bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain assessment and management relating to an indwelling catheter
Authors: Siddle Anne
Published: May 2014

This care study describes and critically examines the nursing role in continence care and the management of pain using the Roper et al (2000) model as a framework. Current practice in pain management and care of a patient with an indwelling urinary catheter is evaluated against best practice suggested by recent research evidence. A multidimensional and multidisciplinary team approach was taken to alleviate pain and promote independence in catheter care. Imagination and a positive attitude led to greater patient comfort and dignity. Recommendations for evidence-based practice are made.
Balancing cost-effectiveness with quality in tissue viability
Authors: Norman Debbie
Published: May 2014

The 21st century has seen an increase in the importance placed on the skills of healthcare practitioners. They now need to be able to demonstrate cost-effectiveness and balance it with quality in the delivery of care in the NHS. This emphasis is driven largely by the emergence of initiatives such as evidence-based practice, clinical governance and cost-effectiveness evaluations. The pressure to demonstrate cost-effective quality practices is becoming more and more prominent in the NHS. This article will discuss the practicalities and implications these pressures have on tissue viability and wound care providers.
An overview of Acticoat dressing in wound management
Authors: Dowsett Caroline
Published: May 2014

This article reviews the in vitro and in vivo studies available on a new nanocrystalline silver dressing, Acticoat (Smith & Nephew), and discusses their relevance to the availability of this product on the Drug Tariff. The addition of nanocrystalline silver dressings will make a valuable contribution to wound care in the community, in terms of providing continuity of care for patients who are discharged from hospital and also in preventing admission to hospital with non-manageable wound infection.
Staff nurse who failed to maintain adequate standards of hygiene
Authors: Castledine George
Published: May 2014

While performing cannulation on a patient in the renal unit of a large NHS trust, the senior sister in charge, Jane, was told by the patient that he had not been too pleased with the way the procedure had been carried out the previous time. Jane did not think to explore these comments further.
Evidence-based care of a patient with a myocardial infarction
Authors: Kelly Jacinta
Published: May 2014

Quality nursing care of the patient with a myocardial infarction is realized in accordance with evidence-based practice and by the willingness of nurses to adjust nursing practice as new evidence emerges. The framework for the holistic care of the patient following a myocardial infarction encompasses a comprehensive assessment, planning, intervention and evaluation process. The intention of this case study is to illustrate the rationale and evidence base underpinning the holistic approach to the care of this patient group.
Will infection be reduced in the coming year?
Authors: Castledine George
Published: May 2014

Ever since Florence Nightingale emphasized the importance of infection control, nurses have been directly involved in providing a biologically safe environment. How seriously nurses still take this responsibility has been called into question recently, especially given the problems of dirty hospitals and the increase in infections, such as methicillin-resistant Staphylococcus aureus (MRSA).
Health and safety considerations following the death of a patient
Authors: Dimond Bridgit
Published: May 2014

Arthur, who had spent all his life in Liverpool, came to live with his niece in Brighton. He was in his eighties and systematically prepared for his death. He told her that he would like to be cremated and the ashes returned to Liverpool. On his death in hospital, the family made arrangements for him to be cremated. Unfortunately no-one remembered or checked about the fact that a heart pacemaker had been inserted many years before, and when questioned by funeral directors, no warnings were given by the family. The pacemaker exploded in the crematorium and the local authority who was responsible for its upkeep claimed compensation from the family or NHS trust. Who, if anyone, is liable?.
Case study: managing and caring for a patient undergoing stoma formation
Authors: Hunter Helen
Published: May 2014

A 75-year-old man had attended his GP as he was worried that his altered bowel habits, and slight rectal bleeding, was more sinister than haemorrhoids. This article describes the subsequent investigations, care and treatment that he received. It highlights how early detection, prompt treatment, appropriate care and management can enable a person to cope with the devastating diagnosis of bowel cancer, surgery and the need for a stoma. This patient was otherwise well which contributed both to the treatment decision and successful outcome. Unfortunately, not all patients have such an experience, and the measures taken to prevent complications are described.
Role of the ‘ordinaryߣ nurse: concept of qualified caring
Authors: Fulbrook Suzanne
Published: May 2014

The vast majority of nurses will probably not expand their role so as to attract the title ‘specialist nurse’ or ‘consultant nurse’. The system will only need a certain amount of these practitioners to fill the gap left by the shortage of doctors. This means that for most nurses issues surrounding remuneration and responsibility will be addressed from an understanding of what it is to be a nurse whose practice lies within the new pay bands five to six within Agenda for Change (Department of Health, 2003). These bands include qualified nurses, mental health nurses, district nurses and health visitors, community nurses and school nurses (Parish, 2004). However, one word binds these practitioners to their colleagues who are to expand their roles — ‘qualified’. We have all undertaken a training of a minimum of 3 years and often with postregistration learning. We are all bound by regulatory and legal principles, with a professional obligation to our employers.
Nursing needs to sort out the role of nursing assistants
Authors: Castledine George
Published: May 2014

The time is nigh to give serious reconsideration to the role of the nursing auxiliary or healthcare assistant. There are several factors at present which are pushing this issue for a major review. First, the individuals themselves are confused as to what their role is, given that there is no clear definition of an auxiliary nurse or healthcare assistant. Second, the training for the role is still very varied, despite the national vocational qualification (NVQ) system. Third, there is a shortage of qualified registered general nurses. Fourth, registered general nurses are taking on more medical tasks. Finally, gaps are appearing in the continuity and quality of the traditional core care practice of nursing.
Nurses must know the steps to ensure safety of patients
Authors: Tingle John
Published: May 2014

The National Patient Safety Agency (NPSA) has recently launched more detailed guidance booklets covering each of its seven steps to patient safety (NPSA, 2004). All the booklets will be of interest to nurses as they relate to essential aspects of the patient care environment. The seven steps are: step 1: build a safety culture; step 2: lead and support your staff; step 3: integrate your risk management activity; step 4: promote reporting; step 5: involve and communicate with patients and the public; step 6: learn and share safety lessons; and step 7: implement solutions to prevent harm.
Clinical skills: nursing considerations in patients with faecal incontinence
Authors: Butcher Lesley
Published: May 2014

Faecal incontinence is a distressing and socially debilitating problem. Nurses are ideally placed to support patients and assist them in improving their quality of life. In order to provide the necessary holistic care the nurse needs to understand the nature of the patient's symptoms and be aware of a variety of management interventions. In this article the author outlines the various causes of faecal incontinence and highlights the importance of a thorough nursing assessment which takes into account the physical, psychological and social aspects of the symptoms. Planned care should be based on a firm knowledge base, but should reflect the needs of the individual. A good nurse–patient interaction facilitates this process and should be valued.
Management of urinary incontinence in a patient with multiple sclerosis
Authors: Simpson Paula
Published: May 2014

Patient care and clinical research looking at urinary incontinence associated with neurological disorders remains under-resourced. With heightened awareness, improved management decisions could be made that would lead to better patient outcomes. With the responsibility that clinical governance conveys, it is vital that an awareness of the risks associated with continence management are identified and minimized. These objectives can be achieved through the formation of a strong evidence base for practice — this will, in turn, allow better planning of care and easier anticipation of potential problems. This article reviews the literature to analyse the care received by a patient with multiple sclerosis and to consider what would have been best practice in this case, proposing alternative treatment options that could have been made available.
Toilet training children with learning difficulties: what the literature tells us
Authors: Harris Alison
Published: May 2014

Nurses and health visitors are the professional group most likely to be involved in advising and supporting parents of children with disabilities (Bliss and Watson, 1992). Little research has been done into assessing and treating urinary continence difficulties of children with learning difficulties and many questions remain unanswered: what is the extent of the problem; what specific interventions do children with learning difficulties require to attain toileting skills; what expectations can the parent and clinician have that children with learning difficulties can be toilet trained and who is best placed to promote toileting skills? The main findings from the literature will support health and education professionals and carers who are involved in toilet training children with learning difficulties.
There is far more to Christian practices
Authors: Likemen Janet
Published: May 2014

I have always had great respect for articles by Bridgit Dimond; however, I have concerns with ‘Disposal and preparation of the body: different religious practices’ in BJN (Vol 13(9): 547–49).
The importance of regulation of healthcare assistants
Authors: Skyte Stuart
Published: May 2014

For something which appears to have universal support, the regulation of healthcare support workers has been a long time coming. This is largely owing to the potential complexity of regulating a heterogeneous group of people who work in so many settings and who have no baseline educational requirements for the job.
New guidelines highlight best practice in stroke care
Authors: Gibbon Bernard
Published: May 2014

Providing the best care, i.e. care that is effective and efficient for patients, is central to healthcare professionals' thinking and is their ‘reason for being’; yet that is not always easy to do in practice. Conflicting approaches and a plethora of sources of information leave the clinician, be that doctor, nurse or therapist, with a bewildering volume of data on which to base clinical decisions.
Acting manager who ignored a care assistant physically abusing a patient
Authors: Castledine George
Published: May 2014

The Rose Care Centre is a registered nursing home with 80 beds, specializing in the care of the elderly mentally ill. The acting manager, Jason, who was in charge of one of the units within the centre, is the subject of this particular professional misconduct case.
Nurses must identify their own position in nursing
Authors: Fullbrook Suzanne
Published: May 2014

In the conclusion of her series of commentaries on the current changes taking place in relation to the nursing role, Suzanne Fullbrook looks at what it actually means to be a nurse and issues surrounding professional identity.
Management of patients who have relapses in multiple sclerosis
Authors: Williams Gaynor
Published: May 2014

Multiple sclerosis (MS) is a chronic neurological condition, which disrupts the typical functions and daily activities of those affected. Approximately 80% of those diagnosed will follow a relapsing/remitting disease course at diagnosis. Patients with relapsing/remitting MS can expect to have episodes of remission, when the disease is not active, countered by disabling episodes of relapse or an exacerbation of the disease and its variety of symptoms. Management of such episodes has always been open to the preferences of the healthcare professionals involved. The aim of this article is to review the evidence that exists to support current practice in the management of patients during a relapse and to evaluate how this evidence can be incorporated into patient care. The article begins by giving an overview of MS, and continues by determining what a relapse is and discussing the speculated triggers of relapse. Methods of treating relapse are then explored. It concludes by highlighting the strongest evidence-based method for treating relapses, and by emphasizing the need for further research into the pharmaceutical and non-pharmaceutical management of MS relapses.
Healthcare professionals' knowledge of motor neurone disease
Authors: O'Brien Mary R
Published: May 2014

Healthcare professionals have a professional duty to provide patients with accurate information in order to assist in managing their illness. This may be more difficult with an uncommon illness, such as motor neurone disease (MND), as many healthcare professionals may feel poorly informed about the illness themselves. This study set out to survey the level of knowledge and understanding about MND among a group of 100 healthcare professionals who had personal experience of managing the care of a person with MND. The value of the MND nurse specialist and the Motor Neurone Disease Association as sources of information were highlighted. There was evidence of active information seeking about MND among all professional groups. However, while many respondents felt that their knowledge of the disease processes in MND and their own profession's role in the management of the condition was good, 57% of respondents felt that their current level of overall knowledge about MND was inadequate.
Incompetent nurse who failed to acknowledge her limitations
Authors: Castledine George
Published: May 2014

Jane was a registered general nurse who worked for a private nursing agency. She was not a registered sick children's nurse but had experience of caring for babies and young children in their own homes. On the night of the incident Jane had been asked to go and care for the twin baby sisters of the Greening family in a large inner-city apartment. The sisters had always experienced health problems and one of them in particular suffered a rare respiratory condition. They had both been in and out of intensive care until eventually they were moved out of the neonatal unit into the children's ward and had received a carefully planned discharge regime.
Drug errors and patient safety: the need for a change in practice
Authors: Preston Rosemary M
Published: May 2014

Concerns regarding drug errors and public safety have recently been raised in the British national newspapers and professional nursing journals. This literature review considers why nurses may continue to make drug errors in their practice. The findings suggest that drug errors are not caused by any one factor, but are multifaceted in nature. Factors include calculation error, overdosing/underdosing of drug dosages, covert drug administration in food and drink, and an increasingly relaxed attitude among professional nurses with regard to ensuring that drugs are administered to the standard required by law. This article considers the notion that nurses may breach the legal ‘duty of care’ they owe patients by being complacent in their drug administration practice. Consideration of a systems' approach to minimize drug error through proactive action planning, risk identification, and implementation of an anonymous incident-reporting framework is briefly explored.
Medicinal products and self-administration of medicines
Authors: Dimond Bridgit
Published: May 2014

Doris was admitted to hospital for an appendectomy. She came in with a variety of liquids and pills for several different conditions including heart problems, arthritis, indigestion, glaucoma, back pain and several others. The admitting nurse said that all the medicines would have to be taken away from Doris during her stay in hospital but that she could obtain replacement medicines from the hospital pharmacy and these would be prescribed by the doctor. Doris protested since she thought this was a total waste of money and they were her medicines and should not be removed from her. She also stated that she was perfectly capable of giving herself the medicines, since she did that at home and could save the nurses' time. What is the law?
The complexities of perioperative blood transfusion in Ireland
Authors: Ayres Una
Published: May 2014

Issues surrounding blood and blood products are important considerations of patient care in Irish society. Consequently, political, socioeconomic, cultural and ethicolegal issues, together with technological and pharmacological advances in new transfusion therapies, are important considerations while caring for clients across all areas of health care. Patient autonomy is proliferating and perioperative nurses have a duty of care to patients to provide information regarding impending surgery and available alternative treatments. This article will focus on issues surrounding blood and blood products in relation to perioperative nursing practice.
Patient assessment: a key requirement of nursing care
Authors: Castledine George
Published: May 2014

Have nurses really developed their patient assessment skills to a high enough level? The nursing process approach to care has been with us for a long time, and yet there still seems to be a general lack of competency in this vital area of patient care.
Managing faecal incontinence or leakage: the Peristeen Anal Plug
Authors: Doherty Willie
Published: May 2014

Incontinence can be a devastating problem to many individuals. It is embarrassing and limiting socially, and prevents those with the problem from going about their day-to-day activities. People adopt coping strategies to manage the problem and those with urinary incontinence often look for containment products such as disposable pads or nappy-style products. These products have been developed using different absorbent materials and are accessible to sufferers in local supermarkets. Absorbency of the products has improved so that once wetted, they hold urine more easily. However, the same cannot be said for faecal incontinence management products and there are few that can be called upon to manage this devastating condition. The Peristeen Anal Plug, developed originally as the Conveen Anal Plug, stands alone in the search for a device to manage faecal incontinence or leakage.
Staff nurse who had an alcohol problem and made nursing errors
Authors: Castledine George
Published: May 2014

Nurse Black had worked as a staff nurse on a small ward devoted to the care of elderly mentally ill (EMI) patients for nearly 10 years when it was decided to close the ward and amalgamate it with a new one. It was felt appropriate by Nurse Black's clinical managers to place her on a more acute assessment ward so that her skills and knowledge would be updated and improved.
Review of recommendations for reforms to the coroner's office
Authors: Dimond Bridgit
Published: May 2014

The Inquiry that was set up following the conviction of Dr Shipman for the murder of 15 of his patients produced three reports, the third of which considered the present system for death and cremation certification and the investigation of deaths by coroners (Shipman Inquiry, 2003b). The report makes extensive recommendations for reform of the coroner's office regarding the certification of death. This article outlines the recommendations made by the third report of the Shipman Inquiry and reviews the potential implications of such legislation.
The proposed assisted dying Bill negates end-of-life care
Authors: Robinson Vicky
Published: May 2014

A House of Lords Select Committee is considering a private members' Bill introduced by Lord Joffe. If passed the Assisted Dying for the Terminally Ill Bill will ‘enable a competent adult who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his own considered and persistent request’. The National Group of Nurse Consultants in Palliative Care has considered the matter at length and is unanimous in rejecting the benefits that are claimed for assisted dying.
Managing and improving care of chronic disease in the NHS
Authors: Lewis Richard
Published: May 2014

The King's Fund has undertaken research into the delivery by managed care organizations (MCOs) of chronic disease management in the US, with the intention of identifying factors associated with effective care for chronic conditions in the UK (Dixon et al, 2004). In the US, MCOs secure comprehensive health care for their enrolled population in return for a fixed annual fee and bear some similarities to primary care trusts (PCTs).
Staff nurse who wore her uniform off duty to steal from hospital
Authors: Castledine George
Published: May 2014

Nurses are often criticized for wearing their uniform when they are off duty. This particularly occurs when either they are going to or returning from work. There is, of course, the danger of infection control and many hospitals and clinics are now trying to provide better changing and shower facilities for staff.
Accountability and medicinal products 2: civil law
Authors: Dimond Bridgit
Published: May 2014

Lyndsey Bohanna, 23 years, had mild depression and was prescribed Prozac by doctors to combat insomnia and fatigue. Two months later during a routine check-up a junior doctor changed her prescription. He gave her an antidepressant, dothiepin, which is for severe depression and should not be used with Prozac. It is also an antidepressant with one of the highest chances of overdose. Nine days later she was found dead. An independent review found a host of errors during her treatment at the hospital. The junior doctor had not asked the consultant for advice and had not explained to the patient the risks associated with her new medication. He also failed to inform her GP of how many tablets should be given. What is the law?.
Management of a dehisced abdominal wound with VAC therapy
Authors: Penn Elaine , Rayment Sue
Published: May 2014

The management of large cavity wounds has always posed particular challenges for nurses and clinicians. The National Institute for Clinical Excellence (NICE, 2001) suggests that the number of difficult-to-heal surgical wounds may increase in the future and that increased knowledge and expertise should be available across primary and secondary care. Recent research into wound healing has tended to focus on the biology of wound healing and manipulation of the healing processes with new dressings technology and other clinical and cost-effective treatments. Vacuum-assisted closure (VAC) is an innovation that is being given increasing attention. In Northampton, one patient nursed in the community setting has recently benefited from the technology to accelerate healing of a deep abdominal cavity. This article considers the historical management of cavity wounds and presents a case study. The feelings of the patient and the experiences of the district nurses in overcoming management problems are discussed. The case has proved to be the catalyst for a collaborative initiative across primary and secondary care services to ensure that all patients requiring the treatment are able to receive it in the community setting as well as in the hospital, when they are ready for discharge. It is recognized in Northampton that there are several applications for VAC in wound management and that the treatment has many benefits for patients and for those managing finite NHS resources.
Nurse who failed to acknowledge the limitations of her practice
Authors: Castledine George
Published: May 2014

Nurse A came to the UK to develop her career and help with the acute nursing shortage. She had worked in several UK nursing homes and had completed a course to fulfil the requirements for registration with the Nursing and Midwifery Council (NMC).
Problems of obesity: it is time for nurses to act
Authors: Castledine George
Published: May 2014

The trouble with obesity is that it creeps up on you, especially when you are not thinking about it. When I first visited North America in the mid-1980s, I was astonished by the size of everything: not only were buildings and cars big, but also the size of food portions and the problems of over-eating were causing serious health concerns. Now, several decades later, Britain is in a similar situation with the Government declaring war on obesity with proposals for a fat tax on junk food.
Preserving and enhancing standards of care in the NHS
Authors: Glasper Edward Alan
Published: May 2014

The report of the Bristol Royal Infirmary Inquiry revealed that the UK health service was badly in need of reform (Department of Health (DoH), 2001). It stressed that the patient's perspective ‘must be included in the policies, planning and delivery of services at every level’. This inquiry was one of the initiators of the Government's determination to introduce clinical governance through which all elements of the NHS are now mandated to be accountable for the continuous monitoring and improvement of their services.
Safety of learning disability patients must be improved
Authors: Tingle John
Published: May 2014

A recent National Patient Safety Agency (NPSA) report has looked at the specific patient safety risks for people with learning disabilities using healthcare services (NPSA, 2004). It should be read by all nurses as they are likely to meet patients with learning disabilities in their daily practice. The report will also help nurses more easily identify serious potential patient safety risks to patients with learning disabilities.
Management options for patients with intermittent claudication
Authors: Dorgan Sharon
Published: May 2014

Peripheral arterial disease is a chronic condition, affecting a significant proportion of the adult population. Intermittent claudication is the earliest clinical manifestation of peripheral arterial disease and the patient's walking distance can be significantly reduced. This restriction can profoundly disrupt activities of living. Treatment options vary according to the level of the disease and comorbidity of the patient. Current evidence to support risk factor assessment highlights the role of the nurse in encouraging lifestyle modification.
The patient choice initiative does affect nursing
Authors: Close Ann
Published: May 2014

The Government first announced its policy on increasing choice for patients in 2002 (Secretary of State for Health, 2002). However, it is only in the last year that patients have been given the opportunity to choose when and where they have their operation if they are expected to wait more than 6 months for a cataract operation or for cardiac surgery. During the next 2 years choice will extend to all elective cases.
Community care manager who stole money from her clients
Authors: Castledine George
Published: May 2014

Marion was a registered nurse for patients with learning disabilities. She had worked in many residential settings for people with learning disabilities and was sent on secondment to her local social services to take up a post as a care manager for a group of vulnerable clients in the community. Her experience of community care was very limited but she was given the chance of the role because of her excellent employment record and her enthusiasm for the care of this type of client.
Abbreviations: the need for legibility and accuracy in documentation
Authors: Dimond Bridgit
Published: May 2014

This article explores the use of abbreviations in health care. It considers the current advice of the Nursing and Midwifery Council against the use of any abbreviations and suggests, in the interests of using time effectively, that it would be wise for directorates within trusts to create a list of approved abbreviations and symbols so that the dangers of misunderstandings are removed. It also considers how the problem of illegibility should be dealt with as a clinical governance issue.
Preserving nursing's identity in interdisciplinary working
Authors: Castledine George
Published: May 2014

There is increasing pressure these days, whether it be in health, social care practice, education or research, to move towards interprofessional working. The perceived advantages, some supported by research, claim that patients and clients benefit from improved services and quicker referral response times. In the past it has been felt that the NHS in particular had become fragmented and divided into separate individual professional groups. Such groups have kept very much to their own specialties and have set up boundaries, which have led to too much independent care and treatment, rather than integrated working and interprofessional cooperation.
How abusive is too abusive? A senior clinical nurse goes before the NMC
Authors: Castledine George
Published: May 2014

It is not really known why some nurses become desensitised to patients' quirks, while other nurses react badly. In the following case, Kevin reacted inappropriately to some of his patients' behavioural problems.
Access to records by persons other than the patient
Authors: Dimond Bridgit
Published: May 2014

This article explores what rights persons, other than the patient, have to access health records which come under Data Protection Act and other statutory provisions. These other persons could include the relatives of a patient, the parents of a child or those concerned with the estate of a deceased person. In addition, there are other rights of disclosure recognized by the common law and these will be considered in a later article.
A helpline for patients with chronic dermatological conditions
Authors: Joseph Diane , Day Jane
Published: May 2014

A telephone line was set up for patients with chronic dermatological diseases in response to patients' concerns about having a point of contact for advice and for more appropriate and timely access to care when they needed to be seen. The aims were firstly to improve the quality of care and empower patients by providing advice and support with a safety net for those discharged from the authors' service. The second aim was to increase efficiency by reducing unnecessary return appointments. An audit was undertaken to evaluate the telephone service.This showed that patients were reassured that they could access the service according to their needs. There was a high level of satisfaction with the initiative and the advice received. The data also showed that there was a significant improvement in the ratio of new outpatient slots to return appointment slots and waiting times for a first appointment.
Keeping nurses satisfied could be the key to keeping nurses
Authors: Castledine George
Published: May 2014

Surprisingly, very little is definitively known about what leads to nurse satisfaction. This is perhaps rather strange considering that the most effective personnel strategy a healthcare organization, such as an NHS Trust, can take is to find ways of retaining the staff it already has.
A staff nurse's perspective of infection control problems
Authors: Grainger Michelle
Published: May 2014

Earlier this month astonishing figures causing major concern were released from the Department of Health (DoH) showing the number of cases of Clostridium difficile in the over 65s in hospitals in England. This article focuses upon what is already known about infection control and concludes that a greater collaborative approach to infection control is needed, with a prudent use of broad spectrum antibiotics and a greater use of precautionary isolation measures based on patient symptoms, if infection rates are to fall.
Recognizing care and compassion in nursing
Authors: Castledine George
Published: May 2014

Reflecting on the values of foreign travel, especially when you can make comparisons between nursing in this country and other countries, is an enlightening and salutary experience. Recently Jean Clarke (senior nursing lecturer) from Dublin and I were sharing our experiences of nursing in third world countries when she suddenly said, ‘the trouble with “care” is that you only recognize it when it is not present.’
Lean but not mean: economics of the NHS
Authors: Newbold David
Published: May 2014

This summer the healthcare system and the way it is paid for has been under intense media scrutiny. One theme that is hard to ignore, in both the nursing and general media, is the claim that there is a general financial crisis in the NHS. A variety of sources, e.g. Smith and Farmer (2005), make for stark reading because they report a number of possible consequences of this ‘crisis’.
Preimplantation genetic diagnosis to prevent genetic disorders in children
Authors: Lashwood Alison
Published: May 2014

Preimplantation genetic diagnosis (PGD) is an alternative reproductive option for couples at risk of having a child affected with a genetic disorder. Although prenatal diagnosis (PND) has been available for many years, it is not acceptable to many owing to issues relating to termination of pregnancy. PGD involves assisted-reproductive technology, even though most couples undertaking it are fertile. However, if the treatment is successful, the couple will not have to consider PND. PGD is only available at a small number of centres and for a limited number of genetic conditions. It is a complex and time-consuming procedure. The success rate is around 20%; consequently, there is a relatively low chance of success and this requires careful consideration by couples who generally can become spontaneously pregnant. However, PGD is now more widely understood and available to all at the point of referral. This article sets out to explain the PGD procedure, its implications, limitations, and regulation in the UK and to discuss associated dilemmas.
Exploring the conditions leading to stoma-forming surgery
Authors: Burch Jennie
Published: May 2014

The most common disease leading to the formation of a stoma is cancer. However, there are many other diseases that affect the gastrointestinal or urinary system that may also require either a temporary or permanent stoma to be formed (a colostomy, ileostomy or urostomy). Stoma-forming surgery may be undertaken for a number of reasons, such as to eradicate a disease or improve the patient's quality of life. Cancer, inflammatory bowel disease and diverticular disease are the most common conditions that lead to stoma formation. However, faecal incontinence, familial adenomatous polyposis, Hirschsprung's disease, spina bifida and Ehlers-Danlos syndrome may also require a stoma to be formed. The nurse's role in caring for these patients at a potentially traumatic period of their life is discussed.
Removal, retention and storage of organs and tissue in the UK
Authors: Dimond Bridgit
Published: May 2014

Diane's daughter, aged 6 months, died in hospital following heart surgery. It had been explained to Diane that there was only a tiny chance of the operation succeeding. She opted for burial of the baby. She subsequently discovered that the heart had been removed without her consent and her child had been buried without her heart. She is very upset and is considering suing the trust for compensation. Is she likely to succeed?.
Better communication with older people is needed
Authors: Castledine George
Published: May 2014

It has been said that ‘working with the elderly is like going to a swap meet — you swap your conversations, you swap your personalities and you share your time. Failing to do this will be failure for both. They won’t benefit and neither will you' (Tedrow, 1977).
An audit of nurses' views on DNR decisions in 1989 and 2003
Authors: McAdam Catherine , Barton Anna , Bull Patricia , Rai Gurcharan
Published: May 2014

Guidelines on making do not resuscitate (DNR) decisions have changed in recent years in keeping with changing attitudes and legislation. Decisions should now be discussed with all competent patients, and nursing staff should be involved in the process. The views of nursing staff in 1989 and 2003 were compared, focusing on what factors they thought were important in coming to a DNR decision and any implications it had for other treatment. A patient's wishes, their previous quality of life and the chances of successful resuscitation were rated highly in both studies. Advanced age was rated as important less often in 2003 but was still thought to be an important factor by 61% respondents. In 2003 nurses were significantly more likely to state that active treatment, such as admission to an intensive care unit or surgical intervention, could be appropriate for patients with DNR orders. However, the number of respondents who considered intravenous fluids (18%) or antibiotics (26%) inappropriate for patients not for resuscitation was concerning.
Modern Matrons: can they be easily identified by hospital patients?
Authors: Bufton Sally
Published: May 2014

The Modern Matron was introduced into hospital Trusts in April 2002 to improve the basics of patient care. They were to be easily identifiable, highly visible and authoritative figures. This article reports on a quantitative study done to ascertain if patients can identify the Modern Matron in one acute NHS Trust. A researcher-developed questionnaire was sent to 20 Modern Matrons and a different questionnaire was distributed to 72 randomly selected patients. The results demonstrated that only 5% of patients surveyed were able to correctly identify the Modern Matron by their uniform. This may be explained by the response from the Modern Matrons when asked how much time was spent with patients; 67% of their normal working day was taken up with management of staff, paperwork and meetings, leaving very little direct patient time.
Exploring the law regarding the making and execution of wills
Authors: Dimond Bridgit
Published: May 2014

Bill Murphy was involved in a head-on collision when driving his motorbike on a motorway at 3.00am. He was brought into accident and emergency (A&E) barely conscious with serious internal injuries and coughing up blood. He knew that he was extremely ill and could die. He had not made a will, and was anxious to record his wishes. He asked the nursing staff if they would write down for him his wishes and sign it on his behalf with witnesses. The A&E staff knew that they should not get involved in writing or witnessing a will but doubted if they could get a solicitor or manager to the A&E in time before Bill died. As Bill was so agitated, they wrote down on a piece of paper what Bill had said. Two staff then signed the will and another signed it on behalf of Bill who was too weak to sign it. Later that night Bill died. A few weeks later the A&E department was notified that Bill's sister was disputing the will which left everything to his two brothers and nothing to her. She said that the formalities were not complied with and that it was not a proper will. What is the law?
Promoting quality sleep in older people: the nursing care role
Authors: Béphage Gaëtan
Published: May 2014

Sleep is a basic activity of living. Its restorative properties in healthcare settings — both hospital and community — should be considered by healthcare workers. Its significance in gerontological nursing should not be underestimated. As older people are prone to multiple pathology, disease processes may mask their need for effective sleep and rest. ‘Sleep architecture’ is a term that applies to the mechanics of sleep or its stages and clinicians may fail to identify when this is disrupted. ‘Sleep hygiene’ refers to measures or interventions used to promote sleep and a person-centred approach is necessary, with support from specialist agencies to achieve effective sleep hygiene. The need for long periods of sleep may diminish owing to ageing. However, the quality of the sleep experiences, i.e. feeling rested and refreshed, should be the same. Several factors have been identified in the causation of insomnia. In healthcare settings, environmental factors such as noise and light pollution are the commonest features. Other issues that may be present in both healthcare and community settings are related to varied perspectives, such as physiological, psychological and spiritual–religious. Providing a climate conducive to healthy sleep in all settings becomes a requisite in the planning of care.
Nurses should use politics to bring about change
Authors: Castledine George
Published: May 2014

I was never really interested in politics when I was younger because I felt, as a nurse, I should be neutral. Over the years, however, I have become more aware of my responsibilities to vote and listen to what politicians have to say. In the past, election campaigns seemed to be more exciting, with bigger differences between the parties involved. Nowadays there are more similarities than differences and the outcome of the result does not seriously appear in doubt. Tony Blair will more than likely continue to be Prime Minister and the Government will carry on with its target-driven policies.
Case study: diagnosis and treatment of pyoderma gangrenosum
Authors: Burton Julie
Published: May 2014

Pyoderma gangrenosum, is an ulcerative, inflammatory disorder often associated in the field of stoma care with inflammatory bowel disease (IBD) (Lyon and Smith, 2001). Pyoderma gangrenosum is distinctive in that it normally has a purple rolled edge and is extremely painful. The pathogenesis is unknown but immunologic aberrations of neutrophil granulocytes seem to be important (Petering et al, 2001). This paper demonstrates the rapid development and effective multi-disciplinary team management of an extensive case of Pyoderma gangrenosum. It also explores the possible causes of this particular manifestation.
Nurse whose attitude towards drug administration put patients at risk
Authors: Castledine George
Published: May 2014

One of the key roles of a nurse is to administer medicines accurately and safely to patients. There are many components to this process, one being the storage of patients’ drugs in a medicine trolley, which is still used in many hospital wards today.
The art and science of drug administration
Authors: Castledine George
Published: May 2014

One of the key issues in nursing last year was nurse prescribing. It caused an uproar in some areas of the medical profession, especially when the Government announced that it was going to extend the nurse's power. While patients don't seem to have reacted in the same way as the doctors, probably because they don't care who signs, as long as they get their prescription, the medical profession has branded the proposals ‘irresponsible and dangerous’. Nurses have also been accused of being soft touches to the pharmaceutical industry's marketing ploys and will end up being courted and persuaded to use the wrong products (Copperfield, 2005).
Evaluation of infection control practices during an AE
Authors: Lamb Di
Published: May 2014

The broadening global commitment of UK military personnel since the end of the Cold War has brought them into contact with a plethora of tropical diseases, some of which require isolation and air transfer to a UK medical facility. This presents a number of challenges to the safe repatriation of patients and attending medical and flight crews. During a recent repatriation of a patient with suspected Lassa fever from West Africa, the team's practices were evaluated and recommendations were made for improvements to future transfers by the deployable air isolator team. Valuable lessons were learned by the team, most notably the need to practice safe isolation procedures in a real working environment. In addition, the team should work on exercises together, thus aiding cohesion prior to deployment.
Failing to take appropriate action when informed of patient's condition
Authors: Castledine George
Published: May 2014

The importance of registered nurses taking into account what their junior members of staff are saying to them is well illustrated in the following case. The Don Hospital is an acute hospital with a continuing care ward accommodating 20 elderly patients suffering mainly with advanced dementia. Most, if not all, of the patients were entirely dependent on nursing staff for their physical needs.
Mary Powell: 2006 lifetime achievement award winner
Authors: Castledine George
Published: May 2014

One of the most important things which the BJN does every year through its clinical nursing awards is honour and remember those nurses who have achieved a significant amount in their nursing career. There are more nursing heroes or heroines than just Nightingale and Seacole, and this year's winner proved, yet again, that nursing has an illustrious and proud history. It is also something we should never forget and away from all the political shenanigans affecting the nurses’ role recently, it is a relief to meet a nurse who was a specialist in her field and also cares still about nursing.
Hospital attitudes
Authors: Grainger Michelle , Ness Caro
Published: May 2014

I recently visited a friend in hospital and at my friend's request, I was talking to the ward manager at the nursing station, as she had asked me to try to find out the treatment plan the doctors intended to carry out. Two staff nurses were sitting behind the nurse's station reading a magazine and drinking a cup of something. While we were talking, one of the side room doors opened and a female patient walked out and went over to a large trolley filled up with the ward linen. She began to take out items of linen, putting some items back until she found the items she wanted. On walking back to her room her underwear fell down to her ankles. I alerted the ward manager to the situation and she replied to me ‘Oh that's Mrs X, she always does this, she's a wanderer.’
Adam: a case study of a young person's journey through madness
Authors: Singleton Laura
Published: May 2014

This case study of a 15-year-old boy diagnosed with bipolar affective disorder considers some of the biological, psychological, social and familial factors that precipitated and perpetuated his mental health problems. His mental health difficulties are considered using anti-psychiatry theories to take into account that his family's construction of ‘normal’ would be considered pathological by others. The impact of labelling a person as a ‘difficult’ client is examined and staff's attitudes (and subsequent behaviour) towards such service users are considered. Despite his immersion in a world of ‘madness’ this young person managed to use the therapeutic interventions that were offered to him in an adolescent unit and he emerged from his mania remarkably intact. The impact of parental mental illness on children and young people is discussed in this case study and some recommendations are made for future practice.
Generalist and specialist nurses: caring for a patient with a stoma
Authors: Dimond Bridgit
Published: May 2014

This article looks at the legal liability of a specialist nurse in relation to the general nurse who has invited her advice on the care of the patient. It considers the law relating to negligent advice and the concept of vicarious liability. It also looks at the dangers which could result from the specialist nurse taking over basic care of the patient as general nurses become deskilled.