bluuebunny/crossref_metadata_2025 huggingface dataset:
Recognising and managing allergic disease in the community
Authors: Bostock-Cox Beverley
Published: May 2014

Allergic disease and its symptoms, whether seasonal or perennial, can have a significant impact on individuals’ quality of life. Asthma, allergic rhinitis, eczema, urticaria and food allergy are among the common allergies that nurses may encounter in the community. This article discusses the causes of allergic disease, the importance of considering allergen avoidance, and the alternative treatment options available.
Changes and sticking points in adult safeguarding: a discussion
Authors: Manthorpe Jill , Wilkinson Ann , Chinn Deborah , Coopamah Vinoda
Published: May 2014

The care and treatment of vulnerable adults was the subject of regular public and media concern in 2011. This article discusses the potential impact of these concerns on community nursing practice and reflects on the ways in which such concerns may be discussed in professional development activities. It alerts nurses to the importance of considering the effects on patients and carers of exposure to negative findings from inquiries and inspections. It identifies ways in which professional development opportunities can be used to update general skills in safeguarding practice. These are likely to be of growing importance to the work of community nurses in the context of an ageing society and occasional potential conflicts between patients and carers. Keeping abreast of legal frameworks will be required of nurses if they are to advise and to advocate for their patients.
Protection of Freedoms Act 2012: safeguarding vulnerable groups
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In last month's article on changes to the law protecting vulnerable adults from harm by health and social care professionals, Richard Griffith and Cassam Tengnah discussed changes to be made to Criminal Records Bureau checks. This month's article discusses the changes to the vetting and barring scheme to be introduced under the Protection of Freedoms Act 2012, which mean that people currently working in regulated activities with vulnerable groups, such as district nurses, will no longer need to register and be monitored by the independent safeguarding authority or its replacement, the Disclosure and Barring Service.
Supporting home enteral tube feeding: some considerations
Authors: Best Carolyn
Published: May 2014

This article addresses some of the issues that may arise in preparing the patient with an enteral tube feed for transfer into the community. It highlights the knowledge and skills that the patient and/or carers will need to develop before being able to manage independently. It outlines potential problems that may be experienced when first taking responsibility for their own care. It also provides some valuable resources to support care for staff and the patient.
Wound cleansing: has it become a ritual or is it a necessity?
Authors: Lloyd-Jones Menna
Published: May 2014

Wound cleansing is considered to be an integral part of wound care, nevertheless wound cleansing is very often said to be a ritualistic procedure that is undertaken with very little thought or rational ( Magson-Roberts 2006 ). Is wound cleansing a procedure that needs to be performed and what is the difference between wound cleansing and debridment. The aim of this article is to consider the need for wound cleansing; the solutions used and the preferred method of cleansing wounds.
Dressing challenging anatomical areas: the Allevyn Gentle Border range
Authors: Stephen-Haynes Jackie , Greenwood Michelle , Merrick Jola , Callaghan Rosie
Published: May 2014

Wound care is a complex area, and there are several factors that can influence the choice of dressing. These factors include: the care setting, type of wound, desired frequency of dressing change, and estimated duration of treatment. Further, dressing choice can be influenced by complications such as wound infection.

In addition, when choosing a dressing, clinicians providing wound care need to consider the following factors: wound bed characteristics; ease of dressing application and removal; conformability; exudate management; dressing wear time; and tolerability by the patient, including the effect on lifestyle and quality of life. If all these factors are taken into account, patients are more likely to be concordant with treatment and a positive outcome achieved. For these reasons, a holistic approach to care can inform dressing selection.

There are six case studies of patients presenting wounds that showed improvement after treatment with dressings from the Allevyn Gentle range.
Case study: use of oscillation therapy and MLLB in cancer-related oedema
Authors: Jones Joanne
Published: May 2014

Lymphoedema treatments have for some time been limited to a few specific interventions. Those proven to be of effectiveness and research based are used. However, what about emerging new treatment modalities? For those clinics lucky enough to be able to have these new methods are they cost effective and what use are they in the clinical setting? The following case study examines one such emerging new treatment namely oscillation therapy. An oscillator was purchased for the service to be used on patients with stubborn oedema but how best to monitor its effectiveness? Is it possible to prove they work in order that additional equipment may be purchased in a time where resources are scarce? Patients often approach the clinician with articles cut from newspapers or with information gathered from other patients using networking. It was decided that it was time to examine in a small way the clinical effectiveness of the equipment already purchased and in use in clinic.
Parenteral nutrition: considerations for practice
Authors: Wilson Neil , Blackett Brenda
Published: May 2014

Malnutrition in the UK is estimated to affect 3 million people in the UK, costing the economy £13 billion a year. The effects can adversely affect an individual's wellbeing by exacerbating illness or reducing the prospect of a speedy recovery. The early identification of this actual or potential risk is recognised by using a validated nutritional screening tool as part of the patient assessment. Where risks are identified a structured plan should be put in place utilising oral and enteral techniques in nutritional support. However, for a number of patients these routes of feeding may not be an option, or may not fully meet the patient's nutritional requirements. It is in these circumstances that parenteral feeding may be considered under the supervision of a nutrition team. The careful selection of the parenteral solution alongside the most appropriate venous device to deliver the nutrition can assist in the effectiveness of this treatment and help in reducing the potential complications associated with this route.
Effective management of exudate with AQUACEL Extra
Authors: Tickle Joy
Published: May 2014

The management of patients with highly-exuding wounds can often lead to the use of unreliable and costly treatments. Patients are frequently found to be at increased risk of infection and delayed healing, which results in a huge negative impact on their quality of life. In the political and health arena, reducing health-care costs yet maintaining high quality and productivity is high on the list. With current economic, health-care and political targets, it is crucial to address the importance of effective wound management, particularly the importance of managing exudate. Inappropriate management of wound exudate can lead to prolonged wound healing, peri-wound maceration and excoriation, and can result in deterioration of the wound.
Moisture-associated skin damage: an overview for community nurses
Authors: Voegeli David
Published: May 2014

The harmful effects of excessive moisture on the skin are well documented. Although traditionally this has been considered as being a specific problem of continence care, it is a common problem encountered in many different patient groups. As a consequence the umbrella term moisture-associated skin damage (MASD) has been introduced to describe the spectrum of damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate etc. It is generally accepted that MASD consists of four distinct conditions, each having slightly different aetiologies, namely: incontinence-associated dermatitis; intertrigo; peristomal moisture-associated dermatitis; and periwound moisture-associated dermatitis. Careful assessment can help distinguish between the four and enable appropriate prevention and management interventions to be implemented. Whatever causes the excessive moisture, effective interventions should consist of the adoption of a structured skin care regime to cleanse and protect, and methods to keep the skin dry, controlling the source of the excessive moisture and treating any secondary infection.
Preventing occlusion and restoring patency to central venous catheters
Authors: Bolton Deborah
Published: May 2014

Central venous catheters (CVCs) may be used for treatment of critically and chronically unwell patients in hospital or in their homes. Complications can occur and should be resolved promptly so they do not result in increased lengths in hospital stay or readmission for patients receiving intravenous therapy at home. This article defines CVCs and the types of central venous access device that are in use in the UK; describes how to prevent occlusion and maintain the patency of CVCs; describes the types of occlusions that may occur; and discusses how to assess each type of occlusion and how they may be managed.
The importance of fixation and securing devices in supporting indwelling catheters
Authors: Yates Ann
Published: May 2014

Health-care professionals follow recognised national guidelines to assess clinical reasons for the insertion of urinary catheters. However, the use of fixation and securing devices is an area that is often neglected. Health-care professionals sometimes employ a ‘do-it-yourself’ approach, using adhesive tape or Velcro strapping devices, neither of which are appropriate. If urinary catheters are not secured appropriately, they can lead to severe trauma of a patient's urethra, potential damage to bladder neck, infection and inflammation, pain and irritation, possible bypassing, accidental dislodging of a catheter and a cleaving (condition whereby the catheter splits the penile or labial tissues). This article identifies reasons for using securing/fixation devices and explains the advantages and disadvantages of the different types of device in relation to individual patients.
Early-onset dementia: the impact on family care-givers
Authors: Flynn Rachel , Mulcahy Helen
Published: May 2014

People with early-onset dementia (EOD) and their family carers remain an overlooked population within the policy and practice priorities of community health care. No standard provision of care or support currently exists for those with EOD and the family carer. Yet family members provide the majority of the full-time care required for this progressive, irreversible illness. The aim of this research was to explore the impact of care-giving on family members caring for a relative with EOD. The care-giving experiences identified in this study emphasise the need for improvement in the provision of community and specialised services for people with EOD and family carers. The key themes of this qualitative study were diagnostic problems, impact of care-giving, relationship change and lack of resources. These findings provide key directives for improving community practice, services and support for people with EOD and their family carers.
Mobility restriction and comorbidity in vision-impaired individuals living in the community
Authors: Cobb Siobhan Mac
Published: May 2014

A review of data presented in a national study of perceptions and experiences of mobility with an age-stratified sample of 564 Irish adults with vision impairment found that mobility was a significant issue. Comorbidity is a factor with 97 (29.5%) of the under-65 age group and 135 (59%) of the older age group reporting additional health challenges. Adapting to vision loss and ageing has psychological, functional, social and health implications and help-seeking is a complex process. This may explain the limited use of mobility aids and guide dogs in the total sample (5%), with a notable absence of use in the older age group. A broad view of the Person–Environment–Occupation Model was proposed for primary and community care services, in collaboration with specialist vision impairment agencies to enhance mobility, maintain functional capacity, influence positive and healthy adaptation to vision impairment, social inclusion and quality of life in a population expected to increase by more than 170% over the next 25 years.
Recurrent urinary tract infection in older women: an evidence-based approach
Authors: Nazarko Linda
Published: May 2014

Ageing increases the risk of a woman developing a urinary tract infection (UTI). It also increases the risk of misdiagnosis and inappropriate antibiotic therapy being prescribed. Antibiotic therapy has costs as well as benefits and can lead to changes in gut and vaginal flora that further predispose older women to UTI. Antibiotic resistance is growing and those who do have a UTI may experience treatment failure because of resistance to commonly used antibiotics. Accurate diagnosis and effective evidence-based treatment becomes even more crucial in the face of an ageing population and increasing antimicrobial resistance. Furthermore, the need for specific evidence-based guidelines for UTI in older people is increasing.
Sharps injuries and the new European regulations
Authors: Griffith Richard
Published: May 2014

Concern over the number of sharps injuries in the health-care sector in Europe has led to a directive aimed at preventing such injuries. The provisions of the directive that were not already covered by existing health and safety law have been implemented by the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013, which came into force in May 2013. This article sets out the key provisions of the 2013 regulations and considers their impact on district nursing practice.
Developing a nurse-led integrated ‘red legs’ service
Authors: Elwell Rebecca
Published: May 2014

This project was developed to set up a nurse-led service based on the needs of patients diagnosed with ‘red legs’. These patients are often wrongly admitted into hospital for treatment of cellulitis. Representatives from the specialties involved in caring for those individuals with red legs were invited to participate with patients to create a stakeholder group whose purpose was to develop integrated care pathways focused on referral criteria, diagnostics and treatment to inform a new nurse-led service. There was a commitment to utilising a number of facilitation techniques and practice-development methods in the progression of the project with the support of the Foundation of Nursing Studies. Much of the prescribed care can be carried out by the patients at home and only 25% patients have required a follow-up appointment within the new service. The service has now been fully commissioned and a secondment opportunity has been developed to lead the new service. Significant savings have been demonstrated and regular revision of the integrated care pathways with all groups, including the patients, will take place.
Pharmacological versus non-pharmacological approaches to managing challenging behaviours for people with dementia
Authors: Hungerford Catherine , Jones Tony , Cleary Michelle
Published: May 2014

When people with dementia demonstrate challenging behavioural and psychological symptoms of dementia, the levels of stress experienced by their carers increases. Furthermore, there is an increased likelihood that the person will be prematurely admitted to a residential care facility. The adverse side-effects that have been associated with the use of antipsychotic medications in older people with dementia have given rise to a renewed emphasis on the use of non-pharmacological approaches to manage challenging behaviours. This article describes the approaches taken by the multi-disciplinary team of a Dementia Behaviour Management Advisory Service in Australia to support people with dementia who have challenging behaviours by using non-pharmacological interventions.
Disrupted social connectedness in people with Parkinson's disease
Authors: Soleimani Mohammad Ali , Negarandeh Reza , Bastani Farideh , Greysen Ryan
Published: May 2014

A study was conducted to explore the effects of Parkinson's disease on people's social interactions. An exploratory qualitative design was used. Participants were a purposive sample of 10 people with Parkinson's disease who were attending a hospital outpatients’ neurology clinic. Data were collected by semi-structured in-depth interviews. All interviews were transcribed and analysed by using conventional content analysis to explore the participants’ experiences and perceptions on social interactions, using the central question ‘what effect does Parkinson's disease have on people's social interactions?’ Analysis revealed that Parkinson's disease affected social interactions by disrupting social connectedness. Social connectedness was disrupted by a number of factors, including ‘progressive physical disability, mood disturbances, shrinking of social activities and secluding oneself’. Older adults with Parkinson's disease therefore face a number of challenges to remaining socially connected. It appears that disrupted social connectedness is one of the negative consequences of living with Parkinson's.
Promoting intermittent self-catheterisation to encourage self-care in district nursing patients
Authors: Cassani Roberto
Published: May 2014

Intermittent self-catheterisation (ISC) is deemed the preferred option for the management of urinary incontinence and/or retention in patients requiring a catheter. It also allows patients to self-care, thereby placing fewer demands on district nursing (DN) services and meeting the requirements of the current health policy agenda. Yet many patients who could benefit from ISC in the community still use a long-term urinary catheter. This may contribute to increased morbidity, poorer quality of life, and unnecessary visits from the DN team. This article analyses the role of the district nurse in promoting and supporting the use of ISC with suitable patients.
Food safety and older people: the Kitchen Life study
Authors: Dickinson Angela , Wills Wendy , Meah Angela , Short Frances
Published: May 2014

Foodborne illness (FBI) is a major public health problem in the UK. Recent increases in cases of listeriosis in older people have focused attention on consumer food-related practices. Previous studies highlight poor relationships between what people know, what they say they do and what they actually do in the kitchen. The aim of the Kitchen Life study was to examine what actually happens in the domestic kitchen to assess whether and how this has the potential to influence food safety in the home. Drawing on a qualitative ethnographic approach, methods included a kitchen tour, photography, observation, video observation, informal interviews and diary methods. Ten households with older people (aged 60+) were recruited across the UK. It was found that trust in the food supply, use of food-labelling (including use-by dates), sensory logics (such as the feel or smell of food) and food waste were factors with the potential to influence risk of foodborne illness. Practices shifted with changing circumstances, including increased frailty, bereavement, living alone, receiving help with care and acquiring new knowledge, meaning that the risk of and vulnerability to foodborne illness is not straightforward.
Mental health part 2: Depression and treatment
Authors: Simpson Clive
Published: May 2014

People often say they are ‘depressed’ when they mean they are sad, upset or just fed-up. But the clinical condition of depression is very different and much more distressing than these ordinary, everyday human experiences. This, the first of two articles, will provide a broad introduction to this most common of mental health problems. It will briefly describe theories on the causes of depression, and how to recognize it. It will also look at treatments for people with depression. The second article will look at some principles of caring for people with depression and essential interventions that healthcare assistants and assistant practitioners can get involved in.
When patients refuse treatment
Authors: Nazarko Linda
Published: May 2014

Mrs Janet Johnston is refusing medication, failing to comply with her diabetic diet and refusing to mobilize following a repair of fractured neck of femur. If she does not improve, Mrs Johnston will be discharged immobile, with a large package of care and long-term health needs. Using a holistic approach can enable staff to see the person behind the problems and develop a partnership with Mrs Johnston to enable her to heal and become well again.

This article will use the fictional Mrs Johnston as an example of a patient refusing care.
Standard precautions: how to help prevent infection
Authors: Nazarko Linda
Published: May 2014

Every two minutes a patient acquires a healthcare associated infection. Every two hours a patient dies because of healthcare associated infection. Five thousand people die every year as a result of health care associated infection. Despite this healthcare staff do not fully comply with standard precautions to prevent infection. This article provides information about infection risks in healthcare and what can be done to improve infection control practice.
Helping individuals to overcome fatigue
Authors: Swann Julie
Published: May 2014

Fatigue affects many people and can be a result of another illness or condition such as multiple sclerosis or depression. It can also occur as a side-effect of certain medications. It is important to treat fatigue as it can severely affect a person's standard of life.
Body fluids: composition and disorders of pancreatic and intestinal juices
Authors: Peate Ian
Published: May 2014

Pancreatic and intestinal juices, just like gastric juices, are digestive fluids. They have a role to play in breaking down food substances into smaller units that can be absorbed from the intestine into the blood and then used by the body for repair and growth of body tissue.
Nutrition part 2: maintaining good oral health
Authors: Nazarko Linda
Published: May 2014

People with learning disabilities, those who are critically ill, acutely unwell and frail older people may have difficulty maintaining oral hygiene. Poor oral hygiene can lead to oral health problems and these can affect the ability to eat and drink. This article explains how the healthcare assistant can help prevent oral health problems and enable people to remain well-nourished and hydrated.
Infection control: hand hygiene
Authors: Gould Dinah
Published: May 2014

Hand hygiene is the single most effective way of preventing and controlling the spread of infection. It is the responsibility of all health and social care workers to cleanse hands effectively in order to reduce the risks of cross-infection. Hands must be cleansed even when gloves are worn. Fingernails should be kept short, the sleeves should be rolled up and gloves and wristwatches should be removed (‘bare below the elbow’) to further promote patient safety. Care of the hands is important to reduce the risks of infection and to promote the wellbeing of health and social care workers.
Post-stroke psychological and communication issues
Authors: Ross Sarah , Barton Jane , Reading Jennifer
Published: May 2014

This article describes the development, content and evaluation to date of an in-service, interdisciplinary training programme on psychological and communication problems after stroke. The training is open to all staff but is particularly focused towards qualified and unqualified nursing staff and therapy assistants who work in acute stroke care and rehabilitation both in hospital and community settings.

Content: The programme, developed by the authors whose backgrounds include speech and language therapy, occupational therapy, and clinical psychology, aims for all staff to develop an integrated, patient-centred approach to care, and addresses issues such as improving the patient and carer experience of rehabilitation, as well as reducing the negative psychosocial consequences of stroke. Service users are involved in delivering the training. Informal evaluation highlighted improvements for trained staff in knowledge and perceived confidence in the recognition and basic management of communication, cognitive and emotional problems after stroke.

Conclusions: Limitations in evaluation in terms of design, methodology and data are acknowledged, however, preliminary findings highlight the benefits of this programme in holistic stroke care delivery. Suggestions are made regarding future more empirically rigorous research into longer-term effects of the training both for staff and patient outcomes..
Teaching stoma patients the practical skills for self-care
Authors: Black Pat
Published: May 2014

In approximately 65% of patients who have a stoma formed, it will be a permanent adaptation to their bowel management. This represents a major transition in a person's life and requires a great deal of adjustment. Most stoma patients experience psychological concerns, and lose their confidence, independence and often dignity. These patients need psychological support and the teaching of practical skills to help them regain their independence. This article aims to equip healthcare assistants with the knowledge they need to teach patients how to manage their own stomas effectively.
Maternity focus: caring for vulnerable pregnant women
Authors: Gregory Irene , Kinge Suzanne
Published: May 2014

Pregnancy is a difficult time for some many women and can accentuate any vulnerabilities that they may have had before the pregnancy. Guidelines from the National Institute for Health and Clinical Excellence (NICE) (2010a) has set out what individual health professionals and antenatal services as a whole can do to address these needs and improve pregnancy outcomes for this group of women. This article looks at the implications that these guidelines have for the professional lives of support workers employed in a maternity setting in order to help them provide the best standard of care for women, particularly those from difficult social circumstances.
Why complaints are a positive for support workers
Authors: Stonehouse David
Published: May 2014

Support workers have a privileged position within the team of professionals looking after clients. They are the one group of staff that spends the most quality time with them. They are the ones delivering the basic fundamental care needs and through this develop a close professional working relationship with patients and clients. When things within the delivery of care are not going quite as they should, it is the support worker who is often the first member of the team to become aware of this—either by identifying the problem themselves or being informed of it by clients. How support workers deal with issues and complaints will play a major part in how the service is viewed by the client from then on. Complaints should not be viewed negatively or shied away from, but seen positively as a way that support workers. All staff can develop and improve the quality of care delivered.
Resuscitation: is it a technical or legal question?
Authors: Yeomans Paul
Published: May 2014

Cardiovascular failure is a feature of all deaths, even though now brainstem death is the definition of death. Cardiopulmonary resuscitation (CPR) is presumed to be good practice, but ‘do not resuscitate’ (DNR) decisions by the patient or the doctor and clinical team are acceptable where (1) CPR won't work (2) CPR will work briefly but the patient will still die (3) the pros of survival are outweighed by the cons. The courts have reminded that purely ‘technical’ decisions on futility of CPR are unlikely to need legal rulings, and even quality of life DNRs should be referred to court sparingly. There is amply guidance and room for reassurance and discussion without recourse to the law. But the courts reserve their authority where there is genuine dispute or a novel situation.
Mary Seacole: nursing care in many lands
Authors: Anionwu Elizabeth N
Published: May 2014

Mary Seacole, a Jamaican/Scottish nurse and businesswoman, was a celebrated Victorian heroine, due to her bravery in nursing soldiers in the Crimean War (1853-6).

She was also admired for her use of Creole herbal remedies to relieve the symptoms of infectious illnesses such as cholera in Jamaica and Panama. .
Treatment for lymphorrhoea in limbs and in advanced disease
Authors: Board Jane , Anderson Julia
Published: May 2014

Supported by the NHS Lymphoedema Service Administrator, this article reports on a project undertaken by a clinical nurse specialist in Lymphoedema (CNS) and in part fulfilment of an MSc in Skin integrity skills and treatment, achieved from the University of Hertfordshire, September 2011.

The need for the project was generated by the 5-day delay experienced by terminally ill patients in a hospice while waiting to receive treatment for lymphorrhoea from the community-based CNS.

The training and assessment of healthcare assistants in a cost-effective treatment enabled the instigation of care within 3 hours of the development of lymphorrhoea in a patient and an evaluation of its competent delivery.
Clinical skills series/1: oxygen therapy
Authors: Peate Ian , Gault Christine
Published: May 2014

The roles and functions of the healthcare assistant (HCA) and assistant practitioner (AP) are wide and varied; so too is the care they offer people. This care takes place in a number of settings, fo example, in the hospital or in the person's own home. This article provides an overview of the care needed for those people who require oxygen therapy. In order to care safely and effectively for people who require supplementary oxygen, the HCA and AP need to have an understanding of the anatomical and physiological processes involved in the act of breathing and gas exchange.
Role of HCAs and APs in the evolving protection landscape
Authors: Yeomans Paul
Published: May 2014

The landscape of protection is changing and HCAs/APs must be confident of their place in it in order to work effectively. Each devolved and neighbouring jurisdiction of the UK has its own guidance for children and young people (CYP) and for vulnerable adults (VAs) (or adults ‘at risk’). If abuse is suspected or reported, you are in the realm of criminal investigation and it may be necessary to contact the police immediately.

Besides the substantive offences, HCAs/APs should be confident with disclosure and information-sharing between agencies and professionals. All health staff need to know how to contact others (designated health lead or expert, social services, NSPCC, police, probation).

As part of professional development, there may be monitoring issues for colleagues, as well as ensuring that signs of abuse are acted upon appropriately. Regulations, guidance and government responses to failings and scandals also influence public awareness and opinion, which can affect cooperation and disclosure too.
Appraisal and its benefits for the support worker
Authors: Stonehouse David
Published: May 2014

Within this article, the author will examine what an appraisal is and how, if done correctly, it supports and develops quality care. Appraisals receive a negative press with both employees and managers. Reasons for this will be explored before moving on to identify the purpose and benefits that following an appraisal process brings. The many different forms that appraisals can take will be highlighted. What factors make up an appraisal will be discussed, from reviewing past performance to the setting of realistic and yet challenging goals. The importance of preparation for the support worker prior to the appraisal process will be highlighted as a key factor to success.
Spirituality article 8: the role of the healthcare chaplain
Authors: Barber Chris
Published: May 2014

The role of the healthcare chaplain is one of the most misunderstood and yet important aspects of both health care and the healthcare team. This article highlights who the healthcare chaplain is, his or her role within the healthcare team and the role of the HCA/AP, nursing student and registered nurse in working with the chaplaincy team.
Rehabilitation of patients with head injuries
Authors: Swann Julie I
Published: May 2014

Head-injured patients experience diverse problems, including physical, cognitive, behavioural, or emotional dysfunction. There is a team of people who can help to regain a patient's former level of abilities or teach adaptive methods. This article outlines the different roles of the rehabilitation team, and the vital role HCAs and APs have in the rehabilitation of a head-injured patient.
The first BACCN military region HCA critical care workshop
Authors: Carter Chris , Sessions Julie
Published: May 2014

This article outlines the role of Army healthcare assistants (HCAs), gives an introduction to the British Association of Critical Care Nurses (BACCN)—Military Region and offers feedback from the recent BACCN Military Region study event specifically for Army HCAs.
How sociological perspectives on ageing can aid reflection by HCAs
Authors: Hayes Catherine
Published: May 2014

This article provides healthcare assistants (HCAs) with an insight into the sociological theories that underpin how ‘old age’ as a concept is constructed by society and how this can influence the way that older people are perceived as a result. The theories discussed offer consideration from both a historical and a comparative standpoint in order to stimulate thinking and discussion of emotive topics such as ageism. It also allows HCAs to engage in critical reflection on their own contribution to healthcare practice so that they can develop best practice and seek to change aspects of their interaction with older people that might not before have been considered. The article emphasises the relevance of this to HCAs by giving examples from practice, to demonstrate how these sociological theories impact on the everyday ability to provide care.
Cashing in on the benefits offered by total bed management concept
Authors: Tracey Clive
Published: May 2014

The concept of ‘total bed management’ and how it optimised bed usage and translated into significant cost savings for the King's Healthcare NHS Trust.
Please don't shoot my Fox, Mr Duncan Smith
Authors: Roth Andrew
Published: May 2014

As soon as the rumours reached me in late July of a new looming shake-up of the Conservative front bench, I got down on my knees and sent up my agnostic prayer to the bald deity with a perpetual frog in his throat: “Dear IDS, please don'tshoot my Fox: my Dr Liam Fox. It takes so long to tell the real opponents of the NHS from its constructive critics!”
Consensus and contention: doctors’ and managers’ perceptions of the doctor-manager relationship
Authors: Davies Huw T.O. , Hodges Claire-Louise , Rundall Thomas G
Published: May 2014

The relationship between clinicians and managers is central to the success of health care reform and improvement. This paper assesses how they see each other.

This paper expands and elaborates on survey data originally published as a ‘short report’ in the BMJ (BMJ 2003;326:626-8). Data reproduced with permission.
Dyspepsia and GORD care after PPI use
Authors: Evans N , Rawaf S , Holmes J , Dawson S
Published: May 2014

Chronic proton pump inhibitor (PPI) use is a major health economics issue in the UK. NICE recommends that patients with nonulcer dyspepsia and gastro-oesophageal reflux disease should receive the lowest dose of medication necessary to control symptoms.
Reviewing the dementia strategy
Authors: Nazarko Linda
Published: May 2014

Dementia is a global term used to describe a syndrome or group of concurrent symptoms caused by a number of different illnesses, and is described as (Council on Scientific Affairs, 1986
Practitioner-led rapid cycle change
Authors: Powell Alison , Rushmer Rosemary , Davies Huw
Published: May 2014

The practitioner-led ‘rapid cycle change’ approach uses the Plan-Do-Study-Act cycle widely promulgated by the US Institute for Healthcare Improvement (IHI). It has been used in many healthcare organisations, particularly as a key component of quality improvement collaboratives. As a small-scale, bottom-up approach, rapid cycle change has several advantages over other quality improvement approaches, but like them it runs into a range of obstacles in healthcare settings. Further studies are needed to establish its impact on practice patterns and outcomes.
Meet the management: a local initiative
Authors: Kadir Shanil , Nazir Tahir , Ahmed-Little Yasmin
Published: May 2014

Medical management has recently gained importance with an increasing number of doctors tryingto learn more about it. There have been medical leadership programmes and junior doctor'smanagement workshops held by various organisations, all geared towards doctors in general and junior doctors in particular. These programmes not only provide doctors with an insight into theworking of NHS but also give them a platform to put up their ideas and get involved. This article discusses a unique and simple event conducted by us which made a drastic impact on the relationship between senior management and junior doctors, and provided them with a platform to bring about and implement new ideas and discuss issues.
Benchmarking length of stay
Authors: Jones Rod
Published: May 2014

Our perception of how health care behaves is reflected in the policies formulated to contain health care costs. Therefore, most would view length of stay as a continuously decreasing measure, reflecting increasing efficiency. Deviations from this assumed behaviour are therefore regarded as evidence for poor efficiency.
Key performance indicators and HoNOS
Authors: Dickens Geoff , Sugarman Philip
Published: May 2014

St Andrew's Healthcare has pioneered the use of Health of the Nation Outcome Scales (HoNOS)data to power key performance indicators demonstrating change on global and risk-related outcome among a diverse group of patients with mental disorders, neurodevelopmental and learning disabilities, and acquired brain injury. Performance indicators based on routinely collected outcomes data for 2008 and 2009 were calculated for six specialist services (at Northampton men's, women's, adolescent, older adults secure services and our brain injury rehabilitation unit; and in our low secure adult service in Essex) to demonstrate change. Mean 90-day changerates of +0.64% and +0.52% on the risk outcomes indicator, and of +0.78% and +0.66% on global outcomes measures were demonstrated for 2008 and 2009 respectively. Differentials in change ratesbetween services with highly specialised service-user needs reflected clinical realities. St Andrew's Healthcare has now published six years of performance data demonstrating continuouspositive change for our patient groups. These indicators should be viewed as valid and stable andshould be more widely adopted.
Organisational learning: where professions rule
Authors: Gunawardena Indunil
Published: May 2014

Organisational learning is collective learning. It builds on experience and therefore depends on organisational mechanisms for retaining and deploying knowledge. Organisational arrangements can foster or inhibit the learning process. Learning has been identified as a central concern for a modernising the NHS. How NHS professionals interact with each other and the organisation itself is paramount to the effectiveness of its service. The attributes of professions or professionalism and the structural and cultural features of the NHS should be conducive for organisational learning if the NHS is to be an organisation with a memory. This article looks at the interaction between professionalism and organiasational learning within the framework of the NHS.
Emerging clinical leadership development in the NHS
Authors: Moll Sarah , Ahmed-Little Yasmin , Brown Benjamin , Abdalla Hesham , Owen Elaine
Published: May 2014

Leadership development for clinicians is a relatively new concept in the NHS. Even more recent is the notion that investment in emerging clinical leadership also has added value. Most previous initiatives have aimed primarily at leadership development amongst senior doctors. However, opportunities to engage more junior colleagues in clinical leadership and medical management within the NHS have started to appear and attract increasing interest. In the NHS Next Stage Review in 2008, Lord Darzi called for the establishment of clinical (Darzi) leadership fellows to support clinicians with a particular interest in leadership. Within the North West 14 such posts were piloted in 2009–10, identifying and recruiting emerging clinical leaders from multidisciplinary backgrounds. This article highlights some of their experiences and lessons learnt.
Inpatient elderly care: reducing re-admission rates
Authors: Xu Gang , Whitaker Elizabeth , Whitaker Elizabeth , Hubbard Irene
Published: May 2014

In our hospital, when demand for medical beds overwhelms capacity, patients are often ‘out-lied’ into other specialties beds to free up capacity. An observational study compared outcomes of patients admitted into an elderly care ward and outlier beds in our hospital over 14 days. Six weeks after completion of the initial study, inpatient geriatric services were expanded, and some medical outlier beds were incorporated into a new ward—the study was repeated on this new ward. 38, 26, and 35 patients with a mean age of 79, 85 and 80 years were admitted to the medical ward, outlier beds, and new medical ward respectively. Mean number of medications, comorbidities, female-to-male ratio, destination of discharge, and mortality was similar in all three cohorts. Mean length of stay was 23 days, 42 days, and 24 days. Three month re-admission rates were 25%, 50%, and 13%, respectively on the established medical ward, outlier beds, and new medical ward. The length of stay and re-admission rates for elderly patients in outlier beds were higher than patients on the medical ward, despite similar demographics and destination of discharge. Our data suggests that outlying elderly patients is hugely inefficient.
Delayed discharges in mental health beds
Authors: Manzano-Santaella Ana , Goode Belinda
Published: May 2014

The Department of Health (DoH) has identified a high number of hospital delayed discharges in patients diagnosed with a mental illness. Since 2006, the weekly monitoring of these delays is required for all non-acute and mental health trusts. This article explores the limitations of standardized definitions of ‘safe to transfer’ for mentally ill patients; the conundrum created by co-morbidity and legal requirements; and the constraints of current categories for delay established by this performance system are exposed. Establishing when and why hospital discharges are delayed is not an easy task. It is embedded with subjectivity and complexity, which increases in the context of the intricacy of mental illness and discharge-pathways. Considering the constructed nature of delayed discharges, the limitations and over reliance on quantitative data collection must be taken into consideration in the case of quantitative itemization of mental health needs for Payment by Results tariffs, or when using audit data to construct evidence-based systems of care for people diagnosed with mental illnesses.
Identifying clinical leadership functions
Authors: Willcocks Stephen
Published: May 2014

The white paper Equity and Excellence: Liberating the NHS (2010) , will bring about large-scale changes to structure, process, and not least, new ways of working—requiring inter-related changes in culture, behaviour and practice. Given the scale of these changes, this represents a considerable challenge for clinical leaders in the NHS. As Giordano points out: ‘Courageous decisions are needed to reshape services and help us prepare for the most significant leadership challenge the NHS is ever likely to face’ ( Giordano, 2009 ). It may well be the most significant challenge but it is not necessarily new to the NHS. It has happened at each change of government. Flanagan, writing at the beginning of the New Labour government in 1997, wrote: ‘Managers are key to implementing change in the NHS. New Labour will require them to drive their set of changes over the next few years. Have they been equipped to cope?’ ( Flanagan, 1997 ). The same question can be asked this time round, although, given the nature of the reforms, it can also be asked of clinical leaders. Are they equipped to take on the leadership role/function?
GPs’ attitudes to practice based commissioning
Authors: Astles Stephen , Jones Colin
Published: May 2014

Using a sample of 85 GPs, this study aimed to gain a deeper understanding of GPs attitudes towards commissioning. The study employed survey and focus groups as the principle methods of data collection During the study the new coalition government published a white paper which planned to make GP commissioning compulsory, this obviously had ramifications for the legitimacy of the study and this was incorporated into the work.
Commissioning for pain management services
Authors: Hobbs Greg , Knaggs Roger
Published: May 2014

The management of chronic pain commonly arising from musculoskeletal disorders such as lower back pain, osteoarthritis and rheumatoid arthritis is, with a few notable exceptions, much neglected in the UK. Although most trusts have pain services, with a handful of secondary care centres of excellence offering first-rate chronic pain management, this service is not available to all patients in primary care settings. During the course of a normal consultation, GPs often do not have the time to assess and understand the cause of chronic pain in individual patients, let alone provide worthwhile solutions in terms of drug therapy and other pain-relieving interventions. This article outlines the extent of the problem and highlights what has been and is being achieved in Nottingham and the surrounding community to improve patient access to chronic pain management.
Time to re-evaluate financial risk in GP commissioning
Authors: Jones Rod
Published: May 2014

Financial risk is the gap between the available funds and the healthcare costs (activity and case mix) incurred by the population. Costs are subject to both statistical and environmental volatility. This article demonstrates that the combined and interactive effects of the wider environment leads to very high volatility in year-to-year costs and also generates a set of poorly-understood long-term cycles in healthcare demand leading to prolonged periods of above-average cost. It suggests that there are genuine sources of risk over which there is little direct control and that funding may need to follow a more flexible trajectory. What is called the ‘post code lottery’ arises out of the mismatch between the capitation formula and the susceptibility of local costs to volatility due to the environment.
The Gordian knot: provision in Scotland and England
Authors: Donaldson Jayne , McIntosh Bryan , Jones Simon
Published: May 2014

Jayne Donaldson, Bryan McIntosh and Simon Jones argue that England can learn from Scotland's approaches to the nature of hospital capacity and the workforce's delivery of service