bluuebunny/crossref_metadata_2025 huggingface dataset:
Never forget the importance of caring
Authors: Castledine George
Published: May 2014

To delegate fundamental aspects of the care of vulnerable older people to anyone who is not a qualified nurse is a risky business in any society. Recently, a BBC Panorama team went undercover in some of Britain’s biggest homecare suppliers and found that the quality of care was extremely poor. They also found that many of the carers had so little training that they lacked the insight into what it was about their care and behaviour that was failing their patients.
An assessment tool for acutely ill medical patients
Authors: Gleeson Margaret , Kellett John , Western Mid , Cowan Mairead
Published: May 2014

This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors’ hospital between June 2007 and July 2008. The SCS was well received by the staff – 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.
Haywood case is a lesson for nurses and managers
Authors: Castledine George
Published: May 2014

Not only has the decision of the NMC’s Conduct and Competence Committee to strike off Nurse Haywood from the register caused significant media interest, but it has also angered many nurses. In trying to protect vulnerable patients, the central role of the NMC, it has incensed nurses who are frequently seen as the patient’s only advocate, and may have even deterred some from attempting to highlight poor care.
The role of nurses in the prevention and management of obesity
Authors: Lazarou Chrystalleni , Kouta Christiana
Published: May 2014

This paper examines the current scientific knowledge on the relationship between diet and obesity, and considers the implications for nursing practice. It focuses on the main nutritional elements that have been identified as significant in the prevention and management of obesity. Research findings reveal the important role of specific dietary habits and patterns and their influence on obesity; particularly on childhood obesity. This paper discusses the nursing implications in relation to the prevention and management of obesity.
The principles of decontamination in gastrointestinal endoscopy
Authors: Chapman Warren
Published: May 2014

Modern endoscopes can be used to examine the whole of the gastrointestinal (GI) tract. During these examinations, biopsies may be taken, or treatment provided via working channels in the endoscope. Demand for GI endoscopy is increasing because of the National Bowel Cancer Screening Programme and a rise in dyspepsia. Endoscopes are complex and expensive, so are reused. To prevent cross-infection and cross contaminiation, endoscopes need to be adequately decontaminated between patients; there are specific concerns around transmission of variant Creuztfeldt-Jakob disease. Endoscopes are sensitive to heat and cannot be autoclaved, so other methods of decontamination are needed. This article looks at endoscope decontamination processes, and the systems and management that need to be in place
Would a change in the student nursing programme bring any real benefits?
Authors: MM Rankin Lesley
Published: May 2014

I had a read of the above article and it paints a very scary picture. My placements haven’t all been pleasant, but even in the worst ones, both the placement and myself have learned some very important lessons to apply to practice. This was only able to happen because (although supernumerary) the current nursing programme encourages multidisciplinary working, linking that work to theory. This happens in all modules of my education programme, and it is only by being completely involved in all aspects of the nursing role within my placement (including ward politics), that myself and my fellow students can truly apply theory to practice. Having a completely involved student nurse in a lacement is both beneficial to the placement and to the student nurse
The use of silver-impregnated dressings in blast injuries
Authors: Elliott Chris
Published: May 2014

This article aims to critically examine the management of military patients who have been the victims of thermal injuries, which have become infected resulting from their inoculation with dirt and foreign bodies during blasts and explosions. In the interests of maintaining confidentiality, the names of NHS trusts, military hospitals and specific military operations have been omitted. This action has been taken in accordance with guidelines from the Nursing and Midwifery Council (2008)
Team nursing: finding the ideal
Authors: Castledine George
Published: May 2014

There has inevitably been a lot of discussion about the recent failings of the English football team. Blame for defeat in the World Cup has been put down to the manager, the system, the players and the money they get. It would seem that everybody has an opinion as to what went wrong. In some ways there are similarities between football teams and nursing teams in the way that they are managed. Nurses may not get anywhere near the salaries that football stars get, but they need to work together as a whole to reach their goals. If there is any discord or friction between team members then this can lead to problems and disruption. It may be that some team members are lazy and rely on others to do all the hard work, while they wait on the wings or roam about looking busy. There is a particular danger in nursing teams that some players reduce nursing care to a series of procedural steps or tasks, without understanding the underlying principles on which nursing methods are based.
The Snapshot tool: a new form of practice assessment
Authors: Tolley Kim , Marks-Maran Di , Burke Linda
Published: May 2014

This article presents a pilot study that was undertaken to test the Snapshot tool—an innovative tool for making judgements about clinical practice performance. An evaluative research design was used. The Snapshot tool was designed and was piloted on two groups of students (n=180; n=152) in a university-based simulation setting. Data were collected through questionnaires containing a mixture of Likert-style and open-ended questions. First-year students found the Snapshot process and criteria to be realistic and relevant/applicable to practice, useful for receiving feedback and for structuring feedback to others, and the Snapshot was largely perceived as more preferable for university-based assessment than Objective Structured Clinical Examinations (OSCEs). Third-year students evaluated the Snapshoot tool in terms of both the Snapshot process (40% of statements made) and the Snapshot criteria used (60% of statements), finding the criteria realistic, appropriate, clear and comprehensive, and the process helpful to their learning, helping them to identify their strengths and weaknesses and helping them to identify specific skills that they need to improve. This article makes a contribution to the clinical assessment agenda for two reasons. Firstly, with the introduction of the use of simulation as part of legitimate clinical practice experience it offers a tool for assessment of students in simulation activities. Secondly, it explores the potential for this tool to be used as a part of the assessment of students during their clinical placements
Advancing menopausal care
Authors: Abernethy Kathy
Published: May 2014

Nurses occupy a unique position in menopausal care. Kathy Abernethy explores the crucial role that menopause nurses can play at this sometimes difficult time.
Does home haemodialysis produce better outcomes for patients?
Authors: Miller Jennifer
Published: May 2014

Demand for renal replacement therapy (dialysis and transplantation) is projected to rise by approximately 5% every year until at least 2030. Therefore, particular attention should be paid to areas in which significant increases in demand are likely to lead to further pressure on services. There is evidence to support higher patient survival rates in home haemodialysis compared with those that receive hospital- or satellite-based haemodialysis (i.e. a smaller renal unit based in a community hospital closer to the patient’s home). Furthermore, studies suggest that home haemodialysis is at least as effective as and less costly than hospital or satellite unit haemodialysis. Therefore, there is a greater requirement for expanding the provision of home haemodialysis, and to make this treatment option available to a wider range of patients
Biologic therapy and screening for tuberculosis in a new service
Authors: Peters Julie
Published: May 2014

Plaque psoriasis is a common skin condition that can greatly affect quality of life. Biologic therapy is an effective treatment, but it poses risks to patients, particularly concerning latent infections such as tuberculosis (TB), which may be reactivated. Medical practitioners therefore need to screen patients before commencing a biologic therapy. There are a number of screening tools for TB infection, which vary in efficacy depending on the patient being screened, and some tests can give a false–negative result for TB infection. It is important to screen for TB and to take a good clinical and lifestyle history before commencing biologic treatment. This article discusses the above in the context of setting up a dedicated clinic to monitor patients on biologic therapy for plaque psoriasis.
New landscapes, new horizons, new regulator
Authors: Peate Ian
Published: May 2014

The Nursing and Midwifery Council (NMC), its predecessors the United Kingdom Central Council for Nurses, Midwives and Health Visitors (UKCC), and the General Nursing Council (GNC) have taken the statutory role of regulating the nursing and midwifery professions. Their aim is to safeguard the health and wellbeing of the public.
Presbycusis and its management
Authors: Ko JungYung
Published: May 2014

Age-related hearing loss, or presbycusis, is becoming a public health issue. With the large number of ageing baby boomers, primary care providers can expect to see an increase in older adults suffering from chronic health problems such as presbycusis. It is the primary care provider’s responsibility to perform prompt auditory screenings and to recognize the early clinical signs and symptoms of hearing loss. Early interventions, such as hearing aids or surgery, could help to improve the client’s quality of life. Primary care providers should also teach older adults proper auditory hygiene, and provide information regarding support groups to the family and the caregiver as needed.
Enteral tube feeding -from hospital to home
Authors: Best Carolyn , Hitchings Helen
Published: May 2014

There are a number of benefits to providing home enteral feeding, however, problems can occur if care is not taken to arrange training and after-care appropriately. It is therefore essential to facilitate an informed and thorough transfer of care to minimize potential problems. This article will address some of the issues that arise when patients who require home enteral feeding are discharged from hospital to their own homes or to care homes. These issues include the knowledge that is required to enable the patient and/or carer to safely manage their feeding tube, the feeding regimen, the continuing support required from health-care professionals, and some of the more common problems that may arise.
The fat of the land: obesity prevention over obesity treatment
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasperlooks at the ever-increasing problem of obesity, and the complications involved when caring for a bariatric patient. He examines new healthcare guidance for dealing with these complex nursing problems, and what nurses can do in the fight to prevent obesity
Are nurses blurring their identity by extending or delegating roles?
Authors: Harmer Victoria
Published: May 2014

Nursing may be going through an identity crisis. The Department of Health commissioned research identifying where nurses stand within society (Maben and Griffiths, 2008), ‘with the stimulus for the report being the sense that nursing had lost its way’ (Maben and Griffiths, 2008). The professional identity of nursing appears to be unclear and an area where confusion and conflicting opinions are invisible. This, combined with the extension of roles that many nurses have accepted in recent years, may have allowed a blurring of boundaries between healthcare professions, which has resulted in a blurring of the professional identity of the nurse. Perhaps, while nursing was busily extending, expanding or delegating more traditional nursing duties, it lost its way. To this end, this article concentrates on identifying what professional identity means, then investigates changing roles and role extension nurses are undertaking, referring to relevant literature.
Caring in Lourdes: An innovation in students’ clinical placement
Authors: Baldacchino Donia R
Published: May 2014

The study unit Spirituality for Health Carers was part of the BSc(Hons) nursing/midwifery programme which aimed at providing an innovative clinical placement for students. This placement promoted the delivery of spiritual care to clients in Lourdes. This paper discusses the experiential learning of students based on Gibbs (1988) Framework of Reflection. The scarce research demonstrates that caring for clients in Lourdes enabled students to develop meaningful relationships due to increased carer to clients’ ratio, more time available and the presence of role models who were dedicated and compassionate with clients. Qualitative data were collected by a reflective diary, a written reflective assignment and a focus group discussion. The four themes which emerged from the data are team building, holistic care, trustful nurse-client relationship and strengthening personal spirituality. Recommendations were proposed to enhance the delivery of spiritual care and holistic care by further exposure of students to care for the pilgrims in Lourdes.
Models of knowledge in the assessment of postoperative pain
Authors: Yang Sung Eun
Published: May 2014

This article illustrates a process of knowledge development and the interrelationship between knowledge and practice using Carper’s fundamental patterns of knowing. It explores two kinds of knowledge, theoretical knowledge and practical knowledge, using postoperative pain assessment as an illustration. By using their theoretical knowledge and their practical experience, nurses can maintain and develop their professional knowledge and competence.
Central venous access devices: Part 2 For intermediate and long-term use
Authors: Scales Katie
Published: May 2014

This is the second of a two-part article that provides an overview of central venous access devices (CVADs) in clinical practice. Part 1 (Scales, 2010) focused on CVADs for acute care and presented an algorithm for device selection. The procedure for insertion and removal of non-tunnelled central catheters was described, highlighting the infection control recommendations from epic2. Part 2 reviews the selection of CVADs for intermediate and long-term use. The procedure for insertion of peripherally inserted central catheters is described, again highlighting the infection control recommendations from epic2. The care and management of CVADs for intermediate and long-term use is also discussed
Bridging the theory–practice gap in pressure ulcer prevention
Authors: Moore Zena
Published: May 2014

Pressure ulcers are a largely preventable problem, but the incidence can impact negatively on the ability of the health service to deliver effective and quality care. Pressure ulcers commonly occur in the very old, the malnourished and those with acute illness. As pressure ulcers most commonly occur in the hospital setting, this can increase both length of stay and costs to the health service. As a result, prevention and management strategies should be core components in the strategic planning of healthcare services. This article discusses the importance of education and knowledge in pressure ulcers, and the onus of the nurse to put theory into practice in order to prevent this problem.
The effects of silver dressings on chronic and burns wound healing
Authors: Elliott Chris
Published: May 2014

Silver (Ag) has been thought to improve wound healing and reduce instances of associated infections for many years. There are centuries-old records of silver being used in wound treatment, but the past two decades in particular have seen an increasing clinical application of silver-impregnated wound dressings and as such, have seen the number of research articles similarly increase. The majority of these articles focus on the positives and potential negatives (e.g. the toxicity of silver as a heavy metal) of using silver-impregnated dressings in the clinical management of wounds. This article examines the potential advantages and disadvantages of using silver in the management of chronic and burn wounds, and provides a physiological understanding of the body’s response to silver absorption. The author also attempts to critically appraise the opposing literature related to the clinical relevance of microbial kill-time and the volume of silver contained in dressings, while investigating the efficacy of silver-impregnated dressings in the management of burns and chronic wounds. In order to collect literature relevant to this review, the author searched CINAHL, Medline, BMJ, Medscape, Journal of Advanced Nursing, the Electronic Medicines Compendium (EMC), and the Cochrane Library, using the terms silver, silver sulfadiazine, impregnated, wound, burn, dressing, review, quantative, efficacy, in vitro, in vivo, nanocrystalline, toxicity, infection, microbial kill-time, and comparison
The management of stress urinary incontinence
Authors: Billington Angela
Published: May 2014

This article examines the issues of stress urinary incontinence (SUI) in women and a new treatment option now available; FemSoft, an intraurethral insert. SUI is the most common type of urinary incontinence in women. There are many causes, risks and predisposing factors that nurses need to be aware of, both in treating the complaint and preventing future episodes. As incontinence causes a high level of embarrassment, patients are reluctant to seek help, so when the patient presents, nurses need to be able to provide accurate information on all treatments available. A brief description will be given of other management options, but the main focus will be on FemSoft, describing its features, benefits and research evidence so far.
Knowledge, attitudes and practices in the provision of nutritional care
Authors: Fletcher Antoinette , Carey Eileen
Published: May 2014

The nutritional care of patients is one of the primary responsibilities of all registered nurses ( Persenius et al, 2008 ). A poor nutritional status can lead to malnutrition, which can have serious consequences for an individual's quality of life ( Field and Smith, 2008 ). This paper commences with an introduction to the concept of nutrition, provides an overview of nutritional guidelines and nutritional screening tools which identify those at risk of malnutrition. It reviews the literature on nurses' knowledge, attitudes and practices in the provision of nutritional care and debates challenges and opportunities encountered to help nurses ensure adequate patient nutrition.
The nature of leadership style in nursing management
Authors: Azaare John , Gross Janet
Published: May 2014

The purpose of this study was to explore the nature of leadership styles used by nurse managers, and describe staff nurses' perceptions of leadership styles. Effective leadership among nurse managers has been associated with staff nurse job satisfaction and retention. Twenty staff nurses from two hospitals in Ghana responded to tape-recorded interview questions. Four themes emerged from inductive analysis of the data. Findings suggest that nurse managers employed intimidation and minimal consultation to control their employees. The study further indicated that nurse managers were perceived as ‘figure-heads’, who are weak and inarticulate at the level of policy planning and implementation. It was therefore concluded that staff nurses in the study site hospitals lack confidence, trust and satisfaction with the current style of leadership. Staff nurses preferred a more proactive, articulate and independent nursing leadership at the top level. It is recommended that effective leadership training be instituted for prospective nurse managers before appointments are made into management and administrative positions.
Compression bandaging: types and skills used in practical application
Authors: Todd Marie
Published: May 2014

This article discusses long-and short-stretch compression bandages and the theory underpinning their practical application. The Laplace equation is outlined to estimate sub-bandage pressures. Challenges associated with applying therapeutic levels of compression include bandage tension, number of layers, limb circumference and bandage width. Multi-layer bandaging is important for the management of chronic oedema. As poor bandaging techniques can lead to tissue damage, pain, oedema and necrosis, practitioners should be skilled in their application. Through collaboration between specialists and generalists and ongoing practice development, patient outcomes can be improved.
Cultural diversity and dementia in Scottish care homes
Authors: Mullay Steve , Schofield Pat , Clarke Amanda , Primrose Willie
Published: May 2014

Background:

theoretical guidance and policy directives emphasize the necessity of considering the culturally-specific needs of health and social care service users as part of ‘person-centred’ approaches to care. This article outlines the ideas underpinning an ongoing PhD study of the interactions between care staff and residents which is aimed at gaining insights into how person-centred care is fulfilled for people with dementia in Scottish care homes.

Discussion:

certain dynamics may constrain the deployment of culturally-meaningful care approaches for certain service users in Scottish care homes. These include limited understandings of the nature of cultural diversity in modern Scotland, failure to recognize the import of ‘inter-generational’ cultural change, lack of research around the interactions between staff and service users from different cultural backgrounds, and a sketchy demographic picture of the ethnic/cultural composition of Scottish care home populations. Groups of service users in particular settings (such as older people with dementia in long-term care) may be especially vulnerable to the effects of care processes constituted under such circumstances.

Conclusion:

poorly recognized gaps in understanding of the sociocultural and historical influences which help constitute ‘the person’ in many Scottish care home residents may exist. If these are found to constrain ‘knowing the person’, can the term ‘person-centred’ be meaningfully applied to care?
Incontinence in patients with dementia
Authors: Price Harriet
Published: May 2014

The high prevalence of incontinence in dementia sufferers will only increase as the population ages ( Alzheimer's Society, 2007 ), but the evidence-based knowledge for management of these long-term disorders combined is lacking ( Hagglund, 2010 ). Management techniques for incontinence need to be developed to ensure that dementia patients receive the best care, as current methods such as behavioural techniques may not be appropriate for people with limited cognitive function. This article will address issues that arise with current incontinence management for dementia sufferers and possible courses of action to tailor them more specifically to those people with cognitive impairment. Quite often, incontinence is just managed with incontinence pads and treatment is not discussed, which can have detrimental effects on the patient ( Omli et al, 2010 ). Nurses have an important role in incontinence treatment and can change this misuse of incontinence pads and ensuring a holistic approach to care will help when treating a patient with dementia. Ethical and legal issues will also be discussed as they must be considered when providing holistic care.
Spirituality in nursing: a systematic review of the literature from 2006–10
Authors: Pike Joanne
Published: May 2014

Spirituality in nursing care has been discussed for many years in the nursing press. There has been no literature review that explores only UK literature, and this article updates a literature review carried out in 2006 ( Ross, 2006 ).

Aim:

The review was designed to investigate the current nursing evidence underpinning the concept of spirituality and its application.

Method:

A systematic review of the literature was undertaken and a thematic analysis performed following a search for literature using defined dates, databases and search terms.

Results:

Four major themes emerged from the literature: concept clarification; spiritual care-giving; religion and spirituality; and nurse education.

Conclusion:

Definitions of spiritual care vary, and the concept of spirituality in nursing is still under development. However, until a common language of spirituality is developed, models of spiritual care developed through research involving mainly nursing staff will be difficult for nurses to apply.
Parkinson's: treating the symptoms
Authors: Lindahl Andrea J , MacMahon Doug
Published: May 2014

Parkinson's disease is frequently encountered in general nursing environments and particularly those dealing with older adults. There are a range of drug treatments and other therapies available that can be used to enhance the quality of life and social engagement of people who have the condition. The drugs need careful administration and attention to detail in terms of dose and timing. This is where nurses, especially Parkinson's disease nurse specialists, have an important role to play.
Fibromyalgia: an overview and comparison of treatment options
Authors: Ryan Sarah
Published: May 2014

Fibromyalgia is a common condition characterized by a multitude of physical and psychological symptoms which tend to persist overtime. The dominant symptom is that of widespread musculoskeletal pain. This paper discusses the possible causations of fibromyalgia, as well as the need for a biopsychosocial assessment to fully understand the pain experience and to inform treatment and the evidence base regarding therapeutic interventions.
Why is the regulation of advanced practice essential?
Authors: Brook Simon , Rushforth Helen
Published: May 2014

For many years, nurses have sought to define advanced practice (AP). There is now a developing consensus that it should be broadly defined in ways which include and embrace not only clinical practice, but also other domains such as education, management and leadership. This broad definition is congruent with Benner's notion of the novice to expert trajectory and lends support to the view that the risks around AP are minimal, since advanced practitioners by definition have expertise.

The broad model of A P, however, ignores one distinct subset of advanced practice nurses who we term nurse practitioners (NPs). NPs are distinct because of their hybrid, quasi-medical practice, which crucially involves autonomous medical diagnosis and treatment. The risks in this area of practice are substantial, and consequently require nothing less than a nationally-regulated set of benchmarks. These must address the training, assessment and registration of NPs for the primary purpose of public protection.
Using Actico bandaging for chronic oedema/lymphoedema management
Authors: Pike Cheryl
Published: May 2014

Actico has been used successfully within clinical and community settings and is best used as part of a multi-layered lymphoedema bandaging (MLLB) system. This system is designed to produce a semi-rigid casing that is comfortable enough to allow patients to continue with their activities and exercises so as to generate an optimal resisted muscle pump action within. Correct application is key to using this cohesive short-stretch bandage, and collaborative working between clinics and community nurses is made easier through using Actico as part of oedema management. The case studies enclosed aim to illustrate the use of Actico MLLB for both patients and clinicians.
Venous leg ulcers and the impact of compression bandaging
Authors: Todd Marie
Published: May 2014

Venous leg ulcers are a major health issue in terms of financial burden to the NHS, Nurses' input, and physical, psychological and social impact to the patient. The best practice management of leg ulcers is the application of high compression, which is a complex task and requires substantial skill and knowledge. Healing and recurrence rates are poor in some cases and this adds to the physical and psychosocial impact, as well as the financial burden. Many of the sequelae of ulceration hinder patients' ability to tolerate treatment. Nurses must acknowledge the difficulties patients face and become skilled in holistic assessment, care planning and the delivery of patient-focused best practice.
Writing for professional publication. Part 7: structure and presentation
Authors: Fowler John
Published: May 2014

How to get your work published is the essence of this series on writing for professional publication. The previous articles focused on the preparation required before you start writing your article, ways to create interest in the reader's mind, and the importance of writing a well-constructed abstract. In this article John Fowler, an experienced nursing lecturer and author, discusses the structure and presentation of a potential article and how this differs from an essay that may have been written as part of a university course.
Feedback on an enhanced recovery programme for colorectal surgery
Authors: Taylor Claire , Burch Jennie
Published: May 2014

This article describes a study carried out to examine service users' views on an enhanced recovery programme (ERP) for colorectal surgery patients, in order to improve service provision. Background: ERPs combine elements to enhance patients' recovery before, during and after surgery, but patient experiences are unknown. Method: 50 patients were invited to attend one of three focus groups in May and June 2009. Findings: Ten users attended the focus groups. All were generally very satisfied with the ERP, primarily because they could leave hospital quickly and felt empowered to take charge of their own recovery. Areas of concern included support after discharge, postoperative diet and achieving optimum analgesia following discontinuation of continuous analgesic infusions. Conclusions: This patient sample indicated that the ERP offers clear benefits. Feedback was turned into realistic action plans, concerns were addressed and the service enhanced. Obtaining feedback is vital for improving the quality of care and keeping patients at the centre of health services.
Diagnosis, treatment and management of pruritus
Authors: Karim Kelvin
Published: May 2014

Pruritus is a ubiquitous symptom with a wide range of presentations, often causing considerable distress for many individuals and resulting in reduced quality of life. In recent years there has been renewed interest and increased research activity in this previously neglected field. Although there is still much to be learnt about the mechanisms of pruritus, appropriate nursing interventions can be pivotal to the success of treatment. This article focuses primarily on the diagnosis, treatment and management of pruritus resulting from common dermatological causes. Key aspects of effective management of pruritus include individualized management and holistic assessment. The words ‘pruritus’ and ‘itch’ are used synonymously in this article.
An aging renal population – is dialysis always the answer?
Authors: Noble Helen
Published: May 2014

As people age and live for longer they are more likely to develop comorbid conditions including chronic kidney disease (CKD). This paper discusses the treatment options for stage 5 CKD including haemodialysis, peritoneal dialysis, transplantation or conservative management, also known as supportive care, for those who decide not to undertake dialysis. It also highlights the complexity of offering a treatment such as dialysis, viewed as a requirement to prolong life, without which people will die, which is unable to restore the kidneys to normal function, only substitute for.

Dialysis is also an arduous therapy known to shorten life. In the past refusal of dialysis was viewed as akin to suicide and it is not until more recently that the needs and experiences of those who decide not to embark on dialysis have started to be recognized. Clearly dialysis is not suitable for all, particularly those who are frail with multiple comorbidities and so supportive and palliative care may be a more suitable option for some.
Effects of patient death on nursing staff: a literature review
Authors: Wilson Janet , Kirshbaum Marilyn
Published: May 2014

There were 509 090 deaths recorded in England and Wales for 2008 ( Office for National Statistics, 2010 ); of these, over 56% (260 000) occurred in NHS hospitals. The death of a patient is an event that most, if not all, nursing staff will encounter during their work. This experience can elicit physical, cognitive, behavioural, spiritual and emotional responses ( Parkes, 1998 ).

Aim:

The aim of this literature review is to explore how the death of patients in a hospital setting impact on nursing staff.

Method:

A review of the literature was undertaken using the online databases CINAHL, Medline and Psych Info. The search was limited to articles in the English language and those from peer-reviewed journals.

Results:

Themes arising from the literature review included: the theoretical context; the emotional impact; the culture of the healthcare setting; staff's previous life experiences; and support available for healthcare staff.

Conclusions:

The death of patients does have an impact on nurses. This can affect them both in their work environment and outside of work. Education around grief theory and support from others are helpful for staff in developing strategies for coping with patient deaths.
Debridement – is it time to revisit clinical practice?
Authors: Young Trudie
Published: May 2014

Debridement is the removal of non-viable tissue from a wound bed. It is an essential procedure in order to achieve wound healing and symptom control. The clinical presentation of non-viable tissue varies in content, appearance, depth and level of hydration. There may be a risk of systemic infection if non-viable tissue is not removed in a timely fashion. There are various methods of debridement each with its own advantages and limitations. The competence of the practitioner undertaking the debridement is crucial and is a key consideration along with availability of the necessary equipment and the provision of the optimal environment. Client choice and involvement are vital to the debridement process. There should be no hierarchy of debridement methods and the chosen method should achieve timely optimal pain-free removal of non-viable tissue. There is a need to question the current situation in which the specialist nurse is highly skilled in the debridement process while the generalist nurse potentially carries a higher caseload of patients who require this procedure.
The use of complementary and alternative medicine by nurses
Authors: Buchan Shonagh , Shakeel Muhammad , Trinidade Aaron , Buchan Duncan , Ah-See Kim
Published: May 2014

Background:

Complementary and alternative medicine (CAM) use is common among patients attending the department of the authors of this article. With expanding roles of nurses in various clinics, the nurses are often asked for their advice on CAM use by their patients. CAM education is not part of the nursing curriculum in various parts of the world. The aim of this study was to establish the use of CAM by nurses along with their knowledge base and attitudes towards it.

Methods:

A questionnaire-based study based on the published literature was used among qualified nurses. The data were collected and analysed using SPSS for Windows.

Results:

The response rate was 86% (531/621; females were 91% and the mean age was 32 years (range 20–63). Eighty percent of the responders admitted to use of CAM and 41% were using CAM at the time. The most commonly mentioned CAM were massage, cod liver oil and cranberry juice. CAM was mostly used for relaxation, joint pain and urinary tract infection. Only five nurses believed CAM was not effective and 74% would recommend CAM use to others. Ninety-three percent of nurses did not have any formal education on CAM. Most nurses would consider some education on CAM to enable them to counsel their patients.

Conclusions:

The use of CAM is high among nurses. As patients are increasingly relying on nurses for advice on its use, it is important for nurses to be educated about CAM in order to guide their patients.
Over-the-counter medicines: their place in self-care
Authors: Rutter Paul M
Published: May 2014

Over the last 20 years, there has been a shift in Western countries’ healthcare policy to empower patients to exercise self-care by taking greater control in managing their own health, especially in cases where their conditions are deemed minor and self-limiting. In the UK, this has been facilitated by the Department of Health in making more medicines available to the public without the need for a prescription. This article highlights how policy is affecting practice, what attitudes the public and health professionals have toward greater medicine availability, and considers their place in patient management.
Medication administration practices among children's nurses: a survey
Authors: Murphy Maryanne , While Alison
Published: May 2014

Aim and objectives:

The overall aim of this study was to investigate the medication administration practices of children' nurses. The specific objective was to identify practices that may improve the medication administration process, where necessary.

Design:

Using a non-experimental survey design, a ‘Medication Administration Practices Survey’ was developed for use in this study. The survey was designed to include questions based on medication administration practices and not solely on medication errors. Ethical approval was obtained from the local research ethics committee where data were collected. All clinical staff working in all areas in a children's hospital were included.

Results:

Interruptions in the medication process, a heavy workload and fatigue were some of the findings that emerged from this study. Inadequate knowledge and skills and a failure to comply with hospital policy were also identified.

Conclusion:

A lack of adherence to hospital policy and the frequency of interruptions in the medication administration process are important practices that require change as indicated by this study. Several recommendations are made, directed toward preventing or reducing medication errors and supporting children's nurses in providing best practice.
The use of Resolor (prucalopride) for chronic constipation in women
Authors: Woodward Sue
Published: May 2014

Chronic constipation is a common problem among women, is associated with anxiety and depression and can adversely affect quality of life ( Mason et al, 2002 ). Chronic constipation is often unrelieved by simple laxatives, dietary manipulation or lifestyle modification, with other specialist treatment options being invasive and often not widely available. More recently attention has turned to newer prokinetic agents, such as prucalopride (Resolor®), which increase gut motility and intestinal transit, for the relief of chronic constipation. While these are not effective for everyone, there is evidence that prucalopride can increase bowel frequency, relieve bothersome symptoms associated with constipation and improve quality of life for women who have failed to achieve satisfactory relief from two other laxatives (National Institute for Health and Clinical Excellence).
Exploring the cultural validity of rheumatology outcomes
Authors: Sanderson Tessa , Hewlett Sarah , Calnan Michael , Morris Marianne , Raza Karim , Kumar Kanta
Published: May 2014

In rheumatoid arthritis (RA), the use of a ‘core’ set of treatment outcomes was pioneered to ensure that the same outcomes are measured across all clinical trials to enable comparison of trial results. However, studies have not investigated the influence of patients' ethnic and cultural backgrounds on treatment outcomes. This pilot study identified 74 treatment outcomes from female Punjabi RA patients, including 21 new ones that were not identified in previous research with white British RA patients. The social impact of RA created significant additional burden for these Punjabi women, with ‘less stigmatisation’ and ‘improved ability to carry out family duties’ generated as important new outcomes. This study illustrates a need to address cultural validity in outcome elicitation and prioritisation, to ensure that interventions are evaluated using criteria that have meaning for people with that condition.
Withdrawing and withholding life-sustaining treatment
Authors: Griffith Richard
Published: May 2014

There has been considerable criticism recently over the use of end-of-life pathways and do-not-resuscitate orders with vulnerable, incapable patients, often without discussion. This criticism has led to press and judicial scrutiny of the lawfulness of decisions to withdraw or withhold life-sustaining treatment. In this article, the author reviews the law and argues that flawed decision-making by doctors and nurses, rather than the actual end-of-life pathway or do-not-resuscitate order, is where the lawfulness of withdrawing and withholding treatment must be challenged.
Patient satisfaction in three clinics managing long-term conditions
Authors: Land Lucy M , Jobanputra Paresh , Webber Jonathan , Ross Jonathan DC
Published: May 2014

People with long-term conditions are frequent visitors to outpatient clinics. In order that they get the best out of their visits, the health professionals taking care of them need to understand their experiences and work towards service improvements. A survey of 3 clinics (HIV, rheumatology, diabetes) was undertaken using a set of three simple, open questions. A total of 147 people responded that, above all, care, attention, friendliness and efficiency were their most valued experiences. Shorter waiting times and cheaper car parking came up most frequently as sources of dissatisfaction. The study concludes that there were no distinct differences in the experiences of the patients in each clinic. All care needs were relatively simple and, on the whole, met.
Cardiovascular disease, statins and vitamin D
Authors: Wilding Peter Mark
Published: May 2014

Cardiovascular disease is the number one killer in the UK, causing more than 50 000 premature deaths per year, at a cost of over £30 billion to the economy ( British Heart Foundation, 2010 ). Reducing this burden is a priority of the Government and health professionals ( Department of Health, 2000 ). The aim of this paper is to inform and update nurses on four aspects. Firstly, to examine a more accurate test than cholesterol to predict cardiovascular risk that used C-reactive protein (CRP), an inflammatory marker, called the Reynold's Risk Score. Use of this score reclassified almost half of women, and one-fifth of men, into lower or higher-risk categories, more accurately compared to conventional tools ( Ridker et al, 2007 ; Ridker et al, 2008b ). Secondly, to highlight a potential change to the indications for statin-therapy; an indication for those who ordinarily would not receive a statin: healthy middle-aged adults with normal or low cholesterol, but elevated CRR This includes discussion of the JUPITER trial and its sub-analyses. This large, multicentre, double-blind randomized, placebo-controlled trial in apparently healthy men over the age of 50 years and women over 60 years, with normal or low cholesterol but elevated CRP, demonstrated significant benefit. Rosuvastatin 20mg per day compared to a placebo reduced myocardial infarction and stroke by half, and reduced venous thromboembolism by almost half ( Ridker et al, 2008a ; Glynn et al. 2009 ; Everett, et al, 2010 ). Thirdly, to discuss the pleiotropic effects of statins, which include reduction of CRP ( Ridker et al, 2008a ), increases in endothelial repair cells ( Spiel, et al, 2008 ), alteration of clotting factors ( Glynn, et al, 2009 ), and enhancement of vitamin D metabolism ( Yavuz et al, 2009 ). Fourthly, to discuss evidence that the pleiotropic effects of statins may be attributable to the vitamin D effect. This paper therefore evaluates the evidence suggesting that vitamin D supplementation may attain the same benefit as statins ( Grimes, 2006 ), in addition to reducing statin-associated side-effects when co-administered ( Ahmed et al, 2009 ).
Use of bullying as a management tool in healthcare environments
Authors: Barber Chris
Published: May 2014

Bullying is very much an aspect of contemporary society and perhaps it always has been. Many may have experienced it from early childhood while at school, either as victims or perpetrators. The healthcare industry is, sadly, not immune from this phenomenon. This short article seeks to answer the question: ‘Is bullying deliberately used as a management tool within the healthcare industry?’ Although bullies exist in many healthcare environments, and there may be a culture of bullying in some of these work places, the proposition that some people actually use bullying as a management tool is more difficult to prove.
Catheter lubrication and fixation: interventions
Authors: Wilson Mary
Published: May 2014

This article looks at the indications for catheterisation, the anatomy of the urethra, the importance of asepsis and the rationale for the use of urethral lubrication for catheter insertion. The variations of lubrication available are discussed, including the use of products containing lidocaine and chlorhexidine. It then considers the problems caused by traction to the catheter and discusses the securement devices available for preventing tissue damage at the bladder neck, within the urethra and also at the meatus. The variation of devices is examined along with the potential problems associated with their use. Finally, it discusses the importance of clinicians being knowledgeable about the problems looked at and how to resolve them.
Care at the end of life: how policy and the law support practice
Authors: Brown Michelle , Vaughan Carol
Published: May 2014

The End of Life Care Strategy was introduced in an attempt to achieve a high standard of care for patients nearing the end of life and to improve carer experience. This high standard should not depend on socioeconomic status, geographical location or diagnosis. It was to ensure that individuals felt supported, informed and empowered, and that symptoms and issues were managed by experienced staff who employ evidenced-based practice. In addition, the service provision should involve a multidisciplinary team and have the patient at the centre of all decision-making. This would be facilitated by endorsing the use of end-of-life care pathways. These recommendations are further supported by frameworks and policies, for example the Preferred Priorities for Care Gold Standards Framework in Primary Care. Health professionals must also be cognisant of the legal frameworks that protect patients and facilitate their rights to exert their autonomy, for example the Mental Capacity Act and advanced directives. The issues surrounding care at the end of life with respect to legal frameworks alongside ethical and moral dilemmas will be further explored within this discussion paper.