sábado, 1 de julio de 2017


Let's start from the beginning, What is nursing?


The challenge to find a simple, workable definition of nursing remains. It’s long history and wide diversity of setting and action are proof that it is a flexible and dynamic activity, therefore complex to define. Castledine elaborated a simple definition based on nurturing back in 1994: "Nursing is nurturing people with their health-related experiences, problems and concerns".
He believed that there is more to the nature of nursing than any definition can encompass.

Other authors like Nancy Roper have used personal experiences to define nursing. She used three nursing procedures to illustrate different points: giving medicines as an example of the dynamic nature of a procedure over time and how it needs to respond to increased knowledge from research; how serving meals, on the recommendation of non-nurse researchers, was designated a non-nursing duty with disastrous results for some patients; and how the many interpretations of the nil by mouth regimen have caused malnutrition in postoperative patients. 
She states that beliefs about what constitutes nursing are not static, nursing policy responds to changes in a wide range of interfacing areas but she is convinced that there is a nurse-initiated core that concerns patients’ problems with everyday living activities. She believes that it is the core that enables nurses, even in their diverse practices, to speak with a united voice, particularly to those in power, so that nursing will be adequately financed and resourced to provide an ever-evolving, high quality, cost effective service.

In the table below there are the definitions provided by different official organizations and search engines nowadays:


Google gives a very simple definition, which is probably the most common understanding of nursing:
"The profession or practice of providing care for the sick and infirm."

All the definitions, except the one given by google, acknowledge the amount of different tasks and even roles that nursing involves and most of them agree that there is a core  common to all different specialties and forms of nursing.
The next question is: why is nursing important?

-Castledine, G. (1994) A definition of nursing based on nurturing. British Journal of Nursing, 3(3), 134-135.
-Castledine, G. (1994) Nursing can never have a unified theory. British Journal of Nursing, 4(3), 180-181.
-Roper, N. (1994) Definition of nursing: 1. British Journal of Nursing, 3(7), 355-357.
-Roper, N. (1994) Definition of nursing:2. British Journal of Nursing, 3(9), 460-462.

martes, 30 de mayo de 2017


I have used this blog as a learning tool through my journey in Nursing.
I remember wearing my uniform with pride, feeling so lucky because I was working in something that I loved.

But the uniform started to get heavier, the time spent with the patients decreased dramatically while paperwork, recording to "cover your back" or "signing for your life" took over. It makes you feel like the patients are your "enemies" and everybody is waiting for that mistake that you are going to make that will destroy your career, your life.

I am the kind of nurse that cares, that does all the training available and goes an extra mile for her patients, but it is not fair, what you are giving, for what you are getting.

The tolerated and systematic abuse from some patients and families, the long hours without food, breaks or without going to the bathroom, the dangerous short staffing levels, the unreal expectations and responsibility, the poor pay for the essential and hard job that nurses and carers do on a daily basis... these are just some of the reasons why I have decided to take a step back, a break, from Nursing. 

Weekends off, your family and friends, and your own health become difficult or even impossible to maintain. Doing further studies while working... well, you can imagine.

A profession so admirable, recognized by none but blamed by all when things go wrong. I just do not have the strength anymore, and its painful, and I am sorry.

To all the health care professionals that have ever worked with me, thank you, I have learned from each and every one of you, we have shared our passion for the job and supported each other, I will always look up to you.

To all the ones that I have treated, admitted, informed and a long etc, I hope you noticed my devotion and believe me when I say that I truly did my best.

To all the nurses and carers, I hope your job, our job, gets properly recognized and rewarded one day. You are super humans, and the last remains of humanity and compassion in a world that 
sometimes seems to have lost its way.

  • The human right to health guarantees a system of health protection for all.
  • Everyone has the right to the health care they need, and to living conditions that enable us to be healthy, such as adequate food, housing, and a healthy environment.
  • Health care must be provided as a public good for all, financed publicly and equitably.

This is not a goodbye, it is a see you later Nursing.

Antia Veiga Feijoo
Staff Nurse

-Research papers can be found in Google Scholar.

miércoles, 7 de septiembre de 2016


Sepsis is a serious illness. It happens when your body has an overwhelming immune response to a bacterial infection. The chemicals released into the blood to fight the infection trigger widespread inflammation. This leads to blood clots and leaky blood vessels. They cause poor blood flow, which deprives your body's organs of nutrients and oxygen. In severe cases, one or more organs fail. In the worst cases, blood pressure drops and the heart weakens, leading to septic shock (multisystem failure - shock).

  • Anyone can get sepsis, but the risk is higher in:
-people with weakened immune systems
-infants and children
-the elderly
-people with chronic illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease
-people suffering from a severe burn or physical trauma

This response may be called systemic inflammatory response syndrome (SIRS).

The symptoms of sepsis are not caused by the germs themselves. Instead, chemicals the body releases cause the response.
A bacterial infection anywhere in the body may set off the response that leads to sepsis. Common places where an infection might start include the:
-bones (common in children)
-bowel (usually seen with peritonitis)
-kidneys (upper urinary tract infection or pyelonephritis)
-lining of the brain (meningitis)
-liver or gallbladder
-ungs (bacterial pneumonia)
-skin (cellulitis)

For patients in the hospital, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown, known as bedsores or pressure ulcers.

In sepsis, blood pressure drops, resulting in shock. Major organs and body systems, including the 
kidneys, liver, lungs, and central nervous system stop working properly because of poor blood flow.
A change in mental status and very fast breathing may be the earliest signs of sepsis.

In general, symptoms of sepsis can include: chills, confusion or delirium, fever or low body temperature (hypothermia), light-headedness due to low blood pressure, rapid heartbeat, shaking, skin rash and warm skin. Bruising or bleeding may also occur.

Fast action is key to prevent sepsis death:

Following the recommendations of The UK Sepsis Trust we can assess our patients easily. If our patient looks sick or the New Early Warning Score has triggered we should wonder if there is an infection present even if the source is not clear yet.

If there is an infection, we should look for ANY Red Flag Criteria:

If one of the above is present, the Sepsis 6 pathway should be started immediately. If none of the above is present we should look for any Amber Flag criteria:

If there is an Amber Flag criteria present a set of routine blood samples and an urgent senior review should take place within an hour, if Acute Kidney Injury is present the Sepsis 6 pathway should be started.

Sepsis 6 pathway
When the Sepsis 6 pathway has to be started, a treatment escalation plan should be made and the CPR status of the patient should be clarified. The patient has Red Flag Sepsis and all the following actions have to be completed within one hour:

If after delivering the Sepsis Six, the patient still has:
-systolic BP < 90 mmHg
-reduced level of consiousness despite resuscitation
-respiratory rate over 25 breaths per minute
-lactate not reducing
or the patient is clearly critically ill at any time, Critical Care Outreach team should be called immediately.


martes, 30 de agosto de 2016


Nausea and vomiting (also called emesis)
Nausea is an uneasy or unsettled feeling in the stomach together with an urge to vomit. Nausea and vomiting, or throwing up, are not diseases. They can be symptoms of many different conditions. 
Many common problems may cause nausea and vomiting, including:
-food allergies
-infections of the stomach or bowels, such as the "stomach flu" or food poisoning
-leaking of stomach contents (food or liquid) upwards (also called gastro-oesophageal reflux or GORD)
-medicines or medical treatments, such as cancer chemotherapy or radiation treatment
-migraine headaches
-morning sickness during pregnancy
-seasickness or motion sickness
-severe pain, such as with kidney stones

Nausea and vomiting may also be early warning signs of more serious medical problems, such as appendicitis, blockage in the intestines, cancer or a tumor, ingesting a drug or poison (especially by children) or ulcers in the lining of the stomach or small intestine.

Nausea and vomiting are common. Usually, they are not serious. Medical advice should be sought immediately if :
-vomited for longer than 24 hours
-blood in the vomit
-severe abdominal pain
-headache and stiff neck
-signs of dehydration, such as dry mouth, infrequent urination or dark urine.

The most common symptoms of vertigo include a feeling of spinning (you or the room around you), tilting or swaying and feeling off balance. These feelings come and go, and may last seconds, hours, or days. You may feel worse when you move your head, change positions (stand up, roll over), cough, or sneeze. Along with vertigo, you may vomit or feel nauseous, have a headache or be sensitive to light and noise, see double, have trouble speaking or swallowing, feel weak or short of breath or sweaty and have a racing heart beat.

The most common causes of vertigo include:
  • Inner ear problems: collections of calcium, inflammation, and certain infections can cause problems in the vestibular system. The vestibular system includes parts of the inner ear and nervous system, which controls balance.
  • Benign paroxysmal positional vertigo (BPPV): sometimes called benign positional vertigo, positional vertigo, postural vertigo, or simply vertigo, is a type of vertigo that develops due to collections of calcium in the inner ear. These collections are called canaliths. Moving the canaliths (called canalith repositioning) is a common treatment for BPPV. Vertigo is typically brief in people with BPPV, lasting seconds to minutes. Vertigo can be triggered by moving the head in certain ways.
  • Meniere disease:  is a condition that causes repeated spells of vertigo, hearing loss, and ringing in the ears. Spells can last several minutes or hours. It is probably caused by a buildup of fluid in the inner ear. 
  • Vestibular neuritis: vestibular neuritis, also known as labyrinthitis, is probably caused by a virus that causes swelling around the balance nerve. People with vestibular neuritis develop sudden, severe vertigo, nausea, vomiting, and difficulty walking or standing up; these problems can last several days. 

  • Head injury: head injuries can affect the vestibular system in a variety of ways, and lead to vertigo.
  • Medications: rarely, medications can actually damage or affect the function of the inner ear or brain and lead to vertigo.
  • Migraines: in a condition called vestibular migraine or migrainous vertigo, vertigo can be caused by a migraine. This type of vertigo usually happens along with a headache.
  • Brain problems, such as a stroke or TIA (transient ischemic attack), bleeding in the brain, or multiple sclerosis can also cause vertigo. 

-Drugs used in nausea and vertigo:

  • Antihistamines:                                                                         
           -cinnarizine (Stugeron, Arievert)                                                        -cyclizine (Valoid)                                                                    
           -promethazine hydrochloride                                                              -promethiazine teoclate (Avomine).                                                              
  • Phenothiazines and related drugs: 
            -chlorpromazine hydrochloride
            -prochlorperazine (Stemetil, Buccastem)
  • Domperidone and metoclopramide:
           -domperidone (Motillium)                                      
           -metoclopramide hydrochloride (Maxolon)
  • 5HT3 antagonists:
           -dolasetron mesilate (Anzemet)
           -granisetron (Kytril)
           -ondansetron (Zofran)

           -palonosetron (Aloxi)
  • Neurikinin receptor antagonist:
          -aprepitant (Emend)
          -fosaprepitant (Ivemend)
  • Cannabinoid: nabilone
  • Hyoscine: hyoscine hydrobromide (Joy Rides, Kwells, Scopoderm TTS patches)
  • Other drugs for Meniere's disease: betahistine dihydrochloride (Serc).  


jueves, 21 de julio de 2016


The Misuse of Drugs Regulations 2001 (and subsequent amendments) define the classes of person who are authorised to supply and possess controlled drugs while acting in their professional capacities and lay down the conditions under which these activities may be carried out. In the regulations drugs are divided into five schedules each specifying the requirements governing such activities as import, export, production, supply, possession, prescribing, and record keeping which apply to them.
  • Schedule 1: includes drugs such as lysergide which is not used medicinally. Possession and supply are prohibited except in accordance with Home Office authority.
  • Schedule 2: includes drugs such as diamorphine (heroin), morphine, nabilone, remifentanil, pethidine, secobarbital, glutethimide, the amfetamines, sodium oxybate, and cocaine and are subject to the full controlled drug requirements relating to prescriptions, safe custody (except for secobarbital), the need to keep registers, etc. (unless exempted in Schedule 5). 
  • Schedule 3: includes the barbiturates (except secobarbital, now Schedule 2), buprenorphine, mazindol, meprobamate, midazolam, pentazocine, phentermine, temazepam, and tramadol. They are subject to the special prescription requirements. Safe custody requirements do apply, except for any 5,5 disubstituted barbituric acid (e.g. phenobarbital), mazindol, meprobamate, midazolam, pentazocine, phentermine, tramadol, or any stereoisomeric form or salts of the above. Records in registers do not need to be kept (although there are requirements for the retention of invoices for 2 years).
  • Schedule 4: includes in Part I benzodiazepines (except temazepam and midazolam, which are in Schedule 3), zaleplon, zolpidem, and zopiclone which are subject to minimal control. Part II includes androgenic and anabolic steroids, clenbuterol, chorionic gonadotrophin (HCG), non-human chorionic gonadotrophin, somatotropin, somatrem, and somatropin. Controlled drug prescription requirements do not apply and Schedule 4 Controlled Drugs are not subject to safe custody requirements.
  • Schedule 5: includes those preparations which, because of their strength, are exempt from virtually all Controlled Drug requirements other than retention of invoices for two years

Standards and safety checks

NMC(standards for medicine management)

-Controlled drugs are kept in a locked cabinet and the keys are carried by the nurse in charge (access to the keys and the CD cabinet is restricted to authorised registrants). CD stationery which is used to order, return or distribute controlled drugs should be kept in the locked cabinet. No other medicines or items to be stored in the controlled drug cupboard.
-There should be a list of the CDs to be held in each ward as stock items, only the CDs listed may be routinely requisitioned or topped-up.
-A copy of the signature of each authorised signatory should be available in the pharmacy department for validation.
-When CDs are delivered to a ward they should be handed to a designated person, under no circumstances should they be left unattended. After the delivery, the registrant in charge and a witness (another registrant) should check the CDs against the requisition, place the CDs in the CD cupboard, enter the CDs into the ward controlled drug record book, update the running balance and check that the balance tallies with the quantity that is physically present.
-All entries in the controlled drug record book must be signed by two registrants.
-Checking the balance in the controlled drugs register against current stock should be done twice a day, recording stock checks along with the date and signature of both health professionals carrying out the check. 
-The registrants should record the amount given and the amount wasted (if there is any) when administering a CD.
-Audits should be carried out to ensure that the record keeping is up to date and correct.

-Controlled drugs: safe use and management(2016) NICE guideline NG46
Images: kwizoo.com, www.officestationerywarehouse.co.uk, www.davidwolfe.com, www.opiates.com.

martes, 12 de julio de 2016


Obesity means having too much body fat. It is not the same as being overweight, which means weighing too much. A person may be overweight from extra muscle or water, as well as from having too much fat. Both terms mean that a person's weight is higher than what is thought to be healthy for his or her height.

Taking in more calories than you burn can lead to obesity. This is because the body stores unused calories as fat. Obesity can be caused by: 
-Eating more food than your body can use 
-Drinking too much alcohol 
-Not getting enough exercise. 

Many obese people who lose large amounts of weight and gain it back think it is their fault. They blame themselves for not having the willpower to keep the weight off. Many people regain more weight than they lost.
Today, we know that biology is a big reason why some people cannot keep the weight off. Some people who live in the same place and eat the same foods become obese, while others do not. Our bodies have a complex system to keep our weight at a healthy level. In some people, this system does not work normally.
The way we eat when we are children can affect the way we eat as adults.

The term eating disorder means a group of medical conditions that have an unhealthy focus on eating, dieting, losing or gaining weight, and body image. A person may be obese, follow an unhealthy diet, and have an eating disorder all at the same time.

Sometimes, medical problems or treatments cause weight gain, including: 
-Underactive thyroid (hypothyroidism) 
-Medicines such as birth control pills, antidepressants and antipsychotics. 

Other things that can cause weight gain are: 
-Quitting smoking: many people who quit smoking gain 4 to 10 pounds in the first 6 months after quitting 
-Stress, anxiety, feeling sad, or not sleeping well 
-Menopause: women may gain 12 to 15 pounds during menopause 
-Pregnancy: women may not lose the weight they gained during pregnancy.

Obesity should be managed in an appropriate setting by staff who have been trained in the management of obesity; the individual should receive advice on diet and lifestyle modification and be monitored for changes in weight as well as in blood pressure, blood lipids and other associated conditions.
An anti-obesity drug should be considered only for those with a body mass index of 30kg/m or greater in whom at least 3 months of managed care involving supervised diet, exercise and behaviour modification fails to achieve a realistic reduction in weight.
Drugs should never be used as the sole element of treatment. The individual should be monitored on a regular basis; drug treatment should be discontinued if the individual regains weight at any time whilst receiving drug treatment. 

1. Anti-obesity drugs acting on the gastro-intestinal tract:
-Orlistat (Xenical).

2. Centrally acting appetite suppressants:
-Rimonabant (Acomplia)
-Sibutramine Hydrochloride (Reductil).

In July 2012, the FDA approved two new medicines for chronic (ongoing) weight management. Lorcaserin hydrochloride (Belviq®) and Qsymia™ are approved for adults who have a BMI of 30 or greater. 

Weight-loss surgery might be an option for people who have extreme obesity (BMI of 40 or more) when other treatments have failed. It is also an option for people who have a BMI of 35 or more and life-threatening conditions, such as:

-Severe sleep apnea 
-Obesity-related cardiomyopathy
-Severe type 2 diabetes

Two common weight-loss surgeries include banded gastroplasty and Roux-en-Y gastric bypass. For gastroplasty, a band or staples are used to create a small pouch at the top of your stomach. This surgery limits the amount of food and liquids the stomach can hold. 

For gastric bypass, a small stomach pouch is created with a bypass around part of the small intestine where most of the calories you eat are absorbed. This surgery limits food intake and reduces the calories your body absorbs.
Like any surgery, there are risks associated to this interventions, side effects and lifelong medical followup is needed after both surgeries.

-BNF 57 March 2009

lunes, 27 de junio de 2016


Clinical communication with patients, relatives and care givers can be a challenge to healthcare providers. However, the use of communication skills and a therapeutic relationship may help seriously unwell patients and their families achieve the best way possible to cope with the illness (Finset 2015).

The first thing to be done whenever a clinical interview takes place or very important medical information is going to be disclosed to patients and/or family is planning and preparing the interview. 
Breaking bad news is reported to be one of the most stressful communication tasks (Porensky et al. 2015), this is why preparation is so important, including where and how the information is going to be given and anticipating possible questions. Preparation includes preparing oneself, the patient/family and the environment (Barnett 2013). 

Allowing enough time is key to enable successful communication. As the Regional Guidelines state “that it is strongly recommended that the person (named or specialist nurse) accompanying the professional who delivers the news, remains with the patient or family member if appropriate and help provide continuing support” (Department of Health, Social Services and Public Safety 2003). 

Different strategies for managing difficult situations like the Ten-step approach, SPIKES (Box 1) and Seven-step approach have preparation as its first step (Lewis et al. 2010).

Use a “warning shot;” that is, say something to prepare such as, “I do not have good news.”
Regional Guidelines state “that warning a patient or family member that bad news is coming may help lessen the shock and may help to process the information they receive” (DHSSPS 2003). 
Social psychology research has suggested that this approach may be most effective in reducing shock and distress of news with potentially serious implications (Porensky et al 2015). 

The news should be given in small chunks with pauses in between allowing time for information to be processed and encourage questions (DHSSPS 2003). Although the medical team will always try to make decisions in the best interest of the patient, the involvement of the patient and the family is decisive as the evidence suggests that patients increasingly want additional information regarding diagnosis, prognosis and treatment (DHSSPS 2003). It is important to remember the use of simple words and short sentences to ensure that the information provided is as clear as possible.
Patients and family often express feelings without talking about them (Egan 2013), their reactions and non-verbal communication can give us an idea of what the patient and family think and feel. 

Planning and preparing includes establishing goals and objectives, select method of disclosure, select the content and arrange resources (Hargie 2010).  Patients and family who have a clear plan for the future are less likely to feel anxious and uncertain (DHSSPS 2003). Furthermore, communication has a direct impact on the degree to which patients cope (Hawthorn 2015).
A study has shown that individuals who hear the negatively-framed prognosis are significantly more distressed than individuals who hear the positively-framed prognosis (Porensky et al 2015).

Breaking bad news is often a continuing process, it is important not to offer unrealistic hope but it is equally important that patients and family can discuss, consider options and come to terms with limitations without feeling abandoned by the health professional team (DHSSPS 2003).
Every person is different and the degree of information desired can vary as well as their expectations and their coping mechanism.
Evidence suggests that tailoring the amount of information provided according to the level of information a patient desire is associated with lower anxiety and better problem-focused coping (Porensky et al. 2015).

Breaking bad news can be extremely stressful for the professionals involved, emotions such as anxiety, a burden of responsibility for the news and fear of a negative response can have an adverse effect on those receiving and those delivering the news (DHSSPS 2003). Preparing the interview and following steps is a useful way of gaining confidence. Being clear about care goals may also assist staff who may need formal support in order to deliver high quality of care (Lewis et al. 2010).

-Egan, G. (2013) The Skilled Helper. 10th Pacific Grove, California Belmont Brooks Cole/Cengage Learning.
-Hargie, O. (2010) Skilled interpersonal communication: Research, theory and practice. Hove Routledge.
-Porensky, E.K. and Carpenter, B.D. (2015) Breaking bad news: Effects of forecasting diagnosis and framing prognosis. Patient Education and Counseling, 99, 68-76.
-Lewis, D. and Kitchen, C. (2010) The role of communication skills in end-of-life care. Journal of renal nursing, 22(2), 69-74.
-Hawthorn, M. (2015) The importance of communication in sustaining hope at the end of life. British Journal of Nursing, 24(13), 702-705.
-Barnett, M. (2013) Breaking Bad News – Pointers and Pitfalls. Scottish Universities Medical Journal, 2(2), 54-57.
-Leonard, M., Graham, S., and Bonacum, D. (2004) The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care, 13(1), 85-90.
-Department of Health, Social Services and Public Safety. (2003) Breaking bad news  Regional Guidelines. DHSSPS, Belfast.
-Finset, A. (2015) The elephant in the room: How can we improve the quality of clinical communication during the last phases in patients’ lives? .  Patient Education and Counseling, 99, 1.