bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving self-management skills: a whole systems approach
Authors: Kennedy Anne , Rogers Anne
Published: May 2014

This article outlines the rationale behind an approach developed at the National Primary Care Research and Development Centre (NPCRDC) to improve patients' abilities to self-manage their conditions with the support of services provided by the NHS. The approach is systematic and requires involvement of patients in the development of information, changing access arrangements to health services and promoting a patient-centred approach to care. A programme of research and development is currently being undertaken at The University of Manchester by researchers based at NPCRDC to investigate the effectiveness of this approach. The evidence base for the strategy under investigation is discussed and proposals are made for the role of nurses as facilitators for the self-management agenda in the NHS.
Inappropriate hospital admissions: patient participation in research
Authors: Glasby Jon , Littlechild Rosemary
Published: May 2014

Although political interest in reducing the number of inappropriate hospital admissions is mounting, methods for researching the rate of inappropriate admissions have several major limitations. Whereas traditional studies have tended to be predominantly subjective, more recent studies using clinical review instruments also have a number of limitations. Chief among these is the failure to consider the potential input of the individual patient. To illustrate some of the possible benefits of patient participation, this article cites findings from a study in Birmingham which sought to involve individual older people in a research study into emergency hospital admissions.
Troubleshooting common problems associated with long-term catheters
Authors: Rew Maggie , Woodward Sue
Published: May 2014

A catheter complications survey study, carried out over a 2-year period in three Bristol health districts, recorded 506 emergency referrals during a 6-month period (Kohler-Ockmore and Feneley, 1996). A further detailed study on 54 of the patients showed that 48% experienced catheter blockage and 37% reported urine bypassing. Urinary catheterization can cause many health problems; bacteriuria is inevitable in long-term catheterized patients (Cravens and Zweig, 2000). This article identifies some of the common problems that can occur with long-term catheters, makes recommendations and applies an evidence-based approach to catheter care. In order to identify and treat the associated problems, it is necessary to understand the anatomy and functions of the bladder. The article addresses this before examining the problems, which include: catheter blockage; bypassing of urine; catheter rejection and balloon non-deflation; and latex allergy. The psychological and social aspects, although not covered in this article, are also important and should always be considered along with all other aspects of care.
Caring for adults with a learning disability in the community
Authors: Powrie Elaine
Published: May 2014

A recurring theme within the literature is gaps in the delivery of services for people with a learning disability living in the community. These gaps occur between health professionals, primary and secondary care and specialisms within nursing. Gaps also exist between social service policy and implementation, health and social care. Recent national and local reports have sought to address these issues by promoting ways for health and social services to work in partnership. The theme of health promotion is highlighted in all these documents, but implementation of health promotion has been firmly placed within the boundaries of primary care. This poses a dilemma for primary care: does the primary care team or a more specialist community learning disability team provide better care for people with a learning disability? This article summarizes strategies and policies within the literature and difficulties that need to be considered when offering a service to people with a learning disability.
Cardiac rehabilitation: the needs of South Asian cardiac patients
Authors: Tod Angela M , Wadsworth Enid , Asif Safia , Gerrish Kate
Published: May 2014

There is an indication that South Asian people in the UK experience greater delays than white British populations in obtaining appropriate treatment and intervention despite experiencing higher levels of coronary heart disease (Chaturvedi et al, 1997). Evidence suggests that access to and uptake of UK cardiac rehabilitation services is disproportionately low in South Asian populations (NHS Centre for Reviews and Dissemination, 1998). This article examines the results of an audit of cardiac rehabilitation among cardiac patients of South Asian origin who were admitted to a large city teaching hospital in Sheffield. The results are discussed in the light of current concerns about the adequacy of communication with non-English speaking NHS patients. The implications for access to services and clinical practice are considered.
Outpatient nurses: from handmaiden to autonomous practitioner
Authors: Brenchley Tina , Robinson Sally
Published: May 2014

Little seems to have been written about health promotion in outpatients' departments. This article argues that outpatient nurses have the potential to play a significant part in promoting people's health. Outpatient nurses may be the first hospital nurses that an individual meets. What people observe and how they are treated may make a difference to both their experience of hospital care and their health. Outpatient nurses may have been perceived as the doctors' handmaidens of yesterday, but today they are evolving into an effective force for change. For example, evaluation of nurse-led outpatients' clinics is showing that they have the potential to complement doctor-led clinics and improve the healthcare experience of patients. It is argued that the health-promoting role of the outpatient nurse can be enhanced by a department that is a health-promoting environment.
Disposable non-sterile gloves: a policy for appropriate usage
Authors: Raybould Linda M
Published: May 2014

Since the implementation of universal precautions, the use of disposable gloves has become part of everyday clinical practice. Guidance has been published to advise healthcare workers of the risks of latex allergies associated with the wearing of powdered latex gloves. The literature supports the use of gloves when contact with blood or body fluids is likely. However, an audit of glove usage indicated that practitioners were wearing gloves inappropriately, i.e. to wash patients (20%). The results of this study also demonstrated that a small percentage of staff (20%) were wearing vinyl gloves to deal with blood spillages and for venepuncture (13%) and cannulation (10%). A glove policy and a flow chart to assist staff in the selection of gloves were introduced. An educational programme for all hospital staff was commenced. These measures can assist healthcare workers in making an informed choice regarding glove usage.
Down's syndrome: experiences of mothers from different cultures
Authors: Gatford Ann
Published: May 2014

The purpose of this study is to explore the lived experiences of mothers from different cultural backgrounds who have a child with Down's syndrome. Today, in multicultural Britain, cultural awareness and understanding are necessary if relevant care is to be offered. People from different cultures have different health beliefs, understanding and expectations. In order to try to understand these differences, a small selected sample of mothers from three different cultures who had given birth to a child diagnosed with Down's syndrome were interviewed in their own homes. When their responses were analysed they demonstrated their comparative isolation and the influence of cultural beliefs, and also that despite much research and study there is still a lack of respect and value in the way they had been treated. The author of this article addresses the requirement of more sensitivity and empathy to parents' needs.
Importance of pH monitoring in the care of long-term catheters
Authors: McCarthy Kate , Braun B , Hunter Iain
Published: May 2014

One of the main complications encountered by patients with long-term indwelling catheters is that of catheter blockage as a result of encrustation. This is usually managed at a district nurse level by the administration of catheter maintenance solutions (CMSs) or frequent catheter changes. However, catheter changes and maintenance solutions are often only employed after blockage has occurred. Regular recording of catheter care and urinary pH monitoring can be utilized to optimize the management of long-term catheters and plan catheter changes and CMS administration in a prophylactic manner. This article reviews the literature regarding CMS and urinary pH and demonstrates how the introduction of continued and formalized recording of catheter care and pH monitoring can improve long-term catheter management.
The nurse$s role in assessing alcohol use by older people
Authors: Schofield Irene , Tolson Debbie
Published: May 2014

Nurses have the potential to carry out health promotion activity related to alcohol use in a range of settings where older people receive care. The majority of the literature on alcohol use in later life has focused on abuse, especially on the more common risk of drug'salcohol interactions. In order to work effectively with older people in health prevention and education, nurses need to be knowledgeable about older people's patterns of drinking, the effects of alcohol on medication and the current evidence on the harm and benefits of alcohol to heath. In carrying out assessments, a skilful approach needs to be adopted in questioning older clients on what some might regard as a sensitive issue. Screening tools for the detection of alcohol abuse in the general adult population may not be valid for use with older clients. Tools specific to the detection of alcohol abuse by older people will be considered.
The role of peer assessment and peer review in nursing
Authors: Gopee Neil
Published: May 2014

With the implementation of clinical governance and professional self-regulation, substantial responsibility is devolved on to clinical nurses. Central to these two concepts is accountability for practice. We are accountable for our professional competence and knowledge to various parties such as the professional statutory body, the employer, society as well as ourselves. Although self-assessment provides each individual with a medium for ascertaining his/her own level of performance and, therefore, identifying his/her learning needs, peer review and peer assessment provide healthy means for obtaining feedback and external perceptions. They also bring with them several other benefits and meet other recommended professional requirements. Peer review is an intrinsic component of clinical governance, and it can be initiated and implemented at one-to-one, departmental or organizational level.
National Service Framework for Older People: management of falls
Authors: Biley Anna
Published: May 2014

The National Service Framework (NSF) for Older People was launched in England in the Spring of 2001. It sets out national standards and guidelines and with an increasingly ageing population is welcomed as a way forward to improving the care of older people across the health and social care spectrum. In Wales, work is underway in developing an ‘Older persons' strategy’, which is expected to reflect the main principles of the NSF. The NSF is underpinned by eight standards which are identified as priority issues. This article focuses on standard six: the prevention, treatment and management of falls. The implications and opportunities for health promotion that may arise from the standard are considered, in particular with reference to the development of an integrated falls service.
The biosciences and Fitness for Practice: a time for review?
Authors: McVicar Andrew , Clancy John
Published: May 2014

The learning of biosciences by preregistration students has been recognized as being problematic, and the need for better resourcing of education has been identified. The Project 2000 initiative (UKCC, 1988) expanded the breadth and depth of the curriculum content in order to support the delivery of holistic care, and so the resources for bioscience education seemed likely to remain limited. However, the UKCC has concluded that there has been a shortfall in the acquisition of practice skills by preregistration students (UKCC, 2001). To address this, new directives indicate that curricula should move to competency-based outcomes, and use student-focused learning. However, there is a lack of clarity as to what the basic expectation is for bioscience learning at registration, and how this might be continued in postregistration programmes. The authors argue that if resources for bioscience teaching in preregistration curricula cannot be improved then it is time to review the situation to ensure that expectations are realistic and attainable. Criteria are required to establish exactly what life-long learning means in relation to the biosciences, from registration through to specialist practice.
Overview of research to investigate pressure-relieving surfaces
Authors: Russell Linda
Published: May 2014

Pressure-relieving equipment plays a key role in the prevention and treatment of pressure ulcers. Every year an increasing amount of equipment is launched on to the market. The efficacy of this equipment is traditionally qualified with interface pressure and case studies, but rarely with randomized controlled trials. With the advent of The New NHS: Modern, Dependable (Department of Health (DoH), 1997) and Pressure Ulcer Risk Assessment and Prevention (National Institute for Clinical Excellence (NICE), 2001), a clinical governance system has started to be put into place and hopefully more evidence will be produced by the manufacturers and the NHS. With some 200 different types of mattresses on the market, emphasis needs to be placed on good quality randomized clinical trials to establish effectiveness of what can be costly equipment. This article gives an overview of how, historically, pressure-relieving mattresses were marketed on case studies and interface measurements. Recently, randomized controlled clinical trials are being used to demonstrate the efficacy of the mattress and reduction in the incidence of pressure ulcers. Seating is also an important aspect in continuing 24-hour pressure area prevention and treatment. Patient posture in a chair needs to be fully understood by the practitioner and key strategies are made in this article. Little research into seating has been undertaken and is urgently required.
Are standards of basic nursing care falling?
Authors: Castledine George
Published: May 2014

The concern many of us have over the present poor standards of general nursing care is starting to get publicity. On Radio 5 Live (Sunday, 29 January) there was a hard hitting and critical report about the falling standards in the nursing profession.
Practice nurses and their ‘lived experience’ of clinical supervision
Authors: Cutcliffe John , McFeely Siobhan
Published: May 2014

Increased workload in primary care and the advent of primary care groups means that practice nurses (PNs) are experiencing a profusion of changes. As a result, PNs have taken on board many new skills, and this has increased the demands and stresses made upon them. Accordingly, this study investigated 17 PNs' lived experiences of clinical supervision following a 4-day training programme. It adopted a hermeneutic, phenomenological method. Data were collected by means of semistructured interviews within a series of focus groups. The data from the focus groups underwent a thematic analysis, which induced an emerging theory comprising five key themes: (1) providing support (2) nurturing and growth (3) enhancing and enriching practice (4) encountering a new experience, and (5) engaging in intellectually challenging and demanding work. The findings indicated that the central theme of the PNs’ experience of clinical supervision was that of ‘providing support’, in that, without the presence and application of support, the effectiveness of the other themes appears to be diminished. The findings additionally indicated a range of issues, discussed under the headings: practice, education, policy, and further research.
Rosidal K: a short-stretch compression bandage system
Authors: Williams Clare
Published: May 2014

Management of venous leg ulcers account for a large proportion of the work of healthcare professionals, especially for those who are community based. Multilayer and long-stretch bandage systems have been used successfully for many years in venous leg ulcer management. Rosidal K, a short-stretch bandage, is now also becoming more widely accepted in this country as an effective and cost-effective bandage system. This product focus looks at bandage systems and examines the research supporting the use of short-stretch bandages and Rosidal K.
Managing faecal retention and incontinence in neurodisability
Authors: Pierce Elaine , Cowan Pauline , Stokes Maria
Published: May 2014

The large number of patients with faecal retention and/or incontinence in continuing care wards and rehabilitation units presents a considerable challenge. In order to maintain dignity and minimize the unpleasant odour so commonly associated with these wards and units, effective bowel management should be planned for individual patients. For an effective bowel management regime a team approach should be adopted, involving, where possible, the patient and carer as well as all the health professionals administering the care. Two case studies illustrate the use of assessment and management of bowel problems in patients with severe complex neurodisability. Bowel dysfunction in this patient population, in general, is poorly covered in the literature. The present article, by relating theory to practice, offers information and guidance for nurses working with patients who have bowel-related problems.
New Developments in the Use of Dressings on Surgical Wounds
Authors: White Richard
Published: May 2014

At the 10th European Wound Management Association (EWMA) conference in Stockholm, Sweden, a concurrent session was hosted by ConvaTec. The topic was ‘New dimensions in the treatment of postsurgical wounds’, and it focused on the new hydrofibre dressing, Aquacel, and its use in a variety of surgical wound types.
Perceptions of tissue viability nurses of their current roles
Authors: Fox Charles
Published: May 2014

This qualitative and quantitative study was undertaken on a national scale. It identifies the perception of the role of the tissue viability nurse by its incumbents through the circulation of postal questionnaires sent to 173 identified tissue viability nurses, of which 87 responded. A constant comparative analysis of the responses identified the repetitive phrases and key words for the qualitative data. The quantitative responses were facilitated through the use of closed questions. The research facilitated four areas of discussion: role overview; perceived levels of education; positive/negative aspects of the role; types of wound contact and reasons.
The tissue viability nurse and effective documentation
Authors: Culley Fiona
Published: May 2014

The problems associated with inadequate record keeping in tissue viability have been highlighted in a number of related legal proceedings, professional misconduct cases (UKCC 2001a,b), and investigations by the Health Service Commissioner (Ombudsman) (HSC, 2001). Each serves as a reminder of the importance of nursing documentation towards protecting the welfare of patients and clients. A rising tide in clinical negligence (National Audit Office, 2001), and an increase in the number of nurses removed from the UKCC register (UKCC 2001c), indicate a greater likelihood of nurses (including specialists), being called to provide evidence of standards of care when investigating, predicting and managing clinical risk. This article examines the continued importance of documentary evidence to support such inquiries, clarifying the tissue viability nurse’s responsibility in producing accurate and effective records in all aspects of an increasingly expanding role.
The use of honey in the treatment of infected wounds: case studies
Authors: Kingsley Andrew
Published: May 2014

Honey is gaining popularity as a dressing for chronic wounds. Existing literature attributes honey with a number of useful properties, such as a broad-spectrum antimicrobial activity, deodorization, debriding and anti-inflammatory actions and stimulation of new tissue growth. Case studies are being published increasingly which record positive outcomes with its use. Recent national media attention has featured the beneficial effects of honey in wound care and patients are beginning to request treatment. While honey may become a useful and widely accepted product for wound management in the future, the following case studies demonstrate that not all the expected beneficial effects are always realized in practice.
Benchmarking best practice for external ventricular drainage
Authors: Woodward Sue , Addison Clare , Shah Sarah , Brennan Frank , MacLeod Ann , Clements Mark
Published: May 2014

Sharing of best practice and use of all available evidence is important in developing effective clinical guidelines for nursing practice. This can be achieved through benchmarking. Sharing of good practice and achieving consensus guidelines can avoid repetition of effort by nurses engaged in similar fields of practice. The Pan London Neuroscience Practice Development Forum was established in 1998 to share best practice within the field of neuroscience nursing across London. The Pan London Forum has now achieved consensus and developed evidence-based clinical guidelines for the management of external ventricular drainage. Within the scope of this article, the principles of external ventricular drainage will be highlighted, before identifying the evidence base for nursing management of patients. Approaches for troubleshooting common problems will also be discussed and the benchmarked clinical guidelines will be presented.
Views of family carers and older people of information technology
Authors: Andersson Nils-Bertil , Hanson Elizabeth , Magnusson Lennart , Nolan Mike
Published: May 2014

Until recently the prevalent view has been that older people do not adapt well to technology. However, the early work within the ACTION project highlighted that older people are often willing to use technology, particularly if it was easy to learn, easy to use, easy to understand, and if it was fully available and they perceived it as directly benefiting them in their caring situation (Magnusson et al, 1999, 2002).
Case study: benefits of IT for older people and their carers
Authors: Hanson Elizabeth , Magnusson Lennart , Oscarsson Thomas , Nolan Mike
Published: May 2014

The first article in this series (Vol 11(11): 759–63) described the development of the ACTION project, an information technology-based initiative designed to enhance the quality of life for family carers and older people, and the second article (Vol 11(12): 827–31) considered how the usability of the ACTION system as a whole was evaluated. This, the third article, presents a case study which describes in more detail the impact of the ACTION project on the lives of both a family carer (Rolf) and his wife (Kerstin), and on the technical worker (Thomas) who helped Rolf and Kerstin to learn to use the ACTION system. The impact of the intervention is assessed using two broad sets of criteria: (1) those relating to the PREP (Preparedness, Enrichment, Predictability) model of nursing interventions, and (2) those relating to the wider implications of participation in a research and development project of this nature.
Identifying important issues for people with Parkinson's disease
Authors: Hayes Christine
Published: May 2014

This article identifies issues that are important for people with Parkinson's disease (PD). A review of the literature showed that information about PD commonly relates to anatomy and physiology, medication and activities of daily living. These categories were used to formulate statements on a questionnaire, which was distributed to members of the Parkinson's Disease Society within the East Midlands. The results demonstrated that those with PD wanted advice on maintaining their independence, the amount of movement they were capable of and how to respond if their symptoms changed. They wanted to know when to seek medical advice, information about their medication and the treatments available for PD. Knowing what could be tried next if the present treatment failed was thought more important than knowing about all treatments.
Urgotul™: alternative to conventional non-adherence dressings
Authors: Benbow Maureen
Published: May 2014

This article describes a novel dressing product that was developed from existing technology: hydrocolloid. The main benefits of Urgotul™ relate to the fact that it does not adhere to the wound surface, so both wound trauma on removal and the build up of moisture under the dressing are avoided.
Meeting the needs of people with learning disabilities in acute care
Authors: Glasby Anne-Marie
Published: May 2014

This article describes the work of the Birmingham Acute Hospital Liaison Project, which seeks to support people with learning disabilities in acute care. Following the community care reforms, more and more people with learning disabilities are accessing mainstream primary and secondary healthcare services in community settings staffed by generic rather than specialist learning disability staff. Unfortunately, research suggests that some people with learning disabilities receive poor quality care and that available services are not always responsive to their needs. As a result, the Acute Hospital Liaison Project has a dual role: supporting people with learning disabilities as they enter hospital; and working with ward staff to equip them with the skills and confidence they need to work more effectively with people with learning disabilities.
Self-disclosure in adult and mental health nursing students
Authors: Ashmore Russell , Banks David
Published: May 2014

Self-disclosure, the process whereby people verbally reveal themselves to others, is an important interpersonal skill in initiating, developing, maintaining, and terminating therapeutic relationships. Studies of this interpersonal skill in nursing have, primarily, focused on adult nurses. They are dated, make no comparisons between this and other nursing specialisms and have not considered the patient as a focus for nurses' self-disclosure. This study attempts to address these issues in relation to student nurses by: replicating a previous study of self-disclosure in adult nursing students (ANS), and offering a comparison of two nursing specialisms, reporting on the use of this skill in relation to the patient. A matched sample of 25 ANS and 25 mental health nursing students (MHNS) were asked to complete a modified version of Jourard's 25-item self-disclosure questionnaire. The findings suggest that: ANS were more self-disclosing than students sampled in an earlier study (Burnard and Morrison, 1992); both sets of students disclosed significantly less items to the patient as target-person than to other categories; and MHNS disclosed significantly more items than the ANS to the patient category.
A survey of ‘teamwork’ in mental health: is it achievable in practice?
Authors: Stark Sheila , Skidmore David , Warne Tony , Stronach Ian
Published: May 2014

As part of an ENB educational evaluation of teamworking in mental health, a report-and-respond survey was used as one of five data collection methods. This instrument disseminated earlier findings back to the participants and invited further comments. This article discusses the usefulness of this type of survey as a data collection tool and presents the findings of the survey which was administered to service professionals, educationalists, students, users and carers involved in mental health throughout England. The findings show that when groups of professionals are working within increasingly tight financial constraints and increased workloads, multiprofessional teamworking can be scarce in reality. These tensions present issues for nurse education and training at both pre- and postregistration levels in relation to the teaching of, for and about effective teamwork.
Developing the use of poetry within healthcare culture
Authors: Macduff Colin , West Bernie
Published: May 2014

While the visual arts are often given consideration as an important feature of healthcare environments, the literary arts remain an under-developed resource. This article describes recent nurse-initiated developments in Aberdeen which attempt to integrate poetry into the culture of hospitals so that patients, visitors and staff can be involved. In particular, the ‘Poem Post’ project is described. This project makes a selection of short poems available on postcards in wall-mounted racks within local hospitals, and incorporates a facility for feedback of comments and new poems. Feedback has been generally very positive and over 100 new poems have been submitted to the project. Issues arising from evaluation of the project are discussed, and lessons learnt from the experience are reviewed in order to encourage nurses to consider the possibilities that poetry can offer in the workplace.
The important aspects of nurse specialist roles
Authors: Castledine George
Published: May 2014

Recently, I have been interviewing a variety of nurse specialists to find out about their unique contribution and value to health care. There has been an increase in the number of nurse specialists over the past few years. The prime motivators towards this trend have been patient need, doctor shortages, Government support, and professional ambition. Unfortunately, however, there is a lot of confusion, suspicion and misinformation about the role. Nurse specialists in the UK usually assume seven major roles. They:
Myocardial infarction: nursing responsibilities in the first hour
Authors: Edwards Sharon L
Published: May 2014

The aim of this article is to provide a comprehensive review of the physiological processes that occur during the first hour following a myocardial infarction (MI). It will identify the general principles and the physiological processes that occur in response to a MI, outlining the consequences of cellular hypoxia to the heart. The implications for clinical practice and how they link to the physiological processes are detailed. Understanding the physiological principles involved in a MI is important for identification and to ensure patient management is initiated. This, together with prompt diagnosis and interventions, will assist in reducing mortality within the first hour following a MI.
An exploration of district nurses' perception of occupational stress
Authors: Evans Lorella
Published: May 2014

Many studies in nurse occupational stress have been carried out on high-dependency areas in general nursing, while community nursing has been neglected. District nurses, however, appear to be under increasing pressure, especially in the light of recent NHS reforms. This study aimed to explore district nurses' experiences in relation to the range and severity of stressful work-related events encountered in district nursing practice. The study was undertaken in a Yorkshire community healthcare NHS trust, with a convenience sample of 50 qualified district nurses, of which 38 successfully completed the questionnaire. The sample included F, G and H grade levels working both full-time and part-time. The research design adopted was a descriptive, non-experimental cross-sectional survey, integrating quantitative and qualitative approaches. Data were collected using the Community Health Nurses' Perceptions of Work-Related Stressors Questionnaire (Walcott-McQuigg and Ervin, 1992). Results revealed that the most stressful aspects of work for this group of district nurses were: work overload; climate of change; nursing patients with complex care needs; lack of teamwork with other departments, and family responsibilities (home/work interface). Results were consistent with much of the evidence reported in the literature, demonstrating that district nurses are a comparatively stressed group of healthcare professionals.
Improving diagnosis of malignant leg ulcers in the community
Authors: Walsh Rachel
Published: May 2014

Over 80% of all leg ulcer patients are cared for in the community by district and practice nurses, or by a relative who may or may not be adequately instructed or supervised. Many patients have never been referred for a specialist opinion, although their ulcers have been in existence for many years. This article discusses the current lack of community leg ulcer nurse specialists who could perform biopsies on non-healing wounds and thus reduce the amount of unnecessary hospital referrals. In turn this would speed referral times to hospital of patients with malignant leg ulcers.
Nursing at a specialist diagnostic clinic for multiple sclerosis
Authors: Porter Bernadette , Keenan Elizabeth
Published: May 2014

People with multiple sclerosis (MS) need support, information, education and guidance in order to adapt effectively to the impact of the disease (Sheridan, 1997). The care received at the time of diagnosis is central to this adaptation process as the information given and received may impact on the person with MS for the rest of his/her life. In order to achieve effective coping strategies, the person with MS needs to develop a collaborative relationship with the team of healthcare professionals. At the National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospital (UCLH), the MS team believes that the foundations of this relationship should be cemented at the diagnostic stage. This article describes a diagnostic model that facilitates accurate timely diagnosis of MS and the role of the MS nurse in providing expert clinical assessment, guidance, support and education in order to help the patient adjust to the disease.
Discharge planning in rehabilitation following surgery for a stoma
Authors: O'Connor Gloria
Published: May 2014

Discharge planning and establishing goals for rehabilitation after stoma surgery is an ongoing process, which should be preceded by an holistic assessment, ideally carried out by a specialist practitioner with knowledge and experience in this area. The practitioner needs to have effective listening skills to ensure that both practical and psychological care are patient-centred. The patient and his/her carers must be involved in all aspects of care planning and establishing goals for rehabilitation. The specialist practitioner should adopt an evidence-based approach to care, ensuring that important aspects of care, such as the early teaching of stoma management skills, are not neglected. The specialist practitioner may not be able to meet all the patient's needs and should refer on to other specialist staff where these services are available. Such multidisciplinary input, utilizing appropriate problem-solving approaches with the involvement of patients and their carers, can only enhance the quality of care delivered and optimize the process of rehabilitation.
Use of non-verbal communication skills to improve nursing care
Authors: Chambers Simon
Published: May 2014

This article describes non-verbal communication (NVC), its nursing assessment and its use with people who have a learning disability. A nursing diagnosis of altered non-verbal communication is outlined and a new wellness diagnosis is proposed of potential for enhanced non-verbal communication. The use and encouragement of non-verbal communication with people who have limited verbal comprehension is discussed. Nurses are considered an important focus for change: for enhancing a person's non-verbal skills, for improving their learning environment and for ultimately improving their social development.
A review to examine the use of SF-36 in cardiac rehabilitation
Authors: Brown Kimberley
Published: May 2014

The aim of this article is to review critically the current literature on a health-related quality of life (HRQL) measurement tool — the Medical Outcome Short-Form General Health Survey (SF-36) — and to examine the evidence for its use in cardiac rehabilitation. A literature review was carried out using the databases Cinahl, Psychinfo, EMBASE and Cochrane. Key terms used included ‘cardiac rehabilitation’ and ‘SF-36’ and the search was carried out for the period 1995–2002. The literature examined indicates that the SF-36 is a sensitive, valid tool that provides broad applicability and is appropriate for use with cardiac rehabilitation patients. However, it remains to be seen whether a disease-specific tool could be even more effective. More research needs to be performed to compare generic measures of HRQL directly with disease-specific measures in cardiac rehabilitation populations. Until then, the author advocates its routine use as a screening tool in cardiac rehabilitation to gain insight into areas of concern so that interventions can be planned to improve patient outcomes.
Medicinal products and consent by young persons to treatment
Authors: Dimond Bridgit
Published: May 2014

Laura is 14 years old and suffering from leukaemia. She has recently lost remission and her prospects for survival are uncertain. She has started refusing treatment and says that she is not prepared to undergo a further course of chemotherapy. Her parents are anxious for everything to be done to ensure her survival and wish chemotherapy to be undertaken. What is the law and would it be different if Laura was 16 or 18 years?.
Interprofessional practice and learning disability nursing
Authors: McCray Janet
Published: May 2014

Several decades of policy and service change in the field of learning disability have set in place new service boundaries in health and social care, leading to different working relationships for professionals based on interprofessional and interagency collaboration. However, economic pressures may result in agencies offering resource-led rather than needs-led services, resulting in fragmented services and tensions between professional groups faced with tough choices in order to meet the long-term needs of people with learning disabilities. One of the key roles of the registered learning disability nurse (RLDN) is that of facilitator in meeting the healthcare needs of people with learning disabilities, which involves interprofessional working across these new health and social care boundaries. The aim of this article is to present the findings from a small-scale research study that was undertaken to explore the views of the RLDN group in relation to interprofessional practice in the long-term support of people with learning disabilities. Set within a grounded theory methodology, this article focuses on one element of the research study, which was a descriptive analysis of individual practitioners' experiences. In documenting the practitioners' accounts, the research begins to identify a series of key roles and significant practice knowledge held by those employed in learning disability nursing positions.
Access to the internet in an acute care area: experiences of nurses
Authors: Todd AM , Harrison J , Morris Docker S , Black R , Wolstenholme D
Published: May 2014

The internet is expected to play a key role in delivering evidence-based practice (Department of Health (DoH), 1997, 1998a; Beyea, 2000). In the UK, poor access to the internet and a lack of knowledge and confidence have been identified as barriers to nurses accessing evidence via the internet. The study described here aimed to evaluate how open access to the internet in an acute ward area had an impact upon the evidence-based practice of nurses and allied health professionals. The study was funded by the Department of Health. It incorporated a survey of over 200 staff, semistructured interviews and monitoring of internet use. The results indicate that the ward-based internet facilities were valued and used by nurses. However, time, support and training are required for nurses to realize the full potential of the internet. Future partnerships between health sciences libraries and the NHS are recommended to help staff to access and use the internet in order to answer clinically derived questions.
The value of continence training: does it change clinical practice?
Authors: Rigby Deborah
Published: May 2014

It is estimated that one in six people over 40 are incontinent ‘several times a month’ and that most of them will not have sought help (Perry et al, 2000). Containment of the problem is no longer the first-line treatment and patients should be given access to an assessment, with a management plan addressing the cause of incontinence. It is thought that around 70% of the estimated population with continence problems in the UK would show a good response to treatment (Royal College of Physicians (RCP), 1995). However, it is recognized that healthcare professionals need knowledge and training to deliver care (Brittain et al, 2001). Previous studies have shown continence education, for both professionals and users, to be cost-effective because investment in techniques to promote continence can reduce dependence on incontinence containment products (Bradley and Morgan, 1998; Williams et al, 1999). This study was based on the belief that there is an educational gap between what is taught and what is practised (Macleod, 1998; Severinsson, 1998). The study drew on an opportunistic sample of students attending continence training courses. They were asked to complete pre- and post-course questionnaires. Using a follow-up research design, three periods of data were collected. Data were analysed using Microsoft Excel and the Statistical Package for Social Science (SPSS). The results conclude that there was a statistically significant change in the quantitative measure — the test result — but qualified nurses were experiencing some difficulty relating the theory to clinical practice.
Philosophy, knowledge and theory in the assessment of pain
Authors: Walker Jennie-April
Published: May 2014

Pain is generally accepted to be an unpleasant sensory experience that can affect patients' quality of life if not addressed adequately. Pain assessment is a key aspect in the nursing management and delivery of care within the clinical environment. Effective pain management is thus reliant on a comprehensive assessment of the patient and his/her pain. It is through the assessment process that the skilled nurse utilizes many aspects of knowledge including that of the underlying pathophysiology, pharmacologic knowledge of the drugs available for use, and knowledge of the patient being assessed. The use of these varying types of knowledge is essential when caring for a variety of patients. To ensure pain assessment is based on sound judgment, effective nurses will utilize their knowledge acquired through different sources, including any relevant theories or research, and their understanding of the philosophical dimensions of pain and its treatment. The ideology behind effective pain assessment and pain management is to achieve a pain-free status whenever possible. Although this sets the nurse a very difficult challenge, the aim is to ensure that the patient achieves the best possible treatment.
Why patients do not comply with compression bandaging
Authors: Edwards Lynfa M
Published: May 2014

The aim of this study was to explore the perceptions of patients presenting with venous leg ulceration who were labelled as ‘non-compliant’ with compression bandaging by district nurses. A hermeneutic approach was taken and 14 patients with chronic venous leg ulceration were interviewed. Six themes emerged from the data: (1) lay perceptions of the cause and healing of leg ulceration, (2) concurrent problems of leg ulceration, (3) dilemmas of treatment, (4) perceptions of healthcare professionals, (5) the need for health education, (6) what it is like living with a leg ulcer. Patients did not have a clear understanding of their condition or treatment regimens. Concurrent problems associated with compression bandaging included pain, leakage of exudate and skin irritation, and these symptoms adversely affected patients' lifestyles and contributed to ‘non-compliance’. Patients acknowledged that acceptable care was given in the community. However, they said that healthcare professionals misunderstood how their physical and psychological problems affected them, which in turn led to disagreements and disempowerment. Finally, it was apparent that patients were lacking in information relating to their condition and treatment. This study identified that many aspects of patients' perceptions of their condition and treatments influenced their ability to tolerate compression bandages. Non-compliance is a multivariant concept in which both physical and psychological determinants play a key role. Nurses need to gain a clear understanding of patients' concurrent physical problems and perceptions of their health beliefs.
Comparison of dressing removal following hypospadias repair
Authors: Sanders Caroline
Published: May 2014

Hypospadias occurs when the urethral folds fail to fuse on the ventral aspect of the penis (Thomas and Barker, 1997). Surgical repair is often warranted and standard postoperative practice in the UK often includes the application of a dressing around the penis. This article reports the outcome of a small randomized controlled feasibility study to compare two methods of dressing removal following hypospadias repair. The same dressing was used throughout the study — a control group used a standard method of dressing removal, while an experimental group had an additional barrier film applied before the dressing was attached to the wound. The primary outcome measure was the time taken to remove the dressing. The time interval between starting the process of dressing removal and having no dressing left in place was used for statistical analysis. Secondary measures included assessment of the child's pain at different intervals by the parents and by an independent nurse observer. General discussion took place with the parents regarding any experience of anxiety. This was to assess whether parental anxiety should be measured in a future randomized controlled trial (RCT). There appeared to be implications with regard to time savings with the new method of dressing removal. Issues about the most suitable environment to remove dressings and differences between pain assessments of nurse and parent are noted. This was only a small-scale study. To investigate these issues more fully, a RCT has since been developed, has gained ethical approval and is due to start in August 2003.
Clinical skills: empowering people with diabetes to minimize complications
Authors: Meetoo Danny
Published: May 2014

Diabetes mellitus is a lifelong condition. It represents a major cause of morbidity and mortality, often brought about by diabetic microvascular (retinopathy, nephropathy and neuropathy) and macrovascular (peripheral vascular disease, cardiovascular disease and stroke) complications. Although incurable, it is nevertheless possible for the person with diabetes to lead a normal life by adhering to a self-care management regimen. However, this complex, lifelong activity cannot be achieved in isolation. The role of the nurse, particularly as an educator and facilitator of learning, is therefore critical. This article aims to increase nurses' knowledge regarding the importance of ongoing education for the person with diabetes in order to minimize the development of microvascular and macrovascular complications. It also emphasizes the importance of including the individual in any decision-making process to ensure that empowerment is visible.