Education report needed to be more prescriptive

The UKCC's Education Commission has made some commonsense suggestions for improving the fitness of nurses to practise (UKCC, 1999). For example, longer clinical placements with students being more actively involved in patient care (see also Pp. 1126 and 1182). However, the Commission has neatly sidestepped some of the most crucial issues relating to preregistration nurse education, particularly which subjects students should cover on the common foundation programme (CFP), and whether the current branch programmes should be disbanded in favour of a more generalist approach, retained or even extended to reflect the changing healthcare environment.

Should children be able to request euthanasia?

The Dutch Parliament is expected to effectively legalize euthanasia in Holland next year following the publication of a Bill that guarantees doctors immunity from prosecution so long as they follow certain guidelines. The guidelines state that the patient must make a voluntary and informed request and be suffering irredeemable pain, and all other medical options must have been exhausted and a second opinion sought. All cases will have to be reported to the coroner and a regional panel which can recommend prosecution if the doctor has not followed the correct procedures.

Public and private sectors need the same standards

The standard of care in the private health industry has always been the subject of much scrutiny and debate. Therefore, the publication of the Government's consultation document looking at the regulation of the independent sector is to be strongly welcomed (Department of Health (DoH), 1999). The document states that current regulatory arrangements in the independent sector are ‘out of date, unsatisfactory and not sufficiently independent… nor do they provide the protection to which the public is entitled’.

More clinical skills but not at the expense of theory

The Government's new strategy for nursing in England, launched this month, supports the development of clinical career paths and a more clinically focused educational system for nurses and, as such, is long overdue (Department of Health (DoH), 1999).

Nutrition and hydration are not options but rights

The BMA's new guidelines regarding the withholding and withdrawing of life-prolonging medical treatment (BMA, 1999) is an attempt to clarify the confusion that exists in relation to this controversial area of patient care. Simply stated, if a treatment fails or ceases to give a ‘net benefit’ to the patient then the BMA now deems that it is ethical for it to be withdrawn or withheld. In addition, doctors are not routinely obliged to seek court approval before withdrawing artificial nutrition and hydration from patients(see news p. 846).

Healthcare professionals must learn to say sorry

Health Service Ombudsman, Michael Buckley, charged with investigating complaints made against the NHS, has published his annual report for the period 1998–1999. The majority of complaints made against the NHS during this period concern clinical matters and a wide range of NHS services (Health Service Commissioner (HSC), 1999).

Nursing professionalism is marred by sexy stereotype

The professional status of nurses has long been the subject of heated debate. There are those who believe that nursing is already a fully developed profession and, as such, its members should be awarded appropriate status and responsibility. However, there are others who believe that nursing is not yet a true profession and that professionalism will only be achieved through constant striving for higher levels of nurse education and practice. Nursing has concerned itself with this debate because it knows that with true professionalism comes attendant power and responsibility.

Nurse leaders must be more clinically credible

The reason why the case of Caroline Flint, the midwife who came up before a UKCC disciplinary hearing, has been so widely publicized is because she previously had held the position of president of her professional body — the Royal College of Midwives (see news p. 636). The fact that someone as prominent as Ms Flint could be involved in regular direct care is a mark of how practice has always been at the heart of the midwifery profession.

NHS executive tells nurses to be 'public spirited'

The NHS Executive has recently announced that the millennium is, for pay purposes, just an ordinary bank holiday, but that for service provision, extraordinary measures need to be planned.

It is time to take a legal stance on euthanasia

An American court's decision to send Dr Jack Kevorkian to prison for between 10 and 25 years is certainly a set back for supporters of legalized euthanasia. Dr Kevorkian was found guilty in the second degree of the murder of 52-year-old Thomas Youk, a man who had become a victim of the progressive and seemingly incurable Lou Gehrig's disease.

Nurses must protect patients' nutritional needs

The case of the 85-year-old woman who died in a nursing home following the withdrawal of her food and fluid supplements raises serious issues in relation to the management of people in the end stages of their lives for both the medical and nursing professions (see p. 416 for details).

Nurses must debate new prescribing proposals

The final recommendations of the review of the national system for the prescription, administration and supply of medicines, chaired by Dr June Crown, have now been published (Crown, 1999) and are to undergo a period of consultation.

Health care for elderly people should be free

The long-awaited publication of the Royal Commission's report into long-term care for elderly people has been given a qualified welcome by organizations dealing with the welfare of older people (please refer to news p. 274).

New body to replace UKCC and national boards

The year-long review of the Nurses, Midwives and Health Visitors Act 1997 by the independent consultants, JM Consulting Ltd, has culminated in a report which, surprisingly, has been welcomed almost unanimously. The Government has accepted most of the reports recommendations which means that the UKCC and the four National Boards are to be abolished and replaced by one UK-wide statutory body (please refer to p. 198 for full details).

Pay award is welcome but will it help retention?

The much publicized national pay increase for nurses, which is to be above inflation, can certainly be viewed as progress, but is hardly the panacea for the problems facing mursing that the Government would have us believe it is.

Education must not be made a scapegoat

A Sunday Telegraph columnist recently wrote: ‘Intelligent nurses who squander half their training in the classroom, studying pseudo-academic subjects such as race awareness, arrive on the wards unable to take blood pressure or insert catheters…Perhaps its as well that they tend to cluster round the “nursing station” ignoring the patients’ (Marrin, 1999).

Who owns a person's body organs after death?

There is currently a deficit between the number of patients in need of transplanted organs and the number of organs available for transplant. At present, the situation in relation to organ donation is that if people wish to donate their organs after death they place themselves on a donor register or carry an organ donor card. Alternatively, relatives of the deceased are approached for permission to harvest the deceased's organs for transplantation.

Slow rehabilitation of a traumatic lower limb amputee

A 65-year-old male (GM) was referred to the physiotherapy department of the regional limb fitting centre for outpatient rehabilitation following a right transfemoral amputation five weeks previously. He had been knocked down by a bus and suffered a crush injury to the right leg resulting in a stable fracture to the right pubic ramus, a fractured skull and orbital bone. Immediately following admission to the local district general hospital, his right leg was amputated at the transfemoral level. He was nursed post-operatively in ITU for three days and was ventilated during this time. GM was then transferred to the general orthopaedic ward. He received physiotherapy throughout his hospital stay by ward-based physiotherapists--not experts in amputee management but with access to specialist advice. Early physiotherapy was primarily concerned with respiratory care and maintenance of limb mobility and function in bed. Gentle, active stump exercises were commenced on the first post-operative day. GM sat out of bed on the sixth day and stood with the support of two people on the eighth day. His wound was healing well and treatment in the physiotherapy gym began the same day. Use of the pneumatic post-amputation mobility aid (PPAM aid) (Redhead, 1983; Marks, 1996) was started on day nine. However, progress with this early walking aid (EWA) was slow and GM achieved independent walking using parallel bars on the eighteenth post-operative day.

A higher level of practice is the way forward

At last the UKCC has shown that it can provide effective leadership by bringing order to the chaos that surrounded the specialist practice framework. Since this framework was first outlined in the PREP document in 1994 there has been a proliferation of nurse specialist posts. The criteria necessary to qualify for these roles have never been made clear by the UKCC which has led to trusts and the profession interpreting them in various ways.

Nurses must be protected by law from assault

The assault of a nurse carrying out his/her professional duty is completely unacceptable and the severest sentences possible should be meted out to those who are found guilty of this type of offence.

Care of elderly people in hospital is inadequate

It is a damning indictment of health care today that a recently completed report has shown that care of elderly people in 16 randomly selected acute wards in England was seriously lacking in a number of fundamental areas. The report Not Because They are Old (Health Advisory Service 2000, 1998) was commissioned by Frank Dobson, the Health Secretary, in response to public concern over deficiencies in current systems of care.

HLA restriction patterns of gliadin- and astrovirus-specific CD4+ T cells isolated in parallel from the small intestine of celiac disease patients

Celiac disease is a common HLA-DQ2-associated enteropathy caused by an abnormal T-cell-mediated immune response to ingested wheat gliadin proteins. We have previously isolated in situ activated mucosal T cells from celiac disease patients and demonstrated that these T cells were gliadin specific and predominantly DQ2 restricted. In contrast to this, gliadin-specific T cells isolated from peripheral blood display a variable HLA restriction pattern, thereby indicating that the skewed DQ restriction of T cells resident in the celiac lesions could be dictated by a preference for DQ-mediated antigen presentation in the mucosa of CD patients. To address this, we analyzed the HLA restriction of T cells recognizing astrovirus, a common gastroentetitis virus, isolated from intestinal mucosa of six celiac disease patients. As an internal control, gliadin-specific T cells were isolated and analyzed in parallel. The gliadin-specific mucosal T cells were marked in their DQ2 restriction, whereas the parallel astrovirus-specific T cells were predominantly restricted by DR molecules. Our data indicate that the repertoire of T cells present in celiac lesions is determined by the priming antigen(s) and not by a skewing in the expression of functional HLA class II isotypes in the disease affected small intestinal mucosa.