When did playing outside become a disease?

I couldn't believe when, watching TV the other night I saw an advert for Oralyte for healthy kids. For those who have not come across this before, it marketed in the UK as Dioralyte and is a drinkable  salts and glucose mixture used to help rehydrate patients who have severe intestinal problems and had nifty little animations demonstrating how salts ad electrolytes are lost through sweat and how easily they are replaced by Oralyte. This advert was encouraging mothers to feed this stuff to their children who "become dehydrated when playing outside. I'm sorry....what??????????

In a society which seem sdetermined to prevent children from playing In streets parks and gardens, walking to school and generally rushing around on bikes this seems the final step to far. Kids who are playing outside require (I'm told from my friends with kids) frequent feeding and watering and if this is done the there is no need to seeking medical treatment.

It  seems to me that this is a cynical attempt to frighten parents into buying a treatment for their kids that is unnecessary and redundant. Whilst electrolyte replacement compounds have been used to treat severe diarrhoea in children there is no evidence that in ordinary thirst it is any more effective than ordinary water or fruit juices especialy in healhty individuals.
This does 2 things, firstly it exploits parents by implying that the old way to look after their children in the summer is to make them drink electrolyte supplements and secondly it emphasise a more important trend in today's society to find medical ways of treating ordinary life experiences. Is this how we want our children to grow up - frightened to play in case they dehydrate?

Feet of clay?

The first professional idol I had was a ward sister called Angela Knight. I worked on her ward at the start of my third year of training and she was the first person that I looked at and thought " When I'm a ward sister I want to be like her!" Fortunately my placement was only for 10 weeks so I left the ward with my awe intact. Since that innocent time I have been sadly disappointed in my ( very few) idols since. Finding an individual I held in great regard operated, on closer inspection, in a cloud of glamour with little substance behind the show, meeting a key nurse theorist who changed the way we think about nursing and finding them to be inarticulate and shy was a massive disappointment. It shouldn't detract from the esteem in which I hold their work but somehow....

And maybe that is the way to ensure that your professional idols maintain their mystique, appreciate them from a far and never, never get to know them!

Meetings, meetings

In the 21st century isn't it about time we came up with something to replace the endless and pointless meeting to which we all go. Why do I have to travel 50+ into work to sit in an over or under heated room (depending upon whether it is summer or winter) with only half of the people who should be there to attend "a meeting". I have lost count of the number of meeting that I have turned up for that have been cancelled at the last minute because too many people sent apologies. Why do we have to have "team meetings" it's not for team building purposes because, generally, half to two-thirds of the team are missing and it can't be for communication purposes because, well....half to two-thirds of the team are missing. If something is vital for everyone to know - send an e-mail, or a text, or tweet about it. If you want more people to attend - hold your meeting in cyber-space via Skype. If I hold a meeting, it has a clear purpose, stated aims, a proposed outcome,  an agenda - to which we stick- and is targeted at the people who will help to make those aims a reality. Does it make me naive to if I wish that al meetings could be like that?
I now have two goals for meeting attedence;
1. The pupose of the mmeting, and my contrubution must be clear to me from the moment the invite to attend reaches me.
2. The meeting should not be higher that then first floor of any building.

Actually, the last point has little to do with the effectiveness or otherwise of meetings and more to do with my lack of desire to slog up more than one flight of stairs for anybody!.
If anyone wants to discuss this further, contact me with some diary dates and we'll set up a meeting

Who cares?

From time to time, I am "invited" to take part in selection interviews for student nurses. At some point in the interview some one on the interview panel will ask THE question - which is, of course, "why do you want to be a nurse?" To which the interviewee inevitably gives THE response "Because I want to care for people". I struggle a bit with this answer I have to be honest - why is nursing still primarily associated with caring rather than say, a satisfying career, the opportunity to do health care research or a fulfilling academic challenge? If people are so keen to care why not become lollipop ladies/men. They also care, they have a cool uniform and they only work about fours hours a day!

These individuals clearly have a view of nursing that is predicated upon the concept of caring, even thought they often have only the vaguest notion of what that may mean. They come into nurses education keen to care, nurse educators invest a great deal of time and energy in encouraging caring but once such students make it into the stress filled world of clinical delivery...guess what is the first thing to be subsumed?

This is why, in the UK at least, we have things such as the North Staffs enquiry, continuous reports about poor care for older people and only last week the report that doctors are now having to prescribe water to patients in hospital in order to prevent them dehydrating. This is shameful. Its not what potential students mean when they say they want to care, it  isn't what universities are teaching  so what is going wrong?

My friend became a grandmother for the first time earlier this year and found her daughter in such an appalling state post delivery that she signed her out to take her home. Not a bad idea, mother and baby were perfectly healthy, if not being washed, fed or being relieved of an  over flowing bed pan that had been used two or three times but not removed. On top of these indignities, the final words of the "caring professional" as this distraught first-time mother was helped from the ward by her family were "If your baby dies tonight - that won't be our problem".

That's a damning anecdote, but what it is worse is that every one who has fallen into the hands of organised health care, even briefly has a story that is similar or worse. My friend is a strong, assertive woman (wouldn't be my friend otherwise) but she didn't feel that it was worth her while to complain. If we as nurses and unaware that our caring attitudes are eroded by practice and our patients are not encouraged to be the custodians of our caring skills - then what hope is there for caring in health care?

Where are the maverick ward leaders of yester year?

Reluctent though I am to turn into one of those annoying people-of-a-certain-age who start every rant/blog with " When I was in clinical practice.."  but.....


When I was in clinical practice if I considered my leadership skills at all (and I didn't) I would have assumed that because I was willing to bend the rules for my patients and support my staff if they did the same I was a good leader. I ran a trauma ward in an area with a large elderly population, often we admitted elderly women whose husbands had never had to cook or shop for themselves so we would 'fiddle' the menus so that we could feed them. We would allow people to have their pets bought into to visit them (although not small babies!). We'd let people visit outside of visiting hours, in fact as a ward team we did all sorts of things that I suspect ward leaders theses days are too scared or too down trodden to contemplate and as a consequence we were a team that had a strong sense of both our professional identity and our professional responsibilities.

I wonder why we see very little evidence of leaders like this in modern health care. Ward leaders seem less willing to go the extra mile for their patients, whether this is because they are less caring (I don't think so) is it because they are frightened about maintaining their registration or have other hospital become places in which the individual has not place? I hope when I fall into the hands of organised healthcare, somewhere to care for me

Continue the discussion this Thursday on #healthcarechat at 8pm GMT+1

Poor pain management? I blame Margot......

Without doubt the most significant development in pain management in the UK was the publication, in 1990, of the College of Anaesthetists and Royal College of Surgeons working party report on pain after surgery. It was this report that lead to the creation of Acute Pain Services who would take the lead for improving pain management in hospitals.  Since then analgesic drugs have improved, we have better delivery methods and awareness of the importance of good pain management in a patients recovery has been fully emphasised. So, the question remains – why are patients still experiencing poor quality pain management?

Personally I blame Margot McCaffery. She it was who coined the annoying phrase “pain is what the patient says it is and occurs when the patient says it does”. On the face of it, there is little wrong with this, it raises the importance of believing patients when they say that they are in pain and that can only be a good thing, furthermore it’s catchy and easy to remember – and that is the bit I object to. It seems to me that one could walk into any clinical area in any hospital in the UK and say “Complete this sentence. Pain is what the patient says it is and.....” then brace yourself for the noise of all the staff finishing it off in loud and confident unison. The problem is that although every nurse in the UK knows and believes this statement, hardly any of them act as if they believe it. I think the difficulty if that this short statement has a nice bouncy rhythm, like the old drinka-pinta-milk-a-day or clunk-click-every-trip, to it that makes it easy to parrot and trot out at appropriate time. It has the advantage of sounding clinically empathetic without having to invest a great deal of intellectual effort. Nobody stops to consider that often pain is more than the patient says it is and occurs more often than the patient says it does.  It also implicitly excludes those patients who, for whatever reason, will have difficulty communicating their pain to the health care profession. Thus, despite parroting this annoying little phrase at every opportunity, there is little evidence that patients are believed when they report their pain, significant evidence that certain sections of society and not only disbelieved but labelled as drug abusers when they report their pain, and no evidence at all that a patients previous history of analgesic use is taken into account when prescribing and administering pain killing drugs.

It seems to me that despite all those better drugs, better delivery systems, enhanced prescribing practices and more supposedly patient/practitioner partnerships, pain management is still poor in the UK and it’s all down to McCaffery and her annoying little phrase. Time, I think, for educators and nurses to leave it behind and move on towards genuinely believing what patients tell them about pain and using their not inconsiderable resources to alleviate it.

Curated Chats

Our curated chats can be viewed by following these links:

5th May - Assisted dying

12th May - The role of government in healthcare 

19th May - Pain Management

26th May - Leadership in Healthcare

2nd June - Caring

9th June - Patient choice - open mic 

16th June - Meetings 

23rd June - Genetic testing 

30th June - Online learning

7th July - Professional Idols - are they up to scratch?

14th July - The medicalisation of normal

21st July - Involving patients in their care

28th July - Paying for healthcare

8th September - How do we measure quality in healthcare?

15th September - Should we refuse care based on a patients lifestyle?