Marie Glackin

Investigation into experiences ofolder students undertaking a Pre-registration Diploma in Nursing

This paper sets out to investigate the experiences of older students undertaking a Pre-registration Diploma in Nursing in a large college of nursing in Belfast. Questionnaires were sent to all students aged 21 years or over on starting the course since its inception in February 1991. These amounted to 92 students. Quantitative and qualitative data were collected regarding the problems, needs and issues surrounding older students. The findings indicate that the college is not adequately meeting the needs of many older students and this is also the case when students are in the clinical area. Most of the respondents already had a high level of education and work experience. However, most were disappointed by the fact that this experience and their maturity was not always recognized, particularly in the clinical setting. This study provides clear evidence to suggest that older students perceive themselves to be more motivated than younger students and better able to study independently. However, even though older students may have some advantages over younger students they do have specific problems and needs which should be addressed. These are related to various issues amongst which may be finance, family commitments, academic study, difficulties in their adaptability and the speed at which they are able to learn new skills.

Characteristics and outcomes of haematology patients admitted to the intensive care unit

AIM To profile the characteristics and outcomes of adult haematology patients admitted to the intensive care unit (ICU). BACKGROUND The role of intensive care support for haematology patients is contentious due to high mortality rates thus generating debate regarding the inappropriate use of limited resources versus denial of effective care. METHODS Medical notes, laboratory records and Intensive Care National Audit and Research Centre (ICNARC) data for all adult haematology patients admitted to Belfast City Hospital ICU in 2009 were analysed. RESULTS Twenty one patients were admitted to the ICU; mean age was 56 years (SD 12·5), 52% were male and 82% (n=19) had a malignant diagnosis. The main indication for admission was neutropenic sepsis with associated organ impairment (n=18, 85%). ICU mortality was 43%. Three-month and six-month mortality rates were 62% and 67%, respectively. ICU survivors had lower acute physiology and chronic health evaluation (APACHE II) scores, and decreased requirements for invasive ventilation and inotropic support. Of the post-six-month survivors, one had a relapse, one had responding disease and five remained in remission. Two patients have subsequently undergone a reduced intensity conditioning transplant. CONCLUSION One third of patients survived for >6 months indicating that critically ill haematology patients can benefit from ICU admission, allowing progression to potentially curative therapies. RELEVANCE TO CLINICAL PRACTICE This study highlights the necessity of individualized assessment regarding patient suitability for admission to a critical care facility, incorporating the perspective of both the haematologist and the intensivist.

Screening-detected non-symptomatic breast cancer: a case history

Alice is a 65 year-old woman who was recalled for further investigations following a routine screening mammogram, which showed a 25 mm mass in her left breast. This case history will report on the further investigations and surgery required to manage this infiltrating ductal carcinoma. The histopathology report will be analysed to provide a rationale for future treatment with radiotherapy, and Alices expected prognosis will be presented using the Nottingham Prognostic Index. Alices psychological support needs will identified and the appropriate interventions will be discussed with a particular focus on Alices history of depression. The supportive and educational role of the breast care nurse and the multidisciplinary team will be highlighted throughout the study.