Aim.  To explore the existential experiences of 10 patients with chronic obstructive pulmonary disease (COPD) who had been prescribed long‐term oxygen therapy (LTOT) and their carers. Background.  Chronic obstructive pulmonary disease is a progressive and debilitating condition, with an insidious onset often diagnosed in the middle to later years of life, after a history of worsening breathlessness (Herbert & Gregor 1997). It is a life limiting condition that is on the increase worldwide. Evidence suggests that for some people with COPD oxygen therapy can improve longevity and quality of life (MRC 1981, NOTT 1980). Understanding of the existential meaning of COPD for people is required. Method.  This longitudinal Heideggerian study was carried out between 2005–2006. Participants were interviewed separately, in their own homes, at the start of LTOT, second 3 months later and finally at 9 months. Results.  Themes of living with COPD emerged from the data; struggling, fear, experience of ill health, blame, fatalism and hidden disability. Conclusion.  The participants all shared very negative experiences regarding the changes that living with COPD had placed on their lifestyle and quality of life. The introduction of oxygen appeared, for all but one couple, to increase the negative impact of living with poor health. Relevance to clinical practice.  The participants’ experiences in this study highlight the need for health professionals to explore with people what it is like living with a long‐term condition. This sharing of experiences may help individuals to make informed choices about treatment and readdress their perception of ‘just existing’ with ‘no quality to their lives’ thereby enabling people and carers to adjust to living with a life‐limiting condition like COPD and the introduction of life long‐term therapeutic interventions.

Providing enteral nutrition to preterm infants is a challenge because of the immaturity of the gastrointestinal tract. Clinicians often take a cautious approach to advancing enteral feedings because of concerns related to development of feeding intolerance or necrotizing enterocolitis. Gastric residuals provide a mechanism for monitoring feeding tolerance since they are easy to obtain and quantify. Despite the common practice of monitoring gastric residuals, there is a lack of agreement in determining when an obtained gastric residual becomes clinically significant. Furthermore, numerous factors can affect the characteristics of the gastric residual. A review of the literature demonstrates significant variability in defining a clinically significant gastric residual. Importantly, there is a lack of available evidence to support selected parameters. Recommendations for practice are discussed.

Historically, inhaled placebos have been provided by pharmaceutical companies and have been widely used by nurses both in primary and secondary care to teach respiratory patients how to use prescribed inhaled therapy. Over recent years, the author of this article has had concerns about the potential risk of cross-infection as a result of reusing placebos with disposable mouthpieces. This concern has been heightened by the lack of verbal and written guidance from the pharmaceutical companies that provide these placebos. There are no recognized protocols or guidelines on the most effective cleaning methods that would minimize or prevent cross-infection. The cleaning of large volume spacers, which are used to enhance a patient's inhaler technique, are particularly problematic as it is not possible to use a disposable mouthpiece with this device. In response to this problem, a cross-sectional, multicentre, regional audit was designed to identify the decontamination process adopted by nurses working in the fields of respiratory care and infection control. The audit outcome confirmed that nurses were using a number of different cleaning methods, with no sound evidence base to support their chosen methods of decontamination. This is an issue that requires further investigation and clarification if nurses are to continue assessing patients' techniques with inhaled devices.