taighwilliam

No one else got any thoughts ???

I agree that 'walk round' reports frequently breach confidentiality. Also not all aspects of care to be given are appropriate for the patient to hear i.e. tentative medical diagnoses. My current work area uses face to face handover- this does have the benefit of direct questioning. Also if the nurse knows the patients they will ask for only a brief run down on the changes that day. However i feel that nurse mentors are not putting enough effort into teaching student nurses how to do an accurate but also concise report. Like most systems of communication we need to assess it's merit in how it helps us look after our patients.' Face to face reports are of extremely good validness when the nurse knows her patient well. Anyone wh has done interviewer research will know the depth of information that can be obtained from face to face communication.

I mean has anyone set up any policy or care pathway to help decide when palliative care begins for the patient and curative medicine ends. My current experience is that this decision is made by a senior physician and that this brings with it variability.

I work in a busy acute medical admissions unit- has anyone carried out work wrt to end of life decision making? At the moment this is haphazardly carried out (varies greatly between physicians). It would also be of interest if the recommendations from such work was accepted by the MD.

I think for a nurse it is irrelevant whether they practice as PA or NP...you can't remove the fact they have nursed. Nurses stay with the patient throughout their ordeal and take a much wider, holistic view of their patient. For a nurse, reversability of an illness is not always the appropriate action to take for the patient. However unlike the MD or PA, the nurse must understand both nursing and medicine. This understanding allows her/him to unite these differing spheres to the benefit of all patients.

I must say i have never heard of the 'clinical doctorate' concept