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Discussion

Nursing Dissertation / Thesis

Hi,

I am a final year student nurse and just about to start my dissertation. I still have no idea on what exactly I want to do.

I am studying in the UK so our topic is in relation to implementing something in the National Health Service in order to provide better patient services/outcomes.

I am really interested in Cardiology and was thinking something along the lines of heart screenings for every person wanting to join a sports club, as have SVT myself so have quite a good understanding of arrhythmias. also you see so often young people passing away from cardiac arrest after having 'undiagnosed' heart arrhythmias in newspapers, social media etc.

Or, there was a case this year in the UK where there was a little boy (Alfie Evans) who was clinically brain dead, and the doctors wanted to turn off his life support, however, the parents didn't agree, as they wanted to try other therapies in Itlay. This case was brought to the high courts and was all over the news here. Nurses and doctors who worked at the particular hospital received a lot of abuse during this time by protesters. Unfortunately, the little boy passed away after the high court giving the case to the doctors who wanted to end his suffering. I don't think there are enough policies in place in who has a say in Critically Ill patients or how they go about choosing to turn off support systems and is clearly very difficult for the family to deal with and are probably not in their right mind-frame when situations like this arise. therefore I was thinking of trying to create some sort of policy to say how long patients should be kept on life support or something in the lines of this.

if anyone has any recommendations or ideas could you please let me know?

I really want to obtain a first in my degree and want to do everything to achieve that!

Thanks

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    The first one could be a good topic... maybe explore adding additional cardiac screening to standard care?

    The second is an important topic... personally I think it's gross overreach to put a hard-and-fast limit on life support. As an ICU nurse I've seen countless pts whose family opts for a trach'n'PEG... some cases have made me feel physically ill because I felt like we were torturing that pt. But I have also seen a few who I would never in a million years expect to have any quality of life... but months, a year or more later they come visit us to say "thank you for saving my life." I would hate for those people to be denied life based on a time pre-determined by legislators who don't know that pt from Adam.

    Plus how do you measure improved outcomes?

    The issue with that case you mention -- and we have had a couple similar cases in the US -- is that the child was *brain dead.* Brain dead = deceased (at least in the US... the officially recorded time of death is the time the physician confirms brain death -- not when the pt is taken off a ventilator, or when the heart stops.) Brain dead is not a coma or a vegetative state -- it is DEATH.

    To keep a brain dead person on cardiopulmonary support, unless the pt is an organ donor -- in my opinion is the mistreatment of a corpse... because that pt is dead.

    Personally I would love to see wider education on what brain death is. Part of that, I think, is the term "life support." It is cardiopulmonary support, it is a ventilator or mechanical ventilation, etc.... but in the case of a brain dead person it is not LIFE support. Because that pt is no longer alive.

    Another issue kind of related that I think would be beneficial, is assistance for families in making the decision that THE PT would want... not necessarily what they as the family wants. A big part of that is having these conversations with our loved ones.

    So maybe propose some kind of education initiative on these issues, through the NHS again as part of standard care? Kind of like how here, families with new babies are ALWAYS taught about shaken baby DAIs, corificeat safety, feeding etc.

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