lunes, 28 de agosto de 2017


It is not a secret that nursing morale is low and that there are ongoing problems in the recruitment and retention of nurses and that those in the profession feel they are undervalued, underpaid and overworked.
This is an issue not only in the UK, Sweden, USA, Canada and Australia among others also have reported low morale in nursing (Callaghan 2002).

"The main drive for people to enroll in the nursing profession, even when the work conditions are so oppressive, is the compassionate side of it (Zeldin 1995)".

What is nursing morale?
Morale can be defined as the confidence, enthusiasm, and discipline felt by a person or group of people, especially in a dangerous or difficult situation (Cambridge University Press 2017, Oxford University Press 2017). Morale was first used meaning confidence in 1831 and related to the military.
Assurance, self-esteem, attitude, mood and humour are synonyms while fear and weakness are considered antonyms (Philip Lief Group 2009).
The person/group have morale when they feel confident and safe, there is passion, a deeper feeling of power, determination and energy to achieve certain goals. But also, discipline and team working.

Term clarification
Low morale is a negative state of mind which impacts on feelings, emotions, confidence, motivation, determination, cheerfulness and willingness to do certain actions.
Burnout is a psychological term that refers to long term exhaustion and diminished interest in work. The symptoms are similar to those of clinical depression. The Oxford dictionary also includes that in burnout there is physical impact caused by overwork or stress. There are different kinds of stress, pressure of work would be classified as routine stress however, chronic stress is reported to have serious health effects.
It could be said that prolonged low morale due to chronic overwork could be a potential trigger for physical and mental problems (burnout) as it has negative effects on emotions, confidence and motivation.

The components of the morale of nurses can be divided in:
-extrinsic (out of control of the individual nurse or the group they work in): organisational structures, operational issues, leadership traits/management styles, communication and staffing.
-intrinsic (nurses have some control over them): professional worth and respect, opportunity/skill development, work group relationships and patient care.
The factors that enhance morale appear to be intrinsic factors, whereas the extrinsic components dominate the factors that reduce morale (Day et al 2006).
Word Cloud (1).png

What are the causes of low morale?
-hospitals more concerned about finances than with patient care (Castledine 1997, 1998).
-low pay (Callaghan 2002, Day et al. 2006, Day et al 2007).
-lack of support for education and training, despite emphasis on further qualifications, nurses feel they are not supported in gaining these qualifications (Callaghan 2002, Day et al 2007).
-the quality of nursing education (Day et al. 2006, Day et al 2007).
-frustration about limited opportunity for promotion (Callaghan 2002, Day et al 2007) and the lack of recognition for job performance and professional achievement (Day et al. 2006, Day et al 2007).
-lack of resources (Callaghan 2002).
-job insecurity, despite the shortage of nurses, interviews carried out in Scotland indicated that there was a strong feeling of insecurity in relation to jobs, the uncertainty of the future of the health service, the number of changes and the lack of resources (Callaghan 2002).
-job pressure and overwork (Callaghan 2002, Day et al 2007).
-shortage of workers (Day et al. 2006, Day et al 2007)
-difficulties in recruitment and retention of staff (Day et al. 2006, day et al 2007).
-professional support and prospects (Day et al 2006)
-fiscal responsibility, litigious environment and increased client expectations (Day et al 2006).
-autonomy, recognition and interpersonal relationships (Day et al 2007).
-nurses strongly value the ability to provide good patient care and the failure to do so can lead to feelings of low morale. There is evidence of of the negative effects of high workloads and low staffing levels and its subsequent effect on providing quality patient care and morale. Demoralization may be exacerbated by continual and incremental pressure to provide care in an environment driven primarily by cost containment at the expense of patient care (Day et al 2007).
-how nurses are perceived in the workplace, how they perceived they are undervalued as professionals, and how they are excluded from the organizational decision-making process. Nurses find themselves in a system over which they have little control or little ability to do so(Day et al 2007).
-nurses are finding that they are being loaded with additional administrative and reporting tasks while expected to undertake an increasingly complex clinical load (Day et al 2007).
-abuse and violence in the workplace either from patients, families and other health professionals (Graydon et al. 1994, Laschinger 2014)
-increased role ambiguity that leds to decreased job satisfaction and increased perceived stress. Occupational stress has a strong influence on the development of depressive symptoms in nurses (Revicki and May 2010).

What are the consequences?
-anxiety, stress, decreased performance and increased professional negligence (Castledine 1997, 1998, Day et al 2007).
-costly to organizations and a key source of poor patient outcomes and care (Day et al 2006).
-negative impact on staff's health and well-being, focusing specifically on mental health problems, Borrill et al (1996) found that 28% of nurses in the NHS were suffering from minor mental health problems, generally identified as anxiety and depression. Similar findings were reported by a study that concluded that mental health problems were significantly correlated with increasing workload, understaffing, job insecurity and perpetual organisational change. So serious have nursing absence and sickness rates become that they were estimated in 1998 to be costing the NHS about £700 million annually. Also, a report found the risk of health professionals killing themselves was 24 per cent higher than the female national average, adding: "This is largely explained by high suicide risk among female nurses" (Daily Mail 2017). Suicide risk among nursing professionals is associated with symptoms of depression and correlated with Burnout Syndrome (Dos Santos et al 2015).
-nursing has undergone a great deal of change, growing pressures to increase efficiency and cost-effectiveness, changes in management roles, decreased number of qualified nurses working in wards, the system of "integrated care" which emphasizes communication between specialities, and ongoing training and updating of knowledge. Also, there has been a change in the education of nurses from a hospital-based to an university-based programme.
In summary, rising costs resulted in a reorganization of the health services changing the working environments of nurses, these changes, including increased workloads and a climate of uncertainty lead to high rates of nurses leaving the profession. This FACT is not a recent problem, there are studies from the 1980's stating that the NHS was having difficulties recruiting and retaining nurses and there were predictions of future nursing shortages (Price Waterhouse 1988).
-negative impact on patient experience, satisfaction and even outcomes (Yang and Huang 2005).

"Unless the factors contributing towards low morale are addressed, qualified nurses will continue to leave, potential recruits will be discouraged from entering the profession and those remaining will continue to be overworked" (Day et al 2007).

Any solutions proposed?
-increased health service resources, in particular for nurse education, might improve nursing morale, but it would take time before any changes would be felt at the ward and individual nurse level. A successful strategy for nursing education has to be consistent and provide resources to pay for this education, time off to do this courses and cover wards when staff are absent for this purpose (Callaghan 2002).
-better pay and better work conditions (Castledine 1997, 1998)
-analyse why morale is so low (Castledine 1997, 1998)
-develop appropriate workplace strategies (Day et al 2006)
-good relationships with co-workers (Day et al 2007)
-participatory supportive management styles, decentralized organizational structures, adequate staffing, flexible working schedules, professional autonomy and responsibility, emphasis on teaching, education and career advancement opportunities (Day et al 2007).
-consider alternative management styles that allow greater flexibility of clinical practice and decision-making while minimizing the level of "non-essential! paperwork and bureaucracy (Day et al 2007).
-encouraging and fostering team work, reducing organizational impediments, antiquated management structures and a mindset of cost-reduction to allow nurses to deliver quality patient care, creating an environment where nurses are recognized for their skill, experience and important contribution to health care provision and consulting and involving nurses in the changes to the health care system (Day et al. 2007).

Nursing is one of the major workforces in the healthcare system, ensuring that nurses are treated fairly and that their morale is protected will increase staff retention and patient safety while potentially, improving patient experience and outcomes (Bengoa et al 2016).

If research is not applied, what is the point of it? 


-Andrew, N., Lopes, A., Pereira, F. and Lima, I. (2014) Building Communities in Higher Education: The Case of Nursing. Teaching in Higher Education, 19(1), 72-77.
-Bengoa, R., Stout, A., Scott, B., McAlinden, M. and Taylor, M.(2016) Systems, not structures. Changing Health and Social Care. Full report. Belfast: Department of Health. Available at: [Accessed 2nd December 2016].
-Cambridge University Press. (2017) Morale. In:  Cambridge English Dictionary. Available at: [Accessed 1 April 2017].
-Callaghan, M. (2013) Nursing morale: what is it like and why? Journal of Advanced Nursing, 42(1), 82-89.
-Chan, C. C. A., McBey, K., Basset, M., O’Donnell, M. & Winter, R. (2004). Nursing Crisis: Retention Strategies for Hospital Administrators, Research and Practice in Human Resource Management, 12(2), 31-56.
-Chin W., Leon Guo, Y., Hung, Y., Hsieh, Y., Wang, L. and Shiao J.S. (2017) Workplace justice and intention to leave the nursing profession. Nursing Ethics.
-Clyde, E.B. and Richardson, R.C.(1963) Twenty-Five Years of Morale Research: A Critical Review.  The Journal of Educational Sociology, 36(5), 200-210.
-Cowden, T., Cummings, G. and Profetto-McGrath, J. (2011) Leadership practices and staff nurses’ intent to stay: a systematic review. Journal of Nursing Management, 19, 461-477.
-Day, G., Minichiello, V. and Madison, J.(2007) Nursing morale: predictive variables among a sample of Registered Nurses in Australia. Journal of Nursing Management, 15(3), 274-284.
-Kalisch, B.J., Lee, H. and Rochman, M. (2010) Nursing staff teamwork and job satisfaction (2010) Journal of Nursing Management, 18(8), 938–947.
-Kirkwood, M., Wales, A. and Wilson, A. (2003) A Delphi study to determine nursing research priorities in the North Glasgow University Hospitals NHS Trust and the corresponding evidence base. Health Information and Libraries Journal, 20(1),53–58.
-Kleinman, C.S. (2004) Leadership: A Key Strategy in Staff Nurse Retention. Journal of Continuing Education in Nursing, 35(3), 128-132.
-Li-Chun, C, & 張理君 (2009) The Study of Relationships between Perception of Patient Safety Culture and Morale of Nursing Staff'. Networked Digital Library of Theses & Dissertations. Available at: [Accessed: 4 May 2017].
-Migration Advisory Committee. (2016) Partial review of the Shortage Occupation List, Review of Nursing. London: Migration Advisory Committee.
-Niklasson, J., HÖRnsten, C.,; Conradsson, M., Nyqvist, F., Olofsson, B., LÖVheim, H. and Gustafson, Y. (2015) High morale is associated with increased survival in the very old. Age & Ageing, 44(4), 630-636.
-Nolan, M., Brown, J., Naughton, M. and Nolan, J. (1998) Developing nursing's future role. 2: Nurses' job satisfaction and morale. British Journal of Nursing, 7(17), 1044-1048.
-Oxford University Press. (2017) Morale. In: English Oxford Living Dictionaries. Available at: [Accessed 1 April 2017].
-Paley, J. (1996) How not to clarify concepts in nursing. Journal of Advanced Nursing, 24, 572-578.
-Philip Lief Group. (2009) Morale. In: Roget's 21st Century Thesaurus. 3rd Ed. Available at: [Accessed 1 April 2017)..
-Russell, A.C. (2012) Moral Distress in Neuroscience Nursing: An Evolutionary Concept Analysis. Journal of Neuroscience Nursing, 44(1), 15-24.
-Strouse, S.M. and Nickerson C.J. (2016) Professional culture brokers: Nursing faculty perceptions of nursing culture and their role in student formation. Nurse Education in Practice, 18, 10-15.
-Tiaki, K. (2017) Nursing morale continues to decline -NZNO survey. Kai Tiaki Nursing New Zealand, 23(1), 7-7.
-Valizadeh, L., Zamanzadeh, V., Habibzadeh, H., Alilu, L., Gillespie, M. and Shakibi, A. (2016) Threats to nurses’ dignity and intent to leave the profession. Nursing Ethics.
-Velasquez, M., Thomas, C.A. Shanks, S.J., and Meyer, M.J. (1990) Justice and Fairness. Ethics, 3(2).
-Wager, E. and Wiffen, P.J. (2011) Ethical issues in preparing and publishing systematic reviews. Journal of Evidence-Based Medicine, 4(2), 130-134.
-Walker, L. O., & Avant, K. C. (1995). Strategies for theory construction in nursing. Norwalk, CT: Appleton & Lange.
-Yang, K.P. and Huang, C.K. (2005) The effects of staff nurses' morale on patient satisfaction. Journal of Nursing Research, 13(2), 141-152.
-Yoder-Wise, P.S. (2011) Leading and Managing in Nursing, 5th Edition. St. Louis: Elsevier.
-Young, P.D. and Hylton Rushton, C. (2017) A Concept Analysis of Moral Resilience. Nursing Outlook.
-Zeldin, T. (1995) An intimate history of humanity. New York : HarperCollins.

-Links to articles:

"Subjectivity can be considered a human trait and, as long as humans carry out research objectivity can be questioned. The best thing that researchers can do is acknowledge this reality and attempt to control it."

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.

-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

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