British journal of nursing (Mark Allen Publishing)
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This article examines current research, literature and government policy that influences how health funding is allocated for treatment and care of the chronically sick. Chronic disease represents a huge burden of ill health in the UK and a substantial cost to the NHS. With both an increase in the ageing population and advancing technological developments giving doctors the theoretical ability to sustain the most fragile life, the issue of providing unlimited access of care to the chronically sick within financial limitations is clearly untenable. ⋯ The issue of how to ration resources to the chronically sick remains unresolved. Social gerontologists predict that living to 120 years of age may become the norm before the end of this century. Exploitation of the genome map and society's unwillingness to accept the inevitability of disability resulting from chronic illness will further increase pressure on healthcare financing and, as a result, demands will be forever increasing despite the most rigorous attempts at rationing.
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The decision to limit care for critically ill intensive care patients is not uncommon, and most deaths in the intensive care unit are now preceded by do not resuscitate (DNR) orders, which are regarded by some as a way to make death more humane and respect patient autonomy. When a patient receives a poor diagnosis the family needs to discuss the medical care and respect the patient's wishes. Many relatives hesitate to discuss these issues, because they wish to avoid discussing the idea of death or any serious change to the patient's condition. This article aims to address DNR orders and discuss the mechanisms available to achieve a good death for patients and their relatives, instead of enduring a distressing and undignified end.
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The last two articles considered the right of others under Data Protection legislation to access a patient's records and the right to access medical reports for employment or insurance purposes. This article considers the duty of confidentiality and the provisions of the Data Protection Act 1998, which protect the confidentiality of health records.
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This article is the first in a two-part series which explores pain and its management from a physiological perspective. Pain is a common experience which is often inadequately managed in hospital and community settings. While nurses are in a key position to contribute to successful pain management there are frequent accounts in the literature that nurses lack knowledge about pain management. ⋯ This article introduces nurses to the components in the pain pathway and describes nociceptors which respond to pain stimuli and identifies pain fibres which carry pain information to the spinal cord. The processing of pain in the spinal cord is explained and the role of the brain in the manifestation of the pain experience is also explored. The gate control theory of pain and the more recent neuromatrix theory are discussed.
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This article explores what rights persons, other than the patient, have to access health records which come under Data Protection Act and other statutory provisions. These other persons could include the relatives of a patient, the parents of a child or those concerned with the estate of a deceased person. In addition, there are other rights of disclosure recognized by the common law and these will be considered in a later article.