Andrew Carr describes the treatment of a common and distressing presentation to accident and emergency departments

There are many nursing procedures in the A&E department which are both unpleasant and painful to perform. The nurse’s responsibility when undertaking clinical procedures is to discuss care with the individual concerned and to ensure that appropriate measures are taken to minimise discomfort and distress. By acting as an interpreter of the hospital experience, the A&E nurse can reduce the level of anxiety and stress felt by that individual (1). The trephining of subungal haematoma is one area of nursing care where good communication, and a high-level practical skill can significantly reduce patient anxiety.