Donation and Compensation

Organ dontation, to opt in or to opt out, that is the question.

I am on the regiser as an organ donor, I'm also a blood donor between piercings, tattoos and foreign travel. Clearly I am a pro-dontation so I don't doubt this affects my opinion on the subject.

Personally I would be happy to see the introduction of an 'opt out' system of presumed consent. We need to increase the number of tissue and organ donors in the UK as we currently cannot meet the demand. I think that there are many people who would be happy to donate but just never get around to making that decision and registering. Where as, if an opt out system were in place, I expect those who do not wish to do not would feel quite strongly about this and be motivated to opt-out. I also feel that organ donation should be in the hands of the individual, not the relatives.

However there are problems with presumed consent. Is it informed consent, as is required for consent for other medical procedures, and how can we ensure it is informed consent? Making the material available for the individual to read does not necessarily mean they will (though personally I feel that's their choice).

How easy will it be to opt out and will that wish be respected. As with all things there is the risk of abuse. What if a person chooses to op out in the last moments of their life, can this be verbal withdrawal of consent, must it be written? What about children? Would the responsibilty lie with thier parents, and at what point would they be able to make their own decision?

Those are jsut a few of the issues that spring to mind and clearly it's an ethical minefield. (Life would be a lot easier without ethics I often think!) However I think it's worth considering the issue fully. On first thought I'm compeltely in support of the system. When I think further on it I see the difficulties that may arise. However ultimately I am in favour of it.

Suing hospitals for compensation is my next port of call. It's the recent story with Lesley Ash being awarded £5million that has prompted this and I've been considering for a while what I wanted to say about it.

*deletes all the heartless things she wrote*

Undoubteldy Lesley has suffered and I don't deny that there was negligence on the part of the hospital however it is an absolutely atrocious anount of money for one person to be awarded. Ultimately it feels rather like revenge on her part. But more importantly the part that bothers me is people taking much-needed money away from a FREE healthcare system. At the end of the day money doesn't bring back the dead, won't make you walk again but it will make a difference to patient care.

I'm not saying the hospital shouldn't be held accountable in some way, and change should be implemented, but compensation is only good for one thing, satisfying the greed of the individual. (I know that in some circumstances a person may be unable to work as a result of negligence, they may therefore be unable to keep up with rent etc, but that is a very different situation to suing for £5million, more money than you could ever need, even then it feels wrong to be taking money away from the service.)

People make mistakes. Nurses make mistakes. Doctors make mistakes. Surgeons make mistakes. This is human error and generally speaking not malicious, we are doing our best in an over-worked, under-staffed, and under-appreciated system. The NHS is a FREE healthcare service, and whilst we should be striving to maintian high standards of care, people should spend more time being grateful for what we've got and less time working out how much money they can get out of it.

Please feel free to comment on this. I know I'm being rather opinionated, possibly narrowminded and almost certainly heartless, but nursing and the NHS is something I feel passionately about.

Return

I've been meaning to write ni this for a while now. Thank you MMW for your comment, it was a kick up the arse, I'm sorry it's taken so long to write since then.

Since I last wrote I have completed my nurse training, started working a staff nurse in a busy SW London hospital, ended a 4.5 year relationship and began a new one.

I've wanted to write so often recently, but this has usually been following a bad day at work where the madness of the NHS boils my blood! I still LOVE my job and it's partly for this reason that I've not written. I don't want this to become a negative "The NHS is Bad" blog.

However, I suspect many of my posts will remark upon the state of the NHS and nursing today. I will endeavour to include something positive, because the job is not all bad and there is still a lot of reward in it.

I was recently asked a question about the current NHS, red tape and political correctness. I've decided for my first post I shall copy my reply in here.

Sometimes I feel that the paperwork that has sprung up from politically correct government think tanks and public inquiries impedes nursing care. It detracts from what is important; caring for the patient, not just doing tasks, but caring for them, being with them and supporting them. I wonder why a paitent's ethnic origin is important to document, as far as I'm concerned everyone should receive the same high level of care and be treated individually. 4 hourly waiting time in A&E, if a patient isn't transferred/discharged within 4 hours they "breech" and this is a terrible thing. I think they explode or something like that. I frequently run (literally) down to the A&E department to collect patients before they breech and at the cost of my own patients on the ward: their pain relief has to wait, their dressing change has to wait, their feed has to be late. I'm sure as far as the governemnt is concerned this is good nursing: the patient in A&E isn't waiting more than 4 hours, but would an extra 15 minutes really make a difference?

But then I think about Victoria Climbie (if you've not read the Laming Report I sincerely reccomend you do, it's not pleasant reading but I believe awareness is the start of prevention). That child suffered terribly and was failed by so many people and services. A lot of systems and paperwork have been put in place since then with the aim of protecting children and preventing the reccurence of such a tragedy. Surely this a good thing. Yes, it's a pain in the arse when you have 5 different referrals and telephone calls to make, but if it can prevent a child's death or maltreatment then it's worth it in my eyes. Whether it would have actually made a difference in Victoria's case I don't know, personal accountability has to come into it at some point, beyond whether you ticked boxes and filled in a referral form. But we're trying.

So, after that long-winded and off track response I agree with Doc: Too much red tape is a bad thing, not enough is worse. The difficutly is trying to find the balance. In the NHS most red tape is aimed at improving patient care. Or am I being naive? Perhaps it's aimed at improving the hospitals bank balance. Whether in reality patient care is improved, I think you'd need to look at that on a case by case basis.

I'm going to leave it there for now, though this is something I will come back to.

MMW: Please give me time to catch up with you blogs! I'm incredibly out of the loop, I can only apologise.

Megan's Law and Iraq

So as I said earlier, I was going to rant about two articles I saw in the Metro.

Firstly the introduction of a trial of "Megan's Law". Basically, parents will be able to find out if a convicted sex offender lives in their street/on their school route and how many, but they won't be told their names or addressed. Well what is the point? How is it going to help the situation in any way? (I'm not suggesting we tell people who they are).

How will knowing a convicted sex offender lives in your area change your actions? Will you not let your children out ever? Well that's impractical and not good for the children and their development. Will you stop your 7 year old playing unsupervised in the street? Well I'm not sure they should be allowed to do that anyway. Will you teach your children to be streetwise, not to talk to strangers etc? Well shouldn't you be doing that anyway? All I can see it causing is panic and knee jerk reaction. And what if someone suspects they know who it is? Lynch mobbing. Plus there's all the sex offenders who haven't had a conviction of course.

The second part of today's rant. Iraq. I read today about protests in Iraq at the continued American presence 4 years after Saddam's regime ended. I won't get started on my feelings about that, the part that really got me was a military spokesperson saying that this is great, it's freedom of speech, how wonderful it is for the Iraqi people to be able to do that, they wouldn't have been able to do it under Saddam.

So self righteous, thank goodness the Americans (and the British come to that) were there to give back the Iraqi people freedom of speech, freedom to protest. Of course we will ignore completely what they are saying and want they want for their own country, but that's okay because we're letting them say it. Which is so very different from not allowing them to say it at all.

The latest installment

Once again there are plenty of things I can write about. But I need to have a whinge, as I am so disappointed and upset.

My final Portfolio essay was due in in the beginning of January, I sought advice from the programme leader who emailed me saying:

"Deferring your Portfolio essay will not be a disadvantage providing you pass it the first time when you submit on the 2nd att date. If you need to resubmit it it can delay you finishing..."

I also had a conversation prior to this email where she said it's only a problem if you don't pass it on the first attempt. Well now I have found out I won't get my results until the 29th of May. 6 weeks after my course finishes. 6 weeks where I can't start working as a nurse because I won't be qualified. If I had been told this when I sought the deferral I would not have taken it, and now there's nothing I can do. I just have to hope my delayed start date won't affect my chances of finding a job. I am so cross/upset about it.

In other matters, my placement is going well. I'm now unsure about whether I have hours to make up or not, not that it matters now as I'm not finishing on time anyway. As if I didn't have enough to worry about with finishing work and finding a job.

I know this is all incredibly self centred of me, other people have far worse troubles. Like the mother of the 18month old who had to be resuscitated and transferred to Intensive Care. Or the woman in adults on Wednesday who had an accident at work involving her hand and an industrial food blender that resulted in the loss the fingers on her dominant hand.

I'm most upset because I feel I was misled, it wasn't a decision made given all the facts.

Nights

Right, where to start? I feel like I've been AWOL for weeks. Firstly, I have a job interview on the 16th of February, my first nursing interview and for a job I would really like. I've got some preparation I need to do for that, including writing my portfolio (that I was supposed to have maintained as I went along).

I've found out that I shouldn't have any time to make up at the end of the placement which is a relief, one step closer.

Nights have been good. The first was horrible as I'd been up since 11am and started working a 8pm that night, we literally had about 10 patients all night so it dragged and I have no idea how I made it through! The second one was much better after a good day's sleep and looking after my own (lovely) patient until 3am. The third flew by and now I'm trying to adjust my nocturnal pattern.

We have the most amazing doors in our A&E department. They seem to miraculous cure children.
[Mum] He's been crying inconsolably for hours.
[Baby] *giggle* *gurgle* *smile*
[Nurse] He's a lot happier now, must be our magic doors.
[Mum] Really, he wasn't like this an hour ago.
At which point the parent usually makes an embarrassed apology and we tell them not to worry we'll check them out anyway. Invariably, as they have no other symptoms than crying, it's because they had a tummy ache or there's is nothing detectably wrong with them.

We had one 3 year old brought in in the early hours of the morning, she'd had an ear infection and been spiking temperatures for a week that were well managed at home, but the previous night it had spiked really high and had not been controlled so the family called the LAS. When they arrived they handed over that she'd had a temperature of 40.4DegC with them. With us it was 36.4. The explanation? In the last 10 hours mum had give 6 doses of paracetamol as "it wasn't working". Fortunate they did call the LAS and come in really or I think they would have continued to overdose their child. So we did some health promotion, sang ibuprofen's praises and sent them over to the out of hours GP.

We often try to stream patients to the Walk In Centre during the day, and our of hours GP at night, when they present with something that is neither an accident nor an emergency, we have criteria for doing this. During the day the department can be quite busy and it's far better they are seen in a more appropriate setting. At night the department is often very quiet, and for many hours empty, but we will still stream the patient tot he out of hours GP. If the GP is busy we will sometimes see them in the department, they are quite flexible.

On the one hand I feel we should just see them anyway if we're not busy, why send them somewhere else where they may have to wait when we have a doctor sitting reading a magazine. On the other hand I feel that it's an important issue of education. People use the A&E department inappropriately and will continue to do so if we just accept everything that turns up.

We had an 11 year old Sickle Cell patient turn up in crisis around 20.30. She had only taken paracetamol at home, without much effect and was scoring her pain at 7/10. Sickle cell patients have a pain relief protocol that is followed in hospital and at home. She should also have been given Ibuprofen and Codeine at home but her mother hadn't and just brought her in instead demanding stronger pain killers to be prescribed. What did we do? We referred to haematology (as all SC patients automatically are) and gave ibuprofen and codeine.

2 hours later she reported that her pain was a lot better. The haematology Registrar was busy with a very sick patient on the ward and had not yet been down. The mother decided to self discharge. But throughout the 2 hours they were there she complained constantly and demanded pain relief (that wasn't needed) and wanted to know why she wasn't being seen and said her other daughter had school the next day and she couldn't be waiting around in A&E all night. Essentially she was blaming us for something that was her own fault; she could have (and should have) been at home doing exactly what we were doing. We suspect she was trying to get in and out of the department with stronger pain killers early so they didn't have to come back in the middle of the night. Incidentally she didn't return that night. It is unfortunate that the Reg was busy elsewhere (how inconsiderate of the ward patient to be so ill!), but it was her own fault that she was waiting in the department for that time when she could have been treating her at home, instead she blamed us loudly in front of all the other patients.

I'll leave it there as this is getting to be a long, ranty entry. I'm sure there have been other blogworthy things but I shall save those for another time.

Disgusted

I am absolutely disgusted at the BBC and it's exploitation of children in cheap entertainment, also known as the show Baby Borrowers. I find it incredibly irresponsible of the BBC to have made this program, and it is taking the world's craze for reality television too far. The Metro covered the show in an article on wednesday which my boyfriend highlighted to me tonight and I felt compelled to Blog about it. I shall shortly be writing a letter of complaint to the BBC and OFCOM.

I do not care whether the parents consented to loaning their children out to make a television show (I wonder how much money they made from this), I personally think it says something about the kind of parents they are, it's a disgrace. It puts the children at risk physically and emotionally/psychologically, the consequences of which could be far reaching in terms of their development and mental health, if not their physical health.

The shows claims that it has taken "extraordinary" measures to safeguard the children, but it only takes minutes for an accident to happen that could result in a child's death, for example a baby being dropped by an inexperienced "parent" or a child unhappy in a stranger's arms, and no matter how much CCTV you have this is not preventable. Despite the many "experts" the BBC have monitoring the CCTV is it not always possible to predict the negative effect this separation could have on a young child.

The Metro article claims that a ten year old child goes unfed for a day, and that one baby had to be removed from one couple after thier relationship breaks down. I will not be able to confirm this as I shall not be watching this program.

Simply I see this as the exploitation of children in the name of cheap "entertainment", children unable to protect themselves and parent's who clearly need a good slap don't know any better, or just don't care.

Right, off to write a strong worded letter.

EDIT: Apparently you cannot complain to OFCOM until the program has actually aired so I'll have to wait until tuesday for that.

Political rant

On another blog I was just reading someone made a comment asking who the writer would vote for, Cameron or Brown, and I just had to make a post. This is something that I really disike: People consider the Conservatives and Labour to be the only contenders in the general elections, perhaps they are, but only because some people have already decided this and choose to vote for the lesser evil and not the party they actually feel would best represent their interests.

Whilst I understand why poeple tactically vote, I think it's really important that people vote for the party they feel should be in power, not the lesser of two evils; if poeple always do this there will never be any change. What's the point in living in a democracy and having the right to choose from a variety of political parties if it's not exercised.

Take the Liberal Democrats for example, they've not been in power for ages and poeple don't consider that they'd have a chance in a General Election. I know poeple who would vote for them but because they don't think they can win choose to vote Labour or Conservative. If those people actually voted for the LibDems we might see a change in government, but it's a cycle - people don't think they have a chance, so they don't vote, so they don't have a chance.

Now, from reading this you may just think it a Pro-LibDem rant, but it's something that I feel really strongly about. People complain about Labour and the Conservatives, but they don't have the motivation or courage to try and make a change, be that voting for the LibDems or Greenpeace or whoever.

Which brings me finally to a quote I have written on my bedroom wall.

"The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man." Bernard Shaw

Why should we settle? We have reasons to be grateful certainly, when we compare our country and political system to others, but that doesn't mean we should stop striving for change and improvement.

All done!