Objective To investigate in‐vitro haemostasis in subjects with symptoms suggesting a mild bleeding disorder. Design A prospective study in which an extensive range of in‐vitro tests were applied unselectively. Setting Patients were referred from community‐based practices and hospital outpatient services. Patients Ninety‐three consecutive patients were examined. Hospital patients with severe illness were excluded. Clinical features Patients presented with easy bruising (68%), epistaxis (12%), excessive operative bleeding (7%), menorrhagia (4%), haematuria (3%), dental bleeding (1%) and bleeding from other sites (5%). In no instance was the bleeding life threatening. Outcome measures Results of laboratory tests for patients presenting with the symptoms of a mild bleeding disorder were compared with the results for a healthy reference group. Results Abnormal results of in‐vitro tests were found in 53% of the subjects. Thirteen per cent had a prolonged bleeding time, of whom the majority had abnormal results of other in‐vitro tests. Von Willebrand's disease was diagnosed in 7% of patients, although only half of these had a prolonged bleeding time. Conclusions Abnormal results of in‐vitro tests were prevalent among subjects with symptoms of mild bleeding disorder. Easy bruising was as powerful a clue as any other bleeding manifestation to the presence of an abnormal in‐vitro test result.

This article highlights the vulnerability of people with dementia in the acute hospital setting, where they are more likely to experience clinical incidents such as falls, contract infections and be prescribed neuroleptic drugs. This patient group has a significantly longer length of hospital stay and higher mortality rate following discharge compared with those without dementia. As many as one third are discharged to institutionalised care. The article explores the knowledge gap concerning the complexity of caring for a person with dementia and highlights factors that can lead to staff detaching themselves from engaging in meaningful communication with patients. It also discusses the syndrome of 'cascade iatrogenesis' in relation to patients' physical and cognitive decline. More emphasis needs to be placed on addressing these issues to ensure the safety and welfare of people with dementia in hospitals. A case study from the author's clinical practice is used to illustrate the issues.

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Faecal incontinence is a distressing and socially debilitating problem. Nurses are ideally placed to support patients and assist them in improving their quality of life. In order to provide the necessary holistic care the nurse needs to understand the nature of the patient's symptoms and be aware of a variety of management interventions. In this article the author outlines the various causes of faecal incontinence and highlights the importance of a thorough nursing assessment which takes into account the physical, psychological and social aspects of the symptoms. Planned care should be based on a firm knowledge base, but should reflect the needs of the individual. A good nurse-patient interaction facilitates this process and should be valued.

Continence care breaches social norms about privacy, nakedness and bodily functions. Faecal incontinence (FI) is a condition that is associated with a significant emotional impact, which extends to not only the patient but also the nurse or care worker. Patients can experience feelings of guilt and shame and a sense of ‘incompetence’, which can be connected to childhood experiences. Similarly, nurses and caregivers can encounter feelings of disgust and revulsion, which are often denied, as part of the perceived professional expectation. Nurses can develop self-protective behaviours including emotional detachment and development of a task-orientated approach to physical care. This can, in turn, accentuate the negative feelings experienced by patients with FI. Nurses developing self-awareness through reflection on their own difficult feelings can help to improve communication, which will meet patients' emotional needs and improve the therapeutic relationship. This article aims to encourage nurses and care workers to develop an empathetic understanding of the basic human emotional responses experienced by patients. It also aims to improve nurses' awareness of their own feelings and help them recognise the effect of these emotions on their own behaviours and their patients. Lastly, the importance of providing emotional care to patients with FI is discussed.