bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing proteinuria in hypertensive pregnancy
Authors: Davies Lynn , Waugh Jason , Kilby Mark
Published: May 2014

The development of proteinuria in a hypertensive pregnancy is significant, as the likelihood of both maternal and fetal complications increases when proteinuria is present. Pregnancies complicated by gestational hypertension only have been shown to have a similar outcome to normotensive pregnancies. Accurate, rapid detection and quantitation of proteinuria is therefore essential for the management of these high-risk patients. However, at present, a variety of different ‘screening tests’ can be employed and there is no universally accepted ‘gold standard’ laboratory assay. The prevalence of proteinuria is thus dependent upon the accuracy of the screening test and the total amount of protein in a 24–hour collection is dependent on the biochemical assay employed in the laboratory. Owing to the discrepancies between dipsticks and laboratory assays, there can be confusion when evaluating results from investigations and comparisons between studies are difficult to interpret.
Staff experience in vaginal breech delivery
Authors: Thornton Jim , Hayman Richard
Published: May 2014

In 2000 Jean Robinson claimed (Robinson, 2000) that midwives were losing their skills at breech delivery. A study by Hannah et al (2000) provided evidence that a policy of elective caesarean section reduces fetal morbidity, and this may have made many people reluctant to attempt vaginal delivery.
Midwife-led units: getting it right
Authors: Warriner Sian
Published: May 2014

Numerous NHS reforms of the last 20years have led to the closure of many community midwife-led birth centres. This trend, while not reversed, has recently been slowed with the opening of a number of well publicised birth centres. Oxfordshire has been fortunate in being able to retain three community midwife-led units (MLU), Wallingford, Chipping Norton, and Wantage which provide care for women alongside a district general hospital in Banbury and a large teaching hospital in Oxford. These MLUs provide care, for women assessed as ‘low-risk’, and are characterised by a philosophy of viewing birth as a normal physiological life event. MLUs can be free standing, attached to a community hospital, as they are in Oxfordshire, or sit in or alongside a district or regional hospital.
There are many changes for midwifery to be proud about
Authors: McCormick Catherine
Published: May 2014

I am delighted to be asked to contribute to the 10th anniversary edition of the British Journal of Midwifery. The journal has been a real catalyst for change in midwifery publishing, offering excellent evidenced-based articles and keeping midwives in the UK and around the world in touch with changes in practice, education and innovations in NHS maternity services.
Northern Ireland in changing midwifery environments
Authors: Barrowman Lesley , Clarke Ruth
Published: May 2014

Northern Ireland (NI) has undergone significant changes within the last decade as the various initiatives to bring about peace have improved the quality of life for its various communities. Devolution and setting up of the Northern Ireland Assembly, which unfortunately is presently suspended, has had a positive impact on service delivery. Members of the Local Assembly have demonstrated a keen interest in developing the health services, including maternity services. Midwives have adapted to this and have developed the care they provide to women and their families.
A survey of maternity care in Sweden
Authors: Ragnar Inga , Tydén Tanya , Olsson Sven-Eric
Published: May 2014

A study was carried out in Sweden in 1998 and its purpose was to survey Swedish labour wards and the conditions under which Swedish midwives work. Sweden has a population of almost 9 million and more than 99% of all births take place in hospitals. Sweden has 55 labour units and births annually varying from 214 to 5074. Thirty four per cent of the midwives working in maternity care worked only in the labour ward and 24% worked in integrated labour and postnatal wards. Forty two per cent of the midwives rotated between labour and postnatal, gynaecological or antenatal care units. Thirty one per cent of the maternity clinics used computerized clinical records. Regular internal training for midwives occurred at 78% of the labour wards. Research and development projects carried out by midwives were reported by over half of the clinics. There are many small labour wards in Sweden, but this is a necessity because of the long distances between cities and towns in the northern part of Sweden.
Learning not to teach: part one
Authors: Brunt Christina
Published: May 2014

Part one of this series of two articles seeks to explain what happens within the inquiry-based learning (IBL) tutorial group of one midwifery curriculum. From the first tutorial meeting students are introduced to professionally relevant material which is used to enhance motivation for learning. Students are encouraged to make decisions and take responsibility throughout the course. Opportunities and support are provided to enable them to construct knowledge across traditional boundaries and paradigms. Through articulating their own understanding and listening to the interpretations of others, students develop different ways of seeing and understanding the complex world of midwifery practice. Some important issues for teacher and learner will be addressed. easily taught.
Caring for the newborn: infant nutrition part 1
Authors: Venter Carina , Dean Tara
Published: May 2014

This article is part 1 of an overview of infant nutrition. It discusses government and European Union advice, as well as the specific nutrients contained in breast milk and breast milk substitutes. Essentially breastfeeding should be recommended to all infants for at least the first six months of life and continued for as long as the mother wishes. Breastfeeding women and breastfed infants over six months should be advised to take a vitamin D supplement. Weaning should not begin before six months, but at least not before four months.

Breast milk is the ideal source of nutrition for infants because of its immunomodulatory components and its nutritional profile. If mothers choose not to breastfeed, cannot breastfeed or need to use a top-up feed, ordinary cows' milk should not be used for a number of reasons. Cows' milk based infant formula is the only suitable alternative. Midwives should be well informed regarding the benefits of breast milk and how the different formulas compare to breast milk and to each other. This will enable them to convey up-to-date information to pregnant women/mothers. Part 2 will discuss allergy prevention in small babies.
‘Six hat supervision’: a model for the supervisor of midwives
Authors: Burton Sally
Published: May 2014

If midwives are to recognize supervision as being a proactive supportive model, the role of the supervisor may require a degree of simplification and a new identity that can be readily recognized, understood and accessed. This article explores the use of ‘six hat supervision’ adapted from De Bono's (1990) metaphorical thinking hats as a possible solution. Each of the six hats represents a facet of the role of the supervisor and a direction of thinking, which is used proactively rather than reactively. The model's potential as a useful, supportive, visual analytical framework and deliberate supportive thinking technique is demonstrated by examining the role and responsibilities of the supervisor of midwives following a specific clinical incident. As a consequence of using ‘Six Hat Supervision’ it is anticipated that midwives will choose to seek support from supervisors who will then be well equipped to ensure that the practice of midwives is both safe and effective.
Reducing Stillbirths: a parent's perspective
Authors: Wildsmith Chris
Published: May 2014

As a young child I was always fascinated watching my toy yacht sail in boating ponds and I would often pester my parents to find new ponds to try. Fast-forwarding 30 years, I am sat next to a fantastic boating pond on a lovely summer evening in an unspoilt seaside town. My thoughts are all about my perfect son Elliot, who was born 13 months ago, as I watch the children pushing for the best spot and staring in awe as the wind catches their yacht sails. What could be a more perfect moment?
Students midwives' views of enquiry based learning: the BUMP study
Authors: Brown Sarah , Wilkins Carol , Leamon Jen , Rawnson Stella
Published: May 2014

One of the reasons enquiry based learning (EBL) has been adopted into midwifery education is that it is considered to make learning relevant to practice. This article reports on a qualitative exploration of EBL, which forms part of a larger action research pre-registration midwifery programme. Analysis of the data found four themes: facilitation; group interaction; evaluation of learning; and using triggers in EBL, linking theory to practice. Learning appeared to be affected by how the groups were facilitated and if the group dynamics were fully realized. Students appeared to use EBL as an opportunity to bring practice into the academic setting and engage in deeper learning which is probably why it was valued within the curriculum.
Using the postnatal period to help reduce obesity: The midwife's role
Authors: Keating Nicola Carmel
Published: May 2014

The postnatal period represents a key opportunity for education and support to be given surrounding weight loss ( Gore et al, 2003 ; Bastian et al, 2010 ; Cahill et al, 2010 ). Midwives, owing to their role and relationship with women, are in a unique position to provide this education and support. In this article, the possibility of providing a 6-week postnatal appointment with a midwife will be explored. This appointment would be aimed at providing weight-loss education and advice and offer further breastfeeding support, in an effort to combat the obesity epidemic. It will also highlight the importance of reflection as a tool for midwives to use in dealing with the issue of obesity.
Increased iron supplements offer no difference in birth outcomes
Authors: Bainbridge Jane
Published: May 2014

Australian researchers have found that increasing iron supplements from twice weekly to daily has no added benefIts for mother and baby
Group supervision: An introduction to annual reviews in midwifery supervision?
Authors: Roseghini Manjit , Nipper Bernie
Published: May 2014

This article describes the implementation of group supervision at a large maternity unit in London and its subsequent evaluation from the midwives who participated. In October 2011, following a Care Quality Commission (CQC) visit to a London NHS Trust, concerns were raised in relation to training and supervision of staff ( CQC, 2011 ). External report findings ( Drummond, 2011 ) were similar to those of the CQC in relation to poor staffing levels, high midwifery vacancy levels and the need to improve care for women through, for example, a new triage system and one-to-one care in labour. In response to a high number of vacancies and an increase in midwifery staffing establishment, a total of 44 midwives were recruited and in post by September 2011 (25 midwives were from Italy). Following the Local Supervising Authority of London action plan for all midwives to take part in a group supervision session, there was feedback from the Local Supervising Authority Midwifery Officer (LSAMO) ( Helleur, 2011 ) that 19% of midwives (n=76) in post had never had a supervisory annual review. In response, this new initiative of group supervision was set up by the London Local Supervisory Authority (LSA).
Education must not be made a scapegoat
Authors: Scott Helen
Published: May 2014

A Sunday Telegraph columnist recently wrote: ‘Intelligent nurses who squander half their training in the classroom, studying pseudo-academic subjects such as race awareness, arrive on the wards unable to take blood pressure or insert catheters…Perhaps its as well that they tend to cluster round the “nursing station” ignoring the patients’ (Marrin, 1999).
Nurses must now take control of their profession
Authors: Castledine George
Published: May 2014

Nursing has certainly hit the headlines this new year. Not only have nurses had to take the brunt of the pressure in relation to the flu casualties, but also people are starting to criticize nurses for wanting to be academic and professional. (Please also refer to pages 68 and 71.) There are three main problems in nursing at the moment: pay, conditions of service and education. There is a danger that these are being used by the Government to deflect the spotlight away from an NHS that is starting to break down.
Specialist nurses must understand clinical negligence litigation
Authors: Tingle John
Published: May 2014

As the largest professional group of health carers in the NHS, nurses are bound to come into contact with the clinical negligence litigation system. This may be as a witness to an act of negligence, or as a party to a claim. Also, a patient may allege that a nurse was negligent in carrying out treatment and that injury has resulted. Therefore, knowledge of the system will be beneficial. This is particularly so with specialist nurses as expanded professional roles mean an increase in legal accountability. Nurses undertaking expanded roles will be expected to perform at the level of the post-holder who normally carries out the clinical activity, in most cases a doctor. Professional practice in any sphere must accord with the law and this is particulary so with specialist nursing.
Devising an effective general nursing continence assessment tool
Authors: Winder Ann
Published: May 2014

Incontinence assessment forms are routinely used by nurses in order to implement the appropriate management, treatment and referral of patients suffering from bladder dysfunction. A thorough literature search using recognized databases revealed that no specific work has been carried out in respect of validating symptom scoring assessment tools for nurses. Validated symptom scores are available but these are generally used within specific areas of medicine, e.g. prostatic screening incorporates lower urinary tract symptom scores, and physiotherapy, to measure pelvic floor tone. This article examines the need for validity and symptom scoring within a general nursing incontinence assessment tool.
Why does modernization mean medicalization?
Authors: Castledine George
Published: May 2014

The fundamental core or soul of nursing is grounded in nurturing, care and healing. These practices have been carried out by a variety of compassionate individuals, from mothers to religious orders, to the modern day nurse. Today's nurse has been the product of an historical evolutionary process.
Principles for the correct administration of medicines: 1
Authors: Dimond Bridgit
Published: May 2014

Heather was drawing up antibiotics which were to be given intravenously to a patient suffering from a severe chest infection. She had to mix the antibiotic with a saline solution and then administer it to the patient. She had a lot of patients to care for and failed to notice that the expiry date on the antibiotic had passed. The patient subsequently suffered harm. Is Heather to blame?
The basic principles which apply to the writing of prescriptions
Authors: Dimond Bridgit
Published: May 2014

A woman in a private hospital was prescribed a top-up epidural following a hysterectomy. The junior doctor mistook a dose of 3ml of diamorphine for 30ml. The woman collapsed following its administration and the doctor was unable to use the resuscitation equipment as he had not had the necessary training. Although the consultant was able to revive her, she died a few days later (Kennedy, 2000). Who is liable?
Patient group directions to enable hospital nurses to supply medicines
Authors: Dimond Bridgit
Published: May 2014

Sarah is a nurse specialist in accident and emergency (A&E) nursing. She is told by the consultant that as a nurse specialist she is able to supply various ointments and pain killers for patients who are only seen by the clinical nurse specialist in A&E. She feels that this is the equivalent of prescribing and considers that there should be a more formal procedure. What is the law?
NHS targets are having negative impact on nurses
Authors: Castledine George
Published: May 2014

The outgoing chairman of the British Medical Association (BMA), Dr Ian Bogle, recently criticized the NHS as being too ‘target-driven’. His comments, which made headlines in many newspapers (e.g. Hawkes, 2003), emphasized the effects of the latest Government measures to ‘modernize’ the NHS. He said the suffocation of professional responsibility by production-line values left little room for the professional judgment of doctors or the needs of individual patients. He added: ‘Ministers and managers have muscled in on the doctor–patient relationship. Clinical decisions have been taken out of clinicians’ hands and the fundamental principle of care based on need has been superseded by the principle of care based on numbers' (Hawkes, 2003).
Using reflection in the care of a patient with lymphoedema
Authors: Woods Mary
Published: May 2014

This article describes an incident that occurred during a Iymphoedema clinic consultation between the author (a Iymphoedema therapist) and a patient with Iymphoedema of the leg. It focuses on the author's reflection of the incident, using Johns' model of structured reflection (Johns, 1995) to provide a framework. The incident highlights the importance of understanding the patient's perceptions of his/her swelling and its treatment and matching this to aspects of expert practice in order to plan and evaluate the treatment provided for the patient.
Medicinal products and consent by mentally capacitated patients
Authors: Dimond Bridgit
Published: May 2014

Roy Dawes has been diagnosed as having diabetes, but is not prepared to keep to the necessary diet which should have been able to control his condition. In particular he is a heavy drinker. He was therefore advised that he would require insulin and regular blood testing. He failed to comply with this regimen and the community nurse wondered if he could be compelled to have his medication. What is the law?
Nursing role in the management of constipation: use of laxatives
Authors: Peate Ian
Published: May 2014

Constipation is extremely common and may affect a variety of patients from different age groups. This article outlines the causes of constipation and describes the nurse's role in the management of patients with constipation, from assessment to intervention. The skills required of the nurse, including taking a detailed history from the patient, the subsequent examination, and the administration of laxatives are discussed in detail. Nurses are best placed to assess, plan, implement and evaluate care for patients presenting with constipation. The article stresses the need for healthcare professionals to aim to prevent constipation and to identify early those patients at risk of developing constipation, to ensure that patients' needs are met fully. Recommendations for good practice are given.
The NHS University should benefit all staff in the NHS
Authors: Glasper Edward A
Published: May 2014

The dawn of 2003 sees the launch of the NHS University (NHSU) consultation document Learning for Everyone: A Development Plan for NHSU (Department of Health (DoH), 2002). Pertinent to this educational debate is the reality that more than 2 million people are employed within the NHS and social care services and that this workforce consists of some of the most well educated and also some of the least well educated people in society.
Clinical nursing skills must be recognized
Authors: Castledine George
Published: May 2014

This year should hopefully see new initiatives in recognizing excellence in the practice of all nurses. The Government has recently reiterated its proposals in Agenda for Change (Department of Health (DoH), 1998) relating to the structure of nursing careers and has indicated that nurses' pay will be linked to expanded role activity.
New nursing roles must retain nursing's principles
Authors: Castledine George
Published: May 2014

Debates about the nurse's clinical role are always interesting, often controversial, and usually end up frustratingly deadlocked. Recently, discussions were held in Scotland aimed at producing a consensus statement about new nursing roles.We are often told that the time is right for nurses to develop their nursing care and yet, at the same time, there are many concerns and worries about the quality of the fundamental aspects of nursing care. Nurses, as generalists or specialists, work in almost every place where health care is delivered. New types of positions or modes of practice seem to arise at an ever-increasing rate. There are so many different titles used by nurses these days that it is not just the nursing profession that is confused, the patients are as well.
How can the working lives of NHS staff be improved?
Authors: Castledine George
Published: May 2014

The ‘Improving working lives’ (IWL) programme has been an important element in the Government's strategy to modernize the NHS (Department of Health (DoH), 2002). Over the next few months most NHS employers will be striving to achieve practice status and provide evidence that they are improving the working lives of their staff.
Correspondence
Authors: Farmer Paul , Jones Chris , Taylor Joanna
Published: May 2014

Care homes for elderly people are still being promoted as a ‘last resort’, even by the NHS, and not as part of community care. However, they should be promoted as a positive option for those who want/need the security, social inclusion, occupation, affection, communication and social environment that care homes can provide.
Delayed discharge from the perspective of older people
Authors: Lishman Gordon
Published: May 2014

The issue of delayed discharge or, to use the pejorative term ‘bed blocking’, as it is more commonly described, frequently grabs the media headlines. Much is made of the effect the problem can have on hospital waiting lists but there is little consideration of the impact that delayed discharge can have on the patients involved.
Nurse who ignored her patients' wishes and basic procedures
Authors: Castledine George
Published: May 2014

In the following case, Madge decided that she knew what it was that patients needed with regard to their nursing care. Over the years Madge had worked in many different nursing settings and when her family had grown up, she returned to full-time nursing at the local general hospital.
Male nurse who harassed and followed home a female colleague
Authors: Castledine George
Published: May 2014

Barry had worked as a staff nurse for many years on several wards at the local psychiatric hospital, and was well known among his colleagues for his pranks and mischievous acts. Female colleagues would warn each other of his ‘sexual banter’ which many just about tolerated.
The statutory framework for the control of medicines
Authors: Dimond Bridgit
Published: May 2014

This new legal series will aim to cover all aspects relating to the legal aspects of medicines. There have been extensive developments in the legal powers of the registered nurse and midwife in relation to the prescribing of medicines, and this series will cover all these developments and look at the issues which arise in the administration of medicines in a variety of clinical settings. This article will provide a background to the series by highlighting the statutory framework that is in place in relation to the control of medicines.
A compendium of nursing errors which could be avoided
Authors: Tingle John
Published: May 2014

The latest report of completed investigations from the Health Service Ombudsman (HSO, 2003) shows the largest number of nursing errors taking place that I have ever seen in my many years of commenting on HSO reports.
Are TVNs compromising their clinical practice?
Authors: Gray David
Published: May 2014

On first inspection there may not be a realistic link between the report into children's heart surgery at the Bristol Royal Infirmary 1984–1995 (The Bristol Royal Infirmary Inquiry, 2001) and the field of tissue viability. However, while the specialties are different there are some lessons that we can learn from Bristol.
Use of larval therapy to treat a diabetic patient's pressure ulcer
Authors: Semple Lorna
Published: May 2014

This case study reflects on the care of a diabetic patient with an extensive pressure ulcer on the heel. It addresses the issue of the limitations of scope of practice and expertise of the tissue viability nurse with regard to effective treatment of the diabetic foot. Methods of autolytic, sharp and surgical debridement are all attempted with varying degrees of success, together with one application of larval therapy. The importance of collaboration with members of the multidisciplinary team is addressed. Unfortunately, the final patient outcome is not yet known but this has provided a valuable reflective learning experience for myself as a tlssue viability nurse.
Short Report: Epidermolysis Bullosa
Authors: Pillay Elizabeth
Published: May 2014

Epidermolysis bullosa (EB) is a group of rare genetically determined disorders affecting the structure of the skin and sometimes the internal mucosa. Severely affected individuals may die in early infancy, or may live a life where they are never free of wounds. The charity DEBRA (Dystrophic Epidermolysis Bullosa Research Association) funds a healthcare team including eight specialist nurses who offer a service to all those affected by EB throughout the UK. Recent National Specialist Commissioning Advisory Group (NSCAG) funding has led to the provision of additional specialist services.
Communication barriers when managing a patient with a wound
Authors: Goode Mary Louise
Published: May 2014

The management of a wound can prove challenging to the nurse when the needs of a patient are complex and there are barriers to overcome. This case study discusses the methods used by a community nurse when considering some of the problems that presented as a result of communication difficulties with a patient. The use of a wound assessment tool proved valuable when collecting and organizing information and the importance of gaining adequate information at assessment is outlined. The article shows how communication impacts on the quality of care given, and how it effects the experiences of both nurse and patient, especially when the psychological and physical aspects of care are both equally demanding. The need for nurse and patient to work in concordance is reflected on as one of the lessons learnt from this case study.
It is time for the nursing profession to get serious
Authors: Castledine George
Published: May 2014

The media coverage of the RCN Congress this year has been lamentable. Perhaps this was because of the quality of the resolutions or discussion items. A satirical BBC Radio 4 news quiz programme picked up on one of the more absurd and inept resolutions which proposed that nurses should give up their caring role. How the news quiz report came over was that nurses are no longer prepared to do ‘menial’ tasks, such as washing bottoms. Unfortunately I was not able to be at Congress this year as I was engaged in speaking at two other nursing conferences. If I had been, I would have protested about how ridiculous and inappropriate the resolution was, as I strongly believe that caring is fundamental to all aspects of the nurse's role.
Research shows nursing agencies in a positive light
Authors: Sanderson Diana
Published: May 2014

According to the results of an independent study, last-minute agency nurses are a cost-effective way of covering unforeseen nursing shortages in NHS hospitals (Sanderson and Chaplin, 2004). This appears to turn conventional wisdom on its head, i.e. agency nurses can play an important role by delivering a highly cost-effective solution for short-term vacancies, particularly those that occur at the last minute. The fact that this flies in the face of popular opinion highlights the urgent need for more research.
An overview of meningitis: signs, symptoms, treatment and support
Authors: Peate Ian
Published: May 2014

This article aims to raise awareness of meningitis and its symptoms. It describes some of the practical support that can be offered to sufferers, their families and friends. Meningitis can kill and immediate action can and does save lives. The practice nurse or the nurse working in the accident and emergency (A&E) department may be the first person to be sought for advice; therefore, it is vital that he/she gains an insight and understanding of this disease in order to offer effective advice and take prompt action. A definition of the disease is given, and viral and bacterial meningitis are discussed. Epidemiological data are presented concerning rates of infection and mortality. The signs and symptoms are outlined and the mode of transmission and the treatment needed are also considered. The prognosis and possible complications are described. These include potential problems such as sensorineural deafness, raised intracranial pressure, the need for skin grafting and the amputation of limbs and/or digits.
Changing roles and titles: HCAs now deliver the care
Authors: Fulbrook Suzanne
Published: May 2014

Healthcare assistants (HCAs) are employed by healthcare institutions to assist other health professionals in the delivery of health care. As we speak they are not registered with a professional body charged to ensure that the standards of competence of its members are such so as to protect the public. All of this is set to change. The current debate centres on a perceived need to regulate HCAs (see p. 826).
Chronic obstructive pulmonary disease: importance of diagnosis
Authors: Booker Rachel
Published: May 2014

Chronic obstructive pulmonary disease is a common, smoking-related respiratory disease. It is responsible for considerable morbidity and mortality and accounts for a large amount of NHS resources. Despite this, it is underdiagnosed, often poorly managed and its impact on patients is underestimated (British Thoracic Society (BTS), 2001). The first step is to make an accurate diagnosis at as early a stage as possible. This article explores the prevalence, impact and presentation of the disease, and how it can be identified and diagnosed.
Traumatic injuries to the head and spine 1: mechanisms of injury
Authors: McLeod Anne
Published: May 2014

Trauma to the central nervous system can have devastating consequences on the person who sustained the injury and his/her family and loved ones. This article reviews the mechanisms of traumatic injury as these can determine the type of injury sustained. Additionally, primary and secondary injuries are explored. This is the first of two articles; the second article will appear in the next issue and will explore nursing considerations in the care of this patient group.
Not for resuscitation instructions: the law for adult patients in the UK
Authors: Dimond Bridgit
Published: May 2014

Marion, aged 55 years, has suffered from multiple sclerosis for 10 years and had reached the stage where she was wheelchair bound and had become extremely depressed. She was admitted to hospital for review of her medication and treatment plan. She discussed with a nurse what should happen in the event of her suffering a cardiac arrest and stated that she would not wish to be resuscitated. She had not discussed this with her relatives, nor had she put the instructions in writing.Two days later, when her daughter was visiting her, she had a cardiac arrest. Her daughter was anxious that every effort should be made to resuscitate her and asked the nurse to call the arrest team. However, the nurse said that Marion had told her that she did not want to be resuscitated and that was therefore binding upon her. The daughter disagreed. What is the law?.
The worldwide burden of COPD is on the increase
Authors: Cross Sue
Published: May 2014

The worldwide incidence of chronic obstructive pulmonary disease (COPD) is increasing and, in parallel, so is the social and economic burden.
Nurse manager who was rude to staff and lied about his qualifications
Authors: Castledine George
Published: May 2014

John was employed as a nurse manager at Bloomsday Nursing Home, a position he had held for 3 years. The home was a former residential home, which was converted into a nursing care. It was felt at interview that he would be an ideal manager as his curriculum vitae (CV) contained excellent references and a past employment history which demonstrated he had worked successfully at a similar level in another nursing facility.
Learning disabilities: there must be a change in attitude
Authors: Jukes Mark
Published: May 2014

Since the 1980s, in the UK we have accumulated quite a reservoir of evidence to support the fact that people with learning disabilities are not achieving access to equitable mainstream health screening and services. The late 1990s heralded a succession of guidance documents informing services in both acute and primary health care of such deficiencies, culminating in the launch of Valuing People: A New Strategy for Learning Disabilities in 2001 (Department of Health (DoH), 2001).
Older people deserve better lives and an end to abuse
Authors: Castledine George
Published: May 2014

You may have seen the advertisement on television about the comedian who tells his mother to pack her bags, as it is time for her to go into the local nursing care home. The irony of this scene is that the mother is neither frail nor vulnerable enough to warrant such behaviour. Unfortunately, however, many old people are persuaded to go into nursing care homes before their time, or arrive there following a medical crisis in their lives. Many people are often very quick to pass on the responsibilities for their ageing parents to someone else. Recently, there was a case in the national media about an old person who had been dumped by his relatives in the local hospital emergency department.
ECG interpretation causes debate
Authors: McIntosh M J
Published: May 2014

While the article by Brendan Docherty ‘12-lead ECG interpretation and chest pain management: 1’ (Vol 12(21): 1248–55) is a useful introduction to this area of practice there are a number of inaccuracies and areas of confusion.
Nurses should be more involved in DNR decisions
Authors: Castledine George
Published: May 2014

Do not resuscitate (DNR) orders continue to raise difficulties. Recently I was asked to talk to a group of nurses who worked in a hospice which had a close association with a large general hospital. A patient with renal failure had been transferred to the hospice for intensive nursing care. He was in a poor state and was unlikely to survive a transplant. His consultant, however, wanted him to be resuscitated and this was also the wish of the patient and his relatives.
Accountability and medicinal products 4: professional issues
Authors: Dimond Bridgit
Published: May 2014

A woman was prescribed a top-up epidural following a hysterectomy. The junior doctor had difficulty reading the prescription and discussed the dose with the staff nurse, Mary Brown. They mistook a dose of 3ml of diamorphine for 30ml. The woman collapsed following its administration and died a few days later. The staff nurse, Mary Brown, was subsequently reported to the Nursing and Midwifery Council.
The role of exercise training in patients with chronic heart failure
Authors: Appleton Barbara
Published: May 2014

The National Institute for Clinical Excellence (NICE) has recommended that exercise training be offered to patients with chronic heart failure (CHF). This recommendation is supported by research-based evidence from a variety of studies over the past 10 years. Initially, the studies were concerned primarily with the safety and effectiveness of exercise in these high-risk patients, but more recent studies have begun to investigate the most appropriate methods of exercise for this patient population. This article presents a systematic review of the literature relating to exercise training and CHF. It then attempts to identify, in light of the evidence, the most effective programme of exercise, including type, duration and degree of exercise. Finally, it discusses practical application and implementation of the research findings into everyday health care, including issues such as staff development and training, assessment, exercise and prescription for individual patients, and evaluation of the service.
The Plymouth skin and wound care service goes stateside
Authors: Butcher Martyn , Daniels Jill
Published: May 2014

In 2002 the authors were successful in bidding for an Innovations in Healthcare Travel Award donated through the British Journal of Nursing, in association with J&J Medical. With this grant they were able to travel to the USA and study health care in Boston Massachusetts. The trip was not without problems, both in arranging and subsequently visiting the area. However, both authors have learnt from the experience and have returned with lessons that can be implemented in their healthcare setting. The following is a personal account of that trip and the lessons learnt.
The threat of an avian influenza pandemic
Authors: Higginson Ray , Davies Kevin
Published: May 2014

At the 23rd International Council of Nursing (ICN) congress held in Taiwan last week, the one resounding message that came out of the conference proceedings was that of ‘preparedness’. Nurses, along with all healthcare professionals, need to be prepared to deliver their healthcare skills wherever and whenever it is necessary to provide effective treatment and care for patients.
Staff nurse who drank alcohol before and during her duties
Authors: Castledine George
Published: May 2014

Jane Gill was a 40-year-old staff nurse who worked mostly on night duty at the local hospital. She preferred working nights because it was easier to find someone to look after her children since her husband left her 2 years ago.
Cardiac disease in the non-cardiac surgical population: effect on survival
Authors: Naughton Corina , Feneck R
Published: May 2014

Mortality from cardiac disease is decreasing, yet the prevalence of ischemic heart disease, diabetes and hypertension is increasing. This, combined with an aging population, effects the characteristics of the surgical population. Survival in this subgroup of the non-cardiac surgical population has not been studied in a UK setting. This study aimed to determine the mortality rate at 1, 6 and 24months for patients with underlying cardiac risk factors undergoing elective non-cardiac surgery, and to identify independent risk factors associated with 1-year mortality (death within 365 days of original operation date). Following ethical approval, 1622 patients were included in the study. Demographic, pre-, peri- and postoperative variables were collected from medical and nursing notes. Follow-up was completed using the National Office of Statistics tracking system. Copies of death certificates were obtained on all patients who had died within 12months of surgery. Risk factors for 1-year mortality were identified using multiple regression modelling. Survival at 12months was 89%. The majority of cardiac-related deaths occurred within the first 6months of surgery. Independent risk factors associated with 1-year mortality were advanced age, preoperative angina, odds ratio=1.59 (1.02–2.47), surgery type, perioperative blood transfusion and a prolonged hospital stay. A significant portion of the non-cardiac surgical population who have underlying cardiac disease risk factors are at risk of a cardiac-related death within 1year of surgery. Patients with angina had nearly a 60% greater risk of death compared with asymptomatic patients. In the hospital setting, nurses with the appropriate pre-assessment and critical care competencies are pivotal to the successful managementof this group of patients. In the long-term, careful follow-up by the primary care team can help modify cardiac risk factors and potentially reduce cardiac-related mortality.
Poor standard assessment - putting patients at risk
Authors: Castledine George
Published: May 2014

An old adage which is often applied to nursing students and newly qualified nurses today is ‘can theorize, but can’t catheterize'. Some of the reasons given for this problem are: the overloaded curriculum; too much emphasis on theoretical achievement as opposed to clinical skills; lack of time in clinical areas for supervised practice, mentoring and clinical assessment; and difficulty in developing the right tools for assessing and evaluating clinical practice.
‘Appalling lack of care’ in UK nursing
Authors: Waterlow Judy
Published: May 2014

In response to George Castledine's column ‘Has nursing lost the plot’ BJN 14(15)) — Yes, it has! It really saddens and distresses me to say that I am pleased and admire the courage of the nurse who went undercover in order to bring the situation in many hospitals out into the open.Yes, I and very many nurses still working in all areas of care or retired believe that nursing started to ‘lose the plot’ about 20 years ago.The advent of Project 2000 in the early 1990s and the move to universities meant the closure of schools of nursing within the local area hospitals which could take students from that area.
Data protection rights and preserving confidentiality
Authors: Dimond Bridgit
Published: May 2014

The last two articles considered the right of others under Data Protection legislation to access a patient's records and the right to access medical reports for employment or insurance purposes. This article considers the duty of confidentiality and the provisions of the Data Protection Act 1998, which protect the confidentiality of health records.
Treatment options for patients with osteoarthritis of the knee
Authors: Lucas Brian
Published: May 2014

Knee osteoarthritis (OA) affects many older people and may result in pain and loss of function in the knee. The article explores the wide spectrum of treatments available, including education, exercise, pharmacological agents and surgery. The evidence for these treatments is examined so that nurses have a knowledge base on which to build their practice. The importance of individual patient characteristics and available resources when deciding on treatment options is emphasized. The article is intended to be of use for both acute and primary care nurses who care for patients with knee OA.
Nurse who used her registration for her own commercial interests
Authors: Castledine George
Published: May 2014

One of the cornerstones of good professional conduct is trust. In the following case, Paula used her senior nursing position to gain both financially and personally.
The NHS Redress Bill: a rocky road lies ahead
Authors: Tingle John
Published: May 2014

The NHS Redress Bill (the Bill) has just been published (HL Bill, 2005–2006) giving effect to Recommendation 1 of the Chief Medical Officer's Report (Department of Health, 2003) for reforming the approach to clinical negligence in the NHS. This recommendation was to introduce an NHS Redress Scheme (the Scheme) to provide for investigations when things go wrong, remedial treatment, rehabilitation and care, explanations and apologies, and financial compensation in certain circumstances.
Rediscovering the positive side of nursing
Authors: Castledine George
Published: May 2014

Recently I was lambasted by a letter to the BJN from a reader who feels strongly that I never have anything possitive to say about nursing (p1171). Sarah Forbes is a nurse who has been qualified for five years, and agrees that nursing as a profession leaves a lot to be desired. She believes, however, that in my columns I seem to be ‘damning the entire community of nurses’.
A nurse-led clinic in chronic and allergic contact dermatitis
Authors: Brown Maureen H
Published: May 2014

It has generally been acknowledged that the incidence and prevalence of contact dermatitis has increased in recent years. It can develop at any stage of a person's life span (rare before puberty), and in many different circumstances and occupations. The demand on consultant dermatologists for contact dermatitis services has resulted in the depletion of some essential components to the investigation process, and patient outcomes have been affected. In recent years it has also resulted in the development of nurse-led contact dermatitis services. The traditional role of the dermatology nurse in contact dermatitis is to carry out patch testing. Nurse-led services require the wider acquisition of skills and knowledge in relation to contact dermatitis. This article is an attempt to introduce the complexities of contact dermatitis, and nurse-led services.
Patients deserve better from the NHS complaints system
Authors: Tingle John
Published: May 2014

The quality of any enterprise is judged not only by the quality of its products or services but also by the quality of its complaints system. A company with a responsive complaints system will be much more valued and complainants will hopefully go on to become advocates for that company. An unresponsive company will tend to wither on the vine and will cause customers and clients to feel intense anger and resentment towards it.
Senior nurse whose incompetence resulted in the death of a patient
Authors: Castledine George
Published: May 2014

Mr Johnson had suffered a severe spinal-cord injury and following several years of intensive rehabilitation required further surgery. Unfortunately, following this operation his condition deteriorated and he needed intensive nursing care. A number of new treatment regimens were initiated, including that of nasogastric feeding to improve his nutritional intake and promote wound healing.
Letters to the Editor
Authors: Morris Clare , Parrish Alan A
Published: May 2014

I to am a regular reader of the British Journal of Nursing and this isthe first time that a letter (BJN, 14(22)) has prompted me to immediatelywrite to you.
The debate: myalgic encephalomyelitis and chronic fatigue syndrome
Authors: Shepherd Charles
Published: May 2014

Almost every aspect of myalgic encephalomyelitis (or encephalopathy) and chronic fatigue syndrome is the subject of disagreement and uncertainty – something that has undoubtedly hampered recognition, understanding and research. Although the pathogenesis remains the subject of intense medical debate, a number of predisposing, precipitating and perpetuating factors are now starting to emerge. Therapeutic nihilism is no longer appropriate as there is a great deal that can be done to alleviate some of the more distressing symptoms and improve quality of life for these patients.
Infection control: the rights of the patient
Authors: Dimond Bridgit
Published: May 2014

This article considers the possibility of a patient suing an NHS trust for compensation for harm which has been suffered as a consequence of a hospital acquired infection and the elements which the claimant would have to prove. The patient's rights to criminal injury compensation are also disucussed.
Provision of community services for a patient with multiple sclerosis
Authors: Dimond Bridgit
Published: May 2014

This article explores the law in relation to a patient with multiple sclerosis receiving the provision of community equipment and the rights of the patient to obtain community services. It explores the issue of human rights and complaints procedures.
Top tips if you are considering taking patients away on a trip
Authors: Castledine George
Published: May 2014

Following on from the previous conduct case (BJN 15(14): 772) when we discussed the dangers of the heat wave for patients. Several nurses have contacted me to ask if there are any tips we could offer on what to do if you volunteer or find yourself involved with taking a group of patients or clients away for a summer holiday or day out.
Dermatology: litigation and the NHS Redress Bill
Authors: Dimond Bridgit
Published: May 2014

This article considers an allegation of failure to diagnose a patient's condition by the consultant dermatologist and considers the likely repercussions if the NHS Redress Bill currently going before Parliament is passed and implemented.