midwife have been recognised for their hard work and dedication in Nurses, midwives and health the New Year’s Honours list. visitors at a primary care Rosalynde Lowe, chair of provider that became a social the Queen’s Nursing Institute, enterprise have won their bid was made a Commander of to keep their NHS pensions. the Order of the British Staff at North East Essex Empire (CBE) for her services Provider Services, which to healthcare. became Anglian Community Ms Lowe has worked at Enterprise on 1 January, have local, regional, national and had confi rmation from the international levels – spending Department of Health’s time as an adviser to the World Top achiever: Rosalynde Lowe has been awarded a CBE pensions agency that they will Healthcare Organization. be able to stay in the NHS However, Ms Lowe told my career but it taught me a quality and executive nurse at pension scheme, even though Nursing Times her proudest lot about how you need to NHS Luton, were also ACE is not part of the NHS. achievements came at the start support people to achieve awarded OBEs. ACE will become one of the of her career as a health visitor what they can.” Royal College of Nursing biggest social enterprises in in the North East in the 1980s. Bruce Armstrong, consult- Council chair Sandra James England. It trades as a She said: “I ran a commu- ant nurse and emergency was made a Member of the community interest company, nity education course for a planning offi cer at Basing- Order of the British Empire a limited company with an group of about 10 women. It stoke and North Hampshire (MBE). “asset lock” to ensure profi ts was about caring for your Foundation Trust, was made MBEs were also awarded to: and assets are for “community child. To see these women an Offi cer of the Order of the David Pearson, director of benefi t”. It plans to employ change and develop as they British Empire (OBE). clinical governance and 285 nursing, midwifery and became more confi dent was Major Armstrong – who nursing at North Staffordshire health visiting staff. astonishing.” also serves in the Territorial Combined Healthcare Trust; The DH’s decision to allow One of the women went on Army – helped set up the Rehana Richens, consultant the company access to the to complete an Open Univer- emergency department at midwife and honorary lecturer NHS pension scheme is likely sity degree, something she Camp Bastion in Afghanistan. at University of Coventry to set a precedent for other said she would never have Julia Styles, former head of Hospital, Warwick; and Lesley NHS social enterprises. done were it not for the initial nursing at the Blaenau Gwent Benham, team leader at However, staff joining ACE course. Local Health Board, and Melcombe Day Hospital, from outside the NHS will not “It was quite early on in Margaret Berry, director of Dorset. be entitled to an NHS pension.

lives” would be assessed. experience of their care were However, the framework emerging. DH reproached over suggests it is not possible to She told Nursing Times that do this by asking dying these should be developed surveying bereaved patients themselves for their instead of relying on relatives views on their care. or carers’ views. Dave West Instead it says: “A new Ms Brearley said: “Dying in survey of bereaved carers will hospital is disenfranchising The Department of Health be used to understand the enough already. Nurses risks sidelining dying people experience of the person at working in end of life care by opting to survey bereaved the end of their life, and of know there are already some relatives about care, instead of their wider family.” very good measures [for the patients themselves, The survey is due to be directly measuring the a nursing academic has said. introduced in April next year. experience of end of life care The NHS Outcomes End of life: no voice for the dying But Sally Brearley, visiting patients].” Framework, published last fellow at the national nursing The framework also adopts month, sets out indicators The DH said “improving research unit at King’s College indicators that are directly that the DH will use to judge the experience of care for London, said methods of infl uenced by the quality of service performance. people at the end of their measuring dying patients’ nursing.

6 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net John Bromley

A positive stay helps recovery “Living healthily doesn’t Time with just mean going to the gym” patients urses will be more aware than adopting healthier behaviours. Then see if most people of the importance you can get some support, from your cuts costs of a healthy lifestyle. But, just organisation or from colleagues and Nlike the rest of us, knowing friends, to start breaking those barriers the benefi ts doesn’t necessarily translate down. And while this can be tougher for Ward managers and other into action. nurses than most owing to their profes- senior nurses should give For nurses who provide health instruc- sion, some local schemes are helping. greater priority to improving tion there are added benefi ts. Health The Queens Medical Centre (QMC) patients’ experience in advice is more likely to be acted on if the Campus of Nottingham University Hos- hospital, as it can help save person giving it demonstrates the healthy pital Trust’s ‘Q-Active’ programme is one of money as well as improve behaviours themselves – in other words, them. It found that nurses believed that, as quality, according to the your patient is more likely to quit smoking professional carers, it would be selfi sh if NHS Confederation. if you’ve given up yourself. they took time out for themselves. Nurses Well informed patients Why don’t we live more healthily? We also felt that, if they were doing their job to who feel they are listened to aren’t letting ourselves off lightly if we the full, they shouldn’t have the energy to and are comfortable are less acknowledge that, despite our best inten- exercise as well. High sickness absences put likely to develop complica- tions, things often get in the way. In most staff under further strain, making them too tions or be readmitted, the cases, there will be both internal and stressed to exercise. organisation says in its report external barriers. Internal barriers include To overcome these barriers, the QMC Feeling Better? Improving Patient motivation and belief in abilities; those encouraged staff to relax through group Experience in Hospital. that are external include not having a gym activities and exercise. A staff wellbeing The report, published last nearby, fatty food being available in the room was set up, with relaxation therapies week, says patient experience canteen or having peers who aren’t and a gym. The QMC held regular events to has traditionally been viewed living healthily. create excitement – with free class demon- as something “nice but not Healthier behaviours will often be in strations, competitions and giveaways. necessary” and warns that “a competition with those that are less This sent the message that living healthily big cultural shift at many healthy but more enjoyable. It would be a didn’t just mean going to the gym – there hospitals is needed” if it is to lot easier to embark on a regime of were lots of ways of doing it and, what's get the priority it deserves. healthier eating and consuming less more, it could be fun. Importantly, health Former nurse and Confed- alcohol if colleagues didn’t invite us for champions from among the staff provided eration deputy director of curry and a pint every Friday. And it would advice, information and encouragement. policy Jo Webber said: be easier to give up smoking if it didn’t Peer pressure can lead you astray, but it “Simple things like spending mean missing out on banter with other can also be a great motivator to getting fi t time with patients, talking to smokers and the opportunity to take fi ve and staying healthy. If you and your col- them, listening to their minutes out from a hectic day. Nursing can leagues work together, you’re more likely concerns and addressing be particularly stressful, so after an to succeed in the long term. By forming issues like noise, privacy and exhausting day with barely a break, curling a wellbeing group you can jointly come the quality of food can make a up on the sofa is likely to be vastly more up with fun ideas, keep each other on track huge difference. People who appealing than a gruelling 20 lengths at the or even compete. If you’re put off walking have a better experience in swimming pool. home because it’s dark, why not form a these terms are happier, So, what can you do? The fi rst step is walking group? If healthy food isn’t on healthier and do better.” fi nding out what the main barriers are to offer at your workplace, why not start The report also highlights a joint collection to get healthier snacks work by a number of NHS John Bromley is director of The National Social more cheaply? Maybe even buy a reward hospitals to improve patients’ Marketing Centre (www.thensmc.com). For ideas on for whoever in the wellbeing group experience, for example, how to adopt healthier lifestyles, see the NSMC's case makes the greatest change to promote

Whipps Cross in London. study database at tinyurl.com/nsmc-database healthier behaviour. Alamy

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 7 The Nursing Week The big interview: Viv Bennett

eputy chief nursing officer Viv Bennett is distinctly uncomfortable under the spot- “You have to light. “Why did you want to speak to me?” Dshe asks suspiciously as I sit down in her Richmond House office, with its sliver of a view over the Thames. invest in yourself. However, over the coming year she will inevitably attract growing attention. Widely tipped to succeed Dame Christine Beasley as chief nursing officer for You cannot England, the qualified health visitor was also one of the first nurse commissioners, meaning she is well positioned to inform sweeping NHS reforms. expect it to be Her Department of Health portfolio includes com- munity nursing and health visiting, commissioning, primary care, mental health, learning disabilities, and handed to you” services for children and families. I remind her of a comment piece she wrote for Nurses should make the most of changes ahead, Nursing Times last year, in which she stated: “I was a says Viv Bennett. Charlotte Santry meets the proud commissioning nurse before they were invented”, and she smiles proudly. “What happened to me was very nurse tipped to be England’s chief nursing officer unusual,” she says. While working as a community nurse manager in Oxfordshire in the early 1990s, she was approached about developing a new job that would reflect the new purchaser/provider split. She ended up working in the role herself, looking at

8 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net The Nursing Week the big interview: viv bennett

“the new world of purchasing and providing and what She fostered a disabled child for a short time, an is it that nurses bring to the purchasing side”. Insights experience that made her question why “we some- gleaned during this time made her a fierce proponent times expect parents to do things that we’re nervous of nurse commissioning, which is unlikely to have about getting healthcare assistants to do”. This formed gone unnoticed by the current administration. her view that support staff can be trained to carry out a “Well, who knows a lot about the needs of children lot of the care given to children, despite the anxieties and families? Health visitors do, they work with them of many nurses about the “dilution” of skills. all the time,” she states, hands slicing through the air. Her attitude towards roles is typical of her lack of “Who has views about managing a population with reverence towards fixed structures, demonstrated in long term conditions and keeping people out of hospi- her approach to transforming community services. tal? Well, community matrons do.” Health secretary Under this policy, primary care provider arms will Andrew Lansley had better take note. merge with acute trusts, mental health trusts or But her face flushes when I ask whether she believes become community foundation trusts or social enter- nurses should be given a formal role on GP consortia prises. Many community nurses are concerned about boards. “I can’t really comment, I’m not allowed to com- who their future employer will be and whether their ment,” she stammers, looking to the DH press officer to terms and conditions will be retained. rescue her. But Ms Bennett is uninterested in “systems archi- And she is non-committal when I ask whether she tecture”, which she says is “just stuff” to most knows if nurses have been playing a big role in the patients. Referring to debates over whether health pathfinder consortia announced the day of our inter- visitors should be aligned with GPs or based in Sure view: “It’s varied. They were only announced today… Start centres, she says: “I never like to get too tied do you know what? I’ve been quite busy writing a down with that – where your office is isn’t the most health implementation plan.” important thing, you know.” After rising to a senior role at Oxfordshire Health She is no policy geek, despite her role at the DH and Authority, she became Birmingham Health Authority’s postgraduate study. She appears neutral about senior commissioning manager of children’s services. current upheavals, repeatedly stressing the need to This passion for families and children has provided “make the most of” changes, good or bad, and citing a thread throughout her working life and, despite her “resilience” as the most important leadership quality. obvious reservations about speaking to a journalist, Her real interest lies in ensuring services are work- she becomes incredibly animated. ing for patients, particularly families and children. “Sorry if I wave my hands about!” she apologises, as “Start from the patient then work outwards to see what she explains how, as a student at Oxford School of we need to do,” she advises. Which sounds exactly like Nursing in the late 1970s, she particularly enjoyed the kind of manifesto you might expect from someone working with children and decided to work on a paedi- planning their move to the top of the nursing tree. atric medical ward after qualifying, which she “loved”. Dame Christine is due to retire in March but the “We did a lot of work looking after future shape of the role is not yet set children with epilepsy, doing lots of stud- out. Some predict the position could Military style: for Viv ies into epilepsy and children with cardi- viv bennett be split, with one postholder in public Bennett resilience is ac problems, and it was great,” she says. cv health and the other on the NHS Com- the most important This convinced her to focus on families missioning Board. leadership quality and children, but she realised she “want- Career highlights Would she be interested in going for ed to work with children who were well, ● 1976–80: student it? “It’s not something I ever aspired as well as children who were sick”. nurse, John Radcliffe to do – it’s not that I went to this job “So, I worked as a staff nurse, then did Hospital thinking, ‘oh, yippee, the CNO’s about to a little while on a paediatric intensive ● 1980–86: health retire and I can go for that’. care [unit] part time and then I went to do visitor, Oxfordshire “I went for this job because it’s portfo- my health visitor training, also in Oxford Community Unit lio, it’s what I really wanted to do. So I – Oxford Polytechnic.” ● 1992–96: quality suppose the honest answer is it will Her career has not been without plau- development depend what the jobs are.” dits: last year, she received the title of manager, senior She described her career as “reac- Queen’s Nurse at the Queen’s Nursing nurse purchasing, tive” but says she has always grabbed Institute’s spring award ceremony. public health opportunities. “You have to be open to But achieving her goals involved some practitioner, sideways moves as well as promotions. tough choices while her children, now Oxfordshire Health You have to be prepared to invest in adults, were young. Having not taken a Authority yourself. I don’t think you can expect it nursing degree first time round, she ● 2002–06: director to be handed to you.” gained a BA in social science with the of nursing and She would certainly appear to be a Open University. She was later sponsored patient services, popular choice of candidate, judging by by the NHS to take a master’s degree in South Warwickshire the observations of DH colleagues, one policy studies at the University of Bristol, Primary Care Trust of whom said she was admired for her which she accepts was a lucky break, but ● 2008–present: “incredible breadth of knowledge”. An meant she “had to go away when the deputy chief nursing ex-colleague put it another way: “She’d children were small”. officer for England be a dame if she was in a hospital.”

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 9 The Nursing Week “A leader is only as good as Opinion the people around him or her” Susan Hodgetts p41

Online The Yo u r top 5 survey opinion

The top stories you're reading on We asked: Is it fair for nurses to be nursingtimes.net should nurses this week have a seat accountable for HCAs? Nursing Times will help on the board I would like to raise an important point about health- 1 you to overcome this care assistants following your recent coverage year's challenges of GP tinyurl.com/overcome- regarding training and regulation (news, page 3; challenges commissioning opinion, page 25; 23 November). consortia? Many nursing tasks are delegated to HCAs but Air travel increases consideration must be given to the fact that, while 2 dyspnoea risk in HCAs remain unregulated, they cannot be held patients with chronic YES responsible for the care they give. It will be the obstructive pulmonary 97.8% disease nurse in charge who will be held accountable for tinyurl.com/dyspnoea-risk the actions of HCAs. Terry Galligan, via email Nursing Times asks 3 whether you would I don't have kids but This means higher living costs, be willing to accept a I still need a holiday lower wages, more work. freeze to pay increments NO I only hope the unions will in return for no 2.1% Healthcare professionals say “strike”. compulsory redundancies who have no children are Anonymous, nursingtimes.net tinyurl.com/pay-increments penalised over Christmas. On Such an overwhelming my ward, it’s those with There's more to Even mild COPD response in favour of nurse families and children who treatment than pads 4 harms people's commissioning shows just how are always given the time off. quality of life, reports you believe your involvement in Anonymous, nursingtimes.net In this day and age, it is not a European study procurement of care is just as acceptable to view inconti- tinyurl.com/COPD-QoL important as your involvement It's time for us to say nence as an inevitable part in its provision. Quite right too. of ageing. Poor diabetes control Join our campaign at enough is enough Unfortunately, many 5 has been found to nursingtimes.net/ We have given up our pay healthcare professionals see lower female fertility aseatontheboard rise. We have given up our pads as a solution but these tinyurl.com/diabetes-fertility increments. We are not should be viewed as a last Next week: have you been allowed to replace staff who resort (as with catheters also). vaccinated against seasonal have left. We are not allowed If people are worried about infl uenza yet this year? to recruit more staff to cover incontinence, they should ask the excess pressures. We are for an assessment, and nurses expected to say: “Wonderful, must be able to discuss all the you have gone sick but we treatment options. can manage with one trained Belinda Ellis Macey, Editorial board: Maggie Boyd, executive director of clinical quality and nursing, Derbyshire County Primary Care Trust; Lesley Doherty, chief nurse and one HCA for more nursingtimes.net executive, Royal Bolton Hospital Foundation Trust; Michele Hiscock, than 28 patients.” deputy director of nursing, Royal Brompton and Harefi eld Foundation What are NHS employers Nurses are vital to Trust; Maggie Ioannou, interim director of nursing, quality and safety, NHS proposing in return? No Surrey; Jill Maben, senior research fellow and deputy director, National redundancies even though commissioning Nursing Research Unit, King’s College, London; Gail P Mooney, director, postgraduate studies, School of Human and Health Science, Swansea they are getting rid of the I'm about to go for my University; Andrea Nelson, professor of wound healing, School of staff and not replacing them. interview at the University of Healthcare, University of Leeds; Anne Marie Ra— erty, dean, Florence This is on top of increases Lincoln to become a student Nightingale School of Nursing and Midwifery, King’s College London; in VAT and national insurance. nurse. I've always wanted to Eileen Sills CBE, chief nurse/chief operating o™ cer, Guy’s and St Thomas’ NHS Foundation Trust; Janice Sigsworth, director of nursing, Imperial College Healthcare Trust Tamar Thompson, independent health services Send your views to [email protected] or go online at nursingtimes.net

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10 Nursing Times 11.01.11 / Vol 107 No 01 / www.nursingtimes.net be a nurse and it will be a privilege to be accepted. Nurses work on the Mark frontline and are crucial in ensuring high quality care. It is therefore vital that they Radcli e are involved on GP commis- sioning boards and I for one welcome the Nursing Times A Seat on the Board campaign. Anonymous, nursingtimes.net “It’s not cheesy or crackers » Sign our petition to ensure nurse involvement in GP commissioning at nursing to celebrate public services” times.net/seatontheboard

Is there a role for nough with the cheese. I have put wonder how those of us who spend our on about 5lbs over the festive peri- time providing those things may respond fast food in hospital? od and most of that is Brie and Stil- to that? E ton. Yes, there is some chocolate And of course people will defend their and mulled wine in there too but, in the jobs and services as best they can. There main, it was cheese that did the damage. may be demonstrations, strikes and When people visited I offered: “Tea? marches as public service workers and Wine? Cheese?” And then: “Cheese? Wine? students alike are painted as resisters to Oh I know… Brie? We have a lump of Brie necessary change – naïve and old fash- the size of Stoke draped over the top of the ioned or thuggish troublemakers – either fridge. Take your coat off and I’ll get some way they are not acting in the best inter- crackers.” ests of the country or more importantly I don’t feel good on it. I have an extra the economy. Tingling the taste buds: layer made of cheese and I have been So maybe we should have a party. A would burgers encourage having some very odd dreams. They are party that celebrates public services: the patients to eat? not just enhanced by the presence of people who provide them and the people cheese but actually include cheese. In one I who use them. Surely the existence of Most hospital food is of poor fl y an intergalactic spaceship made of public services makes us a better, more quality and unpalatable. This cheese and I deliver Coldplay to some sort refi ned society? We could make some is why much of it is wasted. of space pirate in exchange for more sandwiches, get some bands in – I’m Malnutrition is a major cheese. Which isn’t a bad deal if you think pretty sure Coldplay will play although issue and, although a daily about it. you’ll have to ask them as they are still a dose of fast food is not Anyway, I am now immersed in the bit miffed with me because of the space nutritious, it would certainly cheese detox and, although there is a lin- pirate thing. In fact, loads of bands will stave off malnutrition for gering smell of Stilton and it takes longer surely come along and spend some time many hospital patients. to lose the weight than it once did, I along celebrating public services. I’ll bring the The issue of malnutrition with the rest of the world am back at work/ cheese. must be addressed, so why in the gym/eschewing dairy products and Because at heart what we do is both not look towards fast food? wondering about a summer holiday. useful and is something to be proud of, Anonymous, nursingtimes.net Indeed, I was wondering if perhaps we something to celebrate. It is something should all have a party? that defi nes the best of a civilised society, Make dementia care Forgive me for picking up so immedi- not something to be ashamed of or to be ately on a pre-Christmas theme but it considered a burden. training mandatory seems to me the national consciousness No doubt the unions are going to be Many nurses will come across for 2011 is fi rmly set on austerity, cuts busy organising resistance but rather than patients with dementia. and the ongoing disdain for anything just march or strike, and thus do what Therefore undergraduate that costs money. Wasteful pointless the government predicts and legislates training in this area must be stuff such as education, healthcare, social for, perhaps we should fi rst embarrass mandatory. There should also service, policing and so on. It seems them by borrowing a park, gathering be an option for postgrad- uncritically accepted that the best inter- together as nurses, teachers, students, uate training that takes into ests of modern society are served by an police, fi re-fi ghters and everyone else in account the number and assault on the things that civilise us. And I public services and dance, laugh, talk and dependency of patients that play. Let's celebrate public service as a nurses encounter. Mark Radcli e is senior lecturer, School of Nursing means of defending it, and re-establish Anonymous, nursingtimes.net and Midwifery, University of Brighton, and author of some clearer social values for 2011. Happy Gabriel's Angel New Year.

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 11 To advertise here please contact Tim Verbrugge Showcase 020 7728 3736

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12 Nursing Times 11.01.11 / Vol 107 No 01 / www.nursingtimes.net HIGHLIGHTS When should you use a nasal Nursing p16 cannula? Barriers to providing Practice one to one care p25 Do discharge plans improve outcomes? p24

COMMENT SPOTLIGHT “A commissioning role would Military injuries give a wider release nurses' creativity” insight into care

Most military casualties are he commissioning of high named case manager (community matron) cared for by nurses experi- quality care is dependent on the who ensures there is detailed care plan- enced in dealing with their right level of advice from front- ning, including a personal escalation plan. injuries. However, the involve- Tline clinicians closest to the They would also call for rapid response ment of UK forces in wars patient and carer. Nurses and allied health community services that can provide addi- around the world means professionals must be fully engaged with tional support to carers 24/7 and a single- more and more nurses will GPs if the aspirations of primary care-led access phone number available all hours. come into contact with commissioning are to be achieved. Investment in telecare and telehealth is military casualties. Nursing Times’ campaign A Seat on the vital to enable distance monitoring of vital As our report on page 17 Board gets to the heart of the issue. It calls signs as are community “bed” facilities to shows, these patients need for every GP consortium to include at least enable additional care to be offered over- specialised critical care as many one nurse on its board to ensure there is night (this may be in the patient’s home or have injuries of a severity nurse input into decisions on procure- in a community hospital). beyond most nurses' ment and provision of health services. Clinical commissioning is an exciting experience. Wounds can be As costs rise and resources continue to prospect and supported by all clinicians. It open for weeks and need be squeezed, the NHS faces unprecedented offers the opportunity to release the cre- constant management. Injuries challenges in delivering high quality care. ativity of frontline staff to create a provider also have a huge psychological The nursing perspective is key to the rapid landscape that is effective both in terms of impact. redesign of services required to ensure ser- outcomes and costs. However, this will Fifty-eight British soldiers vices are sustainable. Models of care need only be realised if GPs involve all their clin- su† ered an amputation in the to increasingly empower patients and ical colleagues. fi rst nine months of 2010. carers to manage their care in the home, A place on the board for a senior nurse Phantom limb pain occurs after supported by professionals as required. with the skills and credibility to infl uence most amputations and can be This is the essence of good nursing care. change will have two benefi ts. It will diŠ cult to identify and assess. Understanding how patients and carers ensure commissioning decisions consider Our expert outlines its perceive the system and then make best the wider implications of care rather than management on page 21. use of resources will challenge all profes- focusing on medical intervention. It will These two articles sionals. Traditional practices need to be also give a powerful message to all nurses provide a fascinating reviewed and changed and signifi cant in that their views are valued. This message and humbling insight this is ensuring that the deluge of informa- will provide the momentum for change into the care of these tion available is used to inform decisions. that will be critical to deliver the vision of patients. They also A great deal of the information relates the white paper. NT o† er all nurses a wider specifi cally to nursing, and needs to be insight into the care interpreted by nurses as partners in com- Maggie Ioannou is director of nursing, of patients with missioning. Ask any district nurse about quality and safety, NHS Surrey severe physical or changes that would enable patients to be psychological trauma. cared for in their own home during an Support the Nursing Times campaign to acute episode and they will come up with a ensure each GP consortium has a nurse raft of changes. These include ensuring on the board by signing the petition at Kathryn Godfrey is practice editor of Nursing that every patient with complex needs has a www.nursingtimes.net/seatontheboard Times. [email protected]

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 13 Rewarding Excellence Patient Safety Awards Ensuring patients stay safe

As patient safety gains a higher profi le than ever, the Patient Safety Awards celebrate the best innovations around the country to improve safety in healthcare

ursing Times – like our sister » NHS Tayside publication Health Service » Salford Royal Foundation Trust Journal – is pleased to » North Tees and Hartlepool Foundation Nannounce the shortlist for the Trust Patient Safety Awards 2011. » University College London Hospitals Innovation in patient safety continues Foundation Trust to grow across the NHS. The awards aim » Royal Devon and Exeter Foundation collection to support venous to recognise the best examples of this Trust thromboembolism assessment work, and to disseminate it more widely » Peterborough and Stamford Hospitals within the healthcare community. Communicating Patient Safety Foundation Trust – Flagging glaucoma: The Patient Safety Awards evolved » Aneurin Bevan Health Board NHS Wales keeping patients in sight from the Patient Safety Congress – a » Accident and emergency department, » Heart of England Foundation Trust major annual event that was developed as South Wales (Royal Gwent Hospital?) » NHS Lothian a call to action for the NHS. » NHS Diabetes » NHS Institute for Innovation & Now in their second year, the awards » Norfolk and Waveney Mental Health Improvement have seen an impressive rise in numbers Foundation Trust from last year’s entries. The shortlist is » NHS West Midlands Education and Training in Patient Safety made up of inspiring examples of » Guy’s and St Thomas’ Foundation Trust » The Primrose Unit innovation and excellence. » Royal Bolton Hospital Foundation » NHS South Birmingham Congratulations to all our fi nalists. We Trust » South Devon Healthcare Foundation look forward to seeing you on 9 March » Derby Hospitals Foundation Trust Trust when the winners will be announced. » West Essex Community Health Services » Worcestershire Acute Hospitals Trust » Royal Liverpool and Broadgreen The 2011 shortlist Data/Information Management University Hospitals Trust Board Leadership » Betsi Cadwaladr University Health » Blackpool Victoria Hospital » Ministry of Defence Board » NHS Lothian » Kingston Hospital » Peterborough and Stamford Hospitals » Portsmouth Hospitals Trust » Salford Royal Foundation Trust Foundation Trust – Electronic data » Worcestershire Acute Hospitals Trust Improving Medicines Safety in Healthcare » NHS Quality Improvement Scotland Organisations » Hounslow and Richmond Community » Guy’s and St Thomas’ Foundation Trust Healthcare – Multidisciplinary action group to reduce the risk in penicillin allergy Changing Culture » Salford Royal Foundation Trust » Blackpool, Fylde and Wyre Hospitals » NHS Tayside Foundation Trust » University Hospital of North » North Bristol Trust Staffordshire » NHS Diabetes » Guy’s and St Thomas’ Foundation Trust

14 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net » The British Thoracic Society, Salford Patient Safety in Maternity Care Royal Foundation Trust and Southend » Doncaster and Bassetlaw Hospitals University Hospital Foundation Trust Foundation Trust » Sheffi eld Teaching Hospitals » Salford Royal Foundation Trust Foundation Trust » University College London Hospitals » Salford Royal Foundation Trust Foundation Trust » Blackpool, Fylde and Wyre Hospitals » Norfolk and Norwich University Foundation Trust – Preventing falls to Hospitals Foundation Trust improve the patient experience » East Lancashire Hospitals Trust » Blackpool, Fylde and Wyre Hospitals Patient Safety in Critical/Intensive Care Foundation Trust » Royal Berkshire Foundation Trust » Salford Royal Foundation Trust Technology and IT to Improve Patient » North West Tracheostomy Group Safety » Nottingham University Hospitals Trust » Spiracur » Great Ormond Street Hospital for » Abertawe Bro Morgannwg University Children Trust Local Health Board » Aintree University Hospitals » Kettering General Hospital Foundation Foundation Trust Trust » Oxford Radcliffe Hospitals Trust Patient Safety in Mental Health » Peterborough and Stamford Hospitals » NHS Tayside Foundation Trust » Birmingham and Solihull Mental » Queen Elizabeth Hospital King’s Lynn Health Foundation Trust – Multiagency Trust working to promote patient, staff and » University Hospitals Coventry and Safety raisers: University Hospitals public safety in forensic child and Warwickshire Trust Birmingham FT and West Midlands Fire adolescent mental health service » Mersey Care Trust Service were winners last year » Norfolk and Waveney Mental Health Foundation Trust Patient Safety in Primary Care » South Essex Partnership University » Sandwell Primary Care Trust – Medicines safety forum – How to Foundation Trust » Wolverhampton City Primary Care improve medicines safety culture in an » South West London & St George’s Trust acute hospital Mental Health Trust – Risk assessment » Primecare » Mersey Care Trust training and education programme » Oak Tree Surgery, Bridgend » St Helens & Knowsley Teaching » South West London & St George’s » North East Lincolnshire Care Trust Hospitals Trust Mental Health Trust – developing patient Plus » Betsi Cadwaladr University Health safety in a forensic mental health service » NHS Grampian Board » Riverside Healthcare » Birmingham and Solihull Mental Infection Control and Hygiene Health Foundation Trust – Managing BE PART OF THE PATIENT » Aintree University Hospitals confl ict and bullying within forensic SAFETY AWARDS Foundation Trust inpatient settings (women’s, men’s and » Plymouth Hospitals Trust CAMHs) The profi le of patient safety continues to » Salford Royal Foundation Trust increase, and the radical plans for the » Birmingham and Solihull Mental Patient Safety in Surgery NHS set out in the white paper Equity Health Foundation Trust » Poole Hospital Foundation Trust and Excellence: Liberating the NHS » Leeds Teaching Hospitals Trust » Plymouth Hospitals Trust maintain this focus, stating that patient » Derby Hospitals Foundation Trust » West Hertfordshire Hospitals Trust safety must be put above all else. » Whittington Trust » Public Health Wales Patient safety is everyone’s priority » Royal Liverpool and Broadgreen » Royal Bolton Hospital Foundation Trust and Nursing Times and HSJ recognise University Hospitals Trust » University College London Hospitals how important it is that everyone plays a Foundation Trust role within this, from board members Patient Safety in Clinical Practice through to frontline practitioners. » Worthing Hospital Patient Safety in Diagnosis Last year’s event sold out, so book » Basingstoke & North Hampshire » Peterborough and Stamford Hospitals your table now to be part of this key Foundation Trust Foundation Trust event. The awards will be held on » Blackpool, Fylde and Wyre Hospitals » South Warwickshire Foundation Trust Wednesday 9 March 2011 at The Hilton Foundation Trust – Reducing caesarean » OCB Media Ltd Hotel, Park Lane, London. section rates using organisational change » Cambridge University Hospitals » Salford Royal Foundation Trust Foundation Trust ● Book online at www. » North Tees and Hartlepool Foundation » The MOLE Clinic patientsafetyawards.com Trust » Salford Royal Foundation Trust

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 15 Nursing Practice ● Nursing Times commissions clinical experts to resolve the dilemmas nurses Practice questions encounter in practice Respiratory care

Nasal cannulas are not suitable for Flow rates of up to 6L can be given but this patients who need controlled oxygen will often cause nasal dryness and can therefore be uncomfortable for patients Patients can eat, drink and talk while (British Thoracic Society, 2008). using a nasal cannula The advantages of nasal cannulas for Nebulised bronchodilators are not patients who have chronic stable respira- tory problems is that it is possible to eat, generally recommended for asthma drink and talk while using the cannulas. However, they can be used to deliver They also reduce the risk of carbon dioxide bolus doses in asthma emergencies rebreathing. Dry nasal passages can be a problem initially but, with continued use, Q this usually resolves itself. Q Should a nebuliser be used routinely to treat an asthma &A attack? Nebulised bronchodilator therapy is A no longer recommended for most Author Carol Kelly is senior lecturer/ people with asthma (BTS and Scottish In- programme lead at the Faculty of Health, tercollegiate Guideline Network, 2009). Edge Hill University Evidence suggests that the metered dose inhaler and spacer is at least as good as nebulisers in adults and children and is Q When should the preferred method for administration of bronchodilator therapy (BTS and SIGN, a nasal cannula 2009). Treatment using an inhaler results in better deposition of the drug in the be used to lungs than with a nebuliser and patients experience fewer side effects. Dry nasal passages may be a problem with high flow deliver oxygen? The BTS/SIGN (2009) guideline, how- rates but usually resolve after continued use ever, does recommend nebuliser use in Nasal cannulas are used to deliver acute life threatening asthma. This is ini- A oxygen when a low flow with a low or tially to administer a bolus dose, although medium concentration is required, and continuous nebulisation may be required the patient is stable. if the response to initial therapy is poor. They deliver oxygen in a variable If a nebuliser is used to treat an acute manner; this means the amount of oxygen asthma attack in an emergency, there are inspired depends on the patient’s risks of oxygen desaturation, so oxygen breathing rate and pattern. nursingtimes.net/ rather than air driven For this reason, nasal respiratory for more compressors should be cannulas are not suitable information on the latest used in this situation. The for use during the acute research and regular updates oxygen should be deliv- phase of illness in patients ered using piped oxygen who need controlled oxygen therapy. This or a cylinder with a high flow regulator at a includes patients with acute exacerbations flow rate of greater than 6L/min (BTS and of chronic obstructive pulmonary disease; SIGN, 2009). NT these patients retain carbon dioxide and a Venturi mask is often used. In other acute situations, patients may References British Thoracic Society and Scottish Intercollegi- need a higher concentration of oxygen, ate Network (2009) British Guideline on the and a non-rebreathe mask or simple Management of Asthma. oxygen mask is often used. tinyurl.com/BTS-SIGN-asthma-guidelines British Thoracic Society (2008) Guidelines Flow rates of 1-4L/min are used with for Emergency Oxygen use in Adult Patients: nasal cannulas, equating to a concentra- Executive Summary.

Alamy tion of approximately 24-40% oxygen. tinyurl.com/BTS-oxygen-therapy

16 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net Keywords: Trauma/Soldiers/Critical care/Rehabilitation Nursing Practice ●This article has been double-blind Innovation peer reviewed Trauma care

Military casualties present specific challenges, requiring British Armed services are repatriated to this centre. changes to routine practice, policy and procedures There are 42 military critical care nurses based across critical care services at the trust, as well as military staff working in various roles. The military nurses work with NHS staff. It is important that civilian nurses understand the pressures of working in a Caring for field hospital and patients’ experiences. The unit manager from Selly Oak crit- ical care spent three months in 2009 working in the intensive care unit in the field hospital at Camp Bastion as part of Op HERRICK, aided by the NHS Support to critically Operations initiative. During this visit, she was able to provide educational support for nurses involved in managing burns or major trauma. Following this, two more members of staff from critical care have been to Camp Bastion. This experience is invaluable not only injured for the individual nurses but also for the rest of the team because they receive feed- back and see photographs of conditions in the intensive care unit in Camp Bastion. This increased understanding between staff of their roles encourages empathy soldiers towards military personnel and patients. Managing the impact of injured troops in a civilian hospital UHB is unique in the number of injured military personnel it treats. On occasions, our critical care unit has accommodated up to 11 critically injured military patients In this article... – the standard capacity of this unit is usu- ally 15 – in addition to serving the Managing long-term open wounds Birmingham area. Supporting the psychological needs of military patients Patients arrive directly at the unit and it is common for two or three injured sol- Dealing with flashbacks and hallucinations diers to arrive together; as many as six How to reduce infection in acute wounds patients have been admitted at the same time. In this situation, organising critical care beds and staffing can be compared Author Joanne Thompson is senior sister in The need for psychological support is with managing a major incident. Patients critical care at University Hospitals Birming- explored because this is one of the most who are fit for discharge to the wards will ham Foundation Trust. challenging aspects of caring for military be identified and extra beds will be opened Abstract Thompson J (2011) Caring for casualties and their families. where possible, with extra staffing critically injured soldiers. Nursing Times; provided by both the trust and military. 107: 1, 17-20. Royal Centre for Defence Medicine The trust and its staff have become an This article highlights the specific chal- Military and NHS nurses have been integral part of military operations and lenges faced by clinical staff caring for working together at the Royal Centre for policies so, when plans are put in place for military casualties and identifies why Defence Medicine (RCDM) since its reloca- a new military operation, the trust has routine clinical practice needs to be tion to University Hospitals Birmingham prior warning to allow forward planning. adapted to provide effective care. (UHB) Foundation Trust in 2001. The move This means additional injured troops can The types of injury are discussed as well followed the closure of military hospitals be cared for while the trust continues to as pain management regimens, which have in the UK. provide a full service to the people of to be tailored to accommodate particular The UHB was chosen because it was a Birmingham and surrounding areas. patterns of injuries. regional burns and trauma centre and it Flashbacks and hallucinations are was near to Birmingham International Air- Blood supplies 18 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net common problems following traumatic port. All British military casualties Support services within the trust, for ex- injury and affect each soldier differently. and entitled personnel affiliated with the ample the blood transfusion service, have

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adapted their practice to meet the dynamic 5 key demand of caring for military personnel. The multiple blood transfusions points received by the soldiers in the hours fol- it is important lowing injury, in addition to frequent 1civilian nurses repeated transfusions, can lead to the understand the development of antibodies. In these cir- pressures of cumstances, patients need a fresh cross- working in a match specimen every 24 hours to prevent field hospital transfusion reaction. and patients' If a number of critically injured military experiences personnel are repatriated together, the Severe blast requirement for blood products – for both 2wounds can planned surgical interventions and ad hoc remain open for transfusions – increases the laboratory many weeks workload. To meet this demand, staff in requiring regular the blood bank are supported by three mil- monitoring and itary biomedical scientists. If large inspection. Surgical amounts of blood are required overnight, debridement may the hospital’s supply of O negative blood be needed every can be used; there is also a trauma techni- two to three days. cian on call who can prepare more blood in Topical negative Casualties are brought into a hospital at Camp Bastion the event of an emergency. pressure can be a useful technique Immediate care for these severe SupporTiNg royal morale Military patients admitted to UHB usually wounds miliTary booSTer have battlefield injuries sustained as part rigorous caSualTieS of Op HERRICK in Afghanistan and previ- 3infection ● Visits from the royal family ously Op TELIC in Iraq. control measures, ● Most war injuries occur as a – the Prince of Wales, Prince Injured soldiers are evacuated from the including the use result of blasts sustained by Edward, Prince William and battlefield by the medical emergency of full length an activated improvised Prince Harry have all visited retrieval team – consisting of doctors, protector gowns, explosive device, commonly – help to boost morale among nurses and paramedics – and taken to the are crucial to known as a landmine. the patients and their families. nearest field hospital to be stabilised and minimise the risk of ● Many of the soldiers are ● Having the chance to tell receive emergency surgical intervention. cross infection amputees and neuropathic their story to people who Following assessment, arrangements for military pain is a major problem. genuinely care about what repatriation to the UK can begin. 4patients ● Injured soldiers require they have been through – Details of patient injuries and recent should be oriented nutritional support to cope knowing that they have taken vital signs are faxed to RCDM along with to place and time with the massive catabolism time out of their busy the estimated time of arrival. The critical as quickly as associated with critical injury. schedules – means everything. care air support team is deployed from the possible so injuries ● Patient diaries are provided ● If a patient is sedated, a tactical medical wing at RAF Lyneham to can be explained to all sedated critically injured message will be left in their retrieve the patient. The team consists of and understood military patients; these help diary for them to read when two RAF ICU-trained nurses, a consultant Staff support soldiers understand what has they wake up. anaesthetist, a medical technician and an 5sessions are happened to them. RAF flight medic. helpful because of ● Patients may be Specialist medical teams are notified in the severity of disorientated as they wake up advance, including surgeons from trauma injuries that they from sedation and this may and orthopaedics, burns and plastics, deal with and their be accompanied by general, and cardiac and vascular special- impact on the flashbacks of their ties. They are on standby for the patient’s patient and their experiences, the incident or arrival and extra theatre facilities are family. Visits to the colleagues being injured. prepared for immediate use. Primary and military rehabilita- ● Getting back into military secondary investigations, including tion centre can routine helps rehabilitation – CT scans carried out at the field hospital, help staff to see having a haircut and shave, are saved on a CD and transferred with patients progress and/or wearing the uniform or the patient. in the longer term parts of it, helps to regain Once patients arrive at UHB and are identity. stable the priority is to change all invasive lines using strict asepsis. After assessment by the relevant surgical teams, it is imperative that the patient goes PA to theatre for a thorough examination➜

18 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net and treatment of all wounds. Traumatic surface waters, soil, sewage and various although this is discouraged where pos- amputations managed in the field hospital types of foods. sible. If no multi resistant infections have will require cleaning and revision to mini- Isolating or cohorting these patients been isolated after seven days, this higher mise potential necrosis and infection. was important but several factors, level of personal protection can be including the number of infected patients stepped down. Injuries and the high numbers of visitors, Patterns of infection can be largely Most injuries occur as a result of blasts prompted a revision of infection control attributed to the area where military sustained by an activated improvised policies to minimise cross infection. This operations are being carried out. MDR Aci- explosive device (IED), commonly known was achieved by small changes, such as netobacter was more prevalent in the desert as a landmine. Activation may have been limiting the number of people entering a areas of Afghanistan; lately, operations by foot or vehicle and the mechanism will bed space to two at any one time. This have moved to farmland areas and, again, impact upon the severity of injuries sus- change was prompted by large ward this is reflected in the clinical presentation tained. Other injuries result from gun rounds – military ward rounds can involve of wounded soldiers. All patients from this shots, rocket propelled grenade attacks 11 clinicians at once. area are immediately started on an anti- and occasional road traffic collisions. Some bedspaces are also demarcated fungal regimen and are reviewed daily by a The most common injury resulting with lines on the floor to discourage staff consultant microbiologist. from an IED is traumatic or immediate from entering unless absolutely necessary, Patients are screened for a variety of surgical amputation of the legs. Shrapnel and providing a physical reminder to put tropical diseases in addition to our routine is blasted upwards and outwards and can on an apron and gloves where appropriate. screening programme. During the malaria cause extensive damage, including The incidence of colonisation or infec- season (May to November), they will also abdominal injuries, trauma to upper limbs tion of MDR Acinetobacter is less common receive antimalarial prophylaxis for four including amputation, extensive soft now, but we still maintain precautions for weeks. tissue damage and/or burns, bony frac- tures from being flung away from the blast Pain management and facial injuries, including penetrating Many of the soldiers are amputees and eye injuries. neuropathic pain is a major problem (see Although staff are working in a regional article on page 21 for more information on trauma centre, the care of wounded sol- phantom limb pain). The acute pain team diers has provided a steep learning curve has developed a successful regimen to treat for all team members. Wounds need to be pain from these injuries. constantly inspected and remain open for On the first day of their repatriation, long periods of time, often for weeks after these patients are prescribed amitrypty- injury. The patient may require surgical line and pregabalin, and the dose is debridement every 48–72 hours. adjusted over time. These drugs will Managing open wounds between sur- be started even if the patient is sedated to gical episodes is challenging. Topical nega- allow a therapeutic level to be reached. In tive pressure (TNP) therapy has been widely addition, they will also be prescribed used with chronic diabetic ulcers (Jones et regular paracetamol, tramadol, and pos- al, 2005), and has been very successful with sibly codeine. This regimen is also helpful this patient group. Our experience with for brachial plexus injuries from gunshot military personnel has led to further devel- wounds. opment of TNP equipment to treat large Sciatic nerve blocks have been used in acute wounds – an advance in technology the field hospital to manage pain -associ that is now available to all patients. This is ated with bilateral leg amputation. These illustrated in Fig 1 and Fig 2. can be left in place for three to four days The types of wounds dressed with TNP and are helpful while waiting for the oral vary from open stump wounds to open analgesic regimen to take effect. Patient abdominal wounds; it is not uncommon Fig 1 and 2. Topical negative pressure controlled analgesia is also helpful in for one patient to have both of these. The therapy has been developed to treat large patients who can use their hands. addition of external fixators for pelvic or acute wounds leg fractures can further complicate these Nutrition wounds, and skill is needed to position the at least seven days for all military patients Injured soldiers involved in active duty dressings to create a good seal for the on the critical care unit to allow any poten- may have very little reserve to cope with vacuum (Fig 1). tial growth to be identified. the massive catabolism associated with In critical care, full length protector critical injury. Infections gowns (including full length sleeves) Early nutritional care is important In the early phases of the Afghanistan war are worn by all clinical staff who are and feeding will be started as quickly as there was a high incidence of infection examining military patients. The protector possible following arrival at UHB. Where with multi drug resistant (MDR) Acineto- gowns are unpleasant to wear for abdominal injuries are present and a bacter in IED wounds, symptoms of which long periods so nurses caring for such considerable delay to feeding is expected, were evident by the time patients reached patients wear ordinary plastic aprons in alternatives – including total parenteral the UK. Acinetobacter is a Gram negative their own bedspace, and a protector gown nutrition – are considered. Facial injuries bacterium that is found in drinking and if assisting in a non-infected bedspace, may rule out nasal or oral feeding;

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alternative routes including per gastric or case conference, which is attended by mili- While we provide treatment in ICU to aid jejunal feeding may be required. tary and civilian clinicians as well as clin- their recovery, it is not until they go to the All military personnel are started on a ical/military staff at the permanent joint ward and spend time with other soldiers that high protein feed, which is increased to headquarters at Camp Bastion and Kan- their psychological recovery really starts. full rate as quickly as possible following dahar, and the Aeromedical Evacuation Getting back into their military routine also the trust’s enteral feeding policy. Enteral Control Centre at RAF Brize Norton. Pat- helps – having a haircut and shave, and/or feeding is continued throughout surgery terns of injuries may be discussed to iden- wearing the uniform or parts of it, help to and other interventions where the patient tify areas for improvement, for example, regain some of their identity. is intubated and has a protected airway. changes to body armour. Surgical spells can last eight hours or Staff support more, which is a significant period of time Patient diaries Staff support is available to all members to be starved when already in a catabolic Patient diaries are provided to all sedated of the team caring for critical care state. critically injured military patients. patients because of the severity of the inju- Entries will begin as soon as possible in ries they encounter and the intensity of Psychological care Camp Bastion and are written in everyday emotions from family members. Staff The majority of military critical care language. They are a useful tool for docu- develop a rapport with families, which patients are sedated and ventilated so our menting key events and present an oppor- makes tough situations, such as the death initial efforts focus on the psychological tunity for visitors, such as colleagues and of a soldier, extremely difficult to accept. support of family members, some of friends, to leave messages. Staff support sessions from trust coun- whom have had to travel considerable There is evidence that diaries can have a sellors have had a good uptake, as distances and many have the added positive effect on psychological recovery do group sessions. Simply having the distress of leaving young children with from ICU experiences, allowing people to opportunity to discuss specific experi- friends and family. gain a sense of coherence following their ences, how they felt in that situation and Accommodation is provided in flats critical illness (Engstrom et al, 2009). having support from other colleagues who refurbished by the military specifically for also felt the same way has proved this purpose, or in hotels. There is a wide Flashbacks and hallucinations beneficial. military support network for the families, Patients may experience disorientation as Visits to the defence military rehabilita- which is often referred to as the "military they wake up from sedation and this may tion centre at Headley Court boost staff bubble". The Defence Military Welfare be accompanied by flashbacks of their morale by providing an opportunity to Service, which is made up of civilians from experiences, the incident or colleagues have an informal trip away from work, and the Red Cross, provides support to the next being injured. to catch up with former patients and of kin and the immediate family. A visiting There are degrees of flashbacks, from observe their progress. Seeing patients officer is nominated from the injured sol- disorientation that simply requires reas- months later learning to walk with pros- dier’s unit to escort the next of kin to Bir- surance to more severe hallucinations. theses and having a positive and deter- mingham and provide family support Patients may believe they are being held mined outlook on life is wonderful. It is a throughout the hospital stay. Military captive by the Taliban, reach for weapons real morale booster for staff and, in turn, liaison officers based at the RCDM head- or try to jump out of bed to escape. allows the nurses to chat with patients and quarters provide a vital link between the Sleep deprivation may be a problem, as their families about Headley Court and injured soldier and their unit. soldiers in the field usually sleep for only what it can offer them. The military duty critical care nurse has a few hours at a time between watches. a vital role, offering a point of contact for Getting back into a good day to night Conclusion families and provides the interface sleeping pattern can improve their University Hospitals Birmingham Foun- between welfare and hospital staff while psychological state in the acute phase of dation Trust has been a Trauma Centre for the patient is unconscious. Daily military injury. many years and is ideally suited to be the patient activity report meetings are held to Soldiers should be oriented to place and headquarters for the Royal Centre bring together the clinical, welfare and time as quickly as possible so injuries can for Defence Medicine. Caring for injured administrative patient care pathways to be explained and understood; the loss of military personnel brings unique chal- ensure maximum care and support. This sight, for example, could exacerbate feel- lenges, which may never otherwise be meeting also plans onward rehabilitation ings of fear and disorientation. experienced. The greatest challenge is the and discharge planning with the rehabili- Where possible, family will be present psychological and social impact of injury tation coordinating officer and the mili- to support the patient when the injuries on the soldiers and their families, and tary discharge coordinators. are explained for the first time. Military knowing the difficulties that lie ahead for Military nurse coordinators are also community psychiatric nurses are avail- them. based at RCDM HQ. Their role is to obtain able to provide support to the patients and Ultimately, what these challenges bring family contact details and try to develop a ensure they receive their mandatory post is a sense of humility and pride that we are holistic care package for injured soldiers. operational stress debriefing. caring for our injured soldiers. NT They provide condition feedback at daily Regardless of the severity of soldiers' military meetings so rehabilitation and flashbacks or distress at the situation References discharge plans can be they find themselves in, they Engstrom A et al (2009) Experience of intensive started. are undoubtedly helped by care unit diaries – “touching a tender wound”. nursingtimes.net/criticalcare Condition feedback is being with their colleagues Nursing in Critical Care; 14: 2, 61-67. for information on the latest Jones SM et al (2005) Advances in wound also provided at the research and regular updates – other soldiers with similar healing: topical negative pressure therapy. weekly joint telephone stories and injuries. Postgraduate Medical Journal; 81: 353-357.

20 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net Keywords: Phantom limb pain/Pain assessment/Neuropathic pain/ Nursing Practice Amputation Practice review ●This article has been double-blind peer reviewed Pain management Nurses must conduct holistic assessments to manage this condition appropriately Dealing with phantom limb pain after amputation

In this article... associated with the physiological mecha- nisms of neuropathic pain (Flor, 2002). The mechanism of phantom limb pain Neuropathic pain is associated with a pri- The barriers to accurate pain assessment mary lesion or dysfunctions in the nervous system (IASP, 2010). Box 2 outlines possible Why patients may not report pain causes of PLP. What pain assessment tools are available Assessment of phantom limb pain Nurses have an important role in manag- Authors Dawn Fieldsen is staff nurse What is pain? ing pain control because they have more orthopaedics and trauma, Huddersfield Pain is an individual experience, which is contact with patients who are experienc- Royal Infirmary; Sharon Wood is lecturer not caused solely by a painful stimulus ing pain than any other healthcare profes- in nursing at University of Leeds. (Mann et al, 2009). The perception of pain sional (Mann et al, 2009). Using pain can be affected by numerous factors, in- assessment tools improves communica- Abstract Fieldsen D, Wood S (2011) cluding memory of previous pain, the tion and makes it easier to select the appro- Dealing with phantom limb pain after cause of the pain, the type and intensity of priate treatment (Mann et al, 2009). amputation. Nursing Times; 107, 1: 21-23. preoperative pain and cultural perspec- The Department of Health (2010) Patients usually experience phantom limb tives of pain (Mann et al, 2009). suggests assessment should include an pain after amputation but it may also occur The International Association for the evidence based tool that is appropriate to following resection of other parts of the Study of Pain (2010) defines pain as “an un- the individual's needs and health problem. body, such as the breast and internal pleasant sensory and emotional experi- Assessment should consider the physical, organs like the rectum. The causes are ence associated with actual or potential psychological, social and spiritual aspects complex and patients require careful tissue damage, or described in terms of of the pain experience (DH, 2010). The Clin- assessment to ensure they receive such damage”. This suggests pain is not ical Resource Efficiency Support Team appropriate care. This article describes the only a physiological process, but an expe- (2008) and the National Institute for Health causes of phantom limb pain and discusses rience that people interpret individually, and Clinical Excellence (2010) offer guid- assessment strategies. regardless of whether there is actual injury ance on the pharmacological management to the body. This may help to explain why and treatment of neuropathic pain. This hantom limb pain (PLP) is report- patients experience PLP. type of pain is often an element of PLP but ed in 60–80% of patients after a guidance does not specifically mention it. limb amputation, with up to 10% The pain response Preporting severe pain (Nikolajsen A response to noxious stimuli occurs after Pain assessment tools et al, 2006). It is defined as a painful phe- amputation surgery, resulting in patients Common pain assessment tools include: nomenon at the site of limb amputation, experiencing nociceptive pain. The noci- » The four-point verbal rating scale (VRS), which gives the sensation that the limb ceptive pain pathway includes transduc- which is used to describe increasing may still be there (Australian and New Zea- tion, transmission, perception and modu- pain intensity: 0 (no pain); 1 (mild pain); land College of Anaesthetists, 2010; Niko- lation (McCaffrey et al, 1999). These are 3 (moderate pain); 4 (severe pain); lajsen et al, 2006). Table 1 lists descriptions outlined in Box 1. » The 10-point numerical rating scale of phantom pain after amputation. Normal nociceptive pain will be experi- (NRS), which is represented as a line Phantom pain has also been reported af- enced after surgery, but the exact physiol- with numbers: 0 (no pain) to 10 (most ter amputation and removal of other body ogy of PLP is unknown (Houser, 2002). It pain possible) on which patients parts, including the breast, rectum, tongue may be experienced in missing limbs and indicate their level of pain. and/or teeth and genitalia. Reasons for am- stumps, and a range of symptoms that are Measuring pain intensity is an important putation include vascular disease (includ- different to those associated with nocicep- part of assessment (Turk et al, 2001) and ing neuropathy caused by diabetes), trau- tive pain will be present (see Table 1). benefits of these tools include ease of use ma, infection and abnormal tissue growth There may be no physical reason for (Jensen et al, 2001). (Limb Loss Information Centre, 2010). PLP (McCaffrey et al, 1999) but it can be Research has demonstrated that the VRS

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does not provide sensitive data (Williamson LearNiNg et al, 2005) and its reliability may be affect- POiNTS ed by the intervals between the predeter- mined levels of pain (Jensen et al, 2001). The Reflect on an occasion when more levels a tool has to gauge pain, the eas- you assessed a patient who ier it is to identify a change in intensity was reporting pain after an (Williamson et al, 2005). The 10 point NRS amputation: could be considered more responsive to the ● What pain assessment tool change in pain intensity than the four-point did you use? VRS, but the advantage of the VRS is that it ● Was this effective in uses words to describe pain intensity. assessing the patient's pain? Using the VRS or NRS may enhance a ● Did you reassess the pain systematic and effective assessment of the to establish whether the pain and evaluation of the effectiveness of analgesia you administered treatments for PLP. However, assessing was effective in reducing the PLP intensity may fail to identify other fac- levels of pain? tors such as reduced quality of sleep and ● What could you have done function, and depression (Turk et al, 2001). Nociceptive pain may be experienced in missing limbs and stumps to improve pain manage- Pain should be individually assessed ment for this patient? and tools appropriate to the patient should include dimensions such as intensity, sen- sation, mood and function. 5 key Table 1. Types of phantom limb pain Multidimensional assessment tools facts Type of pain Symptoms Some multidimensional pain assessment Phantom limb Phantom pain Burning, tingling, stinging, cramping, shooting, tools are specifically designed to diagnose 1pain (PLP) is twisting. Often stronger versions of phantom neuropathic pain. As PLP appears to be reported in sensations considered within the umbrella term of 60–80% of patients Phantom sensations Sense of position, temperature, itching, discomfort neuropathic pain, CREST (2008) suggests following a limb Stump pain Localised pain in the area of amputation, often using The Leeds Assessment of Neuro- amputation acute postoperative pain pathic Symptoms and Signs – Self-report (Nikolajsen et al, Adapted from Australian and New Zealand College of Anaesthetists (2005) tool (S-LANSS). 2006) This tool has encouraged accurate diag- ● This does not There may be Box 1. Perception: noses of neuropathic-related pain – in- 2no physical originate from one distinct cluding PLP – in 75% of people studied and reason for PLP NOCiCePTive area of the brain, which has demonstrates high levels of sensitivity (McCaffrey et al, PaiN PaTHwayS led to the neuromatrix theory (Bennett et al, 2005). This suggests the S- 1999) (Brooks et al, 2005). Melzack LANSS provides a more accurate and sen- Pain assess- ● Transduction: Initial (1989) proposed this theory sitive assessment of PLP when compared 3ment should stimulation of the primary to describe the mechanism of with the unidimensional VRS and NRS. consider the afferent neurons occurs as a phantom limb pain, suggest- Dworkin et al (2001) argued the assess- physical, psycho- result of thermal, mechanical ing a network of neurons ment of neuropathic-related pain, such as logical, social and or chemical stimuli from continuously communicated PLP should include more than one tool in spiritual aspects of amputation surgery and the information about pain order to consider wider aspects of the pain the pain experi- inflammatory response sensation through various experience. The S-LANSS tool diagnoses ence (DH, 2010) (Caterina et al, 2005). This circuits in the brain. the presence and type of pain and, com- There is a lack causes the release of ● Modulation: This describes bined with an intensity score – for exam- 4of guidance on excitatory neurotransmitters regulating the response to the ple, from the VRS or NRS – may help nurses assessing and including prostaglandins, perceived pain (Jagger, 2005). provide the most appropriate treatment or managing PLP substance P and histamine. Melzack and Wall (1965) early referral to specialist services. It may Other aspects ● Transmission: Impulses are suggested inhibitory neurons also be necessary to use additional tools 5of pain may generated along the afferent in the dorsal horn can control that assess the different aspects of the include reduced neurons to the dorsal horn of incoming sensory information effect of PLP on the patient, for example, quality of sleep the spinal cord. Through before transmission to the mood, behaviour and functions. Further and depression excitatory neurotransmitters, brain. Stimulation by massage research is required to identify a tool that the impulse can continue and touch can release will facilitate a holistic assessment of PLP. ™Moving community services across the synaptic cleft, up inhibitory neurotransmitters, The DH (2010) describes pain as the fifth the spinal cord, through the including endogenous opioids vital sign and confirms that assessment of ascending pathways to the and serotonin aiding pain relief it and management strategies should be brain stem and thalamus (Mann et al, 2009; Mitchinson ongoing and regularly observed along with (Wood, 2008; McCaffrey et et al, 2007; McCaffrey et al, other vital physiological measurements. al, 1999). 1999). This can be done with a unidimensional

Alamy VRS or NRS but may be more problematic ➜

22 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net For a Nursing Times Learning unit Nursing on neuropathic pain, go to Times.net nursingtimes.net/neuropathic

➜ with a tool like the S-LANSS as the data pharmacological treatment should be tai- References obtained is more difficult to represent on lored to the individual patient by identify- Australian and New Zealand College of Anaesthe- tists (2005) (ANZCA) Acute Pain Management: vital sign documents. Adapting documen- ing the medication that delivers the great- Scientific Evidence. www.anzca.edu.au tation to include a multidimensional and est pain relief with the least number of side Bennett MI et al (2005) The S-LANSS score for pain intensity assessment tool for people effects. This is why individualised pain identifying pain of predominantly neuropathic origin: validation for use in clinical and postal with PLP would make it more likely that assessment is important. CREST (2008) research. Journal of Pain; 6: 3, 149-158. pain would be treated as the fifth vital. and NICE (2010) have recommended Brooks J et al (2005) From nociception to pain prompt referral to specialist pain services. perception: imaging the spinal and supraspinal Assessment barriers pathways. Journal of Anatomy; 207: 1, 19-33. Caterina MJ et al (2005) Molecular biology of Difficulties are often encountered in clini- Conclusion nociceptors. In: Hunt S, Koltzenburg M (eds) The cal practice when assessing PLP. The com- Nurses should be aware of PLP and how it Neurobiology of Pain. Oxford: Oxford University monly reported symptoms outlined in can differ from other types of pain to ensure Press. Clinical Resource Efficiency Support Team (2008) Table 1 are difficult to understand – as the patients receive holistic care. Nurses should Guidelines on the Management of Neuropathic source of the pain has been amputated, the obtain information about pain from the pa- Pain. tinyurl.com/crest-pain assessment must rely purely on the tient as part of their care plan and use the Department of Health (2010) Benchmarks for patient’s description of it. McCaffrey et al tools available in their clinical area. It may Prevention and Management of Pain. London: DH. tinyurl.com/essence-pain (1999) acknowledged that healthcare also be possible for nurses to access the Dworkin RH et al (2007) Pharmacologic professionals are more likely to treat pain specialist knowledge of pain nurses, who management of neuropathic pain: Evidence-based when the cause is clear. are there to support both nurses and pa- recommendations. Pain; 132: 3, 237-251. Dworkin RH et al (2001) Assessment of It is vital that nurses remain non-judge- tients through the management of pain. NT neuropathic pain. In: Turk DC, Melzack R (eds). mental and administer analgesia accord- HandBook of Pain Assessment. New York: The ing to the pain being expressed. Pain Guilford Press. assessment can be affected by healthcare Box 2. Causes Flor H (2002) Phantom-limb pain: characteristics, of phantom causes, and treatment. The Lancet Neurology; 1: professionals' beliefs that people who 182-189. report PLP construct it in their minds limb pain Houser SA (2002) Phantom limb pain. In: Warfield (Flor, 2002). This can lead to inaccurate CA, Fausett HJ (eds). Manual of Pain Manage- ment. Philadelphia: Lipincott Williams and Wilkins. ● assessment by nurses and non-reporting Allodynia: Pain evoked by International Association for the Study of Pain of pain by patients. stimuli that would not usually (2010) IASP Pain Terminology. tinyurl.com/ Other barriers to the overall assessment be considered painful (Jensen iasp-terminology (2005) Overview of pain pathways. In: et al, 2001). Nerve fibres may Jagger SI of pain that are commonly experienced in Holdcroft A, Jagger S (eds). Core Topics in Pain. clinical practice can include heavy work- lose their ability to desensitise Cambridge: Cambridge University Press. load, constant interruptions and problems the pain sensation and instead Jensen MP et al (2001) Self-report scales and with prescriptions. Barriers to effective evoke pain impulses (Mann et procedures for assessing pain in adults. In: Turk DC, Melzack R (eds). Handbook of Pain Assess- pain management may also include staff al, 2009). Touching or ment. New York: The Guilford Press. shortages, nurses not asking patients what massaging an amputated area Limb Loss Information Centre (2010) FAQs: Limb levels of pain they are experiencing and may cause more pain. Loss? tinyurl.com/limbloss-FAQ ● Mann EM et al (2009) Pain: Creative Approaches relying on non-verbal behaviour to assess Hyperalgesia: Increased to Effective Management. London: Palgrave pain (Mann et al, 2009; Schafheutle et al, response to painful stimuli and Macmillan. 2000). Patients may also be reluctant to lowered pain threshold McCaffrey M et al (1999) Pain: Clinical Manual. (Jensen et al, 2001). St Louis: Mosby. express their pain experience to nurses Mitchinson AR et al (2007) Acute postoperative due to psychological barriers, such as fear ● Central sensitisation: Can pain management using massage as an adjuvant of the meaning of the pain, of injections, occur in the dorsal horn of the therapy. Archives of Surgery; 142: 12, 158-1167. of becoming addicted to pain killers, of spinal cord due to the National Institute for Health and Clinical Excellence (2010) Neuropathic Pain: The Pharmacological becoming an unpopular patient or being increased number or intensity Management of Neuropathic Pain in Adults in disbelieved, or resignation to the pain. of the impulses generated. Non-specialist Settings. www.nice.org.uk/CG96 This demonstrates why pain assessment This results in permanent Nikolajsen L et al (2006) Phantom limb. In: McMahon SB, Koltzenburg M (eds). Wall and changes to the dorsal horn undertaken by nurses may be seen as inad- Melzack’s Textbook of Pain. Edinburgh: Churchill equate (Sloman et al, 2005). neurons (Flor, 2002). Livingstone. ● Neuromas: Commonly form Schafheutle EI et al (2000) Why is pain Treatment of neuropathic and after nerves are cut and can management suboptimal on surgical wards? Journal of Advanced Nursing; 33: 6, 728-737. phantom limb pain lead to spontaneous activity Sloman RG et al (2005) Nurses' assessment of Recommendations for the treatment of and increased sensitivity to pain in surgical patients. Journal of Advanced neuropathic pain and PLP suggest that stimulation (Wood, 2008; Nursing; 52: 2, 25-132. Todd DD et al (2006) Neuroanatomical substrates opioids, such as morphine, and the tricy- Nikolajsen et al, 2006). of spinal nociception. In: McMahon SB, Koltzen- clic antidepressant, amitriptyline, should ● Regenerative sprouting: burg M (eds). Wall and Melzack’s Textbook of be used (NICE, 2010; CREST, 2008). Gabap- Occurs at the site of nerve Pain. Edinburgh: Chuchill Livingstone. injury, which can lead to an Turk DC et al (2001) The measurement of pain entin and other anticonvulsant drugs are and the assessment of people experiencing pain. often used to treat PLP but the evidence increase in pain impulses In: Turk DC, Melzack R (eds). Handbook of Pain base on their efficacy is small (Smith et al, (Wood, 2008). Assessment. New York: The Guilford Press. 2005). These are commonly used in clinical Williamson A et al (2005) Pain: a review of three commonly used pain rating scales. Journal of practice, but they are not effective for all Clinical Nursing; 14: 7, 798-804. people experiencing symptoms of PLP. Wood S (2008) Anatomy and physiology of pain. Dworkin et al (2007) suggested that Nursing Times; tinyurl.com/assessment-pain

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 23 ● The Cochrane Nursing Nursing Practice Care Field specially writes for Nursing Times readers Cochrane summary Discharge planning This review investigated whether discharge planning improved planning was a small part of a multifaceted the appropriate use of acute care and patient outcomes. It also intervention, and those that focused on aimed to discover the impact on overall healthcare costs the provision of care post discharge. Just over half of all the studies included in the review reported that there had been adequate allocation concealment, What is the effect of and 15 described blinding of outcomes. Meta-analysis was undertaken where this was possible. discharge planning? Summary of key evidence » Results from 10 pooled studies indicated that the intervention group (discharge planning) was associated with a significant shorter length of hospital length than the usual care group (P=0.0052). » Pooled data from 11 studies showed that hospital readmission rates were Authors Deborah Kesterson is clinical psychiatric hospital (one study, 343 significantly lower when discharge plan- nurse specialist, Louis Stokes Cleveland patients) and patients from both a psychi- ning was used compared with usual care Veteran Affairs Medical Centre, Cleveland, atric and general hospital (one study, 97 in people admitted for a medical US, and a member of the Cochrane patients). Studies also featured patients condition (P=0.013). Nursing Care Field; Cindy Stern is admitted to hospital following a fall (one » There were no statistically significant administrator, Cochrane Nursing Care study, 60 patients) and patients from a mix differences in mortality between Field, faculty of health sciences, University of medical and surgical conditions (four intervention and control groups in the of Adelaide, Australia. studies, 2,225 patients). following populations: older patients The intervention of interest was an with a medical condition (four studies); his Cochrane review explored the individualised discharge plan that was patients recovering from surgery; following questions: developed before the patient left hospital. patients admitted to hospital following » Does discharge planning All interventions included assessment, a fall (one trial), and those with a mix Timprove the appropriate use of planning, implementation and moni- of medical and surgical conditions acute care? toring components. (one trial). » Does discharge planning improve or, at Interventions were compared with » There was no significant difference in least, have no adverse effect on patient routine care – non-structured, individu- place of discharge (three trials) and outcome? alised discharge planning – which varied patient outcomes (10 trials) between » Does discharge planning reduce overall between studies. intervention and control groups. costs of healthcare? Outcomes of interest were length of » There were mixed results regarding hospital stay, readmission, complications, patient satisfaction in three studies Nursing implications place of discharge, mortality, health that could not be pooled and five studies Discharge planning is a widespread pro- status, patient and carer satisfaction, psy- for cost. cess. Nurses are frequently involved in chological health of patient and carer, cost planning and coordinating discharge. Dis- Best practice recommendations charge planning aims to decrease time || ||| » Current evidence suggests that struc- || | | | | 21 RCTs spent in hospital, improve patient out- | | tured discharge planning probably

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| | | The evidence is not clear on whether | included in this review stay and readmission rates for older discharge planning reduces costs or people admitted to hospital with a medi- shifts them from acute to primary care. cal condition. Further research is needed in order to of discharge planning (to hospital and » Discharge planning does not seem to determine if discharge planning reduces community) and, where applicable, medi- have an impact on mortality, health readmission rates. cation use. Follow-up was carried out outcomes and healthcare costs and between two and 36 weeks. further research is required. NT Study characteristics The following studies were excluded A total of 21 randomised controlled studies from the review: those that used discharge Reference were included in this review, 10 of which planning as part of a larger package of Shephard S et al (2010) Discharge planning from the hospital to home. Cochrane Database of were incorporated into the most recent care, which had not been well described; Systematic Reviews; Issue 1 Art No: CD000313. update of the review. those that did not include an assessment DOI: 10.1002/14651858.CD000313.pub3. Participants were hospital inpatients, and implementation phase of discharge and there were no restrictions on age or planning; and those that did not separate condition (n=7,234). Studies recruited the effects of discharge planning from The full review report, including patients with a medical condition (14 other components. Other studies that were references, can be accessed at studies, 4,509 patients), patients from a excluded included those where discharge http://tinyurl.com/coch-disch-plan

24 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net Keywords: Therapeutic engagement/ Nursing Practice Mental health/Service user/One to one ●This article has been double-blind Research report peer reviewed Mental health

This study explores the barriers to effective interaction (Department of Health, 2010; 2008) back this approach, as do many researchers who between nurses and service users in acute settings believe this relationship is the core of mental health nursing. Nolan (1993) suggested the great strength of mental health nurses is their closeness to clients, while Wilkin (2003) said the emphasis of mental health nursing What is on the development of a therapeutic relationship or alliance. Reynolds (2003) also stresses the importance of “one-to- one” working, believing that a therapeutic relationship is the crux of nursing. In prac- tice, this means nurses should seek to prevents engage with the person in their care in a positive and collaborative manner. This empowers service users to draw on their inner resources, in addition to any other treatment they may be receiving. The Mental Health Foundation sup- one to one ported greater access to talking therapies (www.mentalhealth.org.uk/campaigns/we- need-to-talk), and the recovery approach within mental health services has become a guiding vision that promotes the need to work in partnership with service users care? (Chandler, 2010; Shepherd et al, 2008). However, this is only possible if nurses spend quality time with service users. According to the NHS Institute for Innova- tion and Improvement (2008), ward nurses in acute settings only spend around 40% of In this article... their time on direct patient care. Developing a therapeutic relationship with service users Background Challenging stigma and promoting client engagement This project was initiated after a 2007 visit to West London Mental Health Trust from Improving the efficacy of one to one sessions the Mental Health Act Commission (now Helping nurses make the most of their existing skills the Care Quality Commission), which identified several issues needing investiga- tion (Mental Health Act Commission, Author Keith Edwards is associate lecturer and problems. This data formed a basis 2008). The commission questioned service at the Open University, and former joint for semi-structured interviews with all users and staff and looked at a wide range appointee as a principal lecturer in mental 11 acute admissions ward managers at of services, resulting in a number of fur- health at Buckinghamshire New University the trust. ther visits to monitor progress. and West London Mental Health Trust. Results Five common themes were One major concern was that interaction Abstract Edwards K (2011) What prevetns identified as the major barriers to one to between nursing staff and service users one to one care? Nursing Times; 107: 1, one care: administrative duties; under- had to be more effective. Service users said 25-27. standing one to one sessions; control over they often felt their care plan could apply Background In 2007, West London Mental workload; staff needs; and ward culture. to anyone. Achieving personalised services Health Trust was visited by the Healthcare Conclusion Staff training and education can mean challenging stigma and stereo- Commission (now the Care Quality have been improved, and policies imple- types about mental illness among medical Commission), which identified several mented. As the study is small, replicating it and nursing staff; service users should be issues needing attention. One major nationally would give a better overall recognised as individuals not categorised concern was the lack of effective interac- picture of this issue in mental health services. by legal status or diagnosis. tion between nurses and service users in The commission suggested that ser- ™Moving community services acute care. ental health nursing is com- vices should provide individualised, Aim To determine why mental health plex and demanding. A fun- holistic care that promoted recovery and nurses on acute admissions wards struggle damental part of the mental inclusion, and that service users and carers to spend one to one time with service Mhealth nurse’s role is forming must be involved in care planning. It also users, and how to address the problem. a therapeutic relationship with service recommended that efforts be redoubled to Method Interviews with four senior nurses users and their family or significant ensure ward staff actively engaged with were conducted to identify initial concerns others. Recent government policies service users wherever possible.

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 25 Nursing Practice “Positive feedback from Research report patients can turn a bad day into a brilliant one” Mandie Sunderland p28

BOX 1. SENIOR than just adopting a custo- spend time with patients on PRACTICE NURSE CONCERNS dial role. a one-to-one basis, but often POINTS ABOUT TIME ● Regular audits should be they are seen as working SPENT WITH conducted with both nurses beyond their role, with little ● Look at ward administra- SERVICE USERS and service users to ensure ongoing training. Some are tive duties to see how time one-to-one sessions happen very able while others are can be released for one-to- ● One-to-one sessions with frequently enough. perceived as “plugging the one working. Implement the nurses and service users ● Sessions need a clear holes in the service”. Productive Ward scheme. need to be more integral to structure. ● Bed occupancy and ● Give sta€ the training the working routine. ● Resources are needed to sta– ng levels are not always they need to feel capable of ● The focus of the sessions ensure there are enough synchronised, which leaves engaging with service users. needs to be transparent to sta€ with the right skills to nurses feeling as though they ● Ward managers need to ensure participants under- cover for absent colleagues. have little control over assert themselves and take stand their purpose. A Many bank or agency sta€ admissions. They also feel control of everyday events. working defi nition of showed limited commitment disempowered when others ● Sta€ supervision needs to one-to-one sessions needs and made little contribution. make decisions that a€ ect be consistent, supportive to be developed and agreed. ● Nurses are expected to their work and the time and carried out by appro- ● Nurses' ability to engage in have one-to-one sessions available to spend in one to priately trained, competent therapeutic relationships is with each patient on their one care with service users. and experienced sta€ . often compromised by them caseload at least twice a ● The culture of acute having to take on contain- week but these fl uctuate wards needs to be kept ment roles. between planned sessions under constant scrutiny so ● Nurses need development and those that take place the notion of therapy, rather and support to become "on the hop". than containment, is the therapeutic agents, rather ● Healthcare assistants also philosophy of care.

The project consistent or effi cient manner. Some said ogists were more likely to set up fi xed The project was set up to investigate the sessions only occurred at weekends or in appointments for therapeutic intervention, discrepancy between the role of the mental the evenings when other professionals whereas nurses were only able offer one-to- health nurse described in the literature and were not around; this suggests it was not one sessions when they could fi t them in. mental health nursing practice at the trust. seen as part of the core work of the nurse. The ward managers also acknowledged that it was diffi cult to engage with dis- Phase one Results turbed and demanding service users. Com- We set up informal one to one meetings Interview data was collated and subjected ments indicated staff thought some were a with four senior nurses from the trust’s to a content analysis; fi ve themes emerged. “lost cause”, especially those who were acute care services to identify key concerns regarded as “revolving door” readmis- and nurses’ views about staff spending Administrative duties sions; those diagnosed with a personality time with service users. The nurses were Nurses said there was too much adminis- disorder were seen as “incorrigible”. This given the opportunity to check the accu- trative work – from making and answering was frustrating for staff who felt too racy of meeting notes. The issues identi- phone calls to writing in the ward diary familiar with service users and did not fi ed are outlined in Box 1. and in service users’ notes – as most activi- know how to engage with them in a mean- ties taking place during a shift had to be ingful way. While some staff did not know Phase two recorded. They said this took priority over how to engage, it was suggested that The initial meeting provided a project spending time engaging with service users others “could not be bothered” and merely baseline. We decided to contact all ward on a regular, one-to-one basis. adopted a containment approach. managers in acute areas within the trust as Employing a full time administrator for Managers suggested that developing these were running the wards and pro- each ward could prove more effi cient than guidelines and structure for one-to-one viding leadership. Eleven ward managers – having nurses doing so many offi ce tasks. sessions and interventions would help. representing all the trust’s acute wards – Writing in service users’ notes could be Not all staff have the skills or confi dence to were interviewed; the issues identifi ed in done during one-to-one sessions. engage effectively on a one-to-one basis, so phase one were the focus for these semi- staff training needs were identifi ed. structured interviews. Preset topics and One-to-one sessions Although there are many opportunities for follow-up probes encouraged the partici- It was clear there was a lack of under- staff educational and personal develop- pants to elaborate on their responses. standing of what one-to-one sessions ment, mandatory training took prece- There was no questionnaire, but a crib should entail, or how long they should last. dence over other training and education sheet was used to explore the initial topics A great deal of discussion takes place during that could enhance staff ability. identifi ed systematically. interactions with service users, such as All the nurses had a positive attitude assessments or medication rounds, but Workload control towards doing their jobs effectively. time was not always set aside to specifi cally Ward managers felt they had little control Despite this, they said one-to-one sessions engage with them in a therapeutic way. over their workload and bed management with service users did not take place in a Nurses felt that psychiatrists or psychol- dictated the pace of work. People were➜

26 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net ➜ admitted to wards and those admitting felt facilitators did not always have the nec- education and training to help nurses them had no real understanding of the essary skills or confidence and were ill-pre- increase the amount of direct care time staffing levels and the demands on the pared to make it effective. given to service users has improved, and wards. The message appeared to be: “You the trust has implemented Releasing Time to are an admissions ward so must accept Ward culture Care: The Productive Mental Health Ward admissions.” Other comments included: The ward managers felt administrative (NHS Institute for Innovation and Improve- » “There are too many service users in issues, such as recording the number of ment, 2008). These improvements have seclusion.” admissions, discharges and incidents, been acknowledged by the CQC and work to » “One-to-one observations take up too took precedence over contact with service increase the amount of one-to-one time much time.” users. This was the dominant culture on service users spend with nurses continues. » “Psychiatrists want many admissions the wards and was seen as having greater immediately put on one-to-one importance than valuing human contact. Conclusion observations. This depletes staff Staff attitudes were also highlighted. This study has identified some of the issues availability for more therapeutic and New members of staff could feel stifled surrounding one-to-one care for mental structured one-to-one sessions.” by established staff seniority and the health service users and how they can be Other concerns were that escort duties negative stereotypes attached to service addressed. Since it was only conducted at took up a lot of time and reduced staffing users with conditions such as personality one trust, however, it is impossible to say levels, and a lack of consistency or conti- disorders. whether the findings would be the same nuity with bank staff. Participants also suggested that some elsewhere. Replicating the study nationally The ward managers felt the nurses dealt would enable us to see if other trusts have ||| |||| with the real difficulties on the wards, ||| ||| 4 out of 10 faced similar issues, and what they did to | || || | while the other professionals just “come | | nurses in mental health improve practice. NT | | |

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service users at least twice a week about | their skills Chandler R (2010) Making Recovery a Reality: A care plans but this differed from ward to Lived Experience Perspective of the Sainsbury ward. Some suggested that more protected nurses found it tough to adopt a thera- Centre for Mental Health Workshops. London: time could help with regular appoint- peutic role and give greater priority to SCMH. tinyurl.com/recovery-reality ments (Edwards et al, 2008). managing and containment. Many saw Department of Health (2010) Essence of Care 2010. coping as the dominant cultural expecta- Benchmarks for Communication. London: DH. Staff needs tion, rather than proactive, effective and tinyurl.com/essence-communication Staff training and supervision were major meaningful engagement with service Department of Health (2008) Refocusing the concerns; one-to-one sessions, when they users. There also appeared to be conflict Care Programme Approach: Policy and Positive did take place, varied depending on the over whether acute wards should provide Practice Guidance. London: DH. tinyurl.com/ level of training and support staff had therapy or containment, and getting the refocusing-approach received. Participants suggested involving right balance could be difficult. One to one Edwards K et al (2008) Evaluating protected former service users and role modelling by sessions were conducted on a casual basis time in mental health acute care. Nursing senior staff could be beneficial. and targets for admissions and discharges Times; 104: 36, 28-29. Some ward managers thought staff were took precedence over time for compas- NHS Institute for Innovation and Improvement “burnt out” and not truly engaging with sionate care. (2008) Releasing Time to Care: The Productive service users. They also thought the admis- As nursing on acute mental health Ward. Coventry: NHS Institute for Innovation and sions process was not well thought out wards was seen as a high pressure job, it Improvement. regarding staff levels and there was no was suggested that during quieter periods Mental Health Act Commission (2008) Mental appreciation of staff’s psychological needs. some nurses metaphorically put their feet Health Act Commission Annual Report. West Some saw sickness as a metaphor for stress up to recharge their batteries. London Mental Health NHS Trust. November 2008 and the need for personal space. Nottingham: Mental Health Act Commission. tinyurl. Some long-term staff were seen as resis- Discussion com/mental-commission tant to engaging with service users on a The benefits of working one to one with Nolan P (1993) The History of Mental Health one to one basis and quite content to func- mental health service users are evident Nursing. London: Chapman and Hall. tion in a containment role. from the literature, but this study revealed Reynolds B (2003) Developing therapeutic Recruiting and replacing staff was a con- many barriers to this therapeutic process. one-to-one relationships In: Barker P (ed) cern as it increasd the burden on regular According to the Royal College of Nursing Psychiatric and Mental Health Nursing: the Craft ward staff. The fact that agency or casual (2007), four in 10 nurses working in mental of Caring. London: Arnold. staff had a lower level of commitment than health believe they are not able to make full Royal College of Nursing (2007) Untapped regular staff was also mentioned. use of their skills. If service users do not Potential: A Survey of RCN Members Working in In some areas, support from service receive regular therapeutic intervention Mental Health. London: RCN. tinyurl.com/ managers was seen as very positive, with from nurses, we have to ask whether they untapped-potential clear leadership and good teamwork. How- are being treated or simply contained. The Shepherd G et al (2008) Making Recovery a ever, it was suggested that overall supervi- extent to which mental health nursing is Reality. London: Sainsbury Centre for Mental sion needed to be improved. Supervision still rooted in its more custodial historical Health. tinyurl.com/making-recovery for staff was said to occur monthly in most past requires further discussion. Wilkin P (2003) Clinical supervision. In: Barker P areas, but was not always seen as successful. Much progress has been made at (ed) Psychiatric and Mental Health Nursing: The When group supervision took place, it was the trust since this study was conducted: Craft of Caring. London: Arnold.

www.nursingtimes.net / Vol 107 No 1 / Nursing Times 11.01.11 27 Nursing RoLe ModeL James Moore originally planned an engineering Life career but a family love of nursing and Edith Cavell Ward, St Charles What do you think is likely to a desire to travel Hospital, London. It was a change nursing in the next changed all that combined acute medical/ decade? critical care area. There are many external What is the trait you least like challenges with one of the in yourself and why? greatest being public expecta- Jungle I can be horribly impatient and tion. We are going to have to then feel really guilty afterwards. work hard to retain the respect Jim Whom have you learnt most and affection of the public. from in your nursing career Which job would you have and why? done if you hadn’t become Dealing with injured members I have been lucky to work with a nurse? of a hen party all dressed as so many amazing nurses. Early I would have loved to do safari animals in A&E on a ward sisters still remain role something in fashion, particu- 60 SecoNdS WiTh Saturday night may be as close models as do national nurse larly something involving shoes. as many people would like to leaders such as Liz Fradd. What job would you like to be get to nature, but it was just not Mandie What advice would you give doing in five years? good enough for James Moore. someone starting out in the I would be happy to remain as Mr Moore has practised his Sunderland profession? a chief nurse. It’s a privilege to clinical skills on expeditions We quiz the chief nurse at I would advise any new nurse lead your profession and this in Africa, New Zealand and Heart of England Foundation to recognise their unique role job is certainly never boring. other exotic locations as an Trust, Mandie Sunderland, who – nursing is a privilege. You will What do you think makes a expedition medic. He’s tended has been nursing for 25 years. observe the best and worst of good nurse? to film crews, celebrities Ben people. Laugh a lot as it can be Compassion, skill and a sense Fogle and Joanna Lumley, and bloody hard work. of humour. I also like our Heart athletes undertaking gruelling Why did you decide to What keeps you awake at of England "three Ps" – pride, endurance events. The nurse become a nurse? night? passion and professionalism. runs his own travel clinic I wanted to be a nurse ever As chief nurse my accountabil- if you could change one thing Travel Health Consultancy in since I was a little girl. This was ity centres on the delivery of in healthcare, what would it be? Exeter, and also lectures at the reinforced by visits to the Naval high quality care. Sometimes The constant political meddling Royal Geographical Society Hospital in Plymouth where my we get that wrong and those and bureaucracy. and Royal College of Nursing father was a patient. I fell in love circumstances can worry me. What would your ideal as well as drug companies with that amazing uniform they What’s the most satisfying weekend involve? Sanofi Pasteur MSD and GSK, used to wear. part of your job? Shopping, nice food and wine, on travel medicine. Where did you train? Positive feedback from patients and good company. But Mr Moore decided to I trained at St Mary’s Hospital, and staff can make a bad day if you could spend an hour in dust off his passport after Paddington, London. brilliant. someone’s company, who working for a couple of years What was your first job in What is your proudest would it be and why? at a Bristol hospital. He nursing? achievement? George Clooney – I am very practised in New Zealand and My first staff nurse job was on Haven’t had it yet. (I hope.) shallow. trained with Wilderness Medical Training (and still does) and learnt how vital clinical The consultation that had me in stitches skills could be in expedition and survival situations. A i was new to practice nursing when a patient came in who had just had a Returning to the UK in vasectomy. he walked in cautiously in baggy jogging bottoms and said: i" 2001, he wanted to be his own funny have come for my stitches out." itold him they don’t usually need taking boss and was determined to out but i would check. i had a look and told him it was oK. i removed my set up his own travel clinic in thing gloves and was washing my hands wheni saw him sitting by my desk. i Exeter, dispensing anti-malar- said: "You're oK, you can go." he looked bemused, pointed to his brow and ials and vaccinations, while said: "i have come to have these stitches out," pointing to a cut.Jan Drury giving advice on how to Send your funny stories about nursing to [email protected] survive travel illnesses.

28 Nursing Times 11.01.11 / Vol 107 No 1 / www.nursingtimes.net JOURNAL SCAN

Find out how nurses are using their Nursing skills in a range of different roles Times.net

up one drip. I spent the rest of the time with the film crew learning about the shoot.” Calendar Not that they are always stress free: Mr Moore once spent 9.5 hours carrying a girl jaNuary on a stretcher after she was bitten by a snake in Borneo. Nurses going off on an Foundations for Effective expedition need to have personal, clinical and expedi- Commissioning tion skills in equal measure. Practical half-day workshops to help GPs as well You need to be able to defuse as practice and GP consortia engage effectively a situation with an angry crew with the challenges of commissioning or be able to muck in and Venues to be confirmed | nationwide help people rig up a camera, Tel: 020 3188 7580 start a fire or cook dinner. Email: [email protected] “The best thing about the www.rcgp.org.uk/commissioning job is the excitement. But it’s Nottingham: 18 january; Maidstone: 19 january; also an awful lot of responsi- Birmingham: 20 january bility. When it goes wrong, it can be high profile, and if you make a mistake it’s potentially NLGN annual Conference 2011: trial by media. During the Brazil marathon, one patient Funding the Future just started fitting and we had A unique insight into the new political landscape, to evacuate him through the allowing delegates to prepare their organisation jungle rivers at night. You for the financial constraints outlined in the CSR have to take that responsibil- Church House Conference Centre | London Swapping the ward for the ity seriously.” Tel: 0845 056 8339 jungle: James Moore uses his It’s lucky he enjoys the Email: [email protected] clinical skills on expeditions work because frequently it www.nlgn-annual.com doesn’t pay. “With some 26 january “I teach how to take a expeditions you get costs medical history, insert a covered, some they pay cannula and intravenous and expenses and some they pay Planning for an ageing intramuscular drugs, hang up you. How much you are paid a drip, and straighten and depends on your experience Population splint limbs,” he says. and if you have travelled to Key speakers from different sectors look at the The clinic has been helped these places before.” future of health and social care for older people by the increase in travellers Despite huge responsibility The Barbican | London – Mr Moore sees everyone and low pay, Mr Moore says Tel: 0161 832 7387 from babies holidaying with it’s definitely the career for Email: [email protected] parents, to 80 year olds off to him. “My dad was a mechanic www.psevents-delegates.co.uk/linktrack.aspx Egypt or Africa. until he was about 40, then 27 january “My goal when setting up retrained as a nurse. When I my clinic was to offer was considering going to uni travellers advice on travel to study engineering, he made FEBruary medicine from someone who me think about nursing. I’m has trained at postgraduate glad he did. level but also who has travelled “I went to Sri Lanka after regional Child Health Conference to these places,” he says. the tsunami and before And he’s travelled to all Christmas I was walking with and Exhibition: Childhood Obesity kinds of places. “My mantra to rhinos in Uganda and met A free educational event for health visitors, expedition medics is that if you villagers in parts of Sudan midwives and other health professionals who do your job well enough and that are so dangerous tourists work with children prepare for what may happen, don’t usually to get to see Cranmore Park | Solihull you won’t have anything to do them. I can think of no other Tel: 020 8832 7311 on the trip. I recently did a career where you can travel Email: [email protected] television show where I anywhere in the world and www.profileproductions.co.uk/rch dressed a few blisters and put use your skills.” 1 February istockphoto

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JOBJOB OFOF THETHE WEEKWEEK Borough Solicitor and To place your advertisement Nurse Advisors Monitoring O„ cer NurseBand Advisors 5, £21,176 - £27,534 Nursing Times Band Various5, £21,176 sites – £27,534 Call: Recruitment Team Recruitment Cheshire East VariousSee sites page 34 020 7728 3806 EMAP Inform Please see below Greater London House Are you a Band 5 nurse looking for a new challenge? [email protected] Hampstead Road Also on nursingtimesjobs.com An exciting career opportunity has arisen for Band 5 Nurse London NW1 7EJ Advisors at NHS Direct. If you’re an RN1 Sub Part 1 NMC Registered Nurse looking for unrivalled variety and the opportunity to provide help when it’s needed most, then we CAREERS IN NURSING Senior Nursing Staff, Nurse Educators,would likeSenior to hear Clinical from you.Nurses 38 Head Nurses, Specialists For34 further details and to apply please visit www.nhsdirect.nhs.uk/NursesRegistered Mental Nurses 38 Registered Nurse 31 Unit Leaders, Nurses and Newly Closing date: 23rd January 2011. RGN’s & Primary Mental Healthcare Director of Customer Care and Quality 31 Qualifieds (RMN/RNLD) 35 Therapists 38 No agencies please Lecturer (Cancer Nursing) 32 Theatre Manager 35 NHS Direct is committed Nursesto equal (A&E, opportunities Critical Care, Infection Lecturer (Children’s Nursing) 32 Forensic Mental Health Nursing 35 Control, & other major specialities) 38 Lecturer (Mental Health Nursing) 32 Junior Sister/Junior Charge Nurse 35 Practice Nurse 38 Registered Nurses 32 Clinical Nurse Specialist 36 Full Time RGN’s/HCA’s 32 TRAINING/SERVICES School Matron 36 Nurses (RGN) 32 Post Graduate Certificate/Diploma/MA Clinical Nurse Specialist (Palliative Care) 36 Nursing Officers 33 in Patient Safety Management 38 Band 5 Registered Nurses 36 Nurses - UK wide/Open Days 33 PG Certificate - Weight Management 39 Community Nurse Team Leader 37 Senior Lecturer 34 Emergency Gynaecology Course for Careers in nursing Community Clinical Nurse Specialist 37 Registered Nurse - Outpatients 34 Nurses & Midwives 39

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REGISTERED NURSE SOUTH – WEST BASED Director of Customer Care and Quality NEGOTIABlE SAlARy (C.£30k) + BENEFITS London but requiring frequent travel Our Client was established in March 2007 and is a British, privately owned within the UK Company. They have over a century of experience in the Urology market place £Competitive and their Home Delivery Service has been established for over 25 years. A team Vitalise provides short breaks for disabled people and carers at accessible centres of 6 independent Nurses, plus a dedicated Customer Services team based in in England. This part time post is an exciting opportunity to play a leading part in Cardiff, can offer home based support and confidential advice. the development of an established national charity. A vacancy currently exists for an experienced Registered Nurse to be based This post has overall responsibility for ensuring that our guests experience the in the South-West. The successful candidate must have a urology background highest standards of health and social care during their stay with Vitalise and and be fully trained / qualified in intermittent catheterisation. An excellent salary that the organisation is well equipped to deliver clinical support within a holiday package (c. £30k) + bonus, company car and benefits package is on offer. environment. For full details please call Neil or Sally on: 01227 780888 or email Closing date: 31st January your CV to: [email protected] Ref: MH 3920 For an application pack contact [email protected] or 01539 814692 NT1411AP NT1406AP

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32 NursingTimes 11.01.11 /Vol 107 No01 /www.nursingtimes.net Visit www.nursingtimesjobs.com/alerts Careers in nursing To findoutmore visitwww.sunrisejobs.co.uk 01932 871100foranapplicationpack oremail [email protected] If you are interested infindingoutmore atSunrise about theopportunities Senior Living,thenpleasecontact Is hands-onnursingcare somethingthatappealstoyou? of allpotentialresidents through apre-admission assessmentprocess. Responsibilities willincludetheadministration,ordering andmonitoring ofmedications,ensuringsuitability overall health andwellness. You ofateamtooversee willbepart anddeliver nursingcare toourseniorresidents whilst monitoringtheir Nurses (RGN) appointing experienced nurses who holdaMaster’s degree inNursing or arelated subjectasaTutor. children’s nursing. You mustholdadoctoral degree andideallyberesearch active. We will also consider Interviews willbeheldweek commencing:31st 2011. January 2011. The closingdatefor receiptofapplications:21stJanuary All correspondence shouldclearlystate thejobtitleandrelevant reference number. www.kcl.ac.uk/jobs, oralternatively by emailingHumanResources at [email protected]. Further detailsandapplicationpacksareavailable ontheCollege’swebsite: For moreinformation onPETpleasevisitourwebsite: www.sthpetcentre.org.uk Staff Development) [email protected] If you would like information further abouttheseposts,pleaseemail:Professor IanNorman(Associate Dean, Partners Academic HealthSciencesCentre (AHSC). London’s position attheforefront of academic healthscience with theformation of King’sHealth more thanany other university. Inaddition, thesuccessfulcandidates will benefitfrom King’sCollege for theeducation of healthcare professionals inEurope andfive Medical Research CouncilCentres - of thetop 25universities inthe world (TimesHigher 2009),King’sisalso hometo thelargest centre and isamember of thedistinguished RussellGroup of 20major research-intensive universities. One are permanentappointments. three years from January 2011.TheLectureships inChildren’s NursingandMentalHealth a vibrant andexciting learning environment intheheart of London. Applicants are soughtfrom experienced cancer, mentalhealthandchildren’s nursesto jointhestaff of and achievements £33,070-£47,478, incl. of LondonAllowance dependent on previous experience (Reference: A6/GFM/560/2/10-NJ) Lecturer/Tutor (MentalHealthNursing)-Permanent Post (Reference: A6/GFC/559/2/10-NJ) Lecturer/Tutor (Children’sNursing)-Permanent Post (Reference: A6/GFS/558/2/10-NJ) Lecturer/Tutor (CancerNursing)-Fixed Term, 3Year Post FLORENCE NIGHTINGALE SCHOOL OF NURSINGANDMIDWIFERY Equality ofopportunityisCollegepolicy All applicantsshouldberegistered nurses with clinicalexperience incancer, mentalhealth or King’s CollegeLondonhasan outstanding globalreputation for teaching andresearch excellence The Lectureship inCancer Nursingisafixed-term post to cover for the work ofasecondment for new NTgenericfiller40x11

NT49401AP N1401AP [email protected] Call 0207 408 1234 or email CV to: you! have to love we’d years 3 or £30,000+ months 3 For and benefits. employee housing - company includes £25,000 hospital package Employment time assignments. based Full specialties. years experience. ALL ages, MOST one minimum with NEEDED RN’s [email protected] Full timeRGNs/HCAs Nursing Times when required foraNursingHome may betakenagainstthem. in Nursing the Times action legal style, featured advertisements the manner, of any design or format any reproducing in or repeating, duplicating, Communications copying, of by Ltd rights EMAP the have infringed to If found is edition. party any this of advertisements section classified the in copyright asserts Ltd possible the all Communications EMAP doubt of For avoidance Times Nursing you have on seen when replyingwhen to replying to these replying to these Nursing Times Please mention Please advertisements advertisements Please mention Please advertisements Tel. 0787 9698737 in LondonNW11. these pages these Contact Contact 27/3/09 12:49:58

NT1105AP N1402AP N1101AP Boost your job search with job alerts Careers in nursing Visit www.nursingtimesjobs.com/alerts Another way to work Another way or call 020 7830 4660. 33 11.01.11 / Nursing Times No 01 107 / Vol

www.nursingtimes.net www.nursingtimes.net [email protected] Croydon – 27th January, 3.00pm-8.00pm – 27th January, Croydon 3.00pm-8.00pm Bristol – 31st January, 3.00pm-8.00pm February, London – 2nd & 3rd 3.00pm-8.00pm – 9th February, Norwich 3.00pm-8.00pm Birmingham – 16th February, Open Days/Evenings: Canterbury – 25th January, 6.00pm-8.00pm Canterbury – 25th January, Open Days/Evenings: Alternatively, you can email Alternatively, Please call or email the recruitment team to register your interest in attending one of the events. disability or sexual orientation. age, sex, colour, religion, Atos Healthcare does not discriminate on the basis of race, knowledge and experience and relevant business skills, cations, All recruitment decisions are made on the basis of qualifi Successful candidates will undergo a Criminal Record Bureau check and a Security Clearance check. requirements. Nurses / UK wide ts. benefi £32k or £34k pa depending on location plus excellent or part-time. Mon-Fri 37 hours, Division provides Assessment Our Disability skills. we offer you another way to use your clinical Atos Healthcare, At looking for NMC registered We’re (DWP). and Pensions Work medical assessment services for the Department for role will involve undertaking medical Your RGNs with at post-registration least 3 years’ general medical experience. t claims. assessments and writing reports that enable the DWP to make informed decisions about disability benefi medical indemnity insurance and reimbursement life assurance, private standard package healthcare, will include Your we’ll give you full-time training Upon start, is an integral part of this role. Travel of your professional registration fees. at one of our nationwide venues. please visit atoshealthcarejobs.co.uk nd out more, apply or fi To

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34 NursingTimes34 11.01.11 /Vol 107 No01 /www.nursingtimes.net Visit www.nursingtimesjobs.com/alerts Careers in nursing Closing date: 23rd January 2011. January 23rd date: Closing www.nhsdirect.nhs.uk/Nurses visit please apply to and details further For you. from hear to like would we it’sthen when most, help provideneeded to opportunity the and variety unrivalled for looking Nurse Registered NMC 1 Part Sub RN1 an you’re If Direct. NHS at Advisors Nurse 5 Band for arisen has opportunity career exciting An challenge? new a for looking nurse 5 Band a you Are Varioussites £27,534 – £21,176 5, Band Advisors Nurse FACULTYHEALTHOF CARE SOCIAL AND A secondment opportunity will be considered. be will opportunity secondment A experience. clinical and academic proven and focus customer strong a skills, organisational excellent degree, relevanthave a NMC), or (HPC professional health Youregistered a be must receivethem. to prepared well are placements that and placements their for prepared well are students our Faculty,the within placements that of evaluationensuring deliveryand development, the support will youlevels, all at programmes nursing on teaching to contributing as well As programmes. training and education our of success the pivotalto are Placements professionals. registration post and pre for development and training quality deliverhigh we partners services social and NHS our Workingwith PA£46,725 - £39,635 (PLACEMENTS)LECTURER SENIOR

For full details and to apply please visit www.lsbu.ac.uk/jobsvisit please apply to and details Forfull Closing date: 25 January 2011. 2011. January 25 date: Closing An Equal Opportunities Employer.Opportunities Equal An to equal opportunities equal to committed is Direct NHS please agencies No

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NT1403AP N1409AP N1201AP For full details please call Neil or Sally on: 01227 780888 or email or 780888 your CVto:[email protected]:MH3220 01227 on: Sally or Neil call please details full For commensurate withthisimportantpositionwithinhighlyregardedhome. offer on is accommodation plus pay of rate negotiable competitive A nights. or days for team care professional and established their to join to up skills clinical with date Nurse Registered part-time or full a for exists currently vacancy A elderly 40 to residents withfurtherexpansioninprogress. up to care dementia and EMI nursing, of standards highest the of Gainsborough, North Lincolnshire with excellent motorway links and provides north miles 6 - Scotton of village rural the in situated conveniently is client Our NEGOTIABLE RATES pLUSACCOMMODATION NR GAINSBOROUGH–NORTHLINCOLNSHIRE REGISTERED NURSE o a apiain ak o te bv pss pes cnat h HR on02083473854. department the contact please posts, above the for pack application an For (CRB) Disclosure. Bureau Records Criminal a to subject be will candidate appointed Any Closing dateforreceipt ofapplications:1stFebruary 2011 Nurses, Registered Bank recruiting Theatre Nurses Scrub andODP’s. currently is Hospital Highgate setting isessential. provided at all times. Atis least six care months experience in nursing an acute surgical of standards highest the ensuring patients, of group a or patient, individual an of care nursing total the for responsible Being knowledge base. Experience of working in outpatient department department outpatient in would bedesirable butnotessential. working of Experience clinical base. broad a knowledge as well as of skills range communication wide excellent and experience, organisational a registration in post year work 1 to have must nurse You clinics. registered a recruit to wish We Registered Nurses- Nursing Wards RegisteredNurse Department Outpatient – the at Outpatient andNursing Department Wards. arisen . have vacancies following The specialities. other within surgery of range a undertakes also surgery, but cosmetic of field the in reputation excellent an has wide hospital The treatments. a surgical of range offering hospital, independent bed 28 a is Hospital Highgate Highgate Hospital www.nursingtimesjobs.com/alerts for Nursing Times Job Alerts? Have you up signed 17-19 View Road,Highgate,LondonN64DJ 2postsFull Time

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NT1405AP N1203AP Boost your job search with job alerts Careers in nursing Visit www.nursingtimesjobs.com/alerts NHS Trust Patients First and Foremost 35 11.01.11 / Nursing Times No 01 107 / Vol Junior Sister/Junior Junior Sister/Junior Charge Nurse & Dependency Unit Intensive Care/High Outreach Critical Care Band 6 £25,472 - £34,189 pa our post that will see you work across This is a rotational Dependency Unit at Barnet12-bed Intensive Care/High Hospital Unit at the Chase Farm Hospital. and our 7-bed Intensive Care orientation This is a learning with a comprehensive environment our Practice and support from programme and preceptorship Senior Charge Nurses on both sites. Development/Teaching development opportunities, excellent professional offer We individual support, so if you are clinical supervision and provide highly motivated, enthusiastic and need a challenge, we would you. be delighted to hear from nurse level Applicants must possess experience at senior staff teaching an ENB100, a recognised within Intensive Care, qualification, and the ability to lead a team of nurses in a challenging and multi-disciplinary enviornment. For further information please contact Elizabeth Stewart, on 020 8216 5304 or 020 8216 5298. ITU Matron or apply online, please visit www.jobs.nhs.uk/in/bcf To under Job Ref: 341-BW-7350-7564069. search Closing Date: 31 January 2011 Barnet and Chase Farm Hospitals

Any appointed candidate will be subject to a Criminal Records Records appointed candidate will be subject to a Criminal Any Disclosure. Bureau Holly House Hospital, based in Essex/NE London, is close to Epping Forest Epping Forest is close to London, in Essex/NE based House Hospital, Holly established 55 bedded It is a well End. West the situated for and conveniently undertaking equipped theatres a wide fully three independent hospital with across high quality healthcare Providing specialist surgery. and of general range with you can provide busy hospital that a friendly it is specialties, numerous varied gain team, and dynamic the opportunity to be part of a progressive in-house and from development continuous and have clinical experience sources. external Manager Theatre and innovative a forward-thinking, opportunity for An exciting has arisen department. our theatre individual to manage motivated in theatre has consolidated experience someone who looking for are We the efficient to ensure leadership effective visible, provide can who practice of this service. delivery along a prerequisite, and influencing skills are leadership developed Well and Excellent interpersonal ability. management financial with proven planning and organisational good also essential as are skills are communication A can do attitude is a must. skills. involved is plenty of opportunity the successful applicant to become for There of the theatre development including the current initiatives, of in a number of the hospital. and expansion complex it is also very a demanding one, is undoubtedly although the role Finally, both as successful applicant, benefits to the numerous can offer We rewarding. an individual and member of the hospital group. please contact further to discuss the post in detail, like would If you on 020 8936 1212. Hospital Director Jackie Row, Resources please contact the Human an application pack, For Department on 020 8936 1207/1258. 2011. 24th January Monday, Closing date: at www.hollyhouse-hospital.co.uk Please visit our website

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029 2034 8849 ” Interested in being part part being Interested in Forensic of the future of in Health Mental Australia? Sydney, or enhanced CRB disclosure, dependent on the role. dependent or enhanced CRB disclosure, If successful, your appointment will be subject to a standard your If successful,

With a £5,000 relocation With a £5,000 a £3,000 package and it’s bonus, welcome wanted. nice to feel email: [email protected] email:

and ask to speak to a member of the Recruitment Team or Team and ask to speak to a member of the Recruitment We look forward to welcoming you to team! the you forward to welcoming look We If you are on. a please read Registered Nurse an is Hospital Forensic The with Health, NSW of behalf on recent Health, Justice by Operated Mental Health experience, Mental Health Network. part of the Forensic integral this purpose- 2009, February Located in Malabar NSW and officially opened in and female male, to care specialised high-quality provides facility 135-bed built environment. therapeutic patients in a high-secure adolescent forensic Only 20 minutes from the CBD, close to the world famous Sydney’s best Bondi parks & Beach this cafes, is and a great opportunity to make a difference has to offer. and climate lifestyle great what Sydney’s while experiencing support education salary packaging, options, flexible work offers Health Justice professionals. Health Mental progressive for opportunities development self and If you are a Registered Nurse with recent Mental Health experience and would www.jobsatjusticehealth.com.au our website: please visit like to know more to: letter and resume your covering apply please forward To au [email protected]. or call us on Visit www.lshealthcare.co.uk Interested? .co.uk lshealthcare www. £22,500 to £35,000 per annum plus relocation, plus relocation, annum £22,500 to £35,000 per Wales ts • South and a range of other benefi bonus welcome nd out more about us and our nursing to fi Please visit our website ground in caring breaking new people for We’re framework. development are looking culties and we and Learningwith Mental Health problems Diffi of outstanding Nurses a number for to help maintain our momentum. ts package designed to offering a salary and benefi We’re join us? Why the support have and infrastructureWe in place to enable attract the best. part a beautiful of the world. Wales, operate and we in South ourish, to fl you Unit Leaders, Nurses, Nurses, Unit Leaders, eds (RMN/RNLD) Qualifi Newly

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36 NursingTimes 11.01.11 /Vol 107 No01 /www.nursingtimes.net Visit www.nursingtimesjobs.com/alerts Careers in nursing Closing Date:Closing 25/01/2011 linkhttp://www.stjamesschools.co.uk/recruitment/following For andjobdescription, form anapplication pleaseusethe A knowledge ofhomeopathy ispreferable. of healthcareto260juniorboys andgirls. be candidate will responsiblefor theprovisionThe successful time only). Matron share aweek, on basis(2/3days apart-time/job term from qualified School registeredfor theposition nursesof invite applications London inCentral James JuniorSchool St post, withpastemployers checks and theCRB. including young people. must Applicants toundergoprotection bewilling child screening appropriatetothe iscommitted tosafeguarding andpromoting JamesJuniorSchool thewelfareSt ofchildren and The LondonClinic•20DevonshirePlaceW1G6BW www.thelondonclinic.co.uk The LondonClinicvaluesourdiverse workforce. and aRegistered Charity(No.211136). The LondonClinicisanon-profi t makingorganisation 2011 Closing date:Sunday16January telephone 02076167742(24houranswerphone) at www.thelondonclinic.co.uk, [email protected] For anapplicationformandjobdescription,pleasevisitourwebsite on 02076167748. please contactAmandaHallums,Matron/DirectorofClinicalServices For furtherinformationortoarrangeaninformalvisit, may alsobeavailable. life assuranceandaninterest free seasonticket loan. Nursingaccommodation Staff benefi pensionscheme, ts includeacontributory aprivatehealthcare plan, and education. andstrongly continuingDepartment professional supports development The ClinichasanexcellentClinical Training andPracticeDevelopment be confi dential innature. as theabilitytodealwithchallengingandsensitive situations, someofwhichwill Excellent interpersonal, negotiation andcommunication skillsare essentialaswell implement toolsinorder toauditoutcomes. prevention andcontrol throughout thehospital. Inaddition you willdevelop and evidence basedclinicalpractice changesandimprovements toinfection initiative andeffectively withcolleagues, you willberesponsible for initiating Specialist inInfection Prevention andControl. Able towork onyour own We are lookingtorecruit aqualifi ed, experiencedandmotivatedClinicalNurse perannum(inclusive),band7equivalent one ofthelargestandmostprestigious acuteindependentprivatehospitals. The LondonClinicislocatedinthecentre ofLondon’s medicalcommunity andis Hours: £38,000.00 to£43,000.00 Salary: Job Ref:LC000492 Infection PreventionandControl Clinical NurseSpecialist 35 hoursperweek. January 2011 School Matron required for Charity No 270156 Charity new NTgeneric filler20x21

NT49406AP NT49402AP replying advertisements to these mentionPlease Nursing Times when of sufficient applications. The Trust reserves therighttoclosevacanciesearlyafter receipt Closing Date:18thJanuary2011. to therecruitment team from thewebsite. is 785-PC-NM-325.Applicationsare automaticallyforwarded to www.jobs.nhs.uk andsearch underCoventry, thePOSTREF For themostefficient way toapplyforthispostpleasego Previous applicantsneednot apply. This postissubjecttoaCriminalRecords Bureau Check. been ataseniorlevelincancer/palliativecare specialistpractice. and withpostregistration experiencesomeofwhichwouldhave educated toPostgraduatedegree levelinOncology/Palliativecare, demanding andchallengingpost,youwillbeafirstlevelnurse with otherlocalpriorities.Inorder tomeettherequirements ofthis have knowledgeofpalliativecare initiativesandhowtheyinterface You willbeexpectedtoworkwithahighdegree ofautonomyand with themanagementofpatientspalliativecare needs. and willbeabletoliaisewithotherteamsagenciesconcerned needs. You willsupportandeducateothermembersofthewiderteam symptom control adviceandpsychosocialsupporttomeetcomplex caseload ofpatientsrequiring specialistpalliativecare, providing You willberesponsible fortheday-to-daymanagementofaclinical cancer andotherlife-limitingillness. clinical standards ofcare andqualityoflifeforpatients facing families. Theclinicalnursespecialistplaysakeyrole inraisingthe team, providing excellentendoflifecare topatients and their experienced andmotivatedindividualtojoinourmultidisciplinary within CoventryCommunityHealthServices.We are looking foran An excitingopportunityisavailabletojointhepalliativecare service 37.5 hoursperweek Permanent Band 7£30,460-£40,157 PALLIATIVE CARE CLINICAL NURSESPECIALIST– People AtADisadvantage. To RemoveConditionsWhichPlace ValueWill IndividualAndStrive Every TeachingCoventry CareTrust Primary 27/3/09 12:43:15

N1104AP NT49407AP Boost your job search with job alerts Careers in nursing Visit www.nursingtimesjobs.com/alerts Registered Charity No. 285300 Registered £15pER HR) independent nursing publication independent nursing pluS BENEFITS 27/3/09 15:29:53 37 11.01.11 / Nursing Times No 01 107 / Vol the UK’s most popular most the UK’s The UK’s most UK’s The REGISTERED NURSES (Day & NIGHT) REGISTERED NURSES (Day - DERBySHIRE MaTLOCK (Up TO OF pay RaTES ExCELLENT Our client is an Nottinghamshire. One independent of their homes, group in Matlock, within set is is Home The a care. dementia comprising and nursing substantial residential, offering Home bedded purpose built 10 62 Homes in stunning Derbyshire countryside and and provides a healthy, happy environment for all residents. and fulfilling atmosphere and Vacancies currently exist for two high calibre elderly care experience to join Registered their established and friendly care team. Nurses An excellent with up to hourly date rate of pay is on offer, commensurate with this the opportunity highly for career advancement. regarded In home, addition, the Home as has opportunities is for experienced and qualified carers as well as an opening for a senior carer. CV your email or 780888 01227 on: Sally or Neil call please details full For to: [email protected] Ref: MH 3922 Community Nurse Team Leader Nurse Team Community (HCA) London High Cost Allowance Band 8a + Inner and experienced practitioner has arisen for an An exciting opportunity to manage a team of dynamic, advanced nursing skills manager with specialists and triage nurse, who form part of experienced clinical nurse team. our multi professional Nurse Specialist Community Clinical Cost Allowance (HCA) Band 7 + Inner London High in capacity to enable an increase to increase This is a new post designed supported by a non cancer diagnosis who are the number of patients with expertise for patients, carers clinical knowledge and provide the team. You’ll support patients with life limiting to professionals and health and social care specialist palliative care. illnesses who require experience, some of substantial post-registration For both posts, you will need life limiting disease management in a palliative care, which will have been gained car owner and driver. will also be a You or community environment. ts package, which includes the option to an excellent benefi offer We entitlement equivalent to NHS and support continue NHS pension, holiday development. for professional cation and apply online, person specifi see a job description, To For further information, please visit www.northlondonhospice.org.uk Giselle Martin-Dominguez please call Joint Deputy Nursing Directors on 020 8343 8841. or Maria Turnbull Closing date: 27th January 2011. 11th February 2011. Leader: Interview date Team Interview date CNS: 7th February 2011. HOME MANAGER BRADFORD – WEST YORKSHIRE SAlARYNEGOTIABlE Our client provides professional care for young physically disabled aged 18 to 65 years. The high standard of care enables optimum conditions for the physical health and psychological well being of the individual and enhances the quality of their lives. This Home is within heart the of Bradford and is set in secure, mature, landscaped plenty of private outdoor gardens sensory stimulation which to provide their residents, respite and day care service users alike. A vacancy currently exists for an experienced Home Manager, management skills to lead and motivate a professional care team as well as providing expert with excellent clinical and clinical practice within the home. An excellent negotiable salary benefits and package career development is opportunities commensurate on with offer this key plus position within this well regarded nursing home group. For full details please call Neil or Sally on: 01227 780888 or email your [email protected] Ref: MH 3921 CV to:

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and Midwives Email. [email protected] Gynaecology Out-patients Department, St. Mary’s Hospital, Manchester St. Mary’s Venue: To find out more find out more To call: 024 7679 5959 or email: [email protected] PG Cert Weight Management PG Cert Weight in, an interest of, or having in the area course is intended for those working This multidisciplinary management. obesity and weight complexities of overweight the modules which explore course consisting of three This is a part-time behaviour and diet: to health, environmental and obesity in relation significance of good nutrition for health • Nutrition and the overweight and obesity of and treatment the prevention overweight and obesity, • Consequences of and obesity • Causes and development of overweight in a relevant normally have an honours degree For entry onto this course you should or academic area. professional Saint Mary’s Hospital, Manchester M13 9WL Saint Mary’s Healthier Futures Healthier www.coventry.ac.uk March - April 2011 Fee: £800 Date: March Course for Nurses Course for Nurses Format: 8 half-day sessions (Monday mornings) Tel. +44 161 701 6920 Fax. +44 161 701 6919 Tel. Mrs. Michelle Guinnane, Dr Edi-Osagie’s Secretary, Secretary, Mrs. Michelle Guinnane, Dr Edi-Osagie’s For more details contact Course Administrator: For more Theoretical and practical training in Emergency Theoretical Gynaecology provided by a multi-disciplinary Faculty Gynaecology provided Designed for: Senior Nursing and Midwifery personnel

Emergency Gynaecology Emergency Gynaecology

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40 NursingTimes 11.01.11 /Vol 107 No01 /www.nursingtimes.net Visit www.nursingtimesjobs.com/alerts Training Course Fee:£90/£75(Ifbookedbefore31stJan2011) Key Themes: 0920-1645 The ScandinavianBallroom,RadissonBluHotel,ManchesterAirport,M903RA Thursday 7thApril2011 Course Fee:£100/£75(Ifbookedbefore8thFeb2011) Course Aims: Education Centre,TheChristieSchoolofOncology, WilmslowRoad,Manchester, M204BX Tuesday 8 • • • • • • • • PLUS Callforabstractsrelatedtokeythemes.Pleaseseewebsitefurtherdetails Survivorship Late andlong-termeffects Symptoms &symptommanagementduringcancertreatment To To equiptheparticipantswithknowledgeto care forothersandthemselves To contributetoethicaldebatesregardingsedation andendoflifedecisionmaking To provideaclearbackgroundforcurrentpriorities inendoflifecare highlight the benefits of cross boundary practice For furtherinformation pleasevisitwww.christie.nhs.uk/pro/education/events Upcoming Events End ofLifeCare:ExploringtheChallenges th Rehabilitation inCancerCareConference March 2011 Let’s Talk aboutSex!Cancer&Sexuality Living withCancerConference 0930 -1600 or [email protected] Key Topics Education Centre,TheChristieSchoolofOncology, WilmslowRoad,Manchester, M204BX Course Aims: Education Centre,TheChristieSchoolofOncology, WilmslowRoad,Manchester, M204BX One DayFee:£100 Course Fee:£100/£75(Ifbookedbefore24thJan2011) usa 2d–Wdedy2r ac 01 0900-1630 Tuesday 22nd–Wednesday23rd March 2011 Thursday 24thFebruary2011 • • • • • • • benefit greatly from rehabilitation and rehabilitation techniques Why peoplewithcancerandeventhosereceivingpalliativeorterminalcarecan How cancerdiagnosisandtreatmentmayimpactuponrehabilitation Presentation andmanagementofsomethemorecommoncancers To stretchtheprofessionalscomfortzonewhendiscussingtheseissues To contributetodebatesregardinglongtermcare To provideclearlinkstoeffects oftreatment To raiseawarenessofsexualityissuesrelatedtocancer Two DayFee: £175/£150(Ifbookedbefore11thFeb2011) 0930 -1615 School of Oncology

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Sta Management

The fi ve essential characteristics of a great leader:

A moral compass that remains 1constant and aligns with what most people would defi ne as trustworthy and genuine. That doesn’t mean that these leaders consistently bring good news, but it does mean that you can rely on what they say to be an honest appraisal of the situation. They are ethically sound.

The ability to make healthy, 2appropriate relationships with others, and maintain those relation- You're hired: Lord Alan Sugar leads the way in the boardroom ships whether with a supplier, colleague, line manager, client or THE LEADERSHIP ACADEMY patient, or an inspector. The organisa- tion's success is reliant on the people In the fi rst of our regular section coaching nurses in who work there and a leader is only as good as the people around him management skills, we look at what it takes to be a leader or her.

A talent for staying focused. A From the top: a guide to 3good leader must be a steady hand on the tiller to guide through the good times and the bad. Their being an e ective leader messages are consistent. The content may change depending on the politics of the day, but the behaviours remain constant. ost people know a practice and on various leader when they see training courses? Do they An aptitude for thinking of the Mone, but defi ning one need to practise the body 4organisation, rather than them- is harder than you think. Leaders language that singles out a selves, fi rst. Every day is about have been well portrayed in leader? Can the “aura” that what can be done to improve the fi lms, books and plays, and people refer to when they way the organisation is run and how most employees would be able describe a leader be acquired? Susan Hodgetts is to motivate others. They know the to tell you who the leaders were There is confusion between chief executive of most e ective methods of decision in an organisation. leadership and management. the Institute of making within a framework of good A healthy organisation is The most distinctive separa- Healthcare governance. said to be “leader-ful”. But tion comes from a good friend Management and what defi nes a leader? of mine, Ken Jarrold, who has extensive A desire to ensure the environ- Leaders are born not made stated that leadership is doing experience in the 5ment promotes healthy living and is the old saying. But do the right thing while manage- fi eld of education healthy working. Health and wellbeing leaders have an innate instinct ment is doing things right. and training, both is an important outcome of good or have they learnt the Leaders may also need to within and external leadership. An e ective leader is also behaviours of a leader by manage, but it does not to the NHS health conscious, o ering a good role watching others, and through follow that a manager is also model to those with whom they work. trial and error in their own a leader.

Equal rights Next How the Equality Act will a ect nurses and the health service

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