Letters
Send your views by email to [email protected], the letters editor @RogerEvansE1, post on the Nursing Standard Facebook page or visit www.nursing-standard.co.uk
Please keep letters to a maximum of 200 words, and include your full name and a daytime telephone number. Letters may be edited
We need to return to a service ethos and put the good of patients first I agree with Stephen Wright (Reflections September 3). The NHS changed from a service to a business in the mid-1980s, when general management was introduced, and even more so in the early 1990s with the introduction of trust status. Like Stephen I was a 1970s student and, even as a nursing officer in the early 1980s, the emphasis across the whole hospital was of a service. While everyone did not always agree with each other there was, as he demonstrates so well, a real sense of working together for the common good of the patient. The finance department was a small office that provided the cash and paid the wages. In the early 1990s the emphasis changed dramatically and the director of finance had a whole department and more power than anyone else in the organisation. I well remember when a director of finance said at a meeting: ‘The trust is more important than any individual.’ I realised then there was worse was to come. In my view we definitely need to move back to a service ethos – though I am not sure the finance department will return to that small office. Gary J Jones CBE, by email
WORRY INSTEAD ABOUT THE ONES WHO ARE GIVEN ADRENALINE I was interested to read your Readers Panel (Reflections September 10) on the subject of giving placebos without consent to patients in cardiac arrest. The research is concerned with trying to determine if giving adrenaline is actually beneficial to patients or if, as suspected, it may actually be detrimental. As there is no evidence that adrenaline works and there is a suggestion of harm, it cannot be problematic to withhold it from 34 september 17 :: vol 29 no 3 :: 2014
patients in cardiac arrest. In fact, is it more unethical to give it? To paraphrase Spock (the Vulcan, not the doctor), the needs of the many may outweigh the needs of the one. Does the need to establish, for future patients, whether adrenaline should be given in cardiac arrest override the best interests of a patient? From a legal perspective, can it be in the best interests of a patient to receive a treatment that may cause harm? Perhaps it is not the patients who will receive the placebo we should be concerned about, but those who will continue to receive adrenaline. Marc Cornock
@academiclawyer2
A PLACEBO STUDY WOULD HELP TO DETERMINE RISKS AND BENEFITS With reference to your last Readers Panel (Reflections September 10), no trial of that kind can be conducted without ethics committee approval. As someone who sits on one of Northern Ireland’s research ethics
committees, I am aware of the high degree of scrutiny that applications receive. Randomised placebo controlled trials are considered the gold standard of drug research and, where possible, informed consent is always required. However, in this case most, if not all, patients would be unable to make an informed decision or give consent. Similarly, it would not be viable to seek the informed opinion of the next of kin. Therefore, consent would not necessarily be required in this case. The bigger question is whether the risks outweigh the benefits and, since at present we can’t say, it would appear this study would be worthwhile in order to help answer that question. Jane Wright, research and development nurse, by email
THE FRIENDS AND FAMILY TEST IS JUST AS RELEVANT IN MENTAL HEALTH The friends and family test (FFT) is welcome in mental health: why wouldn’t anyone providing a
NURSING STANDARD
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 15, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Send your views by email to [email protected], the letters editor @RogerEvansE1, post on the Nursing Standard Facebook page or visit www.nursing-standard.co.uk
Please keep letters to a maximum of 200 words, and include your full name and a daytime telephone number. Letters may be edited
We need to return to a service ethos and put the good of patients first I agree with Stephen Wright (Reflections September 3). The NHS changed from a service to a business in the mid-1980s, when general management was introduced, and even more so in the early 1990s with the introduction of trust status. Like Stephen I was a 1970s student and, even as a nursing officer in the early 1980s, the emphasis across the whole hospital was of a service. While everyone did not always agree with each other there was, as he demonstrates so well, a real sense of working together for the common good of the patient. The finance department was a small office that provided the cash and paid the wages. In the early 1990s the emphasis changed dramatically and the director of finance had a whole department and more power than anyone else in the organisation. I well remember when a director of finance said at a meeting: ‘The trust is more important than any individual.’ I realised then there was worse was to come. In my view we definitely need to move back to a service ethos – though I am not sure the finance department will return to that small office. Gary J Jones CBE, by email
WORRY INSTEAD ABOUT THE ONES WHO ARE GIVEN ADRENALINE I was interested to read your Readers Panel (Reflections September 10) on the subject of giving placebos without consent to patients in cardiac arrest. The research is concerned with trying to determine if giving adrenaline is actually beneficial to patients or if, as suspected, it may actually be detrimental. As there is no evidence that adrenaline works and there is a suggestion of harm, it cannot be problematic to withhold it from 34 september 17 :: vol 29 no 3 :: 2014
patients in cardiac arrest. In fact, is it more unethical to give it? To paraphrase Spock (the Vulcan, not the doctor), the needs of the many may outweigh the needs of the one. Does the need to establish, for future patients, whether adrenaline should be given in cardiac arrest override the best interests of a patient? From a legal perspective, can it be in the best interests of a patient to receive a treatment that may cause harm? Perhaps it is not the patients who will receive the placebo we should be concerned about, but those who will continue to receive adrenaline. Marc Cornock
@academiclawyer2
A PLACEBO STUDY WOULD HELP TO DETERMINE RISKS AND BENEFITS With reference to your last Readers Panel (Reflections September 10), no trial of that kind can be conducted without ethics committee approval. As someone who sits on one of Northern Ireland’s research ethics
committees, I am aware of the high degree of scrutiny that applications receive. Randomised placebo controlled trials are considered the gold standard of drug research and, where possible, informed consent is always required. However, in this case most, if not all, patients would be unable to make an informed decision or give consent. Similarly, it would not be viable to seek the informed opinion of the next of kin. Therefore, consent would not necessarily be required in this case. The bigger question is whether the risks outweigh the benefits and, since at present we can’t say, it would appear this study would be worthwhile in order to help answer that question. Jane Wright, research and development nurse, by email
THE FRIENDS AND FAMILY TEST IS JUST AS RELEVANT IN MENTAL HEALTH The friends and family test (FFT) is welcome in mental health: why wouldn’t anyone providing a
NURSING STANDARD
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 15, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
