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The issues of consent and confidentiality in health care are discussed, including a case study.

Graham Pink, former charge nurse, continues to fight for improved standards of patient care, despite losing his job in 1991 following a chain of events which included Pink speaking out on inadequate medical care. Details of how some UK National Health Service trusts are attempting to include 'gagging clauses' in nurses contracts' are included in a related article, together with details of the attitudes of the Royal College of Nursing to whistle-blowing.

The standards for post-registration practice and education introduced by the UKCC, the regulatory body for nursing, midwifery and health visiting, are designed to improve client care. However, the statutory requirement to complete at least five study days or equivalent every three years will not automatically improve standards of care. The UKCC needs to recognise the role of government policies and of health and social care providers in raising standards of care, while practitioners and employers should not hesitate to explore and develop a range of ways of meeting the study requirements.

Experts are welcoming the position statement published by the Department of Health, specifying a set of standards for advanced nurse practitioners. The standards are aimed at clearing confusion among the public over the professional competency and skills of nurses with regard to several titles, and also to clearly define the role of advanced nurses in order to deliver better health care services.

The article determines the relevance of nursing models to contemporary practice, with special focus on policy initiatives aimed at modernizing nursing and raising standards of care. It suggests that nursing models provide a holistic assessment of patients' needs and promote a more organized approach to nursing care.

The Department of Health in England is deliberating on linking the amount paid to hospital care trusts to the quality of nursing care they provide. Officials are considering the inclusion of some nursing quality indicators such as reducing pressure ulcers and falls in its 'commissioning for quality and innovation' framework (CQUIN) to decide on full payments to trusts if they meet high quality nursing standards.

The method NICE follows to issue guidelines to care centers to keep abreast with new developments in the field of medicine and technology are presented.

The article outlines the functions and decisions made by the National Institute for Health and Clinical Excellence (NICE) relevant to providing quality health care. It also lists the drugs and treatments that may be provided under the NHS.

Dr. Gillian Leng, implementation director at NICE agrees that it is indeed challenging for nurses to implement all the guidelines issued by NICE. Leng reiterates that organizational support is equally important.

The analysis presents the various legal implications that hinder the proper assessment of continence in patients and also supports it by a typical situation faced by a patient. Complaints should be raised in such cases to ensure the implementation of appropriate care to the patients.

Clinical audit is defined as a process to improve patient care through the regular review of care against clear standards, and the implementation of change. The NHS Modernisation Agency is set up to support clinical audit initiatives and the main elements are defined as setting clear national standards, ensuring local delivery, and monitoring the delivery.

Issues concerning the introduction of 38 government standards of care for nursing homes are examined. Topics include how the cost of meeting the standards for such requirements as door width may result in the closing down of small private nursing homes, the difference between quality care and government requirements, and the need for financial support from the government to meet the standards.

Standards for systemic reviews of medical research evidence are examined. Topics include 10 steps in the review process, from identifying need for the review to submitting a report; a checklist for conducting a high-quality review; and inclusion and exclusion criteria.

Issues are presented concerning the techniques which are used in the evaluation of the care and treatment given to patients in hospitals and general practice surgeries. The involvement of patients in improving standards is discussed.

The unsatisfactory care given to a women having a hip operation is contrasted with basic nursing principles set out in professional nursing regulations.

The use of standardised patients can provide a valuable insight into the efficiency of periodic health check services provided by primary-care physicians. In 57 visits to physicians by actors posing as new asymptomatic patients, 98% of physicians performed blood pressure measurement, while 86% peformed weight measurement, 83% heart ascultation, 70% neck palpitation and 61% oral cavity inspection. There was a wide variation in the time spent with patients, the services provided and the cost, indicating that health-care providers should ensure that their check-up procedures are in line with current recommendations from agencies which draw up guidelines.

The 2010 national audit of continence care in the U.K. has revealed that more than a quarter of primary trusts are ignoring the guidelines for continence care laid down by the National Institute for Health and Clinical Excellence (NICE). The need for consistently asking at-risk patents about continence as well as providing structured training for healthcare professionals on continence care is highlighted.

Nursing diagnoses should be adopted to allow nurses to gather information and plan a patient's care using a universally standardised system of classified symptoms and behaviours. A nursing diagnosis describes a patient's individual condition as a human being, encompassing psychological, physiological, spiritual, economic and social aspects, says Marks-Maran. The North American Nursing Diagnosis Association (NANDA) is developing a universal classification system of North American nursing diagnoses, with standardisation allowing British and North American nurses to compare like with like. Standardisation could, however, lead to nursing responses which overlook an individual's needs. Informed debate and practice of nursing diagnoses is required.

The USA's system of nursing diagnosis should not be introduced in the UK as it could result in inflexibility and devalue the professional status of nurses. The North American Nursing Diagnosis Association (NANDA) has produced a list of 97 diagnoses which aims to provide standardised diagnostic terms for all nurses to universally understand. The inflexible list is, however, written in an obscure, unintelligible format and apparently excludes several common patient problems. The needs of individual patients are overlooked by a standardised diagnostic list. Nursing diagnoses in the USA also seeks to promote full professional recognition, which might not be the way forward for UK nurses. The NANDA list is strongly linked with the medical model, and its introduction in the UK would be a retrogressive move. The adoption of nursing diagnoses would also create antipathy.

Nurse Graham Pink, who was sacked by Stockport Health Authority because of his campaign for proper standards of care for elderly NHS patients, seems likely to have to fight his battles without any financial support from the unions RCN and COHSE. The unions have not made any contribution to the fighting fund set up to raise 50,000 pounds sterling to cover legal fees for Pink to sue for unfair dismissal. With many nurses seeing the Pink case as critical in the issue of patient advocacy, the appeal fund has already received more than 4,000 pounds sterling in pledges.

The United Kingdom National Health Service has a new set of standards for health services for dhildren, but change is slow, the man developing the new standards acknowledges. Professor Al Aynsley-Green, chair of the National Children's Taskforce feels intimidated by the sheer scale of the undertaking, which keeps him awake at night. He feels children's nurses should have a direct line to trust boards. Recruiting, staffing, and supply and demand for pediatric nurses are discussed. The Association of British Paediatric Nurses gave much time at its annual conference to these issues.

Issues concerning the launch of the National Care Standards Commission (NCSC) on Apr 1, 2002, are examined, focusing on the Commission's duty as an independent organization to regulate standards for nursing homes, nursing agencies, and independent hospitals. Topics include the relationship between the NCSC and the Commission for Health Improvement, and the role of the Commission's chairperson, Anne Parker.

Issues concerning a proposal by health secretary Alan Milburn to allow successful hospitals more independence in their own management are examined. Topics include dangers that staff will suffer, problems in a rating system that determines which hospitals are deemed successful, and the importance for nurses to maintain a voice in hospital administration.

Issues concerning the discrepancies in health care standards between private hospitals and the National Health Service in the United Kingdom are discussed. Particular attention is given to the detriments of privatization as a solution for quality improvements in the health service.

Issues are presented concerning the difficulties which are faced by the government and the National Health Service in meeting the general public's demand for improved health care services in the United Kingdom.

The aims of the Commission for Health Improvement and the functions of its review managers are discussed. The benefits of conducting reviews of health service organisations and qualities required of review managers are explored.

Issues are presented concerning the role of the Commission for Health Improvement in increasing the quality of health care services which are available in the United Kingdom. The inspection of hospitals is discussed.

A description is presented of the poor standard of treatment received by a 74-year-old woman who broke her hip and was admitted to hospital. The importance of listening to the needs of elderly patients is discussed.

Issues are presented concerning the lack of high-quality, safe equipment in the hospitals managed by the National Health Service. The increasing demands made on medical staff and lack of investment are discussed.

The UK government has launched an initiative aimed at improving the quality of care for National Health Service (NHS) patients. NHS trusts will have to undertake a number of activities concerning clinical governance. These activities will include the establishment of a clinical governance committee, the formulation of a plan for improving the quality of clinical care, and the establishment of a system to report publicly on clinical governance work.

Health-care professionals who reveal low standards of care are often victimised and given no support by their unions, colleagues or management. Many of these whistle blowers are nurses who are ultimately called before a disciplinary hearing. Some feel those who speak out should be considered an asset not an embarrassment, with medical personnel needing to be accountable for their own professions. Some feel it is paramount that bad managers are revealed in order to protect the patients, but nurses are often fearful of speaking out in case of retribution.

Good health care practice is the subject of a survey of 122 nurses, health visitors and midwives, commissioned by the Practice Advisory Group of Yvonne Moores, chief nursing officer. The survey reveals that managers should back up their clinical colleagues. Job titles for non-practitioners should not infer that such employees have a clinical role. Services should be improved by taking the views of service users into account.