bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting the carers of individuals affected by colorectal cancer
Authors: Taylor Claire
Published: May 2014

Colorectal cancer is one of the most common cancers, and many difficulties may be experienced as a direct consequence of the disease and its treatment. These can be alleviated and/or resolved with appropriate care. Much of this care is provided informally by the individual’s family and friends, whose care needs may be practical, emotional, financial, spiritual or organizational in nature. Care requirement can, as a consequence, be variable in its responsibilities, regularity and duration, since the individual diagnosed with colorectal cancer may require a wide range of support throughout their cancer journey, or have only a few temporary care needs, depending on their disease, treatment and a multitude of other personal, interpersonal and contextual factors. This highlights the importance of regular and individualized assessment. The care-giver’s role is often forgotten and hence the impact it may be having upon their own health and lives gets overlooked. Yet, a carer’s ability to manage this role has an important bearing not only on patient experience but also on the level of professional involvement. To perform this role satisfactorily carers need to be prepared, supported and also assessed at key points in the patient’s cancer journey. Nurses have a professional obligation to help carers by first preparing them, then maintaining sufficient contact to be able to proactively provide practical support and additional health care as needed. This article focuses on these carers and highlights the scope, associated challenges and possible consequences of the caring role. It also seeks to stimulate reflection of how current service provision for carers might be improved
Coding the path for practice accountability
Authors: Peate Ian
Published: May 2014

The Nursing and Midwifery Council (NMC) was established in 2002 by command of the Nursing and Midwifery Order 2001 with the prime purpose of protecting the public. The NMC does this in many ways, for example it maintains the professional register, and it produces sets of standards for performance and ethics for registered nurses and midwives by the publication of a code of conduct, the code is the key NMC tool that underpins public protection.
Nursing management of patients with a chest drain
Authors: Sullivan Ben
Published: May 2014

Chest drains incorporate the use of a one-way valve to drain fluid or air from the pleural cavity. The valve prevents back-flow of air and fluid into the pleural cavity. They are indicated for use when collections of fluid or air are present in the pleural space, and by draining the collection they restore efficient gaseous exchange. Little has been written on the nursing management of chest drains and the literature highlights a lack of national standardized guidelines for due to the range of thoracic conditions encountered by clinical staff. Themes such as pain management and mechanism of breathing occur frequently; however, there is a lack of up-to-date literature for the nurse to refer to. This article examines the nursing role in chest drain management from insertion to removal and includes aspects of pain management and features of a functioning chest drain.
Toe bandaging for lymphoedema and venous ulceration
Authors: McCann Melanie
Published: May 2014

Lymphoedema and chronic venous insufficiency with venous leg ulceration have long been viewed as distinctly separate entities. This article explores how toe bandaging, a skill used routinely in lymphoedema practice, might benefit people being bandaged to treat venous leg ulcers. A small research study identified that 12 out of 124 people receiving high compression bandaging for venous leg ulcers without toe bandaging developed toe ulceration during a 2-year period. A second study has found no episodes of toe ulceration in patients receiving toe bandaging as part of their care. Unfortunately, there was significant heterogeneity between the two trials in terms of the client group, duration of bandaging and bandaging techniques, meaning that firm conclusions could not be extrapolated. A brief discussion of the pathophysiology and bandaging techniques used for lymphoedema and venous leg ulcers is used in this article to try and explore the rationale behind whether to bandage the toes or not, and to try and help practitioners decide whether toe bandaging should become part of all compression bandaging regimens.
An accountable fistula management treatment plan
Authors: Thompson Mary Jo , Epanomeritakis Emanuel
Published: May 2014

An accountable fistula management treatment plan focuses on combining effective medical and nursing treatment with effective and efficient pouching technique and equipment to ensure patient comfort. Small bowel fistula following abdominal surgery can provide challenges in patients’ medical and nursing management. This article describes a case study of the successful medical and nursing management of a patient post-abdominal surgery. Within days of surgery a small bowel fistula formed within an abdominal wound. Medical management involved the use of total parenteral nutrition, electrolyte balance management, nil orally and Sandostatin medication. The nursing interventions comprised accurate intake and output measurement, effective and efficient pouching systems and appropriate psychological care. The medical and nursing interventions provided during the healing process are outlined together with the assessment and evaluation of a new innovative wound management pouch. This system proved invaluable in the successful containment of a high small bowel effluent and skin preservation. In an attempt to share best practice a pictorial guide is provided to demonstrate the correct application of the pouching system and technique. This article provides details of an accountable fistula management treatment plan which resulted in the successful spontaneous closure of the small bowel fistula coupled with excellent cost-effectiveness and patient comfort.
Tuberculosis and the implications for healthcare workers in hospitals
Authors: Aziz Ann-Marie
Published: May 2014

In response to concerns about the rising incidence of tuberculosis (TB) in the United Kingdom, the National Institute for Health and Clinical Excellence has issued fresh guidance on TB and its management for prevention and control. Inadequate infection control procedures have been cited as the main contributing factors to institutional outbreaks of the disease. The control and prevention of TB in hospitals is best achieved by three approaches: early diagnosis, good isolation management and adoption of personal protective equipment. Implementing appropriate infection control policies and procedures can reduce transmission of TB, help increase healthcare workers’ awareness and compliance with practice and improve patients’ stay in hospitals. This article highlights the role of healthcare workers in minimizing the risk of transmission of TB and reviews the current infection control recommendations for the management of patients with TB.
Foundation degree students as work based learners: the mentor’s role
Authors: Wareing Mark
Published: May 2014

Healthcare assistants and support workers are beginning to access higher education programmes to expand their roles and practice. One example has been the development of the foundation degree (FD) – a 2-year diploma level course delivered via work-based learning. These undergraduate workplace learners require the support of mentors and assessors. It is proposed that traditional notions of mentorship are insufficiently attuned to the needs of work-based learners who need to prepare more for performance, rather than for practice. This argument rests on the observation that FD students are already immersed in practice and possess a wealth of experience to link to the underpinning knowledge gained from higher education. Evidence from a small piece of interpretive research is used to inform this discussion and highlight the unique needs of work-based learners within the clinical setting.
Managing urinary incontinence with BioDerm® external continence device
Authors: Wells Mandy
Published: May 2014

Urinary incontinence (UI) is a common problem, experienced by both men and women, and has a significant impact on quality of life. For male patients, UI can be caused by a number of conditions, including post-prostatectomy, neurogenic problems (such as Parkinson’s disease, multiple sclerosis and spinal cord injury), dementia, and an overactive bladder. One way of managing male UI is through the use of urinary sheaths – containment devices which capture the urine that is voided involuntarily. This article discusses male UI and its management, looking at common problems encountered when using urinary sheaths. It goes on to describe BioDerm®, a new type of continence device that could meet the needs of some groups of men, and is an alternative to the previously used external condom catheter-based system of urinary drainage.
The impact of nocturia on older people – implications for nursing practice
Authors: Booth Joanne , McMillian Laura
Published: May 2014

Nocturia is the most common and under-recognized urinary symptom, experienced by the majority of older people and increasing in prevalence with advancing age. It is associated with a range of debilitating effects including sleep disturbances, falls and instability, depression, and social isolation, yet it is accepted by many as a natural consequence of ageing. However nocturia, like most other lower urinary tract symptoms, is responsive to a range of simple lifestyle advice and behavioural interventions that may be delivered by nurses. This article calls for a raised awareness of this ‘silent condition’ to enable nurses to recognize nocturia, identify its impact on individuals and initiate and deliver intervention to improve the health and well-being of older people
Capacity to consent – health care and adult patients
Authors: McHale Jean
Published: May 2014

As touched on in the last issue, the Mental Capacity Act 2005,pwhich came into force in 2007, provided for the first time a system of comprehensive statutory regulation of the law concerning the care and treatment of adults lacking mental capacity. This article examines the impact of the Act for nurses, in relation to consent procedures for adults today. First, it considers who can decide on behalf of such adults. Second, it explores what criteria should be used to determine whether a person lacks decision-making capacity. Finally, treatment can be given to an adult lacking capacity when it is in their best interests and the article explores what this test means for the nurse assessing the patient.
Incontinence-associated dermatitis in patients with spinal cord injury
Authors: Foxley Susan , Baadjies Ruth
Published: May 2014

Evidence-based patient care for those with urinary and faecal incontinence involves routine tasks that are integral to essential patient care. However, over the past few decades, researchers have demonstrated how ritualistic practice in this area has become. There is also a growing range of skin care products that can be used to prevent incontinence-associated dermatitis and for nurses, deciding which ones to use can be problematic Incontinent patients have a 22% higher risk of developing pressure ulcers – when immobile this risk increases to 30% – and the often indiscriminate use of various lotions, without a significant evidence base, is a growing cause of concern. Maintaining healthy skin for those patients who have a spinal cord injury and also experience urinary and faecal incontinence is a challenge faced by nurses in primary and secondary care. Research undertaken in secondary care demonstrates that standardization to an evidence-based skin care regime, to be used after incontinent episodes, improves patient care in this specialist area.
Exploring the nurse endoscopist Role: a qualitative approach
Authors: Chapman Warren , Cooper Brian
Published: May 2014

Background: Previously, gastrointestinal endoscopy was undertaken only by medical staff. The nurse endoscopist role has recently been developed and is now in great demand. Barriers and facilitators are identified in similar nursing roles, though little research has been undertaken on the nurse endoscopist role. Aim: To examine perceptions of UK nurse endoscopists regarding their experience of the role. This qualitative study involved semi-structured interviews with eight UK nurse endoscopists. Data gained were analyzed qualitatively. The following categories emerged: role structure, collaboration, experience, and education and training. Results: The ‘role structure’ category showed that patient services were better where the nurse endoscopist role encompassed a more holistic approach. In the ‘collaboration’ category, the importance of relations with medical, nursing and management colleagues was observed. It was found that nurse endoscopists may be providing an inferior service due to being given lower priority than medical endoscopists. The ‘experience’ category showed nurse endoscopists valued their nursing experience, while specific endoscopy nursing experience prior to becoming an endoscopist was also useful. The ‘education’ category showed that degree-level education and training were important when accessed, in addition to prescribing courses. Conclusion: Nurses undertaking endoscopy have potentially satisfying roles, which allow them to perform effectively. The roles should be planned adequately and practitioners should receive appropriate degree-level education. Furthermore, patients should receive equitable treatment regardless of which profession undertakes the endoscopy.
Pain assessment and management in surgical nursing: a literature review
Authors: Bell Liz , Duffy Anita
Published: May 2014

Although postoperative pain assessment and management is an integral part of surgical nursing practice, it remains ad hoc despite numerous costly empirical research studies. Patients have a right to pain relief; however, the barriers to assessing and managing patient pain in practice have not as yet been overcome. A literature review to establish the main barriers to effective postoperative pain relief in clinical practice was carried out. The findings suggest that time management, and attitudes and beliefs of both patients and nurses are significant factors hampering practice. The authors conclude that future research in this area is futile, and suggest that nurses should focus on auditing their own practice to improve the effectiveness of pain management in practice and enhance standards of care.
The impact of European Union law on public health
Authors: Hodgson John
Published: May 2014

The previous articles on the European Union and health law have looked at the effect of EU law on the practitioner and on the patient. This article considers the impact on public health. This is a broad concept, and the impact of EU law is equally broadly felt. There is a general recognition of the importance of health issues, reflected in Article 152 (1) EC, ‘A high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities.’ This article focuses particularly on the impact of Article 152 on public health within individual member states.
Managing anxiety in the elective surgical patient
Authors: John Michael
Published: May 2014

Patients coming into hospital can suffer a great deal of anxiety – Mathews et al (1981) suggested patients who undergo surgery experience acute psychological distress in the pre-operative period. These fears manifest themselves as uncertainty, loss of control and decreased self-esteem, anticipation of postoperative pain, and fear of separation from family (Egan et al, 1992; Asilioglu and Celik, 2004). As technical advances and improved anaesthetic techniques become available to the NHS, the ability to offer day surgery to a wider patient population is increasing. In fact Bernier et al (2003) and Elliott et al (2003) have suggested that 60% of future operations will be day procedures. This means as health-care professionals, nurses will have shorter time available not only to identify patients who may be experiencing anxiety, but also to offer them the support they need to cope with the surgery. Anxiety can have a profound effect on patients – it affects them in a variety of ways, from ignoring the illness. which could have a serious impact on the patient’s life, to the constant demand for attention which can take the nurse away from the care of other patients on the ward (Thomas et al, 1995). Recently, there has been increasing interest in the possible influences of properative anxiety on the course and outcome of surgical procedures and the potential benefits of anxiety-reducing interventions (Markland et al, 1993). Caumo et al (2001) suggested that pre-operative management of a patient’s anxiety would be improved if health-care professionals had more knowledge about the potential predictors of pre-operative anxiety.
Impact of an enhanced recovery programme in colorectal surgery
Authors: Slater Rebecca C
Published: May 2014

Surgery is undergoing revolutionary change as a result of newer approaches to pain control, the introduction of techniques that reduce the post-operative stress response, and the use of minimally invasive operations, such as laparoscopic surgery. As demand for hospital beds continues to escalate, it is paramount that patients recover from surgery quickly and safely; the use of evidence-based interventions to hasten recovery within an enhanced recovery programme (ERP) can play a vital role in achieving this, as well as reducing costs by shortening hospital stay. This article outlines the principles and key elements of an ERP, and discusses how it can help to achieve an improved and safe recovery and shorter hospital stay for patients, thereby reducing the cost to the NHS of inpatient treatment and recovery. The literature surrounding the development of ‘enhanced recovery’ (also called ‘fast-track’) surgery is reviewed to determine whether it is appropriate for patients undergoing elective colorectal surgery.
Managing wound pain: is there an ‘ideal dressing’?
Authors: Benbow Maureen
Published: May 2014

Dressing choice, it could be said, is a personal matter which is dependent on many varied factors. For example, the tissue involved, the stage of healing, underlying pathophysiology, the current state of the wound, the aims of treatment, the health professional’s training and past experience of using particular dressings, and the knowledge and competence of the nurse applying and removing the dressing. This highlights the complexity of knowledge and skills needed to manage patients’ wounds with dressings—a complexity that is frequently overlooked or underestimated by nurses wanting to learn about ‘the dressings’ rather than managing the ‘patient with a wound’
Prednisolone in the management of patients with Crohn’s disease
Authors: Cronin Elaine
Published: May 2014

Glucocorticoids, a type of steroid hormone, are widely used in the treatment of inflammatory bowel disease (IBD) in patients with Crohn’s disease or ulcerative colitis. Many patients with these conditions are managed conservatively outside hospital, with continued support from their gastroenterologist and occasional glucocorticoid medication. However, glucocorticoids are not a long-term solution for anyone with IBD, since they carry many unwanted side-effects, and can damage body parts and function years after ingestion, particularly if the dose was high and for longer than 6 months. In the short-term, glucocorticoids can produce some very impressive results, but patients need to know the facts about them and what they should and could expect from taking this medication. This article gives an outline of one of these drugs—prednisolone—what it is used for, and the side- effects that may arise.
Hypoglycaemia, sleep and the problems of cheap air travel!
Authors: Green Barrie
Published: May 2014

As I write this piece I must confess to being an insulin dependent diabetic (or whatever the current politically correct description is), and according to my GP, the second worst controlled diabetic in his surgery. The interesting fact of the latter point is that both myself and the other person are both Registered Nurse and should probably know better However, he continues to persevere with the vain attempt to get my HbA1 (long term blood sugar average) to the ideal 6.5% level, rather than its current double-figured measurement. (NICE, 2004). I him that the levels I currently achieve in this matter would have been considered acceptable when I was diagnosed 30 years ago, after which he inevitably reminds me that not only am now 30 years older, but things have moved on considerably. I do know better, and acknowledge that effective blood sugar control is important to the prevention of complications, but it hasn’t always been either easy or convenient.
Palliative care: a case study and reflections on some spiritual issues
Authors: Ireland Jillian
Published: May 2014

Being aware of notions of spirituality and ethnicity are perhaps at no time as important in nursing as at the end of a patient’s life. This paper reflects on a case study of a patient receiving palliative care who was a nurse from Africa. One key reflection that arose from this case is ‘what is spirituality?’ How this is expressed is a dynamic process, and cannot necessarily be captured by a one-off question and answer session. The following case study highlights that what we want at the end of life, or may think we would want is not at all fixed. Therefore, nurses caring for dying patients need to be open-minded, and check regularly that the patient’s chosen pathway is being followed. Also, there must be space for patients to change their minds. Tools are available and might be usefully adapted to suit individual patients’ needs.
Sacral nerve stimulation for the management of faecal incontinence
Authors: Sharpe Allison , Read Andrea
Published: May 2014

Faecal incontinence is a distressing and embarrassing problem that can have a profound affect upon quality of life. The true incidence is unclear, as figures from studies vary depending on the definition used and the population studied. Data from a comprehensive study by Nelson et al (1995) found that 2.2% of the population has faecal incontinence and 10% of those have severe symptoms. The incidence increases with age (Perry, 2002) This article sets out to highlight the importance of assessment along with exploring appropriate conservative and surgical management options for faecal incontinence. If conservative management fails, sacral nerve stimulation (SNS) is one treatment option which is a minimally invasive technique allowing modulation of nerves and muscles in the pelvic floor. The procedure is carried out in two stages: the diagnostic stage involves a peripheral nerve evaluation (test) and a therapeutic stage involves permanent implantation of the stimulating device. Results from a recent study focusing on the medium term follow up for SNS will be presented.
Breaking down barriers to patient engagement
Authors: Wilson Jo
Published: May 2014

During the RCN congress this month, patient engagement is a key topic that nurses should be discussing. There is increasing evidence that patients who are better informed and more engaged in their own care are more likely to be knowledgeable, to follow their chosen treatment plans and to have better lifestyle, quality of life and wellbeing
Switching to home-based SCIg for Multifocal motor neuropathy (MMN)
Authors: Woodall Amanda , Jones Samantha
Published: May 2014

Multifocal motor neuropathy (MMN) is an immune-mediated disorder with slowly progressive asymmetric weakness of the limbs that can lead to significant disability. The recommended treatment is intravenous immunoglobulin (IVIg) which is often administered in a hospital setting. When self-administered in the home setting both subcutaneously administered immunoglobulin (SCIg) and IVIg provide patients with greater autonomy. The Department of Health’s National Service Framework for long-term neurological conditions promotes supported self-care and self-management for patients living with a chronic disease. This paper reports the objective assessment of three adults with MMN who, supported and trained by two specialist nurses, were switched from IVIg to 16% SCIg self-administered at home. Reasons for switching to SCIg included inconvenience of IVIg treatment (2 patients) and pulmonary embolus after IVIg (1 patient). Grip strength, time to complete a 9-hole peg test in the left/right hands (2 patients), and duration of right heel raise (1 patient) were assessed pre-SCIg and during ongoing maintenance treatment (range: 160-200 mL SCIg/week). With regular assessment of patients’ responses, the SCIg dose was adjusted, when required, to maintain the patients’ normal performance. SCIg self-administered at home was an effective alternative to IVIg in these patients.
Exudate, infection and patient quality of life
Authors: Benbow Maureen , Stevens Jane
Published: May 2014

Efficient and cost-effective management of excessive wound exudate continues to present unique challenges to nurses. Accurate patient and wound assessment is essential to inform the treatment and selection of suitable dressings. The wide range of modern wound management products should be sufficient to meet the needs of every wound type at all phases of healing, and as circumstances change. However, there are still situations in which nurses are having to change dressings a number of times in 24 hours to prevent maceration (i.e. the softening and whitening of skin that is kept constantly wet), soiling, and the potential for cross-infection. There is no easy solution to the problem, but as nurses become more knowledgeable about identifying and managing the causes of excessive exudate, the available management options, and, as dressing materials become more sophisticated, practice should improve in this area.
RCT of urethral versus suprapubic catheterization
Authors: Dixon Liz , Dolan Lucia M , Brown Karen , Hilton Paul
Published: May 2014

Objective: To compare the use of intermittent urethral catheterization with indwelling suprapubic catheterization in women undergoing surgery for urodynamic stress incontinence or uterovaginal prolapse. Design: Randomized controlled trial. Setting: Tertiary referral urogynaecology unit. Population: Women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence. Methods: Women were randomized into one of two groups. Group 1 had bladder drainage using a suprapubic catheter inserted in theatre. The catheter was left on free drainage for 48 hours post-operatively before clamping. Group 2 was catheterized intermittently post-operatively. Main outcome measures: Length of post-operative hospital stay: time to resume normal voiding (defined as voided volumes greater than 200 mls and residual urine volumes less than 100 mls on three occasions); number of urinary tract infections (UTIs); catheterization costs; patient experience (determined from questionnaire); and a pain score. Results: 75 women were randomized; 38 to suprapubic catheterization; 37 to intermittent catheterization. Three were withdrawn from study, leaving 36 women in each group. Groups were closely matched for age and type of surgery undertaken. Length of hospital stay and total duration of catheterization were both significantly shorter for the intermittent catheterization group; although there was no difference in the rate of UTI between the two groups. There was no clear patient preference for a specific catheterization method. Conclusions: The use of intermittent catheterization following urogynaecological surgery is associated with a more rapid return to normal micturition and a shorter hospital stay, although the clinical significance of the difference is perhaps limited.
The importance of effective catheter securement
Authors: Fisher Jayne
Published: May 2014

This article examines the importance of securing/fixing indwelling urinary catheters. The Oxford English dictionary interlinks the two words—‘secure’ and ‘fix’—as having the same meaning. To secure the catheter should not be confused with ‘support’, whereby the weight of the urine drainage bag is supported with the use of velcro straps or a sleeve. The author introduces the need for the concept of this practice to be at the forefront of nurses’ minds in all settings, and this is demonstrated through the use of case studies. Current guidance in this area is reviewed, as well as the problems that can arise when catheters are not secured properly and the available products for health professionals to use
Drug policy, intravenous drug use, and heroin addiction in the UK
Authors: Geraghty Jemell
Published: May 2014

In order to fully understand and appreciate today's drug problem in the UK, the foundations of drug legislation and the history of drug evolution require exploration. This paper critically examines the history of drug policy and the growth of heroin addiction from the perspective of a novice researcher who works closely with intravenous drug users in relation to leg ulceration and wound care in the acute setting. Today's drug policy has come a long way in understanding the problems of heroin addiction and establishing services to meet intravenous drug users' needs and the needs of society. This paper highlights the early warning signs of drug addiction and growth within the UK from an early stage with key areas such as who the early users were and how addiction grew so rapidly between 1920 and 1960. Current policy and decision makers as well as clinicians and researchers in this field must understand the impacts of past policy and embed it within their decisions surrounding drug policy today.
Improving record keeping: important lessons for nurses
Authors: Glasper Alan
Published: May 2014

Professor Alan Glasper discusses the importance of record keeping for nurses and the clear, intelligible and accurate (C I A) gold standard toward which health professionals should strive.
Developing a ‘model of transition’ prior to preceptorship
Authors: Broad Paul , Walker Jennifer , Boden Rebecca , Barnes Abbie
Published: May 2014

It has long been recognized ( Kramer, 1974 ) that the transition from student to qualified nurse or midwife is a steep learning curve which Kramer famously described as a ‘reality shock’. The University Hospital of North Staffordshire (UHNS) NHS Trust has recently taken its established preceptorship programme a step further by integrating ‘key’ components into the final module (module 9) of nurse/midwifery training, now referred to as the ‘transition’ module. The development of this new and exciting ‘shared learning’ approach has been the result of collaborative working with the tutors at Keele University and the clinical education team at the UHNS Trust. The subject material introduced into module 9 aims to both reflect and support the current university curriculum. Initial verbal and written feedback from students who have progressed through the ‘transition’ module has been both positive and encouraging. Students have identified that they feel more prepared to take on their new roles, confident in the knowledge that they can seek support from the lead preceptor nurse/midwife prior to qualifying.
Homeostasis 2: Nurses as external agents of homeostatic control
Authors: Clancy John , McVicar Andrew
Published: May 2014

There are analogies between the components of homeostatic control and the components of the nursing process. Some nurses are familiar with the terms ‘normal’ and ‘homeostasis’ when referring to parameters of assessment associated with observations of vital signs, blood results and urinalysis. However, few nurses relate the components of homeostasis with the components of the nursing process. The last article, the first in a series of six ( Clancy and McVicar, 2011 ), discussed the principles of homeostasis in restoring normal body function. This article, and others in this series, will discuss how the principles of homeostasis apply to health, illness and healthcare intervention. Taking a case study approach, the authors will highlight the role of the nurse as an external agent of homeostatic control. Nature—nurture interactions are responsible for health, illness and individualized health care.
The growth of compensation culture, and its impact on society
Authors: John Tingle
Published: May 2014

John Tingle discusses a report by Lord Young of Graflham to the Prime Minister on the operation of health and safety laws and the growth of the compensation culture.
Managing the psychosocial aspects of heart failure: a case study
Authors: Sykes Catherine , Simpson Susan
Published: May 2014

Background:

Depression is common in patients who have heart failure. This article presents a brief psychological intervention that could be useful for heart failure patients with depression that is likely to be precipitated by heart failure.

Method:

A brief intervention was designed to help heart failure patients. It was delivered in an outpatient setting as an adjunct to a nurse consultant‐led clinic. A case study of ‘Albert’, who completed measures at 1 month on the waiting list before the intervention, and at 6 months after completion of the intervention is presented.

Results:

The impact of the intervention was limited but it did show that the patient's scores on the emotional items of the Minnesota Living with Heart Failure Questionnaire had improved. The patient also used more active coping skills after the intervention. The patient self‐reported an improvement in his loneliness, depression and sleep problems. The nurse consultant involved in his care reported an improvement in his anxiety about his condition.

Conclusions:

This brief intervention showed some benefits for Albert. Ideally, more follow‐up sessions should be provided. However, the patient stated that he felt that the intervention had helped him to start managing his heart failure.
Homeostasis 5: nurses as external agents of control in breast cancer
Authors: Clancy John , McVicar Andrew
Published: May 2014

Breast cancer is caused by a homeostatic imbalance of cell division. Healthcare practitioners need to understand cellular activities to appreciate the physiological basis of health (homeostasis), the pathophysiological basis of illness and the physiological rationale of healthcare. Cells are the ‘basic unit of life’ ( Clancy and McVicar, 2011a ). This article describes normal cell division and the anatomy and physiology of the breast and, using a case study, will show how breast cancer is a homeostatic imbalance of cell division. There are analogies between the components of homeostasis and the components of the nursing (healthcare) process ( Clancy and McVicar, 2011b ) in the condition of breast cancer. After reading this article, nurses should be able to: understand that breast cancer is a cellular hence chemical imbalance that causes uncontrollable mitotic division of breast cells; understand how the cell cycle of cancer cells differs from that of normal cells; identify nature-nurture interactions involved in the aetiology of breast cancer; understand that when caring for people with breast cancer, health professionals including oncology nurses are acting as external agents of homeostatic control as the patient ‘recovers’ from breast cancer, and also to some extent when reducing signs and symptoms, hence quality of life, by providing palliative care.
How healthy are our nurses? New and registered nurses compared
Authors: Malik Sumaira , Blake Holly , Batt Mark
Published: May 2014

This study examined the health behaviour of nursing staff, comparing registered and pre-registered nurses in terms of their self-reported health and lifestyle behaviour. In total, 325 pre-registered nurses and 551 registered nurses, based at the same university teaching hospital and located within an acute NHS trust, completed a self-administered health and lifestyle questionnaire survey. With the exception of smoking behaviour, registered nurses generally had a healthier lifestyle compared with pre-registered nurses. However, when examining the overall health profile of the sample, the study reveals that there is room for improvement in the health and lifestyle behaviour exhibited by both registered and pre-registered nurses. Almost half of the sample failed to meet public health recommendations for levels of physical activity, almost two-thirds did not consume five portions of fruit or vegetables daily and almost half ate foods that were high in fat and sugar content on a daily basis. These findings are alarming given the current government emphasis on the health of NHS staff and the important role that nurses play in influencing lifestyle choices among their patients. There is an urgent need to target education and support services to improve the diet and exercise habits of nursing professionals.
Anthracycline extravasations: prevention and management
Authors: Roe Helen
Published: May 2014

This article highlights the importance of being knowledgeable about anthracycline extravasations, including their prevention, early detection, and prompt and effective management. It also emphasizes the need for chemotherapy nurses to document and report all extravasations when they occur, summarizes the current management options, and offers recommendations for clinical practice. Extravasation refers to the unintentional administration of an agent into the surrounding tissue instead of the venous system; in this case, vesicant chemotherapy. Anthracycline extravasations can lead to significant and lasting tissue damage, infection, pain, and functional impairment; they remain a feared consequence for both the patient receiving the chemotherapy and the nurse administering it. The management of anthracycline extravasations remains a constant challenge to the professionals caring for the patient. One of these challenges is the lack of evidence for many of the treatment options available. The systemic antidote Savene® is the only approved treatment for anthracycline extravasations. It has proved highly efficacious and well-tolerated in prospective clinical studies and in routine clinical practice. Despite national and international professional organizations recommending Savene in their extravasation guidelines, many cancer networks in England still exclude it from their local protocol. Funding decisions regarding the use of supportive treatments are often made on the basis of clinical need; it is, therefore, imperative that nurses promptly report all extravasations or they will remain unknown and management of extravasations will not improve.
GuardlVa: a novel antimicrobial haemostatic IV dressing: Part 1
Authors: Donnellan Peter D , Real Keith , Beilliú Máire Ní
Published: May 2014

HemCon GuardlVa® is a hydrophilic polyurethane sponge dressing impregnated with the broad spectrum antimicrobial agent chlorhexidine gluconate (CHG) and a proprietary formulation of the haemostatic agent oxidized cellulose. The intended use of the dressing is to absorb exudate, cover and protect catheter sites. Some common applications include intravenous (IV) catheters, other intravenous catheters and percutaneous devices. GuardlVa is also the only IV site dressing indicated to control surface bleeding from percutaneous access sites.

A clinical study in healthy human volunteers has demonstrated the ability of the GuardlVa dressing to significantly suppress skin flora re-growth. The antimicrobial and haemostatic efficacy of the GuardIVa dressing and its effects on wound healing have also been demonstrated by independent laboratories in a number of in-vitro and in-vivo tests. These data suggest that GuardIVa would be an effective component as part of a catheter site regimen to help reduce skin microbial colonization, provide sustained antimicrobial protection against the major organisms responsible for catheter-related blood stream infections (CR-BSIs) and prevent the risk of CR-BSIs.
The diabetic foot: an overview of assessment and complications
Authors: Turns Martin
Published: May 2014

Diabetic foot problems are a common complication of diabetes mellitus and can lead to morbidity and mortality. Foot disease is the leading cause of non-traumatic lower-limb amputation in the developed world ( National Institute for Health and Clinical Excellence (NICE), 2004 ). Diabetic foot disease is a result of three main pathologies, which can occur singly or in combination. These are: peripheral neuropathy, peripheral arterial disease and infection. Consequences of these pathologies are ulceration, Charcot foot, painful neuropathy, gangrene and amputation ( NICE, 2004 ). This article offers a podiatrist perspective of the management of diabetic foot problems, from initial assessment to the management of complex foot disease. Patients with a diabetic foot problem must be assessed thoroughly and referred to the local multidisciplinary team, where appropriate ( NICE, 2004 ). Recurrence of ulcers is common, and therefore good foot health education, adequate footwear and regular podiatry, if required, must be an integral part of the patient's review process ( NICE, 2004 ).
International study of a continence device with 12-hour wear times
Authors: Durnal Ann M , Maxwell Terri R , Kiran Ravi P , Kommala Dheerendra
Published: May 2014

This international, phase III, 215-day, open-label, non-randomized, multicentre study assessed the safety and efficacy of 12-hour wear times with a novel colostomy continence control device in participants with end colostomies. Study stages were usual pouching (21 days), wafer transition (14 days), device ‘ramp-up’ for 4, 6, and 8 hours (21 days), and 12-hour device wear (159 days). Of the 78 participants enrolled, 66 wore at least one device, and 45 completed treatment. Median device wear time was 11 hours per day during the final stage. Adverse events were reported by 12%, 7%, and 56% of participants during the usual pouching stage (0.01 events per participant per day), wafer transition stage, and device-wear stages (0.01 events per participant per day), respectively. No detrimental effects were seen on stoma vascularity or the normal gastrointestinal flora. The daily leakage-free rate was 0.89 for any leakage and 0.93 for type 2 leakage (e.g. not contained under the wafer). Most participants (87%) rated the ability of the device to restore continence as ‘good’ or ‘very good’. Overall, the study showed that the continence control device was safe and effective for wear times up to 12 hours per day in colostomy patients.
Blood glucose monitoring: an overview
Authors: Whitmore Catherine
Published: May 2014

Glucose monitoring is done to obtain information on blood glucose levels to ensure a therapeutic regimen; the aim is to maintain consistent glucose levels and avoid hypoglycaemia and hyperglycaemia. Self-management is central to diabetes control. Diabetes is individual, so self-monitoring of blood glucose (SMBG) targets and frequency of testing must be decided to meet each patient's needs. Nurses have key roles in education and advocacy. They can educate patients on what affects glucose levels, why they need to carry out SMBG, and how to interpret and act on the results. Nurses also match glucose monitoring meters to patients' needs by considering ease of use, technical features and lifestyle. Access to testing supplies is sometimes restricted through blanket policies and nurses have an advocacy role here in challenging inappropriate restrictions.
Childhood obesity: nurses’ role in addressing the epidemic
Authors: Rabbitt Aifric , Coyne Imelda
Published: May 2014

Obesity is a significant long-term health problem that is common among children and adolescents in Western countries. Being overweight or obese (extremely overweight) can contribute to type 2 diabetes in childhood and increase the risk of cardiovascular disease in adulthood. Primary prevention of obesity prevents the development of serious secondary complications in adulthood. Nurses can help parents and children by providing nutritional advice and, through weight management programmes, offer strategies for decreasing caloric intake and increasing physical activity. Nurses' actions should always take a whole-family approach because it is challenging for obese children to alter their dietary or physical habits if not supported by their families. Nurses should work with all members of the multidisciplinary team in addressing childhood obesity as it is a major health issue with long-term mobidities.
Evaluation of a nurse-led haemophilia counselling service
Authors: O'Shea Eadaoin , Coughlan Michael , Corrigan Helen , McKee Gabrielle
Published: May 2014

Genetic counselling and testing for females with a family history of haemophilia has long been advocated. However, there is little research in regard to clients' satisfaction with the existing counselling models in haemophilia, and in particular with nurse-led clinics. The purpose of this study was to evaluate whether clients were satisfied with a nurse-led carrier testing clinic and counselling service. A retrospective quantitative study of clients' satisfaction and perceived knowledge was undertaken using an anonymous questionnaire. A sample of 42 women who had attended the clinic in the last 12 months was identified. The response rate for the study was 71% (n=30). Two thirds of the respondents were 35 years of age or younger, 93% had a family history of haemophilia and 56% were diagnosed as carriers. Perceived understanding and knowledge increased significantly between the first and second appointments (p<0.001). Overall, the study identified a high level of client satisfaction with the nurse-led carrier testing clinic and counselling service.
Effect of education on knowledge, skills and attitudes around pain
Authors: McNamara Mary C , Harmon Dominic C , Saunders Jean
Published: May 2014

Aims:

The purpose of this study was to assess the effectiveness of an acute pain educational programme in improving nurses' knowledge, skills and attitudes around postoperative pain management.

Background:

Poor postoperative pain management is consistently reported as a problem for patients ( Chung and Lui, 2003 ; Klopper et al, 2006 ; Bell and Duffy, 2009 ). This is often attributed to health professionals' lack of knowledge and access to training programmes, which have been cited as barriers to effective pain management ( Wilkes et al, 2003 ; Dihle et al 2006 ). The Acute Pain Service (APS) team at HSE Mid-Western Regional Hospital, Limerick, and the Centre for Nurse and Midwifery Education developed a training programme for nurses in pain management based on the International Association for the Study of Pain (2005) curriculum for nurses.

Methods:

A convenience sample of 59 nurses attending an educational programme on acute pain management was studied. Validated questionnaires were completed before, immediately after and 6 weeks after the educational programme to assess knowledge and attitudes towards acute pain management. Nurses were also asked to rate their views on 18 statements on acute pain management.

Results:

The acute pain educational programme intervention improved nurses' knowledge and attitudes towards pain assessment and management (p<0.01). It was most effective immediately after the pain education programme.

Conclusion:

Continuing evidenced-based educational programmes in pain management can improve nurses' knowledge of pain. The results of this study could guide the development and implementation of continuing educational programmes for nursing staff in providing patients with evidence-based pain management.