bluuebunny/crossref_metadata_2025 huggingface dataset:
Cystic fibrosis: inheritance, genetics and treatment
Authors: Steen Colin D
Published: December 2014

Cystic fibrosis (CF) is a genetically inherited and potentially fatal disease. In the Westem world, 1 in 23 people carry the defective gene. This article outlines the genetics of CF and its mode of inheritance and examines what types of carrier screening are available. The carrier frequency is calculated using the Hardy-Weinberg equilibrium. Current treatments are evaluated, with a description and critique of gene therapy, the treatment of the future for respiratory failure.
The nursing management of intravenous drug therapy
Authors: Clarke Angela
Published: December 2014

The Implementation of intravenous (IV) drug therapy is an increasingly common experience for patients and one that carries a significant risk of damaging side-effects. Patients who require IV therapy are likely to be those most at risk should complications arise. It is therefore essential that healthcare professionals involved in any aspect of IV therapy acquire and maintain the necessary knowledge and skills to ensure the delivery of safe and effective care (British Medical Association/Royal College of Nursing, 1993). This article explores the principles that underpin safe administration technique, identifies the risks and hazards associated with IV drug therapy and outlines the action necessary to manage these problems effectively.
The care programme approach: a nursing perspective
Authors: Sullivan Patrick
Published: December 2014

The care programme approach is part of a large body of political guidance relating to the Government's policy of caring for mentally III patients in the community. This policy has been in operation for over three decades and still remains controversial. Recent media attention has focused on mental health care in a far from positive manner, and evidence suggests that the care programme approach has not proved a total success (Hogman, 1992; Huxley, 1993; North et al, 1993; Social Services Inspectorate, 1995). Despite this it remains the foundation on which a series of policy directives have been based over the last 5 years, and it is difficult to disagree with the fundamental philosophy, which reflects the basic principles underpinning the delivery of effective mental health care in the community. There are clear implications for psychiatric nurses, and this article outlines the crucial role that nurses working in both hospital and community settings have to play in the clinical application of the care programme approach.
Supervised discharge: concerns about the new powers for nurses
Authors: Coffey Michael
Published: December 2014

The introduction of the Mental Health (Patients in the Community) Act 1995 has been the cause of much concern, although there has been little published debate from nurses. This article discusses key elements of the Act, including the power to ‘take and convey’, resourcing community care, the principle of reciprocity and the use of coercion to gain therapeutic cooperation. American literature suggests that the way community psychiatric nurses feel about using the power to ‘take and convey’ and coercion is the determining factor in the successful implementation of this Act.
The electrically stimulated neoanal sphincter and colonic conduit
Authors: Stuchfield Barbara
Published: December 2014

Faecal incontinence affects about 2.2% of the population. Non-surgical interventions include dietary manipulation or the use of enemas and drug regimens. Surgical procedures such as anterior sphincter repair may improve function for the majority of patients, but for some a permanent stoma may be the only therapeutic option. A technique pioneered at the Royal London Hospital uses gracilis muscle augmentation combined with electrical stimulation to improve sphincter control. However, some patients experience residual evacuatory problems. Antegrade irrigation may be incorporated into the procedure, but both techniques can be used independently to promote continence. Although these procedures are still in a developmental stage, they are an option for a select group of patients who would otherwise be managed with a permanent stoma.
Nurse advocacy: is it in the patient's best interests?
Authors: Woodrow Philip
Published: December 2014

Advocacy within health care and nursing is a frequently discussed concept, but the many practical problems it can create for nurses are not always considered. This article explores some of the problems identified in the literature and through practice. It suggests that instead of being used as a confrontational means of gaining power, advocacy should become a positive patient-focused action. While interpreting advocacy in practice remains problematic, some ways to achieve a positive patient-focused approach are offered.
Managed care: the benefits and implications for clinical practice
Authors: Arkell Sharon
Published: December 2014

Managed care is a system of coordinating and structuring health care for use by all members of the multidisciplinary team. It is intended to provide quality, cost-effective care that is research- or evidence-based. With limited resources available to the NHS and constantly increasing healthcare costs, a balance needs to be reached between quality and cost. Managed care progammes have the potential to achieve this. This article describes the concept of managed care and some of the tools used in managed care programmes. The benefits of adopting such a system are discussed and the issues that should be considered before its implementation examined.
Nurses must stop themselves being used by doctors
Authors: Castledine George
Published: December 2014

Recently I have become very concerned about the position of nursing in society. It is ambiguous, precarious and transitional and, in relation to medicine, it remains very much the underdog.
Are nurse practitioners a viable option?
Authors: Paniagua Hilary
Published: December 2014

The climate of change within the NHS with its need for doctor substitution stimulated a recent project, sponsored by the NHS Executive, focusing on nurse practitioners (NPs) in Britain (Coopers and Lybrand, 1996). Funds were invested into 10 project sites designed to test the services of NPs from various clinical settings, including outpatient departments, outreach services, the community, school health services and community hospitals. The subsequent evaluation and report must be credited for offering long awaited research into NP care; however, an ideal opportunity to explore the real impact of NPs has been missed.
Treatments and healing rates in a community leg ulcer clinic
Authors: Chaloner Donna , Noirit Janet
Published: December 2014

Leg ulcer management is increasingly becoming a nurse-led specialty with practitioners implementing evidence-based care that is efficient, effective and resourceful. A large percentage of patients with leg ulceration are treated in the community. This article will discuss the healing rates and management of venous leg ulcers, many of which were long standing problems, in a community leg ulcer clinic.
A review of intrathecal baclofen in the management of spasticity
Authors: Porter Bernadette
Published: December 2014

Spasticity is associated with damage to the corticospinal tract and is a common complication of neurological disease. Patients with spasticity complain of Stiffness, involuntary spasm and pain. The majority of patients are managed consrevatively with physiotherapy and/or oral medication. However, 25-35% of patients will develop unacceptable side-effects of fall to respond to oral doses of antispasmodics. Surgical procedures such as myelotomy, rhizotomy and neurotomy have not been universally successful. More recently, intrathecal baclofen has become established as an important adjunct in the management of spasticity. This article describes the mechanism of action of baclofen, the delivery systems available and the criteria for Patient selection. The screening phase, surgical procedure and specific postoperative observations are also described.
Framework for a clinical career structure in nursing
Authors: Castledine George
Published: December 2014

There is an urgent need to define and clarify a clinical career structure in nursing. The development of a career structure is hindered by the proliferation of titles currently used by nurses when developing their knowledge and skills. It is proposed that the term nurse practitioner be replaced by either generalist or specialist nursing practitioner, depending on the individual's bias, and that nurses with a bias towards medicine be designated paramedical nurse practitioners. A three-band clinical career structure is suggested, based on these categories. This structure would allow nurses to develop their knowledge and competency while either remaining in a broader, generalist area or specializing in a particular field. This structure includes an advanced nursing practitioner level to accommodate those nurses with extensive experience of clinical nursing situations. It is imperative that the nursing profession decides its career pathways, otherwise they may find others doing it for them.
Development of specialist and advanced practice in North America
Authors: McGee Paula
Published: December 2014

North American literature provides interesting ideas about the nature of specialist and advanced practice which are useful in informing British thinking on these subjects. However, the two roles do not have the same meanings as their British counterparts. Clarification of the terminology used and the roles described are essential if we are to understand the concepts. This article presents an overview of the literature about clinical nurse specialist and advanced practitioner roles within North America and identifies differences and similarities between the two.
Non-verbal communication: the importance of listening
Authors: Kacperck Lynn
Published: December 2014

This article presents the author's personal retrection on how her nursing practice was enhanced as a result of losing her voice. Surprisingly, being unable to speak appeared to improve the nurse/patient relationship. Patients responded positively to a quiet approach and silent communication. Indeed, the skilled use of non-verbal communication through silence, facial expression, touch and closer physical proximity appeared to facilitate active listening, and helped to develop empathy, intuition and presence between the nurse and patient. Quietly ‘being with’ patients and communicating non-verbally was an effective form of communication. It is suggested that effective communication is dependent on the nurse's ability to listen and utilize non-verbal communication skills. In addition, it is clear that retrection on practical experience can be an important method of uncovering and exploring tacit knowledge in nursing.
Residential alcohol detoxification: new role for mental health nurses
Authors: Ryan Tony , Rothwell Vicky
Published: December 2014

This article discusses the philosophy and practice of a community-based residential detoxification service for people with alcohol problems. The service is provided on a direct-access basis and has a team of 19 nurses who are supported by a GP practice. The article highlights issues relevant to nursing in this community facility by referring to three case studies. The case studies demonstrate that this client group finds it difficult to access other forms of health and social care. The case examples emphasize both the qualitative aspects of nursing care and the decision-making involved in this type of service. The authors suggest that large populations with complex needs can be served by nursing-led services adopting a ‘direct access’ approach.
Management of leisure time by prospective nurses
Authors: Bradby Mary , Soothill Keith
Published: December 2014

A focus on the importance of leisure in the development of student nurses has been neglected in the 1990s. This study considers 444 prospective nurses on conventional, diploma and degree courses in two areas of England. It examines their activities associated with socializing, their social support networks and their use of clubs, sports and hobbies before entering nursing. It is evident that students enter nurse training with a wide variety of leisure experiences. Changing recruitment patterns and the structure of nurse training has an effect on the leisure needs of prospective nurses which must be addressed.
Evidence-based nursing: where is the evidence?
Authors: Castledine George
Published: December 2014

Florence Nightingale is often credited with being the inspiration behind many of today's movements in modern nursing. Therefore, to attribute to her the latest fashion of evidence-based care is not surprising when one considers her sterling work of hospital reform. To a large extent, the questioning approach that Nightingale used died with her which resulted in nurses resorting to custom and routine. It was not until the late 1960s that evidence and research utilization came into focus.
Healthcare assistants need to be regulated
Authors: MacAlister Lanette I
Published: December 2014

The UKCC's decision, announced on 6 March, 1997, to lead a debate exploring the merits of introducing some form of regulation for healthcare assistants is to be applauded.
Clinical implications of circadian rhythmicity for nurses and patients
Authors: Baxendale Stella , Clancy John , McVicar Andrew
Published: December 2014

Recent research suggests that our biological rhythms are regulated by the light/dark cycles and regular time cues in our environment which synchronize our internal body clocks to a 24-hour cycle. Altering these external cues can cause an imbalance in psychophysiological variables which adversely affect an individual's performance and health. This article considers the implications of desynchronized circadian rhythms on nurses working shifts in a continually changing temporal environment. It then discusses the impact this has on patients, their illness and their care. The authors suggest ways in which an understanding of the principles of circadian rhythms can be used to reduce the negative effects of hospitalization on patients, possibly even aiding their recovery.
Testicular cancer: the importance of effective health education
Authors: Peate Ian
Published: December 2014

Testicular, cancer, is the commonest malignancy in the UK among men aged 20–34 years. Although rare, it is one of the most curable cancers. There is a correlation between the incidence of testicular, cancer, and age, histology, social class and geographical region. As survival is dependent on early detection, men should be encouraged to practise testicular, self-examination at least every 6 months. Nurses are in an ideal position to teach and encourage such practice. However, for optimal effect, health education programmes need to take into account complexities, such as cultural diversity, if patients are to heed vital and in some cases life-sustaining advice.
Pressure sores: incidence, risk assessment and prevention
Authors: Young Trudie
Published: December 2014

Pressure sores have a physiological basis which, in common with other disease processes, is influenced by intrinsic and extrinsic factors unique to the individual. A comprehensive patient assessment will identify factors affecting the individual and consequently direct preventive intervention. The issue of pressure sores should be addressed at a patient, trust or regional level to ensure that preventive strategies/policies cross all healthcare boundaries. Identification of the size of the problem is the starting point upon which a preventive strategy can be built. A comprehensive strategy for pressure sore prevention has existed in the USA since 1992, and its contents demonstrate the multidisciplinary input required to develop and implement the recommendations. Nurses have a key role in the prevention of pressure sores; however, they need educational, managerial and financial support in order to function effectively within this role.
Prison nursing: the tension between custody and care
Authors: Willmott Yvonne
Published: December 2014

All prisons provide healthcare services which aim to meet the needs of prisoners. The goal of the service is to give prisoners access to the same quality and range of health care as the NHS gives the general public. However, within the prison environment priorities centre around order, control and discipline and therefore an ethos of health care needs to be developed. Custody reduces the prisoner's opportunity for self-care and independent action as inmates have to consult nursing or medical staff for even the most simple remedies. Nursing staff in the prison service can play a significant part in primary health care, mental disorder and health promotion. Nurses have the knowledge, skills and attitudes needed to deal with this diverse and vulnerable prison population and to promote a positive interface between custody and care.
Consumerism: do patients have power in health care?
Authors: Melville Martin
Published: December 2014

In market rhetoric NHS patients are considered to be consumers of health care. This article considers what attributes and rights consumers have and analyses the possible forces limiting and/or driving their accedance into present day health care. While the term patient is associated with passivity, the term consumer conjurs up notions of rights, power and empowerment. Consumer power may take two forms: the ability to make choices and legal rights. Yet within the NHS there are many forces that attempt to oppose and restrain consumer power.
Community participation within an Irish Health Board Area
Authors: McDonald Anne , Chavasse Judith
Published: December 2014

This article gives a brief analysis of the concept of community participation followed by an account of a small study exploring the views and practices of two populatlons. Public health nurses have implemented their ‘community as client’ role and under favourable conditions would wish to develop further this aspect of their work. Women in the community are aware of the primary healthcare services available to them and as demonstrated by their comments have a holistic understanding of health. The study shows that both public health nurses and women in the community are interested and willing to take part in actions to improve health and welfare. Before genuine community partnership is developed a more defined leadership role which incorporates the skills of both community empowerment and community organization is needed.
Nurses with HIV/AIDS must not be stigmatized
Authors: Castledine George
Published: December 2014

After the recent rumpus over whether or not British doctors should be tested for HIV it is surprising that there has not been a call for nurses to be tested as well. The argument put forward against such testing is that individuals could become infected within days of the test, and that if the test is taken during the early stages of HIV it may prove to be negative. To exclude these eventualities it would be necessary to test all doctors and nurses repeatedly and regularly, the cost of which would be considerable. In addition, screening would give the public false reassurance and could lead to doctors and nurses calling for all their patients to be screened, particularly as a nurse or doctor is more at risk of catching the virus from patients than the other way round.
The tragedy of healthcare rationing by age
Authors: Keady John
Published: December 2014

It is rare that I experience genuine emotions of anger. However, after reading the first part of Age Concern's full review of research on age discrimination in health care (Age Concern, 1997) and Alan William's paradoxical argument for the rationing of health care by age (Williams, 1997), rage would be a better description.
A multicentre comparative evaluation of catheter valves
Authors: Fader M , Pettersson L , Brooks R , Dean G , Wells M , Cottenden A , Malone-Lee J
Published: December 2014

Catheter valves are an alternative to lee balls for urine drainage, but no studies have yet been published which have compared the performance of different valves. This study was undertaken to evaluate the performance of the seven catheter valves available on the UK market in April 1996. The study was carried out by the Continence Products Evaluation (CPE) Network funded by the Medical Devices Agency (Department of Health). Each valve type was tested for 1 week by 19–36 cognitively unimpaired and manually dextrous subjects recruited from 11 test centres. At the end of each week, subjects completed an evaluation form (based on a three-point rating scale) to record product performance. The same catheter valves were also tested for ease of opening/closing by 33 subjects (mostly catheter users) who had some manual impalnnent. Performance scores varied widely between products. It was found that, to be successful, a valve needs to be easy to manipulate, leak-free, comfortable and inconspicuous. Prescribers need to be aware of the strengths and limitations of different valves for appropriate product selection.
Psychological preparation for nasogastric feeding in children
Authors: Holden CE , MacDonald A , Ward M , Ford K , Patchell C , Handy D , Chell M , Brown GB , Booth IW
Published: December 2014

Psychological preparation of children undergoing enteral nutrition by nasogastric tube was evaluated in a prospective study of 48 children nursed at home. They were randomly allocated to receive either standard informal preparation or detailed psychological preparation and support. The children were divided into two groups according to age: group A comprised toddlers and younger children aged 2–6 years and group B comprised older children and adolescents aged 7–16 years. Detailed questionnaires were administered to all parents and older children by dietetic colleagues who were blinded to the type of preparation received by the children. The results emphasize that detailed psychological preparation of families takes time. Passage of a nasogastric tube was seen as very distressing to both parents and children. Having a nasogastric tube was perceived as a major problem by group A. There was no statistical difference in the effects of enteral nutrition between younger children who received routine preparation and those who received detailed preparation; however, parental assessment of their child's behaviour was the sole means of determining how the younger child felt and reacted. In group B, there were marked differences: scores suggested that those who received detailed preparation had been better prepared for enteral feeding in hospital and at home and that the passage of the nasogastric tube, although unpleasant, was less distressing to them (P<0.05). Talking to a nurse and play therapist was seen by parents as essential (P<0.05). The authors conclude that children should be prepared for painful procedures and followed up sensitively, according to their needs.
The health of children looked after by local authorities
Authors: Brodie Isabelle , Berridge David , Beckett Wilma
Published: December 2014

There are some 40000 children ‘in care’ in England and Wales, i.e. being ‘looked after’ by local authorities and living in foster and residential homes. These children come from highly disadvantaged social backgrounds and are likely to experience more serious health problems than the wider population. Despite this, there is evidence to suggest that their health needs are frequently neglected. This is reflected in the dearth of research information. Health professionals play a key role in combating child abuse and are particularly concerned about future mental health, self-injury and high levels of pregnancy in this group of children. Health promotion is therefore vital, but is complicated by the fact that this group of children often do not attend school. The Department of Health has introduced a major initiative which has a strong health dimension to help promote better care planning and monitoring for children who have been separated from their parents.
Scholl compression hosiery in the management of venous disorders
Authors: O'Hare Lucy
Published: December 2014

Graduated compression hosiery has an important role in the management of venous leg ulcers by counteracting chronic venous hypertension. The historically high rates of venous ulcer recurrence can be significantly reduced by optimizing compliance with the wearing of support hosiery. This is facilitated by providing information, practical support and opportunities for regular professional monitoring. Compliance is also aided by ensuring that the garment fits correctly and is comfortable and by offering the client a choice of products from those available.
Wound care in the accident and emergency department
Authors: Young Trudie
Published: December 2014

Wound assessment in the accident and emergency (A&E) department has a different focus from that in other clinical areas because of the lack of available clinical information about the patient. A wound may have had a greater physical impact than is immediately apparent and therefore a comprehensive skin assessment is often necessary. The wound will require thorough exploration and debridement to enable healing to take place with minimal complications. The methods of debridement and cleansing used in the A&E department are often unique because of the complexity of wound contamination. The variety of wounds encountered in this setting necessitate a large repertoire of dressing regimens. Modem wound management products can be adapted to meet the needs of the wounded patient in the A&E department.
Extending the role of nurses as apolitical advocates
Authors: Hudson Neal
Published: December 2014

During periods of III health people may become disenfranchised. This article offers guidance on issues relating to voting rights. Both nurses' and clients' potential for participation can be enhanced by an understanding of the mechanisms set out in the Representation of the People Act (RPA) 1983 and the European Parliamentary Elections Act 1978. Through apolitical advocacy, nurses can assist patients in claiming their right to vote, since RPA 1983 applications by citizens require the nurse, midwife or health visitor to attest the client's claim of temporary or permanent incapacity which prevents their poll attendance on election day. Electoral registration officers are proactive in the formulation of registers with the aim of maximizing the numbers of eligible voters. However, they are not in a position to identify the health problems of particular Individuals.
Medical investigations 1: Lumbar puncture
Authors: Bassett Christopher
Published: December 2014

Lumbar puncture (LP) involves the removal of a sample of cerebrospinal fluid (CSF) from the subarachnoid space via a hollow needle which is introduced into the lumbar cisterna through the third or fourth lumbar interspace (Figure 1). (The 4th lumbar vertebra usually lies in the same plane as a line drawn between the iliac crests.) While non-invasive procedures such as computed tomographic (CT) scanning have reduced the need for LP, it remains a valuable tool in the diagnosis of certain disease processes, e.g. subarachnoid haemorrhage (SAR), viral and bacterial meningitis and multiple sclerosis. LP is also performed to facilitate the instillation of drugs such as antibiotics, antirnitoties and contrast media in myelography. Withdrawal of CSF via LP may also be indicated in the treatment of benign intracranial hypertension.
There is no such thing as a menial task in nursing
Authors: Castledine George
Published: December 2014

In life there are high status tasks and low status tasks. Hierarchies start with the socialization process at school, i.e. the prefect and class monitor system. In society, the status given to tasks is dependent on many things, e.g. the value that is placed on them, the amount of money rewarded to those who perform them and the skill, knowledge and experience needed to carry them out. The grading of tasks is also associated with occupational role, gender and social class. Infact, the development of the British class system is based on the status and grading of work activities.
Nail in the coffin for community care?
Authors: Dimond Bridgit
Published: December 2014

The much awaited reserved judgment of the House of Lords on the statutory duty to provide services to disabled people was announced on 20 March, 1997. In a majority verdict the House of Lords allowed the appeal of Gloucester County Council (GCC) against the Court of Appeal's decision that resources could not be taken into account in fulfilling the statutory duty to provide services to disabled people under Section 2 of the Chronic Sick and Disabled Persons Act 1970 (R vs Gloucester County Council and another ex parte Barry (1997)).
Management of the diabetic patient: causes of leg ulceration
Authors: Young Trudie
Published: December 2014

The diabetic patient is at risk of developing numerous complications, including foot ulceration. The ulcer may contain a neuropathic and ischaemic element. Regular preventive checks can assist in early detection of foot problems. Falling eye sight and absence of sensation often result in patients relying on the healthcare professional detecting abnormalities on their behalf. The long-term effects of foot ulceration in the diabetic patient are immobility, septicaemic and amputation. Treatment options exits for the neuropathic and ischaemic foot but they vary in complexity. Accurate assessment and early recongnition of the clinical signs of neuropathy and ischaemic ulceration will ensure early detection and optimum treatment interventions for the diabetic patient.
Enhancing the health professional's role in requesting transplant organs
Authors: Randhawa Gurch
Published: December 2014

The shortfall in organs for transplant continues in the UK. To address this problem, methods of organ procurement are continuously widening with the recent development of protocols in elective ventilation and non-heart beating donors. Until recently, the nurse's role in the success of organ procurement was largely limited to those working in intensive care units involved in cadaveric transplant and community-based nurses working with patients on kidney dialysis who may become involved with live related transplant. Involvement in organ procurement has now extended to nurses working in general wards and accident and emergency centres. It is imperative that health professionals are aware of the large numbers of patients for whom donors have not been found. They need to be aware of the possible reasons which deter relatives from giving consent for potential donors and prevent relatives themselves from becoming potential live donors. Those who are involved in the organ request process need to be alerted to the factors that affect the decision to give consent. It is hoped that these efforts will help to reduce the drastic shortage of available organs for transplant in the UK.
Effects of resettlement on people with learning disabilities
Authors: Howard Stephen , Spencer Alison
Published: December 2014

This article describes a small-scale study of the quality of life for people with learning disabilities after moving from a large group home with institutional features to community settings. The Life Experiences Checklist was chosen to provide objective measures of their quality of life before and after the move, and a semi-structured questionnaire was used to gain a more personal view of their life satisfaction. The results showed that the overall quality of life for the service users improved following resettlement. In particular, the home environment, leisure facilities, freedom and opportunities for service users had all increased significantly. Participants also reported having more choices and were more likely to take part in leisure and household activities. However, the range and quality of personal relationships experienced by the service users showed slight but not significant changes. These findings are discussed in relation to previous research, and the importance of quality evaluation is considered.
Gentle teaching as an empowering approach to challenging behaviour
Authors: Aylott Jill , Sell Iris
Published: December 2014

This article illustrates how gentle teaching (GT) has helped to liberate a young woman with severe learning disabilities and challenging behaviour and how this process has empowered her parents. The story of Amanda (told by her mother) is sadly not unique and many families are struggling at home with their son or daughter, with very little practical guidance and support. The author (JA) met Amanda's mother (IS) at a GT course run for parents in 1990, where she was acting as one of the facilitators. The author maintained involvement with the family after the course ended and regular visits were made to the home to work with Amanda and her parents. The visits were recorded in a diary and reflection with the parents took place on every visit.
Nursing care of the mechanically ventilated patient in ITU: 1
Authors: Ashurst Steve
Published: December 2014

The mechanically ventilated patient often represents the ultimate in vulnerability and demands the highest standards of nursing care. Not only may the patient be unconscious but also the artificial airway is an unnatural invasion of the most innate physiological mechanism — breathing, and the nurse must safegaurd this during all aspects of care. Nursing these patients is immensely satisfying and varied. It ranges from caring for the patient's activities of daily living to carrying out the highly technical and invasive monitoring and interventions which require specialist knowledge and skills. This article, the first in a two-part series, covers the types of ventilation, suction therapy, oral and eye care, elimination, body position, physiotherapy and the physiological effects of mechanical ventilation.
The Flo-tech range of pressure-reducing cushions
Authors: Young Trudie
Published: December 2014

Early rehabilitation of bed-bound patients has highlighted the need for pressure-reducing seating to complement pressure-reducing mattresses. The technology within cushion manufacturing has responded with a customized contouring principle for cushions. This has previously only been available on an individualized patient basis. The range of Flo-tech cushions has attempted to provide the general patient population with a cushion that will reduce pressure, provide support and improve posture. The importance of seating in pressure sore prevention cannot be overemphasized. The provision of pressure-reducing cushions can assist in providing a total package of pressure reduction for the patient.
Medical investigations 2:ERCP
Authors: Bassett Christopher
Published: December 2014

Endoscopic retrograde cholangiopancreatography (ERCP) utilizes a combination of fibreoptic endoscopy and radiographic techniques to allow detailed examination of the pancreatic ducts and hepatobiliary tree.
Advanced nursing practice: role or concept?
Authors: Murray Cyril , Thomas Mike
Published: December 2014

In March 1997, the UKCC finally released its position statement on advanced practice (UKCC, 1997a). Despite an extensive national consultative process no clear consensus has emerged on either a definition of or criteria for advanced practice.
Nursing care of the mechanically ventilated patient in ITU: 2
Authors: Ashurst Steve
Published: December 2014

This article, the second in a two-part series, outlines the role of the nurse in assessing and implementing aspects of care of the mechanically ventilated patient in the intensive care unit, including sedation, communication, safety, nutrition, and the needs of patients' visitors. The ultimate goal (where possible) is to help the patient manage without the ventilator. This process is referred to as ‘weaning’ and often involves the nurse participating in intricate patient assessment and the implementation of specialized care. The need for a multidisciplinary approach to patient care is emphasized.
A review of beta-haemolytic streptococcal infection in babies
Authors: Greatrex Brenda
Published: December 2014

The incidence of beta-haemolytic group B streptococcal infection in babies at or shortly after birth appears to have risen during the last 20 years. About 30% of women could be colonized at any one time, and because of the transient nature of this organism research has failed to find a way of identifying women who will be colonized at the end of pregnancy. The baby is at risk of early-onset disease from mother-to-baby transmission during the birth process. If identified early enough, those mothers who present a risk can be treated in time to protect the baby during the birth. Late-onset disease can be the result of cross-infection from carers, and the education of midwives, nurses and mothers could reduce the risk. Education could also aid identification of the early signs of disease, and therefore increase the likelihood of a successful outcome of treatment.
The role of Sterigel hydrogel wound dressing in wound debridement
Authors: Williams Clare
Published: December 2014

An incressing number of hydrogel dressings have become available to the practitioner over the last few years. Sterigel (Seton Healthcare) is the latest to be launched. This dressing is able to donate large quantities of fluid and thereby speed up the debridement of slough and necrotic tissue.
Management of the patient with minor traumatic brain injury
Authors: Davidhizar Ruth
Published: December 2014

Staff in the accident and emergency department and critical care unit are often confronted with patients who have sustained life-threatening injuries. In such situations the symptoms of a minor traumatic brain injury (MTBI) may be missed. It is important that, when the physical symptoms begin to subside, nurses are aware of the symptoms of MTBI and respond accordingly. A post-concussion syndrome may develop 2 weeks to 2 months after a MTBI. This syndrome can affect the patient's ability to perform the usual activities of living. This article defines MTBI, describes the symptoms encountered in patients with MTBI, and outlines the pathophysiology, clinical findings, treatment and nursing interventions.
The use of restraint in the care of elderly patients
Authors: Bell John
Published: December 2014

The use of physical and chemical restraint in elderly care settings to restrict mobility and control behaviour is not a new concept. However, until the 1980s, it was an area that was neglected in nursing research. In 1989, Evans and Strumpf carried out an extensive literature review on restraint in an attempt to consolidate the state of knowledge regarding its use in care of the elderly settings. This article aims to evaluate how far the discussion surrounding restraint has progressed since that time and in what direction. It also reviews the extent of restraint use and rationale for its application, the consequences of restraint and progress in developing alternatives.
Medical investigations 3: Percutaneous liver biopsy
Authors: Jenkinson Tim
Published: December 2014

When performed under local anaesthesia, percutaneous liver biopsy is a relatively simple, safe and quick method of obtaining a liver tissue sample for cytological, histological and microbiological examination. It is indicated where there is a suspicion of primary or secondary tumour, a history of hepatomegaly, unexplained jaundice or abnormal liver function tests. Examination of liver biopsy samples may reveal the presence of: primary malignant tumour, e.g. hepatocellular carcinoma, angiosarcoma; metastatic disease; cirrhosis; hepatitis; granulomatous infection, e.g. tuberculosis; and infiltrative disease, e.g. amyloidosis, sarcoidosis.
The dilemma of incorporating research into clinical practice
Authors: Hicks Carolyn
Published: December 2014

Despite pressure to move towards evidence-based practice within the health service, a considerable proportion of nursing intervention continues to be founded on time-honoured tradition and historical precedent. Most explanations for this research/practice hiatus have focused on organizational problems such as the lack of appropriate skills training, inadequate time and limited resources. This article suggests that the problem may also relate to psychological resistance from nurses, especially at the level of professional stereotyping, a lack of confidence and entrenched gender stereotypes, all of which predispose nurses to maintaining the traditional basis of clinical practice. If nursing is to become a more scientific, clinical service then an open-minded and flexible approach which takes account of the relevant psychological factors is required.
Nurses as hotel hostesses: a future path in nursing?
Authors: Castledine George
Published: December 2014

On a recent trip to Hengelo, Holland, I discovered that nurses are functioning as hotel hostesses in a hospital experiment. With the decline in convalescence care, escalating inpatient hospital treatment and patient demands for a more flexible and dynamic healthcare service, this recent initiative in Holland could catch on in the UK.
Dr Shipman: how could it have been prevented?
Authors: Dimond Bridgit
Published: December 2014

The natural reaction to the horrendous story of Dr Shipman, convicted on 31 January 2000 of killing 15 women and suspected of killing many more, is to ask: ‘How could it have happened?’. However, it is now time to look to the future and ask what regulatory systems we need to ensure th at such atrocities never reoccur?
Correspondance
Authors: Murrell Louisa , Norman N
Published: December 2014

J Perkins' letter, ‘Project 2000's failure should be acknowledged’ (Vol 8(19): 1267) has to be the last straw. Let us ponder the subjective, unfounded criticism directed not at the UKCC but at fellow colleagues. J Perkins comments, ‘the sort of education that takes nurses, or potential nurses away from their patients and encourages them to theorize rather than do seems to me to have strayed away from the very point of the nursing profession’.
Blood transfusion: crucial steps in maintaining safe practice
Authors: Bradbury Martyn , Cruickshank Jeremy P
Published: December 2014

The transfusion of blood and blood products remains a highly effective and potentially life-saving treatment for many patients. However, blood is a living tissue and its transfusion, from one individual to another, is not without risk. Significant among these risks is the potential for human error and the subsequent transfusion of the incorrect blood component. Alarmingly, the number of errors would appear to be increasing, with the second annual report of the Serious Hazards of Transfusion (SHOT) Steering Group reporting a 36% Increase in these cases (SHOT, 1999). Reversing this trend can only be achieved by adopting all inclusive and rigorous blood transfusion procedures. The registered nurse is central to such processes and therefore plays a crucial role in the safe administration of blood and blood products. This article considers the nurse's responsibilities and offers evidence-based guidelines for practice.
Avoiding problems: evidence-based selection of medical gloves
Authors: Russell-Fell Ray W
Published: December 2014

Allergenic contact reaction to glove proteins and residual chemicals increased from 1980 onwards; circumstantial and technical evidence indicates that change from reusable to disposable latex gloves was a causative factor. Several protein fractions are potentially allergenic; if low protein gloves contain a dominant protein fraction, people with sensitivity may still have an adverse reaction. Use of chlorinated powder-free gloves reduces risk of allergenic reaction; other powder-free gloves may still pose a contact risk to patients. Adverse comparative tests of vinyl vs latex medical gloves may, in some cases, have used non-medical gloves without assessment of initial quality or involved an unrealistic test method; these have discouraged use of a non-allergenlc alternative to latex gloves. Vinyl medical glove properties are reviewed. Nitrile examination gloves offer better protection than latex types when handling lipid-soluble substances and chemicals. Properties of medical gloves made from other materials are described.
Confidentiality 13: the notification of infectious diseases
Authors: Dimond Bridgit
Published: December 2014

Jenny Rose was a paediatric community nurse who regularly visited a child with a chronic lung condition who was being nursed at home. On one visit she noticed that the child's mother, Jane, appeared to be very pale and thin and was told that the mother had a severe gastric disorder with diarrhoea. From the description of the illness, Jenny thought that Jane might be suffering from typhoid. Jane worked as a cook in a restaurant, was unwilling to seek medical advice and intended going to work that night. Jenny was concerned that Jane could have a serious notifiable infectious disease and therefore be a danger to customers in the restaurant. Jane insisted that Jenny should keep the information confidential. Where does Jenny stand?
A patient temperature audit within a theatre recovery unit
Authors: Kean Melanie
Published: December 2014

Hypothermia in the postoperative recovery phase can be a source of potential danger for patients emerging from anaesthesia. In spite of the vast amount of literature dealing with principles of care in the recovery room, Information regarding the incidence of hypothermia appear very limited. This article presents a patient temperature audit to assess whether patients were being discharged from a theatre recovery unit hypothermic. In addition, patient temperatures were recorded both pre- and postoperatively, as well as on discharge from recovery, to monitor the incidence of hypothermia throughout the theatre suite. The results show that patients were being discharged with core body temperatures ranging from 34.8 to 38°C with no Incidence of hypothermia recorded when the operating room temperature was above 23°C. In general, the coldest theatres were orthopaedic, with this group of patients showing the most incidence of hypothermia. This article aims to demonstrate the use of clinical audit to investigate and evaluate current practice.
Gerontological nursing 3: valuing nursing homes and valuing staff
Authors: Nolan Mike , Tolson Debbie
Published: December 2014

This, the third of five articles considering the future of gerontological nursing, focuses on practice within nursing homes. The important contribution of such environments is highlighted and it is argued that work within long-term care settings must be recognized and valued if the quality of care provided is to improve.
Infection control: reducing the psychological effects of isolation
Authors: Ward Deborah
Published: December 2014

Although previous studies have shown that some patients, when nursed in isolation for infection control purposes, experience negative emotional effects, little research has been published which suggests what healthcare professionals can do to prevent or reduce these effects. A study was therefore carried out involving 21 patients being nursed in isolation who completed questionnaires. Five patients with negative experiences of isolation were then interviewed about the reasons for feeling the way they did and what they felt could be done to reduce or prevent negative emotions. Recommendations made from the research include the provision of written and individualized information, improved communication from medical staff, provision of a common room and better facilities to relieve boredom. Further large scale research is needed to investigate strategies to improve the isolation experience.
Clinical supervision in mental health nursing courses
Authors: Ashmore Russell , Carver Neil
Published: December 2014

The Department of Health (DoH, 1.994) advocated the introduction of clinical supervision into mental health nursing practice and suggested that student nurses be prepared in what to expect from this process. The ENS (1995) supported this recommendation but has offered no guidelines on how it is meant to be implemented. This article reports on an educational initiative in which group supervision was implemented within one cohort of prereglstration mental health nursing students. The students reported a number of perceived benefits: a greater understanding of the purpose and benefits of clinical supervision; skill development; the opportunity to reflect on practice; and the reduction of stress.