bluuebunny/crossref_metadata_2025 huggingface dataset:
Living in limbo - patients with cystic fibrosis waiting for transplant
Authors: Macdonald Kath
Published: May 2014

Lung transplant for patients with end-stage cystic fibrosis (CF) in the UK is recognized as the only successful treatment for CF patients with advanced lung disease. This study uses an exploratory approach to examine how patients with CF and their carers cope with the rigours of chronic illness and life on a transplant waiting list. Eight patients with CF, four awaiting transplant and four who had been transplanted within the previous 3years, along with five of their carers, were asked to recount their experiences using a semi-structured interview technique. Four themes emerged from the interview data; displacement, disorder, life in limbo and readjustment to wellness. Support appears to be particularly important to patients and families after false alarms occur, and upon return home after transplant. The small sample size precludes generalization of the results to all patients with CF but gives an in-depth insight into the lived experience of waiting for transplant.
Central venous catheters: a review of skin cleansing and dressings
Authors: Danks Louise A
Published: May 2014

Having central intravenous devices is an indispensable part of the total care for high dependency patients, as they are used for administrating a wide range of intravenous therapies and for haemodynamic monitoring. However, their use is frequently complicated by a variety of local or systemic infections. Therefore, all staff involved in the management of central venous catheters must base their practice on what is agreed in the literature as being effective in reducing the risk of hospital acquired infections. This article offers a literature-based review of the management of central venous catheters, focusing on skin cleansing and dressing types. Proper skin preparation prior to catheter insertion has been shown to be essential in reducing infections.
Clinical mentoring of nurse practitioners: the doctors' experience
Authors: Barton Thomas David
Published: May 2014

The clinical development of nurse practitioners (NPs) has historically been dependent on mentorship from medical practitioners, yet their experience of this mentorship is generally unexplored. NPs have an ambiguous relationship with medicine as they have been dependent on medical mentorship to develop clinical skills, and they substitute into roles traditionally associated with medical practice. Consequently, NPs challenge professional boundaries and present particular concerns to their medical mentors. Practitioner ethnography examined the experiences of medical mentors, nurse practitioner students and academic staff during a clinical degree programme. This paper reports specifically on the medical mentors, focusing primarily on their professional authority relationship with their students and on their experience of imparting and sharing clinical knowledge. These experiences fell into three perspective stages, the provisional perspective, transitional perspective, and final perspective. Medical mentors were instrumental to the advanced clinical role of the student NP. This resulted in a conflicting experience of promoting a clinical role that challenged traditional medical authority. The effect of this was a cautious renegotiation of professional boundaries. In future NP students (and their academic teachers) need to acknowledge this if they are to mutually gain the most from their relationship with their medical mentors.
Differential diagnosis in advanced nursing practice
Authors: Baid Heather
Published: May 2014

Differential diagnosis has become a key element of advanced nursing roles that are incorporating history taking and physical assessment into their remit of professional responsibilities. The aim of this article is to review the relevant definitions of different types of diagnoses, to describe the process of formulating a differential diagnosis including using clinical reasoning skills, and to use a case study as an example of differential diagnosis in advanced clinical practice.
Catheterization options following radical surgery for cervical cancer
Authors: Roberts Karen , Naik Raj
Published: May 2014

This trial assessed the potential benefits of intermittent self-catheterization (ISC) over standard care with suprapubic catheterization (SPC) in the postoperative bladder care of women with early-stage cervical cancer following radical hysterectomy. A prospective randomized controlled trial of 40 women was carried out. The urinary infection rate (catheter specimen of urine) was significantly higher in the ISC group at day 3 and day 5 (42% and 63%) compared to the SPC group (6% and 18%), p=0.05 and p=0.004, respectively. Forty-seven per cent of patients randomized to SPC documented having problems arising from the SPC site, of which 23% were shown to have a positive wound swab. Despite a greater urinary tract infection rate, the technique of ISC was seen by women to be more acceptable, allowing fewer disturbances at night, greater freedom to live a normal life and less anxiety/embarrassment compared to SPC.
Progressive protocol in the bowel management of spinal cord injuries
Authors: Coggrave Maureen , Burrows Dee , Durand Mary Alison
Published: May 2014

Research into bowel management in spinal cord injury is sparse. Specifically, the use of laxatives in this group, while wide spread, is not supported by research evidence. A prospective study in which baseline and intervention data were collected from each subject was undertaken with 17 individuals. The baseline was the routine method of bowel management in the study unit. The intervention was the use of a progressive protocol which allowed the use of physical interventions and rectal stimulants prior to the use of laxative therapy if required. Though the response of individuals varied, the number of successful bowel management episodes employing laxatives was significantly less in the intervention phase, the proportion of glycerine suppository uses which were successful was significantly greater, the use of manual evacuation was significantly reduced and the duration of bowel management episodes was significantly less. These findings suggest that use of laxatives in bowel management is not essential for all newly spinal cord injured individuals, while the use of physical interventions in this population may be beneficial. The variable response of individuals to the progressive protocol highlights the need for individual assessment in the area of bowel. The findings of this small study must be validated by a larger study.
The business habits of highly effective nurses
Authors: Castledine George
Published: May 2014

Several factors have come to mind recently persuading me that all nurses in future need to gain more business and management acumen. Firstly, there is the trend in NHS Trusts towards becoming more corporate business organizations with aims, objectives, outcomes and values similar to major private companies not associated with health care. Harvard Medical School in Massachusetts has also realized that doctors of the future need more management skills and training and have decided to incorporate this into their education. Although we don't mention rationing in the health service today, there is no doubt that due to all the pressures of cost containment, health services will have to make tougher and more stringent economic decisions. As part of the professional multidisciplinary healthcare team, nurses will be forced into debating and deciding which patients deserve certain expensive treatments and care.
The training and education of nurses working in stroke care
Authors: Edwards Geraldine
Published: May 2014

The National Clinical Guidelines for Stroke (2004) recommend that patients are cared for by staff who have expertise in stroke rehabilitation and access to relevant educational programmes. However, they provide only limited information as to the content and delivery of such programmes and recommend that such decisions are made at a local level. This must inevitably lead to the duplication of efforts and variations in standards and content across national services. This literature review hopes to identify how the content and delivery of educational programmes for nurses on stroke units meet the needs of their role, impact on their practice and influence patient outcomes. It is expected that the findings will be valuable in the development of ongoing training programmes and may contribute to a cohesive approach at national level.
Bacteria and the gastrointestinal tract: beneficial and harmful effects
Authors: Banning Maggi
Published: May 2014

Bacteria are unique microorganisms that have a variety of physiological functions which are beneficial to human beings. However, bacteria can also be harmful and cause infections if translocated from the gastrointestinal tract to the epithelial tissue following surgery. The process of translocation can lead to surgical wounds becoming contaminated with gastrointestinal microbes such as Escherichia coli, Proteus or Klebsiella species. Bacteria can also cause severe gastrointestinal infections as a consequence of the ingestion of contaminated food. Food-borne bacterial infections can lead to serious consequences for the patient. Nurses managing the care of surgical patients and older people need to be aware of the physiological role that bacteria play but also the detrimental effects of bacterial translocation or ingestion particularly in older people, infants and people who are immunosuppressed.
Paying the price: health care and prostitution
Authors: Peate Ian
Published: May 2014

It is estimated that approximately 80 000 women in the UK work as prostitutes (Home Office, 2004). However, this figure must be treated with caution, as it must be a gross underestimation of the real figure and neglects to include children and men who also work as prostitutes. It appears that the Home Office (2004) also make a gross underestimation of the numbers of men, 8.5%, who are reported as having paid for sex in the last 5 years; these men are not a clearly defined group and some men will not disclose participating in commercial sex.
What is effective intervention? – using theories of health promotion
Authors: Davies Karen
Published: May 2014

The increased prevalence of chronic disease offers nurses the challenge of providing educational interventions for people living and managing a condition such as diabetes mellitus. This article uses theoretical models and approaches from health promotion to offer perspectives to explain behaviour and determinants of health. The competing needs and perspectives are applied to see their relevance within diabetes nursing care, and in particular when looking at patient outcomes for a group intervention, raising the question: what is an effective intervention? Evaluating interventions needs clear identifiable values and aims, although this article highlights that success of any intervention will mean different things for the participant or health professional. There is a need for research into the subjective experiences of people with diabetes managing an intensive insulin regimen, and to value and include a wider definition of evidence-based outcomes.
The London Network for Nurses and Midwives
Authors: Pullar Elisabeth , Stonehouse Alison
Published: May 2014

The London Standing Conference for Nurses, Midwives and Health Visitors was started in 1999 by Chris Beasley. Her vision was to provide a new forum and process for nurses which would enable them to have a voice about professional issues and the modernization of health care in London.
Psychological impact of colostomy pouch change and disposal
Authors: McKenzie Frances , White Craig A , Kendall Sally , Finlayson Aileen , Urquhart Mary , Williams Isabel
Published: May 2014

This article presents some of the findings from a multi-centre cross-sectional correlational study to evaluate the relationship between colostomy pouch change and disposal practices and the patient's psychological wellbeing. Five questionnaires were used in a one-off interview with 86 patients. Patients were assessed at between 1 and 4months postoperatively. Results from the Pouch Change and Disposal questionnaire showed that only 25% of patients found disposal of used appliances the most difficult part of their pouch change and disposal routine. Half felt that their body was out of their control and 33% reported avoiding social and leisure activities due to what was involved in their pouch change and disposal routine. Patients cited several factors, such as minimizing odour and having an appliance that could flush away, as factors which would help them to stop avoiding these activities. Stoma care nurses have a unique opportunity to improve the psychological wellbeing of their patients by considering the aspects of pouch change and disposal that pose the greatest challenge to individuals. Use of a modified version of the Pouch Change and Disposal questionnaire may be a useful tool in identifying those at risk of impaired quality of life.
Colostomy: getting patient consent to treatment for surgery
Authors: Dimond Brigid
Published: May 2014

This article explores the law relating to consent to treatment and the duty to inform a patient of the significant risks of serious harm which could arise from the treatment.
Generalist versus specialist nursing practice
Authors: Castledine George
Published: May 2014

Recently at a BJN board meeting, the subject was raised as to whether there were any generalist nurses left in practice. Judging by the number of specialist nursing groups and specialist nurse's journals in circulation, the answer would probably be a rapidly declining number.
Why don't nurses monitor the respiratory rates of patients?
Authors: Hogan Jacqueline
Published: May 2014

Early warning systems (EWS) are being introduced to acute ward areas across the country to support the early recognition of patients at risk of developing a critical illness. All the systems are based on the monitoring of physiological observations of pulse, blood pressure, temperature, respirations and consciousness level. The main problem identified when attempting to introduce an early warning system to the acute general ward areas in one hospital was the general paucity of monitoring of patients observations by the nursing team. Respiratory rate was identified as the one parameter which nursing staff recorded less than 50% of the time. This qualitative study used focus groups in an attempt to understand the reasons behind the paucity in patient observation practice and explore the nurses' values and beliefs about patient monitoring within the context of care. The study identified four major factors associated with the paucity of patient monitoring: organization of nursing care activities, development of nursing observation skills, clinical decision making processes and equipment management issues.
Improving quality of life in venous leg ulceration: a case study
Authors: Bentley Jenny
Published: May 2014

It is not uncommon to find that patients with venous leg ulcers have a reduced quality of life, but to prevent inappropriate management and thus contribute to the chronicity of these wounds, clinical practice must be based on sound evidence and application of research. The choice of compression options is fairly wide, but occasionally problems are encountered with tailoring a particular product to a patient. In this case study, a number of challenges were presented to the nursing team in implementing evidence-based practice and accommodating patient choice, but these were overcome and the patient's quality of life has significantly improved.
Patients’ feelings about hand washing, MRSA status and patient information
Authors: Duncan Christopher Paul , Dealey Carol
Published: May 2014

The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their hands before a clinical procedure and to explore if methicillin-resistant Staphylococcus aureus(MRSA) status and access to patient information about infection control would influence the patients’ anxiety about asking. A descriptive survey was undertaken using a semi-structured questionnaire. The questionnaire was distributed to a randomized convenience sample of 185 inpatients across all departments of an acute NHS Trust hospital (response rate 58.9%). Spearman’s rank order and Kendall Tau-b tests were used to analyse specific correlations. Respondents were more confident than anxious about being involved in a campaign that empowered patients to ask staff to wash their hands. Patients were more anxious to ask if their previous admission episodes were fewer, if their knowledge of MRSA was high and if there was less information about infection control available. Patients who had contracted MRSA in the past were less anxious, as they had a better understanding of the disease. In addition, more patients felt less anxious about asking staff to wash their hands if staff wore a badge saying ‘It’s OK to ask’
Synthesis of qualitative research and evidence-based nursing
Authors: Flemming Kate
Published: May 2014

Evidence-based nursing is central to nursing practice. Systematic reviews have played a key part in providing evidence for decision making in nursing. Traditionally, these have consisted of syntheses of randomized controlled trials. New approaches to combining research include the synthesis of qualitative research. This article discusses the development of research synthesis as a method for creating evidence for nursing practice. It focuses on how the new approach of synthesizing qualitative research may contribute to nursing and its evidence base by examining practical examples. It concludes that qualitative synthesis may contribute to: the development of nursing theory; providing context and meaning to evidence of effectiveness identified in quantitative research; more effective use of primary data; enhancing the generalizability of qualitative research; the identification of future nursing research topics.
Step-by-step guide to critiquing research. Part 1: quantitative research
Authors: Coughlan Michael , Cronin Patricia , Ryan Frances
Published: May 2014

When caring for patients it is essential that nurses are using the current best practice. To determine what this is, nurses must be able to read research critically. But for many qualified and student nurses the terminology used in research can be difficult to understand thus making critical reading even more daunting. It is imperative in nursing that care has its foundations in sound research and it is essential that all nurses have the ability to critically appraise research to identify what is best practice. This article is a step-by step-approach to critiquing quantitative research to help nurses demystify the process and decode the terminology.
The impact of preoperative education on postoperative pain. Part 1
Authors: O Oshodi Titilayo
Published: May 2014

This article, the first of two parts, explores the general concept of preoperative education through a literature review. The relatively complex relationships between the ways people perceive a threatening situation, their levels of anxiety, coping styles and postoperative pain is explored. In dealing with these complex relationships, teaching strategies and forms of presentation of preoperative education are also discussed. The second part will examine the impact of preoperative education on postoperative anxiety, pain and recovery. This will be achieved by analysing the evidence available to provide a rigorous appraisal of the literature.
Recognizing and reducing interference on 12-lead electrocardiograms
Authors: Davies Alan
Published: May 2014

The 12-lead electrocardiogram (ECG) is a diagnostic test used in many different clinical settings. Healthcare professionals who record ECGs as part of their role are often unable to recognize interference that disrupts the quality of the ECG recording. This interference can lead to a reduction in diagnostic quality. Nurses who record ECGs should be able to recognize the commonly encountered forms of interference, and be able to take steps to eliminate, or substantially reduce, this interference whenever possible to ensure the highest possible quality of ECG recording.
A review of maternal nutrition and fetal gene expression
Authors: Derbyshire Emma
Published: May 2014

Research suggests that nutrient imbalances during pregnancy may result in alterations in fetal gene expression. A thorough review of the literature appears to identify that maternal dietary intake of B vitamins, choline and methionine may reduce the expression of potentially harmful genes. This short review aims to evaluate how the maternal diet can affect gene expression and explain how this knowledge can be incorporated within the nursing practice to improve the long-term health status of the next generation.
A new day, a new minister, a new dawn for the NHS?
Authors: Bailey Asa
Published: May 2014

Times change and so do governments – and the transition from Blair to Brown a few weeks back has been enough to eventually oust Patricia Hewitt from the top spot at the Department of Health (DH) – the political coalface she managed to erode away so efficiently.
Legal principles of confidentiality and other public interests: Part 1
Authors: Fullbrook Suzanne
Published: May 2014

The principles of confidentiality are of paramount importance to nurses and all health professionals. This is explicitly so as the Common Law recognizes confidentiality and supports its importance. However, current practice must take cognisance of the realities of 21st century healthcare delivery – we live in an age of electronic data that is potentially very difficult to keep secret. New rules, protocols and guidelines are being formulated, and regulatory bodies such as the Nursing and Midwifery Council (NMC) reflect such rules in their codes of professional conduct. There is, however, a debate that is suggesting that the rules that relate to confidentiality may need to expand or even bend a little as innovate ways of obtaining, storing, utilising and communicating data continue to occupy the minds of government and those who formulate legal principles (British Medical Association, 2005). This series of three articles will explore these issues. The first part is a review of case law that explores the fundamental legal principles that underpin confidentiality. The second will concentrate on a review of the guidelines that are to be found in professional regulatory documentation – the NMC and the General Medical Council as they relate to the legal principles. The third and last part will review and reflect on issues that relate expressly to the implementation of electronic patient records, with a review of appropriate statutory legislation and principles of common law.
Globalization, commodification and mass transplant of nurses: Part 1
Authors: R Cutcliffe John , Yarbrough Susan
Published: May 2014

The world is currently facing a shortage of nurses and this is predicted to worsen as a result of the looming en masse retirement of the so-called ‘baby-boom’ generation. Moreover, this problem is foreseen to be far more pronounced in Western countries where the post-Second World War ‘baby-boom’ demographic was (and is) most prominent. Data collected by various international organizations illustrates a corresponding recent increase in nurse migration and that such mass transplantation inevitably involves the unidirectional movement of nurses from developing countries to developed Western countries. As a result, this two-part article examines this mass transplantation within the context of globalization. Part one provides compelling international data regarding the global shortage of nurses and the corresponding increase in nurse migration from ‘underdeveloped’ to ‘Western’ countries. It then situates the phenomenon in the context of global health and highlights the extent of the debate so far, such as it is.
Brown’s agenda for the next hanges in NHS reform
Authors: Castledine George
Published: May 2014

Well if you thought that Gordon Brown was going to give us a breather then think again because there is more change on the way. Such news sounds rather like the weather forecast this summer in that after we have coped with all the storms, one was hoping to have a settled period of sunshine for a while, but no such luck!
One- and two-piece colostomy appliances: merits and indications
Authors: Burch Jennie , Sica Jo
Published: May 2014

Approximately 10 000 new colostomies are formed each year (IMS, 2006), most of which will be permanent. There is currently a wide range of colostomy products available, and new appliances are constantly coming onto the Drug Tariff. While this gives colostomates greater choice and ensures that their various needs are met, it can make the selection of an appropriate appliance difficult. This article discusses the merits of, and indications for, the one- and two-piece colostomy appliances currently available in the UK. It gives a brief overview of the anatomy and physiology of the gastrointestinal tract in relation to colostomy formation, and outlines the more common types of operation that may result in the formation of a colostomy.
Making a difference with a telehealth service
Authors: Holt Fatima
Published: May 2014

Chronic obstructive pulmonary disease (COPD) kills 30 000 people every year (National Statistics, 2006) in England and Wales alone, making it the fifth biggest killer (British Thoracic Society, 2006). Moreover, it is the only major cause of death whose incidence is on the increase – 95% of all COPD cases are linked to smoking and given our ageing UK population, the mortality rate is set to rise (British Thoracic Society, 2006).
Feedback on Castledine column
Authors: Waterlow Judy , Grainger Angela
Published: May 2014

George Castledine (Castledine Column 9th August: ‘Real life death: has reality TV gone too far?’) goes straight to the heart of a very sensitive point. Yes, the myths on death and dying still abound and we do need to help educate the lay public as well as the professionals on how a foreseeable death can have provision made for a peaceful and dignified ending. The media, in an educative role, along with other educational avenues plays its part in this.
A clinical overview of endometriosis: a misunderstood disease
Authors: Denny Elaine , H Mann Mr Christopher
Published: May 2014

Endometriosis is the presence of endometrial glands and stroma outside the endometrial cavity and is the most common known cause of pelvic pain. The number of women being diagnosed with the disease is increasing, but this may be reflective of improved diagnostic techniques. The aetiology is unknown, although the theory of retrograde menstruation remains dominant. Although pain around menstruation is the most frequently experienced symptom, dyspareunia, dyschezia, cyclical dysuria and extreme fatigue are all common. The ‘gold standard’ diagnostic technique is laparoscopic visualization, and the Royal College of Obstetricians and Gynaecologists (2006) recommends that surgical removal of all endometriotic lesions is the ideal. The experience of endometriosis can negatively affect all aspects of a woman’s life and relationships, and this is consistently reported in research studies. This article discusses the aetiology and clinical aspects of endometriosis as well as giving an overview of empirical literature surrounding the experience of the disease. It provides nurses with the knowledge to be alert to the possibility of endometriosis as a diagnosis in women with a certain set of symptoms, in whatever healthcare setting they work.
Polycystic ovary syndrome and female reproduction
Authors: Elghblawi Ebtisam
Published: May 2014

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The presentation is diverse. There is no single, unified definition of PCOS, no single diagnostic test and no consensus on the diagnostic criteria. Currently, PCOS is most commonly defined by the 2003 Rotterdam criteria, which requires at least two of three features for diagnosis – chronic anovulation, clinical and/or biochemical signs of hyperandrogenism, or polycystic ovaries. The aetiology is unknown, but the principal underlying disorder is thought to be reduced insulin sensitivity in peripheral tissue, and hence hyperinsulinaemia (high levels of insulin in the blood). Some affected women may have hyperandrogenism and polycystic ovaries with normal ovulatory function; however, like women with classic PCOS, they still have an increased risk of type 2 diabetes and cardiovascular events. Some women with PCOS have no symptoms or signs and live a normal life with normal child-bearing status, but it is very difficult to predict which cases will follow this pattern. It is important to investigate women with menstrual irregularity when they first present, because they might have mild PCOS, which could otherwise be missed. It is therefore essential to educate the public, nurses and other healthcare professionals to identify affected women, so that strategies can be put in place to avoid or minimize the complications and consequences of PCOS.
A clinical overview of the treatment of post-prostatectomy incontinence
Authors: Dorey Grace
Published: May 2014

This article discusses benign prostatic hyperplasia, which may be treated by a transurethral resection of prostate and prostate cancer which in turn may be treated by a radical prostatectomy. During both operations the bladder neck sphincter is damaged and continence relies on a competent external urethral sphincter. After surgery men may suffer from stress urinary incontinence, urge urinary incontinence and erectile dysfunction. Men undergoing prostatectomy would benefit from pre- and post-prostatectomy pelvic floor exercises including advice on how and when to perform them. Pelvic floor exercises can significantly help men with urinary incontinence and erectile dysfunction.
Caring for patients with suicidal behaviour: an exploratory study
Authors: Doyle Louise , Keogh Brian , Morrissey Jean
Published: May 2014

Patients presenting to the emergency department (ED) with suicidal behaviour is relatively common. While many of these patients may be referred on to specialist mental health services, many are either discharged with no psychiatric follow-up or leave before being seen. There is therefore an increasing onus on the staff of EDs to become involved in the assessment and initial management of this patient group. The aim of this study was to describe the experiences and challenges that nurses encounter when caring for patients who present to the ED with suicidal behaviour. Forty-two ED nurses completed a 15-item semi-structured questionnaire. Participants in this study identified risk assessment as part of their role but did not focus on psychosocial assessment or psychological management of this patient group. Feelings of sympathy and compassion were reported towards these patients; however, there was often a prior judgement of the perceived ‘genuineness’ of the presentation. Finally, challenges experienced included a lack of appropriate communication skills and insufficient resources within the ED to adequately care for this vulnerable patient group.
Altered living: coping, hope and quality of life after stroke
Authors: Western Helen
Published: May 2014

This care study assesses how individuals who have had a stroke negotiate loss of functional abilities and disruption to life in order to achieve quality of life. Focusing on a particular individual in a rehabilitation ward, the article discusses how continued problemsolving and goal-setting is imperative to life satisfaction. However, this process is only possible when individuals feel that they have autonomy and mastery over their own existence, and so healthcare professionals must encourage them to make decisions about their care. By empowering individuals to do this they can achieve satisfaction by altering the values they ascribe to different areas of their lives.
Characteristics and trends of self-harming behaviour in young people
Authors: Cleaver Karen
Published: May 2014

Deliberate self-harm is recognized as a serious public health issue in young people. There is evidence that young people who self-harm are more likely to repeat self-harm, and this in turn increases their risk of completed suicide. Prevalence studies have identified that the rate of self-harm among young people is on the increase, information largely based on data arising from review and analysis of hospital attendances. However, community-based studies indicate that the prevalence is much higher, with those seen in emergency departments representing the ‘tip of the iceberg’ (Hawton and Rodham, 2006). Young people’s motives for self-harm and the implications of this for their initial assessment in emergency departments are discussed, as are research findings which indicate that nurses can have negative attitudes towards patients who self-harm. The article considers the implications of this for young people and identifies areas for future research.
The impact of faecal incontinence on the quality of life
Authors: Wilson Mary
Published: May 2014

Investigation into the impact of faecal incontinence (FI) on the quality of life (QoL) has resulted in the development of scales to measure severity of the condition. However, some of these have been criticized for reflecting the perspective of health professionals, rather than that of the person experiencing FI. Qualitative studies considering the patient’s experience of FI are more limited. This paper examines the patient’s account, relating the level of adaptation to FI. The amount of time during which FI was experienced without respite affected adaptation and QoL. Self-confidence, family and sexual relationships, lifestyle choices, employment and finance varied according to the level of adaptation achieved, which also influenced QoL. The paper concludes that successful adaptation is reflected by an elevation in the QoL experienced.
Ten steps to developing an abstract for conferences
Authors: Coad Jane , Devitt Patric , Hardicre Jayne
Published: May 2014

There is an increasing importance being placed on the dissemination of research and other high quality evidence. This article is the first in a series of three that will assist you in ensuring that your work is presented in the best light at the conference of your choice. In this first article we guide you through the ten steps you need to take to ensure that you submit the best possible abstract to the scientific committee. We also will guide you through the process of selection.
Preventing patient falls in hospital
Authors: Tingle John
Published: May 2014

The National Patient Safety Agency (NPSA) have just published the most comprehensive report yet on patient falls as part of its Patient Safety Observatory project (NPSA, 2007). This project was set up to examine and prioritize patient safety issues to support the NHS in making healthcare safer. This report includes an analysis of slips, trips and falls in hospitals reported to the NPSA’s National Reporting and Learning System (NRLS) over a 12–month period from 1 September 2005 to 31 August 2006. Information from a variety of other sources including published literature and clinical negligence claims have been used to build up a picture of patient falls in hospitals.
E-learning in wound care: developing pressure ulcer prevention education
Authors: Jones Menna Lloyd
Published: May 2014

Patients with pressure ulcers suffer pain and distress from wounds that can require treatment for many months following discharge from hospital (Havard, 2007). This initial and ongoing treatment accounts for around four per cent of the NHS annual budget (Bennett et al, 2004), therefore pressure ulcer prevention and management is beneficial not only to patients but also the NHS. Education for healthcare professionals is an important factor in the prevention and management of pressure ulcers; however, in the current climate releasing staff to attend study days is becoming difficult. In some locations staff have to travel long distances in order to attend while locally-based study days are poorly attended. Developing e-based learning was seen as a realistic option for nurses working in Trust within a large geographical area.
The Sepsis Six: helping patients to survive sepsis
Authors: Robson Wayne P , Daniels Ron
Published: May 2014

Sepsis kills more people than lung cancer, and more people than bowel and breast cancer put together. The costs to the NHS are significant; it is estimated that in Europe, patients with severe sepsis cost healthcare funders around 7.6 billion euros per year (Daniels et al, 2007). Costs in the United States are estimated at $16 billion annually (Angus et al, 2001), and in the United Kingdom up to 46% of intensive care unit (ICU) bed days are used by patients with severe sepsis (Padkin et al, 2003), with each ICU bed costing around £1700 per day. In 2002 an international campaign was launched: the Surviving Sepsis Campaign. The main aim of this campaign is to reduce mortality from sepsis by 25% by 2009. A lot of the early work has concentrated on improving sepsis care in intensive care units, but many patients on general wards develop sepsis, and the need to educate nurses throughout all areas of the hospital has been recognized. In September 2007 a new part of the campaign was launched called Survive Sepsis, which aims to deliver sepsis education to ward nurses and junior doctors. This article discusses how to recognize severe sepsis and explains how nurses can dramatically improve a patient’s chance of survival by ensuring that six simple things (Sepsis Six) are done in the first hour.
Undertaking a literature review: a step-by-step approach
Authors: Cronin Patricia , Ryan Frances , Coughlan Michael
Published: May 2014

Nowadays, most nurses, pre- and post-qualification, will be required to undertake a literature review at some point, either as part of a course of study, as a key step in the research process, or as part of clinical practice development or policy. For student nurses and novice researchers it is often seen as a difficult undertaking. It demands a complex range of skills, such as learning how to define topics for exploration, acquiring skills of literature searching and retrieval, developing the ability to analyse and synthesize data as well as becoming adept at writing and reporting, often within a limited time scale. The purpose of this article is to present a step-by-step guide to facilitate understanding by presenting the critical elements of the literature review process. While reference is made to different types of literature reviews, the focus is on the traditional or narrative review that is undertaken, usually either as an academic assignment or part of the research process
Smart infusion technology: a minimum safety standard for intensive care?
Authors: Murdoch Linda J , Cameron Victoria L
Published: May 2014

There is overwhelming evidence that medication errors present a risk to patients. This risk is highest in the intensive care unit (ICU) setting and even greater when medications are administered via an infusion pump. Standard pumps will not alert for, or prevent, drug calculation, drug unit, button push, or multiple of ten errors when medication delivery data is inputted. However, the literature suggests that smart pumps programmed with hard (unchangeable) limits can significantly reduce drug errors at the point of administration. Staff at St George’s Hospital paediatric ICU wanted to implement an infusion pump system that would be immediately effective in reducing medication errors at the point of administration. This article presents an overview of the relevant literature together with clinical examples from the authors’ ICU, which demonstrates their experiences with smart pumps. It is the authors’ firm belief that smart infusion technology sets a new minimum safety standard for intensive care.
Is the NHS’s success its own poison?
Authors: Black Peter
Published: May 2014

The cork’s popped, the candles are blown, wishes have been made, and the cake’s been cut – here’s to 60 years of the NHS. It is amazing how it takes a milestone for people to galvanize on opposing sides of the fence as the boundaries of opinion become stark and clear.
Professional regulation in nursing. Part 3: self-regulation
Authors: Fullbrook Suzanne
Published: May 2014

Previously, it has been asked why there was such a shift away from professional self-regulation towards direct control by the Government. It was suggested that there occurred a seminal event – Bristol – that was responsible for a seismic shift in attitude by the public towards the idea that health professionals were not capable of self-regulation; they needed the firmed hand of direct governmental control. This article, and the next two, will examine this in greater detail, by drawing together, thoughts and ideals from that period.
Enteral tube feeding and infection control: how safe is our practice?
Authors: Best Carolyn
Published: May 2014

Enteral feed provides an ideal environment for the development of bacteria. Contamination of an enteral feeding system can have serious complications for the susceptible patient. This article explores the sources and symptoms of bacterial contamination within enteral feeding systems and makes recommendations on how these risks can be minimized. Manufacturers have acted to reduce contamination by enclosing enteral tube feeds within sterile bottles or collapsible packs. National guidance exists to provide standards for the handling of enteral feeding systems but at a clinical level poor hand hygiene and handling procedures are still identified as the main source of contamination indicating that there is a gap between practice and recommended standards of care. Nurses have a vital role to play implementation appropriate standards of care and in minimizing risks of bacterial contamination in enteral feeding systems.
Women and cardiac rehab: overcoming the barriers
Authors: Higginson Ray
Published: May 2014

Coronary heart disease CHD) is the largest single cause of death in the UK, accounting for almost 198 000 deaths each year (British Heart Foundation [BHF], 2008). Within the UK, CHD is the single biggest cause of premature death among the female population. In 2006 alone, 22% of premature deaths in women were from CHD, and every year around one in seven women will die from the disease (BHF, 2008).
Mental health consequences of child sexual abuse
Authors: Mullers Evelyn-Sybille , Dowling Maura
Published: May 2014

Survivors of child sexual abuse (CSA) can experience a variety of long-term mental health effects on their life trajectory, which brings them to the attention of mental health services. It is vital that the mental health nurse remains aware of the mental health consequences of CSA and receptive towards patients’ efforts to disclose a history of CSA. Moreover, fundamentally, the mental health nurse should endeavour to consider his/her own personal feelings on this emotive subject. This article explores the mental health effects of CSA on pre-adolescent children, adolescents, and the long-term effects of CSA into adulthood.
Developing a venous assessment tool in IV chemotherapy administration
Authors: McGowan Donna , Wood Shirley
Published: May 2014

It is recognized that the variety of intravenous (IV) chemotherapy regimens administered within the hospital setting is expanding rapidly, and this places increasing demands on nurses in relation to patient preparation and assessment. IV chemotherapy treatment is given over an extended period and requires multiple and often technically difficult peripheral cannulation attempts. To avoid the physical discomfort and potential psychological morbidity associated with repeated cannulation attempts, chemotherapy specialist nurses, in consultation with senior pharmacists, oncologists and other chemotherapy practitioners in a cancer centre, designed a venous assessment tool (VAT) that uses a scoring system to enable identification of patients who would benefit from insertion of a central vascular access device at the outset of treatment. This article describes the rationale for development of the VAT, the potential benefits of its use for both nurses and patients, and the plans for further refinement of the tool.
Psoriasis: characteristics, psychosocial effects and treatment options
Authors: Ryan Sheila
Published: May 2014

Psoriasis is a complex chronic non-infectious inflammatory skin disease with many different presentations. The classic presentation is of well-defined red plaques with silver scale. The characteristic scale makes the disorder highly visible and intrusive on the patient’s lifestyle. The visible nature of the disease ensures that psoriasis has both physical and psychosocial effects. In normal skin, epidermal cell reproduction and proliferation takes 28 days. In psoriasis this process is considerably accelerated to approximately 4 days, resulting in the deposit of immature cells on the skin. While the exact cause of this process is unknown, certain environmental and genetic factors are known to be provoking factors. Disease management will be dependent on disease severity, psychosocial effects and the patient’s lifestyle. To effectively treat this disease the nurse must be skilled in psoriasis management, and in patient education and motivation. This article reviews the characteristics, aetiology, psychosocial effects and treatment strategies of psoriasis.
Law in focus: incorporating legislation and guidelines into practice
Authors: Fullbrook Suzanne
Published: May 2014

In this new series on specialist healthcare law, the aim is to explore and review the ways in which legislation and government white papers have begun to affect clinical practice. This article discusses how media in the United Kingdom have taken to themselves the task of reporting widely on all aspects of healthcare and its delivery. The effect of this public portrayal is compounded by the disparity between what nurses believe their profession is, and the way in which our political masters have portrayed the profession.
The duty of care and political expectations. Part 1: a literature review
Authors: Fullbrook Suzanne
Published: May 2014

A consequence of the Government’s agenda for nursing is that registered nurses are increasingly required to regard themselves as autonomous practitioners. It is therefore necessary to re-visit the legal principles involved so as to be able to identify where safe practice can be incorporated into the new innovative ways of nursing. The purpose of this article is to identify and reflect upon the ways in which nurses are incorporating these principles into practise, and secondly, to reflect on the question of accountability as expressed through the law and through the professional regulatory body’s code of professional conduct.
Current interventions and approaches to postoperative pain management
Authors: Layzell Mandy
Published: May 2014

Some degree of pain accompanies all surgical procedures. Current evidence informs us that patients will experience significant physiological and psychological effects if this pain is not adequately treated. These effects can cause serious harm, delay recovery from surgery, and in some cases lead to persistent post-surgical chronic pain. This article briefly discusses the importance of assessing patients preoperatively and highlights how some patients will have risk factors which may lead them to experience severe postoperative pain. Approaches to postoperative pain control are focused on ways to address the inter-patient differences in response to pain and treatments and avoid periods of ineffective pain relief. A review of the commonly used analgesics, paracetamol, non-steroidal anti-inflammatory drugs, opioids and local anaesthetics, and methods of administration, is included. The final section provides a short review of emerging trends in acute pain therapy and the implications for improving patient care.
Another day, another dollar … another consultation
Authors: Crawshaw Alison
Published: May 2014

The Department of Health (DH) has once again left the field of stoma care and incontinence nursing in a state of uncertainty over its future. Following its recent publication of responses to the latest consultation into the provision of stoma and incontinence products and services, it determined that no decisions could be made at this point (DH, 2007).