bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of The Patient's Charter on A&E departments 2: the emergency nurse practitoner
Authors: Crinson Iain
Published: August 2014

This article is the second of a two-part study based upon the results of a national survey of senior nurses in accident and emergency (A&E) departments. It explores the development of the nurse practitioner role in A&E. In particular, the extent to which this expanded role has become a means by which patients with minor injuries can be ‘fast-tracked’, to the possible detriment of more holistic goals for care delivery.
Methicillin-resistant Staphylococcus aureus and wound management
Authors: Phillips Eirlys , Young Trudie
Published: August 2014

For many years Staphylococcus aureus had a fairly predictable antibiotic sensitivity pattern, with host strains being resistant to penicillin but sensitive to other antistaphy lococcal antibiotics such as erythromycin and gentamicin.
Death of a patient 1: a personal reflection
Authors: Poole Karen
Published: August 2014

Reflection on practice has been identified as a means of bridging the theory-practice gap, encouraging a questioning, selfevaluative approach to nursing practice. In this two-part article, a clinical incident regarding the management of bereaved relatives is explored, utilising a model of structured reflection.
Suicide and psychological debriefing
Authors: Farrington Andy
Published: August 2014

The death of a patient by suicide is one of many upsetting experiences that nurses face. However, psychological debriefing after such an event is not commonly available.
Continence: a challenge for us all
Authors: Norton Christine
Published: August 2014

At a national level continence services have never had a higher profile. In 1991, the DoH published an extensive review of continence services and made many recommendations. It also decided to fund a national resource centre, The Continence Foundation, which is now established as a charity. The NHS Executive (1993) made implementing these recommendations a priority for purchasers in 1994-5. The Citizens Charter Unit has chosen continence as one of the services to cover in its series of publications on users views of health services (NHS Executive, 1994). The DoH has also funded major projects on the role of continence advisors (Rhodes and Parker, 1993) and their effectiveness, costs of services, targets for health gain and clinical guidelines on promoting continence in primary care. The Medical Research Council recently gave a £5 million grant to a continence project, and the Royal College of Physicians (1995) is about to publish a major review.
In control with incontinence aids
Authors: White Helen M
Published: August 2014

Incontinence is a common condition affecting people of all ages. Many can be cured and all can benefit from appropriate treatment and management. Despite huge growth in this market, many products are neither appealing nor acceptable to those people who have to use them. Whenever practical, it is best that the choice of aid should be a collaborative decision between the user and the carer.
Deduction: moving from the general to the specific
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

This article considers the issue of theory testing, using the hypotheticodeductive model. The nature and purpose of hypotheses are explored and the varying types of hypotheses are described.
Managed care 2: an opportunity for nursing
Authors: Laxade Sylvain , Hale Claire
Published: August 2014

The first part of this article described some of the tools of a managed care system. This article suggests ways in which the nursing role can be developed to take forward the opportunities offered by managed care.
Nimbus and Alpha X Cell
Authors: Williams Clare
Published: August 2014

This article describes four alternating pressure mattresses and recent improvements in their design.
Confidentiality
Authors: McHale Jean
Published: August 2014

The nurse is under a legal obligation not to disclose confidential information without the patients consent; this is subject to a number of exceptions.
IMMEL 2: working to augment coping responses in early dementia
Authors: Keady John , Nolan Mike
Published: August 2014

People in the early stages of dementia have support needs that are often not fully addressed. This article, the second of two parts, suggests that early intervention by practitioners, coupled with the use of appropriate assessment instruments, could make a significant contribution to improving sufferers’ quality of life.
Bringing support home for families of children with cancer
Authors: Evans Margaret , Kelly Paula
Published: August 2014

The Macmillan paediatric service at Southampton has grown in the context of an established service and in response to the perceived needs of families. In the environment of an internal market, care provided must be more explicit to inform decision making regarding its continuation.
Staff stress and satisfaction in small staff houses in the community: 1
Authors: Potts Maggie , Halliday Sabrina , Plimley Caroline , Wright Judith , Cuthbertson Andrew
Published: August 2014

In this article, the first of two parts, the sources of stress and satisfaction experienced by nursing and social service staff working in group homes with young people with severe learning disabilities are investigated. It focuses on the stresses and satisfactions arising out of the performance of the direct care role for staff working in ordinary housing in the community.
Nutritional assessment
Authors: Reilly Helen
Published: August 2014

Undernutrition and obesity have serious implications for both health and recovery from illness or surgery. These nutritional problem s are common in hospital patients but often go unnoticed. This article reviews the means of carrying out nutritional assessment and recommends simple techniques for routine use at ward level to identify patients who need nutritional intervention. Nursing staff are in an ideal position to undertake nutritional screening and simple nutritional assessment should be routinely included as part of patient assessment.
Towards care in the community: a carer's tale
Authors: Waddington Paul
Published: August 2014

It is not easy to write about the recent death of a parent. While carrying out action research on community care planning in the Midlands, the author was compelled to gain first-hand experience of the impact of care in the community at the sharp end by his mother's terminal illness. The learning curve was steep. Care workers have to take a lot of knocks in the current political environment. It is a relief — and no little personal therapy — to be able to report a success story. Writing up the experience provided an opportunity to express gratitude to all members of the care team involved and at the same time to vaunt the concept of the ‘live-in carer’ scheme, an innovation deserving replication elsewhere.
Developing a research culture for nursing in higher education
Authors: Farrington Andyl
Published: August 2014

For colleges of nursing that have moved into higher education over the last 12-18 months, the forthcoming Research Assessment Exercise 1996, conducted by the Higher Education Funding Council, is unlikely to be very meaningful or impact on research activities. While the mission of colleges of nursing, before integration, was to provide good quality teaching, underpinned by innovative curriculum design, the future of nursing in higher education, after integration, is likely to be quite different.
Central venous cannulation
Authors: Gourlay Dorothy A
Published: August 2014

This article addresses a learning experience involving the insertion of central venous cannulae, for both the assessment of a patient's internal environment in relation to the need for medical intervention and the administration of medical treatment. The issues explored highlight the important uses of such cannulae and stress the potential problems which may be encountered during insertion of the cannulae or when they are used for the administration of drug therapy.
Interpreting problematic behaviour in people with learning disabilities: 2
Authors: Slevin Eamonn
Published: August 2014

The main theme of the first part (Vol 5(8): 546–50) of this two-part article was a focus on understanding the causative factors of problematic behaviour in people with a learning disability. A logical sequence to the identification of causes of problematic behaviours is that interactions to lessen such behaviours are identified. In this article, a discussion on interventions to guide nursing practice is offered. A short list of some interventions which emanate from the identified causes is presented in Table 1 for guidance; these interventions are analogous with many nursing and related theories (Peplau, 1952; Johnson, 1980; Wolfensberger, 1983; Roper et al, 1985; Jenner, 1992; Burford, 1993; Quinn and Mathieson, 1993). It is suggested that there is need for a paradigm shift to take place in the interpretation and understanding of problematic behaviours, and it is further suggested that nursing theories should be utilized within such a paradigm.
The public image of the mentally ill and community care
Authors: Glasson Joanna
Published: August 2014

Transferring the care of mentally ill patients to the community is not a new initiative. The first comprehensive Hospital Plan by the Department of Health and Social Security (DHSS, 1962) recognized and recommended that areas of health care which did not need to take place in hospital should be carried out in the community. Some 30 years later, this transition is taking place. This transition has not been a smooth process and in certain cases it has failed. The public image of mental illness has played a significant role in delaying the transfer of care to the community, although this is not the sole hindering factor. Poor liaison between health and social services, closure of hospitals before development of community facilities, inadequate community support and resources, and sensationalized media coverage have all been cited. Community care of mentally ill patients is a reality and it has been demonstrated that it can be well planned and properly funded (Faugier, 1993). Rather than dwelling on the shortcomings surrounding the implementation of community care, the way forward is to learn from mistakes and to identify means of increasing public acceptance of people suffering from mental illness.
Discharge of psychiatric patients into the community: how many more must die?
Authors: Durgahee Taleb
Published: August 2014

Since the advent of community care, mental health services are increasingly coming under scrutiny, particularly the management of people with mental health problems in the community. Several murders committed by psychiatric patients in the community have fuelled public debate. This article reports on a study examining the recommendations of the Department of Health regarding the discharge of psychiatric patients from hospital to community care. It describes the background to events such as the Clunis report and guidance from the Department of Health on the management of mental health services. Semi-structured interviews, questionnaires and document analysis were used to ascertain the views of community psychiatric nurses and managers regarding the discharge of patients into the community. The findings identify areas of good practice and the need for nurses to improve their knowledge of the care-programming approach, risk assessment and interagency collaboration.
Continuing care needs for the elderly mentally ill
Authors: Thomas Ben
Published: August 2014

The demand for continuing care of the elderly, mentally ill cotinues to rise. The Government's latest response to this increase is to issue new guidelines on the responsibilities of the NHS in meeting continuing health-care needs. The general principles underpinning the guidelines are welcomed; however, this article identifies a number of problems with them regarding the elderly mentally ill.
Decision making in professional practice
Authors: Moore Paul A
Published: August 2014

There is a large body of work relating to the nursing process but comparatively little on decision making. Two main views exist, namely the rationalist and the phenomenological perspectives. It can be argued that the rationalist perspective is a quantitative approach whereas the phenomenological perspective offers a more holistic view. Intuitive judgment presents problems as it is only used by experts and is difficult to teach. In professional practice the decision-making process and the nursing process work together.
Sharp debridement of devitalized tissue: the nurse's role
Authors: Poston June
Published: August 2014

It is important that any devitalized tissue is removed from a wound as soon as possible. For most patients, the presence of non-viable tissue is distressing as it can produce a noxious odour and frequently an unacceptable discharge. The devitalized tissue provides a suitable culture medium for bacterial growth, and wounds containing necrotic tissue are therefore at risk of becoming clinically infected. Various methods of both conventional and unconventional removal of non-viable tissue are discussed briefly. However, this article is mainly concerned with the removal of devitalized tissue using sharp instruments. It focuses on the implications of this procedure for nurses who take on this responsibility. Sharp debridement of devitalized tissue has traditionally been an acceptable procedure for medical staff to perform. This article discusses the practical requirements and theoretical knowledge that are necessary for the procedure to be performed successfully. It proposes that, in the patient's best interest, the experienced and competent nurse may be the most suitable practitioner to perform this activity.
Allevyn Adhesive
Authors: Williams Clare , Young Trudie
Published: August 2014

Allevyn Adhesive is a development of Allevyn Hydrocellular produced by Smith & Nephew Healthcare. Allevyn Adhesive comprises three layers and has the same absorbency as Allevyn Hydrocellular. The dressing is waterproof and requires no secondary dressing, tape or bandages. It is able to conform to the most awkward body areas such as the sacrum, heels and elbows. It is suitable for use on a variety of exuding wounds and can be used in conjunction with a hydrogel for sloughy wounds.
Susan's breast reconstruction: a case study and reflective analysis
Authors: Parker June , Scullion Philip
Published: August 2014

This case study describes and analyses selected aspects of the nursing care of Susan during her stay on a plastic surgery unit. The necessity for her breast reconstructive surgery following mastectomy some years earlier is discussed, along with the importance of selection of the appropriate operation and preoperative preparation. A retrospective analysis of aspects of the nursing care is then undertaken, giving insights for possible improvements and role developments. Susan left hospital with a new body shape and was beginning to adapt to her altered body image. Her continued recovery and the restoration of her ‘ideal’ body image are discussed. Finally, the value of case studies is considered along with an outline of their potential as a tool in professional practice and education.
Lyofoam
Authors: Williams Clare
Published: August 2014

Foam dressings provide an excellent healing environment for granulating wounds. Lyofoam is a polyurethane foam dressing that comes in a variety of presentations for differing wound types. Lyofoam is suitable for light to moderately exuding, granulating wounds; Lyofoam Extra, a new addition, for heavily exuding wounds; Lyofoam A, an all-in-one dressing, for granulating wounds; Lyofoam T, a standard Lyofoam dressing with a special cross-cut, for tracheostomy wounds; and Lyofoam C, which has a carbon layer, for malodorous wounds. Lyofoam is a well-estab-lished, clinically proven wound dressing that promotes the ideal wound environment for healing. It has a low-adherent contact layer which leaves delicate granulation tissue undisturbed. It is also effective in the treatment of overgranulation.
Childhood cancer - a family crisis 2: coping with diagnosis
Authors: Heath Samantha
Published: August 2014

A diagnosis of cancer in a child requires families to mobilize their coping strategies in response to an extremely stressful life event. In the second article of this two-part series, the nature of coping, the strategies employed, and the factors that influence the family's choice of strategy are examined. The findings indicate that personality traits may constitute internal factors that affect the coping response, while concurrently stressful events and chronic uncertainty may be considered external influences on the family's ability to cope with a diagnosis of cancer in a child. In the first article of this series, the nature, purpose and functioning of the family were explored in an attempt to explain the impact of a childhood cancer diagnosis on the family. Overall, family reaction appears to be directed by several factors: communication and information; stage and prognosis; and as attitude to the nature of the disease itself.
The value of Peplau's theory for mental health nursing
Authors: Jones Adrian
Published: August 2014

Recent changes in mental health care have necessitated re-evaluation of Peplau's nursing theory. There is an expanding body of nursing knowledge and a debate is taking place regarding the difference between models and theories. Peplau's theory considers nursing as an interpersonal process between nurse and patient. The theory lacks empirical investigation and is not yet tested regarding the multidisciplinary team approach, which is largely based on the medical model. For the theory to gain credibility within the dynamics of the multidisciplinary team, it must be tested within a framework of robust research design involving various diagnostic groups and practice settings. Until such time, the theory's utility must seriously be questioned within contemporary mental health practice.
Continence clinic: Impact of neurological problems on urinary continence
Authors: Woodward Sue
Published: August 2014

Nurses care for patients with neurological problems in many health-care settings. Urinary incontinence frequently occurs in patients with neurological disorders and can be a source of great distress. One study of patients with chronic neurological problems aged 15-59 years revealed that 83% of the 117 men and 36% of the 188 women surveyed had urinary symptoms (Thomas et al, 1988). This article reviews the ways in which continence is affected in this client group and suggests how nurses can help these patients.
The failure of community care for the severely mentally ill
Authors: Alexander John , Farrington Andy
Published: August 2014

For the past 10 years or more there has been an ongoing debate about community mental health (CMH) nursing. It is clearly important in any discourse about CMH nursing to begin by examining where this branch of nursing is at present, i.e. what route it has taken, as well as considering where it is destined to travel. The views expressed in this article are supported by a literature review undertaken as part of a research study into CMH nursing. The first and quantitative stage, which was completed in late 1995, and the second qualitative part of the study has now reached the data analysis stage. The preliminary findings from this study are discussed in this article.
Stress in nursing and patients' satisfaction with health care
Authors: Michie Susan , Ridout Kate , Johnston Marie
Published: August 2014

The aim of this study was to investigate the factors that contribute to the stress reported by nurses and patients. Thirty-four nurses in a London teaching hospital completed the nurse stress index and the Spielberger state trait anxiety inventory and attitudes towards the ward and nursing care were measured in 52 patients. Nurses in the sample reported significantly greater problems than the norm in dealing with stress (as measured by the nurse stress index). In particular; they expressed difficulty in dealing with patients and their relatives, with conflict between home and work, and with and pressure resulting from problems concerning confidence and competence in the role. Patients were generally satisfied with the health care they received. There was a positive relationship between the time that patients spent talking to nurses and the degree to which nurses were perceived as helpful. Results are discussed in terms of possibilities for further research and implications for the design of future intervention programmes aimed at reducing job-related stress in hospitals.
Economics Of Evidence About Nurse Specialization
Authors: Heasell Stephen
Published: August 2014

If nurse specialization Is to flourish within the expected financial constraints then advocates will have to focus attention on research- based evidence about clinical practice that is relevant to clients. This article examines the kinds of evidence that might be sought and considered before decisions are made about the allocation of scarce resources to nursing services. It Is suggested that reasoned decision making for health services In that context would require convincing evidence that each particular commitment of resources to nursing can be expected to contribute as a set of Inputs towards the best possible achievement of overall objectives for health services within the anticipated constraints on resources available. If so, It would be reasonable to expect that those with resources to allocate will seek and will consider evidence about costs associated with nursing; Including adverse risks, as well as that about relevant benefits from nursing. Advocates for nursing, or for specialisms among nurses, would then-do well to demonstrate that they take evidence about both benefits and costs seriously when presenting their case, rather than dismiss either as being merely an annoying and unreasonable distraction.
The documentation of wounds in an acute hospital setting
Authors: Hon Jennie , Jones Caroline
Published: August 2014

This article presents the findings of research into the documentation of wounds healing by secondary intention, in an acute hospital setting. The benefits of recording the nursing assessment of a patient's wound, together with the legal and professional implications of poor documentation, are outlined. The points that specialists writing on the subject identify as necessary when describing a wound within the nursing records are highlighted. A survey is described in which descriptions of wounds healing by secondary intention were collected from the nursing records on six acute wards in a hospital and then measured against an assessment tool. For each criterion selected for investigation, the number of occurrences was recorded, thus providing a quantitative description of the documentation of wounds. The findings indicated deficits in many of the areas selected. While statements such as ‘healing well’ were commonly used, descriptions which would provide information about the state, progress or management of the wound were generally omitted.
Effects of hypoglycaemia: patients' perceptions and experiences
Authors: Richmond Jennefer
Published: August 2014

A qualitative study was undertaken to investigate the perceptions and experiences of insulin-treated people with diabetes mellitus. Seven people were randomly selected from an opportunistic sample and interviewed either at home or on hospital premises. The subjects comprised four women and three men (age range 20–72 years). The study found that hypoglycaemia plays a significant role in the lives of these subjects and that concern over having a hypoglycaemic attack is constantly present All subjects had suffered at least one attack which had potentially serious consequences and six did not always recognize the warning signs of an impending insulin reaction. Only one of the subjects said they would be happy to live alone.
Diabetes mellitus: biomedical health education/promotion approach
Authors: Brennan Arthur
Published: August 2014

Diabetes mellitus causes numerous difficulties for those who adopt a biomedical health education/promotion approach. Its management regimen is notoriously complex, being affected by a variety of cognitive, psychosocial and environmental factors. However, a valuable contribution of biomedical research in this area has been the corroboration by empirical studies that dispositional characteristics have little to do with adherence/non-adherence behaviours. Criticisms of the biomedical approach Include Its omission of the psychosocial correlates of health and illness, and its health expert and Individualistic orientation. In critically appraising the biomedical model and Its related health education/promotion approaches, this article will briefly describe the model and Its origins and critically review its strengths and weaknesses. It will then examine some of the empirical problems associated with the measurement of compliance, metabolic control and self-management as evaluatory outcomes in diabetes.
Elderly patients' participation in discharge decision making: 2
Authors: Jewell Sarah
Published: August 2014

This article Is the second In a two-part series describing a study that explored patient participation In discharge decision making. The study focused on the participatory relationship between older patients and nurses and was performed In two phases. As reported In the previous article (Vol 8(16): 914–16, 929–32) the first phase Involved group Interviews with primary nurses from two elderly care units. This article reports the findings of the second phase which Involved a series of Interviews with five elderly patients during their hospital admission. The data from both phases of the study were analysed using the software package Ethnograph. Unlike nurses, the patients In this study had little understanding of the term ‘participation’. They were mainly concerned with being given Information and reported having unmet Information needs. They felt that they did have a role In discharge decision making but were unable to fulfil It, consequently they relied upon nursing staff to take the lead In the decision-making process.
Psychology 5: implications of the ageing process for nursing practice
Authors: Wilkinson John A
Published: August 2014

Many people are living longer and, as a consequence, the UK Is populated by Increasing numbers of elderly people. This trend towards an increase in longevity has been matched with an increase in morbidity, despite contemporary professional and lay interest in the adoption of healthier lifestyles. Hence, expertise in elderly care is likely to continue to be important for many health-care professionals. This article considers aspects of the ageing process and draws attention to the psychological interpretations of personality and life span, social isolation, intelligence and memory related to elderly people. The main conclusions drawn are that, although becoming older can be associated with health-care problems, the process of ageing is individually experienced and it is inappropriate to assume that all elderly people share common needs. A number of implications for nursing practice are highlighted and recommendations to enhance care are made.
Residential care for people with learning disabilities
Authors: Parrish Alan
Published: August 2014

The report Residential Provision for People with Learning Disabilities (Emerson et al, 1996) is the first phase in the Government's independent evaluation of the different types of residential care for people with learning disabilities. A study into the costs of village communities has also been undertaken (Goushaw, 1996).
Relevance of the nature vs nurture debate to clinical nursing
Authors: McVicar Andrew , Clancy John
Published: August 2014

The philosophy of holistic care underpins nurse education, and the ‘nature-nurture debate’ is frequently used to facilitate discussion regarding the influence of interactions with the environment in ‘shaping’ the Individual. A limitation to this approach is that much of the work cited in the literature relates primarily to psychosocial interactions. This conveys a narrow perspective on holism, and creates an impression that the debate cannot be applied to other aspects of health and wellbeing, yet models of nursing care jemphasize the need for nurses to appreciate the interactional basis of health. This article uses examples from mental health, physical health and the influence of ageing, to argue that Interactions must be viewed from a much wider perspective. Only In doing so can the principles and application of holistic care, and an understanding of the bases of health education practices, be appreciated.
Ageing and quality of life 2: understanding successful ageing
Authors: Lundh Ulla , Nolan Mike
Published: August 2014

Older people are being maintained in their own homes for longer periods and at increasing levels of frailty since the widespread introduction of community care policies across Europe. In order to sustain a good quality of life such individuals are more reliant on support from both informal (family) and formal sources. If appropriate assistance is to be provided then there is a need for a better understanding of how older people maintain their self-esteem. This article provides additional empirical support for the processes of accommodation and immunization and illustrates how knowledge of these concepts is important to the development of improved services for older people.
Administration of PRN medication by mental health nurses
Authors: Gray Richard , Smedley Nicola , Thomas Ben
Published: August 2014

The administration of PRN medication by mental health nurses is an important, yet poorly explored aspect of psychiatric inpatient care. An examination of nurses' reasons for administering PRN medication is essential in ensuring its appropriate and effective use. Data were gathered from the drug charts of 44 inpatients on two acute psychiatric wards. Most PRN medication was given orally and the most frequently administered drugs were procyclidine, lorazepam, ibuprofen, diazepam and droperidol. The main reason for administering PRN medication was because patients had ‘requested’ it. Results were broadly consistent with previous research. It is recommended that nurses should give clear and specific reasons for administering PRN medication based on a valid assessment. Implications for clinical practice and further research are also discussed.
Communication theory and the shift handover report
Authors: Odell Amanda
Published: August 2014

The cooperation that makes human society possible is manifested most visibly within the organization and is almost entirely dependent upon the skill with which we communicate (Tortoriello et al, 1978). By understanding concepts related to communication theory, nurses may be better able to analyse areas of communication in their own practice. This article reviews the concepts of communication in terms of definition, function and purpose. The communication process model is examined and the hindrances to effective communication are explored. The shift handover report is analysed and related to group networking theory. Communication theory is then applied to the shift handover process and recommendations for practice are made.
Development of day case cataract surgery: a literature review
Authors: Cooper Jean M
Published: August 2014

There is increasing demand for day case cataract surgery. This review looks at the varying criteria for suitable patients and compares the use of local or general anaesthesia for day surgery. Preassessment clinics and the possible limitations of patient transport are discussed. Length of stay in the day unit, nurse involvement and discharge procedures are examined. Postoperative visits are reviewed. Studies show that the clinical outcome is not affected by outpatient surgery and that patients report a high level of satisfaction with their day care. Day case cataract surgery is safe and cost-effective and increased patient demand will become a significant factor favouring day case surgery in the future. Further research into patients' attitudes to the continuity of nursing care from preoperative assessment, through surgery to discharge, and whether this plays a part in their overall satisfaction, is recommended.
Clarifying and defining nursing role developments
Authors: Castledine George
Published: August 2014

The following factors have exacerbated the confusion over traditional nursing activities: the need to respond dynamically and flexibly to economic and national health targets; the pressure to reduce doctors' hours and to provide substitutes for the shortage of doctors; the ad hoc development of specialization in nursing, without any formal review or regulation by the UKCC; rapid and uncontrolled nursing role developments which have left nurses free to use whatever title they choose; the language and cultural clash over the way that certain titles from other countries, e.g. North America, have been used in the UK; and the confusion as to what the core terms ‘generalist’, ‘specialist’ and ‘advanced’ mean.
Assisting patients to comply with leg ulcer treatments
Authors: Taylor Pamela
Published: August 2014

A great deal of work has been done in recent years to highlight and improve the leg ulcer problem in the UK. Leg ulcer clinic projects have resulted in effective treatments (Moffat, 1990), guidelines to assist in the appropriate management of leg ulcers (Nelson, 1996) and leg ulcer clinics that aim to prevent recurrence (Ruane-Morris et al, 1995). However, even with the best possible treatment strategies based on reliable research evidence, many patients do not comply with the recommended treatment and therefore have persistent non-healing or recurrent ulceration (Moffat and Franks, 1995). Patient education is vastly important in this area and can be supported by education leaflets to facilitate learning. Educational theories can also be drawn on to ensure that patient education is based on sound evidence.
Can telephone follow-up improve post-discharge outcomes?
Authors: Turner David
Published: August 2014

Much effort and time can be devoted to discharge planning, but what measures exist to systematically ensure that everything has gone according to plan, and that no unforseen problems have occurred, once the patient has returned home? One possible solution evaluated by this study was the routine follow-up of patients discharged from a medicine for the elderly ward by telephone. This method was found to be quick, cheap and effective. It also had the additional benefits of offering the opportunity to give further advice, reinforce health education, and for some help to provide an emotional bridge between hospital and home.
Community mental health teams: development in community care
Authors: Pugsley David , Rees Phillip , Dimond Bridgit
Published: August 2014

This article discusses research undertaken in an area of South Wales on the functioning of community mental health teams, which took place during the closure of two large psychiatric hospitals and the development of the Welsh Office strategy for mental illness. Key findings relate to the lack of clarity of the role of team coordinators, the absence of individual performance review systems, the diversities in referral systems and caseloads. An attempt was made to develop a performance matrix in relation to individual teams.
Paracetamol overdose: pathophysiology and nursing management
Authors: Budden Lea , Vink Robert
Published: August 2014

Paracetamol overdose now represents one third of all self poisoning cases. In contrast to other drugs, the use of paracetamol as a self-poisoning agent is increasing. As very large doses of the drug cause severe liver injury, which can result in fulminant hepatic failure when left untreated, it is essential that nurses have a complete understanding of the mechanisms of normal paracetamol metabolism, effects of overdosage and treatment strategies to guide the nursing management of clients. This review therefore critically examines the pathophysiology and nursing management of clients with acute paracetamol overdosage.
Voluntarism and health education in nursing
Authors: Adams Trevor
Published: August 2014

The concept of voluntarism, as it applies to models of health education, underpins the nursing care of people who are chronically confused and their relatives. This article argues that voluntarism needs to be balanced by the notion of collectivism which takes full account of the contribution made by sociopolitical determinants of health. The central concepts of voluntarism and health education are defined and then the article proceeds to examine the extent to which voluntarism has underpinned various models of health education which can be used to support nursing practice. A critique of the concept of voluntarism, as used in health education, is provided. It is argued that models of health education which are polarized towards either voluntarism or collectivism are based on an inadequate understanding of human social action and that this polarization undermines the usefulness ofthese models of health education.
The research role of the advanced nurse practitioner
Authors: McGee Paula
Published: August 2014

The research role of the advanced nurse practitioner (ANP) is poorly developed in the literature. Clarification of the role is essential if individual nurses are not to be burdened with unrealistic expectations. Organizations need to prepare themselves for research activities and must not expect the ANP to address all the issues involved alone.
Pressure sore prevention: using and evaluating risk assessment tools
Authors: Deeks Jonathan J
Published: August 2014

The Department of Health issued clinical practice guidelines in June 1995 concerning the prevention and treatment of pressure sores (United Leeds Teaching Hospital NHS Trust, 1995). The guidelines were produced through a combination of review of the research evidence, debate in expert panels and wide consultation (Hitch, 1995). This article reviews the section of the guidelines concerning risk assessment. It looks at the research evidence evaluating risk assessment tools, noting problems which exist in interpreting the evidence, and the conclusions that can be reasonably drawn from it. It also discusses the idea of developing and evaluating risk assessment protocols based on routinely used risk assessment tools to ensure that the information acquired through such assessments is used appropriately to allocate effective preventive interventions.
Pre-admission education for patients undergoing cardiac surgery
Authors: Nelson Sara
Published: August 2014

Traditionally, preoperative information has been provided to patients on admission, the day before surgery. This was thought not to be the ideal time. An exploratory pilot study was undertaken to evaluate a new information service for patients about to undergo cardiac surgery. Questionnaires were administered to 20 patients who had attended a pre-admission education programme and 20 patients who had received information from the ward staff on admission. The aim was to assess whether patients' fears and anxieties were reduced by the provision of preoperative information before admission for surgery. One hundred percent of the patients felt that they benefited from the pre-admission programme and 76% felt that their anxieties had been relieved.
The changing role of the continence adviser
Authors: Addison Ray
Published: August 2014

The role of the continence adviser is evolving and developing within today's health service. Research evidence is available to define the role and its principal functions. Since the inception of the role in the early 1980s, there is still wide variation in interpretation, lack of uniformity and wide variance of service provision across the country. It is time to remove the title of continence adviser as it no longer portrays the role as it has developed. In addition, the taboo nature of the word ‘incontinence’ has to be considered as a potential barrier to progress and development. An ENB course has now been established to ensure that continence advisers can take their rightful place alongside their colleagues in other specialist areas of nursing. As these develop, aspects of the continence adviser's role may be under threat. Continence advisers will therefore have to sell their services in the marketplace and move away from pad-oriented activities.
Causality and control: threats to internal validity
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

The essence of experimental research is to establish causal relationships between variables and this requires internal validity. An experiment is said to have internal validity when extraneous variables have been controlled. However, there are many threats to internal validity. This article considers 13 of them, providing examples which clarify and help to identify under what conditions these threats may occur. The threats discussed are history, maturation, testing, instrumentation, statistical regression, selection, mortality, interactions with selection, ambiguity about the direction of causal influence, diffusion of imitation of treatments, compensatory equalization of treatments, compensatory rivalry by respondents receiving less desirable treatments and resentful demoralizatipn of respondents receiving less desirable treatments.
Clinical supervision: what do you do after saying hello?
Authors: Fowler John
Published: August 2014

Many units are beginning to explore and introduce a formal system of clinical supervision. Potential supervisors may feel unprepared for the role that is expected of them. In this article the work of Brigid Proctor and her formative, normative and restorative perspectives of supervion are related to that of John Heron's six categories of intervention. Previous work of the author (Fowler, 1995) which identified three areas of focus for clinical supervision are then incorporated to give a model of supervisory intervention. The result is some practical guidelines for potential supervisors to help them know what to do after they have said ‘hello’.
Implications of transplantation surgery for theatre nurses: 1
Authors: Clay Jane , Crookes Patrick A
Published: August 2014

Transplant donors, although legally dead, arrive in operating theatre departments appearing no different from any other preoperative patient. Some theatre staff may not appreciate, or even be aware, that transplant donors have been certified dead before donor surgery. This article, the first of two-parts, examines the implications of organ donation surgery for the emotional and psychological wellbeing of nursing staff. Other potential problems for nursing staff, related to the process of organ retrieval, are also explored. These include the scheduling of transplant work at times when there is a poor level of skill mix, difficulties in working with unfamiliar staff and equipment, the apparent lack of ‘benefit’ of surgery for donor patients, and the possibility of identifying with the victims of sudden and perhaps traumatic death. The second article, to be published in the next issue, will discuss ways of ameliorating the stress associated with this work.
The nutritional health of the nation: diet, exercise and health
Authors: Goode Jackie , Beardsworth Alan , Haslam Cheryl , Keil Teresa , Sherratt Emma
Published: August 2014

Public health initiatives aimed at changing the nation's diet rely on simple messages to persuade people to eat more from certain food groups and less from others. The underlying rationale of this strategy is that control is located firmly in the hands of the individual who can ‘choose’ health by following the guidelines. The research reported in this article found high levels of public awareness of nutritional guidelines, and a sense of personal control over health. However, accounts of other health-related agendas showed that being in control may mean choosing to become fitter or slimmer. Within these pursuits, nutritional concerns were prioritized only in so far as they were seen to serve the attainament of a desired body shape. Health professionals need to be aware that nutritional guidelines may be competing with other mediating factors along the chosen route to health.
Spiritual care of chronically ill patients
Authors: Narayanasamy Aru
Published: August 2014

In this article, the spiritual features of chronic illness are identified and elaborated. Chronic illness can bring about disorganization and disruption in the sufferer, resulting in spiritual distress. Some guidance is offered to nurses on the skills required to provide spiritual care for chronically ill patients. An example of a problem-solving approach to spiritual care is given along with comments on evaluating the effectiveness of nursing intervention. It is within nurses’ personal resources to provide effective spiritual care as part of their concern for quality of care for patients.
Using reflection to develop clinical expertise
Authors: Andrews Margaret
Published: August 2014

Reflection is becoming widely recognized as an effective means by which nurses can develop their practice and is a prominent feature of both pre- and postregistration education programmes. More specifically, the UKCC directs that all nurses are required to keep a personal, professional profile, which means that they are obliged to engage in reflective activities. In order to develop practice, nurses must reflect on what they do and what they would want to do better. Reflection is a purposeful activity which is more than just a recall of events. Implicit within reflective activity is a need on the relector's part to change behaviour. The following article explores the concepts of expertise and reflection and suggests how one may relate to the other. Its purpose is to heighten awareness of the use of reflection for profile development and ultimately as a means of developing nursing practice.
Accepting the challenges of pain management
Authors: Browne Regina
Published: August 2014

Despite advances in the treatment of pain, studies reveal that hospitalized patients continue to suffer under-recognised and unrelieved pain. Several factors contribute to this problem including health-care professionals’ lack of knowledge about pain and analgesia, the inadequate use of pain assessment techniques and incomplete charting of patients’ reports of pain. This article describes these challenges which must be overcome if the situation is to improve. It outlines the potential value of systematic assessment and documentation of pain so that the patient's pain is acknowledged as a unique experience. This should enable the health professional to individualize his/her approach to pain management.
Elderly people's knowledge of and attitudes to pain management
Authors: Brockopp Dorothy , Warden Sherry , Colclough George , Brockopp Gene
Published: August 2014

Pain is a frequent complaint of elderly people in hospitals and in the community, yet it is often not managed effectively. Barriers to effective management have included fear of narcotic addiction, inadequate assessment of pain, and attitudes of health professionals. Attempts have been made to improve the knowledge and attitudes of health-care professionals. This study examined the attidues and knowledge of acute pain and pain management among well elderly people in rural and urban settings in the southeastern USA in order to identify possible barriers to effective pain management. Questionnaires on knowledge and attitudes towards pain and pain management were given to 62 rural and 63 urban well elderly people aged 65 years and older. Findings demonstrate a lack of knowledge as well as the presence of non-facilitative attitudes about pain and pain management.
Let's get talking
Authors: Stroud Anna
Published: August 2014

Children with speech, language and communication difficulties may feel left out if you don't take the time to communicate with them in a way they feel comfortable with. These activities can help them feel more confident.