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Shell we talk about bones?

3 Aug, 15 | by hnoble

Matthew Carson – PhD student, Queens University Belfast

In 1997 a pioneering study showed that bone formation could be stimulated in humans solely through injections of powdered nacre, or mother of pearl, derived from the shells of oysters. The findings of this work were exceptional but cannot be fully appreciated without first understanding the scale of bone related disorders.

Fractures, whilst an obvious choice when thinking of bone damage, tend to heal within 2 months of injury. Massive trauma can result in complex fractures which are more difficult to treat, whilst a small number of normal fractures can show delayed healing. Osteoporosis on the other hand is poorly understood but more prevalent and difficult to treat. This disease causes a decrease in bone mass and a breakdown in structure, making bones weaker and more likely to fracture after even mild impacts and falls. People in their fourth or fifth decade of life are most at risk of developing osteoporosis; particularly postmenopausal women, of which 30% are estimated by the World Health Organization to have the condition. From a sufferer’s perspective, the disease can be extremely painful, limit movement and significantly reduce quality of life. It’s also expensive, with osteoporosis related fracture treatment costing UK health services £5.4 billion to treat in 2010 and £37.4 billion for Europe as a whole. This condition alone highlights the need for effective clinical interventions for bone disorders, yet there are many others not expanded upon here, such as osteopetrosis and Paget’s disease of bone.

So what can be done clinically to address these complications? There are three key factors that need to be considered when attempting tissue regeneration for the treatment of musculoskeletal disorders. These include a scaffold for tissue growth to take place upon, a cellular component to carry out tissue formation and the inclusion of bioactive factors. Bioactive factors refer to any substance which is able to produce a biological response in the body of the host. In the field of tissue regeneration this is focused upon those factors able to increase the action of the cellular component and therefore decrease healing times and improve patient outcomes. Specifically for bone regeneration Bone Morphogenetic Proteins, or BMPs, are the most clinically developed example of a bioactive. These proteins are known to stimulate bone formation, with both BMP-2 and BMP-7 available for clinical application in the US and UK. Both are being more frequently used in treatment, though their success is highly variable between individuals, gender, age groups and the type of bone being treated. As such there is a need for more effective bioactives to stimulate healing.

One highly promising reserve of novel bioactives is the ocean, which contains a huge variety of organisms adapted to survive under a range of different environmental conditions. Returning to the example of nacre from oyster shells, this shiny material is mostly comprised of a type of calcium carbonate, as well as a small organic component containing proteins important to the process of shell mineralisation. This composition is similar to that of human bone, which led Atlan and his team to the hypothesis that its inclusion in sites of damage may promote healing. Powdered nacre was mixed with the blood of eight middle-aged female patients before being injected into upper jaw defects. Bone biopsies, taken after six months, showed that nacre was non-toxic, presented good biodissolution and enhanced mineralisation. These results indicate the potential of marine extracts to promote healing in relatively simple procedures which require minimal processing steps.

Whilst nacre sparked the interest of the scientific community it is by no means the only marine extract which shows clinical potential. Many algaes have been shown to contain extracts able to promote the activity of bone forming cells, particularly brown macroalgaes. Mineralising species such as the red algae L. coralloides are also thought to increase mineralisation, and there is even a company devoted to selling a ground version of the algae for human consumption. In fact the organisms so far tested solely for their impact on bone cells and tissues are fairly diverse, including corals, sea cucumbers, many molluscs and bacteria, amongst others. However, considering the great diversity of invertebrate life within the oceans, these examples represent only a fraction of the total species which could be tested.

Overall, many marine extracts tested to date do show real promise for the stimulation of bone healing. However, our understanding of these processes is still limited, specifically as to what molecules actually stimulate cell activity and the mechanism of these effects. Furthermore, the majority of research has so far focused on determining the response of cells and little effort has been made to test their impact in animal injury models. Until these steps are taken the clinical use of many extracts will remain limited. However, research in this area continues apace, and the real question now is not whether marine extracts are feasible for use, but how long until they are common place in a clinical setting?

Reality Check

26 Jul, 15 | by rheale

Roberta Heale, EBN Associate Editor @robertaheale

Tomorrow morning I’ll be going to an appointment with an orthopedic physician. Last week I twisted my ankle, fell and found out that I’d broken a chip off my right lateral malleolus. It’s been less than a week with a cast, but it’s been real eye-opening experience.

At first I was frustrated. To start, let’s discuss the crutches. What an enormous nuisance. Awkward, and almost dangerous when I first get out of bed still half asleep. Next, it’s my driving foot. I’ve been ‘trapped’ at home all week. Quite a shock for such an active person! However, after a few days passed I suddenly had a large dose of humble awareness.

I really don’t have it all that bad, in fact, I have very little to complain about. My husband has done all the cooking. He’s wrapped my leg up in plastic so I’m able to shower. Our house is several levels, but all the important bits are all on the main floor (bathroom, bedroom, kitchen, sitting room). Not only do I have amazing support and quick access to good healthcare, but I’m incredibly fortunate to have the physical strength to maneuver on the crutches and do my personal care myself. I also have the mental capacity to make my own decisions. I have a job which gives me the flexibility to work from home and great benefits to cover the cost of crutches and medications.

Since this realization I’ve taken a step back and decided to treat this time as a gift. I’ve been forced to slow down. I’m taking the time to heal and take the time to realize my blessings. I hope that this feeling stays with me when I re-enter my hectic life and that I realize that most of the patients I see don’t have the same benefits in their lives. I hope too, that I’ll be more aware of the need for my advocacy. It’s unfortunate that it takes a minor mishap to confirm for me how lucky I am, but if it makes me a better health care provider it’s well worth it.

Patient Safety: Technical and Nontechnical Skills

23 Jul, 15 | by hnoble



Dr Ian Walsh – Queen’s University Belfast, School of Medicine


“Make our nervous system our ally instead of our enemy…… for this we must make automatic and habitual, as early as possible, as many useful actions as we can, and guard against the growing into ways that are likely to be disadvantageous to us, as we should guard against the plague.” James, W. (1992). Writings 1878–1899, p. 146. New York: The Library of America.

When patient safety has been compromised, what are the first comments to emerge? It’s virtually guaranteed that phrases such as “what were they thinking?”, “I don’t know what I was thinking…..” will be very much in evidence. This is a recognition that there is a fundamental error in thinking at play in the genesis of whatever risk has been exposed (hopefully before adverse consequences ensue).

It is only recently that tribute is starting to be paid to the central issue of faulty thinking in the arena of patient safety. Until now, patient safety has been regarded and discussed using frameworks encompassing essentially two broad areas:

(1) Technical skills.

(2) Nontechnical skills

Technical skills are perhaps the easier to describe and grasp, as they essentially revolve around issues such as dexterity and hours of practice. Proficiency in this area can be assessed by a variety of means, such as via Objective Structured Clinical Examination (OSCE), Direct Observation of Procedural Skill (DOPS) and such. Teaching and assessment of technical skills proceeds in a usually stepwise fashion employing binary thinking and ranking. This generates essential objective data which lends itself well to quantitative analysis.

Nontechnical skills are a less well –defined group.  They are largely concerned with communication, considered by most to be the key nontechnical skill of relevance in the clinical arena. Other such skills include (I’ve included communication as it remains “king”:

  • Communication
  • Teamworking
  • Leadership
  • Active Followership
  • Situational Awareness
  • Decision Making
  • Assertiveness
  • Prioritisation/Workload Management
  • Conscientiousness

Nontechnical skills are somewhat inappropriately referred to as being “soft” skills, yet their absence of presence in poor quality are usually found at the centre of any Serious Adverse Incident in clinical practice. This skill set also sits alongside, and shares a lot of features with, the vastly important Human Factors group; which is thought to account for over two thirds of aviation accidents (the corresponding figure in healthcare is currently thought to be higher than this).

The difficulty with nontechnical skills and human factors lies in the perceived difficulty in teaching and assessing them. Coming from a largely technical skill – biased background in surgery, I was initially sceptical about the validity and reliability of teaching and assessing nontechnical skills. Together with experienced colleagues (all of whom notably also came from Team Technical), my belief was that such skills were not taught, but imparted. Learning by osmosis was considered the norm, if not the gold standard.  My views have come to change in this regard; nontechnical skills can and should be taught to the same extent and arguably to a greater extent than technical ones. Communication can be video-recorded, analysed and archived. Team structure and roles (leadership, active followership) can be explained and practiced with simulated and standardised patients.

It is when one gets to individual nontechnical skills such as decision making ad self-awareness that challenges arise. We must turn to eminent authors in the fields of economics and behavioural analysis for assistance in this regard. As an example Daniel Kahnemann was awarded the Nobel Prize for his sublime work on cognition, fast and slow thinking. The General Medical Council have now come to recognise that such work should inform and be incorporated into undergraduate medical student teaching.

It’s one thing to demonstrate that nontechnical skills can be taught and assessed reliably, but can safe thinking actually be taught; and demonstrably so? I believe it can and recent data would seem to back this up. Introducing undergraduates to concepts of cognition (thinking, essentially) and metacognition (thinking about thinking) and self-awareness rapidly increased their ability to make correct and safe clinical decisions (Walsh et al, 2015).  It remains to be tested if safer thinking can be sustained, but this is a promising start.

Encouraged by these findings, I now propose a different, inclusive view of the structure of Patient Safety and argue that it could apply to any arena where safety is of paramount importance. I’ve somewhat facetiously, yet succinctly named this “Walsh’s Initial Safety Hierarchy”, which then evolves into “Walsh’s Hierarchy of Metacognitive Safety” in the hope (apropos wish)  that this will impart a degree of gravitas, if not admiration……..

WISH image


Metacognition is defined by the Oxford English Dictionary as “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses”; I still prefer “thinking about thinking”). The salient feature of the WHOMS model is the overarching role of metacognition in safe practice.


  1. James, W. (1992). Writings 1878–1899, p. 146. New York: The Library of America.
  2. Walsh IK, Spence A, Murray JM. Cognitive Reflection and Patient Safety. Presented at Association for the Study of Medical Education Annual Scientific Meeting, Edinburgh, July 2015.

Cardiovascular health is a global priority

14 Jul, 15 | by Gary Mitchell, Associate Editor


Dean Davidson

Dean Patricia Davidson @nursingdean from  John Hopkins University’s School of Nursing @JHUNursing will be leading this week’s EBN Twitter Chat (#ebnjc) on Wednesday 15th July between 8-9pm UK time (3pm-4pm EDT) focusing on cardiovascular health as a global priority.

Participating in the Twitter Chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward:

  • Go to your Twitter account
  • Follow the discussion by searching for #ebnjc once linked to the discussion, click “all tweets” to keep up-to-date with recent tweets
  • Add the EBN chat hash tag (#ebnjc) to your tweets to join in, this allows everyone taking part to view your contribution

Cardiovascular Health

Epidemiological transitions have signalled the need to not just focus on infectious diseases but also non-communicable diseases. This is a new paradigm in global health, which has traditionally been geared towards the management of infectious diseases. It has also expanded the roles of nurses and cast the spotlight on their important impact on health care from prevention to palliation.

Non-communicable diseases (NCDs) refer to health conditions or diseases that are non-infectious and non-transmissible. Of great significance to nurses is that many of these conditions can be prevented.

According to the Word Heath Organization, NCDs kill 38 million people each year, with 28 million of these deaths occurring in low and middle-income countries. Cardiovascular diseases account for most deaths from NCDS, or 17.5 million people annually, followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million).

Many of these conditions are chronic, complex and progressive, placing considerable burden on the individual, families, communities and society. As indicated above, cardiovascular disease is the NCD responsible for the most deaths worldwide, and much of this burden is attributable to heart attacks and strokes.

Yusuf and colleagues in the global INTERHEART study documented that nine easily measured risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption, and psychosocial factors) account for over 90% of the risk of acute myocardial infarction. This pattern of risk factors was the same across genders, racial and ethnic groups as well as geographic regions.   Although addressing these factors is overtly simple and low cost, many of us working in the field acknowledge that behaviour change is complex and moderated by physical, social, psychological and economic factors.  We also recognize we need positive policy environments to ensure health environments.

Knowledge is a necessary but insufficient condition for behaviour change but we have to engage society, individuals and providers more broadly to really create a context for a healthy environment.

Public health strategies, such as tobacco control, and boosting health infrastructure must form part of a multifaceted approach to this problem, in addition to an on-going focus on primary care.

Nurses play a critical role in the management of cardiovascular diseases across the health care continuum from prevention to diagnosis and death.  This requires a complex suite of knowledge, skills and values to advocate for the well-being of patients.  The importance of leadership is crucial for improving cardiovascular outcomes.  A range of competencies and skills is required for nursing to provide effective and efficient care. In addition to expert knowledge in cardiovascular care, nurses need to implement and evaluate evidence-based practice within culturally appropriate frameworks as well as advocating for patients and their families. .

Although cardiovascular diseases are preventable, they remain the most common cause of death in the world.

Most important is that although there have been some improvements in developed countries, many low-income and middle-income countries are experiencing a rapid increase in these conditions with limited infrastructure to both prevent and manage these conditions.

This emphasizes the need for crucial conversations to address cardiovascular health from the perspective of the health care system, individuals and health care providers.  Recognizing we live in a global world and our lives are intimately connected is a critical factor in ensuring cardiovascular health is a global priority. We look forward to your views and opinions in our twitter chat.



Anand, S. S., Islam, S., Rosengren, A., Franzosi, M. G., Steyn, K., Yusufali, A. H., … & Yusuf, S. (2008). Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. European Heart Journal, 29(7), 932-940.

Davidson, P. M., Meleis, A. I., McGrath, S. J., DiGiacomo, M., Dharmendra, T., Puzantian, H. V., … & Riegel, B. (2012). Improving women’s cardiovascular health: A position statement from the International Council on Women’s Health Issues. Health Care for Women International, 33(10), 943-955.

Lanuza, D. M., Davidson, P. M., Dunbar, S. B., Hughes, S., & Geest, S. D. (2011). Preparing nurses for leadership roles in cardiovascular disease prevention. European Journal of Cardiovascular Nursing, 10(2 suppl), S51-S57.

Mental Health Awareness week – A student led session exploring contemporary themes related to anxiety and depression

6 Jul, 15 | by hnoble

Paul Canning, Karen Galway, Jean Nugent, School of Nursing and Midwifery,

Queens University Belfast

Year 2 BSc. Mental Health Nursing Student Volunteers1


Mental Health Awareness week is a national campaign promoted by the Mental Health Foundation that runs every year in the month of May. Queens University Belfast (QUB) Staff Wellbeing Team plan and organise a range of events to compliment the national efforts taking place in work places, schools, hospitals and communities to promote positive mental health and challenge the stigma that can prevent people seeking appropriate support. This year the School of Nursing and Midwifery were invited to take part. Teaching staff in the School translated this offer into a learning opportunity for the mental health nursing students in year 2 of the BSc. Nursing programme to develop and facilitate an event.

Mental Health nursing students at QUB undertake a 3 year programme of theory and clinical practice placements. In year 2 the students focus on field specific mental health modules and learning. Staff from the mental health team initially liaised with the Staff Wellbeing Team to ascertain and agree an appropriate slot for hosting an event for all employees across the university. Consideration had to be given to the students’ academic workload, which at this time was considerable, being in the lead up to a very busy period of assessment. It was decided that in order to reduce undue pressure, students would be offered the chance to volunteer for involvement.

The proposal to develop a student-led session was presented to the students in class and followed up by an email, which was sent to all 48 year 2 mental health students as a way of providing further explanation of how the proposed event might be coordinated. A very enthusiastic group of 16 students attended the initial meeting facilitated by Paul Canning (Lecturer in the Mental Health Team). Students addressed two topics; anxiety and depression in the contemporary context of the use of social media.

The lunchtime session was well attended by university employees from a variety of settings and schools across the university. One session – ‘A student led session exploring contemporary themes related to anxiety and depression’ provided two linked presentations using a variety of audio-visual media, and contributed to a lively discussion with attendees afterwards. A good level of discussion ensued in relation to anxiety and depression and the wider challenges we face in overcoming mental ill health. The exploration of contemporary themes in relation to the use of social media was also well received. Presenting the contrast between the potential positive impacts and the potential negative impacts of our use (and abuse) of social media, on mental health and wellbeing proved to be an interesting approach taken by the students which struck a chord with attendees.

The Staff Wellbeing Team gathered email evaluations that supported the initial impressions gathered regarding expectations, the value of discussion time and recommendation of the event to others. Attendees also valued the knowledge of the student presenters and provided useful constructive criticism on the delivery of information. This feedback was also provided to the students who expressed a strong sense of achievement, and some relief!

Screenshot from the student presentation. Your Brain on Stress and Anxiety by John Kenworthy, available at:


Reflection upon this project highlights the importance of supporting students to develop the broader skills and qualities of ‘graduateness’1 whilst studying. The independent nature of a student-led approach proved an excellent opportunity to develop and enhance skills such as; organisation, team work, public speaking, reflectiveness and problem solving, outside timetabled teaching and without the pressure of assessment. It also provided the students an opportunity to consolidate, demonstrate and practically apply their field specific learning2. These are skills that the students and their employers will value when entering their chosen profession of Mental Health Nursing. Student achievement in facilitating this session to the wider university staff body was then circulated via Twitter and Facebook.

Having successfully engaged with staff, the Mental Health Nursing students are now seeking to use this experience and confidence to consider how the session may be altered, enhanced and developed for the benefit of students studying at the university. Thought is also been given as to how students may fundraise to promote positive mental health and reduce stigma. We hope this will become an annual part of Mental Health Awareness Week at QUB.


  1. Freire, P. (1972) Pedagogy of the oppressed. London: Sheed & Ward.
  2. Hill, P and Tinker, A, (2013) Integrating Learning Development into the student Experience. Journal of Learning Development in Higher Education. Vol. 5 [Online] Available: [Accessed 26/6/15]

Music Therapy in Dementia Care

29 Jun, 15 | by Gary Mitchell, Associate Editor

Lucy Frost


Lucy Frost @lucyjmarsters from Brighton and Sussex University Hospitals NHS Trust(BSUH) @BSUH_NHS will be leading this week’s EBN Twitter Chat (#ebnjc) on Wednesday 1st July between 8-9pm UK time focusing on music therapy in dementia care.

Participating in the Twitter Chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward:

  • Go to your Twitter account
  • Follow the discussion by searching for #ebnjc once linked to the discussion, click “all tweets” to keep up-to-date with recent tweets
  • Add the EBN chat hash tag (#ebnjc) to your tweets to join in, this allows everyone taking part to view your contribution


Lucy Frost is a Dementia Nurse Specialist and Dementia Champion at Brighton and Sussex University Hospitals NHS Trust(BSUH). The Dementia Team at BSUH supports people with dementia and their loved ones and carers within the acute hospital setting – Lucy has been heavily involved with the development of this specialist support.  She leads a programme of education around dementia for hospital staff and other health and care professionals.   Lucy is a strong advocate for the need for Dementia Specialist Nurses and their impact across health and social care.

Twitter Handle: @lucyjmarsters



The benefits of music for people living with dementia are obvious aren’t they?  Music brings us back to memories buried deep within ourselves, it re connects us with feelings and emotions, it makes us laugh, cry and feel every emotion in between.  In science, we know that music is a powerful stimulus for the brain.  It is this stimulus that creates a response even when dementia has taken a person’s senses so far away from our reach.

So why is it that many of our hospitals and care homes play music that is obsolete to the people hearing it?  A radio playing lamely in a corner, A collection of discs in a lounge that have not been chosen by the resident or their loved ones.  Why can’t music and singing be heard often in hospital wards?  Why can’t we help a person with dementia make a personal playlist?

I recently spent time with a person with dementia on one of our wards – They had few words, and their distress was obvious.  A nurse told me of the person’s previous career as a dance teacher – A quick google search and clips later-On seeing Gene Kelly – We were singing and dancing in minutes.  The words came back:  We had a wonderful conversation about the dance halls of their era and their favourite dances.

Last year – I became aware of a film called Alive Inside, following a former social worker in his quest to procure music playing devices for American Nursing Home residents.   This film shows powerfully the enormous impact of music when it reaches someone deemed ‘Unreachable’.  The film shows everything that can be wrong with nursing home care, yet when the music comes, the human being within shines.

We decided to hold screenings of this film publicly, as well as using the film as part of an education programme for hospital staff – to show the power of music and get this message out into our local community.  The response showed us how powerful music is – Nursing home leaders pledged to share more music, with one home buying I pods for their residents, hospital staff shared ideas as to how to make music a part of a day on a ward.  The project was evaluated and it was clear that the message of the power of music has the potential to change the life of a person with dementia for the better.

Access to music therapy and the use of music in health care was a subject for debate at the recent Royal College of Nursing Congress in Bournemouth.  The consensus was very much that music clearly is a massive enhancer for wellbeing – yet access to music and music based therapies remain limited.

I would like to know – What is out there for people living with dementia to help them connect with the music that matters to them.  Why don’t people living with dementia have access to a personal playlist – There are people out there trying to widen the reach – Playlist for Life, Memory Bank, Life Story Network, Singing for the brain sessions hosted by the Alzheimer’s Society – Why aren’t these initiatives being adopted everywhere?

What are people’s experiences of using music to help a person with dementia?  What work is going on to show the value of music and therefore promote the uptake of music based therapies?  These are all things I would like to focus on in Wednesdays #ebnjc chat.

I am sure many people will have already seen this – but if you can – watch this:  The importance of music in this moment needs no explanation.



Henry listens to music

Music and Memory Organisation (USA)

Playlist for life (UK)

Sally Magnussun writes about her experiences


First Do No Harm….Lowering One Risk and Increasing Another

22 Jun, 15 | by rheale

Roberta Heale, EBN Associate Editor, @robertaheale @EBNursingBMJ

Implementation of evidence into practice is the gold standard for healthcare. Ultimately, we want patients to have the best possible health outcomes, but nothing is without risk and balancing the risk is not always easy. Take cardiac prevention for example. The ongoing battle to prevent cardiac events led to the development of statins which have revolutionized cholesterol management. A low cholesterol profile is significantly associated with fewer cardiac events and statins are prescribed for both primary and secondary prevention, particularly in high-risk groups such as those with diabetes. However, it is well known that patients with diabetes often have increased blood glucose levels when taking statins. In fact, it has been widely known that statin therapy has been associated with the development of type 2 diabetes, but the numbers were thought to be relatively low (9%). A newly released population-based study reveals that statins appear to increase the risk for type 2 diabetes by 46% in the general population, even after adjusting for confounding factors.

Cardiac care and prevention has now become much more complicated. The risk of developing diabetes related to statins is dose dependent, so prescribing the lowest possible dose is warranted. Patient lifestyle counseling is even more important; increase exercise, stop smoking, low fat diet etc. No easy feat when obesity is on the rise. It’s more important than ever for patients to be fully informed in the decision to start statin therapy.

We want patients to receive the best quality of care, based on the best evidence. Yet, keeping up with changes is difficult. We live in a wonderful age of technology and information. At the same time, how do we stay current and, harder still implement new findings on a regular basis? Given the enormous amount of information available to us daily, this situation is not going away. Finding strategies for flexible approaches to practice is the new normal and keeping the patient the centre of care decisions is the best bet for maintaining your balance.


Raising awareness about falls within care-home settings

19 Jun, 15 | by Gary Mitchell, Associate Editor

This week has been a busy one – on Wednesday 17th June we featured a twitter-chat with Dr. Neil Black from the Western Health and Social Care Trust for diabetes week.  On Thursday 18th June we ran a guest blog from Queen’s University student nurse Nadine Falconer for learning disability week.  Today we are rounding off the week with another guest blog from Four Seasons Health Care’s Melanie Bowden for Falls Awareness Week.

Melanie Bowden & Team

Melanie Bowden & Team


The impact of falls can extend beyond just physical pain, especially in older people.  Falling can indeed cause significant physical injury but it also has an impact on the social and psychological aspects of a person’s life.  For example, if a person falls they may not want to go out or live the life they are used to because of the anxiety or fear of falling again.  With consideration to my role as a Practice Support Manager for Four Seasons Health Care, we noticed that falls had been something that was occurring more often.  While it may be unsurprising that the prevalence of falls is higher in care home residents than in other groups of people this was still something we wanted to give attention to by refreshing the issue with our healthcare staff across our 72 Four Seasons Health Care homes around Northern Ireland.

So what’s a fall? Falling is defined by the WHO (2007) as “An event which results in a person coming to rest inadvertently on the ground or floor or other lower level.”

We began by analysing the data generated within our internal DATIX system, which held all the documented information on falls throughout the 72 care homes.  I could see that falls that were labelled as ‘not known’- were recorded quite regularly and so this was where I set the initial focus.  Our accident forms already have detail regarding falls – questions for example, such as did the fall occur from bed, chair, or was the resident found on the floor?  The form also had the time and location of falls.  The weakness I noted in the system was that although there were procedures in place for falls, our nurses did not appear to be critically reviewing the data so the incidence of falls did not seem to be reducing – we did not appear to be learning from previous falls.  There is never any point in reinventing the wheel so I invited a representative from the Northern Ireland Health & Safety patient forum to join Jonathan McCleery, our Health and Safety manager, and myself, for an initial meeting to see how we could develop an initiative to, not only raise awareness about falls, but ultimately to reduce their prevalence in clinical practice.

I designed an educational resource which was piloted with 18 care homes.  Each care home was required to send 5 members of their clinical team.  The educational resource was mostly based around clinical knowledge which was supplemented by a free online course from future learn.  The course, Ageing Well: Falls , was designed and delivered by the University of Newcastle in 2 hour blocks over a period of 4 weeks.  This was very informative and provided a theoretical underpinning for our educational resource.  As well as providing theory, the educational resource also provided care staff with practical help in relation to falls.  Care homes would place a laminated sheet at their nurse’s station which listed the days of the month.  If a fall occurred on the unit, the care staff would cross the laminated sheet with an ‘X’.  If no fall occurred then the day would not have an ‘X’ beside it.  The idea behind this was to provide a visual aid so as to illuminate the prevalence of falls within any unit.  If people could see that falls were occurring very regularly then this would encourage the healthcare team to critically evaluate the situation.

Staff for each home had their first training on falls off site – they were introduced to the topic and explanations given on how falls could be reduced in the home. To lighten things up a bit I invited a local optician, Optomise, to come and show our staff with their ‘fancy glasses’ what it was like to have poor eyesight – it was amazing to see confident staff become anxious about walking across the room with the glasses on.  This was very powerful in underlining the message that our residents could very easily fall if they had eye problems.  In addition to these we ran other external programmes in relation to falls.  As a practice support team, our team made individual visits to each home on the programme supporting and encouraging the teams as they focused on raising awareness about falls.

Overall, this initiative has led to the development of practice across the care homes within our organisation.  Early empirical data analysis has evidenced a notable reduction in the number of falls as well as an increase level of awareness about the triggers, the impact and the future management of falls.  I was very privileged when the falls programme was recognised at the Northern Ireland Royal College of Nursing Awards recently, finishing runner-up in the category of Chief Nursing Officer’s Award.

FSHC Falls


Melanie Bowden @melaniebowden6

Practice Support Manager

Four Seasons Health Care @FourSeasonsHCUK

Learning Disability Awareness Week 2015

18 Jun, 15 | by Gary Mitchell, Associate Editor

 Nadine Falconer

This week (15th – 21st June) is Learning Disability Awareness Week and to celebrate this we have invited Nadine Falconer, a 1st year learning disability student nurse from Queen’s University in Belfast, to blog about her first year as a student nurse.

I feel very honoured to be asked to write a guest blog on Learning Disabilities in relation to Learning Disability Week 2015, where we all hope to raise awareness and break down barriers that people with Learning Disabilities may face.  I am a first year Learning Disability Nursing Student at Queen’s University Belfast and I am currently on my third and final placement of first year.

Living with a learning disability simply means that the person has a reduced intellectual ability and may need help with everyday activities.  It does not mean they are incapable, nor does not mean they cannot work and it certainly does not mean that the person cannot have meaningful relationships.  This is something that people with learning disabilities often struggle with.  Often, the people they have the most contact with are health care professionals.  As a nursing student, I am fortunate enough to be in a position where I can spend valuable time with the clients and have been able to, not only provide healthcare, but also share in their everyday daily lives.

Nadine Falconer


In my first year of studying Learning Disability Nursing I have been able to learn and put into my practice my new found knowledge.  People with learning disabilities are unique individuals who can teach every one of us something.  Becoming a Learning Disability Nurse is about empowering those individuals and being their advocate, to speak up for them and be their voice when they cannot be heard.  It is not primarily about making the person better.  We focus on the person holistically.  We look at the person as a whole.  We look at their communication needs, we look at how to improve and maintain their quality of life.  We look at how to ensure that individual can access what you and I may take for granted.  Anyone who is involved with people with learning disabilities, will know first-hand how complex caring for a person with a learning disability can be.  The number of syndromes, and complex level of care some individuals require is astounding.  This is where learning disability nurses come in.

As I progress through my course, I continually learn new things about the world of learning disabilities.  It has been difficult but it has been so rewarding.  I have danced, arranged flowers, painted, had the opportunity to go on day trips and provided care for someone at the end of their life.  No day on placement has ever been the same.  I have enjoyed every minute of my journey in becoming a learning disability nurse.  In Learning Disability Week, I would ask that you stop and reflect on what you know about learning disabilities. Not all disabilities are visible and not all disabilities are physical.  Aim to educate those around you and aim to ensure that those with learning disabilities are noticed and celebrated.

As I come to the end of my first year of learning disability nursing, I cannot help but feel excited for my next year and what is to come.  I have felt exhausted, I have felt drained, but most of all, I have felt privileged to be part of the individual’s life, even if it’s only for a short while.  I have met some wonderful people along the way; learning disability nurses, carers, parents and most importantly the individuals with learning disabilities themselves.  As a learning disability nursing student, we play an important role in helping to demonstrate to the other nursing branches just what it is that we do.  As a qualified learning disability nurse, or RNLD, I will be able to care for those with a learning disability from birth to their last moments of life.  So in my next 2 years of education, and beyond, I aim to raise awareness of learning disability nursing.  So if I could ask anything of you, it is this. Don’t think of people with a learning disability as unfortunate, or a sufferer.  Think of them as empowered and educated.  Listen carefully and take note, the future of learning disabilities is changing.  I welcome you to be part of that change.

Nadine Falconer @ld_studentnurse

Queen’s University Belfast @qubnursing


Check out Nadine’s personal blog page here



Diabetes Week: Communication and Awareness

15 Jun, 15 | by hnoble

A Twitter Chat with Dr. Neil Black (@RneilABlack) – Wednesday 17th June @8-9pm.

Dr Black, from the Western Health and Social Care Trust in Northern Ireland, will lead the Twitter chat this week focusing on diabetes communication and awareness. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward:

  • Go to your Twitter account
  • Follow the discussion by searching for #ebnjc and click on “All Tweets”
  • Add the EBN chat hash tag (#ebnjc) to your tweets to join in

Written by Dr Neil Black:

I feel really privileged to have been asked to write this blog during Diabetes week which is about spreading awareness regarding diabetes.  I’d like to use this to share two things that I’ve learnt from people living with diabetes themselves. Whilst I’ve been involved in diabetes care for almost 14 years, this was turned around completely about 3 years ago. What happened?  Well, I really started to listen to people living with the condition.

What do people with diabetes want those who are newly diagnosed to know? How do we talk to people who have been newly diagnosed with diabetes? How can we communicate about complications of diabetes? Last week’s @OurDiabetes Tweetchat was revealing and added much to my awareness. A strong running theme was that people wanted to be told that they weren’t alone and how to connect with others with diabetes. While this was a group of people with type 1 diabetes, the points ring true for those with other forms of diabetes. A knowledge even that someone exists who understands what you are going through could make a big difference. Actually being able to get in contact with others with your type of diabetes could be a life-saver. People wanted to know that while having a new diagnosis of diabetes takes up a lot of time in your life, that you had to make room for it but not let it set the agenda for the rest of your life: diabetes should fit around your life, not life around diabetes. They wanted to know how to manage it themselves and be supported to do so. Talking about a new diagnosis of type 2 diabetes is different, because it has likely been there undiagnosed for years. Sometimes this means that we discover it only when that person presents with a complication of diabetes. I tell people that it is good news they have been diagnosed as now we know that they need protection and how to give it, where prior to diagnosis they had the condition but were at greater risk of the complications. Talking about complications is a sensitive subject in itself. People living with diabetes tell me that they want tact and for us to concentrate on how to reduce risk – they know they could develop complications already and what matters to them is how they can protect themselves.

I’d like to come back to types of diabetes as, after all, it is Diabetes Week. I mentioned earlier that those with established type 1 diabetes want people with newly diagnosed diabetes to know that they are not alone and how to contact others with their condition. Well, 90% of people who have diabetes have type 2 and only 10% have type 1. It’s a common misconception that people with Type 2 diabetes are to blame for their condition. It is true that a sedentary lifestyle, excessive unbalanced dietary intake and being overweight increase the risks of Type 2 diabetes. It is also true that making lifestyle changes and losing weight reduce the risk of developing Type 2 diabetes or delay its onset.  However, many people with type 2 diabetes have a family history of the condition and if you have one sibling or parent with Type 2 diabetes, your lifelong chances of developing it are about 50% compared to about 5% for the general population. So, people with Type 2 diabetes have inherited strong genetic factors that led to their condition. It seems less reasonable to blame people with Type 2 for their diabetes. Interestingly, people with other forms of diabetes may also lay blame on those with Type 2 diabetes for their condition. I hope that seems less reasonable now.

People with Type 1 diabetes can present as a medical emergency in diabetic ketoacidosis but, even if they do not, require insulin injections from the start. A temporary recovery of pancreatic function lasting a few to several months (the ‘Honeymoon Period’) can occur with the person needing very low insulin doses or no insulin at all, but eventually the pancreas cannot make enough insulin and insulin injections or infusion then needs to be lifelong. It is better to think of insulin as a vital life-sustaining hormone for people with Type 1 diabetes, rather than a ‘treatment’ as consistent lack of insulin administration inevitable leads to becoming medically unwell and death if untreated. We should respect people who live with Type 1 diabetes and respect the insulin they take.

Less common forms exist, for example Latent Autoimmune Diabetes in Adults (LADA) appears to be type 2 diabetes at diagnosis but, sometime later, the person develops a dependence on insulin as their pancreas has been attacked just as in Type 1 diabetes. We know that 10-15% of people with apparent Type 2 diabetes actually have LADA which is really part of the spectrum of Type 1 diabetes and together form a spectrum of ‘autoimmune diabetes’. Secondly, about 1-2% of people in the UK with apparent Type 1 diabetes actually have a genetic cause of diabetes called Maturity Onset Diabetes in the Young (MODY). This is important as we think that we are only aware of 20% of cases at best. Making a diagnosis could mean that we can stop insulin therapy which otherwise would be lifelong. Thirdly, gestational diabetes starts in pregnancy and poses risks for the mother and child before, during and after delivery. While it usually resolves immediately after delivery, it usually recurs in later pregnancies and indicates that the woman’s lifetime risk of Type 2 diabetes has risen from 4-5% to 40-50%.

Diabetes week gives an important chance to get these points across. Diabetes is not about blame, but about respect for the person who lives with it. People who live with diabetes need support from each other and healthcare professionals. We can only deliver good care if we follow these principles.

Questions for consideration during our chat:

Q1: How do you think we can best support people as they are informed of newly diagnosed diabetes?

Q2: Do self-help groups for people with diabetes work?

Q3: What are you doing during diabetes week at your place of work?

Q4: Have experienced barriers/support to good provision of education for people with diabetes?

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