bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of water during the first stage of labour: Is this a safe choice for women undergoing VBAC?
Authors: Jackson Rebecca
Published: May 2014

The caesarean section rate is greatly influenced by the amount of elective repeat caesarean sections. By promoting successful vaginal birth after caesarean section (VBAC), the caesarean section rate could be reduced. Clinicians supporting VBAC labour are concerned about the risk of uterine scar rupture; therefore, continuous fetal monitoring is recommended ( Royal College of Obstetricians and Gynaecologists (RCOG), 2007 ). As a result, these women are not recommended to use water for pain relief in labour. Yet, with the support of confident midwives some women have had successful VBACs while labouring in water. The evidence suggests that both labouring in water and undergoing VBAC are both beneficial to women. With a competent confident midwife, the use of water in labour could promote VBAC success rates and reduce intervention. This could improve the experience for both women and midwives, and improve future health for women and babies. In conclusion, the use of water in labour could be a safe choice for women who wish to undergo VBAC.
The benefits to breastfeeding and success rates of a frenulotomy in newborns with ankyloglossia
Authors: Greenwood Gabrielle
Published: May 2014

When undertaking the caseholding unit in my second and third years as a student midwife, I built a good rapport with the five women I was going to provide continuity of care for. Ms A, the woman this reflection is based on, was determined to breastfeed but it soon became apparent that the baby, Isobella, was not feeding successfully. When I saw how upset Ms A became and discovered she was considering ceasing breastfeeding, I was desperate to help. When I was assessing both Ms A and Isobella for the cause I identified ankyloglossia. I believe without the ability to recognise ankyloglossia (tongue-tie) many women will discontinue breastfeeding prematurely, which can be an upsetting decision. This reflection will identify and, to an extent, critically evaluate the literature surrounding the benefits of a frenulotomy when ankyloglossia is present in the newborn, with the aim to improve breastfeeding outcomes. Breastfeeding is a pertinent topic in current midwifery, and I believe this reflection will create an awareness of one of the possible reasons women stop breastfeeding, and how we as professionals can prevent this with timely recognition and treatment.
The bottom line: Iatrogenic fetal anal trauma in undiagnosed breech presentation
Authors: Warwick Andrea , Strachan Bryony , McNally Janet
Published: May 2014

Injuries to the fetal head after amniotomy are well reported in literature, but injuries to the fetal anus in the breech presentation have not previously been reported. Two cases of fetal anal injury are described here, both in undiagnosed cases of breech presentation. In the first case the baby's anus was mistaken for the maternal cervix and a digital examination was performed. After the birth there was significant bruising and obvious trauma to the baby's anus. The baby did not, however, suffer any serious adverse effects. In the second case, an amniotomy hook was used to augment labour. The amniotomy hook caused an anal laceration, which fortunately did not involve the anal sphincter complex. The second baby also suffered no major adverse effects, with regards to continence. However, both babies required a general anaesthetic for assessment of their injuries, a longer stay in hospital and parental anxiety. While fetal anal injury in undiagnosed breech presentation is uncommon, it has the potential to be a life-changing injury. It is therefore critical to accurately ensure the fetal presentation, and to be aware if findings on vaginal examination are at all unusual.
Critical evaluation and reflection on the role of the supervisor of midwives within the maternity services
Authors: Barnfather Tracey
Published: May 2014

This paper critically evaluates and reflects upon an aspect of change (introduction of new electronic records) that occurred in contemporary practice, from a supervisor of midwives' (SoM) viewpoint. The statutory framework of supervision is contextualised ( Nursing and Midwifery Council (NMC), 2011a ; 2012 ), followed by a brief discussion as to why records are important. To facilitate critical analysis of the implementation of a new electronic records system, an adaptation of John Kotter's (1996) eight-step process to change by Kotter and Rathgeber (2006) ( Figure 1 ) is utilised. Throughout the paper the SoM's role, in relation to implementing, supporting and evaluating a change in practice, are debated (including actual actions or suggestions of how to facilitate change). Utilising Leamon's Fusion Framework for reflection (2012) ( Figure 2 ), the change to practice is considered and recommendations for future practice shared ( Stewart, 2002 ). Finally, the paper offers a conclusion summarising the key points debated.

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Perinatal mental health services for black and ethnic minority women in prison
Authors: Foley Laura , Papadopoulos Irena
Published: May 2014

Objective: To provide a synthesis of published research concerning the perinatal mental health needs of black and minority ethnic (BME) women in prison. Methods: This integrative review utilised a narrative overview design to explore available literature. Results: The search strategy identified 13 relevant papers. Out of these, six met the inclusion criteria. The results found that imprisoned women are more likely to be from a BME background. As a group, pregnant women in prison present a vulnerable obstetric risk. In addition to the universal obstacles, BME women face further challenges of overcoming ethno-cultural barriers when trying to access appropriate perinatal mental health care while in prison. Clinical implications: BME imprisoned pregnant women are clearly a high-risk obstetric group, and their numbers are increasing. Deciphering and meeting the unique perinatal mental health needs of this group of women presents a challenge to both the health-care and prison systems. Becoming aware and sensitive to these needs is the first step towards policy makers and service providers addressing them. This research will add to the limited academic field on the perinatal mental health needs of BME women in prison. These findings demonstrate that more research and attention needs to be paid to this highly vulnerable group of women.
New campaign aims to reduce infant mortality in Uganda
Authors: Bainbridge Jane
Published: May 2014

Save the Children report highlights need for vital equipment and drugs in the East African country
Breastfeeding for longer can reduce risk of rheumatoid arthritis
Authors: Bainbridge Jane
Published: May 2014

Research carried out in China has found that the risk of rheumatoid arthritis decreases the longer a woman breastfeeds
What are the professional nursing concerns for 1998?
Authors: Castledine George
Published: May 2014

This year we celebrate 50 years of the NHS. But how far have we progressed in this time?
Hospital vs community care: a Romanian perspective
Authors: Glasper Edward Alan , Robertson Lynne , Watkin Sara
Published: May 2014

In the Summer of 1997, two Romanian charities which provide financial support to care for children with human immunodeficiency virus (HIV) living in Romania invited a team of healthcare professionals to conduct an independent audit of care for children nursed in hospital and community settings. The primary objective of the mission was to: witness hospital and community care of HIV positive children; work with Romanian healthcare professionals in the development of a simple user friendly audit tool for use in a variety of child care settings; and utilize the tool to audit and produce a written report related to care provision in the hospital and community home setting. The results of the audit exercise demonstrate that the provision of care for HIV positive children in the community homes exceeds that of similar children cared for in a tertiary hospital setting.
Cardiopulmonary resuscitation: new European guidelines
Authors: Quinn Tom
Published: May 2014

Cardiac arrest is the ultimate medical emergency. Without rapid action by witnesses and responding health professionals, chances of survival are remote. In this article the key evidence-based aspects of resuscitation, basic life support and early defibrillation are discussed in light of the recent publication of revised guidelines from the European Resuscitation Council. The importance of calling for skilled help at the earliest opportunity is emphasized, facilitating rapid access to emergency services (in the community) and the cardiac arrest team (in hospital). The advent of the automated external defibrillator (AED) presents additional opportunities to save lives and it is recommended that registered nurses are trained in, and authorized to use, AEDs in their professional practice.
The blunders found in nursing documentation
Authors: Castledine George
Published: May 2014

Many nurses, regardless of their education and background, have problems writing nursing reports. In 1910, Lewis wrote: ‘It is one of the most important duties of a modern nurse to be able to give an intelligent (written) report of a case; but it is also that duty which a nurse is longest in acquiring, and which requires, perhaps, more hard work to attain perfection in than anything else which a nurse has to do.’
Adherence and compliance in the management of asthma: 2
Authors: Conway Alison
Published: May 2014

The first article (Vol 7(21): 1313–15) in this two-part article examining the role of compliance in asthma management, discussed the concept of adherence to treatment. In this article, the role of the healthcare professional in improving adherence is discussed in greater depth. When attempting to improve patients' adherence to treatment, the healthcare professional must adopt a number of roles, e.g. counsellor, educator, negotiator and problem-solver. Practical advice and information is provided to facilitate an improved therapeutic alliance between professional and patient, with the emphasis on achieving shared goals.
Pre-amputation assessment using Roy's Adaptation Model
Authors: Dawson Sarah
Published: May 2014

This article describes the use of Roy's Adaptation Model as a framework for the assessment of a 69-year-old man undergoing a right below-knee amputation. The model recognizes that individuals are subject to internal and external stressors which can lead to adaptive or ineffective responses. The practitioner can help the patient to make adaptive responses to these stimuli through nursing interventions. The components of the model are illustrated using the patient as a case study. A comprehensive assessment in the four adaptive modes (physiological, self-concept, role function and interdependence) is undertaken and nursing diagnoses are made.
Nurses are accountable for their records
Authors: Tingle John H
Published: May 2014

We all practice in a healthcare environment where the need to improve our record keeping standards has never been greater. The NHS is currently facing an estimated clinical negligence bill of around £2.8 billion. More than 800 medical accidents occur in NHS hospitals every day, about 200 of which are the result of negligence (Laurence, 1999).
Cervical cancer 1: role of nurses in the primary healthcare setting
Authors: Peate Ian
Published: May 2014

This two-part series examines the nurse's role when caring for women with cervical cancer. The incidence of cervical cancer, survival rates and trends of the disease are discussed, and the role of the nurse and his/her contribution to providing a quality cervical screening service to women is outlined. The nurse in primary healthcare settings takes the majority of smears. In order to detect cancer of the cervix at an early stage, it is important that the nurse provides women with sound and up-to-date information in a way that they understand.
Nurse anaesthetists should not be encouraged
Authors: Castledine George
Published: May 2014

The first John W Dundee Anaesthesia Conference held in Belfast earlier this month gave mixed messages for nurses working in anaesthesia. The conference voted against developing the nurse anaesthetist role but gave overwhelming support for an anaesthetic nurse who took on wider responsibilities in the anaesthetic room, operating theatre and recovery ward.
Consumers not confident about self-regulation
Authors: Murray Cyril
Published: May 2014

As the new Health Bill reaches its final stages in parliament the release of the National Consumer Council's (NCC's) report Self-regulation of Professionals in Health Care is timely as it sharpens the focus on public safety (NCC, 1999). It reveals a confused patchwork of self-regulatory systems which contain loopholes that can be exploited by quacks and incompetent practitioners. While making fascinating reading the implications are frightening for healthcare providers and the public.
The Pentaflex pressure-reducing mattress replacement
Authors: Fox Carolyn , Burgess-Allen Natasha
Published: May 2014

Support surfaces play a crucial role in pressure sore prevention. This article outlines the use of polyurethane foam as a versatile and effective support surface. It briefly describes a number of tests which are used to determine foam quality and summarizes the characteristics and clinical evidence supporting the use of the Pentaflex pressure-reducing foam mattress.
Evaluating Clinical Supervision
Authors: Cutcliffe John R , Ward Martin F
Published: May 2014

This article reports on the development of the Network for Psychiatric Nursing Research National Journal Club. It describes why the club was founded, how it works, who attends, and what happens to the reviews it produces. It includes the club's review of Scanlon and Wier's (1997) paper ‘Learning from practice: mental health nurses' perceptions and experience of clinical supervision’. The key points arising from the review were: the article reflected a current and important theme within mental health nursing, i.e. clinical supervision as a vehicle for improving practice, and recommends that attempts to explore and evaluate clinical supervision should be supported; journal club members were not convinced that the paper was saying anything new although it did add weight to certain arguments; and the limitations of the sampling strategy may have had an impact on the results.
Valuing diversity and ethnicity: UKCC initiative
Authors: Castledine George
Published: May 2014

The recently released nursing strategy for England (Department of Health (DoH), 1999) makes the point that racism still exists in the NHS and that: ‘Black and ethnic minority nurses make up just under 8% of the workforce whereas fewer than 1% of directors of nursing are from Black and ethnic minority communities. Nearly 25% of nurses over 55 are Black or Asian whereas fewer than 3% of nurses under 25 are from Black and ethnic minority communities.’
NaturCare from AlphaMed: the non-scented ostomy deodorant
Authors: Rudoni Caroline , Sica Jo
Published: May 2014

NaturCare is an ostomy deodorant manufactured and distributed by AlphaMed. Currently, it is the only non-scented deodorant available on prescription. Odour can be extremely stressful to both the person with a stoma (ostomist) and those involved in their care. Since NaturCare has no artificial scents added to its formula, it can be extremely helpful to those who find the odour embarrassing.
‘Alert letters’ and the issue of public protection
Authors: Knape John
Published: May 2014

Blacklists, grey lists, warning letters and now ‘alert’ letters — the terminology changes but the basic idea is not new. Recent draft guidance from the NHS Executive (NHS E) proposes a system by which employers of registered nurses, midwives and health visitors can warn other employers about individual practitioners whom they believe are unsafe to practise.
Infection control: public health, clinical effectiveness and education
Authors: Gallagher Rosemary
Published: May 2014

In this article the author discusses three main issues in infection control: the development of clinical effectiveness, education and public health. Present day infection control practice is based on principles put forward by Florence Nightingale over 100 years ago. Despite medical advances, hospital-acquired infection remains a major cause of morbidity and mortality. Further research is required to assess how effective present day infection control activities and policies are in reducing the spread of infection. The success of implementing evidence-based practice relies on multidisciplinary, user-friendly educational initiatives. It is imperative that community practitioners are involved in the promotion of infection control. Greater public awareness of infectious agents and the importance of basic hygiene will ensure that infection control cannot remain the exclusive property of hospitals, but must extend to all areas of public health.
Nurse consultants herald new era for clinical nursing
Authors: Castledine George
Published: May 2014

Of all the Health Service Circulars (HSCs) to come out this year the one about nurse consultants was the one I was most looking forward to reading (HSC, 1999). Ever since the Government announced its intention to establish nurse consultants there has been a negative and, in some quarters, hostile reaction. However, this initiative is more than just a Government publicity stunt, it is about recognizing expertise in nursing and developing a clinical career ladder.
A practical guide to assessing nursing students in clinical practice
Authors: Wilkinson John
Published: May 2014

Preregistration student nurses and qualified nurses undertaking clinical programmes of study spend a substantial proportion of their courses in practice settings where they are contributing to patient care. Much of the accountability for assessing the clinical competence of learners lies with the nursing team with whom a student is working. Assessment is a significant responsibility and one which many professionals find complex, and hence challenging and time consuming (Rowntree, 1987). Making effective use of the time available for assessment is an important component of student learning, and is essential in order to determine competence to practice. This article seeks to offer practical guidance on how to tackle the assessment of nursing students in clinical practice so that the process is both rigorous and manageable.
Current treatment of impotence: Viagra and other options
Authors: Rutherford Derek , Duffy FJ Raymond
Published: May 2014

This article looks at the current treatment of impotence and recent developments in the pharmacological treatment of erectile dysfunction. Sildenafil (Viagra) threatens to become the most costly drug treatment within the NHS, but its value may be overestimated and its effectiveness under-researched. This oral treatment has received a lot of recent press attention and is perhaps overshadowing the value of established treatment regimens. Pharmacological treatment may also fail to tackle the important psychological problems often associated with this distressing condition.
Clinical negligence legal advice to NHS trusts
Authors: Tingle John
Published: May 2014

Anew research report (Dineen and Walsh, 1999) published by the Health Service Management Centre at the University of Birmingham throws new light on how trusts obtain their legal advice on clinical negligence claims. The report reveals that most NHS trusts think they get a good service from the solicitors who advise them. There was not a single trust that rated the service they received as poor. However, data from the report suggest that the performance of advising solicitors varies and that there is room for improvement.
Novice nurses are not well treated by colleagues
Authors: Castledine George
Published: May 2014

As we wait for the report on preregistration nursing education from the UKCC's Education Commission, it is perhaps a prudent time to discuss the problems that novice nurses are experiencing. By ‘novice’ I mean not only newly qualified registrants but also nurses who have returned to nursing following a break in their careers.
Sleeping, drinking and medication malpractice while on night duty
Authors: Castledine George
Published: May 2014

Some nurses get into bad habits while working on long-term night duty. However, when do bad habits become professional misconduct?
Hospitals need specialist inpatient adolescent units
Authors: Glasper Alan , Cooper Michael
Published: May 2014

Arecently published document on the care of young people in hospital (Viner and Keane, 1998) makes depressing reading as it highlights the lamentable situation of adolescent provision of care in British hospitals — only 8% of health authorities contain adolescent provider units in their hospitals.
Nurses committing offences outside the work environment
Authors: Castledine George
Published: May 2014

When can being a bad neighbour get a nurse into trouble with the UKCC? Neighbour disputes can arise for various reasons. These include noise levels, boundary issues, e.g. ownership of hedges and fences, parking places, responsibility for common shared areas, jealousy and prejudice.
The placebo effect and the hidden benefits of oral medications
Authors: Harper Phil J
Published: May 2014

The effectiveness of any drug involves many factors not just the pharmacological ingredients. The hidden benefits of a drug are termed the ‘placebo effect’, but because many of these factors cannot be explained scientifically they are often dismissed as irrelevant. However, factors including the attributes of the drug itself (shape, colour, taste), the relationship between the nurse dispensing the drug and the patient receiving it, the route of administration, the setting in which the drug is given and wider sociocultural beliefs surrounding the ingestion of medicines can all have a major influence on a drug's efficacy. This article explains the term ‘placebo’ and explores some of the factors contributing to the placebo effect in relation to oral medications. Nurses need to appreciate the influence of such factors in order to provide appropriate and holistic care to patients with different social and cultural beliefs and expectations.
Trident T2: a new development in urine bag tap design
Authors: Doherty Willie
Published: May 2014

This article looks at Seton Scholl Continence Care's Simpla Trident T2 leg bag with the new advanced lever-action tap which has recently won the Independent Living Design Award. This easy-to-use lever-action tap has a simple, positive action which allows more independence and less intervention from carers. The lever-action tap enables the patient with limited hand coordination or poor finger/thumb dexterity to operate it effectively. The tap is smooth to the touch and the corners have been rounded to reduce any sharpness. The Simpla Trident T1 and T2 bags have the protected sample port to allow safe urine sampling without the need to break the system.
The qualities needed to become an expert nurse
Authors: Castledine George
Published: May 2014

The publication of the UKCC's draft proposals on higher level practice is a further step towards recognizing excellence in clinical nursing practice (UKCC, 1999a). They describe the characteristics of nurses, midwives and health visitors who are practising at a significantly expert or higher level and specify the professional standard that must be achieved for this attainment to be recognized by the UKCC. The UKCC has also published its findings of the consultation exercise that it carried out from August to November 1998 which puts into perspective why and how this concept has emerged so significantly in our professional lives today (UKCC, 1999b).
Web Watch
Authors: Stone Keith
Published: May 2014

Welcome to this new regular column being introduced by the British Journal Of Nursing. The idea behind the 'WEB WATCH', is to bring together each week a collection of World Wide Web pages that can be found on the Internet. The content of the Web sites provided will contain information that could be useful or interesting to nurses.
Achievements in child health over the first half of the 20th century
Authors: Davies Ruth
Published: May 2014

This article will reflect upon the gains made in the health and welfare of children in the UK over the first half of this century. It will discuss how government reforms covering health, welfare and education have improved all aspects of children's lives and the contribution made by the relatively new professions of nursing, midwifery and health visiting. Finally, it will show how changing attitudes towards children and the two World Wars culminated in international recognition of children’s rights. A future article will highlight the increasing rate of change seen in the second half of this century.
The relevance of degree level preparation for community nurses
Authors: James Eileen
Published: May 2014

The most recent changes in the preparation of specialist community nurses assume that educational improvements automatically increase the skills and knowledge of the participants and thus the subsequent quality of care. The rapidly changing environment of community healthcare delivery has meant that the possession of degree-level qualifications is now seen as necessary for flexibility and responsiveness to change. However, the philosophy behind this thinking is flawed — education does not always reflect the reality of care delivery. Specialist community nurses can become further distanced from reality as their qualifications may elevate them to managerial positions rather than allowing them to concentrate on the practical application of their newly acquired knowledge.
Leukotrines: new therapies and their influence on asthma
Authors: Coakley Ann-Louise
Published: May 2014

Leukotriene receptor antagonists (LTRAs) are new therapies in asthma management which act to block the naturally occurring leukotrienes and improve lung function. It is clear from past research that many asthmatics dislike taking both oral and inhaled steroids and may probably welcome these new drugs simply because they are not steroid preparations. The oral route of LTRAs may be helpful for particular groups of patients, although LTRAs will not be suitable for all asthmatics. Their use so far has been largely as ‘add-on’ therapies for mild-to-moderate asthma with results that are promising in some patients but have been disappointing in others. Fewer side-effects may well improve medication compliance which has caused both unnecessary morbidity and has been linked to mortality in the past.
Does NHS Direct deserve its recent criticism?
Authors: Glasper Alan
Published: May 2014

In recent weeks, NHS Direct has been the subject of critical media coverage (e.g. Financial Times, 2000), following the publication of an investigation by the Consumers' Association (Williams, 2000). Launched on a wave of publicity in 1998, NHS Direct was seen as a strategic plank in the Labour Government's plans for a modern and dependable health service (Department of Health (DoH), 1997).
Web Watch
Authors: Mangan Paul
Published: May 2014

This edition of Web Watch continues to highlight major nursing mailing lists. These are often a good way to ask specific questions, or seek for advice from specialist colleagues around the world. The list-serve mechanism is usually used by sending an e-mail to a specific address with the words ‘subscribe me’ in the e-mail title. Once you have become a member of one or more lists you and all other members of the list will be able to receive all mail sent concerning your chosen subject.
Nutrition and the life cycle 1: maternal nutrition and pregnancy
Authors: Coutts Alison
Published: May 2014

Babies who are smaller than average at birth are more likely to face health problems during their adult life. A major influence on the size of the baby is maternal nutrition. Maternal energy requirements are not greatly increased, but other nutrients have been shown to influence fetal wellbeing; these include folate, riboflavin and some polyunsaturated fatty acids. Other nutrients that may enhance fetal welfare are ascorbic acid, zinc, and magnesium, and there are probably many more. Nurses, midwives, and health visitors need to be aware of the nutritional needs of pregnant women, and of the need to assist women to meet these needs. This is the first in a series of articles reviewing nutritional needs to maintain health during progressive stages of the life-cycle. This article discusses issues surrounding nutrition in pregnancy. Subsequent articles will review nutritional needs in young children, school-age children, adults, and older adults.
Nurses are losing control of their profession
Authors: Castledine George
Published: May 2014

It has always been the Government's intention to reduce the power of the healthcare professions, particularly doctors. Unfortunately, the recent proliferation in cases of medical negligence and misconduct seem to have given the Government a green light to overhaul the entire regulatory system of the professions.
Web Watch
Authors: Mangan Paul
Published: May 2014

This edition of Web Watch looks at the world of nursing theorists. Nursing is a profession because it has its own body of knowledge. Therefore, the giants of this world are those who have contributed directly to this body by the way they have defined and refined a world view of nursing practice and distilled some of that understanding into a theoretical model.
Learning disability nurses must stay linked to the NHS
Authors: Messent Peter , Caan Woody
Published: May 2014

Within the tumultuous organizational changes happening in the NHS, many health and social care agencies are having to decide how best to reconfigure, jointly commission and manage learning disability services.
Cleanliness in hospitals is the role of nurses
Authors: Castledine George
Published: May 2014

Two years ago I wrote that we had become too complacent in relation to infection control and cleanliness in health care (Vol 7(16): 994). The Government now agrees and has decided to do something about it. It has even included the topic in its NHS Plan: ‘The new investment we are making will allow the NHS to get the basics right. Patients perceive a major deterioration in the cleanliness of hospitals since the introduction of compulsory competitive tendering and the internal market. Patients expect wards to be clean, furnishings to be tidy. The new resources will allow for a renewed emphasis on clean hospitals’ (Department of Health (DoH), 2000: chapter 4).
CORRESPONDENCE
Authors: Murrell Louisa
Published: May 2014

In his recent column ‘General nursing does not seem to have progressed’ (Vol 8(21): 1470), Professor Castledine describes why general nursing does not seem to have moved on in the last decade. Many of the senior nurses at the Dudley Group of Hospitals agree and for some time have been raising concerns at the standard of what is commonly described ‘basic nursing care’.
Improving standards for learning disabilities
Authors: Jukes Mark
Published: May 2014

Whatever we may think about the ethics of docu-soaps, I do not think anyone could help but be moved by the reality of abuse highlighted by Donal MacIntyre in his undercover exposé of life within Brompton Care Home for people with a learning disability, MacIntyre Undercover (MacIntyre, 1999). Two days following the broadcast, John Hutton, Minister for Health, announced a national strategy for learning disability services (Department of Health (DoH), 1999a). This was proposed in the light of publication of the report Facing the Facts (DoH, 1999b) where it was found that little progress had been made in the 1990s to get learning disability services to provide improved quality of life for people and where there was no effective system to monitor quality of care at a regional and national level. In his announcement of the strategy, John Hutton stated:
Nutrition and the life cycle 2: infancy and weaning
Authors: Coutts Alison
Published: May 2014

The first article in this nutrition and the life cycle series discussed nutrition in pregnancy (Vol 9(17): 1133–8). This second article will concentrate on infancy and weaning. Weaning infants is an area that causes concern for parents. Health professionals need to be well informed about this aspect of child care, as practices have changed recently. Babies should usually begin weaning between 4 and 6 months of age. Infant diets need to be high in lipid for energy, and for essential long-chain fatty acids and fat-soluble vitamins. Their diets should also be rich in the micronutrients; infants are particularly at risk of deficiency for iron and zinc. Infants should be introduced to as many tastes and textures as reasonably possible, but foods likely to cause an allergic reaction should be avoided for as long as possible. Finally, all the family should enjoy mealtimes, and the pattern laid down for a life of healthy eating. The next article in this series will review nutrition in the school-age child.
Solving the problem of weight control for tube-fed patients
Authors: Kemp Sarah
Published: May 2014

Many patients requiring an enteral tube feed have low energy requirements or are overweight, with some patients gaining weight on as little as 1200 kcal/day. Most standard tube feeds supply 1500–2000 kcal/day. This has previously created a problem for dietitians and clinicians as giving a reduced volume to lower the energy supply has often resulted in the feed being incomplete with respect to vitamins, minerals and trace elements. A new feed, Fresubin® 1000 Complete, has been specially developed to overcome these difficulties. One litre supplies all nutrient requirements, including fibre, and only 1000 kcal. It is presented in a convenient, easy-to-use, pre-filled bag, the EasyBag. Fresubin® 1000 Complete is ACBS approved.
Care worker acquitted of raping vulnerable client
Authors: Aylott Jill
Published: May 2014

Is nursing becoming complacent about the issues of abuse in relation to vulnerable patients/clients? Over the last few weeks the nursing press has consistently reported on the bed crisis and the new nurse consultant posts, but there has been minimal coverage of the case of a care worker who walked free from court after being charged with raping a woman with severe learning disabilities.
Hepatitis B virus: cross-infection in one non-exposure prone procedure
Authors: Curran Evonne T
Published: May 2014

For infection control nurses (ICNs) reading about outbreaks of infection and the lessons learnt allows time for reflective practice and to change policies in one's own establishment. However, outbreak reports are not just for ICNs. One could argue that more benefit would be served if the outbreak reports were printed in non-specialist infection control journals. This article examines the hepatitis B virus and cross-infection.
PAMs are concerned about nurse consultants
Authors: Castledine George
Published: May 2014

The function of some nurse consultant posts is turning out to be rather controversial both within and outside the nursing profession. Professions allied to medicine (PAMs), although small in number, have, over the years, carved out important niches for themselves in terms of providing essential care to patients. However, many feel that their contribution is not recognized. Rarely do the press take up the need for more physiotherapists or dieticians, preferring instead to concentrate on the shortage of nurses or doctors. It is not surprising, therefore, that all the latest publicity over nurse consultants has raised a few eyebrows among the PAMs who work alongside nurses.
Male patients with lower urinary tract symptoms 1: Assessment
Authors: Dorey Grace
Published: May 2014

Male lower urinary tract symptoms include frequency, nocturia, urgency, urge incontinence, stress incontinence, post-micturition dribble and post-prostatectomy incontinence. All of these symptoms can be treated conservatively. In this article, the first of two parts, a detailed subjective and objective assessment is provided based on a Delphi study undertaken by the author. The objective assessment includes a digital rectal examination to assess the pelvic floor muscle strength in order to provide a patient-specific exercise programme. The diagnosis of stress incontinence, urge incontinence, post-prostatectomy incontinence, post-micturition dribble and functional incontinence is made from the assessment. Men with lower urinary tract symptoms need a detailed subjective and objective assessment before a diagnosis is made and individual treatment is planned.
Web Watch
Authors: Mangan Paul
Published: May 2014

Welcome to this regular column of the British Journal of Nursing. The idea behind Web Watch is to bring together in each issue a collection of resources that can be found on the Internet. The content of the Web sites provided will hopefully contain information that might be useful or interesting to nurses.
UKCC will now explain its misconduct decisions
Authors: Castledine George
Published: May 2014

The current system of health care demands more evidence-based accountability from doctors and nurses. Therefore, questions are being asked about the reasons why statutory bodies such as the UKCC make the decisions they do with regard to the professionals they regulate. Recently, there have been some high-profile cases where doctors and nurses have been found guilty in a court of law and yet in their past have survived a professional misconduct hearing, e.g. Dr Harold Shipman.
A supplement for tissue viability nurse specialists
Authors: Gray David
Published: May 2014

Welcome to the inaugural Tissue Viability Supplement of the British Journal of Nursing. This supplement is aimed directly at nurses who specialize in one or more aspects of tissue viability. Our aim is to provide articles which relate to the challenges faced by specialist nurses working in the field.
The improvement of wound care provision in Spain
Authors: Torra i Bou Joan-Enric , Agreda J Javier Soldevilla
Published: May 2014

Wound care is an important challenge for nurses in Spain as the chronic wound problem involves important issues such as patients' quality of life, NHS costs, as well as the commitment of healthcare professionals. Nurses have an important role to play in collaboration with other healthcare professionals in order to achieve an holistic approach to the problem of chronic wounds with the involvement of patients and their caregivers.
The development of an effective tissue viability service
Authors: Deeth Michelle , Hamilton Katrina
Published: May 2014

Wound management and the prevention and treatment of pressure ulcers is recognized as a major quality issue (Department of Health (DoH), 1993). However, there remains a number of NHS trusts who operate without a formal tissue viability service (TVS) (Dealey, 1994). The aim of this article is to assist those wishing to develop such a service by describing how the authors' TVS became established and how it has developed during the subsequent 5 years (Smith, 1996). It is anticipated that this information will provide a framework for practitioners who want to develop this specialty within their own trust. Traditionally, the detection and treatment of pressure ulcers has been the role of nursing staff. However, it is now recognized that this responsibility lies with many members of the multidisciplinary team, the members of which provide the foundation of an effective TVS (Smith, 1993).
Investigating the value of pressure sore prevention
Authors: Maylor Miles E
Published: May 2014

The supposition that pressure sore aetiology can be explained simply in terms of physical causes does not allow for the effect that healthcare staff can have on outcomes. A vast amount of research has contributed to the understanding of the multifactorial nature of pressure ischaemia, but relatively little has been done to identify whether human factors, such as beliefs and attitudes, have an impact on patient outcomes in this area. The identification of risk factors by means of risk-assessment scales may be pointless unless the causative factors are removed or mitigated.
Are we drinking in the ‘last chance’ saloon?
Authors: Gray David
Published: May 2014

The title of this editorial does not refer to the socializing that will be taking place at the Harrogate tissue viability conference in November. It does, in fact, refer to the recent meeting in Leicester of tissue viability nurses (TVNs) from across the UK (please refer to p. 4 for more details).
Nutrition and the life cycle: nutrition and the school child
Authors: Coutts Alison
Published: May 2014

This is the third in this series of articles examining nutrition and the life cycle. The first considered current thinking regarding nutrition in pregnancy (Vol 9(17): 1133's8), and the second discussed nourishing the infant, particularly in relation to weaning (Vol 9(21): 2205's16). This article considers nutrition and the older child. The school years are characterized by increasing independence from parents and exposure to values from outside the home. After being neglected for some years, childhood nutrition is again giving cause for concern. Some children are not eating enough, or not the right nutrients at the right time, while others are becoming overweight, with possible severe long-term effects on their health. Many of these problems are not related to poverty, but rather to changes in lifestyle. Some older children, however, are undernourishing themselves in an attempt to obtain a particular body shape. The last two articles in this series will review nutrition in adulthood and in older years.
WEB WATCH
Authors: Gibson Sue
Published: May 2014

Welcome to Web Watch, our regular guide to resources on the world wide web. This issue looks at national and international sites on pain management, with emphasis on the relief of pain experienced in cancer and other terminal illnesses.
WEB WATCH
Authors: Gibson Sue
Published: May 2014

Welcome to Web Watch, our regular guide to resources on the world wide web. This issue looks at national and international sites on nutrition.
Legal aspects of consent 12: organ donation after death
Authors: Dimond Bridgit
Published: May 2014

Tony has been severely injured in a road accident. He is 23 years old. His parents are told that he has serious brain damage and is unlikely to survive. They are asked if they would agree to the donation of his organs. What is the law?
Esprit HR mattress cover in pressure ulcer prevention
Authors: Khoulowa Joyce
Published: May 2014

Modern mattresses provide soft dense foam, which permits the redistribution of pressure on the patient over a wider area — away from bony prominences where pressure ulcers usually occur. The material used in producing multistretch covers for the new mattresses had a tendency to delaminate as a result of a combination of heat, moisture and inappropriate cleansing techniques causing the water barriers to fail. In partnership with York Health NHS Trust and the material manufacturer, STM Healthcare produced a mattress cover (Esprit HR) which was able to withstand higher pressure from heat and moisture and greatly extended the life expectancy of the Esprit HR mattress.
The accurate measurement of endotracheal tube cuff pressures
Authors: Ganner Catherine
Published: May 2014

The effects of endotracheal tube cuff pressure upon the tracheal wall is well documented and researched. Hyperinflation causes mucosal damage subsequent to restricted capillary blood flow (Seegobin and Hasselt, 1984), and underinflation increases aspiration risk (Bernard et al, 1979). There are critical care areas with no method of obtaining accurately cuff pressure other than adopting the minimal occlusion technique, i.e. inserting just enough air into the cuff to prevent air leakage. Although this is a useful method for obtaining an adequate seal, it does not safeguard against hyperinflation. The aim of this study was to demonstrate that without accurate measurement of intracuff pressures of endotracheal tubes, pressure will be outside the normal recommended limits, which could place patients at risk. Accurate measurements of cuff pressures postcardiac surgery were recorded using a Malincrodt pressure gauge. Theatre staff and intensive care unit nursing staff were unaware of the study until its completion. It is concluded that cuff pressures are too high using the minimal occlusion technique and the cuffs are prone to leaking.
Nursing care is given too narrow a definition
Authors: Scott Helen
Published: May 2014

The Government has announced that it is to provide free ‘nursing’ care for all and therefore will help nursing home residents with their fees. What it does not make clear to the public is that in so doing it is narrowing the definition of nursing care.
Using the Glasgow Coma Scale: analysis and limitations
Authors: Edwards Sharon L
Published: May 2014

This article addresses the gap between the literature and practice in relation to the use of the Glasgow Coma Scale (GCS). It will explore level of consciousness and the GCS. The instigation of both central and peripheral painful stimuli is analyzed in an effort to prevent ritualistic practice. Attention is also given to the importance of including vital signs when using the GCS, as these can tell a lot, if not more, about the patient's neurological condition. Finally, the limitations of the GCS are examined to assist in a more accurate and consistent assessment tool for neurologically impaired patients.
Is preregistration nurse education being ignored?
Authors: Castledine George
Published: May 2014

It seems a long time ago now that the UKCC published its review of preregistration nursing (UKCC, 1999). Among the reasons for the review was the feedback coming from clinical areas that student nurses, both before and after registration, were not as practically competent as they should have been. The review was carried out by members of the UKCC plus key stakeholders.
Legal aspects of consent 17: not for resuscitation instructions
Authors: Dimond Bridgit
Published: May 2014

Ben, aged 75 years, was extremely depressed following the death of his wife. He was admitted to hospital in an emergency for an appendectomy. A young doctor told the nurse that he had spoken to Ben's son and it was agreed that in the event of a cardiac arrest Ben should not be resuscitated. This instruction was not put in writing. Unfortunately, after his return to the ward from the recovery room, Ben arrested. What should the nursing staff do?
Do nurses go on courses just to collect tickets?
Authors: Powell Geraldine
Published: May 2014

The question ‘Which course shall I go on next?’ has become a familiar cry in hospital wards throughout the country. When the postregistration education and practice (PREP) guidelines were introduced it was never envisaged that this would create a new ethos of collecting certificates. There is a fundamental misconception among many nurses that in order to meet their PREP requirements they need to jump constantly from one course to the next.
Will single-sex wards make patients more safe?
Authors: Scott Helen
Published: May 2014

The recent case of an 83-year-old woman who, it is alleged, was sexually assaulted on a mixed-sex ward at the Victoria Hospital in Kirkcaldy, Fife, has brought a renewed call for the introduction of single-sex wards.
WEB WATCH
Authors: Gibson Sue
Published: May 2014

Welcome to Web Watch, our regular guide to resources on the world-wide Web. This issue looks at national and international sites on infection control.
Nurses must now be the champions of older people
Authors: Nolan Mike , Aveyard Barry , Keady John
Published: May 2014

The National Service Framework (NSF) for Older People for the first time sets national standards of care for both health and social services (Department of Health (DoH), 2001). The aim of the NSF is to ensure that older people receive high quality, integrated health and social care and that they and their carers are always treated with respect, dignity and fairness. Some might argue that these are basic rights but, as Alan Milburn, the Secretary of State for Health, acknowledges, they are rights that older people are often denied.