bluuebunny/crossref_metadata_2025 huggingface dataset:
Assisted conception: recognizing the correct parents
Authors: Griffith Richard
Published: May 2014

The Human Fertilisation and Embryology Act 1990 created a system for the regulation of fertility treatment and assisted conception techniques. The process is overseen by the Human Fertilisation and Embryology Authority (HFEA) whose functions are license treatment, research and storage of gametes and embryos and to ensure compliance with the requirements of the 1990 Act.
Balancing risk and choice in childbirth after caesarean section
Authors: Baxter Liz , Davies Sarah
Published: May 2014

Despite a consensus that rates of caesarean section are too high and should be reduced, the rate of vaginal birth after caesarean (VBAC) appears to be declining. This article explores the possible reasons for this, as well as examining the factors that may influence a woman's decision about future mode and place of birth following a previous caesarean section. There is a need for research exploring women's reasons for choosing VBAC or elective repeat caesarean section and the way in which risk is communicated.
The Albany Midwifery Group: perverse findings from a flagship model
Authors: Walsh Denis
Published: May 2014

The repercussions of the Albany Midwifery Practice Group losing their contract with King's are being felt not just across the UK but internationally. Their profile could not be higher in international midwifery circles with regular presentations at international conferences, in journals and in books. Their chapter in last year's Birth Models that Work (Davis-Floyd et al, 2009) seems a cruel irony now. It begs the question, who does it work for? Certainly for women, midwives and policy makers who have championed the model in the King's Fund publication, poignantly entitled, Safe Birth: Everybody's Business (King's Fund, 2008). It works for everybody it appears so how could King's Healthcare take such a drastic step to terminate their contract?
Breastfeeding and depression: empowering the new mother
Authors: Zauderer Cheryl , Galea Ethel
Published: May 2014

For many new mothers who suffer from postpartum depression, breastfeeding is a lifeline to their newborn baby. It may be the only validation of mothering they experience during this time. Mothers who continue to breastfeed while receiving treatment for postpartum depression have reported that breastfeeding was the only act that they felt identified them as the newborn's mother. There are many obstacles to the continuation of breastfeeding while a new mother experiences depression, such as medication management, sleep deprivation, and apathy and depressed mood. This article will attempt to provide information on clinical practice to provide support and encourage these women to continue to breastfeed while they receive treatment.
Power of birth: uncontrollable urges and the transition to motherhood
Authors: Kightley Robb
Published: May 2014

As part of a final-year show for the BSc(Hons) Fine Art at Oxford Brookes University, a series of paintings attracted a lot of attention, particularly on the part of the author who is a registered midwife and midwife teacher.

The intentions behind the creation of the canvasses were explored in an interview with the artist and were analysed in light of birth practices in the developed world and feminist theories.

The main themes identified were: the nature and experience of labour in the developed world with its potential to position labouring women as risks to themselves; the fetus and neonate; and the economics of the health-care organization. In societies where birth is removed from the home, expectations are constructed from representations, few of which depict women as powerful and capable of birthing. The animal–human hybrids of the canvasses highlighted anachronistic discourse of the hierarchy of man, woman, animal, while also reframing the essential act of reproduction as potent and powerful.
Rising rates of intervention in childbirth
Authors: McAra-Couper Judith , Jones Marion , Smythe Elizabeth
Published: May 2014

This article presents the findings of research which investigated what is shaping the understanding of the public and also the practice of health professionals in relation to rising rates of intervention in childbirth. This research was carried out in response to the increasing rates of intervention in childbirth in Aotearoa, New Zealand using critical hermeneutics methodology. The particular approach used was critical interpretation as formulated by Hans Kogler. The findings revealed that the everyday world and its associated processes of socialization in the 21st century—in particular pain, choice, and technology—shapes the practice of health professionals and the understanding of the public in relation to increasing intervention. These findings are supported by the revelation that many of the social and cultural values that underpin Western society in the 21st century, such as convenience, ease, and control, correlate with intervention being increasingly sought after and used. This milieu of intervention, which increasingly surrounds childbirth, calls into question those things that have traditionally been at the heart of childbirth: the ability of the woman to birth and the clinical skills of the health professional. The research presented in this article provides insight into those things that are creating a milieu in which intervention is increasingly normalized.
Persuasion with pictures: piloting a breastfeeding image aimed at children
Authors: Ireland Jillian , van Teijlingen Edwin
Published: May 2014

Ideas about infant feeding are formed earlier than previously assumed. School-aged children have thoughts on how they might feed their future babies. Based on inoculation theory, an image, was designed and pilot-tested which would promote breastfeeding to children as a ‘natural’ behaviour at an age when other influences have not pervaded their consciousness.

Delegates to a breastfeeding conference were invited to view the image; asked for positive and negative feelings about it; and to rate their overall feelings. Demographic data were gathered. Written comments were analysed thematically.

More negative than positive comments were made. Those giving more extreme ratings on the quantitative questions also made more extreme comments in the open-ended sections. Most negatives were about the art work itself rather than the health promotion message.

Using art work in health promotion has specific strengths and weaknesses which include, for example, that art stimulates reactions. These reactions are themselves influenced by personal tastes, culture and the emotions it may or may not evoke. More generally, pilot studies using a mixed-methods approach can help improve the design of breastfeeding images and, consequently, that of health promotion interventions.
Keeping practice up-to-date: review of midwives rules consultation
Authors: Lyne Michelle , Forrester Mandy , Homeyard Claire
Published: May 2014

The current Midwives rules and standards were published in 2004 and the Nursing and Midwifery Council (NMC) are currently reviewing them to ensure they are still robust and relevant.

At the NMC, we have a responsibility to ensure all rules, standards and guidance affecting nurses and midwives are as effective and up-to-date as possible.

Consultations are an essential part of our decision-making process; the NMC will consider all views and factors before making its decisions. By listening to stakeholders, the NMC can fulfil its duty of care to the public by improving professional standards and practice in nursing and midwifery.

The consultation, which is only considering the midwives rules, will continue until the end of July and anyone who wishes to take part can do so on the website: www.nmc-uk.org. ] The standards will be updated in 2011.
Effect of age on maternal and fetal outcomes
Authors: Kenyon Anna P
Published: May 2014

A woman's decision regarding the ‘right time’ to embark upon a pregnancy may vary with personal, family, cultural and religious beliefs. However once a woman over 35 years of age has made a decision to proceed with a pregnancy she faces an increased risk of adverse pregnancy outcome, particularly in those with co-morbidities, multiple pregnancies and/or those conceived through ovum donation. These women need support and carefully planned obstetric care. Women seeking assisted reproductive technologies at over 35 years of age should be offered pre-pregnancy counselling and be advised of the benefit of single embryo transfer. Society as a whole, midwives, obstetricians and gynaecologists, should advocate for policies that enable women to reproduce safely without personal cost to their education, careers, identity and their own or their offspring's health.
Getting that important first job
Authors: Lee Karen , Whitmore Jane
Published: May 2014

This is the first in a series of articles focusing on getting that important first job as a midwife. This article looks at the basics of constructing a curriculum vitae (CV), completing an application form and gives some top tips to help yours stand out from the rest.
Understanding negligence as a crime in midwifery
Authors: Griffith Richard
Published: May 2014

Negligence is generally associated with the civil law. It is the law's way of imposing a standard of care on professionals such as midwives and it provides redress by way of compensation for those harmed by another's careless act or omission. In the NHS, claims for compensation as a result of negligence have been increasing steadily. NHS negligence claims have a potential value of some £5 billion. In 2008/09 the NHS Litigation Authority (NHSLA) received 6080 claims of clinical negligence and 3743 claims of non-clinical negligence against NHS bodies. About £769 million was paid out in connection with clinical negligence claims including £226 million paid out for obstetric and maternity claims (NHSLA, 2009).
Problems and practicalities in student caseload holding
Authors: Fry Jane , Rawnson Stella , Lewis Professor Paul
Published: May 2014

Nursing and Midwifery Council (NMC) standards require higher educational institutions (HEI) to introduce opportunities in which student midwives are involved in the care of a small group of women throughout their childbearing experience, enabling them to gain experience of continuity of care and carer through caseload holding ( NMC, 2009a:16 ). Bournemouth University (BU) first introduced student caseloading in 1996, and the experience has enabled us to evaluate, refine and develop this approach to learning. In this article, the problems and practicalities encountered over the years while supporting students and mentors through the everyday delivery of caseload holding will be considered. Using a case study approach, this article focuses on situational experiences in the antenatal, intrapartum and postnatal periods. The lessons learnt and resultant consequence for the development and delivery of caseload holding at BU have been important in refining our approach. It is through such reflections that we hope to assist other HEIs and midwives in practice to develop and deliver similar approaches to learning.
A bereavement and communication study day for midwives
Authors: Baxter Jackie , Baron Maurina
Published: May 2014

Following the loss of a baby, women and their families have particular needs. As midwives are the main professional group present at this time, they need to support women through the process. However, it may be relatively rare for midwives to encounter bereavement, and so it is important to ensure that competency is maintained in this area. This has been demonstrated by an increasing demand for additional training from midwives, which led to a bereavement and communication study day within the University College London Hospitals NHS Foundation Trust. The study day explored midwives' and women's personal experiences and considered the implications for practice.
Action learning as a tool to prepare supervisors of midwives
Authors: Abbott Laura
Published: May 2014

Supervision of midwives is a statutory responsibility which provides a mechanism to support and guide practising midwives. The preparation course to become a supervisor of midwives (SoM) at the University of Hertfordshire requires a midwife to be nominated by her peers and to undertake a course at Masters level over two semesters. A learning strategy on the preparation course is ‘action learning’ (AL), whereby groups of six or seven student supervisors compulsorily attend six action learning sessions. AL requires skills of analysis, scrutiny and reflexivity. An exploration of AL as a teaching strategy on the SoM preparation course led to the conclusion that this is an appropriate and high-quality teaching method which develops the reflective skills of the participants as well as developing self awareness and communication skills to a high standard.
Making a success of self-directed study: Tackling the dissertation
Authors: Lee Karen P. Werle
Published: May 2014

As students progress through the midwifery programme, more and more study will be self-directed or independent—none more so than the dissertation which is likely to be the largest assessment, worked on over a number of months. Keeping on track can be difficult and a number of students leave this until the last minute due to poor planning or working on other pieces of work. The aim of this article is to give students hints and tips for keeping on track when working with minimal supervision.
A review of supervisory investigations and supervised practice programmes
Authors: Porteous Carol
Published: May 2014

The 1902 Midwives Act introduced the role of supervisor of midwives (SoM) as a means of regulating the profession by ensuring that they were educated appropriately. While the Act has been updated with the Nurses and Midwives and Health Visitors Act 1997, the role has remained the same. The role aims to protect mothers and babies by actively promoting a safe standard in practice, identifying poor practice and implementing remedial action when required. Furthermore, the statutory supervision of midwives is independent of employment and employers, to ensure that midwives registered and working within the UK are entitled to practise as a midwife and competent to remain on the midwives' part of the Nursing and Midwifery Council (NMC) register. The purpose of this article is to guide midwives through the process that supervision must follow to ensure equity and transparency in the investigatory process; the purpose being to determine if the midwife is in breach of the standards for practice set by the NMC. This article will be of interest to all practising midwives, including midwifery managers, who have to resource supervised practice programmes as well as providing an update for SOMs. It will explain why, when undertaken appropriately, supervised practice programmes can provide a positive learning opportunity for a midwife who finds herself on supervised practice.
Decision-making, intuition, and the midwife: Understanding heuristics
Authors: Muoni Tambu
Published: May 2014

To most midwives the terms labour ward and delivery suite may be associated with high stress levels, staff shortages, acute emergencies, life and death situations, high patient turnover, long shifts and lack of breaks. Regardless of the working conditions, midwives are still expected to make quick and accurate decisions regarding patient management. Today's midwives, like all other clinicians, are under a lot of pressure and are expected to work effectively in high-stress and fast-paced environments. Midwives often have to make timely decisions regarding complex situations. Their decisions often reflect their knowledge base and level of competence. Understanding how midwives make decisions in clinical settings is very important, as patient outcomes very much rely on decisions made by clinicians. During an emergency when a midwife is hard pressed for time, or when a midwife has an overbooked clinic, does the midwife turn to heuristics, i.e. experience-based techniques for problem-solving, or does he/she rely on intuition to make decisions regarding patient care? This article will consider this issue—in that split second a midwife has to make a decision, where does she/he get the relevantinformation? And is the information reliable? This article proposes that heuristics form part of the decision-making process and will explore the benefits and dangers of intuitive judgments within the clinical setting.
Delivery method choice in the South African private sector
Authors: James Sindiwe , Wibbelink Margreet , Muthige Noluthando
Published: May 2014

The high caesarean rate in South Africa is five times higher than the World Health Organisation recommended rate. This is a matter of concern and urgently needs to be investigated. Therefore, this study aimed to find out why South Africans have such a high caesarean section delivery rate by exploring decisions made with regard to the choice of mode of birth.

This study found that in South Africa, the advice comes from the obstetrician not the midwife. The pregnant women in this study did not have antenatal health education related to the available different modes of delivery and were denied the opportunity to make an informed decision despite them having attended the antenatal care clinic, being well educated and able to understand concepts explained to them. It was found that the private doctors were still in the forefront of the patient pathway and that the midwife was often left to prepare the woman for the caesarean section even though they perhaps did not agree.
Statistics: take deep breaths and push when I tell you
Authors: Campbell Malcolm
Published: May 2014

In order to inform practice, midwives need to be familiar with statistics so that they can understand the messages given by quantitative research papers and reports. Before they can consider applying the conclusions of that research to their practice, midwives need to be aware of the strengths and limitations of both the design and analysis. This article provides an overview of some of the basic statistical concepts and explains that the choice of appropriate statistical methods for an analysis is largely driven by the type of data involved and the reason for that analysis. Assumptions underlying those methods are often only met approximately. In addition, it can be difficult to quantify potential shortcomings in research design, the selection and recruitment of participants, the administering of interventions and the collection of data. This means that interpretation of the quantitative findings can often be subject to a number of ifs and buts, so statistical conclusions are never absolute. Suggestions for further reading are given at the end of the article.
Evaluating the impact of befriending for pregnant asylum-seeking and refugee women
Authors: Mccarthy Rose , Haith-Cooper Melanie
Published: May 2014

Pregnant asylum-seeking and refugee women are a particularly vulnerable group in society, who may be possibly living alone in poverty in inappropriate accommodation ( Dunne, 2007 ) and experiencing hostile attitudes ( Hynes and sale, 2010 ). They may have poor physical and mental health, placing them at an increased risk of poor pregnancy outcomes ( National Institute for Health and Care Excellence (NICE), 2010 ). Despite this, they are less likely to attend for timely maternity care. This article discusses the evaluation to date of an ongoing befriending project located in Northern england, targeting pregnant asylum-seeking and refugee women and helping to address difficulties that they may face. Volunteer befrienders, who themselves are asylum-seeking and refugee mothers, receive training to provide support and guidance to clients. Preliminary data suggest that befriending has advantages for both client and volunteer: clients appear to develop a trusting relationship with their befriender which facilitates self-confidence and helps overcome social isolation; and the volunteers feel that they are undertaking a worthwhile role and often move onto paid employment. Befriending may be a useful resource for midwives and ultimately improve pregnancy outcomes for asylum-seeking and refugee women.
Research within the field of midwifery: the monster under the bed or just an old sock?
Authors: thomas Sara
Published: May 2014

Research is a vital component of midwifery education, whether utilising others’ findings or conducting one's own. However, opportunities to carry out new research can be rare and are often not taken up by staff at a ward level. Lack of understanding and fear of ‘stepping out of place’, as well as organisational barriers such as workload or lack of funding, are often cited as reasons for not carrying out research. Assimilating new research into the workplace is anecdotally very slow, and the need for stronger links between midwifery research and practice remains a fundamental piece of the equation that is currently missing. A new framework encompassing midwifery practice, research and education is vital to assist in a smoother transition between them.
Midwives' experiences of caring for women whose requests are not within clinical policies and guidelines
Authors: Thompson Angela
Published: May 2014

This generic qualitative study explores midwives' experiences of caring for women who make choices that fall out of the realms of accepted guidelines and policies. Semi-structured interviews were carried out with ten midwives working within an NHS trust in the south west of England. The interviews were transcribed verbatim and analysed using Thematic Analysis ( Braun and Clarke, 2006 ). Results showed that the women generally requested minimal intervention. Midwives found that they were often unable to utilise all their skills and make full clinical judgements, which made them feel vulnerable and anxious. Midwives tried to negotiate and gain the woman's trust in order to deliver the safest care possible, often adapting their care accordingly and trying to ensure that the women remained engaged with the service. There appeared to be conflict between the professional's and the woman's control and autonomy. The research findings recommend that experience be utilised in giving such care and supporting midwives, particularly junior midwives. A team-based approach to care is given and the experience of the delivery suite co-ordinator and supervisor of midwives is utilised.
‘Not in established labour’: Outcomes for women cared for in an Irish antenatal ward
Authors: Panda Sunita , Begley Cecily
Published: May 2014

An audit was conducted in the Coombe Women and Infants University Hospital, Dublin, Ireland in November 2012 with 47 women in early labour, through retrospective review of charts. All women were admitted to the antenatal ward at term gestation with labour-related symptoms. The aim was to ascertain the outcomes of labour and to describe the interventions performed by midwives. The most common reason for transfer of women to the labour ward was establishment of labour (72.34%) and, of these women, only a few (35.29%) needed augmentation of labour. Among the women transferred in active labour, 97.05% had vaginal births with an average duration of labour of 4.1 hours (with no augmentation) and 5.3 hours (with augmentation). All women transferred for augmentation of labour (27.66%) had vaginal births. Women admitted to the antenatal ward to await establishment of labour need quality midwifery care to make their birthing experience a positive and memorable one.
Malnutrition in hospital patients: where does it come from?
Authors: Edwards Sharon L
Published: May 2014

This article provides a comprehensive overview of malnutrition in hospital patients. It explores the issues surrounding nutrition and investigates factors that contribute to the malnutrition seen in patients within the community and to the malnutrition that develops while patients are in hospital. It proposes that although patients are at risk of malnutrition in the community, malnutrition can develop while the patient is in hospital, as the result of changes in diet, nutrition not being seen as a high priority, common hospital practices, and lack of knowledge of patients' previous nutritional state.
Nursing diagnosis in learning disabilities nursing
Authors: Chambers Simon
Published: May 2014

The concept of nursing diagnosis and the relevance of individual diagnostic terms from the North American Nursing Diagnosis Association (NANDA) (1992) Classification Taxonomy 1-Revised are discussed in the context of learning disabilities nursing. The NANDA system of nursing diagnoses was implemented at an adult training centre with a client group who had a severe or profound learning disability. The diagnostic terms used to describe the phenomena found in everyday practice are identified. Due to the inadequacy of the NANDA term impaired verbal communication, a new nursing diagnosis, impaired non-verbal communication, is suggested. A method of recording nursing practice is used which shows client outcomes through diagnostic modifiers (a modifier denotes a change in the nursing diagnosis) over measured time periods. The value of a generic classification of diagnoses is demonstrated in a systematic approach to learning disabilities nursing practice.
TenderWet: an innovation in moist wound healing
Authors: Cooper Pam
Published: May 2014

The use of moisture-retentive dressings (dressings that are capable of maintaining a warm moist environment) has been shown to provide the optimal environment for wound healing, accelerating the healing process and promoting tissue growth. TenderWet, produced by Paul Hartmann, is an innovative dressing that not only provides a moist warm environment but also incorporates the unique properties of Ringer's solution which actively cleanses (debrides) the wound.
The value of prayer in modern-day nursing
Authors: Castledine George
Published: May 2014

Of all the qualities a nurse should possess, perhaps the most important is compassion, particularly when nursing the critically ill and dying. It is not easy to define compassion. Sogyal Rinpoche (1992), a Tibetan monk, sums up what I personally feel is meant by compassion: ‘It is not simply a sense of sympathy or caring for the person suffering, not simply a warmth of heart toward the person before you, or a sharp clarity of recognition of their needs and pain, it is also a sustained and practical determination to do whatever is possible and necessary to help alleviate their suffering.’
Stroke 1: a paradigm case in nursing rehabilitation
Authors: Nolan Mike , Nolan Janet
Published: May 2014

This is the first of two articles which consider rehabilitation following a stroke. Although stroke is a major cause of morbidity and mortality in the UK there have been relatively few studies describing its long-term effects. Despite relatively good functional recovery, in many cases a number of stroke survivors still experience ‘long-term misery’. This article argues for an expanded range of outcomes in stroke rehabilitation and for greater attention to be paid to the psychological needs of stroke survivors and their carers. Areas of deficit in stroke rehabilitation are described, as is the currently poorly developed nursing role.
Nursing management of skin grafts and donor sites
Authors: Young Trudie , Fowler Ann
Published: May 2014

Skin grafting is one of the most commonly used techniques in plastic and reconstructive surgery. The patient undergoing split-thickness skin grafting may pose a variety of wound care problems for the nurse. The issues that may need to be addressed include: the reasons for grafting; type of graft used; preoperative and postoperative care of the recipient and donor sites; and the provision of general measures required to promote wound healing and successful graft take for the patient.
Confidentiality 2: disclosure of information in the public interest
Authors: Dimond Bridgit
Published: May 2014

The first article in this series considered the sources of the duty of confidentiality and noted that the nurse is bound to recognize the duty to protect all confidential information about the patient (Vol 8(9): 560-2). This duty, however, is subject to specific exceptions. This article discusses one of the most difficult exceptions: that of disclosure in the public interest.
Use of catheter maintenance solutions for long-term catheters
Authors: Rew Margaret
Published: May 2014

This article identifies the problems most commonly encountered in the care of patients with long-term indwelling urinary catheters. Using individualized regimens for catheter maintenance solutions (or ‘bladder washouts’ as they are commonly known) minimizes the risk of infection and catheter blockage, thus reducing the need to recatheterize more than is necessary. Ever since catheters have been used for long-term urinary drainage, problems such as blockage and leakage because of encrustation have caused discomfort to the patient. Another major problem associated with catheter use is the risk of developing a urinary tract infection. Research has shown that with careful management, such as urine testing using a pH indicator strip and use of appropriate solutions, complications can be minimized. Information for this article has been obtained via a literature review, interviews and visits with district and hospital nurses, as well as from personal experience.
Psychological methods of treating hallucinations and delusions: 1
Authors: Holland Mark , Baguley Ian , Davies Tom
Published: May 2014

This article, the first in a two-part series, describes how the neuro-biological, social and environmental factors involved in the course and treatment of schizophrenia have helped to establish a pathway to recovery or remission that does not embrace pharmacological therapy alone. Research into drug-resistant symptoms and poor adherence rates (Curson et al, 1985) demands effective alternatives and additions to more traditional approaches to treatment such as medication. The second part of the article describes how evidence-based psychological interventions were used to help a client suffering from treatment-resistant delusions, allied to a chaotic lifestyle and substance misuse, that had previously presented a substantial challenge to the mental health services.
Convicted psychopaths and special hospitals
Authors: Dimond Bridgit
Published: May 2014

The much awaited report from the inquiry chaired by Peter Fallon QC (1999) on Ashworth Hospital has at last been published and its conclusions are of no surprise. It found the allegation of pornography, inadequate security and a child being permitted unsupervised to associate on the ward with paedophiles all proved. It recommends the establishment of a regional network of forensic psychiatric services to prevent the isolation of the special hospitals, and that Ashworth itself should be closed. It also recommends that courts should not be able to make a hospital order for a personality disorder person. Prisons would therefore have the responsibility for such offenders. The establishment of small units for severely personality disordered individuals within high security prison or hospital systems should be developed.
Infection control 1: a practical guide to glove usage
Authors: Parker Lynn J
Published: May 2014

With increased demands from the general public for healthcare professionals to be accountable for their actions, many are becoming familiar with clinical governance and other initiatives to improve clinical practice. Good infection control is central to nursing practice. To achieve higher standards of clinical practice, especially when thinking about how to reduce the risk of cross-infection, it is necessary to not only do the right thing, but also do the thing right. Safe practice should be uppermost in the minds of healthcare professionals when caring for patients. This new series of articles attempts to look at the practical aspects of infection control, highlighting the requirements for risk assessment and applying the principles of infection control to a variety of patient care situations. This article investigates the use of protective clothing and gloves. It looks at the types of gloves available for use, the importance of choosing the correct glove for the task to be undertaken, and the modern day problems of allergies to latex.
The needs of older people with learning disabilities
Authors: Jenkins Robert
Published: May 2014

There has been a growing realization that the needs of older people with learning disabilities are not being met. There has been little attention paid in nursing literature to the needs of this client group. This article will explore the issues about older people with learning disabilities and highlight some of the important areas that learning disability nurses may need to address. It is evident that there needs to be more collaboration between a range of different services and professionals. Areas of good practice can be used in developing innovative and flexible services, which are client led. Learning disability nurses may need to update their skills and knowledge and develop a ‘critical practice’ approach to meet the many challenges that older people with learning disabilities may pose.
Enhancing the nursing role: why nurses want to cannulate
Authors: Workman Barbara
Published: May 2014

This small qualitative study explored nurses' reasons for undertaking a traditional medical task, that of peripheral intravenous cannulation, and their perceptions as to how this task contributes to their nursing skills. The findings suggest that it benefits the continuity and quality of patient care and provides nurses with personal and professional satisfaction, promoting the delivery of holistic care and the opportunity to initiate autonomous clinical interventions. It is argued that the development of such nursing skills may require professional and organizational support in the form of practice guidelines, protocols and vicarious liability boundaries to enable nurses to practise effectively and efficiently.
Developing a multidisciplinary complex wound care service
Authors: Donnelly Jeannie , Shaw Julia
Published: May 2014

This article will describe the development of a dedicated multidisciplinary complex/chronic wound care service. Using a recognized framework, the article will demonstrate how the needs of patients were first assessed and then addressed. The article will conclude that although more research is required, the results of this audit suggest that patients with long-standing complex/chronic wounds benefit from the care of a dedicated multidisciplinary wound care team. For the purpose of this article the term ‘complex’ is defined as any wound which is not progressing as expected despite the application of good quality, standard wound care.
Deliberate self-harm in children: the nurse's therapeutic style
Authors: Cooper Michael A , Glasper Edward A
Published: May 2014

This article examines child health nursing skills in the management of deliberate self-harm in children and young people. In order for education to be effective (i.e. so that it changes practice) it must address the belief systems of the practitioner. It is suggested that such belief systems are embedded in collectively held tribal stories. The more challenging the patient's behaviour, the more powerful the influence of the tribal narrative — possibly as a defensive strategy. The authors outline strategies aimed at increasing the range and depth of the therapeutic response to episodes of self-harm, and outline nursing interventions in the management of self-harming children.
Poverty as a practice issue for learning disability nurses
Authors: Northway Ruth
Published: May 2014

People who have a learning disability are vulnerable to poverty. Given that poverty has a negative impact on mental and physical health, this should be an area of concern for learning disability nurses. Historically, however, this is an area of practice which has not received much attention. It is important that learning disability nurses are aware of the impact which poverty can have on the lives of their clients and that they incorporate this understanding into their practice. Interventions which can be implemented at the level of individual clients, groups and society to tackle poverty and its effects are proposed. It is concluded that, at present, little is known about the extent to which such a perspective underpins practice or about the extent to which poverty is addressed in pre- and postregistration educational courses. The need for further research and development is noted.
Gastric cancer: diagnosis, risk factors, treatment and life issues
Authors: Hicks Sarah J
Published: May 2014

Gastric cancer is the sixth most common malignancy in the UK. It is responsible for over 9000 deaths annually in the UK. Distal gastric cancer has a decreasing incidence, but proximal gastric cancer continues to increase. Gastroscopy remains the gold standard for accurate diagnosis. Early diagnosis is essential, but symptoms and signs are often mistaken for other less serious diseases. Major surgery is the only proven treatment, but 5-year survival rates postoperatively are only 34%, and many people will continue to suffer side-effects of the surgery. Open access gastroscopy and health promotion may be the best chance of detecting this disease early enough so that it is treated successfully.
Caring for the terminally ill: the district nurse's perspective
Authors: Wright Kerri
Published: May 2014

This study aimed to explore the role of the district nurse in terminal care in order to understand and clarify the work that district nurses undertake in this area. District nurses' view themselves as having a central and valued role in terminal care, yet studies have highlighted concerns that they may not have the necessary skills to provide effective terminal care. In order to target the educational and developmental needs of district nurses the role of the district nurse in terminal care was explored using a qualitative approach. Six semistructured interviews, including the use of vignettes, were undertaken with district nurses from one community trust. Interviews were all taped and transcribed verbatim. Transcriptions were analysed using coding and categorizing with constant comparison of recurring themes. Common themes relating to how district nurses viewed their role in terminal care were then developed. The district nurses viewed their role as centring on the development of a relationship with the client and family. The relationship was a foundation to understanding and knowing the clients' and families' needs and was the medium through which all other care was given. The focus of care was determined by those needs identified through the relationship. Care needs identified within the study were complex and difficult to distinguish but fell within four themes: (1) emotional (2) social (3) physical and (4) informational. The importance of the relationship between the district nurse, the terminally ill client and the carer has not been clearly identified before and this study points towards the importance of formal structures to be put in place within palliative care and the provision of district nurse training to allow the opportunity and skills for this relationship to be fostered and developed.
The concept of hope in nursing 5: hope and critical care nursing
Authors: Cutcliffe John R , Herth Kaye A
Published: May 2014

This article is the fifth of a series of six that explores the nature of hope, reviews the existing theoretical and empirical work in several discrete areas of nursing, and provides case studies to illustrate the role that hope plays in clinical situations. In this article we focus on hope within the formal area of critical care nursing. The article points out that there is a distinct paucity of theoretical and empirical work on hope in this formal area. A very limited empirical literature exists, and this work has produced some preliminary findings on the nature and range of interventions for inspiring hope in this client group. Interestingly, while the nature of critical illness appears to indicate the need for the individual to draw upon all his/her intra- and interpersonal sources of help and support, and thus similarly draw upon his/her internal and external hope, the substantive issue of hope inspiration in this client group is not well researched. There exists, no doubt, a range of explanations for this disparity and this article outlines two and introduces a third. Yet hope and hope maintenance/inspiration may just be equally relevant and important to people with critical problems as they are to individuals with chronic problems; this view is supported by the limited empirical work in this area. Consequently, there is a clear need for future qualitative and quantitative research, some of which needs to explore the experiences of hope/hoping/hopelessness for people with a range of critical care needs. Furthermore, despite the apparent emphasis on ‘high-tech’, overt, and tangible practices within some critical care settings, this article would urge practitioners to remain open to the value of the more subtle, less visible, implicit, approaches to inspiring and maintaining hope in these clients.
Physiological insult/injury: pathophysiology and consequences
Authors: Edwards Sharon
Published: May 2014

This article provides a review of the pathophysiological responses of the body to an insult. Once the initial insult has occurred, common pathways are identifiable: the inflammatory immune response (IIR), the neuroendocrine system is stimulated, and endothelial damage initiates the clotting cascade, all of which play an important role in maintaining haemodynamic normality and promote healing. However, after an injury/insult patients are exposed to treatments, invasive procedures and may develop complications which can stimulate further these physiological processes. This can lead to alterations in oxygen supply and demand, metabolism and to the distribution of circulating volume. In some situations this can lead to overstimulation of the processes which, instead of promoting healing, cause damage. Why this downward progression and overstimulation occurs in some patients, despite optimum efforts at treatment, are not fully understood, but can lead to serious organ damage and even death days or weeks after the insult.
Best practice using Excellence in Practice Accreditation Scheme
Authors: McSherry Rob , Kell Jenny , Mudd David
Published: May 2014

This article describes how the University of Teeside School of Health and Social Care practice development team, in partnership with local professional colleagues and organizations, have addressed the issue of providing continuous quality evidence-based practice within the context of clinical governance. The newly devised Excellence in Practice Accreditation Scheme (EPAS) measures the standard of practice for a given health and social care setting by providing objective data indicating the level of clinical excellence obtained for the team or organization. The EPAS differs from other organizational accreditation schemes by facilitating excellence based upon a comprehensive set of measurable core standards: working in organizations, collaborative working, user-focused care, continuous quality improvements, performance management, and measuring efficiency and effectiveness. The standards are derived from a professional peer review of best practices. The uniqueness of EPAS is in consolidating the various organizational standards to elicit the core themes related to best practice where individuals, teams and organizations can be benchmarked and accredited for a level of excellence.
Exploration into the recruitment of South Asian nurses
Authors: Daly William M , Swindlehurst Lyn , Johal Parminder
Published: May 2014

Nursing is currently striving to ensure that its body of practitioners is reflective of the cultural diversity that exists in the population of healthcare consumers it serves. This is perceived as desirable to reflect and accommodate cultural differences within ethnic communities. The aim of this study was to investigate the rationale for the low recruitment of young South Asian people into nursing and midwifery education from an area of rich cultural diversity in the West Midlands. A triangulated approach was used involving four phases and sources of data collection. The study participants included students from secondary school (n=70), parents of young South Asian students, career advisers and a small group of South Asian nurse practitioners. Data collection involved focus group interviews and a postal questionnaire for parents. The data revealed that very few young South Asian females and fewer young South Asian males had ever considered a career in nursing. The students insight into the nature and scope of nursing as a profession was limited and based upon several misconceptions. Interaction with South Asian nursing role models was virtually non-existent. Their views of the physical, social and psychological demands placed on nurses made nursing an unattractive career option. Portrayals of an NHS in turmoil contributed to this view. Cultural issues also created problems for some students such as uniform policies and caring for the opposite gender. Further work needs to be undertaken to raise the profile of nursing and midwifery as a career option for young South Asian people.
Research endeavours into suicide: a need to shift the emphasis
Authors: Cutcliffe John R
Published: May 2014

According to the World Health Organization (WHO, 2002), approximately one million people died as a result of suicide in the year 2000. Perhaps more worryingly, evidence provided by the WHO (2002) indicates that the global rate of suicide has continued to rise since 1950. Consequently, suicide should be regarded as a global problem, and one that is increasing in magnitude. Drawing predominantly on policy and empirical literature emanating from Canada and the UK, this article will show that, despite a substantial research effort and the production of an associated literature, suicide rates continue to rise in the example countries. Even given the existence of numerous positivistically oriented studies, and the introduction of a range of strategies to help prevent suicide, significant reductions in suicide rates have not been achieved. Similarly, while there exists a substantial literature on the issue of suicide, there are many gaps in our knowledge and our understanding of the experiences, and the meanings attributed to these experiences that motivate people to attempt suicide is far from complete. Accordingly, the author argues that there is an urgent need to better understand the particular life experiences and the meanings that individuals attach to suicidal experiences. In order to design interventions to help reduce the suicide rate, whether these are interventions at the pre-primary, primary or secondary level of care, it is argued that it is necessary to gain a more detailed and comprehensive understanding of this highly complex behaviour. Consequently, this article makes the case for the use of hermeneutic, phenomenological investigations, in order to further elucidate the lived experiences of people who have attempted suicide.
12-lead ECG interpretation and chest pain management: 1
Authors: Docherty Brendan
Published: May 2014

The National Service Framework for Coronary Heart Disease provides guidance on important aspects of therapy that may make a substantial difference to patient care (Department of Health (DoH), 2001). It highlights the need to identify and fast-track patients with an acute coronary syndrome so that thrombolysis or appropriate interventional care can take place as soon as possible, to optimize myocardial salvage and reduce door-to-needle time (DoH, 2001; Castle, 2002). It is therefore extremely important that nurses in acute clinical areas are able to record and interpret 12-lead electrocardiograms so that the treatment modality can be initiated as soon as possible, leading to better clinical outcomes for this patient group. Although nurses work within a healthcare team, it is often the nurse who initially assesses, implements and coordinates care for patients with chest pain, be it in the emergency department, cardiac unit, general ward setting or general practice.