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The Story of the AV Block Family



Atrioventricular block (AV block) is a type of heart block where the conduction between the atria and ventricles of the heart is impaired and this is their story.


Wife = P Wave     Husband = QRS Complex    Pacer = Counselling 

Normal Sinus Rhythm

The wife (P wave) waits at home for the husband (QRS). The husband (QRS) comes home on time every night.

[PR Interval is less than 0.2 seconds (One large block on the EKG paper), there is one P wave per QRS complex, and the rhythm is regular.]

1st Degree AV Block

The wife (P wave) is waiting at home. The Husband (QRS) comes home late every night, but he always comes home, and it is the same time every night.

[Impulse is held at AV node, and PR Interval is greater than 0.2 seconds, or one large box on the EKG paper.]


2nd Degree Block, Type 1 (“Wenckebach”)

The wife (P wave) is waiting at home. The husband (QRS) comes home later and later every night until one night he doesn’t come home at all.

Note: Husband (QRS) must come home at least 2 nights in a row to see this pattern.

[PR interval will become greater and greater until there will be a dropped QRS complex and there are two consecutive P waves, after which the pattern will restart.]

2nd Degree Block, Type 2

The wife (P wave) is waiting at home. Sometimes the husband (QRS) comes home, sometimes he doesn’t. When he does come home, it’s always at the same time.

Note: This is usually more serious than Type I, and will sometimes require counselling (pacing).

[PR and R to R intervals will remain consistent, but there will be “missing” QRS complexes.]

3rd Degree AV Block

Wife (P wave) is no longer waiting at home. She and her husband (QRS) are now on separate schedules, have no relationship to one another, and are no longer talking. Each spouse has a regular, individual schedule.

Note: This frequently requires Counselling  in the form of a temporary or permanent pacer.

[Atrial depolarisation will continue with P waves in a “ventricular standstill” while the ventricles (QRS) are depolarising in an idioventricular rhythm – both will be regular, but will be uncoordinated.]

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Student nurses to receive ‘political lobbying lessons’

The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.



Nursing students will learn how they can work with MPs to promote the nursing profession in a new training session organised by the RCN.

Members of the RCN’s student committee and student information officers – the RCN’s representatives in universities – will learn their way around the UK parliament and the government from the UK Parliament Outreach and Engagement Service.


The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.

The RCN’s public affairs team will talk through the college’s approach to engaging with parliamentarians, especially the crucial role members can play. The team will explain different tactics and approaches students can take as well as what they can ask MPs to do to show their support for nursing staff in their constituencies.

Janet Davies, chief executive and general secretary of the RCN, said: “To work effectively, any union must be able to engage MPs and ministers.

“We know our members make the most powerful advocates for the profession. When frontline nursing staff sit in front of parliamentarians, you can see they listen.

“It’s through the hard work of members that vital issues such as safe staffing, harassment and health policy reach the top of the agenda.

“When nursing faces challenges on every front, the RCN wants to make sure our advocates are fully-equipped.”

Charlotte Hall, chair of the students’ committee, said: “Student nurses represent the future of the profession. Learning to engage with MPs is vital if we are to effectively shape that future and ensure the best possible care for patients.

“With these skills, committee members and student reps will be able to help other nurses make their voices heard on behalf of the profession and patients.”

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Nurse apprenticeships to introduced at nine more universities



Nursing apprenticeships are to be introduced at nine more universities in England by September 2018.

Nine universities are to be given part of a £4.9 million grant by the Higher Education Funding Council for England to devise their training programmes for nursing apprenticeships over the next year.


This is the second wave of investment from HEFCE’s Degree Apprenticeship Development Fund, designed to produce 4,500 apprentices from the following higher education establishments.

  • Coventry University.
  • Keele University.
  • Leeds Trinity University.
  • University of Cumbria.
  • University of Suffolk.
  • Southampton Solent University.
  • Birmingham City University.
  • Sheffield Hallam University.
  • Middlesex University.

Madeleine Atkins, HEFCE Chief Executive, congratulated the universities provided with funding;

“They will now work with employers to develop new degree apprenticeship provision across a variety of sectors. This will help more people to access higher education, and to follow their chosen career, while closing the skills gaps in the economy”.

Last year, in its first wave of apprenticeship funding, HEFCE gave money to four universities so they could offer nurse apprenticeships from September 2017.

Alongside this plan, Health Education England revealed last month it intends to train up to 45,000 new nursing associates by 2027.

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RCN introduces new infection prevention course



The RCN has announced an innovative new course which will provide nurses working in infection prevention and control (IPC) with the skills to lead the fight against antimicrobial resistance.

The RCN Professional Development Course for Infection Prevention and Control is an introductory module designed for nurses working in the NHS, independent and social care sectors.


The course will prepare nurses working in or have an interest in IPC for the current and future challenges to their work resulting from antimicrobial resistance. It will be piloted in Spring 2018.

Resistance to antibiotics in health and care settings is increasing globally as well as in the UK. Public Health England’s campaign, “Keep Antibiotics Working”, recently highlighted the key role nurses can play in the fight against antimicrobial resistance. Infection prevention and control and the work of IPC nurses is pivotal in reducing the need for antibiotics and combatting this threat in all care settings.

On the programme, participants will develop clinical and leadership skills in the prevention of infection, learn how to lead a service improvement project in their workplace and the most effective ways to manage and sustain change.

Rose Gallagher, RCN Professional Lead for Infection Prevention and Control, said:

“The UK is leading the fight against antimicrobial resistance and the prevention of infection. Antibiotic resistance is a very real risk whereby simple infections are prolonged or become untreatable.

“Nurses have paved the way as clinical leaders in the prevention and management of infection and this course is responding to their current and future training needs. It will focus on practical work-based learning and develop specialist nurses that can adapt to changes in clinical practice and service provision in line with changes to health systems.

“It’s important we focus on the prevention of infection everywhere, not just in hospitals. The role of IPC nurses is constantly evolving and this course will help direct improvements to combat the rising threat of antimicrobial resistance in all settings.”

Further details about the course will be published in the New Year and expressions of interest can be registered on the RCN website.

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