bluuebunny/crossref_metadata_2025 huggingface dataset:
Spiritual distress and integrity in palliative and non-palliative patients
Authors: Buxton Francis
Published: May 2014

Twenty-two patients in a Midlands acute hospital Trust supplied recorded narratives of their experience of spiritual distress, their hopes for spiritual integrity, and any means that were proving helpful in moving from distress to integrity. The research subjects included both patients in palliative care and those undergoing various therapies. There was little difference between the responses of these two groups. The most frequently expressed spiritual distress centred on the sense of ‘not being myself ’, and concern for the family. The most frequently expressed spiritual integrities, were the hope to help others, and to use the illness as an opportunity for personal growth and acceptance. Support from hospital staff was seen as most important in facilitating change from distress to integrity.
Development of family interventions: a 9-month pilot study
Authors: Murphy Neil
Published: May 2014

This article outlines the introduction and development of a team of like-minded people utilizing family interventions (FIs) in a NHS Trust. FIs can be described as therapy sessions for families of people experiencing psychosis, which involve the family, client and therapist. The sessions focus on key elements, such as engagement and assessment, psycho-education, communication skills, problem-solving and relapse prevention. Through this focus, problems are analysed and ultimately the interventions are decided and agreed upon. The analysis of the team utilizing FIs in a NHS Trust raises many questions, identifies problems encountered in its conception and highlights managerial difficulties that occurred when trying to balance caseload demands and something envisaged as resource- and time-hungry. The Trust, however, views FIs as one of the ways of addressing part of the National Institute for Health and Clinical Excellence (2002) guidelines, Schizophrenia: Core Interventions in the Treatment of Schizophrenia in Primary and Secondary Care, and lately, Organising and Delivering Psychological Therapies (Department of Health, 2004), and are keen to improve the quality of the service user and carer experience.
An overview of head lice infestation in neurosurgical patients
Authors: Sharma Divyesh , Kaliaperumal Chandrasekaran , A Choudhari Kishor
Published: May 2014

Head lice or pediculosis is recognized as an increasing problem in medical practice (Downs et al, 1999). Secondary bacterial infections can occur in patients with infestation. In neurosurgical patients, head lice infestation may be a potential risk factor for peri-operative complications. Secondary infection could further complicate neurosurgical wounds with subsequent complications. The authors discuss epidemiology, pathogenesis of potential peri-operative complications resulting from pediculosis and methodology of treatment of this common condition. The importance of early recognition and prompt treatment in patients with neurological diseases is highlighted. A simple algorithm to treat scalp pediculosis is suggested.
Advancing staff development and progression in nursing
Authors: Narayanasamy Aru , Narayanasamy Mani
Published: May 2014

Staff development in the NHS is integral to clinical governance and therefore important to health service providers. It is concerned with all the activities that advance knowledge, skills and attitudes of staff, embracing induction, mentorship, continuing professional development, learning beyond registration, performance appraisals, promotion, personal and professional development, and related activities. The recent contraction in nursing posts and services and competition for jobs means that only well-qualified staff with an impressive portfolio of staff development are likely to climb the career ladder. Nursing staff development and training needs in the NHS are huge and multifaceted. Healthcare providers need to invest in clear staff development strategies if they are to maintain their status as effective care delivery organizations in an increasingly competitive marketdriven economy. This article examines the many features of staff development and highlights the benefits for both staff and organizations.
Assessment of wound pain: overview and a new initiative
Authors: Young Trudie
Published: May 2014

All wounds have the potential to cause pain, and the nature of the pain varies with the type of wound. Many factors may exacerbate wound pain, including infection, trauma at dressing changes and poor technique when applying compression therapy. Failure to assess wound pain or inadequate pain assessment can cause the patient further anguish and extended suffering. Nurses caring for patients with painful wounds need to identify the source of the pain and exacerbating factors, and determine whether it has nocicoceptive and/or neuropathic elements in order to optimize pain management for the individual patient. This article examines the assessment of wound pain and introduces an initiative that has been developed to improve the assessment process. The ‘Heal not Hurt’ initiative is an excellent example of the profession and industry working together to implement best practice guidance in patient-centered pain-free wound care in clinical care.
The current constraints on nursing education
Authors: Castledine George
Published: May 2014

With the tightening economy and the current financial pressures within the NHS, nursing education will be forced to fight for survival over the next few years. Some observers would probably feel that this may be a good thing as it may well improve the content of the present programmes and make them more practical and in tune with the reality of what is happening in the health service today. It is no secret that the NMC has been concerned about the practical experience that students receive.
Impact of psychotropic medication on sexuality: literature review
Authors: Higgins Agnes
Published: May 2014

Psychotropic medication continues to be a central element in the care and treatment of people experiencing mental health problems. Nurses have a key role to play in patient education and in monitoring the benefits and side-effects of prescribed drugs. However, evidence suggests that nurses tend to ignore or minimize side-effects that impact on sexuality and sexual function. The focus of this article is on exploring the literature on psychotropic medication and sexual dysfunction.
Optimizing wound care with a new lipido-colloid dressing (Urgotul® Duo)
Authors: Meaume S , Ourabah Z , Charru P , Meyer P , Perez J , Sauvadet A , Bohbot S
Published: May 2014

This non-comparative, multicentre clinical trial included 43 patients whose acute or chronic wounds were treated with a new lipidocolloid dressing, Urgotul Duo, for at most 4 weeks, or until healing first occurred. The efficacy, tolerance and acceptability results obtained for this ‘ready-for-use’ dressing were similar to those reported for the Urgotul dressing in numerous previous clinical trials, and for all the different types of acute and chronic wounds. This well-tolerated new dressing greatly facilitates care operations in terms of execution (reduced use of supplementary gauzes for the secondary dressing) and duration (shorter nursing time), while improving patient comfort. This dressing is indicated for the local treatment of moderate exudative acute and chronic wounds in the granulation and epidermization phases.
A review of the treatments for venous leg ulcers
Authors: Palfreyman Simon , King Brenda , Walsh Bridget
Published: May 2014

Venous ulcers, sometimes termed varicose or stasis ulcers, are a consequence of damage to the valves in the veins of the legs, leading to raised venous pressure. They are characterized by a cyclical pattern of healing and recurrence. There is a need to have a thorough assessment of patients with leg ulcers by an appropriately experienced clinician to maximize the chance of healing the ulcer. The main treatment is the application of compression, either in the form of compression bandages or hosiery. Dressings are applied beneath the compression with a view to controlling exudate, comfort and to aid healing. There are a large number of dressing products and types available but the evidence to justify their use is poor. The main treatment for venous ulcers should therefore be the application of compression therapy with a simple, low adherent dressing.
It’s all getting a bit blurry
Authors: Black Peter
Published: May 2014

How defined are the boundaries that exist between different professional roles and areas of responsibility? With the changing patterns of health care, service planners are being forced to examine new elements of service delivery. This results in what has become commonly known as ‘role blurring’. Some nurses would have welcomed this, saying they are now working at higher levels of practice, which allows them to adapt their roles, take on new responsibilities and perform new challenging tasks. Others nurses may not have been as enthusiastic and would rather safeguard their own professional identity.
The spiritual state we’re in: the role of parish nursing
Authors: Castledine George
Published: May 2014

The threatened loss of the hospital chaplain is indicative of the way that some management teams view the holistic and individualized needs of patients – that cutting the chaplaincy service in hospitals will save money; that the chaplain’s work is based on religious dogma, and its value is difficult to evaluate. In one hospital I recently visited the local chaplain sardonically suggested that if the hospital management wanted evidence of the effect of his service they should count the number of new prayer requests that appear on his prayer tree each day.
Promoting safe transfusion practice: right blood, right patient, right time
Authors: Gray Alexandra , Hart Merredith , Dalrymple Kirsty , Davies Tony
Published: May 2014

Despite an array of initiatives designed to support the delivery of safe and appropriate transfusion practice, incidences of patients receiving the wrong blood continue to be reported. Nurses play a key role in delivering safe and appropriate transfusion care and have a responsibility to support national initiatives, such as the NHSBetter Blood Transfusionprogramme of action and the National Patient Safety Agency Safer Practice Notice 14, Right Patient, Right Blood. This article examines factors, which impact on the successful implementation of a programme aimed at promoting best transfusion practice, such as organizational support, leadership, education and competency assessment, and the role of audit and feedback. By championing the systematic assessment of transfusion procedures, the implementation of education and guidelines and the use of innovative approaches, such as care bundles, we can ensure that nurses have the appropriate knowledge, skills and understanding to provide the highest standards of transfusion care to our patients.
RSVP: a system for communication of deterioration in hospital patients
Authors: Featherstone Peter , Chalmers Tina , Smith Gary B
Published: May 2014

Communication failures are a prime cause of patient safety incidents. In a medical emergency, patient survival often depends on ward staff making an early and effective call for help. To improve communication with senior colleagues, ward staff need to create a picture that efficiently and reliably conveys their concerns so that they get the help that they need without delay. This can best be achieved though a structured call for help. The Reason-Story-Vital Signs-Plan system, used in the Acute Life–threatening Events – Recognition and Treatment (ALERT®)course, is easy to remember in an emergency and includes the essential information enabling an experienced clinician to respond appropriate to a call for help from ward staff. The use of such a structured call for help could improve patient safety.
Managing patients with metastatic colorectal cancer on bevacizumab
Authors: Lemmens Liesbeth , Claes Viviane , Uzzell Maggie
Published: May 2014

Bevacizumab (Avastin®) is a humanized monoclonal antibody that inhibits the activity of vascular endothelial growth factor (VEGF), a key molecule controlling tumour blood vessel formation (angiogenesis). By inhibiting VEGF and thus tumour angiogenesis, bevacizumab inhibits tumour growth and survival. In patients with metastatic colorectal cancer (CRC), first-line use of bevacizumab in combination with fluoropyrimidine-based chemotherapy improves outcomes compared with chemotherapy alone. The side-effect profile of bevacizumab does not overlap with that of conventional chemotherapy, and it does not significantly exacerbate chemotherapy-induced adverse events. Specific side-effects of special interest for bevacizumab include hypertension, proteinuria, arterial thromboembolic events, wound-healing complications, bleeding events and gastrointestinal perforation. Oncology nurses are key to early recognition and management of side-effects, in addition to having a key role in patient education, facilitating the optimal use of bevacizumab and thus survival of patients with metastatic CRC.
Shape and direction for the future
Authors: Karstadt Lyn
Published: May 2014

Nursing and midwifery education has evolved over the past few decades, leaving many in the profession — as well as education — slightly confused as to what is going on. In her ongoing column, Lyn Karstadt discusses the changing landscape of nurse training, and the implications of the new set of principles relating to the future framework of pre-registration nurse education.
Management of diabetes mellitus in clinical practice
Authors: Lawal Muili
Published: May 2014

Diabetes is a global health problem, with a challenging epidemiology. It is one of the major health problems affecting countries around the world, particularly the UK (World Health Organization [WHO], 2006; Department of Health [DH], 2006b). It is also a growing public health threat in the US (Mokdad et al, 2001). As a result, diabetes has become an important public health issue, prompting the WHO and International Diabetes Federation (IDF) to adopt the theme ‘Diabetes for Everyone’ for World Diabetes Day 2006. In 2007, on World Diabetes Day, the United Nations also launched its ‘Living with Diabetes at School’ campaign, in response to the growing diabetes ‘epidemics’ (Diabetes UK, 2007). This article provides an overview of diabetes mellitus and its acute- and long-term management, including definition, aetiology, pathophysiology, classification, signs, symptoms and complications. The role of the nurse in providing patient-centred care for people with diabetes is emphasized.
Providing effective support for patients facing disfiguring surgery
Authors: Bowers Ben
Published: May 2014

Surgery for head and neck cancer can leave patients with obvious facial disfigurements. Some individuals adjust remarkably well to their altered appearance and require very little emotional support. Conversely, individuals with poor coping skills or limited support from those close to them can become socially isolated and depressed. Nurses, caring for patients during their hospital stay, are in the ideal position to assess how they are emotionally adapting to having a disfigurement. By listening to the patient, and their family’s concerns, nurses can make a real difference to their recovery and quality of life. Through facilitating the development of the individual’s practical coping skills and confidence in social situations, nurses can help patients to start to constructively adjust to their new appearance. It is crucial to put patients and their families in touch with ongoing support before they go home
Dealing with difficult doctors
Authors: Castledine George
Published: May 2014

Dealing with difficult doctors is not easy, and often many nurses shrink away from conflict situations because they are too intimidated to fight back. Unfortunately, despite years of study and comment, there is still a feeling that some doctors regard nurses as their hand-maidens. To explain this attitude as just a battle of feminine and masculine identity would be very short-sighted as studies have suggested that there is more to the nurse/doctor relationship than following a medical model of treatment.
The effects of biographical variables on job satisfaction among nurses
Authors: Curtis Elizabeth A
Published: May 2014

A review of the literature confirms that there is no clear picture with regard to which biographical variables are strongly correlated with job satisfaction. Studies have shown small and inconsistent effects on variables, such as age, gender, education and personality, on job satisfaction. This study aimed to determine the effect of biographical variables on job satisfaction among nurses. The study used a dominant-less dominant mixed-method design and quantitative data were collected by a postal questionnaire survey. The sample was selected using stratified random sampling. The findings demonstrated no significant differences in job satisfaction for female and male nurses, and between job satisfaction and tenure. The findings did, however, confirm that nurses under the age of 35 were less satisfied than those over the age of 36; nurses with degrees were less satisfied than those without; and nurses in senior positions are more satisfied than their junior counterparts. The findings should be interpreted with caution because of the sample size and the small correlations between variables. Limitations aside, this study provides an insight into the relationship between these variables among nurses in the Republic of Ireland. It is possible that biographical variables are distal influences on job satisfaction, but further research is needed to better understand the relationship between these two sets of variables
Supportive and palliative care for the patient with end-stage renal disease
Authors: Noble Helen
Published: May 2014

As the numbers of patients presenting with end-stage renal disease (ESRD) increases, more are opting to withdraw from dialysis, often due to increased suffering and poor prognosis related to other comorbidities. Concurrently, other renal patients are deciding to forgo dialysis, recognizing that the burden of frequent dialysis may outweigh likely survival and quality-of-life benefits. Renal nursing is concerned with the health needs of individuals and their carers who are experiencing a progressive decline in renal function or who have lost renal function completely, and there is a focus on the provision of renal replacement therapy such as haemodialysis. As more patients decide to withdraw from, or not to embark on, dialysis, an enhanced approach to assessment and control of symptoms, as well as supportive management is required, including effective and high-quality palliative care. There is a necessity for renal nurses to change from disease management through interventions of a physiological nature to that of providing support and symptom management. This article discusses the supportive and palliative nursing care needs of a population largely unheard in the literature – patients with ESRD – and highlights the need for further patient and carer-centred research in this area.
Providing dietary advice for the individual with a stoma
Authors: Fulham Juliette
Published: May 2014

Concerns over diet and nutrition are common among ostomists and their carers. It is important for healthcare professionals involved in the care of patients with a colostomy, ileostomy or urostomy to appreciate that stoma surgery changes the body’s usual processes of nutritional absorption and excretion, so that informed support and advice on diet can be provided. A considerable proportion of patients admitted to hospital in the United Kingdom are malnourished, or at risk of becoming so. Patients undergoing gastrointestinal surgery resulting in stoma formation are at particular risk as a result of the potential for preoperative malnutrition caused by the effects of their underlying disease and prolonged periods of fasting during the immediate pre- and postoperative period. Screening and monitoring of the nutritional status of individuals with a stoma should be an ongoing process, beginning preoperatively and continuing after discharge from hospital. This article will examine the effects of stoma formation on diet and consider ostomists’ potential for altered absorption of nutrients. Current issues relating to patient nutrition in the hospital setting, their relevance for stoma patients and the role of the nurse in the provision of nutritional care will also be discussed.
Mixed aetiology: complexity and comorbidity in leg ulceration
Authors: Anderson Irene
Published: May 2014

Leg ulceration is a condition involving many factors that make assessment and management complex. When comorbidities add to this complexity it is particularly important that clinical management is by highly skilled practitioners in order to facilitate the best possible chance of ulcer healing and to reduce the risk of further complication. This article highlights key comorbidities and the range of reduced compression therapies currently used in clinical practice.
Paediatric stoma care nursing in the UK and Ireland
Authors: Waller Marie
Published: May 2014

Improving quality of care and developing and maintaining high standards of care are issues that are high on the NHS, nursing, and paediatric care agendas. Stoma formation will have an impact on the wellbeing and lifestyle of the person and their family, whatever the person’s age. The specialty of stoma care nursing in the UK and Ireland is well established. However, the sub-specialty of paediatric stoma care nursing is much smaller in its ‘membership’ and its client group. There are differences in the needs of, and the associated care of, paediatric stoma patients even within this overall patient group. Paediatric stoma care nurses are in an ideal position to increase awareness about the specialty and improve standards of nursing care for neonates, children, adolescents and their families. However, until the establishment of the Paediatric Stoma Nurse Group (PSNG) in 2005, this ‘position’ had not being utilized. This article discusses the ongoing work of the PSNG to devise standards of paediatric stoma care nursing, best practice guidelines, relevant patient/ parental information and establish itself as a valuable, proactive and independent forum for all healthcare professionals involved in the care of children with stomas.
An educational partnership to enhance evidence-based wound care
Authors: Hollinworth Helen , Taylor Dawn , Dyble Tina
Published: May 2014

This article describes an educational initiative that aimed to raise the knowledge and practice of nurses at one hospital where staff had become deskilled in wound care. An audit questionnaire was used to determine nurses’ knowledge before and 4 months after an educational workshop, part of which considered pain issues. Following the educational initiative, nurses within the Trust were knowledgeable about when to take a wound swab and could recognize the signs of wound infection, but there were still issues around the clinical practice of taking a wound swab. Conversely, their use of descriptors of tissue type to justify dressing choice was improved. Analgesia was commonly given to address previous uncomfortable dressing changes, but there was no mention of pain assessment. When a product had adhered to the wound bed, many nurses advocated soaking to aid removal. This has limited efficacy, but few nurses advocated using an alternative dressing on subsequent occasions. These results suggest that 4 months may be too short a time to fully evaluate whether a single educational workshop is sufficient to sustain change in an organization. An ongoing competency-based programme has been implemented.
New commission on nursing is a chance to have your say
Authors: Beckford-Ball Jason
Published: May 2014

In an ideal world, everyone would like to make a difference in their professional life, but sometimes working in the NHS can leave you feeling like an anonymous cog in an extremely large and cumbersome machine. The day-today mechanics of such a huge organization can make it hard to feel that you are having a real impact – the turnover of patients and staff, the pressure on beds, and the drive to economize and hit targets all mean that simply doing the job of nursing has grown more difficult as the health service becomes increasingly complex.
Pre-operative antiseptic skin preparation
Authors: Murkin Claire Elizabeth
Published: May 2014

Theatre nurses use antiseptic skin preparation products every day, but little thought seems to be given as to why a surgeon has a particular preference for one antiseptic skin preparation over another – whether it is for its efficacy, safety or application properties. Woodhead et al (2004) states that nurses still work in a ritualistic environment. Rituals are ‘any action performed according to custom, without understanding the reasons why it is being practised’. Nursing practice should be evidence-based; nurses should understand the rationale behind the choice of a particular antiseptic, and be knowledgable about the clinical effectiveness of antiseptic’s use pre-operatively, to achieve optimum results. This article focuses on the main types of antiseptic skin preparation while highlighting each product’s activity and the relevant considerations for choosing the appropriate product for each patient. Theatre staff need to emphasize the importance of skin preparation and the correct application techniques, while educating the scrub team and surgeons with respect to skin preparation.
The prevalence of verbal aggression against nurses
Authors: McLaughlin Sue , Gorley Lyn , Moseley Laurence
Published: May 2014

There have been many anecdotal and press reports of verbal aggression against nurses. The authors undertook a structured review of the published literature on the topic. They found that no consistent definitions or time periods had been used, a consistent estimate of prevalence was impossible to establish, studies had been retrospective, and the commonest form of measurement had been self-report. There had been no culmination of replicable knowledge. The claim of most studies is that verbal aggression is commonplace in nursing. The best available evidence suggests that verbal aggression is often viewed as ‘part of the job’. Consequences can range from emotional effects such as anger and humiliation, through to intent to leave the profession and for some it may have a negative psychological impact. Further research is needed to investigate the multi-faceted nature of verbal aggression. This must be guided by clear definitions and incorporate standardized measures of the effects of verbal aggression so that nurses can compare findings and fully understand all of the complexities and consequences.
Investigating the role and impact of expert nurses
Authors: Currie Lynne , Watterson Linda
Published: May 2014

This literature review was conducted to identify the attributes of an expert nurse and the direct and indirect impact they have on patient care, health-care organisations and nursing. Given the loss of expert nursing posts as a result of NHS deficits, there is an urgent need to differentiate between a range of expert nursing roles and how these contribute to positive patient and health outcomes and organisational efficiency. The focus of the literature search was on developments in the UK and the results indicated that ambiguity and confusion exist around the terminology and definitions associated with expert nurses. Research shows that expert nurses have a positive impact on patient care and organisational efficiency. However, a lack of clarity leads to a dilution of expert nursing roles and nurse expertise. There is a need for national guidance on the skills required of expert nurses and the necessity of considering the formal protection of nursing titles.
An investigation into the role of spirituality in nursing
Authors: Kate Ellis Hannah , Narayanasamy Aru
Published: May 2014

This article examines spirituality in nursing in terms of a critical literature review. The literature suggests that there is an increasing demand for holistic care within the NHS. Holistic care is based on the idea that there should be a balance between body, mind and spirit, however, clinical experience suggests that the spiritual dimension of nursing is rarely considered as there is a focus on what is perceived as scientific professionalism. The aim of this article is to explore the nature of spiritual care, discuss whether there is a need for it in nursing and explore ways in which nurses can provide it. This article is based on a critical review of the literature and empirical data on spirituality in nursing and identifies contrasting opinions around the definition of spiritual nursing care. Nurses can provide spiritual care by being conscious of their own spirituality as well as that of patients.
Is nursing still a recession-proof occupation?
Authors: Black Peter
Published: May 2014

So the champagne’s been put on ice. Talk of the recession’s end had us painting a rose-tinted future. ‘Recession is officially over’, said The Guardian. Coupled with signs of increasing demand in the housing market, pundits were predicting growth this quarter. All this seems to be overshadowed though with political attention shifting towards public-sector spending.
Exploring the role of patients in promoting safety: policy to practice
Authors: Holme Annie
Published: May 2014

That receiving healthcare involves potential and actual risks is widely acknowledged by the public, health professionals and politicians. Ensuring the delivery of safe and effective care is a fundamental component of healthcare policy and underpins many activities undertaken by health professionals on a daily basis. Alongside an increased understanding of health care and its potential dangers, the public has expectations of greater involvement in decisions about the treatments and care they receive. These expectations have arisen from social changes in the past few decades as well as being a consequence of government policy promoting public and patient involvement in health care. Despite the priority given to patient safety and patient involvement in policy development, there has been little debate about the feasibility of patients contributing to their own safety. This article reviews some policy initiatives and explores the potential role of patients in promoting safety and the implications for practice.
Physical activity readiness in patient withdrawals from cardiac rehabilitation
Authors: Rivett Martin J , Tsakirides Costas , Pringle Andrew , Carroll Sean , Ingle Lee , Dudfield Mike
Published: May 2014

Background: Adherence to cardiac rehabilitation (CR) programmes may be an important element for improving and maintaining physical activity (PA) behaviour in secondary prevention. Little is known about the PA behaviour in patients who have withdrawn from CR programmes. Therefore, a study was carried out to identify the reasons for withdrawal and the stage of PA readiness in those patients previously engaged in a Leeds-based community CR programme. Methods: A cross-sectional study was conducted using a telephone questionnaire to determine causes of withdrawal. A questionnaire based on the transtheoretical model of change was used to assess changes in PA readiness in these patients. Results: 101 withdrawn patients (mean age = 61 years; 72% male) were identified. It was found that 20 patients had relapsed beyond baseline (preparation phase) into pre-contemplation and contemplation phases and 15 reported they were in the preparation phase. However, the majority of patients remained in the action (18) and maintenance (48) phases of the transtheoretical model. Patients reported the following reasons for withdrawal: joined other facilities (16%); injury or illness (3%); family demands (7%); work demands (14%); lack of motivation (4%); lack of enjoyment (11%); lack of transport (10%); lack of time (10%); too expensive (6%); too crowded (4%). Conclusion: 66% of patients who had withdrawn from a phase IV CR programme remained in an advanced stage of PA readiness. Drop-out was due to a combination of financial, physical and lifestyle factors.
Nutritional management of enterocutaneous fistulas
Authors: Slater Rebecca
Published: May 2014

Enterocutaneous fistulas (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death. ECF treatment is complex and based on various assessments, treatment can be medical/conservative management or surgical. Depending on the site of the fistula and the nutritional status of the patient, clinicians have to decide whether parenteral nutrition or enteral nutrition should be established. Fistuloclysis is a relatively novel procedure in which nutrition is provided via an enteral feeding tube placed directly into the distal lumen of a high output fistula. Although fistuloclysis is not feasible for all patients with ECF, for those that are eligible, the method appears to be an acceptable and safe method of maintaining and improving nutritional status.
Nursing the patient with malignant melanoma: early intervention
Authors: Wheeler Tracey
Published: May 2014

This article summarizes the key facts about cutaneous melanoma, including its causative factors, incidence, classification, diagnosis and management guidelines. The role of the nurse is then discussed, in particular health education post-diagnosis, the specific information required to improve safety in the sun, the teaching of self-examination techniques, and the provision of psychological support throughout diagnosis and follow-up. Since most melanomas have an excellent prognosis, the majority of nursing care is at the educational and supportive level, however, melanoma can be an aggressive disease, and some aspects of nursing the patient with advanced disease are also considered.
There may be trouble ahead
Authors: Peate Ian
Published: May 2014

Following the NMC’s review of pre-registration nursing education (NMC, 2008) and Lord Darzi’s appraisal of the NHS (Department of Health, 2008), the scene is now set for an all-degree nursing profession. This move to an all-graduate profession is a key force in the modernization of the nursing workforce but is not without potential pitfalls.
Respiratory assessment in critically ill Patients: airway and breathing
Authors: Higginson Ray
Published: May 2014

In this series of articles, the authors outline what they consider to be essential/core critical care skills that all nurses should possess in order to timely and appropriately assess critically ill patients. It is anticipated that the possession of these core skills will enable nurses to appropriately assess and identify those patients who are at risk of deterioration. By comprehensively assessing individual patients and identifying problems early, nurses can initiate specific interventions that may stabilise and/or improve patient outcomes and help prevent unnecessary intensive care unit admission. Having covered respiratory assessment here, in subsequent articles the authors will outline and discuss the following key critical care skills that all nurses should possess: cardiac and circulatory assessment, neurological assessment, hydration status assessment, fluid management and intravenous therapy. In this article the authors discuss the airway, breathing and circulation (ABC) approach to patient assessment and then focus on respiratory assessment and management.
Rehabilitation and stoma care: addressing the psychological needs
Authors: Borwell Barbara
Published: May 2014

Stoma surgery may be required for many reasons. The circumstances in which intervention is required, with possible permanent changes to the patient’s conventional body image and lifestyle, will influence psychological recovery (Borwell, 1997; Black, 2000). Within a diverse multicultural society, addressing the individual psychological problems of the effects of mutilating surgery due to acute/chronic illness can be particularly challenging for health professionals. This can be further compounded if the patient has a physical or mental disability. Stoma care nurses play a vital role in supporting the family of the patient as a whole. Communication is key, encouraging open and genuine dialogue. Listening to patient and family anxieties will facilitate family cohesion and support. Families and/or the significant other of the patient face levels of distress equal to that of the patient, and need to be included in our care package. Psychological adaptation and successful rehabilitation of the patient are potentially achievable by a structured and complete assessment, assisting further understanding of patient, family and social needs. However, existing or additional anxieties will only be revealed if nurses can overcome personal communication difficulties (Borwell, 1997; Black, 2000).
The use of bowel management systems in the high-dependency setting
Authors: Rees Jackie , Sharpe Allison
Published: May 2014

In the acute care setting faecal incontinence is often associated with diarrhoea, both of which are challenging nursing problems. In this environment, it is essential that health-care professionals are able to provide good quality care, therefore, the assessment and management of faecal incontinence are fundamental elements of practice. This article examines the importance of identifying faecal incontinence within health-care settings, highlights the under-reporting of this condition and demonstrates that through careful assessment, appropriate treatment options can be used to provide optimum patient care. The article also describes the implementation of local guidelines for a bowel management system that were developed to promote best practice in patients being nursed in a high dependency health-care area.
The use of negative pressure wound therapy in the diabetic foot
Authors: Chadwick Paul
Published: May 2014

This article reviews the role of negative pressure wound therapy (NPWT) in the management of ulceration of the foot in people who suffer with diabetes. It examines the prevalence and costly implications of this condition and the low rate of healing using conventional therapies. The method of therapy is described and evidence for the use of NPWT is reviewed. There is a discussion regarding the choice of whether foam or gauze is the most suitable interface. There is practical advice given as when NPWT is indicated using a case study to demonstrate its use. The article concludes by suggesting how NPWT may be used in the future.
The Enhanced Recovery Programme for stoma patients: an audit
Authors: Bryan Sandra , Dukes Suzie
Published: May 2014

An enhanced recovery programme was implemented at Salisbury NHS Foundation Trust for elective patients undergoing colonic surgery with a stoma in October 2007. The programme is a multimodal approach first described by Professor H. Kehlet in 2000. In order for ERP to be successful in reducing length of stay and promoting earlier stoma independence, there was a need to educate, inform and prepare patients comprehensively in the pre-operative phase to enhance their understanding. A change of practice was necessary as, traditionally, the majority of practical and psychological care was promoted in the postoperative phase. A retrospective audit was carried out on 20 patients before undertaking the enhanced recovery programme, and 20 patients afterwards, which demonstrated a reduction in the patients’ mean length of stay from 20 to 7 days, with 60% being discharged at 5 days or less after the programme. The mean number of days until stomaindependent decreased from 12 to 5 days as a result of the enhanced recovery programme. A further 40 patients have been audited
The impact of the NSF for Diabetes on patient empowerment
Authors: Begum Shahina
Published: May 2014

The National Service Framework (NSF) for Diabetes was developed by the UK government to tackle variations in care for patients with diabetes. This article critically analyses the impact of this policy and its effect on health care, focusing specifically on Standard 3 of the NSF. This standard discusses patient empowerment and involving patients in their own care. A number of education programmes have been set up to empower patients to better manage their diabetes, and two of these are explored in detail: Dose Adjustment for Normal Eating (DAFNE) and Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND). Research has shown however, that many people are not aware of these initiatives, suggesting that more needs to be done to ensure that patients, nurses and other health professionals are aware of the services available for people with diabetes in the community. Furthermore, research suggests that there is a lack of emotional and psychological support for patients living with this chronic condition. It is suggested here that nurses can provide patients with this support, as well as with information to help them access services to manage their diabetes. This, together with education about diet and exercise, and appropriate referrals, will enable the nurse to ensure that all patients receive high-quality care
The Ostomy Skin Tool: tracking peristomal skin changes
Authors: Martins Lina , Ayello Elizabeth A , Claessens Ineke , Steen Hansen Anne , Hentze Poulsen Lis , Gary Sibbald R , Jemec Gregor B
Published: May 2014

The Ostomy Skin Tool is a standardized measuring instrument for assessing the extent and severity of peristomal skin change in terms of discolouration (D), erosion (E), and tissue overgrowth (T) (DET). The reliability and validity of this tool has been determined in a previous study. The purpose of this article is to highlight the study’s most important findings, and to demonstrate the usefulness of the DET score by evaluating three examples of peristomal skin changes. Additionally, a simplified categorical severity scale (defining ‘mild’, ‘moderate’, and ‘severe’ conditions) is introduced that may improve clinical interpretation of the DET score. It is reasonable to conclude that the DET score may empower the ostomy care nurse with an evidence-based platform to make qualified decisions on evaluation and treatment of peristomal skin disorders
In too deep: understanding, detecting and managing DVT
Authors: Meetoo Danny
Published: May 2014

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious health and social care problem of the developed world, affecting 1 in 1000 adults every year, and with an annual financial overhead of approximately £640 million. The nature of DVT means that often the condition can go unrecognized until the thrombus becomes an embolus. The pathogenesis of DVT continues to be based on Virchow’s triad, which attributes VTE to ‘hypercoagulability’, ‘stasis’ and ‘intimal injury’. The diagnosis of DVT is often the result of a number of tests performed either sequentially or in combination before mechanical and/or chemical treatment is embarked on. Creating public awareness of DVT and PE is the best way to prevent this condition. Nurses are in an ideal position to discuss the importance of lifestyle changes and other related measures to prevent DVT
Future-proofing the NHS: The NMC’s strategic 5-year vision
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper looks at the NMC’s recent Strategic Context Report, which identifies seven key areas where changes will affect the future of nursing in the UK
The Pakistan floods: it’s just not cricket
Authors: Higginson Ray
Published: May 2014

Torrential monsoon rain has recently caused the worst flooding ever seen in Pakistan’s history. World Health Organization (WHO) and Oxfam figures put the current death toll at over 1700. However, because large areas of Pakistan are inaccessible, an accurate figure of those who have died may never be known. In addition, the floods have also adversely affected between 15 and 20 million people (WHO, 2010a). Of these, at least six million now need urgent humanitarian assistance, food, water and medicines. As Watson et al (2007) maintain, the risk factors for outbreaks of disease after natural disasters are primarily associated with population displacement. With millions of displaced people currently living in cramped (often unhygienic) camps, the risk of disease is great. Water-borne diseases, typhoid, cholera, dehydration and diarrhoea now threaten the lives of a significant proportion of Pakistan’s displaced population.
Early warning scoring systems: observation of care in practice
Authors: Morris Andrew , Davies Kevin
Published: May 2014

This article describes the outcomes of an observation of care in an acute setting undertaken as part of the Royal College of Nursing Clinical Leadership Programme. Positive responses of staff and managers to the findings and a subsequent education programme have ensured that the use of early warning scores, and indeed early interventions, have been implemented with consequent improvements in patient caress
Teens with chronic skin: are we speaking their language?
Authors: Wheeler Tracey
Published: May 2014

Many children who suffer significant atopic eczema at a very young age experience a marked improvement of symptoms as they leave infancy behind. By the time they reach puberty, around three quarters of these children are symptom-free. However, the remaining quarter have a chronic visible condition with treatments that may seem onerous and at times useless to the average teenage sufferer. Conversely, puberty is a common time for psoriasis to present, at a stage of life when many seem poorly equipped to cope. So how should health professionals temper their approach to this client group, who have needs that are distinct from those of the young child and the adult patient? There is no doubt that self-esteem takes a huge battering when an individual is coping with a visible skin condition: puberty only serves to magnify this. In a qualitative research study of patients with psoriasis, Ginsburg and Link (1989) identified key areas creating stigmatization. It is interesting that a number of these have resonance with feelings often found in pubescent children, including anticipation of rejection; feelings of being flawed; sensitivity to the opinions of others; and secretiveness.
Incretin-based therapies for type 2 diabetes: a nurse’s perspective
Authors: Hodgkiss Jayne
Published: May 2014

Type 2 diabetes (T2D) is a serious and increasing problem in the UK. Large numbers of people are suffering from the disease, and its onset is occurring at younger ages, requiring prolonged treatment. Current therapies pose challenges for patients and health professionals, and new methods of treatment are therefore needed. This article examines a group of treatments—the incretin therapies—which have recently become available. It considers the clinical evidence for these therapies relevant to UK-based prescribing, and their potential benefits for patients with T2D. Awareness of these therapies, the evidence supporting them, and the clinical recommendations for their use will allow diabetes nurses to expand treatment options for patients with T2D.
Health information and the internet: The 5 Cs website evaluation tool
Authors: Roberts Lorraine
Published: May 2014

As more people use the internet to access health information, nurses need to become skilled in systematically reviewing websites so that they can guide patients to the most appropriate sites. The 5Cs website evaluation tool provides a structured guide to such evaluation, giving tips and suggesting key considerations. The 5 Cs are the key areas that need to be addressed in a comprehensive evaluation - credibility, currency, content, construction and clarity